HomeMy WebLinkAbout0516 SOUTH MAIN STREET - Health (3) 516 SOUTH MAIN ST., CENTERVILLE
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE QFFICE OF ENVIRONMENTAL AFFAIRS
Y. DEPARTMENT.OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE,SEWAGE DISPOSAL SYSTEM FORM
�. PART A
CERTIFICATION
Property Address: 516 South Main Street
Centerville.MA 02632
Owner's Name: Jeanne Ciccone&James Kras
Owner's Address: —34
Date of Inspection: . April 16,2013''.
Name of Inspector: (Please Print) James M.Ford
Company Name: James M. Ford
Mailing Address: P.O.Box 49
Osterville,MAC.,02655-0049•
Telephone Number: (508)862-9406
CERTIFICATION STATEMENT
I certify that I have personally inspected the se}vage 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 15.3.40 of Title 5(310 CMR 15.000). The system: ,
✓ Passes
''nditionally Passes
eds Further Evaluation by the Local Approving Authority
PF ils
Inspector's Signature: Date: April22, 2013
The system inspector shall sub it copy of.this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of complet 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.
Notes and Comments
""This report only describes conditionsq:xt 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.
Title 5 Inspection Form 6/15/2000 page 1
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OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 516 South Main Street
Centerville,MA
Owner: Jeanne Ciccone&James Kras
Date of Inspection: April 16, 2013, '
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Inspection Summary: Check A,B,C,D or.E/ALWAYS complete all of Section D
A. System Passes:
✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)'in,the for the following statements. If"not determined",please
explain.
a '
The septic tank is metal and over 26years 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 dld,is available.
ND explain:
Observation of sewage backup or brezk out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled,of uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pi I e(s)are replaced
obstruction is removed
distributi�pn'box is leveled or replaced
ND explain:
The system required pumping more,than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstructibn.is removed
ND explain: r
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OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
L
Property Address: 516 South Main Street
Centerville M4
Owner: Jeanne Ciccone&James Kras
Date of Inspection: April 16. 2013
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require furth pr 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 withih150 feet of a surface water
— Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
... 1.
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2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tao and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy df the analysis must be attached to this form.
3. Other:
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OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 516 South Main Street
Centerville MA}f
Owner: Jeanne Ciccone&James Kras
Date of Inspection: April 16, 2013
D. System Failure Criteria applicable to all systems:
You must indicate either"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 ;I
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_ ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow
✓ Required pumping more tlian 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped_ ?'
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool:or-' ivy is within a Zone 1 of a public well.
✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
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.
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OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 516 South Mdin Street
Centerville MA
Owner: Jeanne Ciccone&James Kras
Date of Inspection: April 16. 2013
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 n4rinal 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?
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The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
✓ Existing information. For example,a plan at the Board of Health.
✓ _ Determined in the field(if°any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)].
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OFFICIAL INSPECTIOiN,FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 516 South Main Street
Centerville.tLL
Owner: Jeanne Ciccone&James Kras
Date of Inspection: April 16. 2013
RESIDENTIAL FLOW CONDITIONS
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: 2
Does residence have a garbage grinder(yes or no): N/a
Is laundry on a separate sewage system(yes or no): N/a [if yes separate inspection required]
Laundry system inspected(yes or no): no
Seasonal use(yes or no): no
Water meter readings,if available(last 2 yeaiis usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Weekend use a
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): .' gpd
Basis of design flow(seats/persons/sq/ft etc.): '
Grease trap present(yes or no): 9,
Industrial waste holding tank present(yes or'no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: N/a
Was system pumped as part of the inspection`(yes or no): Yes
If yes,volume pumped: gallons-:,:How was quantity pumped determined?
Reason for pumping: Maintenance
TYPE OF SYSTEM
✓ Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy y;
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Date of installation -612194 per as-built
Were sewage odors detected when arriving at the site(yes or no): No
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Page 7 of 11
OFFICIAL INSPECTI6h4 FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 516 South Main Street
Centerville,MA
Owner: Jeanne Ciccone&James Kras
Date of Inspection: April 16. 2013 .
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron 40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 4" r
Material of construction: ✓ concretemetal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1500 Qal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 3"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 10"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage;etc.).
The Tees were Present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage
The tank was Pumped after the Inspection
GREASE TRAP: None (locate on site plan)
Depth below grade: a,
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 6utlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
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OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 516 South in Street
Centerville.MA .
Owner: Jeanne Ciccone&James Kras
Date of Inspection: April 16. 2013' ;
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: °t
Material of construction: _concrete =metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day.
