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HomeMy WebLinkAbout0049 CAP'N ISIAH'S ROAD - Health 49 Cap'n Isiah's Road Cotuit: P A - 038 069 t' Commonwealth of Massachusetts W Title 5 Official Inspection Form , ^� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 49 Capt. Isiah's Rd. Property Address Tracey Kramer Owner Owner's Name' information is Cotuit Ma. 02635 9/20/2007 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered.in any way. Y Important: A. General Information When filling out forms on the computer,use only the tab key 1. Inspector: 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 reran City/Town State Zip Code (508)428-4028 S 14454 Telephone Number License.Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is.true, accurate and"complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310.CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ N Z Further Evaluation by,the Local Approving Authority c-D �..; 9/20/2007 ; r- Inspector's Signature Date '' 1 ry The system inspector shall submit a copy of this inspection report to the Approving Au liority(Board of Health or DEP)within 30.days.of completing this inspection. If the system..s 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 se t to the systerttowner and copies sent to the buyer, if applicable, and the approving authority. c-- r-- ****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. 49 capt.isiahs rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 49 Capt. Isiah's Rd. Property Address I Tracey Kramer _ Owner Owner's Name_ information is required for Cotuit Ma. 02635 9/20/2007 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. 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 pipes)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 49 capt.isiahs rd.-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealthrof Massachusetts . ' Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 49 Capt. Isiah's Rd. Property Address Tracey Kramer Owner Owner's Name information is required for Cotuit. Ma. 02635 9/20/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) J B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. . 1. System will pass unless Board of Health determines in accordance with 310 CMR 1-5.303(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. 49 capt.isiahs rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 49 Capt. Isiah's Rd.. Property Address. Tracey Kramer Owner Owner's Name information is required for Cotuit Ma. 02635 9/20/2007 every page. City/Town State Zip Code Date of Inspection B. Certification '(cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 failut/e criteria are triggered. A co of the analysis must be 99 copy Y 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 El ® 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 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 49 capt.isiahs rd.•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 f Commonwealth of Massachusetts W 'Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 49 Capt. Isiah's Rd. Property Address Tracey Kramer Owner Owner's Name information is required for Cotuit Ma. 02635 9/20/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ E Any portion of a cesspool or privy is within a Zone 1 of a public well. El ® 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. 49 capt.isiahs rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 49 Capt. Isiah's Rd. Property Address Tracey Kramer Owner Owner's Name information is Cotuit Ma. 02635 9/20/2007 required for 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? El ® 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 forsigns 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: w Z 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)] 49 capt.isiahs rd.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 49 Capt. Isiah's Rd. Property Address Tracey Kramer Owner Owner's Name information is required for Cotuit Ma. 02635 9/20/2007 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: 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: 3 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 ,000 :96 Water meter readings, if available (last 2 years usage (gpd)): 2002005:9689,000 Sump pump? ❑ Yes ® No Last date of occupancy: I 9/20/2007- Date Commercial/Industrial Flow Conditions: Type of Establishment: I Design flow (based on 310 CMR 15.203): canons per day(gpd) Basis of design flow (seats/persons/sq.ft.,etc.): Grease trap present?_ ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date,of occupancy/use: Date Other(describe): � r 49 capt.isiahs rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 49 Capt. Isiah's Rd. Property Address 1 Tracey Kramer Owner Owner's Name information is required for Cotuit Ma. 02635 9/20/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Capewide Enterprises,LLC Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? '. measured Reason for pumping: maintenance 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): r Approximate age of all components, date installed (if known)and source of information: 1987 Were sewage odors detected when arriving at the site? ❑ Yes ® No 49 capt.isiahs rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 49 Capt. Isiah's Rd. Property Address Tracey Kramer Owner Owner's Name information is required for Cotuit Ma. 02635 9/20/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 44"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain)-. 