HomeMy WebLinkAbout0086 ORR'S AVENUE - Health 86 ORR'S AVENUE
Hyannis
A = 291'
IV t,//
No. C* _Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
Q PUBLIC HEALTH DIVIS40N - TOWN OF BARNSTABLE, MASSACHUSETTS
(� 01ppliLation for Disposal *pstpm Construttiun per mil it
Application for a Permit to Construct( ) e ( ) Upgrade.( ) Abandon( ) ❑Complete System `individual Components
Location Address or Lot No.94 or fs r Owner'Name,Address,/Iand Tel.No. rG�yJ(,•�y(�
Assessor's Map/Parcel �A M 1 rK/� �(,GrvSAa
Installer's Name,Address,and Te.No. 7A lo Designer's Name,Address,and Tel.No.
K, /-4.A C'1,ts f f at 1,� JG 13ox
S Yivro ne4 S�.tI«}sc. el"�,ph«,,,i,
Type of Building: G
Dwelling No.of Bedrooms ��/cc Lot Size J S, IN. (o sq.ft. Garbage Grinder( )
Other Type of Building rued--Ad No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.requ.red) 1 gpd Design flow provided .3 S� gpd
Plan Date 1 I Number of sheets A Revision Date
Title
Size of Septic Tank e�, �4:,, /OX G"� Type of S.A.S. Y S� G 4
Description of Soil �• s �
Nature of Repairs or Alterations(Answer when applicable) Ab"Alle X rYfw► Q.S, "..s' r
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.
40 Date �610!
Application Approved by PVLVOff� Date
Application Disapproved by , Date
for the following reasons
Permit No. Date Issued
4111) y
,No. 1 ! i -�. � ✓ Fee /(V,
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISkO. -N-.TOWN OF BARNSTABLE, MASSACHUSETTS Yes
t 2pphcatlon for ]Disposal 6pstPm Construction Permit
Application for a Permit to Construct( ) ep r( ) Upgrade.( ) Abandon( ) [:]Complete System N4ndividual Components
' e
Location Address or Lot No.5'/ Q r✓S JQ� Owner's Name,Addre/ss,-and Tel.No.
GU-7�(�•�y(
~�... Assessor's Map/Parcel '1 �G CG
Installer's Name,Address,and Tel.No. �G 13GY Tat(o Designer's Name,Address,and Tel.No.
yGVr4&j4
Type of Building:
Dwelling No.of Bedrooms T k,([c Lot Size S, I ��• (o sq.fr. Garbage Grinder( )
Other Type of Building f ,s('ek^Ati) No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 gpd Design flow provided 3 Sd gpd
Plan Date 1 ) Number of sheets Revision Date
r
Title
Size of Septic Tank nj /060 A) Type of S.A.S. u fiZ
Description of Soil �c
•
Nature of Repairs or Alterations(Answer when applicable) G l_c�l _J I e X+'41n ,4.S. S
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.'fined 4 c Date ol c c3O!
Application,App�ved by d Date
Application Disapproved by Date
for the following reasons _
I Permit No. � Date Issued
------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS'TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
A p
bandoned( )by l�r t, L ti,j c,,,.n S),,0C v�
at u°�o G v��S l�ue has been cons ic ed' acc d
with the provisions of Title 5 and the for Disposal System Construction Permit N . '
Installer A• (t. Designer S,ice�3:r,—
#bedrooms T!,wee Approved design-flow 316 gpd
The issuance of this permit hall of b construed as a guarantee that the system ill functio domes ed.
Date Inspector
---------- U ----— ----------------------------------------------------------- -------------------- ---------------------�--------
�/qN(. � Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-'BARNSTABLE,MASSACHUSETTS
�istJOsat �pstem �DYCstrUctiDtt hermit
Permission is hereby granted to Construct( ) n epai ) rode( ) Abandon( )
System located at G r v 5 A`'e VA
Up
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 mus be co et within three years of the date of this permit.
Date Approved by 7 P% 7
Town of Barnstable.
�•++ Regulatory Services
Thomas F. Geiler,Director
s a
MAW
Public Health Division
•��� Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 -.- Fax: 50/-790-6304
Date: �17 S�� Sewage Permit# c?Gl9-OSO Assessor's Map/Parcel r"
Installer& Desitner•Certifieation Form
Designer: ��TS�C �i✓�i��aitiL Installer: g I�C,,- 404d C0,1S a t1l
Address: �� a ��3 Address: eo
On O' 16& gp;t<« La")d was issued a permit to install a
(date)' (installer)
septic system at ��K s/'" "� '"'f�"'�iS . based on a design drawn by
(address) _
�r�✓v�-Jfc,L [ .vG,e/�,2,�L dated VW 2U ZO/
/ (designer)
y 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 inspected and the soils
were found satisfactory.
