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HomeMy WebLinkAbout0143 FOX DEN BLUFF ROAD - Health 143 FOX DEN BLUFF ROAD, COTUIT I iv c Commonwealth of Massachusetts W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form Not for Voluntary Assessments s ;M 143 Fox Den Bluff Rd. Property Address Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 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: A. General Information When filling out 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 i City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certifythat I have personally inspected the sewage disposal system at this address and that the P Y P 9 P Y 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 6/30/2009 I I pe tor's 6na&w6 Date 7 The system inspector shall submit a copy of this inspection report to the Approving Authority°(bard of Health or DEP)within 30 days of completing this inspection. If the system is a shardd-1syste l or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall stibmit$p report to the appropriate regional office of the DEP. The original should be sent to the cs3stem 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. �O t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 - Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' M 143 Fox Den Bluff Rd. Property Address P Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i ` Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 143 Fox Den Bluff Rd. Property Address Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 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 143 Fox Den Bluff Rd. Property Address Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 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: j D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M ,•''r 143 Fox Den Bluff Rd. Property Address .Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 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 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 143 Fox Den Bluff Rd. 'M Property Address Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 every page. Cityrrown 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 l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 143 Fox Den Bluff Rd. Property Address Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 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 a 1000 gallon leaching pit. Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2007:46,000 g ( y g (gp ))' 2008:40,000 Detail: 2007:126gpd 2008:110gpd Sump pump? ❑ Yes ® No Last date of occupancy: 6/30/2009Date 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 143 Fox Den Bluff Rd. Property Address Arthur Taylor Owner Owner's Name information is Cotuit Ma. 02635 6/30/2009 required for 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: Capewide Enterprises,LLC. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? Measured Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form :Not for Voluntary Assessments ;M 143 Fox Den Bluff Rd. Property Address Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 every page. Cityrrown State Zip Code Date of Inspection D. System. Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 14"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: e0+ t Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 0 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 143 Fox Den Bluff Rd. Property Address Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 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 NA Scum thickness 0 Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Tank pumped at inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structural) sound. pp Y Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 143 Fox Den Bluff Rd. Property Address Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 143 Fox Den Bluff Rd. Property Address Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 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 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 143 Fox Den Bluff Rd. Property Address Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 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 dry soil.No signs of hydraulic failure.Leaching pit was dry at time of inspection with stain line 32" below 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 f ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 143 Fox Den Bluff Rd. Property Address Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 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.