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0054 CAP'N CARLETON'S RD - Health
54 Cap'n ;Carleton's:Road 1rotuit. ,P, --- ---- Q -? M8 056 1 p f �r i 'D' s Commonwealth of Massachusetts ' W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: I � only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5/26/2009 In pector's Signatur 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. L—�j �j6q t5ins•09/08 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 ;M 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 i every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ' ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every 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 water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *' This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria 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 Y2 day flow t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 i� r 4 Commonwealth of Massachusetts u W Title 5 Official' Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM , 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every 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 due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. 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 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f 1. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every 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 Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c,M 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon septic tank,distribution box and five infiltrators. Number of current residents: Unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage NA 9 ( Y 9 (gpd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown 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•09/08 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 °M 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 f Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every 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: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10'+feet Comments (on condition of joints,venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): 8" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 5" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every page. City/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 27" Y Scum thickness Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every 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.): 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G1M , 54 Cap'n Carleton's Rd. ' Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every 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 No 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.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5-Infiltrators ❑ 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.): Sandy dry soil.No signs of hydraulic failure.Leaching was dry at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 r. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name . information is required for Cotuit Ma. 02635 5/26/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every 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 A Q _ P , rnS�'u� po yp�.tt l ao ao` 6 35 3°I 3 3S y� t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 P Y 9 r - Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of Leaching 47' 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: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Cap'n Carleton's Rd. Property Address Janet Duerfard Owner Owner's Name information is required for Cotuit Ma. 02635 5/26/2009 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 z Z - P� COMMONWEALTH OF MASSACH` S, TESB N,a TABLE EXECUTIVE OFFICE OF ENVIRONMEN AIL AF R � 2005 AP 68 DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 54 Captain Carleton Road Cotuit MA 02635 Owner's Name: Helen Helfer ,', Owner's Address: Date of Inspection: April 19, 2005 Name of Inspector: (Please Print) James M. Ford Company Name: James M.Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs F her Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: April24. 2005 The system inspector shall subl 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. Notes and Comments . **"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. Title 5 Inspection Form 6/15/2000' page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 54 Captain Carletons Road Cotuit, MA Owner: Helen Helfer Date of Inspection: April 19, 2005 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. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure'is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced _ obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 54 Captain Carletons Road Cotuit, MA Owner: Helen Helfer Date of Inspection: April 19, 2005 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 2. System will fail unless the Board of Health(and Public Water.Supplier,.if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form: 3. Other: . 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 54 Captain Carletons Road Cotuit. MA Owner: Helen Helfer Date of Inspection: April 19, 2005 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 ✓ 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''/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] 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 11 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 54 Captain Carletons Road Cotuit, MA Owner: Helen Helfer Date of Inspection: April 19, 2005 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: 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)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION_ FORM PART C SYSTEM INFORMATION Property Address: 54 Captain Carletons Road _ Cotuit. MA ` Owner: Helen Helfer Date of Inspection: April 19, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): Yes 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 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd - Basis of design flow(seats/persons/sqft,etc.): 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/use: . ` OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Never pumped(per owner)-Tank pumped after inspection for maintenance Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? ' Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) . Tight Tank Attach a copy of the DEP approval Other(describe): , Approximate age of all components,date installed(if known)and source of information: The tank was installed on 3122178 and a new leach field was installed on 7129199-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 r Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Captain Carletons Road Cotuit, MA Owner: Helen Helfer Date of Inspection: April 19, 2005 r 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: 12" a Material of construction: ✓ concrete _metal _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: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 6" w 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.): 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 for maintenance. 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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 I Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Captain Carleton Road Cotuit, MA Owner: Helen He11er Date of Inspection: Aril 19, 2005 TIGHT or HOLDING TANK: None (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: eallons Design Flow: eallons/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 must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. No solids were present. 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.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 59 Captain Carletons Road Cotuit, AM Owner: Helen Helfer Date of Inspection: April 19, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Y Type leaching pits,number: ✓ leaching chambers,number: 5 infiltrators(11'x 36'x 19-per as built card 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 infiltrators had 2"ofliauid on the bottom. The scum line was at the same level There did not appear to be any signs of failure. The bottom to Qrade was 5. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) x 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 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.): 9 f a` Page 10 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Captain Carletons Road Cotuit, MA Owner: Helen Helfer Date of Inspection: April 19, 2005 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. Q i I,,SPukro� O a B P 0;% 3 ao abe F 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 54 Captain Carletons Road Cotuit, MA Owner: Helen Helfer Date of Inspection: April 19, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 75+/- 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 snaps, the maps were showing gpproximately 75'+1-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function 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. 