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HomeMy WebLinkAbout0062 QUISSET ROAD - Health i 62 Quisset Rosa y _ Hyannis a A=250-130 I a e o Commonwealth of Massachusetts c90 -430 r Title 5.•official h8pection Form Subsurface Sewage Disposal System Form - Not for Voluntary_Assessments \;e 62 Q u isset rd -- ------------------- - Property Address Eric Wallin Owner Owner's Name — information is required for every Cente llle -- , _ _ — - Ma 02632` 6/17/15 - - - page. City own State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the forma Important:When ----- -••- filling out forms A. General l.nfor'rnatlon on the computer, q use only the tab. 1. Inspector: key to move your cursor-do not Michael DiBuono _ use the return key. Name of Inspector ------------ ----— --_-- _DiBuonoSewerand-Drain ' _ iir_ f:' ; ea :. Company Name 8 Johns path t Company Address -- ��� S Yarmouth MA _ 02664 _ City/Town State Zip Code 508-364-9587 —_ S113522 , `Telephone Number License Number B. Certification 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 le Local Approving Authority 6/17/15 - nspector'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 design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \A 62 Quisset rd Property Address Eric Wallin Owner Owner's Name information is required for every Centerville Ma 02632 6/17/15 page. City/Town State Zip Code Date of Inspection Be Certification (cont.) Inspection Summary: Check A,B,C,D or E/ always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system contains a 1000 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The Distribution box is level and at normal level. The leaching is made up of several leaching chambers and at time of inspection levels°appeared to never have been at abnormal levels. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for".yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts _ Title 5 Official Inspection For Subsurface Sewage Disposal System Form -_Not for Voluntary Assessments �M 62 Quisset rd' Property Address Eric Wallin Owner Owner's Name -- information is required for every Centerville _ Mb 02632 6/17/15 _ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 62 Quisset rd Property Address — Eric Wallin Owner Owner's Name information is required for every Centerville Ma 02632 6/17/15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface 'vvater supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *` This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 f Commonwealth of Massachusetts u Title 5 Official Inspection Form 9 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 62 Quisset rd Property Address Eric Wallin Owner Owner's Name information is required for every Centerville _ NYa 02632 6/17/15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) , Yes No ® Required pumping more than 4 times in the last year NOT du,e.to..clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool_or privy is within 100 feet of a surface water supply or tributary'to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private,water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 9p d. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts _ W Title 5 Official , Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 62 Quisset rd Property Address Eric Wallin Owner Owner's Name information is required for every Centerville Ma 02632 6/17/15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: .Yes No.. ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ 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, 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)] D. System lnfOPn'la$1011 Residential Flow Conditions: Number of bedrooms 3 (design): Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Rl Subsurface Sewage Disposal System.Form - Not for Voluntary Assessments 62 Quisset rd Property Address Eric Wallin Owner Owner's Name information is required for every Centerville Ma 02632 6/17/15 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system contains a 1000 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The Distribution box is level and at normal level. The leaching is made up cf several leaching chambers and at time of inspection levels appeared to never have been at abnormal levels Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d gpd 118 _ 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No 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/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 .Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments s e�, 62 Quisset rd Property Address Eric Wallin Owner Owner's Name information is required for every Centerville "' Ma 02632 6/17/15 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from ) and a owner system co of latest Y PY inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ ' Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 62 Quisset rd w Property Address ----- — Eric Wallin Owner Owner's Name information is required for every Centerville Ma 02632 6/17/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System was upgraded in 2005 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer (locate on site plan): Depth below grade: 18" feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented throuqht the roof. Septic Tank (locate on site plan): Depth below grade: 1 ft feet - Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain) 1000 gallon I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gallon Sludge depth: 3" l5ins•3113 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 9 of 17 Commonwealth of Massachusetts WTitle 5 Official Inspecti®n Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 62 Quisset rd Property Address Eric Wallin Owner Owner's Name information is required for every Centerville Ma 02632 6/17/15 page. &Ity/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom,of outlet tee or baffle 24 Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42 Distance from bottom of scum to bottom of outlet tee or baffle 1° Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was pumped in 2012. Grease Trap (locate on site plan): Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date - t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4�M 62 Quisset rd Property Address Eric Wallin Owner Owner's Name information is required for every Centerville Ma 02632 6/17/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees are in place and levels are normal Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day - Alarm present: ❑ Yes ❑ No Alarm level: — Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 62 Quisset rd Property Address Eric Wallin Owner Owner's Name information is required for every Centerville Ma 02632` 6/17/15 page. City/Town State Zip Code Date of Inspection_ D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert At normal level Comments (note if box is level and distribution to outlets equal, any evidence of solids ca:7yover, any evidence of leakage into or out of box, etc.): Distribution Box is level and at normal level with no signs of carry over or decay. 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t51ns•3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 12 of 17 y. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 62 Quisset rd Property Address Eric Wallin Owner Owner's Name information is required for every Centerville-, Ma 02632 6/17/15 page. CltyrFown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number, — ® leaching chambers number: 3 ❑ 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.): No signs of carry over and no signs of hydraulic failure 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal Sys•em•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 62 Quisset rd Property Address — Eric Wallin Owner Owner's Name information is required for every Centerville _ Ma 02632' 6T17715' page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No signs of ponding or hydraulic failure. 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.): 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection For VA Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 62 Quisset rd Property Address Eric Wallin Owner Owner's Name information is required for every Centerville _ 02632 6/17/1"5 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17. Location . 62 Ou ' sset Road V 4. 