Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0006 NOBADEER ROAD - Health
6 NOBADEER ROAD, HYANNIS A=250 133 i b i .Town of Barnsta ble . P# . Department of Regulatory Services Public. 1 Alh.D><vis><on Hate 7 .(cr 12 200 Main Street,Hyannis MA 02601 Date Scheduled / Ti'me Fee Pa . Soil Suitability Assessment for S e Disposal Performed By: 0 � ' Witnessed By: c LOCATION&:GENERAL INFORMATION Location Address �o Name s'Owner 6,es Daso Zap N1 lute C�r7=�vim- Q►If l Address 6 NUbae�ees Assessor's Map/Parcel. ZS-o` / 33 _ Engineer's Name ` NEW 1CONSTRUMON REPAIR Telephone# $O$—73?—Li?ro Land Use. I�,S +07AA V1 i A'�.' Slopes(%) , Z Surface Stones Distances.from: 'Open Water Body A-j L�t- ft Possible Wet Area. ft Drinking Water Well J U _ft Drainage Way 6) ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands to proximity to holes) �6(Cd ' i .. a sue•—�. � ' . tn AJ �.s �.r Parent material(geologic) G't��f�I 0.)f✓ems Depth to Bedrock / Depth to Groundwater. Standing Water in Hole: A)/A Weeping from Pit Face Estimated Seasonal High Groundwater [ZC) DETERARNATION FOR;SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: _ . In. Depth to weeping from side of obs.hole-- in, Groundwater AdJust►ment ft. Index Well# Reading Date: Index Well level,� AdJ,thetor Adj.-Groundwater Level PERCOLATION TESL' bete Time,.. � Observation Hole# 1 Time at 4" Depth of Pent Time at 6" Start Pre-soak Time 0 'lime(9"-6") Truce r c(il • - End Presoak f —63 Rate Min.flnch Site Suitability Assessment:" Site Passed Site Failed:' Additional Testing Needed(Y/N) Original: Public Health Division' ;;- Observation Hole Data To Be Completed on Back ***If percolation test is to be.conducted within 100' of wetland,you must first notify the. * M Barnstable Conservation Division'at least one(1)week prior to beginning. Q:\.SEPfIOPERCFORM.DOC 1 1 DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure;Stones;Boulders. Gravel)Consistency.% 0 = La :rZy/Z y3b �3 5� 16 ►2 FF ZQ co(on t-cj, DEEP OBSERVATION HOLE LOG Hole# Z- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) o S� to o -cam -Cs— Z ,-5-Y cbrck . DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel)- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. i , Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes , Within SOO year twundary No X Yes Within 100 year flood boundary No Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? _ ._. If not,what is the depth of naturally occurring pervious material? Certification I certify that on ( < <qk� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that Ehe above analysis was performed by me consistent with . the required in ,expertise and experience described in 310 CMR 15.017. Signature Date Q:\SEPTlCPElkCFORM-DOC l n, TOWN OF BARNSTABLE LOCATION Cs 9 V b x �✓_er P V a-j J i t SEWAGE# �© I''� ` �• �I C1 VILLAGE ASSESSOR'S MAP&PARCEL ® 13� INSTALLER'S NAME&PHONE NO. tip ®kck s j towt-p SCJ --L-170-�/ yY SEPTIC TANK CAPACITY eelppS LEACHING FACILITY:(type) tcs�a t�t use fs (size) NO.OF BEDROOMS :S OWNER tj® W c,-1C PERMIT DATE: `(� I I Z COMPLIANCE DATE: Separation Distance Between the: Tka-P Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ,`] Feet Niivate 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"�'�Qr, r 0.-J e.S I 3Ae V- IA)- OoT- X.3 -, '`w •\ 4_d-9 p ..., • m r-, r�u to Postage $ ®26® a Certified Fee M Retum Receipt Fee r Postmark C3 (Endorsement Required) He 6 O ResMoted Delivery Fee: (EndoYaement Required) t7 Totai.Postage&Fees •S: rq rc"�,Mr.,Martin Traywick 525 Ocean Street Hyannis, MA 02601 s Certified Mail Provides: o Amailing receipt .0 o A unique identifier for your mailpiece i a A record of delivery kept by the Postal Service for two years Important Reminders. l o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail& c Certified Mail Is notavailable for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized age Advise the clerk or mark the mailpiece with the { endorsement"Reshicted-Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Forrn 3800,August 2006(Reverse)PSN 7530-02-000-9047 Town of.Barnstable . Barnstable Epp THE Tpw n Regulatory.Services Department 1 e"aCity i nARNS'rABLE, r - • - 1A55. a Public Health Division- - 200 Main s Street, Hyanni 'MA 02601 e_ 2e07 Office: 508-862-4644 p Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CH0 -- ""- ---CERTIFIED MAIL# 7011-6470 0001 4525 7376 ,July 25, 2012 Mr. Martin Traywick 525 Ocean Street Hyannis, MA 02601 ' The septic system located at 6 Nobadeer Road,'Hyannis, A was,last inspected,on 6/18/2012 by Michael Kellett,,a certified septic inspector fMor'the'State of Massachusetts. -The Health Division has determined that the system- Tails y G + System is in hydraulic failure. According to page 13,of the septic report:'"The liquid in the pit was within a few inches of the inlet invert. There was staining 4"above the cover.of the pit". You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace-the septic system within the deadline periodfwill result,in future enforcement action. PER ORDER OF THE BOARD OF HEALTH �=M�cE;, .S.,CHO x Agent of the Board of Health 5 • � Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\6 NobadeerRd.,cent-doc x, Town of Barnstable Barnstable yP °� Regulatory Services Department edcaCRY I BARNS-rABLE Dm MASS �b3q. s 0 s Public Health Division �A 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7011 0470 0001 4525-7376 July 25, 2012 Mr. Martin Traywick 525 Ocean Street Hyannis, MA 02601 The septic..system located at 6 Nobadeer Road, Hyannis, MA was last inspected on 6/18/2012 by Michael Kellett, a certified septic inspector for the State of Massachusetts. The Health Division has determined that the system "Fails". • System is in hydraulic failure. C' c OA You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH Thomas McKean,R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\6 Nobadeer Rd.,cent..doc i „1 1 (� A rr 1 �� �Ci � 4 _ , w-� .� Commonwealth of Massachusetts k Title -5 Official lnspecti®n Form Subsurface Sewage Disposal System Form.,-Not-for Voluntary Assessments i 6 Nobadeer , . Property Address • ? -• Martin Traywick , Owner Owner's Name , information is required for every Centerville ; MA r,02632 ` 06/18/12- page. Cityfrown ; State Zip Code Date of Inspection l 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' , 4 on the computer,. t . use only the tab 1. Inspector. - ' '', ✓n , 4 key to move your cursor-do not Michael Kellett ' use the return Name of lrtspector key. 'Aardvark.Environmental Inspections. Company Name -. PO Box 896 ' ` Company Address East Dennis y MA a 02641 , City/Town:: _ =. State:.. Zip Code 508-385-7608 Sl 3742' Telephone Number License Number B. Certification I certify that I have personalty 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'properfunction•and maintenance of slteci sewage disposal systems.,I am a DEP approved system inspector pursuant to Section 15.340-of !11'1 ' Title 5(310 CMR 15.000.The system: ❑ +Passes- 0 Conditional{y Passes , ® Fails . 