11 c/ TOWN OF BARNSTABLE LOCATION S _1J_. C CArlc�,At R�. SEWAGE # 5 C7 VILLAGE C�V�1 ASSESSOR'S MAP & LOT 03� Ot6 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /oUb LEACHING FACILITY: (type) S /A (size) JJ X?6x I NO. OF BEDROOMS 3 _BUILDER OR OWNER 41 tom PERMITDATE: COMPLIANCE DATE: 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) l Feet Furnished by L�Por1 T �o/C Q ` i JASPwsl'�un a po,� 3 zi ao aa� 6 • 33 y� TOWN OF BARNSTABLE Lc?CATIGN'-� lee SEWAGE # VILLAGE G®f"Gl/'T ASSESSOR'S MAP & LOT©��"' INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /i 6& LEACHING FACILrI Y (type) ZtAt lralwS �ST_ (size) NO. OF BEDROOMS 3 { BUILDEk-OR OWNER PERMIT E: 612-9 COMPLIANCE DATE: Separation Distance Between the: Max Feet imum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist e I 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) 460 Feet Furnished-by t A 4Gs L �1 . e ti . �� �� �_ �. � �. ' a �i. O �. yv' �,� o � ®�� � . ._ y.. ,. ,. ::� f i J` \ �n. � No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Miopogar *pgtem Construction Permit Application for a Permit to Construct( )Repair(,/)Upgrade( )Abandon( ) El Complete System MIndividual Components a Location Address or Lot No Owner's Name,Addyess and Tel.No. Assessor's Map/Parcel �t-��T Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �6�tO��l CO z/ 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 gallons per day. Calculated daily flow 31W gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 000 99 ��f157 59 Type of S.A.S. 1Z;V � f // Description of Soil Nature of Repairs or Alterations(Answer when applicable)���e � 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 issued by Bo d f He th. Signed Date �S Application Approved by Date Application Disapproved for the following reaso s Permit No. Date Issued No. 3 w Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Yes (pplication.for Migpogar *potent Congtruction Perto Application for a Permit to Construct( )Repair(Upgrade( )Abandon.( ) ❑Complete System Individual Components Location Address or Lot No. Owner's Name,Add ess and Tel.No. $'�C4�fa/mil 67'���©�15i;, ��i'1��s Assessor's Map/Parcel CD f7 Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. d6�t��o�i Co�sT�39� Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. "'Garbage Grinder Other Type of Building eS� 2f�GC� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //D gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /DOD 94P1 7 �'zi Type of S.A.S. y /// Description of Soil i i Nature of Repairs or Alterations(Answer when applicable) 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 issued by • Bo d Health. Signed Date Application Approved by � l Date Application Disapproved for the following reaso 92 Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS 4:5'3 s-�✓�`6 BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (Upgraded( ) Abandoned( )by at 9 L'C!r - 4/l i! Cp u/ T— has been constructed in accordance with the provision of Title 5 and the for Disposal System Construction Permit No. 9�dated r Installer Designer The issuance of this permit shall not be constr1uppas a guarantee that the sys+�te uvt function a7d ' gnd Date , Inspector/i ne( No. i Fee--� �— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migogar *pgtem Congtruction Permit Permission is hereby granted to Construct( )Re ,air( Upgrade( ) bandon( ) System located at r� � 1`Q/� /-C! ✓; f06/j `p and as described in the above Application for Disposal System Construction Permit.The applicant recognize his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction mus e c pleted within three years of the date of thi e t. © o Date: Approved b r y ` - - NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PEIMNUT(WITHOUT DESIGNED PLAINS) I, ®��r ��� �lJ hereby certify that the application for disposal works construction permit signed by me dated // `�� , concerning the property located at S"�/ �A �� �1e��s /, meets all of the following criteria: The failed system is conner ed to a residential dwelling only. There are no commercial or business es associated with the dwelling. e soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system /There is no increase in flow and/or proposed use change in / 7 ✓ There are no variances requested or needed I✓ The bottom of the proposed leaching facility will not be located less than five feet above the ma..cmum adjusted groundwater table elevation. (Adjust the,groundwater table using the Frimptor ethod when applicable] If the S.A.S. will be Iocated with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation Z® +the MAX High G.W. Adjustment.3c 0/ = 2 DIFFERENCE BETWEEN A and B SIGNED : DATE: d <Y [Sketch proposed plan of system on back]. q:health folder:art �p -W Sy C 7-A,113 CCU-SiT s v �t�-� Y /J TOWN OF/BARNSTA/BLE LOCATION ? CQD /X SEWAGE # Y-J3 VILLAGE CB7Gl/�T— ASSESSOR'S MAP & LOTQ3g"Qr� INSTALLER'S NAME&PHONE NO. 2� �r7-Z:�1117 �g�lsj, 77/ 3�A SEPTIC TANK CAPACITY /i 6,L LEACHING FACILITY: (type) Aa/0rS CS� (size) l'Jlo �x / NO. OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: 6/�sQ� COMPLIANCE DATE: 17- �7�7' 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) / ` Feet Furnished by >`f�d ids t ol` . ch 1� ^ L- y �v. L ` 4 No. ._ Fss.... ....._ THE.,COMMONWEALTH OF MASSACHUSETTS BOARD ®F HEALTH t�.O OF.......;..