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HomeMy WebLinkAbout0058 FOX DEN BLUFF ROAD - Health 58 Fox Den Buff � ._ Cotuit — _ A— 041-032 A, No. "' ' � Fee i/tv THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS r TippliLation for Misposal 6pstrut Construction .3permit Application for a Permit to Construct( ) Repair( ) Upgrade)o Abandon( ) ❑Complete System Xindividual Components Location Address or Lot No. %JFa X lP�en Z>\�!P r%, Q,%, Owner's Name,Address,and Tel.No. CCU Assessor's Map/ParceloLit �3 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. qnu, S"LS a�_ S � Type of Building: Dwelling No.of Bedrooms ;, Lot Size 'SC�, a$ sq.ft. Garbage Grinder(J�144, Other Type of Building No.of Persons ' Showers( Cafeteria Other Fixtures > Design Flow(min.required) 3 � gpd Design flow provided ZJ`i r gpd Plan Date —5 a i Number of sheets 1 r Revision Date TitleG, Size of Septic Tank 1,wq � Type of S.A.S. � �ci,. Description of Soil IliY Q-A-0 Nature of Repairs or Alterations(Answer when applicable) K� 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 Enviro ode rid of ace the system in operation until a Certificate of Compliance has been issued by this Bo of Healt Sigo6d- Date Application Approved by Date ` Application Disapproved by Date for the following reasons Permit No. Z- 0 , - � Date Issued -----__-_______________-__-__-__--__----_--__ t__ ----- H•.��4^. . I ...)', e. . ... •` ....w•e. -.•••...4t`.�. -... • .n..,i/d"�y,'":�+n.^- -,.wy.r1 �+y,.. .T'-fie° ".O.r.l.� s+r -`,`�1 ilY-w't, .° Fee m THE'COMMONWEALT.W0F MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN,OF BARNSTABLE, MASSACHUSETTS . Yes 3 2pprication for Nspsal,6psifi -"ionstr/suction. ermit M Application for a Permit to Construct( ) Repai ( o)��U'pgrade ) Abandon Ej Complete System Individual Components r Location Address or Lot No. , 4rC x'tv,i Via: Gl Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel (�rtt lU3a, t; Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. s; Type•of Building: ` j,Dwe"ing No.of Bedrooms Lot Size 1c;0.-4 A R sq.ft. Garbage Grinder(/y !QOther T e of Buildin No:of Persons Type g A ; Showers,(`,r) Cafeteria( e w Other;Fixtures i Design Flow(min.required) gpd nDes flow provided e4 mac+ gpd ., Plan Date 1- Number of sheets Revision Date 9 A Title --�)rooc 5e e_\ Size of Septic Tank k wo q,G` 8e1� Type of S.A.S. t--, - L`` f„ rhc77t� �A «t Description of Soil .� V 0 v-,Aip f t ` fi,• _ III W Nature of Repairs or Alterations(Answ,er when applicable) -;�r - Date last inspected: C r Agreement: L' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal gystem.in accordance with the provisions of,Title 5 of the Environmental W ode nd not o-place the system in operation until a Certificate of + Compliance has been i sued.by his Board of Healt . , r " Signed ,/ Date -�r Application Approved by Z.•.�a��4�"^'" / --�-- -- Date Application Disapprovedjby Date following`reasons `� y Permit No 2� �y Date Issued -7 00.�P ! �.z.., E�ck-�-•�.m-...r. ,.:: _:- :-t..•,-Yf --a;..:,-,+1'..__::.�a�,� -� -- -- --- -- _�-�.:,'TV.. ..".. - - c-i�^?r.2*�'. THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE,*ASSACAUSETTS a ` Certificate of Comp laancE:. THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( )E Repaired( ) Upgraded(�) Abandoned( ')by p n I e_.jC� ' at F Vb,C ,)zc-,` � ', r has been constructed in accordance *ith the provisiA of Title 5 and the for Disposal System Construction Permit Not021"Ib q dated fi io� nt \ f Installer � .�J C� � Designer -mot r #bedrooms "' Approved design flow 3� gpd The issuance of this permit shall n t be construed as a guarantee that the syst8�will filncf on�gr)sed. Date �lt Inspector _ ._. .--- - '- - ---' ---- - ------------------•---- --------- --------•----'---------- =-'---- --' ---- - - -- - -'- '- -- -- -- _ No. t - f 6 I Fee 1'+/0 . THE COMMONWEALTH OF MASSACHUSETTS i PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS IDi1""' aY pstem (Construction Permit : Permission is herebygranted Construct Re atr U Upgrade V Abandon > i P� ( )' P ( ) Pg ( ) ( ) i f System located at h w 4 and as described in the ab ,e Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with .