;,;of
°A 7ERENC y�s�
(Installer' ure HHT'ES v'
No. 0,799�
_...,._
ems.-.�•` "-'Z�... L9,iTF'Pa
(Designers Sign e) (Affix 1Wii�"r' Stamp Here)
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.
gAoffice formsWesignercertification form.doc
SWEET'SER LNGI11FEE12I1\TG
203 SETUCKET.ROAD_P.O. BOX 713—SOUTH DENNIS-MASSAGHUSETTS 02660
TEL(508)385=6900 Y EMAIL sweetsereng(O'aol.com `FAX(508)385=6991
LAND SURVEYING:=ENGINEERING�i,TITLE.5 SEPTIC SYSTEMS
SEPTIC DESIGN PROPOSAL PAGE 2
PROPERTY INFORMATION AND FLOOR.PLAN SKETCH
Please fill out this form,including the floor plan.sketch,and return to us with the signed proposal and retainer.
This information is necessary to properly prepare your Septic System Design.
If you are planning an addit►on,we require a-set of plans including a foundation plan
V/ Total#of Rooms Year Round Home Seasonal Home r Owner OccupiedR.ental
#Bedrooms Family Room/Den Living Room Dining Room ,1--#Bathrooms
Washer/Dryer _Dishwasher Garbage Disposal Gas Service Town Water
In-ground Electric Wires*. In=Ground Oil Tank* zin-ground Sprinkler* y In=ground Gas Pipes*
*Please note on sketch where.located: Sweetser Engineering assumes.n0 responsibility if in-ground components are
damaged during Soil Testings,Itispec.tions,Locations of and/or Installation of New Septic System.
Cellar: Full Partial(Graw1) Siab
Wells: Main Use In igation Only (please-provide location of all wells)
PLEASE USE THE SPACE BELOW AND THE BACK OF THIS SHEET TO PROVIDE]US WITH.A ROUGH SKETCH O.F
THE EXISTING FLOOR PLAN(ALL FLOORS). Also include any items that.should be avoided,IF FEASIBLE;i.e.shrubs,
trees,patios,electric lines,tanks efe:
oonc 4� C�kvn
STzEe't'
//�j TOWN OF BARNSTABLE
LOCATION Q�h .r�I(I Z. ;;6/10 'SEWAGE#__ ��� a`y 0
VILLAGE #/ oo4l ASSESSOR'S MAP 4i LOT
INSTALLER' NAME&PHONB-NO._ -A & B CM, 775-6264
SEPTIC TANK CAPACITY
a LEACHING FACILITYAm..)
QNO.OF BEDROOMS PRIVATE WELL OR�PIIBLIC WATBR�
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: If
VARIANCE GRANTED: Yes No
g-G -Sb
6-F- S 7
A-�
eo
d � .
f
Town of Barnstable P# l 5 g1;8(n
Department of Inspectional Services
t Public Health Division Date
_-
raA� 200 Main Street,Hyamis MA 02601
Office: 5088-86J24644
Date Scheduled Time / ! Fee Pd. bD 0C)
Soil Suitability Assessment for=pge sposal -
"Performed By: Witnessed By:
-LOCATION&GENERAL INFORMATION
Ucr'
8�
Location Address Owner's Name o22S � pU�1 ��tf'BrtL
V I SJ Ile 14 Address CpG s�/2�s 4 vrAM—
Kd.¢ •l�f
I Assessor's Mab/ParceL Engineer's Name- 'VA,,
�,�f�,p-r W o;! 1
II
Engineer's Email:
NEW CONSTRUCTION REPAIR Telephone k
Land Use ����a x/ �p stopes(%) �7--76
`/ Surface Stones
Distances fmm: Open Water Body ft Possible Wet Area R Drinking Water Well (t
Drainage Way /✓ ft Properly Line ft Other It
SKETCH:(street nine,dimensions of lot,exact locations of est holes&pere tests,locatewetlands in proximity to holes)
U
Parent material(geologic) / •� Depth to Bedrock
Depth to Groundwater:Standing Water in Hole: `O J Weeping from Pit Face All
Estimated Seasonal High Groundwater �D
DETERM94ATION FOR SEASONAL HIGH WATER TABLE .
