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Home My WebLink About0161 EISENHOWER DRIVE - Health 161 Eisenhower7�� V� Cotuit A= 039-127 —�� - - -- -- - — - - - - - - Jul 23 2017 21:41 HP Fax page 1 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �''• 161 Eisenhower Drive Property Address Z Albert Wilbur Owner Owner's Name information is required for every Cotuit MA 02635 7-14-17M page, CityJTown State Zip Code Date of Inspection ^' Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling A. General Information out forms on the computer, H10F uhgrirr' use only the tab 1. Inspector: �.�`y�`�•• ssy4% key to move your ; n , cursor•do not yG James D.Sears �: JAMES N' use the return s m ke Name at Inspector ='_ 0; SEARS y' Capewide Enterprises t-.�r •*` Company Name �r�•..RT I f�0 153 Commercial Street INS*PE�' Company Address unumw ram Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number "r B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority c� Q-el,vne-4-1 ct-' 'ice 7-21-17 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. l5ins,doc•ray.5116 Title 5 Official Inspetilon Form:Subsurface Sewage Otsposel System•Page 1 of 17 �0 Jul 23 2017 21:41 HP Fax page 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 161 Eisenhower Drive Property Address Albert Wilbur Owner Owners Name information is required for every Cotuit MA 02635 7-14-17 page. City/Town State Zip Code Dale of Inspedion B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: Note: Outlet tee has a filter. The system is a 1000 Gal.Tank D Box and two roods of six chamber's per row. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old'or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): 15ins.doc-rev.5116 Title 50flicial Inspection Form Subsurface Sewage Disposal System-Pop 2 of 17 Jul 23 2017 21:41 HP Fax page 3 N Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 161 Eisenhower Drive Property Address Albert Wilbur Owner Owner's Name information is required for every Cotuit MA 02535 7-14-17 page. City/rown state Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpslalarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation Is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ina.doc•rev.6116 Title 5 Official Inspection Form:6Lbsurface Sewage Disposal System•Page 3 of 17 Jul 23 2017 21:41 HP Fax page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 161 Eisenhower Drive Property Address Albert Wilbur Owner Owner's Name informrequire for Cotult MA 02635 7-14-17 required for every page. City,(Town State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must Indicate"Yes" or"No"to each of the following for AH inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to.-an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in is less than 6" below invert or available volume is less than %day flow),CA Q11W P t5ins.doc•rev.6118 Title 5 Of clal hisWbon Forth:Subsurface Sewage Disposal System-Page 4 of 17 Jul 23 2017 21:41 HP Fax page 5 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 161 Eisenhower Drive Property Address Albert Wilbur Owner Owner's Name Information is required for every Cotuit MA 02635 7-14-17 page. cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria Indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] El ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system falls. 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rey.W16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 I Jul 23 2017 21:42 HP Fax page 6 Commonwealth of Massachusetts RN p Title 5 Official Inspection Farm ow Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 161 Eisenhower Drive Property Address Albert Wilbur Owner Owner's Name required�fo �s Cotuit MA 02635 7-14-17 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? ❑ ® 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 NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Jul 23 2017 21:42 HP Fax page 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 161 Eisenhower Drive Property Address Albert Wilbur Owner Owner's Name informatlon is Cotuit MA 02635 7-14-17 required for every page. City[Town Slate Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal Tank D Box and two row's of six chamber's per row. 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes (Z No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No 2015-8,000Gal's Water meter readings, if available(last 2 years usage(gpd)): 2016-45,000Gal's Detail: Sump pump? ❑ Yes ® No NA Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(9Pd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.U16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Jul 23 2017 21:42 HP Fax page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 161 Eisenhower Drive Property Address Albert Wilbur Owner Owner's Name information is required for every COtUIt MA 02635 7-14-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ InnovativelAl tern ative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): i t5ins.doc•rev.V16 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page S of 17 Jul 23 2017 21:43 HP Fax page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 161 Eisenhower Drive Property Address Albert Wilbur Owner Owner's Name information is required for every Cotuit MA 02635 7-14-17 per, Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2009 Permit#2009-353. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2' feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 14 feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal.Precast H-10 Sludge depth: 1" t5ins.doc ray.6116 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 9 of 17 Jul 23 2017 21:43 HP Fax page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 161 Eisenhower Drive Property Address Albert Wilbur Owner Owners Name information is required for every COtUIt MA 02635 7-14-17 page. CftyfTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 1711 How were dimensions determined? Asbuilt-Plan-Tape Sludge Judge 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 at working level. Tank and outlet cover at 14" below grade. Inlet cover under deck. No sign of leakage or over loading. Note: Outlet tee has a filter. