HomeMy WebLinkAbout0101 CURLEW WAY - Health 101 Curlew Way
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TOWN OF BARNSTABLE
LOCATION SEWAGE # 3S
VILLAGE r-O�U, t' ASSESSOR'S MAP & LOT 0.2 — 2
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY (6a(:-`�
LEACHING FACILITY: (type)
NO.OF BEDROOMS r'
BUILDER OR OWNER
PERMITDATE: I1 —3d--O L/ COMPLIANCE ATE: 12.
Separation Distance Between'the;._ T
Maximum Adjusted Groundwater Tabfe 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
.� 30
No. Feel "v
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
91pprication for Miopozal Opmem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System El Individual Components
Location Address or Lot No. 101 G& eiv w O C�
� Owner's Name,Add ss and Tel.N .
C J_k;,f__
Assessor's Map/Parcel ,art 0/'c
® -7
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
3 rV1612 io � `e
� s '54 L4 Kgj4 2,� �w �4_ ,
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Pers ns Showers( ) Cafeteria( )
Other Fixtures
Design.Flow ?J� 3 gallons per day. Calculated daily flow 3 gallons.
Plan Date,&A,2.= 36 DV.> Number of sheets Revision Date
Title
Size of Septic Tank /b oo Type of S.A.S. K�v
Description of Soil
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 provisio o e 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu by thsBoard a h.
Signed Date !"3v 6,V_
Application Approved by Date
Application Disapproved for the following reasons
Permit No go ` _� 3� Date Issued 11 3� `�
Fee ZL
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYication for Oi!5po'nt *potem Con!Wuction Permit
Application for a Permit to.Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor'sap arcel O/
Installer's Name,Address,and Tel.No. O`\ Designer's Name,Address and Tel.No.
3 t� Vvw2 i K)
Type of Building: r I ;
Dwelling No.of Bedrooms Lot Size� d' sq.ft. Garbage Grinder( )
Other Type of Building No. of Pers ns Showers( ) Cafeteria(/)
Other Fixtures € '
Design Flow gallons per day. Calculated daily flow 53 /Allons.
Plan Datey Number of sheets Revision Date
Title
Size of Septic Tank /h oo Type of S.A.S. A-d
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) I
Alt
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 -itle 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board!9He h.
Signed Date // 30- 6
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Qa��`'i! -"-� S Date Issued b G
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of C O li iiArL
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (c.r}Upgraded{ )
Abandoned( )by g�l�
at (ram ,.I.4t has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.?od t j 1* ?S7 dated_L4
Installer a P kA An Designer ,-,p
The issuance of this�ermit shall not be construed as a guarantee that the sys in will ful ti n as signed.
Date I OR 2 I)L� Inspector
ham. ,�' ,
No.�--L�`� —(J Fee',
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Migozal *rwm Cotvwuction Permit
Permission is hereby granted to Construct( )Repair 0-.-.Upgrade( )Abandon( )
Systemlocatedat 1/"�,L_ �i�? 4096c>
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Constru tion m st be completed within three years of the of of'th' rmi t
Dater Approve y
TOWN OF BARNSTABLE
i
LOCATION A SEWAGE # 2vU y-6 3S
VILLAGE.-O"��► �"' ASSESSOR'S MAP & LOT 0.2. — o/z
..
INSTALLER'S NAME&PHONE NO. n-W
SEPTIC TANK CAPACITY 6�Z7
LEACHING FACILITY: (type
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: I I 3d--0 LJ COMPLIANCE ATE: I
Separation Distance Between 1the..
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
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9/16/03
Notice: This Form Is To Be Used For the Repair Of Failed
Septic Systems. Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
I, 8-D W A rao 6r. A4c-u-4e ,hereby certify that the engineered plan signed by me
dated NvV. Z.v zooconcerning the property located at
GL.-iZZ4--w WA)� Mmzt�To vs_ "MLS meets all of the
following criteria:
• This failed system is connected to a residential dwelling only. There are.no commercial or
business uses associated with the dwelling.
• The.soil is.classified as.CLASS I and the percolation rate is less than or equal to 5 minutes
per inch. The applicant may use historical data to conclude this fact or may conduct deep
test holes and percolation tests at the site without a health agent present.
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will-be located no less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the
J �' I J ln' g
Frimptor method when applicable]
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information).
B) G.W. Elevation +adjustment for high G.W. _
DIFFERENCE BETWEEN A and B
SIGNED : S `7 DATE: !/ L Z®v-f
NOTICE
Based upon the above information; a repair permit will be issued for J bedrooms
maximum.. No additional bedrooms are authorized in the future without engineered septic system
plans.
q ASeptic\percexemp.doc
e
Town of Barnstable
Regulatory Services
Thomas F. Geiier,Director
MAS& r Public Health Division
•639 Rio .