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 r Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer I Custom Map Abutters Map Size Zoom Outfl I I I I M j I jIn y le R,)q �yN•h�.� P`1 a? a Il kw r 3.f - - f - 1 4 � !.4 Y� Y yf O j rc_ . 3a% 3 �z I � t. 1 `t Ct Feed_ ...... Set Scale 111 = 20 1 I Aerial Photos I MAP DISCLAIMER (:nnvrinhf 9MF_,)nnG Tnlun of Qn—etn Kln RAA All rinhfc me—, http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=04103 7&mapp... 7/1/2009 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 143 Fox Den Bluff Rd. Property Address Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 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 40' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built ❑ 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 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 i Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 143 Fox Den Bluff Rd. Property Address Arthur Taylor Owner Owner's Name information is required for Cotuit Ma. 02635 6/30/2009 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 17 Y v. Wm. E." Robinson, Jr. Septic.Inspections 43 Tomahawk Drive Centerville, MA 02632 (508) 775-7986 _ Pager 978-622-8700 \ "A JUL 2 4 1998 �' �y TOWNfIF BARNSTABLE -[ALTH DEPT. h of Location 143 Fox Den Bluff Rd. Cotuit Ma. 02635 L. Paltrineri SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Map Number 041 Parcel Number 037 Lot-#21 PROPERTY ADDRESS: 143 Fox Den Bluff Rd. Cotuit Ma. ADDRESS OF OWNER: DATE OF INSPECTION: 7-21-98 NAME OF INSPECTOR: William Robinson I am a DEP approved system inspector pursuant to.Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: W. E. Robinson Septic Inspections MAILING ADDRESS: 43 Tomahawk Drive Centerville, MA 02632 TELEPHONE NUMBER: (508)775-7986 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: ^ DATE: 7-21-98 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the. system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, orD: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the`failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: System is in good working condition and shows very little use. 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 b the Board of Health, will pass. Indicate yes, no, or.not determined (Y, N, or NO). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, unless the owner or operator has.provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20) i Years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked, strimbirnlly nnconnd chows cuhstantial infiltration or PyfiItratinn nr tank is failiirP is imminent ThP SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (CONTINUED) Property Address: 143 Fox Den Bluff Rd.Cotuit Ma. P Owner: L. Paltrineri Date of Inspection: 1-21-98 B]SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: Broken pipe(s)are replaced Obstruction is removed Distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): Broken pipe(s)are replaced Obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 Feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 143 fox Den Bluff Rd.Cotuit Ma. Owner: L Paltrineri Date of Inspection: 7-21-98 D]SYSTEM FAILS: You must indicate either"Yes" or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component.due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded.or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than '%Z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a Significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. ' (revised 04/25/97) Page 3 of 10' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 143 Fox Den Bluff Rd.Cotuit Ma. Owner: L. Paltrineri Date of Inspection: 7-21-98 Check if the following have been done: You must indicate either'"Yes"or"No" as to each of the following: Yes No X Pumping information was provided by the owner, occupant, or Board of Health. X None of the system components have been pumped for at least two weeks and the system has not been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components, including the Soil Absorption System, have been located on the site. X The septic tank manholes were uncovered,.opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. X Existing information. Ex. Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable)[15.302(3)(b)] revised 04 25 Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM IN SPECTION FORM PART C SYSTEM INFORMATION Property Address: 143 Fox Den Bluff Rd.Cotuit Ma. Owner: L. Paltrineri Date of Inspection: 7-21-98 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom for S.A.S. Number of bedrooms: 2 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system es or no): Yes Seasonal use(yes or no) No Water meter readings, if available(last two(2)year usage(gpd): 1 97-40 98-41 Sump Pump(yes or no): No COMMERCIAL/INDUSTRIAL:NONE: Type of establishment: ' Design flow: Gallons/day Grease trap present: (yes or no): Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N/A T.O.B. DPW System pumped as part of inspection:(yes or no) No If yes, volume pumped: Gallons Reason for pumping TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system NOTE: No D-BOX TO BE FOUND. Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed(if'known)and source of information: System installed 10-14-94 Permit #94-448 Sewage odors detected when arriving at the site: (yes or no) No (revised 04/25/97) r Page 5 of 10 f SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM INFORMATION (continued) Property Address: 143 Fox Den Bluff Rd.Cotuit'Ma. Owner: L. Paltrineri Date of Inspection: 7-21-98 BUILDING SEWER: (Locate on site plan) Depth below grade: 3411 Material of construction cast iron X 40 PVC other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:. (Locate on site plan) Depth below grade: 1611 Material of construction X concrete _ metal Fiberglass Polyethylene other(explain) If tank is metal, list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 8'x5'x5' 1000 GST Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 42" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 4 Distance from bottom of scum to bottom of outlet tee or baffle: 1" How dimensions were determined Measured Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Tank is in goodworking condition but should be cleaned in next 12 months. GREASE TRAP: NONE: (locate on site plan) Depth below grade: Material.of construction concrete _ metal Fiberglass Polyethylene _ other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of.leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 143 Fox Den Bluff Rd.Cotuit Ma. Owner: L. Paltrineri Date of Inspection: 7-21-98 TIGHT OR HOLDING TANK: none (Tank must be pumped prior to, or at time, of inspection) (Locate on site plan) Depth below grade: Material of construction Concret metal Fiberglass Polyethylene other(explain) e Dimensions: Capacity: Design flow: Gallons/day Alarm level: Alarm in working order Yes-, _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: none (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc,) PUMP CHAMBER: none: (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber, Condition of pumps and appurtenances,etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 143 Fox Den Bluff Rd. Cotuit Ma. Owner: L. Paltrined Date of Inspection: 7-21-98 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: Leaching pits, number: 1-LP 1000 Leaching chambers, number: Leaching galleries, number: Leaching trenches, number, length: Leaching fields, number, dimensions: Overflow cesspool, number, Alternative system: Name of Technology: Comments: r (note condition of:soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) LP is less than half full at time of inspection and shows very little use. CESSPOOLS: none: (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(cesspool must be pumped as part of inspection) Comments:: (note condition of soil, signs of hydraulic failure, , level of ponding; condition of Vegetation, etc.) PRIVY: none: (locate on site plan) none Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 w UT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 143 Fox Den Bluff Rd. Cotuit Ma. Owner: L. Paltrineri