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present'jnust be opened)(locate on site plan)
Depth of liquid level above outlet invert: fi,en'
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
The D-box was normal
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber;condition of pumps and appurtenances,etc.):
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Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 516 South Main Street
Centerville,MA
Owner: Jeanne Ciccone&James Kras
Date of Inspection: April 16, 20131
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
j..
Type
✓ leaching pits,number: _ 6'x 6' 1000;izal. with stone per design
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length: .
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.):
The nit had 6"of water on the bottom 77tere did not appear to be any signs of failure The cover was 2"below grade
The Bottom to grade was 12'
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
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Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer: a
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no);:
Comments (note condition of soil,signs of hydraulic failure.,level of ponding,condition of vegetation,etc.):
PRIVY: None (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.):
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OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 516 South Main Street
Centerville,MA
Owner: Jeanne Ciccone&James Kras
Date of Inspection: April 16, 2013
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. "Locate where public water supply enters the building.
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OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 516 South Main Street
Centerville,MA
Owner: Jeanne Ciccone&James Kras
Date of Inspection: April 16, 2013
SITE EXAM
Slope
Surface water
Check cellar 7 `
Shallow wells
Estimated depth to ground water 35' +/ feet
Please indicate (check) all methods used to determine the high ground water elevation:
Obtained from system design plans on record- If checked, date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: Topographic and water contours maps
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:,
You must describe how you established the high ground water elevation:
Using Barnstable topographic and water contours mks the maps were showing approximately 35'+/-to ground water at this
site.
This report has been prepared only for the septic system and components described herein. This septic system has been
inspected and passed as of the date o!'inspection. This report is not a warranty or guarantee that the system will
fitnction properly in the fctture. There have been no warranties or guarantees,either expressed, written or implied,
relating to the septic system, the inspection, this report and/or any components of the septic system which have not
been located and inspected.
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COMMONWEALTH OF MASSACHUSETl'S
EXECUTIVE OFFICE OF ENVIRONMENTAL AFF RS
DEPARTMENT OF ENVIRONMENTAL PROTE N
ONE WINTER STREET, BOSTON MA 02108 (617)29 5500
TRUDY COXE
`� Secretary
ARGEO PAUL CELLUCCI � DAVID BSTRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 516 South Main Street, Centerville, MA Name of Owner: Mike White
Address of Owner: Same
Date of Inspection: June 23, 2000
Name of Inspector:(Please Print) James M. Ford
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: James M. Ford
Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 Map: 207
Telephone Number: (508)862-9400 Parcel.005-003
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
✓ Passes
Conditionally Passes
Needs Further Evaluatiow By the Local Approving Authority
_ ails
Inspector's Signature: Date: June 27, 2000
The System Inspector shall submt a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days
of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner
shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
revised 9/2/98 Page Iof11
Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 516 South Main Street, Centerville, MA
Owneii Mike White
Date of Inspection: June 23, 2000
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon
completion of the replacement or repair,as approved by the Board of Health,will pass.
Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not.
The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or
the septic tank,whether or not metal, is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
_ Sewage backup or breakout or high static water level observed in the distribution-box-is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health)
broken pipe(s)are replaced
_ obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
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revised 9/2/98 �g
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 516 South Main Street, Centerville, MA
Owner: Mike White
Date of Inspection: June 23, 2000
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 the
public health,safety and 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 THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2).. SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF ANY)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND
THE ENVIRONMENT:
_ . The system.has a septic tank and soil absorption-system(SAS).and the SAS is within 100 feet to a surface water supply or
tributary to a surface.water supply:
The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
revised 9/2/98 Page 3of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 516 South Main Street, Centerville, MA
Owner: Mike White ;
Date of Inspection: June 23, 2000
D. SYSTEM FAILS:
You must indicate either"Yes"or"No" as to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage into facility or system component due to an 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 lh day flow.
Required i more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
— — eq pumping
Number of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of apublic well
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
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
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further information.
revised 9/2/98 Page 4of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 516 South Main Street, Centerville, MA
Owner: Mike White
Date of Inspection: June 23, 2000
Check if the following have been done: You must indicate either"Yes",or"No"as to each of the following:
Yes No
✓ _ Pumping information was provided by the owner,occupant,or Board of Health.
✓ _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
✓ _ As built plans have been obtained and examined. Note if they are not.available,withN/A.
✓ The facility or dwelling was inspected for signs of sewage back-up.
✓ _ The system does not receive non-sanitary or industrial waste flow.