E0 Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
• Installer & Designer Certification Form
Date:
Designer: 46-PW/w „ z_f• Installer: (cJ lyS V✓ MejR(/'l)
Address: 190Y, ._s"i Address: 7 S S A-
2-G3 7
On P Xa0�f1 was issued a permit to install a
date) (installer)
septic system at iai Cc-irCc-w w�,hi*vwnws Af/,54 s based on a design drawn by
address
iv ��.rC�u� izncs_ dated Moy; tv z0a4-
(design
ti/ I certify that-the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e. .
greater than 10' lateral relocation of the SAS or any vertical.relocation of any component
of the septic system) but in accordance with State& Local Regulations. Plan revision or
certified as-built by designer to follow.
� tH OF M,gss�� •
/ STEMN
fimR.
ta.tler i ature)
of
EDVOW VAIfpSu oQ
f
@ �gnY x Designer's Stamp Here)
'�f RED
PLEAS BARNSTABLE PUB L C HEALTH DIVISION. CERTIFICATE
OF COMPMANM WILL NOT BE ISSUED UNTIL BOTIH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PITUTIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Desiper Certification Form
h 3 -5
i
Commonwealth of MossuChusetts John Grad
Executive Office of ErMronmentat Affdrs D.E.P. Title V Septic Inspector
Department of P.O. Box 2119
Teaticket,MA 02536
EnvAro�nmental Protection (508 - 813
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR S d
PART A �O
CERTIFICATION t APR A D o 7 b
1 1997
Property Address: 101 Curlew Way Cotuit Address of Owner:
Date of Inspection:2f11197 (If different) Q �7N
Frick
Name of Inspector:JohnGracl
Company Name,Address and Telephone Number:
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
This Inspection Is based on criteria defined In Title v
X Passes_ code 310 CMR 15.303.MY findings are of how the system is
_ Condition Ily Passes performing at the time of the Inspection.My Inspection does
_ Need(bmit
e valuation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the
Fails septic system and any of Its components useful life.
Inspector's Signature: Date: 2113197
The System Inspector shall s copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A,B,C,or D:
A] SYSTEM PASSES:
X I have not found any information which Indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion
of the replacement or repair,passes inspection.
Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not.)
_ The septic tank is metal, cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is
Imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 11115195)
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 0 Telephone(617)292-5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 1o1 curlew Way Cotuft
Owner: Frick
Date of Inspection:2111197
_ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken,
settled or uneven distribution box. The system will pass Inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box Is leveled or replaced
_The system required pumping more than four times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
_ Conditions exist which require further evaluation by the Board of Health in order to determine if the
system is failing to protect the public health, safety and the environment.
SYSTEM WILL PASS UNLESS BOARD OF HEALTH 1) DETERMINES S
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
_ The system has a septic tank and soil absorption system and is within a Zone 1 of a public water
supply well.
_ The system has a septic tank and soil absorption system and is within 50 feet of a private water
supply well.
_ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private
water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm.
3) OTHER
D] SYSTEM FAILS:
_ I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary,to correct the failure.
_ Backup of sewage in facility or system component due to an overloaded or clogged SAS or
cesspool.
_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
cesspool.
SAS is in hydraulic failure.
(revised 11115195)
2
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: t111 Curlew Way Cotult
Owner: Frick
Date of inspection:2J11197
D]SYSTEM FAILS(continued)
_ 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).
Numbers of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria:
_ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
_ the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a
public water supply well)
The owner or operator of any such
ull compliance with the groundwatr
eatment
requirements of 314 CMR 5.00 and 6.00m shall system
Please consult thelocal regiona f l office Department the partment for rfurthe Informartio. program
(revised 11115195)
3
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 1ol Curlew Way Cotult
Owner: Frick
Date of Inspection:2I1197
Che
ck if the following have been done:
X Pumping information was requested of the owner,occupant,and Board of Health.
x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
X As built plans have been obtained and examined. Note If they are not available with NIA.
X The facility or dwelling was Inspected for signs of sewage back-up.
x The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components,excluding the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered,opened, and the Interior of the septic tank was Inspected
for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
X The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11115195)
4
s
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 101 Curlew WayCotult
Owner: Frick
Date of Inspection:2J11197
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 330 gallons
Number of bedrooms: 3
Number of current residents: 4
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available: Ma
Last date of occupancy:n1a
COMMERCIAL/INDUSTRIAL:
Type of establishment: Na
Design flow:U gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present:(yes or no) No
Non-sanitary waste discharged to the Title 5 system:(yes or no) No
Water meter readings,if available: n1a
Last date of occupancy: n1a
OTHER:(Describe) n1a
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped in the last two years.
System pumped as part of inspection:(yes or no)Yes
If yes,volume pumped:1000 gallons
Reason for pumping: Maintenance.