1 r Needs Further.Evaluation by the Local Approving Authority wG=<' 06/18/12 Inspector's Signature - Date The system-inspector shall submit a copy of this inspection.report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a designrflow of 10,000 gpd or greater,the inspector,and the system owner shall`submit the 4 . report to the appropriate regional office.of the DEP.,The origins{should be sent to the system owner and copies sent to the buyer,if applicable,and.ths approving authority. ** i-his report only describes conditions.at the time of inspection and under the conditions of use' at that time.This inspection does not address,how?the`system will perform in the future under , the same or different conditions of use. t5ins•11/10 - <,Title.5 Official Inspec io'n Form:♦u su a Sewage Disposal System•Page 1 of 17 - Commonwealth of Massachusetts e. Title 5 official Inspection Forte Subsurface Sewage Disposal Systerri Form-Not for Voluntary Assessments i a , ' ` s v 6 Nobadeer . Property Address Martin Traywick . Owner Owner's Name information is + ` required for every .Centerville MA ` 02632 06/18/1.2 page. Cityrrown State { Zip Code Date of-Inspection B..Certification (cont) - Inspection Summary:Check A,B,C;D or E I always complete all'of'Section D A) System Passes- , ❑• I have not found any information which indicates that:any of the failurecriteria described in 310 CMR 15:303 or in 31'0 CMR 15.304 exist.Any failure criteria not evaluated'are indicated'below.- ° Comments: = P B), System Conditionally Passes: • ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired,.The.sys4m- ,upon completion of the replacement or repair,as approved by the Board of Health,will pass.' Check the box for"yes","fio"or"not determined"(Y;N,ND)for the following statements.If"not determined,"please explain. • The septic tank is metal and over 20 yearsold*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 thatthe tank is lesstham20 years old is available. a ` �• ❑ Y Q N ❑.,ND(Main below): r t5ins-11/10' •Trite 5 official Inspection Form:Subsurface-Sewage-Disposal System•Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection:Form Subsurface Sewage Disposal System form--Not for Voluntary Assessments 6 Nobadeer r - Property Address Martin Traywick Owner Owner's Name information is required for every Centerville MA 02632 06/18/12 page. Citylrown 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,4settled 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): a ❑ obstruction is removed ❑ Y - ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced 0 Y ❑ N ❑ ND (Explain below): , w ❑ 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 ❑ N1 `❑ ND(Explain below): a ❑ 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)thatthe system is not functioning in a mannerwhich 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 a'saltmarsh olll jYCIW111a 11 Met Of IG'llie4lori!lIoe seireye Uspoael J,Jlelr69 , J V1 i i Commonwealth of Massachusetts , Title 5 Official Inspection, .Form s Subsurface Sewage Disposal System Form Not for Voluntary Assessments 6 Nobadeer r Property Address Martin Traywick_ Owner Owner's Name k information is ; required for every Centerville MA., - 02632 06/18/12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will'failiunless tf ee 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: . t ❑ 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. El 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. I Other: ; q • d ` D) System Failure Criteria Applicable to All Systems:; ' You must indicate"Yes"or"No to each of the following for all inspections: Yes -No R . . ElBackup of sewage into facility or system component due to overloaded or ' clogged SAS or cesspool Discharge or ponding;'ofeffluent,tothe surface'of the ground or surface waters ❑ ® ° due to an overloaded or clogged SA�SL or cesspool ❑ ® Static liquid level in the distribution:box above outlet invert due to an overloaded or clogged SAS ar cesspool ❑ Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow t5ins•11/10 • ,~ Title 5Official Inspection Form`:'Subsurface Sewage Disposal System•Page 4 of 17 - Commonwealth of Massachusetts . Title 5 Official Inflection.f or n s Subsurface Sewage Disposal System Fortis-Not for Voluntary Assessments 6 Nobadeer �- Property Address Martin Traywick Owner Owner's Name ' information is t required for every Centerville MA . 02632 06/18f12 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ; Required pumping,more than 4 times in the lastyear NOT due to clogged or obstructed pipe(s)..Number of times pumped: ❑ ® Any portion of the SAS,cesspool'orprivy is below high ground water elevation. El - Any portion of cesspool or privy is within 100 feet of a surface water supply or , tributary to a surface water supply.=; } . • ❑ Z 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 s system passes if the well water analysis,,performed at a DEP certified 'laboratory,for fecal'coliforrn 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. ;r El The system fails.'I have determined that one or more of the above failure r" ® criteria exist as described in 310.'C'MR 15.303,therefore the system fails.The ` system owner should'contactthe Board'.of Health to determine what will be " necessary to correctahe failure. ; E) Large Systems: To be considered 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 r questions in�Section D. Yes No ❑ ❑ the system is within'400 feet of a surface drinking water supply- E] ❑ `the system`is within 200 feet of a".tributary to a surface drinking water supply the system is located'in a nitrogen'senshive area(Interim Wellhead:.Protection ❑ Area—IWPA)or a mapped:Zone l[of a public water supply well: If you have answered"yes"to any question in Section.E the system is considered a significant threat, '+ ovanswered "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 nfficP nfth'e Department t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17„ Commonwealth of Massachusetts 1. Title 5 Official Inspection`For i, Tx Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments 4, 6 Nobadeer Property Address Martin Traywick Owner Owner's Name a information is Centerville •- MA' 02632 0611'8/12" ' required for every _ page. Cityrrown State Zip Code Date of Inspection r C. Checklist Check if the following have been done Youi 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. ❑ Z 'Were any of the system components pumped out in the previous two weeks?' ® ❑ Has the system received,normal-flows in,the previous two week period? Have large volumes of water been introduced to the system recently or as part of- ' ❑ • +®' this inspection? - •. Were as built plans of'the system obtained and examined?'(If they were not available note as NIA) ' ® ❑ Was the facility or dwelling inspected for signs of sewage back up? •- ® ❑ . Was the site inspected for signs of break out? ® ❑ Were all sy"tem.components,'excluding the SAS,located on site? ® ❑ ,Were the septic tank manholes uncovered,opened,and the interior of the tank`, F i• inspected for the condition of the baffles or tees,material of construction, • dimensions,depth of liquid,depth of sludge and,depth of scum? ' ® El information 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 a been determined based on ® ❑ Existing information. For example,a plan at the Board of Health. • w t' ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance_is unacceptable)[310 CMR 15.302(5)]; -D. System Information b Residential Flow Conditions: Number of bedrooms(qe`sign): 3 ' Number of bedrooms(actual),- y,e. 330 , DESIGN flow based on 310,CMR 15203(for examples 110 gpd x#of bedrooms): t5ins•11/10 , •'' : Tide'5Official Inspection Form:Subsurface-Sewage Disposal.System•Page 6 of 17 F. Commonwealth of Massachusetts Title 5 Official lnapect on -Form Subsurface Sewage Disposal System Forrn-Not for Voluntary Assessments 6 Nobadeer Property Address Martin Traywick'. Owner Owner's Name _ information is ' required for every Centerville MA,, .'02632 06/18/12 a page. City/Town - State, : Zip Code^~ Date of Inspection D. System Information t. Description: , • .. a • • ;. f 0 , Number of current residents:' _ Does residence have a garbage grinder? ❑ Yes ® No, Is1aundry on a separate sewage system?.