� Title 5 andth 70,bowing 1 altprovisions or special conditions., A'' Provided:Construction.must be completed within three years of the date of this permit. Date 5 Approved by Town of Barnstable Inspectional Services Public Health Division BARN BTASM A 0 9 \Thomas McKean, Director 1FCNU''IA 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: la�1 Sewage Permit# Assessor's Map\Parcel O 22)a Designer: Installer: v, ��uCSl Address: Address: 46ANCL-)--Q1 C. �`c'nca.�`�-! . t`-td� 0��3(p �. ��rr,oyT�-k �•I,eY O�s"�4� On ,S— ' o�\ u. was issued a permit to install'a (date) installer) -, septic system at 58 Siox D� R,\U r rA based on a design drawn by (address) dated , c� (designer) XI 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. Strip out,(if required) was inspected and the soils were found satisfactory. 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. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed;4i;' ml Hance with the to rms of the a ov etters (if applicable) (In 1 ure) 1„°hill tFi`r2�E",�'t (De ' s ignature) (Affix Designler'=?Siamp Here) t PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. WoaldeptslHEALTMSEWER connect\SSEPTIODesigner Ccrtification.Form Rev&14-13.DOC TOWN OF BARNSTABLE LOCATION�5B Fox 1)ec> Y�1J�s� W, SEWAGE# VILLAGE C©—, U t T ASSESSOR'S MAP&PARCEL O INSTALLER'S NAME&PHONE NO. t-iA°( 96U .Se-IDCS SEPTIC TANK CAPACITY 1)cco LEACHING FACILITY: 1 (type) CC.e C_\-v0(n'Wt� (size) NO.OF BEDROOMS vac. OWNER � Gme3 7PrA PERMIT DATE: —pZ COMPLIANCE DATE: Separation Distance Between the: _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5 ' ' Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) tJ R Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) c IJ R Feet FURNISHED BY J pr -TOOT A6 ve> _ 1.0 ('0 ci s A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments IA 9C4 Property Address Owner Owner's Name information is C0� b 3SL 0 required for State Zip Code Date o ns ection every page. Cityrrown Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your /I�G✓ K / U/2 ` cursor-do not Name of Inspector use the return L--1v11 O key. Company Name �a � d gw VQ Company Address ��s-A"T 0� Mew Cityrrown State Zip Code Sow 7 Telephone ber License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the LH r-0 information reported below is true, accurate and complete as of the time of the inspection. The inspection Se was per Sew based �-�ri fd on my training and experience in the proper function and maintenance of on site c sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: u.- Conditional) Passes ❑ Fails r-• � Passes ❑ Conditionally Passes Further Evaluation by the Local Approving Authority ,,j Oil 3 /0 Inspect ,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 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. (Sins•09108 Title 5 Official Inspection Form:Subsurface Se a Disposal System•Page I of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Y Property Address / 1 t-1 Owner Owner's Name �n / Qa - '� /� information is r-0 4u I63required forState Zip Code Date o n pection every page. Cityrrown B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I always complete all of Section D A) System sses: 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. El Y ❑ N ❑ ND (Explain below): Titre 5 of ciai inspection Form:Subsurface Sewage Disposal system•Page 2 of 17 i5ins•09/08 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name Co o_)(2S /0 information is v required for U State Zip Code �Dte Inspection every page. City/Town 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•09f08 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 Property Address / 4 Owner Owner's Name t� A ��63jr' 3 �0 information is required for CO�� State Zip Code to of Inspection every page. CitylTown 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 ❑ r,/ Backup of sewage into facility or system.component due to overloaded or clogged SAS or cesspool O _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ r—,/ 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 Lam' than '/z day flow Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 i5ins-09tO8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address