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: pate t5ins.doc•rev.Sit Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Jul 23 2017 21:43 HP Fax page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 161 Eisenhower Drive Property Address Albert Wilbur Owner Owner's Name information is required for every Cotuit MA 02635 7-14-17 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.).- Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc-rev.Sh6 Title 5 Official Inspection Form:Subsurface Sewage Disposal stem•P 1 � 8 P Sy Page 1 of 17 Jul 23 2017 21:43 HP Fax page 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Ego W� Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 161 Eisenhower Drive Property Address Albert Wilbur Owner Owners Name information is required for every Cotuit MA 02635 7-14-17 page. City/Town State Zip Code Date of inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): D Box is 16"x16"-42" below grade w/cover at 15". Box is clean and solid w/two line's out. Inlet line has a tee. No sign of over loading or solid carry over. I Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order. ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): ' If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t6ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Jul 23 2017 21:44 HP Fax page 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 161 Eisenhower Drive Property Address Albert Wilbur Owner Owner's Name reformation is equired for every COtUIt MA 02635 7-14-17 page, City/Town State Zip Code Dale of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 at 30' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativelaltemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 12 (36 HC Biodiffuser stoneless). Leaching is two row's of six chambers per row. Ck D Box and camera out to chambers. Chambers are clean and dry. W/no sign of over loading or solid carry over, 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 15ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Jul 23 2017 21:44 HP Fax page 14 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments g 161 Eisenhower Drive Property Address Albert Wilbur Owner Owners Name informationrequired is Cotuit MA 02635 7-14-17 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): 16irta.d=•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systen•Page 14 at 17 Jul 23 2017 21:44 HP Fax page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 161 Eisenhower Drive Property Address Albert Wilbur Owner Owners Name Information is required for every Cotuit MA 02635 7-14-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System; Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet, Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately S��e�fNs� Li g O C7 I 13-9- 3 4• 3 - 3f7 � 3 [Sins.doc-rev.6116 Tide 5 Moat Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Jul 23 2017 21:45 HP Fax page 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 161 Eisenhower Drive Property Address Albert Wilbur Owner Owner's Name information is required for every Cotult MA 02635 7-14-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells No Estimated depth to high ground water: 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: 10-13-09 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on Design plan 10-13-09 10'+ no G.W.. Bottom of leaching at 4' below grade. Bottom of leaching at 6'+ above T.H• Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ims.doc-rev.6116 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Pape 16 or 17 Jul 23 2017 21:45 HP Fax page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 161 Eisenhower Drive Property Address Albert Wilbur Owner Owners Name information is Cotuit MA 02635 7-14-17 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doe•rev.6l16 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION t to ' S e km UmY' D C, SEWAGE# DF - 3 s-3 -VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&.PHONE NO. ei i F L{Zf W at SEPTIC TANK CAPACITY /000 14 to ' xt s l m LEACHING FACILITY.(type) (122,) /1,0,-n 14te 3(, (size) 0) 3K 30 NO.OF BEDROOMS e� OWNER a PERMIT DATE: 1, ' Top COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility !V4 / 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 CApia, R� o25%A a R5 y,� aI ,O"L 83 A o B y S 39 , O . i No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpYitation for bisposai *pstrm Construction permit Application for a Permit to Construct( ) Repair k- Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. , �� Owner's Name,Address,and Tel.No. , � , Assessor's Map/Parcel -3 G`j ]2, `�� ` v Y Installer's Name,Address,and Tel.No.64p. ., Designer's Name,Address,and Tel.No. 3 cam.z�3 Zg f� ta•�.d,�,,.y 1��,.,� . e_ �h�°-�"`i C_ Type of Building: Dwelling No.of Bedrooms 3 Lot Size '70, 3-1 sq.ft. Garbage Grinder( ) Other Type of Building 5 LtA UY L„ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 3 6 .3 gpd Plan Date 1 012jo09 Number of sheets ( Revision Date Title Size of Septic Tank tcic>0 C,jjj 4U. i S Type of S.A.S. 5"n1y'¢ 03 13 L.t7•V't--, 13es.L�� Description of Soil L° `� 3c`� l Nature of Repairs or Alterations(Answer when applicable) CZ' k\ TVyl k -M Y-- j c, L SCU 5, 1 2- T-OS\AL 3c_ 1.4( Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issuerbyithis Board ofe Date 1 i t 0 Application Approved by Date Llzvq Application Disapproved by Date for the following reasons Permit No. Date Issued iF r��,. -..._,.....:.._.+.�+...er..�.trr+�+i., isir...;x:w:s.w*-.�.�•:�. .....-..:..............—..-*.-....,:-�:....,--.:..r.