10'+ Distance from private water supply well or suction line: 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): 4' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) I If tank is�metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No --------------------------------------------------------------------------------------------------------------------------- Dimensions: 8'6"x4'1 0"x57' Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle na Scum thickness 0 Distance from top of scum to top of outlet tee or baffle na Distance from bottom of scum to bottom of outlet tee or baffle na How were dimensions determined? tank pumped empty 49 capt.isiahs rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 49 Capt. Isiah's Rd. Property Address Tracey Kramer Owner Owner's Name information is required for Cotuit Ma. 02635 9/20/2007 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.): Pump tank every 2-3 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. I 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 4 Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection.) (locate on site plan): Depth below grade: \ Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): 49 capt.isiahs rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 L Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �,M s•'' 49 Capt. Isiah's Rd. Property Address Tracey Kramer Owner Owner's Name information is required for Cotuit Ma. 02635 9/20/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow; gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No D-Box found. 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 49 capt.isiahs rd.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 49 Capt. Isiah's Rd. Property Address Tracey Kramer Owner Owner's Name information is required for Cotuit Ma. 02635 9/20/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): " l Soil Absorption System (SAS) (locate on site plan, excavation not required): 0 If SAS not located, explain why:— Type: ® leaching pits number: 1-6'x6' ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology. - ICI 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.No ponding or damp soil. Note:Leaching pit water was 26"to invert pipeat time of inspection.No higher stain lines observed. / 49 capt.isiahs rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 I Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 49 Capt. Isiah's Rd. Property Address Tracey Kramer Owner Owner's Name information is required for Cotuit Ma. 02635 9/20/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of.vegetation, etc.): 49 capt.isiahs rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments 49 Capt. Isiah's Rd. Property Address Tracey Kramer Owner Owner's Name information is Cotuit Ma. 02635 9/20/2007 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference.land marks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. , � 97 + 4 3 , f r �l�may;'iet+',.+�b1 7 - " t`f_�' ♦ � - r � . + . , + , + • 49 capt.isiahs rd.•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Capt. Isiah's Rd. Property Address Tracey Kramer Owner Owner's Name information is required for Cotuit Ma. 02635 9/20/2007 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 ground water: Bottom of pit 35'+- - 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:Gaherty&.Miller Model 12/16/94 ground water elevations. Used:USGS observation well data June 1992. Used:Technical bulletin 92-000-01 plate#2 annual ranges of ground water elevations. 49 capt.isiahs rd.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Town of Barnstable F THE Regulatory Services vWnBLE : Thomas F. Geiler,Director MASK. 9�'ArEi0.jg `- � Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. 51152�j COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r MAP o'3� PARCEL O LOT TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 49 Capt.Is%iah's Road Cotuit MA 02635 RECEIVED Owner's Name: William Hersey and Lisa Clark Owner's Address: Same SEP 112003 Date of Inspection: September 4,2003 TOWH� BARNSTABLE LTH DEPT. Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: (508)428-1779 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 Further Evaluation by the Local Approving Authority Fails �I Inspector's Signature: �c �e,.,tkg Date: m 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. Notes and Comments: Tank in good condition,Liquid level in leaching pit 6-7" below inlet pipe. ****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 I Page 2 of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 49 Capt.Isaiah's Road,Cotuit Owner: William Hersey and Lisa Clark Date of Inspection: September 4,2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: XX_ 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: .Page 3 of I l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 49 Capt.Isaiah's Road,Cotuit Owner: William Hersey and Lisa Clark Date of Inspection: September 4,2003 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 I 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: -Page 4 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 49 Capt:Isaiah's Road,Cotuit Owner: William Hersey and Lisa Clark Date of Inspection: September 4,2003 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ _X_ 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. _X Any portion of a cesspool or privy is within a Zone I of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ 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 forma 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 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. 