TYPE OF SYSTEM
x Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source information:
1989
Sewage odors detected when arriving at the site:(yes or no) No
(revised 11115195)
5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 101 Curlew Way Cotult
Owner: Frick
Date of Inspection:2I1197
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 16"
Material of construction:X concreate_metal_FRP_other(explain)
Dimensions: L 8'6"H 5-7"W 4-IV
Sludge depth:7"
Distance from top of sludge to bottom of outlet tee or baffle: 20"
Scum thickness:3"
Distance from top of scum to top of outlet tee or baffle:6"
Distance form bottom of scum to bottom of outlet tee or baffle: 15"
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to,outlet invert,structural integrity,
evidence of leakage,etc.)
Septic tank and all components are structurally sound.Recommend pumping septic system every two years for maintenance.
GREASE TRAP:
(locate on site plan)
Depth below grade: n1a
Material of construction: _concrete_metal_FRP_other(explain)
Dimensions: nfa
Scum thickness:rda
Distance from top of scum to top of outlet tee or baffle:n►a
Distance from bottom of scum to bottom of outlet tee or baffle: n1a
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
nla
(revised 11115195)
6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 101 Curlew Way Cotutt
Owner: Frick
Date of Inspection:2111197
TIGHT OR HOLDING TANK:
(locate on site plan).
Depth below grade: n1a
Material of construction:_concrete_metal_FRP_other(explain)
Dimensions: nla
Capacity: n1a gallons
Design flow: n1a gallons/day
Alarm level: n1a
Comments:
(condition of inlet tee,condition of alarm and float switches, etc.)
nla
DISTRIBUTION BOX: X
(locate on site plan)
Depth of liquid level above outlet invert: Liquid level with bottom of pipe.
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.)
Distribution box Is structurally sound.
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
nla
(revised 11115195)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 101 Curlew Way Cotult
Owner: Frick
Date of Inspection:2111/97
SOIL ABSORPTION SYSTEM(SAS):x
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present, explain:
nfa
Type:
leaching pits,number: 1-leachptt0'x4'
leaching chambers,number:nfa
leaching galleries,number: nfa
leaching trenches,number, length: nfa
leaching fields, number,dimensions:nfa
overflow cesspool,number:nfa
Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
The leach pit is structurally sound and functioning properly.
CESSPOOLS:
(locate on site plan)
Number and configuration: n!a
Depth-top of liquid to inlet invert: nfa
Depth of solids layer: nfa
Depth of scum layer: nfa
Dimensions of cesspool: nfa
Materials of construction: nfa
Indication of groundwater: nfa
inflow(cesspool must be pumped as part of inspection)
nla
Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
nla
PRIVY:_
(locate on site plan)
Materials of construction: nfa Dimensions: n1a
Depth of solids: nfa
Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
nfa
(revised 11115195)
a
SUBSURFACE SEWAGE DISPOOSAL RT CSYSTEM INSPECTION FORM
SYSTEM INFORMATION(continued)
Properly Address: 101 Curlew"Colult
Owner: Frick
Date of Inspection:2111197
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
9-3
r
a
n62 � Q
A a�
AD 34
A S5
� 33
DEPTH TO GROUNDWATER
Depth to groundwater,12 feet
method of determinalion or approximation:
USGS Maps and Charts
(revised 11115195)
U
Ai
Commor wedth of Mos=hUseifs John Grad
Executive 0Mce of ErMron mintai Affairs D.E.P. Title V Septic Inspector
P.O2119
Department of at*c et A 02
Environmental Protection Te 5108 et,MA(�2536
� (508) 5G4-(R13
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR '
PART A
CERTIFICATION Rf�EIV�-� , �
FEB �,�
Property Address: 101 Curlew Way Cotuit Address of Owner:
�9
Date of Inspection:2111197 (if different)
Name of Inspector:John Gracl Hfq�jp�; �F
Company Name,Address and Telephone Number:
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
X Passes This Inspection is based on criteria defined in Title y
code 310 CMR 15.303.My findings are of how the system is
_ Conditionally Passes performing at the time of the Inspection.My Inspection does
_ Needs Fu her valuation 8y the Local Approving Authority not imply any warranty or guarantee or the longevtty of the
Falls septic system and any of its components useful life.
inspector's Signature: E Date: 2113197
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B,C,or D:
A] SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion
of the replacement or repair,passes inspection.
Indicate yes, no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not.)
The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiitration,or tank failure is
imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 11115195)
One Winter Street ,a Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
1
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 101 Curlew Way Cotult
Owner: Frick
Date of inspection:2111197
Sewage backup or breakout or high static water level observed in the distribution box is due to a broken,
settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
—The system required.pumping more than four times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
_ Conditions exist which require.further evaluation by the Board of Health in order to determine if the
system is failing to protect the public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
ER SUPPLIER,IF APPROPRIATE)
2) THAT WILL
IIS FUNCTIONING BOARD
IN A MANNER THAT PROTECT THE DETERMINES
SYSTEM E PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
_ The system has a septic tank and soil absorption system and is within a Zone 1 of a public water
supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water
supply well.
_ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private
water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm.
3) OTHER
D] SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Backup of sewage in facility or system component due to an overloaded or clogged SAS or
cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
cesspool..
SAS is in hydraulic failure.