{if yes separate inspection required] ❑ Yes ® N.o Laundry system inspected? ❑l.Yes ® No* Seasonal use?, ❑ Yes ®'' No Water meter readings,if available(last 2'years usage (gpd)); , Y Detail: Sump pump? ❑; Yes ® No - 10/10 Last'date of occupancy: 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/persons7sq.ft.;etc.): Grease trap present? f ❑ Yes ❑,No Industrial waste holding tank present's ❑; Yes ❑ No Non-sanitary waste discharged to the" itle 5 system? ❑ Yes ❑ No Water meter readings.,if available: k 't5ins-11/10 Tale 5 MUM Inspection Form:Subsurface'Sewage Disposal.System-Page 7 of 17 . A , •F. .., fit" • " • f t Commonwealth of Massachusetts• Titie 5 OfficiAl Inspection�Fo� x ' a f s Subsurface Sewage Disposal System'Forni-'Not for Voluntary Assessments 4 Property Address Martin Traywick P Owner Owner's Name „ information is , Centerville MA r °02632 06/18/1'2 - required for every 't page. City[Town "' State: Zip Code Date of Inspection^ D. System Information (cont ) _ a ' Last date of occupancy/use: 4 pate ry p Other(describe below):. t T General Information ` Pumping ReCOrdS:. �. ' is + Source of information: • Was system pumped as part,of the inspections $ � k:. ❑ Yes:° No` rr If yes,volume pumped:. allons- '. How was quantity pumped determined? Reason for pumping: Type of System: - ® Septic tank,;distri66ti©n box, soil absorption system a t Y `i&'. r r • S xi•��* w.:fi' •fir• " • ' •'�.• r f ` ❑ Single"',cesspool • �,,. .. `* . ❑. x Overflow,cesspool Privy ❑ Shared system.(yes or no)'(if yes kattach previous,inspection records;if any) •. 4 ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be`obtained from liystem.-owner)and a copyFof latest 44 � inspection of the VA systemby system operator under contract IN ❑ Tightta'nk.Attach a:copygof the DEP approval 3 - ,r a ❑ -' Other,(,describe):, f " k • ,� * a t5i s•11/10 Tide 5-Official Inspecdon'Form:Subsurface Sewage Disposal System•Pager8 of 17' Y' Commonwealth of Massachusetts W Title 5 Official Inspection fdrrn s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 6 Nobadeer Property Address Martin Traywick Owner Owner's Name information is required for every Centerville, MA • 02632 06/18/12 - page. Cityfrown State Zip Code Date:of Inspection D. System Information (coat.} t Approximate age of all components,date installed(if known)and'source of information: 1 09/14/88 per BOH ' Were sewage odors detected when arriving at the site? E •Yes 0 No r { Building Sewer(locate on site plan): t Depth below grade: a 2.2 feet Material of construction: 0 cast iron Z'40 PVC E]other(explain): , Distance from private water supplywell or suction line: feet a Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): f :`. 1.7 Depth below grade: r . feet Material of construction: ® concrete ❑ metal El.fiberglass ❑polyethylene ❑ other(explain) If tank is metal;list age: yearn Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1,000 gal 4�� Sludge depth: r. & f t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments - 6 Nobadeer' Property Address Martin Traywick Owner Owner's Name' information is Centerville „MA' 02632- 06/18/1'2 required for every • - page. Cityrrown ° State Zip Code. ` Date of Inspection ' D. System Information (cont.) Septic Tank(cont.) , Distance from top of,sludge to bottom of ouflettee.or baffle 27. Scum.thickness Y 4„. Distance`from top of scum to top.of outlet tee orbaffle �- Distance from bottom of'scum'to bottom.of outlet tee or,baffle r s = 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): t Depth-below grade: feet x Material of construction; x El concrete ❑'metal ❑fiberglass El polyethylene ❑ other(explain): • 4. - ,• r Dimensions: Scum thickness t 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 Forth:Subsurface Sewage Disposal System•Page 10 of 17 A Commonwealth of Massachusetts Title 5 Official Inspection Form r s Subsurface Sewage Disposal System Form Not for Voluntary Assessments 6 Nobadeer Property Address- Martin Traywick Owner , Owner's Name information is ' required for every Centerville MA '02632 - 06/18/12 page. Cityfrown State Zip Code Date of Inspection D. System Information (cost) 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. Ir "- Design Flow: gallons per day Alarm present: ` 1❑ Yes ❑ No Alarm level:' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date. Comments,(condition of alarm and float Switches,, *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No-, •t5ins•11/10 ,s - .. Title Official Inspection Form:Subsurface Sewage D'sprosal System•Page 11 of 17 Commonwealth of Massachusetts k Title 5 Official i}nispecfioft Foy Subsurface Sewage Disposal System Form=Not for Voiuntary Assessments a 6 No,badeer _ _• Property Address 4� b Martin Traywick. Owner Owner's Name.. 3 ; information is Centerville MA ' ' 'i32632 " 06/18/12" required for every ' page. City1rown '"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 • Comments(note if box it level andAisftutiorf to outlets equal,any evidence of solids carryover,`any evidence of leakage into or out of box,etc 3 ° 4 JA r e • , r n r _ ! V .! i • r .,. .. a { a r Pump Chamber(locate on site plan) _ Pumps in.working order: , °' `° tee, -0, ` Alar`ms in working Order:- A El Yes ❑ No . comments(note condition,of.pump chamber,condfion of pumps and:appurtenances,etc.). € r ,A € y r z ° , y ! t Soil Absorption System(SAS)(iocate on:site plan,excavation not required): r ° If SAS not located,explain why t ' ry 1 . isposal System t5I s•11/10, ,,-; • ?rt - ! ,r.Title 5 Official Inspectlon Form,Subsurface Sewage D Page 12 of 17 A c Commonwealth of Massachusetts. s Title 5 Official Inspection Form : . s Subsurface Sewage Disposal System Form-:Not for Voluntary Assessments 6 Nobadeer Property Address y Martin Traywick 4 Owner Owner's Name ` information is Centerville MA. 02632,_ 06/18/12' required for every •` ^ _. •� , page. Cltyrrown state Zip Code Date of Inspection D. System Information (cont.) 4 Type: F leaching;'Pitsa .. :` number: 1 ❑ leaching chambers number: F ❑ leaching galleries number: ` ❑ -'leaching'trenches number,length: . ❑ leaching fields number,.dimensions: F ❑ 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 - . Ye getation;etc:): 'This'system has.6'x6',precast pit surrounded by 2'of ston .The'liquid in the pit was within a few' '�rrol�s o e iIhlIeetinv—cTtfftmTe wdbs tntng 4"above the cover of the pit. t • Cesspools(cesspool-must be pumped as part' f inspection) (locate on site plan): Number and configuration ' 'Depth—top of liquid to inlet invert ° 4 Depth of solids layer r , Depth of scum layer Dimensions of cesspool Materials of construction 4 r Indication of groundwater-inflow 4* ❑ Yes ❑ No t5ins•11/10 F•. Trde 5 OfWal Inspection Form:Subsurface Sewage.Disposal System•Page 13 of 17 ' . a x r 4. Commonwealth of Massachusetts s ' Tithe 5 Official Inspection - or _ • ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6 Nobadeer Y a - Property Address Martin Traywick ' Owner Owner's Name information is r required for every Centerville MA :' _ 02632 06/18/12 page. Cityfr•owr State Zip Code Date of Inspection -+ D. System Information. (cont.) Comments.