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. A Page 5ofII OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 49 Capt.Isaiah's Road,Cotuit Owner: William Hersey and Lisa Clark Date of Inspection: September 4,2003 Check if the following have been done You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ _ Has the system received normal flows in the previous two week period? _ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ — Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ 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? _X _ 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 _X_ _ Existing information. For example,a plan at the Board of Health. _X_ _ 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)] Page 6 of l 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 49 Capt. Isaiah's Road,Cotuit Owner: William Hersey and Lisa Clark Date of Inspection: September 4,2003 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:3 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no):No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 2001-137,000 gal. 2002—105,000 gal.=331 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMM ERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,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: Last pumped two years+/-ago. Source of information: Owner 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 _X_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: Permit date:1I/1/87 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Capt.Isaiah's Road,Cotuit Owner: William Hersey and Lisa Clark Date of Inspection: September 4,2003 BUILDING SEWER: X (locate on site plan) Depth below grade: 8'(under slab) Materials of construction:_cast iron X_40 PVC other(explain): Distance from private water supply well or suction line: 20' Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: X (locate on site plan) Depth below grade: 5' Material of construction:—X—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: 8'long x 5.2'wide—1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:29" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle:7" Distance from bottom of scum to bottom of outlet tee or baffle: 15" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tank In eood condition.Inlet tee and outlet baffle intact and clear.Liuuid level at bottom of outlet Invert.No evidence of leaks GREASE TRAP: No (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.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Capt.Isaiah's Road,Cotuit Owner: William Hersey and Lisa Clark Date of Inspection: September 4,2003 TIGHT or HOLDING TANK: No (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/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: No (if present must be opened) (locate on site plan) D-Box not shown on as-built probed area to check for box,not found. Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: No (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.): 0 Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Capt. Isaiah's Road,Cotuit Owner: William Hersey and Lisa Clark Date of Inspection: September 4,2003 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 4x6(600 gal.)pit 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.): Liquid level in Ieachine pit 6-7"below Inlet pipe with a high water stain 2"above standing water. CESSPOOLS: No (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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (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.): Page 10 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Capt.Isaiah's Road,Cotuit Owner: William Hersey and Lisa Clark Date of Inspection: September 4,2003 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. 844 150,�m)s w� 3y 3Z 39 + Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Capt.Isaiah's Road,Cotult Owner: William Hersey and Lisa Clark Date of Inspection: September 4,2003 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 30 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: Checked with local excavators,installers-(attach documentation) _X_Accessed USGS database-explain: Topo maps and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows groundwater below el.20 and topo map shows property above el.50. No..,31=347 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............1O.W.6............ ............................... Appliration for Disposal Works Qlanstrurtion 1hrutit V Application is hereby made for a Permit to Construct ( /) or Repair an Individual Sewage Disposal System at: % ..L*....51-26.p.%n...r_]Falab_�l...Rd.............. ............. .................