11ae - C'enterv ' Septic—_P e 1000 Gallon Se Tanis Owner Erik Wallin PUMPING HISTORY 5/21/12 1000 Gals �.J t�. I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 62 Quisset rd Property Address Eric Wallin Owner Owner's Name information is required for every Centerville Ma' 0.Z632'' 6/17/15 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 18+ ft 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: usgs map You must describe how you established the high ground water elevation: According to usgs maps system is approximately 20+ ft above nearest water venue Weguakett lake. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 .Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 62 Quisset rd Property Address --- - Eric Wallin Owner Owner's Name information is required for every Centervi4le - - Ma— 02632"" 6/17/15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑. Insp.ectio.n.,Su.mmary D..(System-Failure Criteria.Applicable-to All Systems)"comp ietea' ❑ System Information — Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.-Page 17 of 17 3 TOWN OF BARNSTABLE LOCATION VaZ U t�SS 1�o �� SEWAGE VAGE �Z y ASSESSOR'S MAP & LOT ' -1 0 II,L 1 INSTALLER'S NAME&PHONE SEPTIC TANK CAPACITY J'x !s` 7 —2 - e . LEACHLNG FACILITY: (type �� NO.OF BEDROOMS _ BUILDER OR OWNER rn t /q � Q T)" PERMTTDATE: a D COMPLIANCE DATE: v Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200.feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Fe--t Furnished by f 1 ®d 90 e � - LA ..L sa b Ll\r Q� Ql vqL ,. l�� w No. Fee d U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Migoal *p6tem Cunotruction Permit Application for a Permit to Construct( )Repair(/Upgrade( )Abandon( ) EJ Complete System Individual Components Location Addrgss or Lot,No. J�}^ \n/ / Ts Owner's Name,Address and Tel.No. Vl'G/ (�G.� �(/, L� T .✓J X'//7 1.61Z 7- Assessor's Map/Parcel 9—/ d Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. EY� Az_ ?36 _ Type of Building: Dwelling No.of Bedrooms_ Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow e714 gallons per day. Calculated daily flow 13 C3 gallons. Plan Date —2- 0 Number of sheets Revision Date Title Size of Septic Tank /oar A xe s r e✓; Type of S.A.S.0) 3® J_0 41' Description of Soil a Nature of Repairs or Alterations(Answer icabl Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu this bf H Signe A Date i e-S Application Approved t Date a. Us Application Disapproved for the following reasons Permit No. D-UO,-- Date Issued sc No. �0 c � � tads " Fee ()(� Entered in computer: THE COMMONWEALTH OF,MASSACHUSETTS p Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Z 5paar *p!5tem CConearuction 3permit Application for a Permit to Construct( )Repair( ;4upgrade( )Abandon( ) ❑Complete System )&dividual Components i Location Address or Lot-No. n / Owner's Name,Address and Tel.No. 0a,! el .S 5 E 9 r/ Ct •ss r! 'vi 1Y° 7 .- , e T Assessor's Map/Parcel 9_ 1 U�1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 2 S0F s 13 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( � Other • Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow e-,,-` gallons per day. Calculat4daily flow CC gallons. Plan Date 7 � ::2. J Number of sheets Revision Date Title Size of Septic Tank a,:-51 o e 4"s )r e s Type of S.A.S.t 3 3 Description of Soil Nature of Repairs or Alterations(Answer when-app icable r G / Date last inspected: i Agreement: € The undersigned agrees to ensure the construction and`maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue• this Board of Health. ` 5, Signed r Date ; }Application pp -A' rjw a ' = ,r s '- - Date --- Application Disapproved for the following reasons Permit No. a oo Date Issued a 'S • ,� -i---------'-.---------------- ------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired( Upgraded( ) Abandoned( )by �,9 /L.e- /-/ G a dL '3 at 02 9'"5-,v C� _ has been construe ed)n accordance with the provisions of Title 5 and the for Disposal System Construction Perm``i��t No. �j }7S dated � I o Installer 4 2 is C.,...s Designer P,4 R. h a/ /I1 C- Y r The issuance of this permit shalL ot-be construed as a guarantee that the system w 11` nc t n s designed. Date Ur� Inspector — -- — 37f --------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS &!6po$ar *pgtem CCongtruction permit Permission is hereby granted to Construct( P)Repair( U ngrade( ).Abandon( ) r System located at d 0 v/ s s : and as described in the above Application for Disposal System Construction Permit. The-applicant recognizes his/her duty to comply with Title 5 and the following'local