✓ _ The site was inspected for signs of breakout.
✓ _ All system components,excluding the Soil Absorption System,have been located on the site.
✓ _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles
or tees, material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
✓ _ Existing information. For example,Plan at B.O.H.
✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
(15.302(3)(b)l•
✓ _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of
SubSurface Disposal Systems.
revised 9/2/98 Page 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 516 South Main Street, Centerville,MA
Owner: Mike White
Date of Inspection: June 23, 2000
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 110 g.p.d./bedroom.
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
Total DESIGN flow 549.7
Number of current residents: 3
Garbage grinder(yes or no): n/a
Laundry(separate system)(yes or no):No; If yes, separate inspection required
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings, if available(last two year's usage(gpd): Private well
Sump Pump(yes or no): No
Last date of occupancy: Curremly occupied
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: god(Based on 15.203)
Basis of design flow
Grease trap present: (yes or no) _
Industrial Waste Holding Tank present: (yes or no)
Non-sanitary waste discharged to the Title 5 system: (yes or no) -
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
Never pumped-per owner.
System pumped as part of inspection(yes or no): No
If yes,volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
_ APPROIIIMATEAGE.of all components,.date.installed(if known)and source of.information: June 2 1994-per as built card.
Sewage odors detected when arriving at the site: (yes or no) No
revised 9/2/98 Page 6of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 516 South Main Street, Centerville, MA
Owner: Mike White
Date of Inspection: June 23, 2000
BUILDING SEWER: _
(Locate on site plan)
Depth below grade:
Material of construction: _cast iron _40 PVC _other(explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints,venting,evidence of leakage,etc.)
SEPTIC TANK: ✓
(locate on site plan)
Depth below grade: 3"
Material of construction: ✓concrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No)
Dimensions: 1500 gal.
Sludge depth: 3"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 10"
Distance from top of scum to top of outlet tee or baffle: 7" r
Distance from bottom of scum to bottom of outlet tee or baffle: 6"
How dimensions were determined: Measuring stick _ . .
j
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.) The tee and baffle were present. The liquid level was even with the outlet invert. There were no signs of leakage.
Recommend pumping The cover was to grade The outlet cover was unaccessible.
GREASE TRAP: None
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
revised 9/2/98 Page 7of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 516 South Main Street, Centerville, MA
Owner: Mike White
Date of Inspection: June 23, 2000
TIGHT OR HOLDING TANK: None (Tank must be pumped prior to,or at time,of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Dimensions:
Capacity: gallons
Design flow: _gallons/day
Alarm present:
Alarm level: Alarm in working order: Yes_ No
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX: ✓
(locate on site plan)
Depth of liquid level above outlet invert: --
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) The box was not dine up.
PUMP CHAMBER: None
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order: (Yes or No)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
revised 9/2/98 Page 8of11
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 516 South Main Street, Centerville, MA
Owner: Mike White
Date of Inspection: June 23, 2000
SOIL ABSORPTION SYSTEM(SAS): ✓
(locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods)
If not located,explain:
Type:
leaching pits, number: I-6' x 6'
leaching chambers, number:
leaching galleries, number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.)
The pit had 4'of water on the bottom. There were no suns of failure. The bottom to grade was approx. 12'. The cover was to grade.
CESSPOOLS: None
(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(cesspool must be pumped as part of inspection).
Continents: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
PRIVY: None
(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.)
revised 9/2/98 Page 9of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 516 South Main Street, Centerville, MA
Owner: Mike White
Date of Inspection: June 23, 2000
Map: 207'
Parcel:005-003
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
3
1
o � a
Al- c 1
81 - 1
ca- y43
93- SL
C,3- 38
we.11
revised 9/2/98 Page 10of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 516 South Main Street, Centerville, MA
Owner: Mike White
Date of Inspection: June 23, 2000
NRCS Report name
Soil Type
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater Feet
Please indicate all the methods used to determine High Groundwater Elevation:
✓ Obtained from Design Plans on record
Observed Site(Abutting property,observation hole,basement sump etc.)