J/ / Owner Owner's Name / 3 �0 information is Da 6 required for �� State Zip Code Datelof 16spection every page. City/Town B. Certification (cont.) Yes No ❑ ,-�/ Required pumping more than 4 times in the last year NOT due to,clogged or u 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 tJ 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. ❑ Ld' 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 is cesspool serving a facility with a design flow of 20009pd- ❑ 10,000gpd. ❑ / The system fails. I have determined that one or more of the above failure I� 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. Title 5 Official Inspection Form:Subsurface sewage Disposal system-Page 5 of 17 t5ins-09/08 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address /kv / G � Owner Owner's Name/� information is ? required for Ci /Town lJ State Zip Code Date of In pection every page. City frown 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 LET 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. / El Determined in the field(if any of the failure criteria related to Part C is at issue E� approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: -- Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): I Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 15ins•09J06 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Fox ,�e­7 Property Address U Owner Owner's Name 63S ! 3 fD information is Cp u t required for State Zip Code Date o Inspection " every page. City/Town D. System Information Description: 41 C' 4,- Number of current residents: Yes �o Does residence have a garbage grinder? ❑ Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes 9—NO ❑ Yes [3-140 Laundry system inspected? Seasonal use? ❑ Yes ( fib Water meter readings, if available (last 2 years usage (gpd)): Detail: ❑ Yes No Sump pump? Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc."): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No k Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of t5ins•09/08 Commonwealth of Massachusetts qM NO Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments eW1 Property Address 1 J 7 U Owner Owner's Name 3 /0 inforrnation is Co I N r f - /'/�1 3S required for State Zip Code Date of nspection every page. Cityrrown D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information 6 tti,�- Pumping Records: f o �, �, � J -Po✓s Source of information: El Yes No p Was system pumped as art of the inspection? 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): Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 8 of 17 (Sins•09/08 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Sv Fo--4 :?d Property Address fi Owner Owners Name C040,information is / /yJ,{ 0.)ur 3 /O f_ /'/f J' required for State Zip Code %DIte 61 Inspection every page. City/Town D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes 9--Ko Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron 0 PVC ❑ other (explain): /0 j Distance from private water supply well or suction line: feet Comments (on condition of joints, venting., evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet (� Material of construction: oncrete ❑ 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 g Dimensions: Sludge depth: 15ins•09/08 Title 5 Official inspection Form:Subsurface sewage Disposal System•Page 9 of 17 II� � Commonwealth of Massachusetts, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address / y /je, / Owner Owners Name AW Oaz /3 V information is 4required for co State Zip Code Date 6f intpection every page. City/Town D. System Information (cont.) Septic Tank (cont.) r �� J Distance from top of sludge to bottom of outlet tee or baffle 7- 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): vul I V? A IN Do Col c'! 7�o�I - /v� L 2c,ly 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 Title 5 omoai Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 tsins•nos r Commonwealth of Massachusetts Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address Owner Owner's Name , //�� 0d-&,TS �V information is Cp �„ , required for City/Town Zip Code Date of Inspection every page. 