Method Used
Depth Observed standing in obs.hole- in. Depth to soil mottles. in.
Depth to weeping ftom side of obs.hole: in. Groundwater Adjustment It.
Index Well I ReadingDate: Index Well level Adj.factor Adj.Groundwater Level
PERCOLATION TEST Date Time
Observation
Hole B Time at 9"
Depth of Pero Time at 6". "
Start Pre-soak Time® Time(9"-6)
End Pre-soak
Rate MinAnch G
Site Suitability Assessment Site Passed Site Failed: Additional Testing Needed(YRN)
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
Barnstable Conservation Division at least one(1)week prior to beginning.
QWpplication FonrdPERCFORM 2018.doc
s
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surfwc(in.) (USDA) (Munsell) Mottling (Structure,Stones,Bouldcr
vel
Z5�/26 c '11 f 2sy
DEEP OBSERVATION HOLE LOG Hole# 2--
Depth from Soil Horizon Soil Texture Soil Color Soif Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulder
ve
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (M-11) Mottling (Str
ucture,Stone;Bouldea.
o sisw cy%Graven
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other -
Surface(in) (USDA) (Munsdo Mouliog (Strucwe,Stones,Bouldets.
Consistency.%Orwell
Flood Insurance Rate Mao:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yes_
Within 100 year good boundary No Yes
Denth of Naturally Occurring Pervious Material
Does at least four feet of n occurring i s materid exist in all areas observed throw out the area
naturally umng Pgy'oft gh -,..,•:
proposed for the soil absorption system?_� L
If not,what is the depth of naturally occurring pervious material?
Certification / �J
I certify ` /that on (date)I have passed the soil evaluator examination approved by the Department of
Environmental Protection and that the above analysis . performed by me consistent with the required training,
expertise and a ce d/b in 3I0 C 1 / f
Signature (.✓ Date
QAApplicadon FormAPERCFORM 2018.doc
ru
�CID _ EU S
ep Certified Mail Fee
Extra Services&Fees(check box,add tee as ap'pidpnate)
❑Return Receipt(hardcopy) $ krd f t
O ❑Return.Receipt(electronic) $ n P mark
C3 []Certified Mail Restricted Delivery $ �•-� �0,9 r MOfe
O []Adult Signature Required $ k,<'�
[]Adult Signature Restricted Delivery$ \
p Postage
�m $a Total Postage and Fees CAMPBELL, DONALD S
$
V•1 Sent To -39 MICAH HAMLIN ROAD
179 i CENTERVILLE, MA 02632
Sfieei andApt No.,or lid.............
Box'j
M1
City,State,ZIP+4® [ T '
:.. r r r rrr•r
jp�rtified Mail service provides the following benefits:
rtieipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
unique identifier for your mailpiece. associate for assistance.To receive a duplicate
■Electronic verification of delivery or attempted return receipt for no additional fee,present this
delivery. USPS®-postmarked Certified Mail receipt to the
•A record of delivery(including the recipient's retail associate.
signature)that is retained by the Postal Service— Restricted delivery service,which provides
for a specified period. delivery to the addressee specified by name,or
to the addressee's authorized agent.
Important Reminders. Adult signature service,which requires the
■You may purchase Certified Mail service with signee to be at least 21 years of age(not
First-Class Mail®,First-Class Package Service®, available at retail).
or Priority Mail®service. Adult signature restricted delivery service,which
■Certified Mail service is notavatlable for requires the signee to be at least 21 years of age
International mail. and provides delivery to the addressee specified
■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent
with Certified Mail service.However,the purchase (not available at retail).
of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is
Insurance coverage automatically included with accepted as legal proof of mailing,it should bear a
certain Priority Mail items. USPS postmark If you would like a postmark on ,
■For an additional fee,and with a proper this Certified Mail receipt,please present your
endorsement on the mailpiece,you may request Certified Mail item at a Post Office-for
the following services: postmarking.If you don't need a postmark on this
-Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion .
of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply
You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.
electronic version.For a hardcopy return receipt,
complete PS Form 3811,Domestic Return
Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records.