✓ Determined from local conditions
✓ Checked with local Board of Health
_ Checked FEMA Maps
Checked pumping records
Check local excavators, installers
✓ Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
The bottom of the pit to grade was approx. 12'. Using the Barnstable topographic map and water contours map, the maps were
showing approx. 37' +/- to groundwater at this site. Using the Cape Cod Commission Technical Bulletin, the high groundwater
adjustment for this site(MI W 29, Zone A, 5100)was 1.3'.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty
y .R or guarantee that the system will junction properly in the future. There have been no warranties or guarantees, either expressed,
written or implied, relating to the system, the inspection and/or this report.
f
revised 9/2/98 Page 11of11
CERTIFICATE OF ANALYSIS Page: 1
Barnstable. County Health Laboratory
Report Prepared For: Report Dated: 03/15/1999
White,Michael Order Number: G9901575
Michael White
516 So.Main St.
Centerville, MA 02632
Laboratory ID#: 9901575-01 Description: Water-Drinldng Water
Sample#: 01575-01 Sampling Location: 516 So.Main St.,Cville Collected: 03/08/1999
ollected by: D.Miorandi Received: 03/08/1999
Test Parameters
ITEM RESULT UNITS MCL Method# Tested.
LAB:IC Lab
Nitrates 0.4 mg/L 10 EPA 300.0 03/09/1999
.Note: Water sample meets the recommended limits for drinking water of all above tested parameters.
Approved By:
(Lab Director
t
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph:508-375-6605
i
TOWN OF BARNSTABLE
LOCATION S/(� ��"jlj dy14vi - T . SEWAGE # ' .3-
VILLAGE CPSyrv-
'/1l(e- ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. t9�" w� �• P3v����.5
SEPTIC TANK CAPACITY �' t'C!® ���•
LEACHING FACILITY:(type) (size) 1, yoo .6i4-��
NO. OF BEDROOMS-PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER mlclg Vie-L
DATE PERMIT ISSUED:
.f
DATE COMPLIANCE ISSUED-
VARIANCE GRANTED: Yes iI No
N3`
0 0
C I
No........ / 7 10.&)......
THE COMMONWEALTH OF N/SSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Diripwial Wor1w Towitrurtion Vamit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System a't:
....... __- ........L o -----•-•.....................................................
Location_e
Address or Lot N..
.. . .......................... .................. ... .
.........................................
S
.............................................. .....
. ........................................
Installer Address
Type of Building Size Lot............................Sq. feet
U
Dwelling— No. of Bedrooms..........<F------------------------------Expansion Attic Garbage Grinder
Other—Type of Building ---------------------------- No. of persons............................ Showers Cafeteria
Otherfixtures ......................................................-----------------_--------I...................................................................
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
04 Septic Tank—Liquid capacity----------_gallons Length................ Width....__........._ Diameter...........__._. Depth................
:V4
W Disposal Trench-- No. .................... Width.._.........._..._.. Total Length.._........_.....__. Total leaching area....................sq. f t.
Seepage Pit No..-_--------------- Diameter......_............. Depth below inlet._....._._._........ Total leaching area..................sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Per-formed by.......................................................................... Date___.......__............................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....._.............._...
04 ....I........................................................................................................................................................
0 Description of Soil........................................................................................................................................................................
W
U ........................................................................................................................................................................................................
... ................................................................................................ ........... ------
U Nature of Repairs or Alterations—Answer when applicab"le.-..... A --------------------------------------------
..... --------------------------------------------------------------
........................................................................................................................................................................ ..............................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the boa d of health.
Signed . . . ...... ....... . ..... ..........IN'te.............
Application Approved By ..........�' . ): - .
. . . ..... ............................................................................... .......
Dice
Application Disapproved for the following reasons.. .......................................................................................................................................
............................................................................................................................................................................................................... ........................................
PermitNo. ...........�3--------V...?-.7................... Issued .........................................................
Dare
—————---———————--- -----————---————---———————————————————————-
THE COMMONWEALTH OF MASSACHUSE17S
BOARD OF HEALTH
TOWN OF BARNSTABLE
(ILTIertifirate.of Compliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
....
...................Insta......................
by ............... ...........................................................................................................
.......Q...CA-Ift......... .. ller
at ............�_It........... ...............�'5.. ...... r............. .....................................
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ............................................. dated ......................................_._
THE-ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------ . . ... ...................... inspector <��",.....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
L TOWN OF BARNSTABLE
No..../..1;1
FEE... ........
Disposal Workii Tonstrudion ramit
Permissionis hereby granted------...... .......... .........................................................................
to Construct or Repair an Individual Sewage Dispos6l System
- . 5T, .........................at No....... .... ........
Street C>
as shown on the application for Disposal Works Construction Permit No.1-3-V7. Dated............I.......
................................
Board of Health
z
DATE_............. .............