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 i HoldingTank (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.): At copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 11 of 17 t5ins•OW8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 0 Property Address Owner Owner's Name // i`l 0.2 6-7J T �information is Cp �(�r '� /(' required for State Zip Code Dat of Inspection every page. CitylTown 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.): kZ-'e�e 11(2 �a ! 1 c� 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: Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 t5ins•09/08 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address 6 / Owner Owner's Name information is Co �,,,r o'z G j::' 3 �� required for State Zip Code Dat of Inspection every page. Cityfrown -D. System Information (cont.) Type: 1 leaching pits number: ❑ 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.): 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•09108 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page Q of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 'i. "�O'- i�/ U. Property Address Owner Owner shame information is required for r State Zip Code Date o Ins coon every page. City/Town 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.): 15ins•0908 Title 5 offidal 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 s Property Address Owner Owner's Name / (� information is (/ XU 0).-&-Is required for State Zip Code Da t of Inspection every page. City/Town 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 6 /¢� =a 3 da- a 5 1 143-3 p 3 ;'� over• 15ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments S9 Property Address Owner Owner's Name j information is �j ?/� required for u State Zip Code Date of Inspection every page. City/Town D. System Information (Cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells /9 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: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: _ �lGi�ts f %P5� ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: 7 ti Ile 0/ S - 14 • s / / /_ 1 1 /,o H n GI-, ✓ Before filing this Inspection Report, please see Report Completeness Checklist on next page. Tide 5 Official Inspection Form:Subsurface Sewage Disposal system.Page 16 of 7 t5ins•09108 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name N �y information is C� �t,,, /'��. a 6?s to required for State Zip.Code Date of Inspection every page. Cityfrown E. Report Completeness Checklist inspection Summary: A, B, C,'D, or E checked DInspection Summary D (System Failure Criteria Applicable to All Systems)completed [System Information — Estimated depth to high groundwater ff'Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 3 Tine 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 l5ins-09108 Commonwealth of Massachusetts Title 5 official Inspection Form , Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments �cS old Property Address / ?�22 le- Owner Owner's Name information is o[/e ems?rvo i f /� Da(e of nspection required for State Zip Code every page. Cityrrown 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? f ,--,/ Have large volumes of water been introduced to the system recently or as part o l� this inspection? Were as built plans of the system obtained and examined? (If they were not u 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? III facility owner(and occupants if different from owner) provided with s� Was the ty information on the proper maintenance of subsurface sewage disposal system 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 (actual): � Number of bedrooms (design): J� v DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): Ttle 5 Official Inspection Form Subsurface sewage Disposal system-Page 6 of 17 15ins-09/08 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ir . /0 Ld jAI�e �a Property Address Owner Owner's Name information is ����/(/f )�-?/4- required for State Zip Code Date Venspe6fi/o/n' every page. City/Town D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells �C) Estimated depth to high ground water: feet Please indicate all methods used to determine the high groundwater 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: s f- %-es ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: j vi /I �ee �!