(revised 11115195)
2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 101 Curlew Way Cotult
Owner: Frick
Date of Inspection:2111/97
D] SYSTEM FAILS(continued)
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).
Numbers of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria:
_ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim*Wellhead Protection Area (IWPA)or a mapped Zone II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11/15/95)
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CH ECLIST
Property Address: 101 curlew Way Cotult
Owner: Frick
Date of Inspection;2111197
Check if the following have been done:
x Pumping information was requested of the owner,occupant,and Board of Health.
X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
x As built plans have been obtained and examined. Note if they are not available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components,excluding the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered,opened,and the Interior of the septic tank was Inspected
for condition of baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge, depth of scum.
X The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11115195)
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 101 Curlew WayCotutt
Owner: Frick
Date of Inspection:Y111197
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 330 gallons
Number of bedrooms: 3
Number of current residents: 4
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available: n1a
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL:
Type of establishment: r9a
Design flow:9 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present: (yes or no) No
Non-sanitary waste discharged to the Title 5 system:(yes or no) No
Water meter readings,if available: n1a
Last date of occupancy: rVa
OTHER:(Describe) Na
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped in the last two years.
System pumped as part of inspection:(yes or no)Yes
If yes,volume pumped: 1000 gallons
Reason for pumping: Maintenance.
TYPE OF SYSTEM
x Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source information:
1989
Sewage odors detected when arriving at the site:(yes or no) No
(revised 11/15195)
5
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PAR
T C
SYSTEM INFORMATION(continued)
Property Address: 101 Curlew WayCotult
Owner: Frick
Date of Inspection:2111197
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 16"
Material of construction:X concreate_metal_FRP_other(explain)
Dimensions: L 8'6'H 5'7"W 4'10'
Sludge depth:7'
Distance from top of sludge to bottom of outlet tee or baffle: 20"
Scum thickness:3-
Distance from top of scum to top of outlet tee or baffle:6"
Distance form bottom of scum to bottom of outlet tee or baffle: IV
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
Septic tank and all components are structurally sound.Recommend pumping septic system every two years for maintenance.
GREASE TRAP:_
(locate on site plan)
Depth below grade: n1a
Material of construction: _concrete_metal_FRP_other(explain)
Dimensions: n1a
Scum thickness:n1a
Distance from top of scum to top of outlet tee or baffle:n1a
Distance from bottom of scum to bottom of outlet tee or baffle:n1a
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
n1a
(revised 11/15195)
ti
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 101 Curlew Way Cotult
Owner: Frick
Date of Inspection:2111197
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: nia
Material of construction:_concrete_metal_FRP_other(explain)
Dimensions: n1a
Capacity: n1a gallons
Design flow: n1a gallons/day
Alarm level: n1a
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
n1a
DISTRIBUTION BOX: X
(locate on site plan)
Depth of liquid level above outlet invert: Liquid level with bottom of pipe.
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.)
Distribution box is structurally sound
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
nla
(revised 11115195)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 101 Curlew Way Cotutt
Owner: Frick
Date of Inspection:2111197
SOIL ABSORPTION SYSTEM (SAS):x
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods).
If not determined to be present, explain:
n1a
Type:
leaching pits,number: 1-leachpite'x4'
leaching chambers,number:n1a
leaching galleries,number: n1a
leaching trenches,number,length: n1a
leaching fields,number,dimensions:n1a
overflow cesspool,number:n1a
Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.)
The leach pit is structurally sound and functioning properly,
CESSPOOLS:
(locate on site plan)
Number and configuration: n1a
Depth-top of liquid to inlet invert: n1a
Depth of solids layer: n1a
Depth of scum layer: n1a
Dimensions of cesspool: n1a
Materials of construction: n1a
Indication of groundwater: n1a
inflow(cesspool must be pumped as part of inspection)
n1a
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
n1a
PRIVY:_
(locate on site plan)
Materials of construction: n'a Dimensions: n1a
Depth of solids: Na
Comments:(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
nla
(revised 11/15195)
8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 101 Curfew WayCotuit
Owner: Frick
Date of Inspection:2111197
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
•s
r
a
A C
�� 3h
g g 33
�C �� L
DEPTH TO GROUNDWATER
Depth to groundwater:12 feet
method of determination or approximation:
USGS Maps and Charts
(revised 11115195)
9
TOWN OF B.ARNSTABLE
LOCATION 7- J U ,L c=uJ 44 4 SEWAGE 10 2.
r
VILLAGE 7/,> ASSESSOR'S MAP & LOT 'Zq - ) Z-
.`
INSTALLER'S NAME & PHONE NO. � 77F -0// Z_
SEPTIC TANK CAPACITY j O a O 9/�
LEACHING FACILITY:(type) 16,eg elf (sue)
NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE .COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
r
33
zs
F
RZ),
'�'�4�6"E RMP NO. 024
NIRCEL N,0.- 012 -7,
No....K . FEB................*.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN 0 F BA RNS T AB LE
...... .. .................. ....