FORM 36508 HOBBS&WARREN,INC..PUBLISHERS
ENVIROTECH LABORATORIES
Mass. Cert.#:MA0637-
449 Route 130 Sandwich,MA 02563 a (508) 888-6460 L
CLIENT: Michael White LOCATION: Lot 516
ADDRESS: 11 Bay Road South Main St.
W. Yarmouth, MA Centerville, MA
COLLECTED BY: Client SAMPLE DATE: 9-6-93 TIME: 2:OOPM
DATE RECEIVED9-6-93 SAMPLE ID:'294
JOB#: Rxi sti ng well WELL DEPTH: 21
RESULTS OF ANALYSIS:
Parameter Units Recommended limit Result
Coliform bacteria/100 ml (MF Method) 0 0
pH pH units 6.0-8.5 5.64
Conductance umhos/cm 500 219
Sodium m /L 28.0 23.1
Nitrate-N m L 10.0
Iron mg/L 0.3 2
Manganese mg/L 0.05
Hardness mg/L as CaCO, 500
Sulfate mg/L 250
Potassium mg/L 20.0
Alkalinity mg/L 200
Chloride mg/L 250
Turbidity NI'U 5.0
Color APC units 15.0
Background.bacteria/100 ml (MF method) 200
VOC 601 602 ug/L N.D.
COMMENT: Low pH indicates high corrosive characteristics.
* N.D. = None Detected - see attached report.
YES NO
X ❑ WATER IS SUITABLE FOR DRINKING PURPOS R P RS TESTED.
Oct, � DATE
I
r'
C-RCUNDWA7�&R
ANALY71CAL
EPA METHODS 601 and 602
Volatile Organics (GC/PID/ELCD)
Field ID: 294 Lab ID: 5914-01
Project: Batch ID: VG2-0221-W
Client: Envirotech '-mpled: 09-06-93
Cont/Prsv: 40mL VOA Vial/NaHSO4 Cool Received: 09-07-93
Matrix: Aqueous Analyzed: 09-10-93
PARAMETER CONCENTRATION REPORTING LIMIT
(u9/L) (u5/L)
Dichlorodifluoromethane BRL 5
Chloromethane BRL 1
Vinyl .' 1aide BRL 1
Bromome-,ha,,a BRL 5
Chloroethane BRL 1
Trichlorofluoromethane BRL 1
1,1-Dichloroethene BRL 1
Methylene Chlor-,,de BRL I
trans-1,2-Dichloroethene BRL I
1,1-Dichloroethane BRL I
cis-1,2-Dichloroethene * BRL I
Chloroform BRL 1
1,1,1-Trichloroethane BRL 1
Carbon Tetrachloride BRL 1
Benzene BRL 1
1,2-Dichloroethene BRL 1
Trichloroethene BRL I
1,2-Dichloropropane BRL I
Bromodichloromethane BRL ?
2-Chloroethylvinyl Ether BRL 1
trans-1,3-Dichloropropene BRL 1
Toluene BRL 1
cis-1,3-Dichloropropene BRL I
1, 1 ,2-Trichloroethane BRL 1
Tetrachloroethene BRL 1
Dibromochloromethane BRL 1
Chlorobenzene BRL 1
Ethylbenzene BRL_ 1
m+e-Xylene * BRL 1
o-Aylene * BRL 1
Bromoform BRL 1
1,1,2,2-Tetrachloroethane BRL I
1,3-Dichlorobenzene BRL I
1,4-Dichlorobenzene BRL 1
1,2-Dichlorobenzene BRL 1
qC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS
a,a,a-Trifluorotoluene 30 32 108 % 87 - 113 % l
1,2-0ichloroethane-d4 36 26 85 % 83 - 117
a ���a
_.
_ �' °
� �
TOWN OF BARNSTABLE
LOCATION ��"/G, -�-(� 6�y�i9jv1 S(
SEWAGE #: `j3 ' �fCi' "Y
VILLAGE ���Try t�i t�� Z67�&4 f a
ASSESSOR'S MAP & LOT
INSTALLER'S NAME fa PHONE NO. or''G�Ov� �, 13
as
SEPTIC TANK CAPACITY S—UO
LEACHING FACILITY:(tppe) T (size) 000
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: 4 2
VARIANCE GRANTED: Yes No
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TOP OF FOUNDATION 20 FT. MINIMUM SOIL TEST
10 FT. MINIMUM CLEAN SAND DAME OF SOIL TEST
ELEV. = WITNESSED BY nvN�vt CONCRETE
PERCOLATION RATE G �1 : uIN./INCH.