-��,,.,;:.-.a.+:-.....-.-'----....-w-...-..--".---.........,._-..-.�..�nw.i^ied++'r�7�r�,93fisr.Y-'�.%�.a�-a"-.^-"^" i._'I. _--�;-�. • <Yl No. a Fee "�' �, Entered in computer: THE�COMMOI��IVEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS, application for Misposal Opstent Construction permit Application for a Permit to Construct( ) Repair x Upgrade({ ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (p( t1� l4,•_,� Owner's Name,Address,and T N Tel. o. S f Assessor's Map/Parcel 3 /2 � 1 e F C 0 3 o 3 i z Installer's Name,Address,and Tel.No.C4 �;� ,� �� Designer's Name,Address,and Tel.No. �a 3� ? �3 ZrGr{ C�a,,S�.f, i w SC Type of Building: Dwelling No.of Bedrooms 3 Lot Size -70 8 32 + sq.ft. Garbage Grinder( ) Other Typelof Building S L%,e L y 1-a.r•,la No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 3 q 6 .3 gpd Plan Date 1 ► ) 3120 o 5 Number of sheets Revision Date ,. Title l Size of Septic Tank (Oo c) c 4I Q r_5 Type of S.A.S. (—) S•tul-e-kc) Description of Soil Nature of Repairs or Alterations(Answer when applicable) �z e_l�ss ✓c,r.�., f Z tu�Z%qL 3(. 1.4( Date last inspected: S A ' Agreement: They undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in •a accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Signed Date Application Approved by Date Application Disapproved by LL Date for the following reasons Permit No. Date Issued o- THE COMMONWEALTH OF MASSACHUSETTS � BARNSTABLE,MASSACHUSETTS Certifitate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(cj[) Upgraded Abandoned( )by �f t C�c 0,q i ) f_ at (—d 4-.- c� has been constructed inaccordance with the provisions of Title 5 and the for Disposal System Construction Permit No.oc.y/ dafed �`' LO Installer C -{j r r9 > �^ Designer cL.29-t, #bedrooms Approved design flow —S ;—45 C) gpd The issuance of thi permit shall not be construed as a guarantee that the system will fmic ate � as�designed. p D ) Inspector 1 _ CEO �- 5- .,;..1 ==- �) No. Fee QY THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal Opstem Construction permit Permission is hereby granted to Construct( ) Repair Q) Upgrade( ) Abandon( ) System located at R(o l V and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction ust be ompleted within three years of the date of this permit. /�7� U] r Date Approved by TRANS. NO.: CITY/TOWN: Cotuit APPLICANT: ADDRESS: 161 Eisenhower Drive, Cotuit,MA DESIGN FLOW: 330 gpd REVIEWED BY: DATE: N/A OK NO y � GE� 6", �R�4L� Legal boundaries denoted [310 CMR 15.220(4)(a)] X Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] X Locus Provided [310 CMR 15.2204(t)] X Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] X Easements shown [310 CMR 15.220(4)(b)] X System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] X Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] X Location all buildings existing and proposed 310 CMR 15.220(4)(c)] X Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] X System Calculations [310 CMR 15.220(4)(f)] X daily flow X septic tank capacity (required andprovided) X soil absorption system (required andprovided) X whether system designed for garbage grinder X North arrow [310 CMR 15.220(4)(g)] X Existing and ro osed contours [310 CMR 15.220(4)(g)] X Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] X Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] X Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] X Percolation test results match loading rate? [310 CMR 15.242] X Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] X Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] X Address 161 Eisenhower Drive, Cotuit,MA Sheet 1 of 7 N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] X within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply X within 250 feet of the proposed osed system location in the case X within 150 feet of the proposed system location in the case of private water supply wells X Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 C_N4R 15.220(4)(1)] X Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) X Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] X Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] X Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] X Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] X Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] X Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] X Benchmark within 50-75' of system [310 CMR 15.220(4)(g)] X Materials specifications noted? [various sections of 310 CMR 15.000] X System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] X Address 161 Eisenhower Drive, Cotuit,MA Sheet 2 of 7 N/A OK NO Size OK? [310 CMR 15.223(1)] X Inlet tee located ten inches below flow line [310 CMR. 15.227(6)] X Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] X Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] X Note regarding installation on stable compacted base [310 CMR 15.228(1)] X Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] X Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] X Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] X Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] X Access to within 6 " of grade - one port for systems<1000gpd, two for systems >1000 gpd [310 CMR 15.228(2)] X All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] X > 10 ft from building foundation [310 CMR 15.211 1 ] X Buoyancy calculation Required/Done [310 CMR 15.221(8)] X H-20 Where appropriate? [310 CMR 15.226(3)] X Setbacks from resources [310 CMR 15.211] X MultCompartm n't anlsHuR,r, kWWWWONNN, Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] X First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and(3)] X "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] X Address 161 Eisenhower Drive, Cotuit,MA Sheet 3 of 7 t N/A OK NO Located at least ten feet from any water line? [310 CMR 15.222(2)] 1 X Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211 1)[1]) X Cleanouts required/provided ? [310 CMR 15.222(8)] X Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] X Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] X Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] X Siphonproblem/(leachfield below pump chamber) X Endca s or vent manifoldspecified? X Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] X Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) X rno Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] I I X Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] X Riser if deeper than 9" [310 CMR 15.232(3)(f)] X Inside minimum dimension 12" [310 CMR 15.232(2)(b)] X Minimum sum 6" [310 CMR15.232(3) e ] X Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] X m Capacity(emergency storage above working=design flow)? [310 CMR 231(2)] X Proper setbacks [310 CMR 15.211 (same as septic tanks)] X Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] X Service components accessible (not too deep with piping, disconnects accessible) X Alarm floats - alarm on circuit separate from pumps specified? X Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and (8)] X Stable Compacted Base [310 CMR 15.221(2)] X Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)] X Address 161 Eisenhower Drive, Cotuit,MA Sheet 4 of 7 r' t SQI AB$7QRPTI�ON,s� S(Sr S) GE �tItAL �� A 4 �K 0 N Calculations correct? X 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] X Required separation to groundwater? [310 CMR 15.212 X Aggregatespecified as double washed [310 CMR 15.247(2)] X System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] X Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] X Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] X Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] X Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] X Aggregate I'minimum- 4' maximum. [310 CMR 15.253(1)(b)] X 2' sidewall credit maximum [310 CMR 15.253(1)(a)] X In bed configuration, inlet every 40 s . ft. [310 CMR 15.253 6 ] X Width T minimum 3'maximum [310 CMR 15.251(1)(b)] X 100 feet-maximum length [310 CMR 15.251 1 (a)] X Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d ] X Situated along contours [310 CMR 15.251(2)] X Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] X ABED S�AS(1VIaxi u_ns�ze�o_flic€��ofi�Ic50�0gp� j `� �' minimum 2 distribution lines [310 CMR 15.252(2)(a)] X Maximum separation between lines 6' [310 CM R15.252(2)(d)] X Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] X Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] X Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] X Bottom area used in calculations only [310 CMR 15.252(2)(i)] X Address 161 Eisenhower Drive, Cotuit,MA Sheet 5 of 7 N/A OK NO D �THEPl_Nagl ' LAVE Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] X Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] X If used in gravelless system-make sure jet is directed as not to scour soil interface [Guidance Document] X Inspections once per year(systems<2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] X Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.25 5(3)? X Impervious barrier and/or retaining wall ? [Guidance Document] X Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] X Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] X Side slope not exceed 3:1 ? 310 CMR 15.255(2)] X Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] X At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 2 (e)] X G avelless S stem�[I/ pproval ettes) ` ' Check DEP Approval letters for credits and design conditions X If used with pressure dosing do not allow pressure discharge to scour soil interface X Alternative,S'epityslem fA�fprova'l Lett+rj °„ i Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? X Is the technology being properly applied and does it meet all DEP Approval Conditions? X Is there a note on the plan regarding the requirement for perpetual maintenance agreement? X Any alarms involved on separate circuits X Did the applicant submit an operation and maintenance manual? X Has applicant submitted a copy of a maintenance X Are the variances listed on the plan ? [310 CMR 15.220 (4)( )] X RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] X New construction or increased flow proposed- [Refer to 310 CMR 15.414] X Address 161 Eisenhower Drive, Cotuit,MA Sheet 6 of 7 N/A OK NO Nit�rogenFSensit�veYeas Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] X Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] X Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] X Pumping to septic tank? [ 310 CMR 15.229] X Shared System [310 CMR 15.290] X Address 161 Eisenhower Drive, Cotuit,MA Sheet 7 of 7 _ I 1 own of harnstame Regulatory Services �i BAR watts, i Thomas F. Geller, Dirrector MA9Qi. A Public Health Division Thomas McKean, Director 200 Main Street,Illyannis, MA 02601 Oftic:c: 508-862-4644 Fax 50$•7�,0-6304 Iui talier & Desianer erti�ic+ atf4n Farm Elate: ( 1 ,2 -C) Designer: _=Ye: f r he' ci r�c.:_�w.. Installer: C,-'p�-)Lv,& 6y*er (-ese-!:) /0dclress: . L6.S N Ctonbecry tA V1,4.x1v - Address: _ If 0 Ga ?L3 C.lt1 4'-.'�!�!��fe1.__was lssllcd a permit to install a (dale;) (installer) septic system at _ 1 e k--L_►Se400(3.:j e.,_ C)c w e. based on a design drawn by (fddressj �" , eonmeecid1.l- --Y��C. dated WoC.t-_ 3 20(( Q (designer) ---- _ -- �/ 1 certify that the septic system referenced above was installed substantially according to the desim which may include minor approved changes such as lateral relocation of th4 distribution box and/or septic tank., 1 certify that the septic system referenced above was installed with major charges (i.c. greater than 10'. lateral relocation of the SAS or any vertical relocation of any component of the septic system.) but in accordance with State & LocaI Regulations. Platt revision ar certified as-built by designer to follow, � ,;0*104 L S'ignati�rej.,.,•--------- � .