Ps Fomt 3800,April 2A75(Revem)PsN.7sao-m-000 e 7
ComplerWAe'rts a- ,and 3. A. Signature
.s P Ir nt n$me and address on the reverse Q�' ❑Agent
so that we can return the card to you. ❑Addressee
y Printed Name) C.Date of Delivery
a Attach this card to the back of the mailpiece, Received b _ �
or on the front if space permits. DiwAld
1. Artie D. Is delivery address ifferent m Item 1? ❑Yes
L19IENTERVILLE,
If YES,enter delivery address below: p NoAMPBELL, DONALD S
,MICAH HAMLIN ROAD `I MA 02632
III1III1I Jill i6iIIIIIIIIII IlJ 1111111111111111111 3.❑Adult
tureeRestrictedDelivery ❑Registered Mce Type 0 Priority Mail ailR®tedl
9590 9402 4116 8092 9359 61 rhrad Mail® livery
Certified Mail Restricted Delivery turn Receipt for
❑Collect on Delivery Merchandise
2. Article Number(Transfer from service labebl 10 Collect on Delivery Restricted Delivery ❑Signature Confirmationrm
--- -r:; .ail ❑Signature Confirmation
7 015 '17 3 0 0 0 01 4968 2064 eil Restricted Delivery Restricted Delivery I
PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
LISPS TRACKING#
First-Class Mail
Postage&Fees Paid
USPS
Permit No.G-10 j
9590 940*2� 4116 8092 9359 61
i
United States Sender:Please print your name,address,and ZIP+4®in this box"
Postal Service
002-D
Town of Barnstable
Health Division
200 Main Street
Hyannis,MA 02601
11113 loll fillilli1/1life
Towne of Barnstable Barnstable
Inspectional Services
IMA 9 MASS $� Public Health Division m
1639.
Arf° �s 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas A.McKean,CHO
FAX: 508-790-6304
CERTIFIED MAIL#7015 1730 0001 4988 2064
January'l8, 2019
CAMPBELL, DONALD S
39 MICAH HAMLIN ROAD
CENTERVILLE, MA 02632
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 86 Orr's Avenue, Hyannis, MA was inspected on
01/05/2019 by Mark Polselli,certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the guidelines
of 1995 TITLE V (310 CMR 15.00) due to the following:
• Discharge or ponding of effluent to the surface of the ground.
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 THE BOARD OF HEALTH
omashWan, R.S., C
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\86 Offs Avenue Hyannis.doc
I
oF�
Town
w of Barnstable
• 3A6N8TABLE. • .
Regulatory Services Department
_- Public Health Division -
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Richard Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 5/11/16
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title,V: 310 CMR 15.000)
An"x"marked in the ❑ is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA
,Discharge or ponding of effluent to the surface of the ground _
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
ONE (1)YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
❑ Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2) YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any"conditionally passed systems (broken cover-,relocation of a pipe,relocation
of a driveway due to H-10 components, etc)
❑ Leaching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline: L
Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
c Commonwealth of Massachusetts a9/^l L7(,
Title 5 Official Inspection Form
�A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i
RE
Property Address t5
Cep',0 le,/l
Owner Owner's Name
information is !/ / �¢ oa 6 0/
required for every
page. CitylTovm State Zip Code Date of In pec 4 n
Inspection results must be subimitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
fmt:When
fillingng out out forms A. inspector Info ation . 51ff f 35*3
on the computer,
use only the tab ll
key to move your Name of Inspector /� _ ���
cursor-do not
�/Ui d
use the return Company Name [`n
key. V 0
Company Address oc .6 6 —
p+S o•V 1 _
City/To �v O / /9 Q State Zip Code
rem _ S / D
Teleph a Number License Number
B. Certification .
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above;the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ❑ Passes
2. ❑ Conditionally Passes
3. ❑ Nee urther Evaluation by the Local Approving Authority
4. FFails
W!nspec1t&snature Date
The system inspector shall submit a copy'of this inspection report to the Approving Authority(Board
.of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP.The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note:This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
?iae 5'YSciai jnspectfon=orn:subsurace Sewage oisposai system•Page'of 18
5insp.doo•rev.7/262018
k0roltd V&7
Commonwealth of Massachusetts
�- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
6 0 A Q
Property Address
CC4
Owner Owner's Name
information is G j4d 1 �
required for every J T
page. City/Town State Zip Code Date of In pecti n
C. Inspection Summary
Inspection Summary: Complete 1, 21 3, or 5 and all of 4 and 6.
1) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in-310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass' section need to be
replaced or repaired.The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes', "no' or"not determined" (Y, N,ND)for the following statements. If"not
determined,' please explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t6inspAoc•rev.7126/2018 Tnle 5 Offiaai m5pec cn Form:suosurace sewage oisposai System.Page 2 of 18
}
c� Commonwealth of Massachusetts
? Title 5 Official Inspection Form
I,} Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address /
Owner Owners Name /) A'4 ��0
information is O /
required for every
page. Cityrfown State Zip Code Date of Ins ectio/
C. Inspection Summary (cunt.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box.System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The
system will pass inspection if(with approval of the Board of Health):
17 broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
ti
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
Title 5 oifidai inspecoon Form:Subsurface Sewage Disposai System-Page 3 of 18
f5insp.doc•rev.7/262018
•
Commonwealth of Massachusetts
- Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address
� qM
Owner Owner's Name
information is ti �1T Q94 Q� f S'
required for every A,a
page. City/Town State Zip Code Date of spe 'on
t
C. Inspection Summary (cant.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if 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, perfonned 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.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No" to each of the following for all inspections:
Yes
❑ ,jiackup 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
Title 5 cri oai!ns?ection Form:Subsurface Sewage Disposal systen•Page a of 18
s t5insp.tloc•rev.725/2018
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
b 2(zs 1-ft
Property Address
Owner Owner's Name
information is A�►✓l .t ///fVV Ad 4 O 7
required for every
page. City/Town State Zip Code Date of In pecti n
C. Inspection Summary (cons.)
4) System Failure Criteria Applicable to All Systems. (cont.)
Yes o
��'than
Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
U uid depth in cesspool is less than 6" below invert or available volume is less
/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:
❑ iy portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ?1"'— 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 water supply
we",
❑ �Any portion of a cesspool-or privy is within 50 feet of a private water supply well.
❑ tom' �Any portion of a,cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this forma
❑ The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ The system fails. i have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails.The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no'to each.of the following, in addition to the
questions in Section C.4.
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
Site 5 offciaj inspection Form!Subsurface Sewage Disposal System Page 5 of 18
t5insp•doc•rev.71262018
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
Property Address
Owner Owner's Name j�J�
information is Q
0001 ,S 1
��
required for every State Zip Code Date of I spa 'on
page. City/Town
C. Inspection Summary (cont.)
f If you have answered"yes'to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed.The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner
should contact the appropriate regional office of the Department.
6. You must indicate "yes" or"no"for each of the following for all inspections:
Yes :;Oe<rmiping
❑ information was provided by the owner, occupant, or Board of Health
❑ ere any of the system components pumped out in the previous two weeks?
❑ he 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 system components, excluding the SAS, located on site?
❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
Existing information. For example, a plan at the Board of Health.
❑ 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)]
Title 5 ot5aat inspection Font Sutsuriace Sewage Disposal system-?age 6 of 1a
t5insp.doc rev.7/26/2018
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments
Property Address
C�
a 6�/
Owner Owner's Name
information is Q�
required for every H D� /
page. CityfTown4 State Zip Code Date of I spe on
D. System Information
.1. Residential Flow Conditions:
Number of bedrooms (design): Number of bedrooms (actual):
�30
DESIGN flow based on 310 CMR 15.203 (for.example: 110 gpd x#of bedrooms):
Description: i 1.
/ADO
I !d�/,`C4�(�✓�
Number of current residents:
Does residence have a garbage grinder? ❑ Yes No
Does residence have a water treatment unit? ❑ Yes No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No
information in this report.)
Laundry system inspected? ❑ Yes [y'"No
Seasonal use? ❑ Yes to
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump?
❑ Yes No
Last date of occupancy: date
?iqe 5 `dai inspection=cm.sucsuiace sewage Dispcsai System•Page 7 of 18
t5insp.doc rev.7125"2018
Commonwealth of Massachusetts
i- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Property Address ^ C4' / // e
Owner Owners Name f ��OQ�
information is
required for every A4
page. City(Town State Zip Code Dat6 o nspe on
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancyluse: -Date
Other(describe below):
3. Pumping Records: /
Source of information:
Was system pumped as.pan.of the inspection? ❑ Yes No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Tine 5 offioai:nspecbon=.?m subsurface Sewage Disposal system•?age 8 of 18