(note condition of soit,signs of hydraulic failure,a'evel of'ponding,condition ofvegetation;- '. �• etc.): Privy(locate,on site plan) - 1. � ! ♦ Y I' , i A a a, C e k* _ _ �"Y �.` , _`. P . Materials of construction: .Dimension s k Depth of solids Comments(note condition of soil;signs of,hydraulic,faildre,level of ponding,condition of vegetation, etc. y" ,.' ✓' t5ins•11110 - , ' '- Tiffe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14_of 17 f Commonweal h of assachtisetts gi a .U- Title 5. ici . sp,ectioForm Subsurface Sewage Disposal System Fornn-Not for Vokmtary Assessments 6 Nobadeer Property Address Martin Traywick Owner Owners Name infomation is required for every CenterWle MA 02632 MUM page. City/Town state Zip Code Date of Inspection D. System information (cont) Sketch Of Sewage D*qoosal System:'Provide a view of the sewage disposal system,including ties tD ; 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: 0 hand-sketch in the area below A drawing attached separately j: i 97, a� a t5ins•11110 Td�5 awl h gxceon Form:Subsurtaw sewage DbPWM System i page 15 of 17 • 4 Commonwealth of Massachusetts` - Title 5 Official In'sp"'ection Form Subsurface Sewage Disposal Systern Forrn-Not for Voluntary Assessments: 6 Nobadeer r Property Address s . Martin Traywick Owner Owner's Name _ information is required for every Centerville ' MA 02632. '06/18/12 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) , Site Exam: ® Check Slope' ❑ Surface water - ® Check cellar ` ❑ .Shallow wellsY - 1 9 20. Estimated depth to higfi�ground water. feet0 Please indicate all methods used to determine the higli ground water elevation: , El Obtained system design plans on record ,r If checked"date of design plan reviewed: 4 r 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) ® f Accessed USGS database-explain: - You must describe how you established the high ground water elevation: USGS maps show an elevation of over 20.0 feet.. , ' Before filing:this Inspection Report,please see Report,Completeness Checklist on next page. t5ins•11/10 Title 6Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17; . • t Commonwealth of Massachusetts - Title 5 Official Inspection Form .. x Subsurface Sewage Disposal System Font-Not for Voluntary Assessments 6 Nobadeer Property Address Martin Traywick Owner Owner's Name r information is Centerville MA $ ' 02632 06/18/12 required for every page. Cityrrown State Zip Code Date of Inspection E. Report,Completeness.:,Cheeklist ®`Inspection Summary:A, B, C,D, or E checked ® Inspection Summary D(System FaH.Ure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater • Sketch of Sewage Disposal;System either drawn on page 1'5 or attached in separate file 5 t5ins•11110 - w e Trite 5'Official lnspection Form:Subsurface Sewage Disposal System•Page 17of 17 ' �� �No. Fee I�� THE COMMONWEALTH,OF MASSACHUSETTS Entered in co puter: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for l pis 6a' 6pstrin Construction 3permit Application for a Permit to Construct( ), Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. t, IV moo/ 4k. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 5-0 —1.3 q .j Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 6r'— —sq.ft. Garbage Grinder( ) Other Type of Building vet/y Y No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.re uired) 0 gpd Design flow provided !3 gpd Plan Date i, 9 ,Pr Number of sheets -'I-- Revision Date Title Size of Septic Tank Type of S.A.S. ?°ls Description of Soil Nature of Repairs or Alterations(Answer when applicable) %NS k-CA-11 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. rgn Date G ��-- Application Approved by Date Application Disapproved by Date for the following reasons Permit No. C� 7 Date Issued U No. Fee — THE COMMONWEALTH�OF MASSACHUSETTS Entered in co pu er: PUBLIC HEALTH DIVISION -TOWN Of BARNSTABLE, MASSACHUSETTS Yes - application for Bi*sal 6pstem Construction 3permit Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (� A10�G': P %�yi'� -Owner's Name,Address,and Tel.No. s Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Alt Type of Building: ! Dwelling No.of Bedrooms Lot Size 15� " sq.ft. Garbage Grinder( ) Other Type of Building harz or No.of Persons Showers( ) Cafeteria( ) Other Fixtures . 4 . Design Flow(min.required) gpd Design flow provided 2 �z��j �-( gpd Plan Date Number of sheets /L_--•. Revision Date Title -` Size of Septic Tank jr:�ui r2; rive Type of S.A.S. �r �tJst'(S Description of Soil Nature of Repairs or Alterations(Answer when applicable) j n4S jn` A -Dateslast inspec0d': 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 Certificate of Compliance has been issued by this Board of Health. rgn - Date G �•.— Application Approved by Date a), Application Disapproved by Date for the following reasons Permit No. C-3D/ p' Date Issued ------------- - --------- -- - -_x,__ _,�__._ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( W_ pgraded( ) Abandoned( )by at 4 /vv Gc has been constructed inoo accordance with the provisions of Title 5 and the for Disposal System Construction Permit No� o� a 4/4ated � 'U � ) Installer Designer #bedrooms Approved design ow0asdes gpd The issuance of this permit shall not be construed as a guarantee that the system i 1 doed. Date Inspector -=--------------------------------- .-. ------- _ ------------------- No. "7� Fee Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS ;Disposal Apstem Construction Wrinit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at / Ctdrloi, La and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. , Provided:Construction must be completed within three years of the date of this pe it. Date �L� ) --. Approved by Town of Barnstable Regulatory Services Sl, Thomas F. Geiler,Director MAS• S Public Health Division 039. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 'Z1 Z. Sewage Permit# Assessor's Map/Parcel Z�0 133 Installer&Designer Certification Form Designer: S,., ; n-SAW-I',„s, lasso Ltr Inc . Installer: P-A, V'\ L Address: z W. Crb S S :e Icy IZf• Address: (,<GL 1L( Ce� � ' r On 19.A- `a'U?'Jd` c was issued a permit to install a ( a e) (installer) septic system at 6Lc U V"0 q based on a design drawn by (address) f dated ( Z-- (designer) .<_I certify that the septic system referenced above-was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic; system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) was ' cted and the soils were found satisfactory. jt1 OFMAssq PETER T. cGi+ a McENTEE ( nsta ler's Signature) " CIVIL Nov 35109 0 Q aTS������• (Designer's Signature) (Affix Design re) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office forms\designercertification form.doc �t Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification Important: When filling out 1. Property Information: forms on the computer,use 6 Nobadeer Road- Centerville, MA only the tab key Property Address to move your Judy Norris cursor-do not Owner's Name use the return key. 6 Nobadeer Road Owner's Address rib � Centerville ---"MA 02632 City/Town State Zip Code Date of Inspection: October 27, 2005Date 2. Inspector: David D. Coughanowr, R.S. Name of Inspector Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364 0894 Telephone Number Certification Statement: I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ._. ❑ Needs Further Evaluation by the Local Approving Authority - # co co , 4D.