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HomeMy WebLinkAbout0825 MAIN STREET (COTUIT) - Health 825 Main Street (c otu it)"-`- �~ Cotu it F 035 063 f o�6 aa3 Commonwealth of Massachusetts COP 4lI -=,10 Title 5 Official Inspection Form . ' — I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ef< r. 825 Main Street _ Property Address Donald MacKinnon Owner Owner's Name information is t required for every Cotuit _ __ MA 02635 July 11, 2019 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 3 on the computer, use only the tab _Patrick T. Sullivan_ key to move your Name of Inspector cursor-do not Ready Rooter Excavating _ use the return key. Company Name Box 89 Co r� Company Address Forestdale _ _MA 02644 City/Town State Zip Code ion 508-509-_0802 _ S112843_ Telephone Number License Number B. Certification certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1: ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails July 15, 2019 Inspecto s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of. 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. 4 Please note: 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. t5insp.doc•rev.7/26/2016 Title 5 Offuaal Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �. 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 825 Main Street _ vl Property Address Donald MacKinnon Owner Owner's Name information is Cotuit MA 02635 July 11, 2019 required for every --- — page. CityrTown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) 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 ezfiltration 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. f, * 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): e t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 f i 1 �X Commonwealth of Massachusetts --�, Title 5 Official Inspection Form - I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 Main Street Property Address Donald MacKinnon Owner Owner's Name information is Cotuit MA 02635 July 11, 2019 required for every — — — - page. City/Town State Zip Code Date of Inspection C. Inspection Summary (coat.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or d'ue to a broken, settled or uneven distribution box. System will pass inspection if(with approval/of Board of Health): ❑ broken pipe(s) are re-'laced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is rem ved ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box/is or replaced ❑ Y ❑ N ❑ ND (Explain below): .i ❑ 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 1 ❑ Y ❑ N ❑ ND (Explain below): t ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): i i r' 3) 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. a. 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: t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 1�_N� Commonwealth of Massachusetts Title 5 Official Inspection Form � — — i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 Main Street Property Address Donald MacKinnon_ Owner Owner's Name information is Cotuit MA 02635 Ju1y_11, 2019 required for every — -- — — — page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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: j i ❑ 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. f I ❑ The system has a septic tank and SAS and/the SAS is within 50 feet of a private water supply well. j ❑ 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". (I Method used to determine distance: 1 " This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and theipresence 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. c. Other: r - 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ( Y 825 Main Street Property Address Donald MacKinnon_ Owner Owner's Name information is required for every C y _otuit MA 02635 Jul 11., 2019 _ page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 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 '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ M 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 water supply ❑ ® 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 2000 gpd- 10,000 gpd. ® 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. 5) 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 CA. ; Yes No i i ❑ ❑ the system is within 400 feet of a surface drinking water supply I ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the systerryls located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 r Commonwealth of Massachusetts -- - , Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 Main Street Property Address Donald MacKinnon_ Owner Owner's Name information is Cotuit MA 02635 July 11, 2019 required for every --__ __ -- --- page. Cityrrown _ State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected 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? El 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)] t5insp.doc•rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 tom. Commonwealth of Massachusetts Title 5 official Inspection Form — Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �. 