Apphration for Bhqpaaal Works Tonotrurtion "ermit
V
Application i herel2y made for a Permit to Construct ( X) or Repair an Individual Sewage Disposal
System at: 11 Lot 1, Curlew
_&bEmZZ: . ..... ................Lot....I.......................................................................
----------—-----------------------------tio'n... ...dress------- ----T y Lot No.
Coy's Brook ReLATty rust 24 Forsyth Ve. , So. Yarmouth
......... ..... ........ .........
Owner 7 Address
Installer Address
------------------- -------- ----------
'n
u
PQ 43,561 ...Sq. feet
1� Type of Building Size Lot.........................
U 3
Dwelling—N70f Bedrooms............................................Expansion Attic Garbage Grinder ( )
P4 Other—Type of Building ........................... No. of persons............................ Showers Cafeteria ( )
Otherfixtures ..........................................................................
Design Flow...........................................gallons per person_p er day. Total daily flow........................330.....................gallons.
04 Septic Tank—Liquid capacityltOO�allons Length... ...... Width...4.'_.1.0!!_ Diameter................ Dep
, I th...
Disposal Trench—No. .................... Width-.:................. Total Length.................... Total leaching area------.............sq. f t.
1 81011 11
Seepage Pit No--------------------- Diameter.._............. --- Depth below inlet_............._._................ Total leaching area..................sq. ft.
z Other Distribution box ( X) Dosing tank ( )
Percolation Test Results Performed by.-P,---aulli.ya'n-3ax-Ler... ........... Date...LQ/26/"a4- -------------------
aa
Test Pit No. I.........2-----minutes per inch Depth of Test Pit...1-4-'.0..1
...... Depth to ground water...NJA..............
114 Test Pit No. 2................minutes per inch Depth of Test Pit._-_................ Depth to ground water.---.---__......._.._...
9 Test Pit #1
K"i...ii............ ...................*-----------------------**........",""....... ---------- --------------------------
0 Description of Soil............ 2 0 Loam & Subsoil
.. ..... .................. ......... .. .........
�4 2 0 ii 3'6 Co mDa ct ed Sand & Clay_...
............................................I....................I............................................. . ... ...........................................*-------------------------------
-------------------------- ...........3...6......-...5.-6 Clqy................... ..Medium--$
.......... _gad..........................
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'THE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
,L_�
operation.until a Certificate of Compliance has b4eeni ue
jbthe boardiealth.
Signed_= . 7
.... ...........................� Date
Application Approved By...................<�,. ...............10/ *-&
..............................
Date
Application Disapproved for the following reasons:................................................................................................................
.........................................................................................................................................................................................................
Date
Permit No............. ?.- /o I- Issued.............. ...a-7.......
....................................
Date
024
012
No .:.. �._ Fss......................
THE COMMONWEALTH OF MASSACHUSETTS
o .
BOARD OF HEALTH
TOWE
..... O F...........BARNS'TABLE...
t
Vpfiratiun i f ur" hipusal Works Tonutrurtiun "amit
Application is hereby made for a Permit. to Construct ( X) or Repair ( x) an. Individual Sewage Disposal
System at
......-.ot l.... Ct3x-1 i7vi�� �...� 77/7"............ - - -----••. ---- -- --• •------•---•---....-•---
....
Location Address or Lot No
N Cov's Brook.Realt 'I' >'ae 24 Forsyth Ave Spa Yarmouth
J11,,f&J,�^ Owner Address
W 4f T�. c..�
Inst3 ler Address
Type of Building Size Lot _ ......._____._Sq. feet
Other Type oof Building ooms � No. of persons
Attic _ Showers Garbage Grinder
Dwelling,— P ( )
__,_ ) — Cafeteria
a' Other fixtures ..
•----- ---------------------• -•---•------•----------•.-------------
Design Flow.............................. _____:.:_.gallons per person per day. Total daily flow____._._ 3 gallons. .
W tt •*f t1i
R: Septic Tank—Liquid capacity 3. allons Length _ _$-6___._ Width__.�t_Q__10._f't Diameter......... ___. Depth___ ...
Disposal Trench—No____________________ Width __ Total Length.................... Total leaching area---_____________. sq. ft.
Seepage Pit No______ ___________ Diameter at P 9 tt g q
. ..�._.-_.___ De th.below inlet.�._0__..._.____ Total leaching area________________s ft.-
z .Other Distribution box ( X) -Dosing tank
~' Percolation Test Results Performed by.... ,,.. , -.. ,?� ^__ ,_ __._____._. Date_:_�026 ?44:.... .....:..
Test Pit No. 1._:_____ .:._minutes per inch . Depth of Test Pit <h��°1?�0____. Depth to ground water....NIA.
(s, Test Pit No. 2..._............minutes per Inch Depth of Test Pit____________________ Depth to ground water...............
a Tc i� P ..............................................................................................................