Date of Inspection: 7-21-98 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100(locate where public water supply comes into house) c J - %JT 2 a R'C'«� B•C s3b�6�, 0 C_ 1000 6ST X, 3 q L P-t ooO (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 143 Fox Den Bluff Rd. Cotuit.Ma. Owner: L. Paltrineri Date of Inspection: 7-21-98 Depth to groundwater 20+ feet Please indicate all the methods used to determine High'Groundwater Elevation: X Obtained from Design Plans on record Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data 4escribe in your own.words how you established the High Groundwater Elevation. (Mus be completed) RQrmit#94-448 (revised; 04/25/97) Page 10 of 10 a� TOWN OF BARNSTABLE LOCATION DeAA glow Qd. SEWAGE # `14-40 VII; .AGE C&U411 r__ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE_NO. ntSt SEPTIC TANK CAPACITY /0 0o 9 5T LEACHING FACILITY: (�o`jpe) P"f' (size) 1PIl�4o �iI NO.OF BEDROOMS WM. R081Nsom $2p4f�- ZkRV^ Btm.DER OR OWNER C.PAhci/1Lrr '7�at�98 S ec-ZNSpeef& PERMITDATE: COMPLIANCE DATE: GA Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility-(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by a C 1000 65( A C. w LOCATION � d Oc 1 SEWAGE # VILLAGE ASSESSOR'S,MAP & LOTd / 03 IV INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY /4-e'V L19 � LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR UBLIC WATE BUILDER OR OWNER co?J DATE PERMIT ISSUED: 9 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No '4'3 •-f�,1� a rev �� �4J .' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TO- IJ' oF.......�,� R �1' ' 1' .1�.r4 Appliration for Biiivoiittl Workii Tonitrnr#ion Vamit Application t hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal System at:/p� IS- If LOT 2 FaX V � �F D. ----....... •--•••--......-•-.•••. . $1..L2_.....----• R .....----•-••• .....---• ...._.. ......... ... . ••---••-•---••- / l f Location-Address or Lot Ng� q E!1 e.tn,e....•--•-----•.............•-------...-------- .............. l� a!�- �"/�!vJ 1 -� Owner ddress J j � 3 I L / .S vL. -------------------------------- ••... •--• ¢ F i�`�•-•------•--•••• ••-•.........---.....••-- C/ Installer Address U Type of Building Size Lot-7 0,0 4.6 a...Sq. feet Dwelling—No. of Bedrooms____--_.3-------------------------------Expansion Attic ( ) Garbage Grinder ( � aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ...._._.. - -- d ........................................................ -----•...,.q..-- W Design Flow..........5577.....................gallons per person�j e4 da, Total daily pyjv----____c3 ..6.[.._....._. ............ lonsr,/ WSeptic Tank—Liquid capacity 0 _gallons Length-_L�---- -- Width6r_' _. Diameter_______________,Depth. .%.''�y x Disposal Trench—No. .................... Width_._______.__.._... Total Length.................... Total leaching area.........._.__. sq. ft. Seepage Pit No--------�_.-.--.-_-- Diameter--------1,!---- Depth below inlet....�j..1....... Total leaching area....3.Jgj..sq. ft. z Other Distribution box ( ) Dosing tank `-' Percolation Test Results Performed G Date..J.!�221r7............... Test Pit No. 1-------7.r-----minutes per inch Depth of Test Pit-----ISI..... Depth to ground water-----&.S,Q_0?. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------••-•........_-•-•- -........................................................... O Description of Soil. 0_-3-•.....---ter--. �.� � �.?,'�..�.�Z.�.---...M_-.C....��A��-------------------------------•-•--•---------- x M W 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu b th board of health. Signed ........... .... ......._.............................. ..-..... .. ........ .._. ' 7- Dare Application Approved By ............ v 4 ------------,.-------------------------------------------------------....... ----------------- Dace.................. Application Disapproved for the following reasons: . ................................... ........... ....... .............. -- -- -----....... ----------- ................................................................................................................................................................................................................. ........................................ Dace Permit No. --------C LY.