--------------------- X,o t, :.Address or 1-1 No. ............... r ......qa_.(ne.<x .......................... ............... .........ZL....al.. YC, Address Installer Address Type of Building Size Lot-O....2....4_69Q..Sq. feet Dwelling—No. of Bedrooms.--.......................................Expansion Attic Garbage Grinder P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria P4Other fixtures ...................................................................................................................................................... Design Flow.................5.t).................gallons per person per day. Total daily flow................55.0.............eWlons. Septic Tank—Liquid'capacitMj(X?.gallons LengtO!;�.Lf"... Width.4 JO.". Diameter.5�1'%... Depth.tT..11.I Disposal Trench—No..................... Width..............._.... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No.......I............ Diameter..10..10.2.... Depth below inlet.Z?.'.9........ Total leaching area..OL&...sq. f t. Z Other Distribution box (V'j Dosin tank i +( dI.W.V.e................................ Date.q.Q.0C...1'1,11bl. Percolation Test Results Performed by.Ut7y_E. ..... Test Pit No. I................minutes per inch Depth of Test Pit...1.4........ Depth to ground water..O.Q.0.1ce...... fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............___....._... QiIt .............................................................................................................................................................. 0 Description of Soil.o.. ....��o !� h..*..6.................................................................................................. ry - - ...X...amanq ---------- ... t......................................................................................................... .............................................................................................................RO.....9ML)f)AQM_e_K�....eab.O.A Ecd...... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b hnissuedd.by th oa d f ,, Signed....... .. . ....... /> D;7 ApplicationApproved By---..-- . ....10... ... ........... ......... . ..... ....................Date.- .............. Application Disapproved for the following reasons:..........................................................................................................__ ..................................................................................................................................................................................................... Date Permit it No.---- _7.:.3.5...7................... IssuedL..................................................... Date c No. .1.:.3.1__7. Fps..., ,.a..... THE COMMONWEALtTH OF MASSACHUSETTS i BOARD OF HEALTH Appliration for Disposal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct (v) or Repair ( ) an Individual Sewage Disposal System at: -- - ----------------------------------------------------•-------•-• -----.......... :........--------------------•--...-••-----------............---- Location-Address( .................................. - or Lot No.------------------•--•----...•.....-•----. ---------- Ownerer Address W Installer Address d Type of Building Size Lot�2q C ©...Sq. feet U Dwelling—No. of Bedrooms..._._--�.................... .Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ....----•-----•------------ W Design Flow.................... ........._.___..gallons per person per day. Total daily,flow.................. ...___......gallons. WSeptic "Tank—Liquid capacit}�1-�_Pv.gallons Length IU.�-.__. Width.-.'_.�U-... Diameter...��._..____ Depth�-�----_�_.... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......I------------- Diameter.•-----_.©_...._ Depth below inlet�___�._...-... Total leaching area__��=�.o�....sq. ft. Z Other Distribution box (V) Dosing tank ( Percolation Test Results Performed by- .r'.V_N-!�e----------------------•_...._.._ DateU .__.� _�lb �._. Test Pit No. 1................minutes er inch Depth of Test Pit._ i Depth to ground water. ..................... (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 11 ........... --............................................................................................................................................... 0 Description of Soil.._' ............................ '.. ___':S b5U t x ------------------- U ��- 4!}W''...._.( !2c1�um �'d.....................................................__.._....................................... x i0 ��o nd fie --.. a me«c...... V Nature of Repairs or Alterations—Answer when applicable................................................................................._............_. -----------•---•------------•---------•--------------------------------••-----------.................---•-------•--------------------------------------••-•----------------------------••--------•.•---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIS 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... .......................... Application Approved BY---•- Date t= �1....a - `= ""' ": ---•-•----••------•..........--•---. Date Application Disapproved for the following reasons:............................................................................................................. ..............................