[5insp.GOC•rev.726l2018 - ,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
0 -86 0Q,2s
Property Address
Owner Owners Name
information is
required for every
page. Cityrrown State Zip Code Date of In ect96
D. System lnfor (cont.)
4. Type of S em:
Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
ao�Approximate age of all components: date installed (if known) and sources, of jgformation.-
Q
fr+� [1,70�„/LL— T
Were sewage odors detected when arriving at the site? ❑ Yes L�
5. Building Sewer(locate on site plan):
Depth below grade: feet
Material of constructio�40
❑ cast iron PVC ❑ other(explain): ! 0
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
'.:te 5 0%ciai inspection=0-7r,.sucsur;ace sewage Disposal system•Page 9 of 18
t5insp.doc•rev.7/2 612 0 1 8
lt
Commonwealth of Massachusetts
z Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address
Owner Owner's Name / /�
information is Q���f MC7�bQ / /`
required for every J _
page. City/Town State Zip Code Date of IrApectit
D. System Information (cons.)
6. Septic Tank(locate on site plan):
Depth below grade: feet
Materi construction:
concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
is age confirmed by a Certificate of Compliance? (attach a copy of certificate ❑ Yes ❑ No
Dimensions:
Sludge depth: IL —
Distance from top of sludge to bottom of outlet tee or baffle /
Scum thickness el
Distance.from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle r '
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
?me 5 officai inspection ortn:suosurface sewage oisposai system-?age 50 of 18
t5insp.doc-rev.726/2018
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�J Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property.Address 6,,rt r47 / //
Owner Owners Name /W ,+ Q.o1 60 / 7 1 9
information is A��l s �/�- l
required for every State Zip Code Date of Ins ction
page City(rown
D. System Information (cost.)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑`metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions: _
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
I g. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑
metal ❑fiberglass ❑ polyethylene , ❑other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
we 5 C'f�aa'.Inspecuon Pon:subsuaace sewage Dispcsai system•Page t t of 18
t5insp.doc•rev.7/26/2015
Commonwealth of Massachusetts
- , Title 5 Official Inspection. Form
1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address
Owner Owner's Name
information is � S
required for every 0d60
page. Cityrrown State Zip Code Date of Insp ton
D. System nformation (cons.)
8. Tight or Holding Tank (cont.)
Alarm present: ❑ Yes ❑ No
Alarm level Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.).-
i
Attach copy of current pumping contract(required). is copy attached? ❑ Yes ❑ No
9. Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
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.):
SoI cS
7;,ie 5 Ofiaal:nspruon For.Suosudace Sewage Disposal system•?age 12 of 18
t5insp.00c•rev.7t262018
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
96
Property Address �
Owner Owner's Name / `'
.- Q 6 D/ /
information is �/� �
required for every
page. City/Town State Zip Code Date of In ecti n
D. System Information (cont.).
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No'
Alarms in working order: ❑ Yes ❑ No`
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
1
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
leaching pits / number
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number; dimensions:
I I overflow cesspool number:
❑ innovativeialtemative system
Type/name of technology:
we 5 pffiaal:;nspeczdon Form,:Suos.rtac sewage Disposal system•Page 13 of 18
tsinsp.doc•rev.7/262018
I
c� Commonwealth of Massachusetts
Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�o S live
Property Address 01 L
Owner owner's Name �7C/
information is A��i5' vow Q
required for every
page. CitYlToKm State Zip Code Date of In ecti
D. System Information (cost.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
✓r�9 0 a /14t/-8/�-
a w
h ssf n 1J'49c,4,s w f- �ts�
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert 1
Depth of solids layer f
Depth of scum layer
Dimensions of cesspool
Materials of construction
Yes No
Indication of groundwater inflow
❑ ❑
Comments (note condition of soil, signs of hydraulic failure; level of ponding, condition of vegetation,
etc.):
we 5 oai inspection=orrn:Sucsujace sewage DsPosai SYs[em•Page 14 of 18
t5insp.doC•rev.7262018
Commonwealth of Massachusetts
Title- 5 Official Inspection Form
�q Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address /
Owner Ownet's Name
information is a✓�hls ✓
required for every _
,y//•
page. CitylTown state Zip Code Date of I pecti
D. System information (cont.)
13. Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
7iue 5 offioaj mspecuon=om: suosudac sewage Disposal System•?age 15 of 18
t5insp.doc•rev.7/262018
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Properly Address
Owner Owner's Name '/..'ICA,
information is I-A10641S 9
required for every
page. City/Town State Zip Code Date of In pec n
D. System Information (cons.)
14. Sketch Of Sewage Disposal System:
Provide a view-of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the bin Check one of the boxes below:
hand-sketch in the area below
❑ drawing attached separately
i
i
1
l
i000
6--W-m I
141
SO
I
i
I
i
i
`i
l
Title 5 Offiaal inspectlon Form:Suoscrface Sewage Disposal System•Page 16 of 18
t5insp.tloc•rev.7t26/2018
Commonwealth of Massachusetts
P Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address
Owner Owner's Name •
information is
required for every Inv( S 19
page. City(fown ` . State Zip Code Date of Inipecon
D. System Information (cons.)
15. Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: feet
Please indicate all methods used t determine
o d �e ne the high ground waterelevation:
Obtained from system design plans on record
If checked; date of design plan reviewed: Date
❑ served site (abutting property/observation hole within 150 feet of SAS)
Checked with local Bo of Health - explain:
❑ Checked with local excavators; installers - (attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Before filing this`lnspection Report, please see Report Completeness Checklist on next page.