>, 1 .��...._..... r� ..g '18, --"-----...--•---"----"-------- App iratiun for Bi,4pugal Works Tongtxnrtion Frrmit Application is hereby made for a Permit to Construct Vor Repair ( ) an Individual Sewage Disposal ` System at: .... ,-Address or Lot No. � Omer Address W c Insta:_er Address dType of Building Size Lot._�...��_'��...Sq. feet U Dwelling—No. of Bedrooms______________________________ __ _Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................ W Design Flow....... ____________________________gallons per person per day. Total daily flow______._= ....................g41 o.n s. 4 Septic Tank—Liquid ca acit _�ALk). allons Len th__&-("__ Width Diameter________________ De th� �---- Disposal Trench—No_____________________ Width____;�...._._....... Total Length.................... Total leaching area,.................... ft. Seepage Pit No--------------------- Diameter....... Depth below inlet_4�_ "___. Total leaching area_ . --- . ft. Z Other Distribution box Dosing tank ( ) aPercolation Test Results Performed by... G ..__F1.��WM?& Date_171.1 ___�___�NS Test Pit No. 1_._�� _____minutes per inch Depth of Test Pit____{�_/ ____ Depth to ground water_. d____. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------="----•-------------------------------...._........-•-•---•--------•-•------•-•-----............._._....._.._------- ------•-- 0 Description of r--...20 �--.�i/��t!45� *��= ���Z ��� fU�_��•E�� w -•-•------•-•---•-•____________ rTm !^T W --- -=-•-•-e-r--11--y--/���............... _______________________________________________________________________________________________________________t_e^TA `t:e�/1A a"-A�!1"L ^�-:�'�� UNI i VRI i ING U Nature of Repairs or Alterations—Answer when applicable...... s_td-..rers.g En pn__ 2: `^TAL L [7_I iN•_S�H1CT ------------------------------------•--•---•---"--•--•------------------------------._...---.._.-••••--••-••••". a------------••-"--------------••-•----•---- Agreement: The undersigned agrees to install the afored ed Individual Sewage Disposal System in accordance with the provisions of �TL of the State Sanitary o —Yhuersigned further agrees not to place the system in operation until a Certificate of Compliance has be issuedoard of health.Si ned••-••-• 2_ �... : ---------.......----•------•---••--.......__ ....-- , teApplication Approved BY••---•••••••- ••••••�= -1 - ��• 1-ate Application Disapproved for the following reasons:................................................................................................................ ................•••-•-•-••----•-•-----•••-•----••---•••••••-•.....-••-•••-----••-------.....-•••---•---------•••-•...-••-•••••••••---••-----••-•---•-•••-••---•-•••••-••-• ............................. Date PermitNo......................................................... Issued....................................................... Date No........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ .........OF..... ........................................................................... Appliration for Disposal Marks Tonstrurtion Prrmit Application is hereby made for a Permit to Construct �4_or Repair an Individual Sewage Disposal System at: LQ 13 CA PNO CAILETDOS reQ 7&.... ... ..................................... ................ Lo tiqrh-Address or LoGjy. ... ........ ................ O Address .......... ......... Installer Address Type of Building U Size Lot...' ....................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ...................................................................................................... Design Flow........57.5..........................gallons per person peT day. Total dail w......... 1:4 Septic Tank—Liquid capacity./5040gallons Length._.4?.-��... Width....._" Diameter................ Depth.ir�_7_11 Disposal Trench—N?--------------------- Width......o............ Total Length.........,.._.... Total leaching area area.....- ............sq. ft. Seepage Pit No........