.:
O Description of Soil...........DrVOn Jk�J. ad I-•-•---•---•---------------
x •-•- ?V.0 ..» z ee s(� s� t 4 ..............................-•----•---•--------• ---_-
---•- a Fo ,� tlF Clay � n .� 001
..._of .&.MA.--••-------- ----
„ r
V Nature,of Repairs or Alterations=.Answer'when applicable........_..............................
Agreement
Tlie`ttindersigned agrees to install the:aforedescribed Individual Sewage Disposal System in accordance with '
the provisions of T IE 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 _ ---•-•--••-•-•••-------------- --• ------- - -. -
----_. ._.... •• .....
Uts�'c Date ;
ApplicationApproved By...............••. .......................................................................... _ -----------------------.---
Date
Application Disapproved for the following reasons=-..........------------------•-----...-•-----------=----------•---------------------•--•-•-----•-- -------
•-----•----------••----•--••-•--••----•------•-------•------...---•-••-.........................................................-------•--•---...•-----•--•-•--------••- •--•-•-•-••------•----•-•-
Date
PermitNo...............................I....----.:...----=-------- Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
.BOARD OF HEALTH
.................... ?IN............OF...........................BARNSTABI�......,......_.........._...
VErrtif iratr of- Tautphattrr
H'�IS T _ RTIFY, That the Individual Sewage Disposal System constructed ( } or Repaired ( }
- l4(�ll� .z
by...... ... ....................
-• ..
-•V.) Installer �� l
at...................-•--................................................_..__._._.... .......- -----------------------•------•._...__......--•--•---•-----•--------• ----- --•=•---
has been installed in accordance with the provisions of TT_ i_ 5 f Thel SytZ_Sanitary a� Pc in the
application for Disposal Works Constriction Permit No__________________:_____.___________.__._ dated__...____._.__/____._..____......................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY. A
DATE.------••-----------•---------------•--.... ,.. -- Inspector__...-•--- u-_ -
u
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
c , 7 .z T41�i BARNSTABLE
I C� ..........................................OF................_.__._.._.._..._._....._......__....._...........__....•-•--.........
No......................... FEE........................
iu ru A $ dun trttrtiun rrMit
Permission is hereby granted,-••-------------•=............ ................ ..................................... ....................................................
to Construct ( ) or Repair 1( )„an Indi xidual eewa e Dig3spl,Systel� �j ,j,
as shown on the application for Disposal Works Construction Permit ..y
�-.
PPP - ._..-------: Dated------ ------------•-----...............
•--------------•--•-----------------•----------------------------------------•••---------..._------•..._
Board of Health
DATE------------------------------ •---•---•---- ...............
FORM 1255 HOBBS & WARREN." INC.. PUBLISHERS _ -
TOP OF•FOUNDATION
CONCRETE COVERS
4'CAST IRON 9, �
OR SCHEDULE . 4"SCHEDULE 40 P.V.C. (ONLY) 12"MIN.
�. P.V.C.PIPE MIN. PIPE-MIN, A. LEACHING FIELD (.J.REDLIIRED)
rid PITCHI/4"PER.F1 PITCH 1/4-PER-FT �t�R IA"-1/2 WASHED STONE �'EG,2.7•CIN /
f„
� • GAS BAFFLE
EL.. so7 SEPTiC TANK INVERT 6 E INVERT WASHES/4M—II/2"STONE �r
,'• INVERT /000 GAL. INVERT
EL y�:.�7 EL 27:/9 DIST. INVERT INVERT
[,83 7•�/
BODC EL.z..........
• ; 6" RU HED ........S NE ovtw- 9•6
� � t°R•isTi�/G �
PROFILE OF 30
SEWAGE DISPOSAL SYSTEM GROUND
UNDWATER
AE CROSS So
SOIL LOG NO SCALE LEACH i N G FI ELD
TIME Z:�� hiy .• NO SCALE
TEST HOLE I TEST HOLE z DESIGN DATA
ELEV.. 3i oo . .. ELEV. 3�°R I
,3
NUMBER OF BEDROOMS . . . . . . .. . . . .. .. . . ..