---`--- Y �. Issued .. .. ... ...................... . ............ ------------------- Dace No.. /:.--mac Fim......... •- THE COMMONWEALTH OF MASSACHUSETTS l BOARD OF HEALTH Appliratiou for Ui,ipu,sal Workii Tonstrurtinn Prrutit Application is hereby made for a Permit to Construct ( or` Repair ( ) an Individual Sewage Disposal System at ..L.... -...=----.�-- =---------------------------------------••--------......-........-----------------.......--------- Location-Address or Lot No. -•...................._.-_.._._..-..__.._...-----•-----....-__.._-------------=----•----•--••--•- --••--•--•----•••••••-...--•••-••-•--•••---••----....._..--------..._...._...............---...... Owner - Address w Installer Address Type of Building Size Lot__ 0 b_6_0___Sq. feet .. Dwelling—No. of Bedrooms_________ _______________________________Expansion Attic ( ) Garbage Grinder aOther—Type of Building ____________________________ No. of persons----------------------------- Showers ( ) — Cafeteria dOther fixtures ------------------------------------------------ -------------- Desi n Flow___________ ___ __ _ _ _______gallons per person er day. Total daily fl3316 w g - � g P P YJ pry s,}�' --- .......................gallons. i.j WSeptic Tank—Liquid capacity),00.0galIons Length_-_. -Width_ ' __ Diameter_______________ Depth_4`/-' .. x Disposal Trench—No_ ____________________ Width.......... Total Length.................... Total leaching area_____:._____.___ -'sq. ft. Seepage Pit No-_______-i...__-___. Diameter____-___.�'Z•_._. Depth below inlet_______..___._. Total leaching area� - g 5- �- --sq. ft. Z Other Distribution box ( ) Dosln tank Percolation Test Results Performed by � '/_ 7t. --------- Date..i __ s ............... 04 Test Pit No. 1.......Zr....minutes per inch Depth of Test Pit_____ '.._..__ Depth to ground water...... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------ ------- ..............:.••••-------•.........•-•-------•- � .g 0 Description of Soil " - °..:?_.: .: �'-�--------$ 4-... ---------------------------------------------- x 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 has been issued by the board of health. Signed ........................................---------------------------------------------------------------- .......... .. .............._.... Dare ApplicationApproved By ..--------- tics �\------------------------------------------------------------------------- ....................................... Dare Application Disapproved for the following rea.rons- --------------------------------------------------------------------------------------------------------------------------------------- .. ....................................................... ................ .............................. . -- . . . . --. -- .. . . ..... ........................................ Permit No. ......__ ._Ll..._..... Issued ---....--'---------- ....._..k............. ..........._._..----------------..._ Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............................................. OF ------------------------------------------------------------------------------------- (gertifirate of Tomplian e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by -------------- '-�-L�ii e".-----------------------------...------------.............................---------------------------------- .................................................... — - -------...-�Ct;.:-.^.-� Installer at ........ ...... ... �. �_tr.. �---/------------- �!G-------- �}- - .........� �` has been installed in accordance with the provisions of IT f The State Environmental ode as described in the application for Disposal Works Construction Permit No. ....f_I --. -/!,,� r ........ dated ------------------------------------------------ Y THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEDAS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. `.. .... _... ....................... Inspector . .: :.., � �L --------------------------- THE COMMONWEALTH OF MASSACHUSETTS . BOARD OF HEALTH OF.......... 4: No. �- / 1 Z ....................................... ....1.� ....... FEE....�tZl._i.....:.:. Disposal Works Tnnstrutinn rrmit Permission is hereby granted------------- - ��.