�cil . Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 Official inspectlon form:Subsurface Sewage Disposal System-Page 16 of 17 tsins-OV08 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments Property Address Owner Owners Name 1 /�/� Q�6 Vlsoe�bon information is � r/ld1rf/�o/Irequired for Ci Mown State Zip Code Da of every page. ty 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 etch of Sewage Disposal System either drawn on page 15 or attached in separate file Title 5 Otfidal Inspection Form Subsurface Sewage Disposal System•Page 17 of 17 15ins•09108 Air- TOWN OF BARNSTABLE LOCATION 9-3 FO 60A k SEWAGE # -I VILLAGE C O fi c ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. S �.�TQ�� on;i -gig SEPTIC TANK CAPACITY (.()(3() r `LEACHING FACILITY:(type) / f (size) y x NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER � BUILDER OR OWNER li DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Me4/jv J 3 ti R T i - THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN•OF BARNSTABLE Apptiration for Disposal Works Tpnstrnrtiun Prratit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ket If---- ----•--------•----------•------------------ •---- _ -.-•••••-••-= oc .Address -----•--•------------------------------------ -- Lot No. Owner Address W Installer Address d Type of Building Size Lot----------------------------Sq. feet- U Dwelling—No. of Bedrooms,3......................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ...._.. No. of persons........................ Showers Cafeteria efixtures -----------•-----------------------•------------------=----------------------------------------------------------------------............---•-------- W Design Flow.. .... 1-V--_------.--•---gallons per person per day. Total daily flow--.._33©...........................gallons. WSeptic Tank—Liquid ca.pacity4 gallons Length.... ....... Width.----.---. Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area•----_--•---•-.---sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►-' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+ ------------------- -- ------•----- ODescription of Soil + ------------------------------------------------------------------•--.----------------•----------•------- x W V' Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----•-----------------------•------------------.............-----...----------------.....---------------------•-------------------------------•---..................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The unders' ned further agrees not to place the system in operation until a Certificate of Compliance hs e ued oard of health. Signed.. l 4 -------------------- .............---�-e- .------------- Application Approved BY -------------------- ----- Or :` . Application Disapproved for the following reasons: --- - ----- ------------------------------------------------------------------------------------------------------------------- ----------------------------- --- ---------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- ........................................ q/� Date PermitNo. --------/f-.. 1.0-----�J'------------------------ Issued ----------------------------------------------_--------------... Date • Vt_ i _ l - ` No......_2/ fir, S Fps.. ... . . rirHE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,- ' TOWN OF BARNSTABLE Appliration for Disposal Works Tonst urftbii'Vprrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Locat Address or Lot No. .............................................. -....-• ---••..... ................. V _ Owner Address W ------...... •.••.....- t�' mow, .•---•--•-•-•-•................................. ....................................... Installer Address Type of uilding Size Lot............................Sq. feet II Dwelling—No. of Bedrooms.' -------------------•-_•_-----____-___Expansion Attic•( ) Garbage Grinder ( ) Other—Type of Building ...... No. of persons............................ Showers — Cafeteria P- Other fixtures --------------- ------------------•---•---•------ Design Flow__ ` .:.