provisions or special conditions. t� Provided:Constructio mu t be completed within three years of the date of th e i t! Date: 2 f1G Approved by r 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only . PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, bii ` hereby certify that the engineered plan signed by me dated 2Z .0 5 ,concerning the property located at �p f V) ss eT yoplc-p meets . all .of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with.the dwelling. • The.soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: . r� c� A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation 3 3 +adjustment for high G.W. = a A b 6 K) 7 D ENCE BETWEEN A and A/r 7,0 1 -� T5 o s SIGNE DATE:D: NOTICE Based upon the above information;a repair permit will be issued for 3 bedrooms maximum_ No additional bedrooms are authorized in the future without engineered septic system Plans. , 1 f qAS-epdc\percexemp.doc Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS:�20�/' a Pyilb,-al j BUSINESS LOCATION: /0 diz/�5&E MAILING ADDRESS: �i�1T�1�. ���iTb"-7ty/GL&- Mail To: TELEPHONE NUMBER: 5 DAP- Board of Health Town of Barnstable CONTACT PERSON: P.O. Box 534 z EMERGENCY CONTACT TELEPHONE NUMBER: `0(P _"3 V3- Hyannis, MA 02601 TYPE OF BUSINESS: 6 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS k The Board of Health has determined that the following products exhibit toxic or hazardous character- I istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. # Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants I Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels 1 G Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers EL/6�G �Gsp WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS i Town of Barnstable Regulatory Services Thomas F. Geiler,Director sw�uvsTnsre. • 9�a ' Public Health Division rFoa Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-8624644 Fax: 508-790-6304 Installer & Designe'r Certification Form Date: SOO Designer:' 1 Installer: Address: P`Q ` 50Y U Address: Sp-r-vio wit# 61537 f i On was issued a permit to install a ( at ) (installer) septic system at &11QUI556'T 4)ko based on a design drawn by (address) _ - - ----- - _ es dated J�1H 22_� (designer) 1--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. 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 lations. Plan revision or certified as-built by designer to follow. \A of VA. s y (� / .DF EN U f f1hi staller's Signature _ 1140 o j `S.gNI7AR�`� (Designer's Signature) (Affix Designer's Stamp) ere) 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:Health/Septic/Designer Certification Form LOCATION QU�Sst`�' R�SEWAGE PERMIT NO. VILLAGE �]� � � ON INSTALLER'S NAME & ADDRESS d U I L 0 E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� sp i 1� j W t� No.EI—Z1 f Fss....��.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH n� P �� ............ L'0.. .............OF......... -3ar.!2.S.X � l"`�I Allp iratinn for Uiiv.aa al Works Tonstrurtiun Vrrmit 130 Application is hereby matlbsk for vPer}nit to Construct (+/j or Repair ( ) an Individual Sewage Disposal System at: / �C ..... ........ .01"...3�r.... _�: �..._.. lr ...e �?1�G1.---.�_'�._!27A:rv�l .:.... a4 Location-A Tess Lot Nq. --I_..... ......... ..... - Owner // � > Address ,Wj ! ..�P_. .tl---------••••......-• fY_. l�CS....�-f-•�•.....---••-----------••.................. M Installer Address VType of Building Size Lot.Z�._ 1s ...._S . feet Dwelling—No. of Bedrooms.................3......................Expansion Attic ( ) Garbage Grind Other—T e of Building No. of persons............................ Showers — Cafeteria a —Type g P �.�`) ) dOther fixtures -------------------------------•----------------•.....--------------•-------•--•----------------........�-},-................................ W Design Flow........................._....._._....gallons per person per day. Total daily flow------_...........� .... Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........./.......... Diameter... Depth below inlet...5.._®.':_. Total leaching area.Zd �1'sq. ft. Z Other Distribution box Dosing tank ( ) `-' Percolation Test Results Performed by._/3r'v .. 1 ... !!LtY Date._....��/jr�................ P/94.7 Test Pit No. 1------ _'2:---minutes per inch Depth of Test Pit-----/L.'..__.. Depth to ground water...