�-a ---------------------------------------------.___...............-•--•-•- to Construct ( ) or Repair ( ) an In ' al Sewage Disposal System at No..-----.--� t�s �•--••-.. r .-E-,-•��'2 tr as shown on the application for Disposal Works ConstructiiOn it ��__ Dated.......................................... .,. ------------------------------------- ' 7.Y 'G� Board of Heal h DATE.......-�--'�-�-----------•---------•--•---.....•... .:................ Form 1255 H&W HOBBS a WARREN TM Publishers -.47P,17t(M9XS ?Vt//BIsttltilpY '-.SNgh:tt.lt{M1(!C:-tl5r�,dYk1YGn'y17R'Al}DYl73A",}:`215°a7tt4lt1[#l='1!Rllt.qCll1'!fY'. s'1RMA"p!RgMl4'XCKi't.".e (,r�'TF't1i 9RR. fitS'.+#.s7-a"i:R:a'..'.' _ rY aT. ' y 3r ' .:. +'t-• NFe _i' a3S,. ,4'7W:.3hien'itch+''!7°Y°!1ff3 ? @7F.:k-?d. .ltS'7•i''3FiS6>fl. '!t -n : . ., .. .. .. .____ .... . :. .- . A" 1<y1[yi} F111 .... .7}M.,;-tFVYMITIUfi`.1IP'D'" 7r.•.R-..r.T.4}1^.0.'/MttSf+rR'YtLfYl`f11I.iDJ.9!'(N14 N:v.h`M1.kl IAIH•;Rf02f:i1tSN."T1'GAT'I-.._•--....:..._... ...s........_....-... -e•.... -. -.-.. -.. .. ........_.. ........-...... ..n-......• .o .... ..,... ..-.-. ......._......._-+......v.. .........•.,.. ,w-._..._...............-..w.......... .- .. ..r. ._.....—... _.. •_ •.w ,� wa+f.'acr+Ywntt*'(+MI++a1LTR+KAR}.lR1dtR1'r.ra4.rylelrwriww:ir.CmAsrqw.i'wraPiMw„uRf µTt+KS!(!'.. liltw+w:'/ry9,mu'11RTJ'MRi' .71i14PwY (,WSMYY:fYtttWtAi0." .Rol.'+,rstVgi'.lPIq.R+1M'.71R.tMM ••+•••4fe+watlL[axi�Cl* Y, . a. IF!/�. 9Tw. F1 SOIL TEST PIT DA TA: { f T.P. -.f T.P. 2 �E Y. -7. �b 6RN0. ELEY. kl. 6.X. ELEY. . � DESIGN CRITERIA: 5u�$01L DE.516N P7OM'3 B ,c f ,, Q, a` Y E1lR!JOM ZL DJE'SE- I'�ti �� � . 1 0 6Ht� DA)'' EOUALS4-40GALS PER DAY. z SEPTIC TANK REQUIRED.• INDICATES G Y 3 o GPD X l50A' _ 4 9 5 y6AL. s TEST ca�c r•,� SEPTIC TANK PROYIDE7I' = 10 O O SAL. • SIZE OF LEACHING FACILITY REQUIRED: 0 S PD INDICATES DESIGN PE9C. RATE = 2 MINUTES/INCH OBSE9Ya7 6ROUAMATLR q.4-CJ6ALLONS PER DAY s` \ SIZE of LEACHING FACILITY PROYIDED.• t i . I`L 00 Chu C4 PIT XITH 3 STONE 41. 63 ow -7•Z , 67 DATE: �. SIDEXALL Z 2! F X Z.5 ' / Q TEST BY.• Imo, BULL)vac TEST BY. '`� > �'� •g >c�r-�.R. 1 .� { 'LNG BOTTOW ! 1 3 5� >S l , Q ,r L � /v o ° XITJ1 ssw BY.• S, n)U N i MITNEMED BY.• TOTALS 33 o 7 d C�P� �-1 PER RATE PERC. `RATF4 ZM1 111G C. BREAKOUT CAL CULA TIONS.' ` 7066 S.F. SLOPE / X f50 ' °,, A-bdt'TI ON F MA R "•�� 10 $. 0 O � 6>,t sv 1,� oatACCESS COVERS MUST BE IIrITHIN M' OF FINISH 6R49E. e 1 103 $ © r 1 Y AlIN. 2r a OF 1/8 -1/2 DIA. �6y, �• o vrsr. MASHED STONE r f CO CRE BOUND � a �:. 09. T4 S U © i �'-O' XIH. I Z LlW D .. , AIASHEO STOKE `� f 00 GAL. � E y o SEPTIC W ;d TANK q7� l -i I • Z �o LEGEND p• r 4 �-' - - 0 50--' = EXISTING CONTOUR ,gyp G, r�,-�, �o • � .- -, - ',� • 1RJ � r ��1. \ ' n _, 50 = PROPOSED CONTOUR ' � ' ao INVERT ELEVA TIONS.' PRoP - SOT GRAOE ! PROPOSED P l 0�1 6 Z \ ° '� ) SkPbr•6G L INVERT AT BUILDING , `-- b , rth X �, -�►= DIRECTION OF STORMYA TER INYEAr M AT SEPTIC TANK 104•��• REVISIONS. UN INYERT OUT AT SEPTIC TANK j CFF i0 .l� N0. DATE REVISION 8 0o INVERT M AT DIsr. BoX 10 1 INYERT OUT AT DIST. BOX J0•- INVERT M AT LEACH PIT BOTrOM OF LEACH PIT °I ..da, GENERAL NOTES, f. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION OF THE SEWAGE DISPOSAL FACILITY Ol1/L Y. ROGER 2. ALL CONSTRUCTION AfETHODS AND AM 7ERIALSPAUL . FOR THE SEPTIC SYSTEM! <�r ; I—; ado.:tv420 SHALL COAF61 M 70 MASS. D.E. G.E. TITLE 5 � `, c�� CIVIL ,�, AND LOCAL BOARD OF HEAL TH REGULATIONS. t5r 1rrc ��, a, 3. ALL SEPTIC SYS7ZW COAlPMEWS SUBJECT TO Y YE YraE LOADING (I.E. UNDF_R DRIYEXA M ETC.) l SHALL BE DESIGNED TO XITHSTAND f -20 LOADING. y. 8 • g g89` � � y , - W. /LL SEkER PIPE SHALL BE MhEDULE 40 OR APPROYED EQUAL. PLAN SHOWING THE DESIGN OF A PROPOSED 5. BEFORE STARTING CONSTRUCTION CALL DIG SAFE SUBSURFACE SEPTIC DISPOSAL S rSTF ' �! f-B00 322-4B44 FOR��ATZON Or f unrvERGRouNO urlLzr LOT . , FOX DEN BLUFF ROAD E. DATWI is B, RNST, 9 .� N, r 7 , 5��� S LcaG,av'C�a 1-s "C►-�►, VIP GP�Ohtu���,r,�`Te.� SCALE' 1 � = 40 ' AUGUST 3, f594 � 1 'PtzQ"�'.G'�'1�3•Pl bV�fZ�A`t' '�715"fF�1G"t Zofl� g. 0 EAGLE SURVEYING G EAVINEYER.1'NG, INC. ell S 44f ROUTE 130, SAWIVICH MA PR0�IECT NUMSER `94 0T4 _.Aat ....,oOn .. •tl.YV„f.(a. ¢..R...Rf .R.. ! .,,,..,=,.R,UgYY ..E1F.,t(.lal. a..(