• - -� gallons per person per day. Total daily flow.......J0..........................gallons. WSeptic Tank—Liquid capacity-4 .gallons Length------f------- Width.-5'--.----- Diameter............... Depth.......... x Disposal Trench—No-----------------•--- Width.................... Total Length-------------------- Total leaching area............_.......sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 'Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-____-____---------___-. f3, Test Pit No. 2........`'.....minutes per inch Depth of Test Pit.................... Depth to ground water........................ . xDescription of Soil-------4�.. .___ . U ---------------------------------- -------------------._..._..........---------------------------------------------------------•--------------------•-----•--------•--------------------- ----------------------------•-------------•---•--------------••--------------------•--.....-----...------------------------------------------------------...... .. 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasbeenrissiled by-the-board of health. e Signed (/ P� - ------ ------ ------------------- Application Approved B ---------------�I........ - Application Disapproved for thepollowing ea : ............................................................. ................Dace....................... Permit No. ` l7 Issued --....... CS'...5............... Dace...............-...---------- .-_-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CPrtifirate of Cotupliatt.CE THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (__) or Repaired ( ) b n - ' Y ------- - ---- -------------C Installer at ... zE -------------1 " A Tent,- has been installed in accordance with the provlsions o "TILE 5 o`� te EnvironmYrCode :s described in the application for Disposal Works Construction Permit No. ....... l� - ,� ,.... -'.... dated ....................................._--------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE,CONST Ed AS A GU RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......:�.It.I-...A.k........... ................................................ Inspector -----.�..la'JA THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Disposal Works Tonotrnrtiun "rrmit � Permission is herebyanted...-.--•'•--.- � ,+-' .... ...._f�...!n........,�e.._r.._.fl._.... � �....... ...�...__. _ 2-✓L ( c f ... .... to Construct ( ) or Repair ( ) an Individual Sewage Dispo,, ystem �� Street as shown on the application for Disposal Works Construction Permit N�o�l../..�..�__. Dated.......................................... ......-••.......••---•-•••-....... _ ............. -------•- (� Board—of�Health DATE................................................................................ �/ FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS n� i y '� D-SIGN l_ ;DATA 5A1Cc T' / c Z SINGLE;FAMILY BEDROOM t4 r q NO GARBAGE DISPOSAL -;DAILY FLOW = -110 x 3 = 33o G P D' ' t i ` :...SEPTIC o TANK 33 poi ' x 15 ! ; , f l_ I USE 1000 GAL , .a Sc E s1aE7 . 2k DISPOSAL PlT— USE (i); bov Gat✓ �1' w,iTN 4 STon)E _ . SIDEiNALL 4S - 1. i S.F; x 2.5 'BOTTOM EA �•� � tS.F..Y SF .0 _ f540 PD . +n 1a- 1 , ' .. �-;—� ....._..r•-f .. -:TOTAL DESIGN G. D. = t` 539 P. .. TOTAL DAILY FLOW:= 33 o G.P.D PETER ; PERCOLATION RATE : I" IN 2 MIN OR LESS SULClVAN PiIiRD — . 29733 awn : , - _• r �" ' i ...i , TEST" HOLE- : #' 4. 1 �iv�.`-r.1FSSC►j' �y T--�.`� fl �?� +.1G BAD_i�3 a H - ��: , r el TQz_ 0-0ye r�C. E 1 # r 5 F.G. _ .5S5 7''t F.G = S�,S` •: TOP FND.=5.7.5'' s i/t //c / � - :'i /'' // /.• /: i '/// / .:i/i: i/ ii ; a .• SCHED: 40 I o a o P.V.C. •.' INV. SAS' ll o61AL o .DIST. INV. GAL. INV. �-EAc N i Nv-535� BOX P,T - >r4./' SEPTIC S¢.3' Sfl,�ID KITH 4 ' TANK lot osgSF{L INV S3i7' INV S3� IT C sLZ 4­1 _ t 1p NO : SCALE .- • r -Y 39 CERTIFIED PLOT PLAN IU(3(L-lL lglCL- oV�U,s� D I;-CERTIFY THAT LO_CA� CoT�i MASS, : T THE PROPOSED FOUND.A'rION SHOWN HEREON COMPLYS' WITH THE,SIDELINE AND SET6ACK SCALE /'= loci ' DATE 3 Zs�S I ;EQUIREMENTS OF THE _TOWN OF - PLAN REFERENCE 3A Rti151-Ag1. r 1.F AND;-IS NOT LOCATED ,NITHIN;-THE FLOOpPLAIN. ' LoT%G � '�-- BAXTER 8 NYE, INC, T_HIS_PLAN IS NOT BASED ON AN REGISTERED LAND SURVEYORS NSTRUMENT SURVEY AND THE'OFFSETS $ SHOWN_SHOULD NOT;`BE USED .TO CIVIL. ENGINEERS DETERMINE.LOT LINES; f OSTERVILLE, MASS, ,.APPLICANT {........ 