4" SCHEDULE 40 PVC PIPE '�►
MIN. PITCH 1/8" PER FT. 2" LAYER A J�rrt OBSERVATION HOLE 1 OBSERVATION HOLE 2
1/8" TO 1/2" ` g� 2 V.= ;°/ ELEV.= 10 3 2-
CONCRETE OVE WASHED STONE p 0 o
12" MAX. 5 g fvr� TOP AND
4" CAST IRON PIPE Soil Z Y SUBSOIL S'� �''�
--- (OR EQUAL) MINIMUM 36"
PITCH 1/4" PER FT.
CJA.G 3 r C
FLOW LINE 04
ELEV. _ {0 10" �� S
'� 7 -'MIN. 1 g' ELEV. _ . . o ° o c i
ELEV. _ y c� _ 1Sb I(vb .9'
ELEV. L ° 0. °
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ELEV. = o ° p o ° c 77 Z. WATER AT _ EL= ?T I
0 WATER AT EL
DISTRIBUTION ELEV. _ ° o o 0
BOX 3/4" To , 1/2" o°° ,, DESIGN CALCULATIONS
WASHED STONE 00 . 00 NUMBER OF BEDROOMS
1500 GALLON TO BE WATER TESTED o 00 0 o ELEV. _ 7 GARPAGE DISPOSAL UNIT
w 4 IF MORE THAN ONE OUTLET -,� _ TOTAL ESTIMATED FLOW
C� SEPTIC TANK ( Lt 0 GAL,/BR./DAY X 8R.) GAL/DAY
v PRECAST _LEACI AID 6' DIA. REQUIRED SEPTIC TANK CAPACITY 660 GAL.
WELL
BASIN OR EQUIV. fr� Z ONE ACTUAL SIZE OF SEPTIC TANK GAL
LEACHING AREA REQUIREMENTS
r�' �'`� I INDEX SIDEWALL AREA GAL/S.F.
SEWAGE DISPOSAL SYSTEM PROFILE ADJUST BOTTOM AREA GAL/S.F.
NOT TO SCALE
LEACHING CAPACITY (BOTTOM + SIDEWA4) ��9 7 GAL/DAY
\ %�\— x s 9 sx /.cy) +�(a x 3 ��x s.�Gx 2
_►Z 2, RESERVE LEACHING CAPACITY S�9 7 GAL/DAY
BOTTOM OF TEST C TA
SSERVED WATER TABLE /WATER / ELEV. _
NOTFS:
J .-- Ixi' -� 1. ALL WORKMANSHIP AND MATERIALS SHAL1 CONFORM TO D.E.P.
I TITLE 5 AND THE TOWN OF 9���s r''�`}�'� RULES AND
LEGEND.
REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE.
EXISTING SPOT ELEVATION OOxO 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO
EXISTING CONTOUR ----00---- "
WITHIN 12 OF FINISHED GRADE.
FINAL SPOT ELEVATION
r FINAL 3. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME
t ! r' CONTOUR A. ALL . UP�T-S OF THE•SAWTARY 'EM SHALL BE CAPABLE OF
T�. ;.. r t b01L 1E5"1_ LOCATION �ISTAN i t'' O W1r . DIN _ ADING UNLESS THEY ARE UNDER OR WITHIN
TOWN WATER ---= W-- F. = _ LOADING SHALL BE
N :r. CATCH BASIN �®� U:> - +.�PJL)Lk OR it IPl N 10 I T. (Jr JF�fVES C)!r PAKKINC r,KtA�.
/ — \1,_j 5. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHAL.L
�'r BE MORTARED IN PLACE.
G. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH
N DEEDED OR ZONING REGULAMON& OWNER / APPLICANT IS TO
' ► k OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
i � D► / p� �rtlr 2 7. � 2 7a 8e- !2k"ildGCsT-47CC>
H 7 APPROVED: BOARD OF HEALTH
Z,q
DATE AGENT
PROPOSED PLOT PLAN
FOR
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PROJECT LOGATIbN
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ts�.1�1�t►,►� �h Y r�,,,,�Q. -. Lt�w 2 �k l o'�; � E��n� i 1.J;� L D u}�2, �.��+ �.
f`` `` �►o;. ,-n �6� a �>� n 1 I 1 �� I?00NA
Q DATE:
0
- DONALD I. MEYER REVISED J
Professional Building Designer
P.O. Box 532
W ..� t t 1-C�•, hL �'� y ' �, �' jz4jP Y� A 394-5 96 2 DRAWING NUMBER
2
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