�lt,eT.�.__. frq Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ................................-....................................................................................................... ...r O Description of Soil....................... .Z Z.f- ..�311�z.�at�y U •-----------------•---•-•--------------...---•---------------------•-•---•----------------------------...----••-- ------•-----------------------!5 k-`-Z------G rca !l .............. UNature 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 ITL 5 of the State Sanitary Code—The u dersigned further agrees not to place the system in operation until a Certificate of Compliance has iss e y e of health. gn ---------------•- .................... -------- --------- ApplicationApproved By-------- _.�1 .••-•-• ----•-------------•--------•...••----••-••-.................---------•-- ---4 . ......--•--•--- Date Application Disapproved for th following reasons:---------------•-----------•----•----------------------•--------------------------•-•-•---•--••--•••----......_ --------------------•--------•------------------....---------•------------....-------------------••------•-----------------•----•----••-•-----•--------•-•---------•--•-•---•---•-••--------------...... Date PermitNo......................................................... Issued....................................................... Date N3.._ ..'.�1�. .1.. F�sl . .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF. �. .� _._. ............. `�........................ Appliration for Diipooal Works Tonotrurtion rrrutft Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at ........... ........ ---' Location-Address or Lot No. _____________________r'^�_.. '/"l' / • ` ...............//J '�..F'-/ ,G�r-_^__ "., . /i—: . Owner ' # Address / Installer Address CA 7L d Type of Building � Size Lot__�•_".:__!____�......._. eet Dwelling—No. of Bedrooms___________________..__.._...__..____._.._._Expansion Attic ( ) Garbage Grin `k Other—Type T e of Building No. of ersons____________________________ Showers Q, yP g P ( ) — Cafeteria ) Q'I Other fixtures ................................................... Design Flow..................... _ ___________.__..gallons per person per day. Total daily flow_____.._.______._*"-*.«______._......__gallons. 9 Septic Tank—Liquid capacityMl�P.gallons Length.__=.��j:__ Width................ Diameter................ Depth................ Disposal Trench—No_____________________ Width.................... Total Length..........__.__.:... Total leaching area....................sq. ft. Seepage Pit No________ __________ Diameter... Depth below inlet___.6_'� . _. Total leaching 3sq. ft. Z Other Distribution box ( +f) Dosing tank Percolation Test Results Performed by--- ....... ' . ..............•j..... .......................... Date____. +j:_/:` ............:... ,aa P!,%4•7 Test Pit No. 1_._.=_ ___minutes per inch Depth of Test Pit..... Z=....._... Depth to ground water...........A_,-__. (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4x •---•---------------•---------•-______j____ n :_I_------�--,•-__.....____:�-i--•--�---�-" "� ........................................................- D Description of Soil______________________�.: Zc: ._ -•-------t----------------------------------- r fr . ! V .___________________________________________________________________________________________________________________________________________________� .. ..... I W ---"....................•-------------•---•----"-------------•--•-"""---.-.--._._.._--.----_----...---"--------....._.-._..----....----•------•-••-""---.--.-----...---•----.____.____---..........__. U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ -------""-----------------------""--"-"-"-""-""-"-"""----"----"._......_.."-"""""-""-""-"-"----------------___....-----___---•----_---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT y g g p y S of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of health. lgf d............__........................................................................ / ' 6� el, � Application Approved By_______________r __"``.__r_.__._______. Date Application Disapproved f o t e following reasons:_...""-------"---"---"---"--""""--•""-"---------•-----"--"-"-""-------------"--"------------__.