1 YFi ti Ir i I_f } , _t-L �.-T !. + �".��'J.--� -�-i J- ' ' i-... a r I �' _f -E i ! ' _ { i. i � � r_ FTER ct SULLIVAN oR{cEtaa� U NoNO- : s• � 44 'a-r- .-y- r , I I ...5- _ .1N:K� t r_r/:.� , i Yo E-r r + } 'mil I t ._' t 4 l _ _!\ ff � ! r - f 1 ! + "-+^+ -- r i•Y t ! t 5��1 *- I'Si$ r'/\p - � ¢ \• `.�i �:P r --Y ! ra 9 - ; . t t + � <-.- F �# _S '� T-t /• ,1i� 2 \ i p ! T_.. :• . ; 49 0 P o of -7 91+ �j c c ,V F i- !), J- _.' ��-_' �} .}\ try s.��7 '.. i \�:.i. \ _�; ' • i ' f r -1 i r } r r r WRr ! i { ° y -•� I t 1 �_, i i ff _ k 4. ,i { r - a ', i y ti_r.. ? t,� .{ y-_, r �. r r-•r .` -YIr "'� '"+�. c !. r { �4 1 {{ `: y- J. __r ' t-}_ I- r •� T ( t {- , i �"�' -.-r � }}"i E ' � r t .-t-\-- I \- 7 t �.t i i �� - ' .1 C r To fir. i I 1 r f j i.l yj* , C L g t ? F Fo IL: ai r F 4 a _ ,4 8 i- _ r r !-��. _} 1 t—T �� E`r••i� �.i t:� r�r4��� �. J S � ( $ �`, ' t..� ? r � 4^�j� l Y i-^ I � 1 ! P ;' s ..�._ i --�•- � ' 1, - �—F i r; }.._i._y-_;..-{_ � �. I ,1f !i � � r ! ".� { ' -:+ t IIL� �. _� i k 1 E sw'j` � 1 • 4 r ' E ...__yy t i 3 i : �..r,�.y�' �r..�... "."'f.7 "(`{.'.s" 1'}'i". ,-•F Y"Vt - i � - - •i'._,!^ :..., ._ ... ;.. .e r r t•: _ _ Tot�S l3A EDDo� 1� V+;-7 r' I. ' tf_._f._. t -a • t 1 t f I 5......._L�..,3-..j...� J`. '.._� _.-. .._� r. { 1b 0o OR' b % 6 b S 04D 48, 29" I4' ; } 444.89' PROJECT BENCH MARK TOP OF FOUNDATION : ------------ ELEV. = 100.00 (Assumed) Failed LOT #E>8 Cb t` v TEST S i2- Leach Pit t ��\ 80,7Y8 SQuare Feet+/_ _ —'" i i /� E1.E = 98.50 EXIST. 1 �-- _-- — — '0/1 -too ' 1000 al. SEPTIC TANK -98 1 i 1 EXIST. 4 - ' TEST HOLE #1 PATIO i ELEV.= 98.50 PORCH r j S%ISTINO 1 � Sonotubea 1 i 3 DBDROOM � 1 1 t -- t HOUSE r - t , 1 ♦} i GARAGE 0 30 60 70 \ 4120 ti _ 4 g „ SCALE: 1 "=30' 33 \ ASPHALT` DRIVEWAYi _ OA GENERAL NOTES P LOT P LAN � � ''�- - _ ;='�'` '� ` i ;= .J 1. Contractor is responsible for Digsafe notification, Verification of Utilities `\��� `��� and protection of all underground utilities and pipes. \` OF PROPOSED SEPTIC SYSTEM UPGRADE 2. The septic tank a d distri ution box shall be set 9 �� �P F PREPARED FOR level on 6" of 3�4 —1 1�2' stone. g0 C o 3. Backfill should be clean sand or ravel with no stones over 3" in size. g �g oo���j JAMES & MARGARET DENT 4. This system is subject to inspection during installation 9� AT by Carmen E. Shay — Environmental Services. �9 f O 58 FOX DEN BLUFF ROAD 5. The contractor shall install this system in accordance � �` ;' with Title V of the Massachusetts state code, the approved plan ASSESSORS ID: 041-032 and Local Regulations. 6. If, during installation the contractor encounters any = C OT U IT, MA soil conditions or site conditions that are different THE PROPERTY LINES ARE APPROXIMATE AND from those shown on the soil log or in our design PREPARED BY: installation must halt & immediate notification be COMPILED FROM THE SURVEY PLAN BY NEWLL B SNOW, PLYMOUTH, MA V .� ,. ENTITLED: SUBDIVISION PLAN OF LAND IN COTUIT MA — LC 39660 SHEET 4 made to Carmen E. Shay — Environmental Services. t- E$ x 7. No vehicle or heavy machinery shall drive over the DATED DECEMBER 12, 1989 C' `. HAY EVVVIRONMENTAL SERVICES AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN septic system unless noted as H-20 septic components. o c� 8. Install Tuf—Tite gas baffles or equals on all outlet tee ends. IT SHOULD BE USED FOR NO PURPOSE OTHER THANTHE SEPTIC SYSTEM INSTALLATION. 