_............ Diameter......../0-0'/Depth below inlet.. Total leaching area...... sq. ft. ......... -----7.. Z Other Distribution box Dosing&,,, Percolation Test Results Performed by............��J.... Date... 1�11 ......... .......... -----/----------------- Test Pit No. L_4rArz----minutesperinch Depth of Test Pit...../!_Z*�� --- Depth to ground water..__1V.A_R ..... riq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....._.............._... .... ............. ........---------------------- -----------------------------*.......*..................... 0 Description of Soil...40............................. 'j...... 1 C46WA) �� W ................................................................... M ---------- -----------*-------------------------------------*---------------------------- 7------------------------------------*...*-----------*---------------------- I - ---------------------------------------------------------*-------------------------------------------------------------------------------------------------------------------------*-------------------- U Nature,of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................... ............................................ Agreement: The undersigned agrees to install the aforedes > Individual Sewage Disposal System in accordance with the provisions of TITA 12 5 of the State Sanitary C — The rsigned further a rees not to place the system in operation until a Certificate of Compliance has bee ued by ar f ie th. �iunaA ........................................................... ............... a Application Approved By............... Z", .................................................................................... ........ . . ...... ........... Date Application Disapproved for"the following reasons:....................................................................................I.......................... ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOA W OF HEALTH 41DWAJ krz—,7* ..........................................OF.........................................................................Tntifirate of Toutpliattrr THIS IS TO CER,;El- .;-That thenJ�ividu age Disposal S7stem constructed or Re Y by--- .................................................................................................................................................................................... at......................... .............................................................................................................................................................................. has been installed in accordance with the provisions of TiTF ate Sanitary C the application for Disposal Works Construction Permit .... dated-...... ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. .......................... Inspector..... ....................... COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH &Q- ..........................................0 F....................................................................................... ............. FEE........................ Permission is hereby granted.....__YIAJ5� ........................... ............................................................................................ to Construct (11*,T"o'_r Reair a4.4" dividual SetWe Disposal System ............. .. ..... ..................... at No.----- ......................... .... .. ... Street as shown on the 4aplication for Disposal,.Works Construction Permit o..................... .... ....... ................. ................................................................. ........ ................. .... Board of Health DATE....................... .............( (Ct=0q' ........................../.............. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS TOWN OF BARNSTABLE s q LOCATION Co Cfa 'n Ca(soclu,s SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. o �, Dt�t��}1S 3��3 V,67 SEPTIC TANK CAPACITY Q Q LEACHING FACILITY:(type) /000 PO (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER , Est- DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No `� U h: t* y } q a 6 e? 3 l' No. ......... .....(./ full.....A.r.............._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF - HEALTH . .....................OF................................................................................................................................ Appliration for Disposal IV' - Tonstrurtion Vrrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: , ............ .......-............ ......�.......--•-•-...._. Location-Address • lz...� ..........__/-�-`• �.?� .._... �atr J ............................ or Owner L W ------------------------------------------------ _____________•-•-----------_-_-_______---------•-- Installer Address Type of Building Size Lot___�__0�2p�_:.Sq. feet U Dwelling No. of Bedrooms_.................................Expansion Attic ( ) (.�; ge Grinder ( ) '4 Other—T e of Building ___ No. of persons_____________________________ Showers — Cafeteria a Other fixtures _________________________________ Design Flow___,/1_-_'ems____________________________gallons pe per�ciay. Total daily flow.....................�............gallons. W WSeptic Tank—Liquid capacity/C.o.o..gallons Length._'........ Width... Diameter________________ Depth___......... x Disposal Trench—No_ ____________________ Width_____... _._._.... Total Length.................... Total leaching area... q. ft. 3 Seepage Pit No......../-------- Diameter_/D'__ Depth below •nle ��� .._ Total leaching area _ ft. Z Other Distribution box Dosing tankTF- '"' Percolation Test Results Performed b _ : _...___��.1� Date-•/__! .......... Y- - `'la Test Pit No. 1__-_, _A7-__minutes per inch Depth of Test Pit-----------......... Depth to groun water_.___.________.__._._... (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------------------------------------------------------------------•••••-----............---••=•.......................................................... 0 Description of Soil.',....... . ....... . x d-.... w -------------------------- VNature of Repairs or Alterations—Answer when applicable.___________________________________________________________________________________`..I :. Agreement: -'_1_1 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL 1 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss b� ign -- - -----------•-•-•---•----•-•- Application Approved By........... { s3__-.2�Da ............ Date Application Disapproved for the following reasons____________________________ _______________ ___ ____ ____ ___________________________ __ -------------------------------------=---------------•------•-------•-----•-------------•--•--------------•-•--•-....---_•• •--•• --•- Y.- ,.,• .r ate PermitNo................•--•----•-------------------•-•--• •-- Issued... Date --•--•• ---...--- .-------- ------------- F ( Y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.......................................................................................... Appliratio t for Disposal 10aAWTutuitrurtion Permit Application is hereby made for a Permit to Construct (' or Repair ( ) an Individual Sewage Disposal System at: 617 ......... .......... ........ ............................................. ...---•- --- ram.........----------- .. ............. Location-Address or Lot No. �C� Owner - ............................. _ �--... •- ---- ... Address a ••...............................................•..................... ..........-----------•--.............................---- Installer Address Type of Building } Size Lot_..._:� '._._Sq. feet U Dwelling—No. of _Bedrooms..»�__�.....................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Otherfixtures ----------------------------------= ------.. •--•---•-------•- --••-•----------------•---•-----------------...--------- WDesign Flow...!:'.............................gallons per-person per day. Total dai) flow____._.- _#_______._.____________gallons. WSeptic Tank—Liquid capacity-627-Pa.gallons Length.. _........ Width...,.' .-........ Diameter................ Depth"............ Disposal Trench—No. .................... Width..._..-,........... Total Length.................... Total leaching area.............. sq. ft. Seepage Pit No......../........ Diameter.�q.'..:' .... Depth below inlet.- -' ?-.._.. Total leaching area:...`....! ..sq. ft. Z Other Distribution box O` Dosing tank ( ) / f '� 7r'' '-' Percolation Test Results Performed by.. 'w' ' ?.. '. ^±?� � ____ Date_.f /ip4l4; a � 7------�----------------------- Test Pit No. 1.......<./.2-minutes per•inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •-- ........................................ --------------- .......................................................... O Description of Soil.. " ._ �' '% %:_ ...__ '� _ ---------------•----------•-- x W ------------•----------------------•---------•------•-•-•---------...:---'-----•-----------------------•...•-------------------------------------------•-•----.----------•..._.. -------------- V Nature of Repairs or Alterations—Answer when applicable - -----------------...._:__....