5insp.doc•rev.7252018 -itle 5 079aal MspeGon=or:suosur ace Sewage Disposal System•?age 17 of i8
t
Commonwealth of Massachusetts
Title 5 Official Inspection Form
V Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
-
Q—
Property Address � 7
Owner Owners Name
information is
required for every f
it 770= State
page. C Zip Code 4ofja n
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
A- Inspector Information: Complete all fields in this section.
Certification: Signed & Dated and 1, Z, 3, or 4 checked
C. Inspection Summary:
1, 2,;uZreCriteda)
ompleted as appropriate
4 F and 6 (Checklist)completed
❑ D. System Information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
Title 5 07"Oai inspection For-.SUDsur,%Ce Savage D'sposai system-?age 18 0'18
tsinsp.doc•rev.7126/2018
licinlARK
� TOP OF FOUNDATION 20 FT. MINIMUM FROM C SOIL TEST
'CELLAR OR CRAWL SPADE �-- �1-`�
i 10 rT. MINIMUM FROM SLAB DATE OF SOIL TEST JAN ARY 8 2019
I I ELEV. 100.00 10 FT. MINIMUM �L SOIL TEST DONE BY SWEATS R ENGINEERING p .
(ASSUMED) - I CONCRETE EAN SAND WITNESSED BY _�� �RA
l COVERS 7INSPECT.`QN PORT ._-___--
i t 4" kHEOULE 40 PVC PIPE 1. LOAM AND SEED g
T MIN. PITCH 1/8" PER FT. \ 1 2" LAYER OF OBSERYA'nO '# HOLE 1 ELEV,=--98.5-
?/8" TO 1/2" PERCOLATION RATE - < _2MIN./INCH _ _
.AT 4 INCHES
WASHED STONE
4" p 59.08 MAX. \ \\ OR F L' 'R FABRIC' , yENT �JEP i HOR'Z 1 TEXTURE -- COLOR --- I MO"". OTiE2 -- --
3.0 t CAS, IRON PIE 1 _ 98.E
I (OR EQUAL) MINIMUM ___ 1 _ NCT REQUIRED l0 B tAp LOAMY SAND 10YR4/1 INO ROUTS
I PITCH 1/4" PER F? I FLOW I ' TEE I I -z !8-29" 18 LOAMY SAND 110YR6/8 ;ROUTS
LEVELERS 1
29-126 iC !MEDIUM SAND !2.5Y7,/4 !
FLOW LINE10. NO W'ATFR ENCOU'vTERED AT 26. E'�. _ 88.0
ELEV.
ELEV
' I ELEV. - Q5.90 22 a" ° ° °° o + ... /�filC3rt�I iC�L. 2 ELEV.=-
JJ I - -� LEvEL - I ° ° ❑ ❑ ❑ ❑ ❑ co ❑ ❑ ❑ ❑ Ia �M 98.6
I J ELEV. _ _K07_ ADD GAS I ELEV 9�_70 6' SUMP ELEV. - _95.53_ °
BAFFLE tt I p n� t b°° °°f O ❑ G a✓ O ❑ ❑ ❑ ❑ ❑ G' o j' �o i DE�'`H FiORIZ TEXTURE COLOR MCTT. 10THER
TI�wV TIO ° o o� n r o l of i0-8" Ap LOAMY SAND 10YR4/1 NO ,ROOTS
11ELEV ❑ ❑ u ------
QpTD OUTLET� BOX - _ o o° ❑ ❑ ❑ ❑ ❑ ❑ �a ° }° ELEV. �3.30 �8-29" �8 iLO.AMY SAND 10YR6/8 i ROOTS 1
EXISTING T VR 2 500 GALLON GALLEYS WITH �- ;29-120" IC (MEDIUM SAND 2.5Y7 '4 T�
�4 FEET '4 INCHES (EXISTING) 0 BE WATER TESTED
j 5 FEET 19 INCHES ;v� 'F MORE THAN ONE OUTLET STONE IN AN l
i 6 FEE- 24 INCHES 1 VW GALLON I ENCOUNTERED 120" E:
EET 29 lNCI-LS r , T WELL NO WATER Eh.,OUh.�ER�D A' __-._-- REV.