-4 5�), 6*4, K S October 27, 2005 Inspector's Signature Date i. y N The system inspector shall submit a copy of this inspection report to the Appro!ing Authority s(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 ownX 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. t5-2214.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Gniy A. Certification (cont.) 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection 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: Inspector's Note==> Aseptic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: t5-2214.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 t5-2214.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: I t5-2214.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'LAM A. Certification (cont.) 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection 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 '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 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes No ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. t5-2214.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5of16 E Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form A. Certification (cont.) 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection 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. t5-2214.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form B. Checklist 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection Check if the following have been done. You must indicate "yes" or"no" as to each of the following: YES NO ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, including the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] t5-2214.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): n1a Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a—no plan Number of current residents: 2 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 334 gpd Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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: Last date of occupancy/use: Date Other (describe): t5-2214.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection General Information Pumping Records: Source of information: owner 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age unknown—system is assumed to have been installed at time of dwelling's construction in 1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2214.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 9of16 r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 2feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer appears structurally sound with no evidence of backup or leakage into dwelling Septic Tank (locate on site plan): Depth below grade: 2feet 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 ❑ Yes ❑ No certificate) Dimensions: 8.5 ft x 5 ft x 5 tt(1000 gallon) Sludge depth: 2 inches Distance from top of sludge to bottom of outlet tee or baffle 32 inches Scum thickness trace Distance from top of scum to top of outlet tee or baffle 10 inches Distance from bottom of scum to bottom of outlet tee or baffle 14 inches How were dimensions determined? Probe to top of tank t5-2214.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M C. System .Information (cont.) 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time but maintenance pumping is recommended within and every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. 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 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): t5-2214.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection Tight or Holding Tank (cont.) 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.): Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert At outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box appears structurally sound with no evidence of leakage in or out. Some solids in sump. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2214.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 12 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection 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: Type: ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils above leaching pit appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Pit was uncovered and found to contain effluent at a level 16 inches below inlet invert. No staining at cover interface or in overlying soils was noted. t5-2214.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments M Subsurface Sewage Disposal System Form C. System Information (cont.) 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): t5-2214.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 14 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments ^M Subsurface Sewage Disposal System Form C. System Information (cont.) 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection 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. LOCATIONS A B C LEACH 1 13 f t 22 ft PIT SEPTIC TANK 2 27 ft 21 ft 3 Z0D-BOX Ed 3 29 ft 28 ft B C A EXISTING DWELLING # 6 W I Z J W W 3 I NOBADEER ROAD NOT TO SCALE t5-2214.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 6 Nobadeer Road Property Address Centerville MA 02632 City/Town State Zip Code Judy Norris October 27, 2005 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 30+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: Barnstable GIS Department You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is over 30 feet above groundwater table. t5-2214.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 16 of 16 i �A, DEC BORTOLOTTI CONSTRUCTION,INC. �(yy� 2 I1 99 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 "` { C� 508-77.1-9399 508-428-8926 FAX: 508-428-9399 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION � / CL 4,1, Property Address: �/`� Date of Inspection:f ?-/�', Inspector's Name` ,- Qw,per's Name and Address: c c: J CERTIFICATION STATEMENT* I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in-the,proper function and maintenance of on-site sewage disposal �j'stems. The System: �/ Passes Conditionally Passes Needs Further E aluation By the Local Aproving Authority Fails Inspector's Signature: A Date: The System Inspector shall submit copy of this inspection report to the Approving authority within thir- ty(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 systenrowner 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 IM ARYL A)SYSTTyi4I PASSES ,,.. �/ I have not found any information which indicates that the system violates any of the failure criteria as defined in'310 CMR 15:303. Any failure criteria not evaluated are indicated below. b Is B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple-. tion of the replacement or,repair,passes inspection. Indicate yes,•nor,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,cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system,will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is:levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require farther evaluation by The Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE i SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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 clog- ged SAS or cesspool. Liquid depth in cesspool is less than G below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- .