-_--........................._-_-................._............. -•------------•------------------------------------•------------------------------....---...--•------....----•---------------------..............------•----------------------------.....----•-......... y Agreement:The undersigned agrees to`install the aforedescribed Individual ySewage Disposal System in accordance with the provisions of TITAIL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss t bo r slth. S'gned'; - --- -- ----------------- --------•------------------- ................................ Date Application Approved By----•------ -� : : �,= .t �+r�1 ;...... - Date Application Disapproved for the following reasons:...................... -----------------------------•---........................••.. .__......._._. ....................•------...---•--..........------------------------------------------.....-----------•---...--------•---••••-•----•---------------••-----------•-------------•-------------------•--- Date PermitNo..................................._..................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I ....OFoz'x�- 44- I- r�, ............................ • (Intifiratr of Tompliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( Of'or Repaired ( ) by......................7.......•------------------..........._...........................----nsc-•i�---------�..-----------....--------------------------------------------•-------•---- f ��c � � �j at....-- . .`-. ...... •- �r t• W 1 ld w - C da�t�t �" = .1" ..�........ has been installed in accorflance with the provisions of TIT F 5 of .The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__.. _ ............... dated.--...... -.A.2.-.7 ............ THE ISSUANCE OF.THIS CERTIFICATE SHALL:NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIQN SATISFACTORY. DATE... ----- Inspector. THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH ..............t. ;r!-� a....... %-.,o............................. 010 N0............... Q FEE................. .... ro Disposal nrk Tondr ion rrmit Permission is hereby granted.......... 11 ' to Construct Repa ( j)`a ndivl�l Sewage Dispo Sryst - at No..---.... �a 2t= 1 �i att -�.. .. 5 treet as shown on the application for Disposal Works Construction Permit-No____ ated_ a----7E .----- -- ---Boa o Health DATE............ 7 .....°................................. - - . •; FORM 1255 HOBBS & WARREN, INC., PUBLISHERS LO CAT.:ON A7 EW 2PRM1 NO. VILLAGE C -rv�.� I N S T A LLER'S NAME & ADDRESS /17I� 171�,Id%/? /r ylzrc B:UILDE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 3/ / �� 1 r. �. f / E 1 c �:, � _ � I ®� �� �; ��' ,� %'� �' / r � �� ,� ��' �� i .__�_: �- . w GENERA L NO TEE Ao�--� . I. A,G1.. EUE4.9T/DNS SHOWN ARE OA::/ 17,cl OF, -_- - - - 3' t�5 ,_ .—� j ,2• PITCH'Al,�, .G/NES A MINlkfl Al OF %8'lFT. 4 ��1 p G O O UN4ESS OTHERWISE SPEC✓F/ED. �3. 44L PIPES TO ANP IN THE 3YSTE•M SHAkA, . BE CAST IRO aR SCNE'DU+GE 40-PVC. 0 O .( 0 @ 0 � A/,�, SEPTIC TAN✓{S, O/STR✓Bi1T✓ON BOXES, Nt �tv+�t fi ® � O OO CD ,4NP 4EAG'HJNG PITS SHA4�, BE AES/GNED FOR H-ZO WHEEI- 40,WINGS WHEN , c _ �- `: ' C� (D 0000 0 UNDER PAVrNG. (� 0 0 0 0 t BENE',J TH T/qE INYElf 7 Ck CY,4 TIOA45 " ,r � « ;1: _ (D0 oO O a ( 0 Or/ME L��1r_ 0/7 :FOR A Pl.'57, CE of X Z /. 4NIMRY TEE' ;. 0 �.� JO � � T. � ID AN6✓ BACKFJ�C.�, WITH C�GAY:FREE , Ll (D0 ODD (DoSAND;9N,0 .GRAVE,(, HAY NG A PERG'O.✓.AT/DItJ r P/CrQ�. G�/STf�I UT�CJNA60X � TE. 4F. .� MINUTE'S PEh'"/NCH4R kEz8,< ,:T. - + �.. 6. THE ?�rclT BfJARD •OF HE A.(,TH NltlS7' uo �u�.-T�2 �]c.ou�lr�2�J� NOT TO SCA,C,E TYP/CA�. �C.V CN//1/G P/T t NOTE ©/STRIBUT/ON BOX AND Wa GA✓:,, NOT TO SC.gGE BE NOTJF/ED I� 1 N THE' SYSTEM/S NEAR ,. CBSE ?V4T/0N P1T%5, REINFORCED SEPTIC TANK BY Ck'F/��/NG: TYPICAL IWO G4L. SEPTIC. TANK h T N�,E E NO SS TE /, SY TE _, ,; ► .4�E/rR% AN P>4'ECAST OR E- UA.(. ' TO P Q �, S hf COifIP�ETION ANP PR/OrQ •. •U h flTHERW/S PERC4,GA770N RATE - L 4 Ntr.J� C Q NOT TO SC.I1,.E CO1fPDNENTS SH,444 ,BE INST.44LED IN OBSERYf1T/ONS BY-T r NOTE« TANKS REIN GDRCEI /fJROUGNOUT ACCOfs'PANCE 6Y/TfN. T/TEE Q OFTHk'STATE mod.�:►15Z". B'DARl� OF HEA,G TH - . W1.rH E4E'CrRIC WEI,P4,P ICY/�i'E PY1.rH.24,- YZ SANITARY COPE AND ANY �,OCA4, RU�,ES ENGINEER ARROW ENG/Nk-ERJNG INC t E�tf'BEd?PEl� STEED- RDC-'SIN TDP� e©TTO..�u. - eYHICH �.4Y ,gPF',�Y. MATE: CONC,.ETE /6 4,000 P.SI• TE"S/" NOTE• AGG E55 MAIVfI'O.