______________.^ ....................••-------______-•--_...__________-------------------------------....____________...._-----____--------------___-----___--------------------•-------___--•------------____________--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF......................................................... .......................... C9rdifiratr of ffoutpliFanrit TH 0 CERTIFY, That the Individual Sewage Disposal System constructed `�) or Repaired ,: ) by......r -- ---- __..._...--" _______________••--- . / Installer at: " ---------- has been installed in accordance with the provisions of TI ` The State Sanitar o ascribed in the Y f.� P f Y application for Disposal Works Construction Permit No________________________________________ dated.........................._._._.___..______.____ THE ISSU CE O THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT THE SYSTEheI FUN N SATISFACTORY. DATE.... -• " - ""-"-•"":........................•______ Inspector__... _._._ ......._..__.._._._.._________---------__-_______--------____.....--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH NO. �..................rl� ..........................................OF...........:-.-........._.__...-........_....._...._.._..._.. _: ,�0 FEE ..................... �io�osul orko �ono�rion rr # � ` Permission rris hereby granted.....*0110................................................................. ................................................ to Construct (f ) or Repair ( } an Individual S ,age Disposal System at No.---------- -________._ ...___.*;t ' -- -------- ----- -... V��� V Street as shown on the ppl•cation for Disposal Works Construction Permit N _____________________ Dated_._� _. ........................:.. Board of Health DATE..� e -----•-----------•-----•-------•-----••-•--•---------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - i C L0 CAt-ION QU1SstT.Rr) EWA G E. ' PERMIT N0. VILLAGE v M9, 13a. INSTA LLER'S NAME ADDRESS - ' _� -eA) t U 1 L WE R OR OWNER DATE PERMIT ISSUED - ' DATE COMPLIANCE ISSUED �� 5 NIP a . y p` c9: V�0 0 Or 14 , ZOO 0 S 3 DRA10. V t � s3o•ov' �•`�' a c oN LO knowledge, infox t .on and ���.JT�CRV ILL�I'c,p�Al�I..ISTAP+6.I�c, MA+• , On the basis Of u►y . belief, Z certify to @ t e ground AuCO 1 ��0 that as a result of a survey. on .,3..., Z find that t �J��1 oture k s) ars 1004t" on the Bite as shown. �n�..�/plmace r�/ i 4�7;;">O! �e9.�•�9 La s IdJM, M,W n¢u,J f L K fi I A1G The. tit�. linen d � Qf : eau t�. i the 2 'K I Q49. P4L MauTN I tills► , site .axe as shown.hereon.+ tN of the 131 0 is situated IA zone �v►LunM Amtu'��► Y 'anel 1�0 a.SG�o oe M. M WARWICK MP. 19771•�ie�` / � 4 s T I R Amp Sl TE PL A lV T YPICAL PROFIL E _ — NOT TO SCA L F_ SCA L E -_ _ r-L . V.L . &h �, _ I8"STD. LT. WGT C.I. MH COVER P 4`C.J. PIPE- 4' BIT. FIBER PIPE TIGHT JOINTS __�_.._ OUTLET LEVEL - FLOW LINE ( - O TO F/RST JO/NT - DWELLING Sai. 3� �/O Iq O O C./. TEE C.I TEE ! STANDARD PRECAST $ �� T' - j Sr o CONCRE 1'E- t p'OpGALLON _ SEPTIC TANK 6 -" 0/5 TRIBU.T ION BOX TO BE INSTALLED ON LEVEL , STABLE BASE. SEPTIC TANK TO BE INSTALLED ON LEVEL , STA8LE BASE 4b 2"- //B" TO I/2 " WASHED PEA STONF LEACHING PIT ALL AROUND FREE OF IRONS, FINES BASE TO SE LEVEL s �A-NDDDDU-S�-T IN PLACE 4� T r �1e E4 A yT ���c \{p` C LAP BRICK B MORTAR COURES .314" TO I-//2" WASHED CRUSHED ' a AS REQUIRED TO BRING `+ STONE ALL AROUND FREE OF COVER TO GRADE 24' C.I. MH COVER ° IRONS, FINES AND DUST IN PLACE -- AND FRAME q PT ti 4- T A r-J K 7��/ E . A.tiQ evx . (' � �. 4" -__ LEACHINC PIT SECTION/NLEr8' FLOW p° PIPE - ---� -V- - t. CONCRETE TO BE 4000 PSI 28 DAYS 2. REINFORCED WITH 6" x 6" N0. 6 GA. W.W M 3 fry c —1- f 3. 2` AND 4' SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS. t �� '; .--x `Z (14 *� '� OPENING WITH 4-I/B" 4. NUMBER OF PITS REQUIRED _ t OUT£R DIAMETER B NOTE, EXCAVATE TO ELEVATION `��'`� OR LOWER A5 :p 1-3/4 ' INS/OE DIAMETER REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH L © T 3 �? V o f PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN { A GRAVEL TO DESIGNED GRADE g r I a M 1 MIN. i EfFECTIVE DIAMETER (NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) >' -- •�-v WATER TAB E - �_ V7 r_J O +`1 �J C. 0 tJ N_J T s w- 19 a » hd S$ SOIL AND /4'ERC. DA TA GENERAL NOTES PERC. RATE 2 MIN. /IN . NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. SEPTIC TANK, DISTRIBUTION BOX , LEACHING PITS TO BE STANDARD i T � cJG� �1 eLZ-.