a FEET 34 INCHES '�EQTItr TANK (TO BE PLACED ON FIRM BASE) 13 X 25 X 2' TRENCH FORMA:ION � ,�30 WELL N A
i - ZONE
3/4" TO 1 1/2" CLEAN EX
i I DOUBLE WASHED STONE SAIL ABSORPTION 10 ND
, 'ADJUST N ESiGN CALF!JLA'nONS
FREE OF FINES & SILT SYSTEM SAS I ` NUMBER OF BEDROOMS _ 3 _
} GARBAGE DSPO�S
USGS PROBABLE WATER TABLE ELEV. _ AL UNIT
i SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / / } ELEV. _ TOTAL ESTiMA"=D FLOW
NOT TO SCALE BOTTOM OF TEST HOLE ELEV. _ ( 110 GAL/9R./DAY X 3_ BR.) _ Q_ GAL./DAY
REQUIRED SEPTIC TANK CAPACITY GAL.
i ACTUAL SIZE OF SEPTIC TANK 1000 GAL.
SOIL CLASSIFICATION
DESIGN PERCOLATION RATE <_„'� MIN./IN.
EFFLUENT LOADING RATE .0,.7.4_.. GAL./DAY/S.F.
LEACHING AREA 477_OQ SO. FT.
(13X25)+(38X2X2)
-EACHING CAPA.C!TY (AREA X RATE) .M2.91 GAL./DAY
477.00 X 0.74
RESERVE LEACHING CAPACITY PlQW_ GAL./DAY
NOTES:
ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P.
TITLE 5 AND THE TOWN'S RULES AND REGULATIONS FOR
THE SUBSURFACE DISPOSAL OF SEWAGE.
2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO
105.06 yd r WITHIN 6" OF FINISHED GRADE.
3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN
10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE
9S R fF USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS.
,Y 4. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE S-
-&E WOR T AREC, "LACE. -
r 1 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITti
I SOILLOT 10 DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO
TE5T ' .EST 2 OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHOR!?Y.
I� 00 15, 174,6 t S.F. "t 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR
�' iS TO CALL "DIG-SAFE" AT 1-868-34.4-7233 AT LEAST 72 HOURS
PRIOR TO COMMENCING WORK ON •SITE
7. CONTRACTOR IS TIC VERIFY GRADES AND ELEVATIONS AS WELL AS
98.6 I SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION
IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER
�y D.
98.4 ! iMMEDIATELY. •
BOX 8. PARCEL IS IN FLOOD ZONE X_
9. LOT IS SHOWN ON ASSESSORS MAP 291 - AS PARCEL _ 196 _ I
10. EXISTING LEACH PIT IS TO BE PUMPED AND REMOVED ALONG WITH
11. THE I ST LLER SiSOI TO GIVE UH E ENGINEER A MINIMUM OF 48 HOURS
(2 WORKING DAYS) NOTICE FOR THE FINAL INSPECTION (NUMBER BELOW) `
IIn
99.0
99.0 99.0 tCa 98.6
APPROVE, EALTH
9.3
H97
99p a DATE AGENT
99.2 " _.+
.. .......�M.,,.,�.
9 9�.2 -�- HYANNIS, MAC PROPOSED SEPTI DESL%j 1
98.9 98.9` FOR< LOCUS ,1,./Vj.�,� 1 �.SB�JrL.iL
99.0 98.7 ¢ A8 ft : v' .. .--
. 4 86 0RRS AVER, T 10
MI7CHELL S- HYANNIS, MASS. I
98.3 � !
7.7 P"Q6 y� > NOR 203 SETUCKET RCAD
�0 �FN 385�690 SOUTH OD 8N°NIS71MASS.
,� 0 0266C
`, DN 00103q1 �I
l , _ 1
0
S v r y `'0!v .0 Y AJO 3 ���c� ly r`�\% C DATE A 28, 2019
SC ALE 2 0,
GNALSOUTH
REv.
OUTH STREET - � �oB N0' 8147-00
,.�. 0 LOCATION MAP REv _- -- -� 1 SHEET 1 OF 1
C. �SB\PROJ�8147-DO�dwq�8147-SA5.DWG C2019 SWEETSER ENGINEERING(