••--•--•-....•..----------....----•---------•--------------------------.••- Date c� 7 Permit No._.. .. .:_.. %-...---••-.. ..................... Issued_....................................................... / Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .:.: Ii �:G:' i-............OF. A.(a. r ...:....... ..... ("arrtifiratr oaf Tv'm:p'fiattrr"*­ THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) --------------•------------------------................--....------.........••-•--•-••-•-•---- L Installer at............�.o.. - --- ....... ta.......... !a- — ? _�1.. `�.--•-----_.- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._%2_-..... ;__l__ ....... dated.............................:.................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....................�.�....-_. . '. ............................ Inspector..................... t C THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.. :_-�. ...... ..::r:':`'�—: ....OF......f.:�: .^......::�-.. .. ...... ......................................l � FEE ..?......' Disposal Works T.unstrnrtiun amit Permission is hereby granted-•--- �J.��.Z: ,r �-r---•-•-----•----•--•................ to Construct (k') or Repair ( ) an Individual Sewage isposal System Street as shown on the application for Disposal Works Construction Permit N __3 _7.._ Dated.......................................... ....................•------•-- ff . . ......................................... DATE••---/ /'� = Board of th FORM.. 1255 HOBBS & WARREN, INC., PUBLISHERS y9 TOWN OF BARNSTABLE LOCATION Via[ �Cc Zidlt4 SEWAGE # ��?1 / VILLAGE l ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. W�NZ,2 SEPTIC TANK CAPACITY $� LEACHING FACILITY:(type) Ila 0i (size) H NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER, L 6�I&tC /,C/?,, DATE PERMIT ISSUED: 8/1 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No b� � o 1 -�v w 1 „` 5 YS TEM PROFIL E NOT TO SCAL E TOP FDN. FINISH GRADE 74 . B FINISH GRADE OVER EL .75.50 o FINISH GRADE OVER DIST. BOX a8. 5 FINISH GRADE OVER SEPTIC TANK r 'Z LEACHING PIT- :Q.:o VARIES p, o:° e. •o e....e.;..a:•.:;•o o::o:°:e. a:e�.''':e'',: :e .;� a!;:a ep 3" OF ? ?/2" !2" JAW ASHED PEASTONE ST CONC. OR 3„ ...e.•. .o... BRICK C MORTAR ° OUTLET PIPE LEVELHA �: ' 4 FOR 2 FT. MIN. TO 12" BEL OW GRADE 00 �,. e; a ro5.53 �o5.4'J :::•:• :..°•... ;;o.o;:o: .,;..o:o: :o ro .a, o•,.;po: °. C. I. OR PVC TEES Gl5. 2<0 b• D e: Igo' e. '0• ,e'o'.'p'' a :D:' 'e '�• '1 1000 GALLON BSMT. FLR. e n DIS TRIBUTION BOX o EL .CP8.00o'• •o' �: .•o :b •v 6 PRECAST CONCRETE o• INSTALL ON LEVEL BASE o a: 3/4" TO ?-1/2 PRECAST ' Op o::u'.•e. °.•°:o: d WASHED o i °' H— l 0 REINFORCED a CRUSHED I e CONCRETE 6: e.°,o• ,e•o-o•.o•..e:a :a:o,o,o.b:p•, p• :°.o p'.e:.::.a' 6 'o.'• b o:o. STONE •s ', .b;,o;•o. b:.o.p�.o:o•'O•o:o e.,•o••o,'•;o.b••e.o• o•:o•o•.• .o:.•p•. o•b.•p:: L• '� H— /0 REINFe n ' SEPTIC TANK �:6 :a'• o:l ' INSTALL ON LEVEL BASE NOTE.' EXCAVATE TO ELEV.55.SfOR ° °• ; a°O. .op-••o• c: —•, , LOWER TO REMOVE ALL IMPERVIOUS - — `' =MA TERIAL BENEA TH THE L EA CHING AREA 2 '-0 " 2 '-0 " REPLACE EXCA VA TED MA TERIAL WI TH 6 '-0 " ` CLEAN, CLAY FREE SAND 10 '-0 " EFFECTI VE DIAMETER v ti J 7�' Go LEACHING PIT 0� GENERAL NO TES r- INSTALL ON LEVEL BASE 1. AL L EL EVA TIONS ;SHOWN ARE BASED ON A SSUMED 2. ALL PIPES IN 'THE SYSTEM MUST3E CAST IRON OR SCHEDULE 40 'PVC. OBSER VA TION PIT - - G4 S8 3. THE BOARD OF HEAL TH MUST BE NOTIFIED 4 ` s. 0 WHEN CONSTRUCTION IS COMPLETE PRIOR BAXTER 6 NYE 0 6�' PfiE ST CONCRETE G6 ,' �' 0 .0 TO BA CKFIL L ING PERCOLA TION RA TE.' P�h`6� LEAC ING PI T : p �O 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED 2 MIN./IN. BY THE BOARD OF HEALTH AND CAPE 6 ISLANDS WITNESSED BY.' 6g H* 6 2 SURVEYING CO ,-ING. R. GIFFORD \ �4 5. MATERIALS AND INSTALLATION SHALL BE IN COMPLIANCE W T TH THE STA TE SA All TARY 100 GALLON BARN. BRO. OF HEALTH DESIGN DA TA ` 1 � q� PREC ST-C cRETE SEPT TANK Lo T 50 CODE TITLE V AND LOCAL APPLICABLE DATE.' ✓UNE 19,GG 198? RULES AND REGUL A TIONS NUMBER OF BEDROOMS 3 �p 6. NORTH ARROW IS FROM RECORD PLANS AND 0 �07. 8�-- . L ��p i io 8 IS NOT TO BE USED FOR SOLAR PURPOSES GARBAGE DISPOSAL NO 10 _ �� ?O TOPSOIL 6 d¢,a - -� �, 7. FL 000 HAZARD ZONE C DAILY FL ON 330 !iA L . B, WA TER SUPL Y TOWN WA TER SUBSOIL P 1000 GAL . ' 36" SEP TIC TANK REG 'D. -vim• SEPTIC TANK PROVIDED74 1 D00 GAL . LEA CHING REQUIRED 330 GPD. 74 7 2 MEDIUM SAND SIOEWALL AREA 113 S.F. 74 70 113S.F.X 2. 5 G/S.F. = 281 GPD BOTTOM AREA 79 S.F. z L EGEND 79 S.F.X 1. 0 G/S.F. = 79 GPO L EA CHING PRO VIDED = 360 GPD �rNa► 6 8 PROPOSED EL EVA TION 144" NO GROUNDWA TER E LOT 52 N�. -- -ro -- EXISTING CONTOUR SINGLE FAMILY `RESIDENCE 6 OBSERVA TION PIT LOT 5 1 ❑ DISTRIBUTION BOX �`� �qc� RA ,nnnMB w PROPOSED SENA GE DISPOSAL SYSTEM 20, 0005 os �� C, QERTRAND N E,4,CHING PIT 9F' 29890 PREPARED, FOR 91.E°S2'� o o S PTIC TANK NAMES GUILD 74 9 0 5 - �8 (RPi RESERVE �,� rf9�� LOT 51 CAP 'N ISIAH 'S ROAD °A"'° BARNSTABLE MASS. 70 CHAFi`FS SANNOKI 72 .QQ PIPE INVERT ELEVA TION 23035 Go DA TE: I 1567 �FG/STFR� �� CAPE 6 ISLANDS SURVEYING, INC. PLOT PLAN s�'0AL LANDq� � SCALE AS NOTED P. O. BOX 334 SCALE.' ? --- _- - PLAN NO. 57787 TEA TICKET, MASS. 31