r z � r �� Z3� TOTAL' ESTIMATED FLOW . . .. . . .. . ... GALLONS/DAY 4"
S �,. 6 iiij
7 BOTTOM LEACHING AREA .4So...... SOFT/TRENCH
f So /
Qq sf«YtZ �2.7G 83 SIDE LEACHING AREA . . Moa/F .... . SO.FT./TRENCH G-.3/4=11/2"
�. z�.d¢
GARBAGE DISPOSAL % AREA INCREASE) WASHED
STONE
TOTAL' LEACHING AREA 4So . .....: SO.FT. 3 r 3 ' 3' 3' �r ovez
SAaID S�rD 1-01
PERCOLATION RATE . .. ...,er►�T4w Nr�t PER.INCH
- LEACHING AREA PER PERCOLATION RATE ;3 3:c. SO.-FT
` rr r TABLE
GROUND WATER TA E
/D$ oo /o8 L2.22.00 APPROVED .. .. . . . . . . . . . .. BOARD OF HEALTH
. ?..WATER ENCOUNTERED DATE..... .. ..... ..... . . . . . . . . . . �°° OF
AGENT OR INSPECTOR E
�$ d
WITN ESSED BY :
. . . .. BOARD O Y
v,
!o/ C�r1lNw W �1ti#1vSTavS / S No. 26100
lzDWAKa Gl; c''" Y ?1?LS, ENGINEER
/�SSe°3SoAZS MAP l¢.P/1JPtZ 0/L s/DMAL IST
LA�d�'
. . . . . . .. . . . . PETITIONER
NoTLs— �jus/n/G Gor�/ST7ZcJc.�'ioN TJljdr' A/~
- W/l.L •OE GoC*4w&v /•rives PLAw
OF Mqg i
o� S
- 3
a
Q o
3�I/08 /3 gyp
� Z
i
o J �y
l D
o
Lcr9c q Fjc-r a
� / ;T '�'X.3a'
J�J sue
/.
3c
C P /q
y
• i
f1l14_"
TOP OF FOUNDATION
CONCRETE COVERS
•3,43 r 17
AST IRON 9"MAX ��CHEDULE 40 4"SCHEDULE 40 P.V.C. (ONLY) 12�MIN. /.PIPE MIN. PIPE-MIN. t'8& LEACHING FIELD (.1-REOUIRED)
HI/4"PER.Fi: PITCH 1/4"PER.FT. A, IA"-1/2 WASHED STONE ,/'�L a7•G/
. , I wv,RY
GAS BAFFLE " INVERT wASHEO " "STONE �..
SEPTIC TANK 12�_RT 6 E�z�.oy 3/4 —11/2
:. INVERT EL....:3k
:. EL27.•�z r/000 GAL. INVEER / DIST INVERT INVERT
EL...7._9 Box EL.24,83
6" RU HEO S NE r / ov�w $7 6'
PROR LE OF 30
GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM TYPICAL CROSS SECTION
SOIL LOG No SCALE LEACHING FI ELD
DATE � ���.. TIME.Z:���� .. NO SCALE
TEST ELEV.H3 °0... .. TEST H /oo, DESIGN DATA .
ELEV.. " I/qp�
12 MIN. WNUMBER OF BEDROOMS . . 3 .. . . . . Se . . . .. all
s TOTAL' ESTIMATED FLOW , , . . .„ GALLONS/DAY S d 4"SCHED LE 40 �„
4 Coq;�pf ��' 60A 80TTOM LEACHING AREA .'f:f?!...... SO.FT./TRENCH ATED
f'. So
Q� SfC94Yz. ALL.ZL 83 SIDE LEACHING AREA . . Noti/E ... SO.FT./TRENCH L3/4" IV2".
�. U.J¢ n/oNG� o -
GARBAGE DISPOSAL ... . . . . ..(50 /o AREA INCREASE) WASHED
M&VI Mev/ STONE
09 -
TOTAL LEACHING AREA . .'�So . .....: SOFT. J 1 3' 3' 2 , ovez
S<MlD CSA?+D PERCOLATION RATE �?s?H' ? 9.M^�' PER.INCH iS 9•L
LEACHING AREA PER PERCOLATION RATE ;jJ•3;Q. SOFT
GROUND WATER TABLE
/o8rr ey,zz:oo_ io8� a,22,00 APPROVED .. . . . . . . . . .. BOARD OF HEALTH
..Y9� . ... .
..WATER ENCOUNTERED — — — — DATE . .. ... .. . �P� OR
.
AGENT OR INSPECTOR �d�+ E
WITNESSED BY
. . . .. BOARD OF HEALTH . . . . . . LoT d . . . . . :. a LLEY
No. 26100 $�
.l.DWAKa Gs;�CG4G /?1?Ls� ENGINEER , r�i.�71NW .W/ ,j,1�1/.ITo/VS ,LS y nJ, '�fCigtER�`�
"- ' � /�sSeSsoAZS,M� Z¢.,PnF�Z OlL s�aAL LAN��'
. . . . . . . . . . . . . .. . . PETITIONER WRLT�rp,T. .
NO DWaINC ca vsr7z4.o*Ca-.ow 7hl& A/~ sysrr�
Goc,4sesv 14wv 14ivD A5_aw,L7 RZA w
sTEr
R. N ,� 4
Q
of �►���' b'
EVALOp�O�
3 -
391• / - -
a
3e,•
Kr e— 1 \ ( \ Id
&a 1AfC
i W � PRopeseb p
28'—
4
i �,T
�3 srj roe Cr�-
30
//A7Flo
q i
•
PROFILE DESIGN DATA SOIL TEST DATA
no scale Remove impervious material (below -�
inletl a distance of to it in all Number of Bedrooms 3 Date of Test! IJ- 2G� - 8� P 37 c.9
Top of Finish Grade Finish Grade directions from leaching pit . Estimated Flow: 33k� gpd Tested by: P Skiiicezi)-i - ba)e_t?a - �vr<
Foundation r-El v `> !•��' Elev _�� U Backfilt with clay-free sand.