��z. w�t MQ 7 1. (l�eslgner's Si e) , (A.�'fl esignor 5 tamp I•Iere) A`E lltl",I I• SLY'v&a iJ .J 1 1 CT CATEF CO a \ ILL " REE,CEBY.IHE BAMTAAL r Aff JYED THANKT.J. A VISION YO Q: Neolth/Sept(c/Designer CP,rtiflc,atrion Fon-n 10 'd L9£O 2LZ 8OS ONIN33NION331' 140 2-0: T1 6OOZ—£Z—AON oF� Town of Barnstable P# yA2 Departmnent of Regulatory Services = 61 ILE, Public Health Division -Date i ate � D t639. ,6� 200 Main Street;Hyannis MA 02601 ATE . Date Scheduled 10 �G 1 3 0 _- Time - Fee Pd. )13 -- _ Sail Suitability !Assessment for Sewage isposal M j Qe I g Performed By: IC I 7'��}�?CI I"� L s E Witnessed By: .!IT l'.V. � Location Address LOCATION & GENERAL INFORMATION Owner's Name C.4" Address Assessor's map/Parcel: Engineer's Name NEW CONSTRUCTION �C �h9111eCflVlyt�.►1C.. REPAIIt �/ �l pp� -oo Telephone# 5a�273-4M Land Use 1�GSiCiQn�tG - Slopes Surface Stones Distances from: Open Water Body possible Wet Area ____-__ft Drinking Water Well ft Drainage Way ft Property Line i+ Ft . Other ft SKETCH: (Street name,dimensions of lot;exact locations of test holes&Pere tests,locate wetlands in Proximityhole to s) Parent material(geologic) 6dW4S� of Depth to Bedrock NGr1Q Depth to Groundwater. Standing Water in Hole: Nvh e . /�dh� pp Weeping*om Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: 0 cec f- Observnl•W n Depth Observed standing in obs.hole: Nvvt� l�e��e Depth to weeping from side of obs.hole: Np�� in, Depth to soil mottles: Index Well# — in, OrdunclwulerAdJustment in. Reading Dater Index Well level --� Ad,faCtoY _ Adj.Grountlwater Level PERCOLATION TEST Duce is 1 a a x>r1,�_igsoA AMObservation Hole# ! -- �-- Depth of Perc Time at 911 3a � — .. Time at 6 Start Pre-soak-Time @ Ayuf Time(9".6") End Pre-soak V 1 Rate Min./Inch ft, h Site Suitability Assessment: Site Passed Site Failed:. Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of Wetland , you must first notify the. Barnstable Conservation Division at least one (1) week prior to beginning. Q:4SEPTIC\PERCFORM.DOC DEL,P.OBSERVATION HOLE LOG Hole# FDcpth from Soil Horizon Soil Texture ace(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones;Boulders. O on istency,% ntvel K 30 6-Z LS la�K � 6 3d-S o - So—iaa. C-z DEEP OBSERVATION HOLE LOG Hole# I- Dcpth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel)______ U-� L 10YA31 ^ y-►p ��I L� l0 2s - - , 30 8-Z 30-S-o C—I CS 2 Y� ��-I2 G-Z Z s�6 6 ua3� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) (Munsell) MottlingOther (Structure,Stones,Boulders. Co5igtency,S' G vet DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistencyI Flood Insurance Rate Map: , Above 500 year flood boundary No_ Yes .✓_"-_ With-in 500 year boundary No Yes Within 100 year flood boundary No Yes . Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? -YiS If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of.Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertis and ex p 'ence described in 310 CMR 15.017. Signature Date 0-03-0 9 Q:\SEPTiC�PERCFORM.DOC Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 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. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 'eQ0" City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site ,.. . sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of o Title 5(310 CMR 15.000). The system: uek,co Passes ❑ Conditionally Passes ® Fails t❑ Needs Further Evaluation by the Local Approving Authority „a013 C) ;�2! C=> t 9/24/2009 cz In"spe or's Signature Date C> F-- r"a The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage D osal System-Page 1 of 17 I Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 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: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 `ti r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. ,M 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M4.1161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate "yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 s ro t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 M , 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon septic tank and leaching pit. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 9/24/2009Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): s t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1978 Were sewage odors detected when arriving at the site? ❑ Yes ® No c Building Sewer(locate on site plan): Depth below grade: 20"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of leakage.system vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 14"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) ` If tank is metal, list age: years f Is age confirmed by a Certificate of Compliance. (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 1" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 1" 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 13" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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 Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): Sandy soil.Leaching pit shows signs of hydraulic failure.Water level was 4' below invert at time of inspection.Heavy stain lines observed up to invert. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑: drawing attached separately �a 1 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LP 20' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 platew#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 161 Eisenhower Dr. Property Address Catherine Burke Owner Owner's Name information is required for Cotuit Ma. 02635 9/24/2009 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed Z System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 17 r rj - zo ~ i �( pl- LOCATION ,, , SEW�AiGE PERMIT NOA VILLAGE co v a r INSTA LLER'S NAME 8 ADDRESS BUILDER OR OW93ER Y R-ea-ZI !