[.ES 7"O SPT/� TAN.C� A n/D /-EACHINO PITS TO,B,E 341ILT UP TD E•,GEY, -4� ."Z /Z" 34,LO n/ F/N/SH 6P-40,E. f YNISH GRADE F/NISH GRADE Ol'�'R TANK FfN/SH GIr,4DE FIN15H ORADF OV,E-,2 - - , Alf P Ol'EFt'"P"'BOX E�EV E�EV' q2�2 c3�- a �!t+8 L,EAG/-IING PIT �_ %9'P,FA5TONE • / S© x, /NV= Q N v38+ o aa° oog NY� e90 ® 0 O° 0 lf� /aoo.G I SST. BOX O O O ° ooaoo �" a� r . A..C.. �E�r or�c D 0 p o 0 o a 0 �p CQU�R4,0 57iME pn V w .STAB,GEJ �° 0 ,0 a :o p�aQ . _. _ �� .. •CONCRETE • as a m v %S, f'7'✓C r,4NK m p © (D a a BOTTOM OF P!T (TO BE /WFl/Z4 C STAB,GE� IN!/= +� oo ,E/ !/ - i f�• ('?-0 SE ,LEV,E•L. 4 �5TAOLE) : TYPICAL SEI�✓AC� SYSTEM P�041"Il ..� d NOT T© scA�� - Tz> 4�uM(�Et�:e 1 f ► . . _ � P SEC T�aJv PARCE" "(g7 AvvR ss 93 3 JCo Lo j �4rJf , R7 p x' K1 dC PAS TiPICT F/.OQG.1-14 ZARI> p. .�•, } / - - 40 TA; ~ - n R 7 N R TFfi'l,A �C.E'GENO � Ph`' P4SE'D �GOC. T/ON 4 OIEZ /NG . K tom`: - .'.`y.�..�.'•. G�t. .c. •a"-' `r.r,,. ,.. _ _ / ,:, ,•^'•""°".'."s,,,,yy `�,.«. - , _ , EX✓ST. CONTOUR -- - --8rft , A A14I f84'R OA' BEDROOMS --'�— . '�` �'�. rr.-� .,. ate, SEW 6,E RUP064 cSY TE ple00,4' PROPOt"SEP CONTOUR ' w.: >- _ - . LOT , � , �4 �� •ems• - r / �. ,+ a` is t :. :at t : f3AkkoNS PEfi P��"iSON PER.PAY� ,EXIST vf�'OT E�(,EY.QT/ON c9 4 .p x ►t�. t LEA ER , RE©U!/°� D 3. ' PROPOSED SI�i3T E�C,EVATI4N 8 �?. .� - J Qi z ` ,_; x - . ,C.EACN✓NG F'Rc�l//DE•D. ��� PEfi'CO,G.�T✓ON 7'E'ST �' : . . , .4f'!',G/C,4/VT ENG//YE,ER x No P/ PC1SA�(, DBSE' 't�A�"I P✓T - S ON , tiOf Y. v� r� tit A' OW 46�/ I R l�� � C. .. ., .... \ •. .. : .-0.l:'.cam w^' ' . l �'��f� �E�S1GN -kJ/d•"L.:i•,I.^'Y+c.•/v ',../l.,C. r .. 5+ d7 ,.< ... 3 r BaT/ ©/rI .�,, L' : .� I 1 DRAvYN eY Cf✓ECit" 'G BY' HIPPO. "8 Y; P.�4N NO. ,� SEA 114 i) ' I GENERA L - NOTES , L AL A,. E EY /OIV 44YN ARE 0-AJ :4,V O 2. PITCH'A44, .LINE'S A MINIMUM` OF %8'1.rr •.: O O ( O 0 O (1) 5 0 UN4,CS5 OTHERWISE SPECIFIED, . 3 A,�.�. PIPES TO ANv IN THE' S-YSTEA�f SHAD. p rnrn@O O 1 BE CAST IRON 4R SC gtPME 4O PVC: O O : 4, ,444 SEPTIC TA1ViYS !O%STR/BUTTON SUXES c _ 0 0 . , __ u Nt ANP. ,G SWC'H/NG P/TS SHAG 4 ;BE PES/GNCP mm Jj MCf� r-` �-�, a r; : • - ". O O O O UJ O 4 FOR H-ZO lYHEE,G .COAhIN.G5 W.�IE%v fT - 00 O O o 0000 0 '' _ T. REMOYe .,44,.G 4INSUITABk C MATERIAA. 0 0 © O@O0) 00 H _ O -' RENEW r// THE' INVERT Ek,EY,4 RONS L-/_O-'� _� }� �: [ C� (/ O O O 0 (D � 4F THE �EAG�1. F-,T,'FOR A P/STANCE OF 1� k Z �9' =' ,, O Q� O OO /0SAND, BACKFILk WITH CLAY:FfEE E a S.4Nh.AN,O Gh",4 Mk fI,4YING A'PERCO,L•4TIC�N TYPICAL PAVRI$urr©n� : Box z8�c -� RA?'E OF:.� ti//Nl1T�S'. PER JNCH 0 �FSS 00 wA-r�z e-+JCou{._1-T-F_R_E:_D NOT TO SCA.[.E TYPICAL .( MCI�//NG P/T 6 THE �A�t157"' BOARD•of N�'.4�,rHR415T NOTE: P15TR/BUT/ON BOX ANP..&a GA1.; NOT TO SCA1-E BE'NOTiFIE.0 `YHE'N THE •5YSTFM l5 NEAR 06SER11,4T/ON PITS ,�E1NFoRCEP 6EPT1c rxNK ,eY CO.�P1,er10 VANP t�Rfor� To a,Mei1,41NAG: . -TYPICAL /G�o G.4�C.. SE'�'T/C TANK PERCO.LAT/ON RATE = t 2 ME;Jfioco AVER104N PRE•C,4ST 0/?' tQUAl, . 7 'Z/N.css •OTHE'ewlsE NOTED,,41,k•SYSTEM NOT TO SCA/,E COOPONENT5 SHA1,�, BE /NST,41,LEO IN OBSEfi't�.�lT/DNS BY:-To+ t M .�a� NOTEy TANKS 14E/1VFORCEO THROUGHOUT ACCO�h�1NCL' fy/Tl/. •TIT�,E' T�" Of TXE.STATE �A��a -1 BOAfs'O. OF HEA,GTH WITAI ELECTRIC WELhEO 11�/fi'� YYI TH,.Z4,- %Z'l ENGINEER ;ARROW &NG/NEEF'/NG INC. SANITARY COPE dNO A/YY ,OCA� RV1,ES E:lfl9El��Ef� S'TEE,�, R0,AS IN TOP� BOTTO•,N - PATE, &/Z%gam CONCRETE /S 4,000 P, S,/- 7-ES?° lrY�//Ch' .y1.4Y APP�Y " NOT,E•'ACC E55 IIAA fP0,LE570 SE•PT/C •ZAIV ��x< r..,FL . ANO L EAGI!/NG PITS TO B.6 Bl1lt..T LJP TO e4 EY, 45,2 /Z Bel-0W F/NA5h' G4AO,E. F%N/SH GRADE FINISH GRADE OYEIi' TANK FIN/ H Gl ,4PE ., OYE� 'v BOX F/IVISf-1 G,2AD,� OYE'2 ELEY. A2+P� E.CE-Y= q2+?- .�i1t8 L,EAGNING PIT c •F- g2r2 / N A a '1 , - , .. ' .,,,. •.r,• t. /Or ''�IJ /7 � ATONE _. o INK a3� a o0 0o 000. 00 o°o j ' , ..��. • . . - :G4.,�.. !S'T. BOX • . �Qo�o oOF 0 O O .m o 0 + t23RE/Nf01PCEv :: : ('TO B£,L.EYE� �$g C CONCrf,ETE ': - ti5T.4B,(E oa 0. O (J O CD o$ QUSfH,EO ;STONE O 0 � SEPTIC TANK /NV= �00 �,8 ® o BGtTTOMlOF P!T ' (TO BE .LEYE'x, F 5uBur) o 46 I,�-AG1-�iNG � `/T. A 2 _ = (TO 6E 4EVEL c• S rA 04 E) ' - • �2x� - o TYPICAL %5EWAC75 SYSTEM f R01c'l'L.E NOT- TO SCAL 19 � ,t3E kyvr� eq:c ►z3, 0 S'ECTiOIv f',4RCEL k&7' A OR SS .. LO a evx r R/CT F/.OQv•HAZARP .ZONE. vlsT ION: r , d 4 1 t • { • • PROPOSER OC /ON ^ r�Es/GN CR CITIA L EGIENv .��„ Y � S ,4 l OF PMEZ.4I NG ► , . NUihfBER OF BEPROO�MI$ EXIST, CONTOUR 6 . s � ���� . . ; � : PER�ulJNS P�'R SEG1�c'O tiY PRO/''OcSEP C`O/VTOURROBERT PAYWlfD ' G, : �a QAA,LONS PER PC9,50N PER aPAY EX. /ST door E`l,EVATION - di-0 '�;�; ,L£AC IN`G QL/IR Pif'OP05Ev SPOT E.GE!/.4T/ON 8 O, s ++ 46x, �C,EAeNING° PRO PERC04ATION TEST p t l`.'. .. 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