�i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen: E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safet and the environment because one or more of the following y g conditions exist: The system is within 400 Feet of a surface drinking water supply The system is within 200 Feet of a tributary to a surface drinking water supply The system.is located in a nitrogen sensitive area Interim Wellhead Protection Area QWPA)or a mapped Zone Il.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 requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM E PART B " 'CHECKLIST Check if the following have been done: Pumping information was requested of the owner,occupant,and Board of Health. __j,,—None of the system components have been pumped for atleast 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. ___i�fAs-built plans have been obtained and examined. Note if they are not available with N/A. �dThe 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. V"A11 system components,excluding the Soil Absorption System,have been located on site. ice' The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of baffles or tees,material 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 existing information or approximated by non-intrusive methods. -3- I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) e'lhe'facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL:X"', > — Design Flow: 3 J allons Number of Bedrooms: �, Number of Current Residents: �l Laund Connected'I'o S stem: Seasonal Use: Garbage Grinder: Laundry y _ / Water Meter Readings, if ilable: Last Date of Occupancy: .Gt�'���%1i7`-- COMMERCIAL/INDUSTRIAL: Type of Establishment: Design Flow: gallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: : P GENERAL INFORMATION PUMPING RECORDS and source of information:: Z �� -- �c%— System Pumped as part of inspection:; � if yes,volume pum d: gallons Reason for pumping: TYP&0F SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other(explain): kPROXIMATE AGE fall co m nents,date installed(if known)and source of information: Sewage odors detected when arriving at the site: -4- - n t - SUBSURFACE SEWAGE DI SPOSAL OSAL SYSTEM EM INSPECTION FORM PART C GENERAL INFORMATION (continued) , SEPTIC TANK: Depth below grade:,' ' /A Material of Construction:V concrete metal FRP Other (explain) Dimisions: % ° Li / Sludge Depth: '� Scum Thickness:- Distance from top of sludge to bottom of outlet tee or baffle: 3`/ 11 Distance from bottom of scum to bottom of outlet tee or baffle: v3'' Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to utlet invert, structural integnyy,evidence.of leakage,etc.) v y/Y� GREASE TRAP: Depth Below Grade: Material of Construction: concrete metal FRP Other (explain) — — _ _ Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage,etc.) TIGHT OR"HOLDING TANK: u Depth Below Grade: Material of Construction: concrete metal_FRP_Other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet tee,condition of alarm and float switches,etc;) DISTRIBUTION BOX. t� - Depth of liquid level above outlet invert: � � Comments: (note' vel and distribution is ual,evid6ke 9f solids darryover,evide of leak into nt or put of box,etc. 9 ) �� y� —'yL PUMP,CHAMBER: -'d/() Pump is in'working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) . -5- 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): (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:Leaching chambers, number: Leaching galleries,number: Leaching trenches, number,length: Leaching fields,number,dimensions: Overflow cesspool,.number: Comments: (note condition of soil, signs of hydraulic failure level of pondin , ition of vegetation, �� Ir CESSPOOLS: Number and configuration: Deptli-lop of liquid to inlet invert: Depth of solids layer: 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 soilk, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: .d Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -6- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: v F Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. . DEPTH TO GROUNDWATER: Depth to groundwater: 7— Feet e Method of Determination or Appr ximation: r _ TOWNN'G.-BARNSTABLE LOCATION /��t[�0 P d SEWAGE # VIIIL GE _ ASSESSO MAP& 2�- z��rLfA- R s � , NAME&PHONE NO. � J 7`� SEPTIC TANK CAPACITY /&)o G 4/ 7 `7 k LEACHING FACILITY: (type) Ci_) (size) /DUO��'u NO.OF BEDROO BUILDER OR OWNE PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /V 114 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching fac' ) /- 'Al AA Feet Furnished by�Jl''/abk �l �� O `^ � / �� �� �, �� � . LOC~AT ION SEWAGE PERMIT NO. )-cEr lid 93 s ISO VIL , AGE —9.5Z- /.3� INSTALLER'S NAME & ADDRESS e 8UILDER OR OWNER �l+(iQ-) DATE PERMIT ISSUEDt DAT E COMPLIANCE ISSUED Qc� .� � � � �o �� ._ . . -� , z ��� Not _f THE COMMONWEALTH OF MASSACHUSETTS BOAR® /OAF HEALTH 7d Gc1 ......OF.......L�.�l"'I?S..f? ole.................................... ApplirFatiun for Uiipuiiaal lVorks Tonstrnrliun ramit Application is hereby made for a Permit to Construct (✓j"or Re air an Individual Sewage Disposal System at: ...............:__ ...r. Z--....._1S.11�.�!Zf.esr�� -- �ls...... l�S =.......... ........_..... -- Lo ation-Ad r s r Lot 40 GGi�pp owne/r� �(/y �� ,w Address � .......... _ �rrs�JK�s.....KTIj�.�'S'.................................. Installer Address QType of Building Size Lot..zZ,,-72.5---_-Sq. feet U Dwelling—No. of Bedrooms........ .__..Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building No. of persons............................ Showers t� yP g ---------------------------- P ( ) — Cafeteria ( ) Q' Other fixtures ......................................... W Design Flow..................XS�..............___gallons per person per/dly. Total daily flow................Z3.0_...............gallons. WSeptic Tank—Liquid capacity./ llons Length__..ST '._ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......../----------- Diameter...l®.-G..... Depth below inlet...Jr.n#4-..... Total leaching area.3/7, -7..sq. ft. Z Other Distribution box (✓S Dosing tank ( ) Percolation Test Results Performed by--- Date........6123 e3............ a Test Pit No. 1.....4.1-minutes per inch Depth of Test Pit....... X...... Depth to ground water....A.4*A2c_- _. (r., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ C4 ••-••••••-•-••-••---••--••--••......-••--•......-••-•••••. • ••--•--•••...............•••-•._......-•---•-•-•-----•.... - O Description of Soil.................... J-Z- f �P F✓ ,� y -- --------- - - W L `�------r-zr �� ' 8�/Z, 6-cam W ----------------------------------- ------- r •--•••••••-••---•----••-•••--------•---••••••••••-••--••••-•--------•---•-------•--••••-•••-••---•------••-••--•-----•------•...------•••••••---•----•••••-•••-•••---•--••-•••-•-•••--•--•••......