EIev a, Finish Grade Slope P % Septic Tank Required : 4-1)5 gal Witnessed ey. :1�rYs Con--tor,
Finish Grade EIev L O'
Eleu 31 J' � - Septic Tank Provided: I.coO gal Q PERCOLATION TEST
Depth of Test: I �'
Inv - Leaching Facility Provided
4'sch 40 PVC' Rafe' 2 min , in
Z % Slope MIN 25 O H 10 Precast Concrete Type ` L��c1�
Leaching Pit Number- I TEST PIT DATA
Inv 1 Dimensions 4' x !Z" Test Pit 1
Elev +�-2 in Layer 1/8 to /2
�q•p 4'sch 40PVC .j Inv-- Inv °etc''% Washed Stone Leaching Capacity Required. 33(� gpd Depth EtQv
2- % Slope M►►) lny� Inv EI v Dist Box Elev :a"� �,s:
O 3t • p'
Elev�- Z .,O
27•g3 �,�„ - ,,,,,f Leaching Capacity Provided
Elevoutlet pipe
2i •�•. , y �, •.d,, 3/4' to 1-1/2` Bottom: 113 'sgf t X I.G gpd'sgft 115 gpd
level for firs# ,;p.�,, �` -•• •� Washed Stone =4"_ 2 0' Com ed Sand_ . �la�
2 it �• •} o ;•,•.;� Sidewal t: 150 sgft X 2.5 qpd/sq.fJ 375 gpd - - 9•. P j
H-10 Precast Concrete Total: +68 gpd 3-tn Z Cla
IoOG gal Septic Tank �� y
W/ 2,CManhole Covers �;•� Bottom of Leaching Pit
Raised to within 12 of �-�--- Etev 21.c�' Garbage Grinder .wilt not be. used
Finish Grade (when } _ 6' 3 4min Breakout Calculation:
req'di
ZZ.5
USGS ESHWT Elev Observed Water Depth. loi�e E1ev:
Bottom of Test Pit Elev I �.C�' BENCH MARK USGS ESHWT Elev,
Description: 7co p o f Co^nC�-te e bao�id ® Test Pit 2
Elevation: 30.0 (Aj�u► ed ) Depth Elev
BAKER .� LEGEND
il 31 CB,FND. 30 --- — — Existing Contours
Q p ' Proposed Contours
1A/
�� Water wService
/O•�= ` Septic Tank
Z3 W B.A,I• ®. , ✓ Dist Box
;CB. FND, col)/
Leaching Pit
� � , , � � � Reserve Area Obse, vecl Water Depth! Elev:
L4 , ` Q =" `JSCS ESHWT Ele,r:
4' Lj) ...
c',) ("�� _ , JOB NUMBER: 701 ,.- MA` HPE � y
��x �� 1 REFERENCES p7 Tr;. :'r -�.
L_0 T � � �• � ` 1 I ��_—� i 1 DATE: 2- a - .- , � _ ,l LINE /
I Plan Reference �� 3 REVISIONS- 412` j', 7 %-LCT /
/10 CONSTPUCTIONC� ck 398 F4�3c ( �. >
Assessor's Map 02.4- Fav-c.ei 017 US 7 4-' x t2' LE14CN/N<, PIT-
Zoning District RF To AVO10 F�EiiO✓ALCF CL,IY
HOUSE U///GARAGE Side,. Setbacks Front 30' ► �l _-
=0 2 0' " ' . .
Back 2a' /
Flood Hazard Zone C
"I, o FIA Map Z5ool oO21 r. Dated 8 - 19- 85 �� Z
"
z9
P �Il. � z� � � r �N• ,_� � ��� NOTES z
i
1. All installations shall conform to the minimum requirements ( LOCUS
28 L(77 ( of State Environmental Code,Title 5,and the Town of say g tabl
Board of Health.
2. Prior to backfil ling,notify Board of Health for inspection. SEWAGE DISPOSAL SYSTEM
r 3. Any changes to this plan must be approved by the Board of DESIGN
" 1 Health.
4, NC
on. LOT / for: COY F1;OCK I .
. '
CUFL
11,A
/ Ile COT(J�T� MAY S4YAFMUUTH VA..
�' ��'�� ► , ASSESSORS MAP 0'
PA9'CEL 0/2
29 + y! -_ . .-- N 72 a 07 C�,,. _� _� p - 10 J� R 77 S.77- - r � ,
i i
�. ` - L � +
- ' ��_ .,ram �++• ....,• ..•..
C'U L- E V/ Ufa � � _50 �'V/DE
u*.i GIF L.
p LOMISAR00
SRNMRY �s
No ° 3
i.
PL ' scale 24 Forsyth Ave S Yarmouth MAA '.,., 16171398 5215
/ "= 30'
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