/ /Y�s 1 DATE PERMIT ISSUED �-- �� -7 DAT E COMPLIANCE ISSUED 35 �0 � ?� � � � � 6 N -----•t`f .... Fss..... ......................_ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH /..------oF.....-,6A.- ;gte...................... Appliration for UiipAtiai Vurkg Tonotrnrtion ramit Application is hereby made for a Permit to Construct ( �r Repair ( ) an Individual Sewage Disposal System at: r:.�----- ........................................- .t s. nr.,ryo�r.E . ._ ,re ..._.. Z Lo• t' Address or Lot No. Address t S iid�wG ( ti _ _ _W , �i YP g Installer .Address.. .. Q �� Sq. feet Dwelling—No. of Bedrooms___________ ____________________________Expansion Attic ( ) Garbage T Type of Building Size Lot__ �. rbage Grinder ( ) 04 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures . _. allons a 'p A��er da Total daily flow............ gallons. W Design Flow ��d g P � P Y Y3 Q WSeptic Tank—Liquid capacity�QQQgallons Length,&::d.". Width._tO__10___'Diameter________________ Depth__5'''v- W Disposal Trench' -No_ ____________________ Width.................... Total Length.................... Total leaching area__..................sq. ft. Seepage Pit No.....f............ Diameter._/Q_.F'j'._. Depth below inle _ 4 ._ __. 1 leaching area....Zd0.7..sq. ft. Z Other Distribution box ( c, Dosing tank ( ) �� Percolation Test Results Performed byzdlf�! �-- Date1_7 $ ?�-------- W Test Pit No. 1... .Z....minutes per inch Depth of Test Pit_.1___�____. Depth to grounr___________ _________ GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ••---------- ---------------------•--------•-----------•------•---- O Description ofSoil__C1- y........4....."--3 �-----_3G W UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System-in:accordance with the provisions of L ,TI r 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_ ....... ..................... / D � i �l3✓T Date Application Approved BY-- - � � Ly' 'g a ----•- Date Application Disapproved for the following reasons_......................._.........._............................................._______________________________ .........-•--••--•--•-•--...-•-•--•-•-----•----------------------•-----•-------------•--------------------•-...._...----•--•-------------------------------------------•----•--------------•----•------- Date Permit No......................................................... - ------------------------------------- Issued.-------�---------------------.........----------- Date No....--•- y l Fims.......: ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TW.#JV............oF..... 2 ,sr.,09.154.e..---•-•---•-----••----- M Appliration for Disposal Works Tonstrnrtion rumit Application is hereby made for a Permit to Construct ( doror Repair ( ) an Individual Sewage Disposal System at: ---- ............................... 'd' -' - - ............ •Location-Address n or Lot No. -.. . :.:. ,[.�L. L/I�1�7Z?!Yt .�►�l tq s ..................... yS7 t, Address... . -- .. ............... Installer Address Type of Building ? Size Lot..zV---�� _Sq. feet V Dwelling—No. of Bedrooms.............5..........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ---------------------- ---- -------------------•...... ...........................•------.-- C11 W Design Flow...........&d........................gallons per+"i;o3 per day. Total daily flow...........&3.43_0.................gallons. WSeptic Tank—Liquid capacityJOVOQ allons Length.l �ii..' Width.4.�/-D Diameter________________ Depth_$....4.-V_" x Disposal Trench—No- -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........../......... Diameter.../..d_Ff_. Depth below inle� ..F T leaching area...Z�_ ..sq. ft. Z Other Distribution box ( y' Dosing tank ) rC� - ` `-' Percolation Test Results Performed by___. ._.kt..................4I ''�!i`!^-.......... Date_..T1/. Z.$......_. aTest Pit No. 1...2!92.....minutes per inch Depth of Test Pit-A00..".... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --------------------........................................................................................................................................ D Description of Soil_=4:_-_L.......JA40, 0441 e9oC?, �---•--. �. 474AF4nt_.....AIWD.---...WAS ............................•-----------...........----------------------------..........--------------------•------------------- W ------••••-•-------•------------------------•-•---•-•--------••••--••-------------•-------•------•--•-•-••••-•••-----•-----------••-•-•--•-----•--••-•--••------•-•-•---••--•••...............----•••--- UNature of Repairs or Alterations—Answer when applicable............................................................................................... •----------------------------------------------•--------------•--•-•---•-----------.....------•--------••---•-----------------------------------------•---------------------.....---....---------...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITTIE 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. igned-; }. l . ....��3----7 .._.... ate Application Approved By-•------•- •l---•..... - ------- --- -- -- -- .. .may •---------- .........Z /...-7 -'- Date Application Disapproved for the following reasons:................................................................................................................ ............................................................................................................................ = Date • 9 PermitNo............................................!• .......... . Issued....................................................... 1 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ...........�./A? U- "? oF.......... . ... ..z................ Trrtifirtttr of TwompliFanrr THIS IS TO CERT Y, That t e ndividual SewageDis osal System constructed or Repaired b -., �� k .taller 4 j �.._ 7 " --- `t L has been installed m accordance with the provisions of 'TIT60> f The State Sanitary Code.as described • the application for Disposal Works Construction Permit No.................. .._....... dated_--.____-_--"' --_--___7.(j.......... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE . SYSTEti! V111LL FUNCTION SATISFACTORY. �........--••-•---•-•--.......--•---•--- �� — 7 DATE.............. :. ............ ........................... Inspector....... . THE COMMONWEALTH OF MASSACHUSETTS C4�/7d ..................1_617_4*41....OF.......... I . ... ....... ............. BOARD HEALTH No......................... FEE.................. Disposal o Tonstrwtion finmit Permission is a by granted c...... ......-•--.. .........`' � > t'..........°.......... to Constru tom( e�r2eei �) ,a divi al Seva Dis�r� ---•--------------•-----......-•-..........------.----- ......--------------•-----•--------••------.....-------•----------.._...... ..;... Street as shown on the application for Disposal Works Construction Permit �__.---•--- ___ D e .......�..^.`a�..�...-��.�...... .................. ......_ / Board of Health DATE...................................—%O FORM 1255 HOBBS & WARREN.,INC., PUBLISHERS E /.SENHOWER DRIVE -8,M. - m P o f \ I ASSU/�E D oo/ I T °Q 53 _ LOT26 / - l a LOT2y so,e- 1 SEP_T%C.TANI, = TE 5 T I } /LEACHING-Ply Sox � � I��•— --_=1 96 20' � I EXPANSION' O l l3 f / 99 00 /oZ /ol /oo 9el 97 - _ Lor_.30 / &0 7 T/N G .9 N p F/NAG G'Oz.,g-p S TO �Fr��4/N J= SS,ENT/ALL �/ Th+/� si9ji�F a�L O VI OF H OF Py+ RJAMESD n�� RICHARD �`�� yv Clr o JAMES + ram+ c, O'HEARN y O'HEARN I 1 No. 27871 y Ci No. 694- `t-1 I IST EXISTING SPOT ELEVATIONS 0,0 �SUpvf�' EXISTING CONTOUR- - - 0 -- - - - FINISHED SPOT ELEVATIONS b.0 FINISHED CONTOUR-0 PROPOSED PLOT PLAN APPROVED: BOARD OF HEALTH CoTU IT .._ , MASS. _r.'ATE AGENT LOT25- EISENHgQW T^DRIVE I CERTIFY THAT THE PROPOSED R. v: O1HJEARPd, INC., RLS, RS BUILDING SHOWN ON THIS PLAN 191 MAIN ST. (RTE. 28) CONFORMS TO THE ZO'e;NG LAWNS WEST DENNIS, MASS . OF ARNSTAR�F _ MASS. DATES 712 0 78 SCALE: L - O__-- - jO8 NO. 76 -267 �r.1iz-1F;,1T: M�LAUGNL/M DAT - EGiSTFR - SURVEYGI: I UQ. BY : F 1 SOIL TEST INVERT ELEVATIONS NOTES: DATE OF SOIL TEST /a 6' INVERT AT BUILDING 92_� FT. ALL WORKMANSHIP AND MATERIALS WITNESSED BY 2• `. 2 INLET SEPTIC TANK _97 o FT, SHALL CONFORM TO D.E.Q.E. TITLE 5 PERCOLATION RATE - Z MIN,/INCH ' OUTLET SEPTIC TANK �6=$__ FT. AND THE TOWN OF RULES OBSERVATION HOLE I OBSERVATION HOLE 2 INLET DISTRIBUTION BOX 96- FT AND REGULATIONS FOR SUBSURFACE ELEVATION - 98 ELEVATION'_ OUTLET DISTRIBUTION BOX 26'.3 FT. DISPOSAL OF SANITARY SEWAGE _ 0 INLET LEACHING PIT 2�.o' FT. y„ooDcoA�„ BOTTOM LEACHING PIT —90. 0 - FT. S�aso<< DESIGN CALCULATIONS NUMBER OF BEDROOMS . , , 3 4% GARBAGE DISPOSAL UNIT... G°LE.9N n��D TOTAL ESTIMATED FLOW (1LGAL./BR./DAY.X9 BR.),,, 33 O GAL./DAY s.4Na REQUIRED SEPTIC TANK CAPACITY. . . . . . . . . . . . GAL. ACTUAL SIZE OF SEPTIC TANK TO BE INSTALLED... . /,20 O GAL. LEACHING AREA REQUIREMENTS SIDE WALL AREA 2-fGAL./S.F, BOTTOM AREA Z- 0 GAL./S.F. LEACHING CAPACITY ( BOTTOM Y-SIDEWALL ).. .... . . . . . . _-549-"7 GAL. 3. / 5l x 57-x x/•o Y- 3./•�,Y G x /o x Z, S . RESERVE LEACHING CAPACITY. . . . . . . . . . . . . . . . . . . . . . . y9.7 GAL. TOP, OF 20 Fr. Miry. . � FOUND. ELEV.=/02.0 CONCRETE. 4" SCH. 40 CLEAN SAND COVERS PVC PIPE MIN PITCH CONCRETE ' COVER 1/8 PER. FT. o .lN OF tt�`,! OF F. 2 /o MIN. PITCH A MgtJ, S y 12 MAX. RICHARD `�- 7n� RICHARD °.� • - Z u n � o JAMES o JA1v1E5 N — 2 LAYER OF 1/S - 1/2 O'HEARN c� O'HEARN FLOW LINE — g WASHED STONE "° s�e�t y ,Q No. 694 y p•, �CISTE�(�7Q��/� �Ci1:1 r 4" CAST IRON �� z � � o � 3/4 n- 1 1/2n O -k ,� 1 PIPE - MIN. PITCH o w WASHED STONE SUR SANITAR%`''',�. 1/4" PER FT, DIST. o � I=- o PRECAST LEACHING BOX op w o a BASIN OR EQUIV. W a o LLL /000 GAL �~ SEPTIC ter. I r MASS .. TANK . R . O I~� .... .�,f'N 11NC., RLS, RS ^�' R. L.!;=�f k' ST. (RTE 28 ) WEST DENNIS , MASS . PROFILE OF GROUND WATER TABLE JOB N0. zG7 ; CLIENT SEWAGE DISPOSAL SYSTEM _ clgc,o'y �! NOT TO SCALE DATE /Zd 2g SHEET Z OF Z ----------- ---------- ----------- ------ -------- PROVIDE PRECAST CONCRETE GENERAL NOTE S T.O.F. EL.= 52.5' EXTENSION RISER WITH CONCRETE INISH GRADE OVER D-Box= - 48.7' 4"SCHEDULE 4)PVC MIN.SLOPE I% FINISHED GRADE OVER DIFFUSERS 47.5' - 48.6' COVER,TO WITHIN 6"OF F.G. OVER INLET&OUTLET COVER. REMOVABLE WATER-TIGHT COVER OVER SLOPE @ 2%MIN. 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION r-F F c 5"DIA. OU INSPECTION PORT WITH ACCESS BOX TO METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL RISER 6F FINISHED GRADE FINISH GRADE IR T WITHIN "OII WITHIN 3-OF F.G. (ONE PER TRENCH) CODE AND ANY APPLICABLE LOCAL RULES. @ FND. EL, 50.0'+ FINISHED GRADE OVER TANK EL. 50.0'+ TLET(S) 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. /,---EXISTING 4" PROPOSED 4" 9"MIN. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PVC SEWER PIPE 36"MAX. 9"MIN. SYSTEM UNLESS OTHERWISE NOTED. SEWER PIPE 36"MAX. TOP OF SAS B.O. = 45.63 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 3"DROP MAX F PROVIDE WATERTIGHT 6" 3" 2-DROP MIN 3" 9" MIN..SLOPE 1% L 27' JOINTS(TYP.) ELEVATION=45.6:T FOR A DISTANCE OF 1 VAROUND THE PERIMETER OF THE SAS. UNLESS A 10- k 4"PVC IN FROM 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 1 14" *47.6'± SEPTIC TANK 4"PVC OUT TO 1.33' 16"TYP THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 10 nITYP I I ITI I=T Tr:;= 7n L LEACHING FACILITY (TYP-) 10.75"TYP 5. SLOPE ALL SOLID PIPE AT 1.0% MIN MUM. 1 2" 6" 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. CONTRACTOR CONTRACTOR SHALL I OUTLET TEE 45.47 MIN. 45.3' SHALL VERIFY SIZE 48- VERIFY CONDITION OF 45.2 \--44,3' (LAID FLAT) -2.875'(34.5 5.75' 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES 22"ZABEL FILTER 6"CRUSHED STONE 5.01 (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS MODEL#Al 801-4x22 OVER MECHANICALLY (TYP-) 11.50' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE &MIN. AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX 30.0-(TYP FOR BOTH TRENCHES) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 47.00'ESTABLISHED TO BE INSTALLED ON A LEVEL STABLE ON TOP OF A CONCRETE BOUND AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 37.53' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW BIODIFFUSER (PROFILE) BIODIFFUSER (END VIEW) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL 12 ARC 36HC (#3616BD) BIODIFFUSERS TO THE DESIGN ENGINEER. TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA w --mg- REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM IR, PERC NO. 12742 APPROPRIATE AUTHORITY. INSPECTOR: DavidW. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE EVALUATOR: Michael Pimentel, E.I.T. THEY SHALL WITHSTAND H-20 LOADING. C.S.E.APPROVAL DATE: Oct. 1999 'V%121!i 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. October 13, 2009 E: MAP 39 DAT s'- TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE PARCEL131 ELEV TOP 47.7' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY, REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, MAP 39 ELEV WATER= <37.53' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). PARCEL128 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PERC RATE <2 min./inch 00 SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. STKITK DEPTH OF PERC= 30"-48" 16. PROPOSED PROJECT IS LOCATED WITHIN: z TEXTURAL CLASS: 1 ASSESSORS MAP 39 PARCEL 127 81*38-13V OWNER OF RECORD: CATHERINE M. BURKE ADDRESS: P.O. BOX 512 on 47.7' ONE 2 Loamy Sand CUMMAQUID, MA 02637 MAP 36 1 1 1 A 1 OYR 3/1 MAP 39 EXISTING 1000 GALLON SEPTIC 4" Loamy Sand 47.37' PARCEI- 1�i TANK TO BE UTILIZED AS PART OF 131 FEMA FLOOD ZONE C PARCEL132 20,832 S.R THIS DESIGN. CONTRACTOR TO ......... I OYR 5/8 46.2' COMMUNITY PANEL# 2500010018 D 18 VERIFY THAT NO SUPPORTS FOR IUJ zi Loamy Sand 17. DEED REFERENCE: CERT.80204 PORCH ARE DIRECTLY OVER B2 1 OYR 5/6 TANK AND NOTIFY ENGINEER 'k, 18. PLAN REFERENCE: L.C. PLAN 36608 C CL 45.2' -A 300' It U- / 10 Perc Coarse Sand ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 6 19. TREELIKE .C'4 vto -u C-1 48" 2.5Y 6/6 43.7' o r20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY S-I-w 50" 43.53' FOR SEPTIG SYSTEM UPGkADE. JG ENGINEERING WILL NOT ASSUME'ANY-LIAMTTY EXISTING LEACHING PIT TO BEems- UJI 2"'U.'n PUMPED AND FILLED WITH CLEAN FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. COARSE SAND &ABANDONED PAVED DRIVEWAY • C-2 Medium Sand ON 2.5Y 6/6 60 PROPOSED DISTRIBUTION BOX V LOCUS PLAN_ % 1 #161 W PORCH > EXISTING SCALE: 1"=1000' PROP. TOTAL 12 ARC 36HC BIODIFFUSERS 3-BEDROOM 122-1 137.53' (6 BIODIFFUSERS EACH TRENCH) 2311 DWELLING e3 TOF=52.6 0No Mottling, Standing or Weeping Observed 60' z 3 LU 9 LU DESIGN DATA TEST PIT DATA LEGEND 8.8 0 a c?" t -z PERC NO. 12742 '7 50xO EXISTING SPOT GRADE CO V Vo L- INSPECTOR. David,Wl 'Stanton, R.S. 0 V� Pi co Uj NUMBER OF BEDROOMS(DESIGN) 3 EVALUATOR: Michael Pimentel, E.I.T. 50 EXISTING CONTOUR 47x7 % DESIGN FLOW 110 GAUDAYIBEDROOM X LU C.S.E.APPROVAL DATE: Oct. 1999 TOTAL DESIGN FLOW 330 GAUDAY 50 PROPOSED CONTOUR L3 2911 JJTP 2 00 % 660. GAUDAy DATE:- October 13, 2009 0 01- DESIGN FLOW X 2 UGE EXISTING UNDERGROUND UTILITIES - 47x7 USE EXISTING 1,000 GALLON SEPTIC TANK TEST PIT#: 2 ELEV TOP= 47.7' TELE EXISTING TELEPHONE UTILITIES 70' ELEV WATER <37.53' GAS EXISTING GAS LINE C /DH T,REELINE MAP 39 B.M. I GAS PERC RATE -W-W EXISTING WATER LINE PARCEL133 Top of CB1DH N810'Mf13'W INSTALL 12 - ARC 36HC (#3616BD) BIODIFFUSERS DEPTH OF PERC= - Elev. =47.0' PROPOSED INSPECTION PORT WITH 143-671 U -T I �i TEST PIT LOCATION Approx. M.S.L. ACCESS BOX TO GRADE (TYP OF 2) Q I SYSTEM CAPACITY TEXTURAL CLASS:. 1 EXISTING 1,000 GALLON SEPTIC TANK (TOTAL L.F.OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD Eq ')(7.8 SF/LF)(0.74 GAUSQ.FT.)= 346.3 GAL. LEACHING DAY 0" 47.7' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE 1 #161 (60.0 Loamy Sand PORCH 1 OYR 311 MAP 39 1 EXISTING A 4" 47.37' 13 PROPOSED DISTRIBUTION BOX 3-BEDROOM TOTALS: Loamy Sand PARCEL126 PC2 X DWELLING 131 1 OYR 518 PROPOSED ARC 36HC(#3616BD)BIODIFFUSER TOF=52.5' TOTAL NUMBER OF BIODIFFUSERS: 12 18* 46.2' TOTAL NUMBER OF COUPLINGS: 0 B2 Loamy Sand TOTAL LEACHING AREA: 468.0 SQ.FT. 1 OYR 5/6 (4) TOTAL LEACHING CAPACITY: 346.3 GAL./DAY 30" 452 REV. DATE BY APPD. DESCRIPTION Coarse Sand PROPOSED SEPTIC SYSTEM UPGRADE HC I C-1 2.5Y 6/6 IVA4 OF A4, 50" 43.53' PREPARED FOR: (2) JOHN L. 0 NOTE: CHURCHILL JR. CAPEWIDE ENTERPRISES 0 EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE Ant- DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER 41807 LOCATED AT (3 "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO C-2 Medium Sand ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3,2003(LAST 2.5Y 6/6 161 EISENHOWER DRIVE SWING-TIES MODIFIED JUNE 30, 2009). TRANSMITTAL NUMBER=W000052. COTUIT, MA NOTE: SCALE: 1"=20' 122"1 37.53' SCALE: 1 INCH = 20 FT. DATE: NOVEMBER 3,2009 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE 0 10 20 40 80 FEET TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. DESCRIPTION HC 1 PC No Mottling,Standing or Weeping Observed BIODIFFUSER CORNER(1) 39.6' 25.2' PREPARED BY: RESERVED FOR BOARD OF HEALTH USE 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE JC ENGINEERING, INC. BIODIFFUSER CORNER(2) 21.9- 32.6' LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE 2854 CRANBERRY HIGHWAY CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. BIODIFFUSER CORNER(3) 33.4- 41.8' EAST WAREHAM, MA 02538 REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS 508.273.0377 ARE NOT CONSISTENT WITH TEST PIT DATA. SITE PLAN BIODIFFUSER CORNER(4) 46.9- 36.3' SCALE: 1"=20' Drawn By: BMB Designed By:BMB 3 No.1705 - ------------ -------------