•--••- V 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 HT12 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a.Certificate of Co lianc has been issued by the board of health. ed-•-•••••-•••••-••••••••-•••--••-•-•---•••-•-••••-•--••••-•......--•••••-•............ ................................ Date ApplicationApproved By....... -• ... ... -•-•--••.r................................................................ Date Application Disapprove th lowing reasons:.............................................................................................................. •-•••••••••-••••-••••--•••....•••....••-•...........-•-••••••--••••••-•••-•---•-••••--........•••-••-••----••-•--.....-••••-•-•-••-•------•-----••••••••••••----......--•••--•••-•---•--•...--••--•••-•- Date Permit No......................................................... Issued.....'.'...... - Date Not � �-- THE COMMONWEALTH OF MASSACHUSETTS BOARD �OF HEALTH %, r U1-r:7............OF........ ----- /� AppilrFation for Bhipajs al Works Tomlratrtiun rantit Application is hereby made for a Permit to Construct or Re air an Individual Sewage Disposal System at: ................_............ .................................................... ..t Location Address Lo - Owner f /W amInstall Address .r ......-•................� ......... f er / .r �......_ ..... Address U Type of Building Size Lot... z.-f: l...S feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures W Design Flow..................=`_`......................gallons per person per day. Total daily flow..................TI ................gallons. 9 Septic Tank—Liquid capacity_..,-'..2:2gallons Length...... ...5�.... Width................ Diameter................ Depth................ J Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......../............ Diameter..! .` _... Depth below inlet_...-?:"-_ ?.... Total leaching area.._-/%�_7__sq. ft. Z Other Distribution box (✓) Dosing tank ( ) '-' Percolation Test Results Performed by..� !�''�'_ /��? ''�!�_f' � �` 1 a ••-• - Date......:. .. . .:............ Test Pit No. 1.....!.:=_..minutes per inch Depth of Test Pit......< ......... Depth to ground water........................ fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil � n . GAG r�< �_r� y�.... ................ ........... . x - - V ...... W V 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'TTLE p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Cokplfian5p has been issued by the board of health. ;>%4&ned...................................................................................... ................................. Date ApplicationApproved By.................................................................................................. ........................................ Date ' , s• - Application Disapproved for the following reasons: ..-------------------------------------•-•-----••-. ... ... ................ .. --------•-----------••---••-...Date t � PermitNo......................................................... 1`ssued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... . L'yrrtif iratr of f ompliFanrr THIS IS TO CERTIFY, hat the I2dividual Sewage Disposal System constructed ( ) or Repaired ( ) b .................................... .---• .................... , -- -......... ---------------------------- ,,.�J Installer ----••- has been installed in accordance with the provisions of TITL: j of The State Sanitary Code described in the application for Disposal Works Construction Permit No........f o5t_ 'jd.__.._.... dated............. y__;F03................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY: DATE................................................................................. Inspector_...---------•-••--•--••-•--•-------------.................._..._........-••-•-•-- THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ..... . ....... .........O F...... ...............~�-�... ................................ FEE No..... .. .... Disposal kn nn trltr�wi n rrnttt Permission is hereby granted....... ................. .. ----.. ........................................................ r to Construct�K) or Repair ( S .w DisP s S at No.•----ter �: ,.�✓----•-- jh-e�`-!� ::: f� �. Street as shown on th/app icatio for Disposal Works Construction Permit ..'�l_ tl Dated.._....____ :......••.............. .4.DATE----•�� .15- ................................................. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS LEGEND a , 88 — N ° — EXISTING CONTOUR — — .. _ x^100.98 EXISTING SPOT°-GRADE W EXISTING WATER SERVICE N EXISTING p G' G GAS SERVICE o TEST PIT aLua ' BENCHMARK 92 t 4�5 C (5 ` Brian Ln r IP LOCUS r Fo►mo� Rd -Route z8 BENCHMARK I. Dunes v Pond EXISTING SEPTIC .TANK. OUTSIDE COR.%BOTT. STEP �:�CU$ MAP (TO REMAIN);. a.* EL.=102.21 (Assumed) NOT TO SCALE x a TOP OF TANK, EL=99.37 INV.(OUT)=98 04t a a: h EXISTING LEACH-PI T TO BE PUMPED & FILLED 136 03 W/SAND°AND ABANDONED i � .00 w x 100,81 100.86 Q2 Q x 101.07 I DECK x 101 X6, 10 64 �'�3�r�= ;101,26 4 xi wir I/// 20 x x.101.19 ^'�► ��14 101.39 .,' wTP-1 / i0 EXISTING DECK HOUSE a fr/fir jl' T.O.F.-=102:04f In. '100.87 w TP-2 16'_ �(ia� Q , GARAGE Cellar 101,15 Co h©3 101,20 '. - 01,27 101.1 x 101.54 10187. X r' a. a x 01 7 ;v \\ L MP GS 00• 1 \ 10L62 L Z \\ °1 1;47 /��7\ STONE s� '/00 't DRI IIEWA Y 10079 k 101,0 \\ \ I s 100. 7 \\ 100r,72 I �' \ 100,93 \ LOT 32 10�.g3— 1,fl, , i - MLU 250— 3 Y-- -- -= - �. \\ 22,725 S.F.f � \ 100.92 LAMP , � WSG �. 8 Y 100,38 -, y\ 120.00' 100 6 100.49 k yBG G 100.23 0 100,00 pavement,, 99,90°'PK 6XT edge of 99.56" • 99.02 99.23 n PLAN OF RECORD PK SET 7 70� - COMES DASOUZA, MARLUCE P 6 NOBADEERRVILLE ROAD 4f4SS /�rOB 1J CENTERVILLE, MA 02632 PROPOSED SEPTIC SYSTEM UPGRADE PLAN o PETER T. � { McvTE lE w NOBADEER ROAD, HYANNIS, MA No. 35109 M Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 RFCISTE�`�� �� Engineering, by: SCALE DRAWN JOB. N0. FF #_ Engineering;..Works, Inc. 1"=20' P.T.M. 208-12 PLAN REFERENCE A 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. LCP 40592 C. — Sheet 1 (LOT 32) (508) 477-5313 7/26/12 P.T.M. 1 Of 2 c r s NOTE: TO PREVENT. BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL•98.0 r FOR A DISTANCE OF.�15' AROUND.THE PERIMETER OF THE S.A.S. SEPTIC-TAN PROPOSED D-BOX . PROPOSED S.A.S. INSTALL'RISERS & COVERS OVER INLET & INSTALL" RISER & :COVER;. t OUTLET AND'TOIF ,`SET TO 6" OF FINISH GRADE INSTALL 2 INSPECTION PORTS (MWIMUM) EXISTING F.G. EL.-T01.Of F.G. f G.DEL.=101'.0(MAX.) SET TO 6" OF GR a s. k - •EL 100.9t , MAINTAIN 27. GRADE (MIN.)=OVER S.A.S. L'_ 25' L = 15' . L --6-(MkO 2 INSPECTION PORTS ® S=1% (MIN.f ® S 1% (MIN.) �' ®RS=1% (MIN.):, (MINIMUM) ' ` 4"SCH40 PVC 4"SCH40 PVC 4"SCH40•PVC el I 614 'TO ISTING48" LIQUID y ,'INVERT LEVELADD INV=97 89 PROPOSED INV=97.72 (3ROWS OF 5 UNITS AT. 6.25'/UNIT) + 0.T WEDGE = 32.0' GAS BAFFLE. . .. . _ „. INV=98.04t D-BOX = - INV' 97.66 EXISTING 3 OUTLETS' (MIN.) { ' . * SOIL'ABSORPTION SYSTEM (PROFILE) EXISTING SEPTIC TANK �> ESTABLISH VEGETATIVE COVER ' BACKFlLL WITH CLEAN NATIVE OR s f PERC SAND TO TOP OF CHAMBERS. NOTES BREAKOUT'EL TOP EL f:; y s TOP ELEV.=98.05 1) CONTRACTOR:..SHALL VERIFY-ALL EXISTING PIPE' - .... -• - .. _• - INVERTS, PRIOR TO INSTALLATION. INV., ELEV.