> 'wM, wAtz1L) �K I� y50G, thJG.} TEST BY: PRECAST REINFORCED CONCRETE UNITS WITNESSED BY. e5. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE TC REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE , TEST PIT GR. EL.- (f ' DATE ' MINIMUM REOUIREMENTS FOR THE SUBSUFACE DISPOSAL_ OF TEST PIT N0.1 P-I�47 TEST PIT N0. 2 SANITARY SEWAGE EFFECTIVE I JULY 1977. 0" — 0" ------ -- 1 aNY CHANGES TO THIS PLAN MUST BE APPROVED BY THE g BOARC OF HEALTH. AT COMPLETION OF CONSTRUCTION , PRIOR TO BACKFILLING, THE E r �J tZ AV E-L BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. PITCH ALL SEWER LINES 1/4" /FT. UNLESS INDICATED lr CCL4a.J T OTHERWISE. 1JG" L.)A.10k)A-rF_'02, o,5 SI6N DATA {� REDROOMS DISPOSAL '`l a t! fi EST. TOTAL DAILY EFF. _ LLa __GALS. L EGEND — SEPTIC TANK loo c GAL SIDEWALL AREA Z ' GAL./SQ. FT �/J//��` /'�/ �/ j �/J BOTTOM AREA —_ I' �' GAL./SQ. FT. SEl�UAGE DISPOSAL S / S I- d z oC EXISTING GRADE LEACHING REQUIRED I`�`'�''`�5 SQ.FT. ZONE p_-_ ___.__ a o�� FINISHED GRADE ACTUAL LEACHING AREA e_f_- -'• SQ.FT. FOR ,A y lu lrt.! AT � 12 v . Dc� INVERT ELEVATION !,- .•�° r. i _ �'" ,,� - GZ V t `� �� tst O A, Cj'--- - DOMESTIC WATER SOURCE'__ _ _^ _ PROPERTY LINE G ►J I Cc tz V t inL t%li.--17 A W- R*Le_ L SCALE' AS INDICATED DATE : PLAN REFERENCE -- MEAN HIGH WATER BENCH MARK DATUM v NA y '9? ' " p -f- AL- 3- MARSH WM. M WARWICK B ASSOCIATES BOX 801 - NORTh FAL1190UTH +rLoo o zo >.J = C ti - LA �. PC. o G " 9,:SSACHUSET TS 02556 i ASSESSORS MAP : TEST HOLE LOGS �n NOTES: F 6 Uq�N PARCEL : 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH le In i°9q� TAN o 1995 MASSACHUSETTS TITLE V & TOWN OF FLOOD ZONE : � �� SOIL EVALUATOR : - TH{LNj, BOARD OF HEALTH REGULATIONS. WITNESS : N� Q�?VIk,61 , sPn REFERENCE : DATE : I� 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, 3 PERCOLAT I O RATE: SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO INSTALLATION. Cl. SS _CS01 L1 I p'R =Q. rd/� v . - - - -- 3 u 28 J 1po� � TH- 1 ,1..(>Z.'�r� Jt� TH-2 U, (pZ,70 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION Hyann ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE i g S �OA4vt 'a DETERMINATION. + ,, M / 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS [ ,' LOA✓�. SPECIFIED OTHERWISE) 32 �° LOCATION MAP (N T.:�� �?� -I� � � M>�I UM P 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A !t" ral: joylz � --, � C., O jo (K6 z ��,37 a GARBAGE DISPOSAL. S� T 7,57 6Zi rj�,S� 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON �a 1/ C rop2 �Y A BASE OF 6"OF CRUSHED STONE. 930 13`� 51>IZ j- 1 P ,C /1ld 6 til oBS.` /�Jo G�>J d Iri LA e-V > - T7-TLE V/ Ho �-001/v o_ pp--I VJAn� Vv ewe_ (JV/t N 150 OF � , �EAO-Il SEPTIC SYSTEM DESIGN 9�_06 WE7�,A-)V� w/IN. 150701- P2or. h rfy tJ4 . FLOW ESTIMATE icx) ;qo .v' I4r t'o rmM-.__T�1 -� - G ��1.w o f- jA - c BENCH MARK 3 BEDROOMS AT I CO GAL/DAY/BEDROOM - 330 GAL/DAY TOP OF CONC BOUND ELEVATION - 65.28 SEPTIC TANK !� I USG$ DATUM ASSUh1ED E T pp PA�EIMEv� — 330GAL/DAY x 2 DAYS - (�(od GAL U I S UE s L- E�. -�' USE GALLON SEPTIC TANK- E,X677N - F-6,0t- rE wj//j b0 , allarj ' -- 146.87 OF '-' A. \� SOIL ABSORPTION SYSTEM �DARR�Ss9c�G ss \ 1 EN m - — D/�,q/NAG l `�^ _UGJL'i ({,'`�� �/A)r TdI UNj Z,f o _I � ,f c: f' 'I t' .�� ;,? ,l .�, Ud�JC: vN i�A3fJ J C. : !lY a 2-'�� No. 114[� s4 .--� .s4 S DE AREA: 3v 2 fi 10 2- X2 X 0,7y= j c/STER C a F'9 � �gNITARI ORIVEWA 9E/vT BO7FOM AREA: 30 k 10 O,?Y P� 3 G � � SEPT I C SYSTEM SECTION441 3v r O t EXIS TING ?o f� 63 � 1�3 D WEL L ING ry �/ TOP OF i - �- FNpN �. -----�.--------------,- �,. L 0 T 35 E� 64.49+— C.( ((J� - _ _ ___ AREA 20063 sf +- \ I 5 �� t3"Nr Cavejes {L1 W fE; EX ST. �' � IO" n (o b� T-7r1!�� l'>`IXC^�! , �►IAI , +�r jns Poff' IODD6l1i- o / e O j 7 !36 f will. � �'�►1ts� l4� SEP• us Bad Q 60- 67 1 15T: O 630 /^ j� 60-0 GAL &WO,17 roL , r , LE GZx7 'l[ SEPTIC C TANK 1 . �. p 77 �+� PL A N SCALE: I in 30 ft + ----___ 0 L K 1 0 Its ,. �38 B�( � OF T�i h�"cZ - - � A . Ws—vie S I TE AND SEWAGE PLAN L� ��g►' jj i LOCATION . ,Z U/S567 ol9- , PREPARED FOR 0 SCALE : DARREN M. MEYER, R.S. Z P.O. BOX 981 DATE: 7 Z� U w EAST SANDWICH, MA 02537 w DATE HEALTH AGENT Ph: (508) 362-2922 Z