0 201 PLUM HOLLOW ROAD 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. �� �`� 10. All solid piping, tees & fittings shall be 4" diameter EXISTING PIT TO BE PUMPED OUT AND FILLED IN PLACE (3.fgTE FALMOUTH, MA 02536 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE �NIT \A z Schedule 40 NSF PVC pipes with water tight joints. FROM THE EXISTING CESSPOOL/LEACH PIT TO BE DISPOSED TEL/FAX 508-294-7498 11. Municipal Water is Connected to ALL OF The Residence and Abutting OF AS PER BOARD OF HEALTH SPECIFICATIONS. SCALE: 1"=30' DRAWN BY: CES DATE: MAY 5, 2021 Properties Within 150 Feet. 17ROJECT#58 FOX DEN FILENAME: 58 FOX DEN.d g SHEET 1 OF 2 SECTION A -A *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. VENT PIPE® Least 24 Inches tall) PROFILE VIEW OF LEACHING SYSTEM D-BOX cover must be Schedule PVC w Charcoal Odor Fliter 10' min. from / EXISTING Foundation house to septic tank within 8" of GRADE SAS cover must be Septic tank covers must be within 8" of GRADE within 6 in. of finished grade /s•to r 1/2Iadad ay.A.s Stints •qJ r/a•_ r/a•rack"Peasem Grade over Septic Tank - 98.50 Grade over D-Box - 98.50 de over SAS- 98.50 ' INSPECTION cover must tx3 within 6 in. of finished grade S @ 0.02 3 HOLE 5=0.01 (HOLE DIST. BOX . TOP OF SAS - 95.50 O O 0 Q O O o 0 20' o EXIST. 1,000 GA o Nsmena o 0 0 o a EXIST. PIPE S° 0.010• er foot FROM FOUNDATION n SEPTIC TANK 15' rn H-10 .�s 04 15 0 0 0 11� vw'r'.me.Woos CONCRETE FULL FOUNDAMO > 11 ui ui o 0 m > II rn rn ui 4 Units 6 ' = 24' a� � � II °' SYSTEM PROFILE y d d I I - a_� 5' P OVIDED Not to Scale c ; �' Q'6� ^�, 2•6' II Effective Length II-•---B m NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE a In.of 3/4•-1 1/2" Effective width S❑IL ABS❑RPTI❑N SYSTEM (SAS) compacted atone a8 LC-6 H-20 LEACHING UNITS / WIGGINS PRECAST Bottom of Test-Hole 1 Elev.= 87.50 Not to Scale 2-18• DIAM. ACCESS MANHOLES P E R C 0 LAT I 0 N TEST - ALL OUTLET PIPES FROM THE DISTRIBUTION Box SHALL BE e Perc #1 SET LEVEL FOR AT LEAST 2 FT. 12• COVER Date of Percolation Test: APRIL 16, 2021 Depth to Perc:36" to 52" 3_ 5• OUTLEUT *•••.�:.�..• 2• ter.•. .2i `�"''j"� '"` Test Performed By CARMEN SHAY Perc Rate= 2 MPI ASSUMED f KNOCKOUTS f '�', c_ Results Witnessed By. Donald Desmarais-(Barnstable BOH) Groundwater Not Observed 'J - '_ �5. + OUTLET , 1Y INLET EXCAVATOR:SHAY ENV. SRVCS.. No Observed ESHWT , e• B +. Percolation Rate: Less Than 2 MPI 036" ADJUSTED H2O Elev. = None 10 1 - 2 OUTI / `` T Test Hole Test Hole y'�S• 4" - SCH. 40 Te 2• •.`� h'• THE ACCESS COVERS FOR THE SEPTIC TANK, No. 1 No. 2 PLAN SECTION CROSS-SECTION .- DISTRIBUTION BOX AND LEACHING COMPONENT ,•• 7.7, ,, :,;• ;..5,� ..•� . ��, SET DEEPER THAN 6 INCHES 80.0W FINISHED DEPTH soils ELEV. DEPTH SOILS ELEV. 3 HOLE H-10 DISTRIBUTION BOX GRADE SHALL BE RAISED To WITHIN 6. OF STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. 0 98.50 0 98.50 NOT TO SCALE Loam PLAN VIEW INSTALL TUF-TITE GAS BAFFLES OR EQUALS Sandy Loamy Sand2A3 3-24" REMOVABLE COVERS 10 YR 3/2 10 YR 3/2 6" Ap 98.00 0.- 6" �b 98.00 �. .. .. .t. 4. r.:. P LOT P LAN 3• min. clearance • FILL FILL 8' m1n.T_L2" In inlet to outlet 6•min. IX"�'T' ' ,a-mtn. Liqu�k lave! 14. WET :� 6"- 18" 97.00 6"_ 18" 9,,DD 0 F PROPOSED SEPTIC SYSTEM UPGRADE 5' -7• :t - L_ }. :'5' -7• Loamy Loamy PREPARED FOR Sand E� . ~' : Liquid d depth 10 YR 3/2 10 YR 3/2 J A M E S 8c M A R GA R ET DENT �'_ ss.00 0 18"- 2a" As 18•- 24" As 96.00 AT Loamy Loamy Sand Sand 58 FOX DEN BLUFF ROAD . ... 8'_0. ...,.. .. 4...-10" 10 YR 5/6 10 1R 5/6 CROSS SECTION END-SECTION 24"-36" B. 95.00 24"-36" B» 95.00 ASSESSORS MAP ID: 041-032 TYPICAL 1000 GALLON SEPTIC TANK I Mad. Med. COTU IT MA Design Calculations Sand Sand , a 2.5 Y 7/4 2.5 Y 7/4 rR PREPARED BY: 36"-132 87.50 36"-132" 87.50 ell .°'t Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day per Title V) Garbage Grinder: No `t�=� ` � SHAY ENVIRONNErNTAL SERVICES Septic Tank - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank. Sidewall(ENDS) Area: 11' x 2' = 22 SF t' SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch o 'JK = Bottom Area: 0.74 gal/day/sq. ft. x 308 sq. ft. = 227.92 gallons/day 2 22 x 2 ENDS x 2 201 PLUM HOLLOW ROAD = 56 SF v 44 SF '1. 1' o Sidewall Area: 0.74 gal./day/sq. ft. x 15 sq. ft. = 115.44 gallon day Sidewall(Side) Area: 28 56 x 2 SIDEWALLS =112 SF ��." �� FALMOUTH MA 02536 Providing: =343.36 gallons/day I S� � C� Use: (4) LC-6 H-20 CONCRETE CHAMBERS, HAVING A 1' EFFECTIVE DEPTH, TOTAL SIDEWALL AREA =156 SF s9NIT AR�fr-- TEL FAX : 508-294-7498 (3' W x 6' L) TO BE USED WITH 4' OF WASHED STONE ON THE SIDES AND Bottom Area: 28' x 11' = 308 SF SC L : 1 r.=20' DRAWN BY: CES DATE: MAY 5, 2021 2' OF WASHED STONE ON THE ENDS AND 1 FOOT OF STONE UNDER PROJECT#58 Fox Den FILENAME: 58 Fox Den.dvig SHEET 2 OF 2