=97.94 a 2) D--BOX SHALL,BE SET LEVEL AND TRUE TO BOTTOM_ELEV:=96.72' ` GRADE,ON A MECHANICALLY COMPACTED.SIX = III 2.83' II III�II l�l INCH ,CRUSHED STONE.BASE, AS SPECIFIED `IN 310 CMR 15.2121(2). 5' MIN. ABOVE.BOTTOM OF ` T.P.,�EXCAVAT10N OR G W. EFFECTIVE WIDTH=8.5' '3) INSTALL INLET & OUTLET TEES AS REQUIRED. = EXISTING SUITABLE 4) GAS BAFFLE,TO BE INSTALLED ON OUTLET TEE BOTTOM OF TP,'-EL-9'1.0 - MATERIAL AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. NOTE'` - SOILS•,SHALL BE VERIFIED BY USE .3 :ROWS OF.5-16"(H-20) ADS BIODUFFUSER UNITS + WEDGE A,-SOIL EVALUATOR PRIOR .TO" 1 WITH NO SEPARATION BETWEEN EACH ROW & NO STONE ` " PRIOR TO INSTALLATION - TYPICAL. SECTION SEPTIC SYSTEM .,PROFILE 4: �TS h } :SOIL LOG , a f °DATE , r':. JULY 17, 201'2 REF 13,699) GENERAL` NOTES. SOIL.'EVALUDATOR: PETER McENTEE (S E#1542) ' 1.'ALL CHANCES TO THIS 'PLAN MUST BE APPROVED BY THE LOCAL WITNESS; ONALD DESMARAIS R.S.-HEALTH AGENT, BOARD, OF HEALTH AND. THE- DESIGN ENGINEER: a Elev.*, TP-J Depth;+ Elev. T - th "P 2 De ,2. ALL WORK AND MATERIALS SHALL CONFORM'TO ,THE REQUIREMENTS . T01 1 A 0 101.0 A 0" e OF THE STATE ENVIRONMENTAL CODE, TITLE,V, AND:ANY APPLICABLE 3 SANDY LOAM SANDY LOAM LOCAL RULES. 10YR 4/2 10YR 4/2 3. THE SEWAGE DISPOSAL` SYSTEM SHALL NOT BE BACKFILLED PRIOR :` 100.4 B . a 8" Y00.5 B 6" TO INSPECTION AND APPROVAL BY THE BOARD OF 'HEALTH'AND.-THE DESIGN ENGINEER. : SANDY LOAM SANDY LOAM_ -_ �. 1OYR 5/810YR 5/8 -- ANY 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING gg,1 36" gg.2 34 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN. ' C C ENGINEER BEFORE CONSTRUCTION CONTINUES. ° 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF M C SAND M-C SAND THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF TM 2.5Y 6/4 2.5Y 6/4 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. '.t • r> >207 GRAVEL - '` >20%-GRAVEL ,7. WATER ,SUPPLY PROVIDED BY,TOWN WATER SERVICE. &. THERE'ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 120' 91.0 120" 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON_BY OWNER AND CONTRACTOR OR AS OTHERWISE - PERCH RATE: <2 MIN/IN. 1("C" HORIZON)"On file 5/3/83 DIRECTED BY THE APPROVING AUTHORITIES.> g NO GROUNDWATER;;OBSERVED 10.. .IT SHALL BE THE RESPONSIBILITY,OF THE CONTRACTOR TO VERIFY --75" THE LOCATION OF -ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING > ` CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR:SHALL REMOVE ALL UNSUITABLE SOILS_ IN THE AREA.$ENEATH AND'FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). ` 12. AREAS REQUIRING STRIPOUT^OF UNSUITABLE MATERIALS SHALL BE t .INSPECTED BY"DESIGN ENGINEER PRIOR TO BACKFILL: �q ,... p 76„ 13. THIS PLAN_IS TO .BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND PROFILE ' NOT CONSIDERED-TO BE A PROPERTY LINE SURVEY., • w 11:2 DESIGN CRITERIA 34 NUMBER OF BEDROOMS: , 3 BEDROOMS '# SOIL TEXTURAL CLASS: CLASS I SECTION. END CAP DESIGN PERCOLATION..RATE: <2 MIN/IN " 16" HIGH- CAPACITY H-20) BIODIFFUSER UNIT DAILY FLOW: 330.GPD MODEL 16'`. HICAP; UNITS-MUST,.BE STAMPED H-20', DESIGN FLOW: 330 GPD •LENGTH ^` 76" NOTE:..UNIT�CONFlGURATION AND AVAILABILITY SUBJECT GARBAGE GRINDER:' NO EFFECTIVE LENGTH' 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY - y DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. LEACHING'"AREA REQUIRED: (330 GPD) - 445.9' SF SIDE WALL HEIGHT 11.2" ",.74 GPD/SF OVERALL HEIGHT. 16" EXISTING SEPTIC TANK: - 1000 GALLON CAPACITY _ OVERALL`WIDTH 34" 4640 TRUEMAN BLVD PROPOSED D-BOX::• 1 INLET, .3 OUTLET (MINIMUM), H-10 RATED l ",13.6 CIF ® HILLIARD, OHIO 43026 CAPACI TY USE 3 ROWS OF 5-16 (H-20) ADS BIODIFFUSER UNITS. (101.7 CAL) ADVANCM DMWE SYSTEMS. INC. W/NO STONE AND EXTENED 0.7' w/ CONTOURED WEDGE PROPOSED SEPTIC SYSTEM UPGRADE PLAN BOTTOM AREA: (GENERAL .USE APPROVAL FOR 4.73 SF/LF OF UNIT) (BIODIFFUSERS) 15 UNITS x 6.25 LF x 4.73 SF/LF = 443.4 SF r "6 - NOBADEER ROAD, HYANNIS, MA (CONTOURED WEDGE) 3 ROWS x 0.7' x 4.70 SF/LF = 9.9 SF TOTAL AREA = 453.3 SF,. Prepared°for' D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 Engineering',by. , SCALE DRAWN JOB. NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(453.3 SF) = 335.4 GPD^: Engineering Works, Inc. NITS P.T.M. 208-12 HIGH. CAPACITY (H-20) INFILTRATORS MAY BE SUBSTITUTED. 12.West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. IF THE 3 WEDGES -ARE SUBSTITUTED WITH THREE CHAMBERS. (508) 477-5313 =a 7/26/12 P.T.M. 2 of 2 SI TE PL A lV i YPICAL P,ROFIL E NOT TO SCALE __-- /8"S70. LT. WGT. C.l. MH COVER 4"C.1. PIPE 4"BIT. FIBER P/PE TIGHT JOINTS ----- OUTLET LEVEL _ .:. '44 -_ FLOW L/NE 0 TO FIRST JOINT DWELLING o IO /4" O O ." Gv.S3 f GD.Z C./. TEE C. TEE �.40 60 7o STANDARD PRECAST 4 ! GO,p S-�,o CONCRETE GALLON SEPTIC TANK I DISTRIBUTION BOX B TO BE INSTAL L ED ON G� LEVEL , STABLE BASE. — ----- SEPTIC TANK S /30 /A 2G TO BE INSTALLED ON LEVEL , STABLE BASE ry u + 1 I I. 2"- //8" TO 1/2" WASHED PEAS TONE LEACH/NG PI T 154. SS.a ALL AROUND FREE OF IRONS, FINES BASE TO BE LEVEL AND DUST IN PLACE BRICK 9 MORTAR COURES pQEsCgsr _ AS REQUIRED TO BRING STONEOALL/AROUND FREE OF c`pRr /'��4W COVER TO GRACE 24 C,I. MH COVER IRONS FINES AND DUST IN PLACE. p '"�•' ; �Fr�rc r�ac AND FRAME 1 ,4 - - �` _ _ 4 4" L EACHING Pl T SEC TION— jIN INLET 81 FLOW LINE PIPE I. CONCRETE TO BE 4000 PSI 28 DAYS —7-_„ 2. REINFORCED WITH 6" x 6" NO. 6 GA. W.W.M. `-b 3. 2' AND 4' SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS. O o\ Q r Q OPENING WITH 4-I/8 4. NUMBER OF PITS REQUIRED __L__— IV (� '7A NOTE: EXCAVATE TO ELEVATION .S/.o OR LOWE R AS 44. e.3.c v' �3/4R INSIDE DIAME TER 3', b( ,14 REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH �'►I i PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN GRAVEL TO DESIGNED GRADE . 6'-6 -- / r MIN' EFFECTIVE DIAMETER _ J .- - -- -- - -- - (NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) WATER TABLE /VnAvE 10 SOIL A NO PERC. DA TA GENERAL NOTES PERC. RATE : L MIN. /IN . NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. SEPTIC TANK, DISTRIBUTION BOX , LEACHING PITS TO BE STANDARD -. ,. TEST BY: 13.E_'uG f,/�[ o UNITS. PRECAST REINFORCED CONCRETEfk` WITNESSED BY �.I. �N��nsi i3/",�,� ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE, r, TEST PIT GR. EL.:- G 3, DATE 5� J MINIMUM REQUIREMENTS FOR THE SUBSUFQCE DISPOSAL OF Y TEST PIT N0. 2 SANITARY SEWAGE EFFECTIVE I JULY 1977. i TEST PIT NO.P1444 ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE O II To/- 3 BOARD OF HEALTH. AT COMPLETION OF CONSTRUCTION PRIOR TO BACKFILLING THE G BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. PITCH ALL SEWER LINES 1/4" / FT. UNLESS INDICATED rvJED S.9.v/� OTHERWISE. DESIGN DA TA BEDROOMS 3 DISPOSAL A'111)ti—= '. EST. TOTAL DAILY EFF. 2-10 GALS. SEPTIC TANK ©o� LEGEND — GQL' e, SIDEWALL AREA 2,-5 GAL./SQ. FT }` 'a BOTTOM AREA _.__ 410 GAL./SQ. FT. OXOO EXISTING GRADE LEACHING REQUIRED___2--1,41-3 SQ.FT. SEWAGE DISPO,-SAL SYSTEM ZONE _ Z0- / o 0o FINISHED GRADE ACTUAL LEACHING AREA /�Z-SQ.FT. FOR Tram O• or7 INVERT ELEVATION DOMESTIC WATER SOURCE !!1v1rjLCJ�Uts�i� -' _____-- _ _. ")pr��- PROPERTY LINE "� ���-� 'ass, - - PLAN REFERENCE c�\ — ---- MEAN HIGH WATER ,. / ,'A, % Rabe+f hl SCALE: AS iNDICATED DATE BENCH MARK DATUM U-SC-s3 [/929 rj-IL -0ATur,�) i r- MARSH s z 1�,� �� t;r _ vVM. M WARWICK B ASSOCIATE HOX BO! — NORTH FALMOLITH Al~- A4444P_0 �c :r1l.'. S,4 CRUSE T T S 02556