825 Main Street Property Address Donald MacKinnon Owner Owner's Name information is Cotuit MA 02635 Jul 11 2019 required for every _ � page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 603 GPD Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to:Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 2018= 131 GPD 9 ( Y 9 (gP )) 2019= 107 GPD Detail Property is used mainly during summer months. Sump pump? ❑ Yes ® No Last date of occupancy: Current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts _ Title 5 Official Inspection Form I o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 Main Street `tJ - Property Address Donald MacKinnon_ Owner Owner's Name information is Cotuit MA 02635 Jul 11, 2019 required for every —___ __ _ _ page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? �" ❑ Yes ❑ No If yes, discharges to: - I l'r Industrial waste holding tank present? ; El Yes ❑ No r i Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: - Last date of occupancy/use: Date Other(describe below): i i 3. Pumping Records: Source of information: Ready Rooter records: Pumped Oct 2018._ Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? — Reason for pumping: - t5insp.doc•rev,7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments b � 825 Main Street _ \ Property Address Donald MacKinnon _ Owner Owner's Name information is required MA 02635 July 11, 2019 requiredd for every — .— page. City[Town State' Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: System installed 11/10/2005. Certificate of Compliance on file at Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ( 825 Main Street Property Address Donald MacKinnon Owner Owner's Name information is required for every Cotuit MA 02635 Jul 11, 2019 — --y page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 1.8 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: 12.5' x 5.5' x 6' 2000 gallons 1" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 36" Scum thickness - Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? DjRtube and tape measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet tees in place. Liquid level at outlet invert. Risers bring covers within 6" of grade. Effluent filter in outlet tee should be cleaned every year with full time use. Recommend maintenance pum ip ng every two years. Irrigation runs over outlet cover._ t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5, ®fficial Inspection Form — — Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 Main Street Property Address Donald MacKinnon Owner Owner's Name information is required for every Cotuit _ MA 02635 July 11, 2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: ; feet f 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: i ❑ concrete ❑ metal �f ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: i Capacity: f gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 Main Street Property Address Donald MacKinnon Owner Owner's Name information is Cotuit MA 02635 Jul 11, 2019 required for every _ Y page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) 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 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): One inlet, three outlets. H-20 D13-9 with riser(20" round concrete cover)within 8" of grade. No solids caraoover_ No h�ih�c h water staining over outlet inverts. _ 15insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts qn - -; Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 Main Street Property Address Donald MacKinnon Owner Owner's Name information is Cotuit MA _02635 Jul 11, 2019 required for every y page. City(Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): i Pumps in working order: i ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑.No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 7'_ * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type. % ❑ leaching pits number: ® leaching chambers number: 5 w/4' stone ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: — ❑ innovative/alternative system Type/name of technology: — t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts Title 5 official Inspection Form i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 Main Street Property Address 1 Donald MacKinnon Owner Owner's Name information is required for every Cotuit MA 02635 July 11, 2019 __— _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 5-flow diffusors with 4' of stone. Camera used to locate and inspect leach chambers. No standing liquid, damp base at time of inspection. Clean stone visible in sidewall. No sign of past hydraulic failure. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration l Depth —top of liquid to inlet invert -- Depth of solids layer Depth of scum layer % — 1 Dimensions of cesspool Materials of construction Indication of groundwater inflow �� ❑ Yes ❑ No Comments (note condition of soi(, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �c 825 Main Street Property Address Donald MacKinnon Owner Owner's Name information is required for every Cotuit MA 02635 July 11, 2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: — i Dimensions �I Depth of solids Comments (note condition of soil, signs of/hydraulic failure, level of ponding, condition of vegetation, etc.): i t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 r— Commonwealth of Massachusetts Title 5 Official Inspection Form - w; - �� Subsurface Sewage Disposal System Form Not for Voluntary Assessments ` l� `� 825 Main Street u Property Address Donald MacKinnon Owner Owner's Name information is Cotuit MA 02635 July 11, 2019 required for every _ — — — — - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 01 I ' i 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 825 Main Street Property Address Donald MacKinnon Owner Owner's Name = information is required for every Cotuit MA 02635 July 11, 2019 - - page. City(Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >5 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: 09/20/2004 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ® Accessed USGS database -explain: maps.massg is.state.ma.us/oliver.php You must describe how you established the high ground water elevation: Test hole in 2004 found no ground water at 144". Base of leach pit 60+" below grade. No high cgrround water in area of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 4 Commonwealth of Massachusetts � -- -; Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 Main Street Property Address Donald MacKinnon _ Owner Owner's Name information is Cotuit MA 02635 July ,11 2019 required for every -- _ _ page. CitylTown State Zip Code Date of Inspection r E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank-Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE J tf(� �� Li,;,C:ATION f__�� /� SEWAGE # VILLAGE L®A ASSESSOR'S MAP & LOT 3,15 INSTALLER'S NAME&PHONE NO. r��t�TTi Ca�J7�i►.G�ieJ S��'�SZ SEPTIC TANK CAPACITY .2Or,b G"aC LEACHING FACILITY: (type) F1sW-4.9aJ&,-J �S� (size) 42 X �� NO. OF BEDROO ,.y� BUILDER O OWNER /�� krrlH® PERMITDATE: /O" /3-6yY COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility r4- 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 off leaching facility) Feet Furnished by y- �/� G w w° O e To. :LJ _ ��� Fee ' HE COMMONWEALTH OF MASSACNUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Migonl *p5tem Com6truction 30ermit Application for a Permit to Construct(")Repair( )Upgrade( )Abandon( ) R Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/P. el �r cowl� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Aa Type of Building:Dwelling No.of Bedrooms S Lot Size j�y � sq.ft. Garbage Grinder( � Other Type of Building/ eWLGNo.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 611100 1 3 It P gallons. Plan Date YZZ ® Number of sheets Revision Date /® / Title Size of Septic Tank 7 Nell Type of S.A.S. -� ` J�l�D4� 4:7- �10 d.5 Descriptiom of Soil. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been I by it �od ea . Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued :r'r tit �e-�y�. .:. .. ,r � ..�*M a •, .. ._... :� -..,.,����� ---- ; _ _ _ � -- _a y, . Q� C �4 `�_ A'�\µ /S W Fee /J 'p °NE COMMONWEALTH OF MASSACF�USETTS Entered in computer: Yes ` (20 Q S PUBLIC HEALTH DIVISION -TOWN OFBARNSTABLEs�MASSACHUSETTS 1 ZIppric4tion for DigpozaY 6p5tem Congtrucftott 'Permit Application for a Permit to Construct/Repair( �)Upgrade( ( ) L/J Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 3 Assessor's Map/Parcel Ow � l, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. XL .3 Type of Building: Dwelling No.of Bedrooms S Lot Size 9© � sq.ft. Garbage Grinder(AO Other Type of Building No. of Persons Showers( ) Cfeteria( ) @ Other Fixtures Design Flow / D �' _gallons per day. Calculated daily flow gallons.. Plan Date ?Z Z 7119L/ Number of sheets / evision Date /® /3 i Title ✓`�P� G SY .Seize of Septic Tank_ ype of S,,.�'S. �' ©!J/,�4' Description of Soil Nature of Repairs or Alterations(Answer when applicable) �r P Date last inspected: Ei Agreement: , The undersigned agrees toensure the construction and maintenance of the afore described on-site sewage disposal system `` in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been 115 ed by this Board of Healt . / Signeuk Date Application Approved by Date /-3 .S Application Disapproved for the following reasons Permit No.�[M 5 .So Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the O -site Sew a e Disposal System Constructed( IL�epaired ( ' )Upgraded( ) Abandoned( )by �q! � 1 /`�60 s1`� at !i�- --el/.T/d' S�; G'f yG`1! 7` has been constructed in accordance with the provisions of Title 5 and the f r Disposal System Construction Permit No, Q Og'dated l Q/,, Installerer�.- -U°74 1 Designer The issuance of this permit shall n t be construed as a guarantee that th syste w I1 ti o n as desigtied. Date 10 l `J Inspector No. 00 IS y — Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS migogar *p5tem Cottgtruction Permit Permission is hereby granted to Construct( Repair( ' )Upgrade( )Abandon( ) System located at T.?, 4 .7 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to . comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the ate this�thiss Date:_ �n /13 Approve 1✓ �. 77 Town of Barnstable "wa Regulatory Services W. Thomas F.Geiler,Direct or Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form ' Date: Sewage Permit# 20oS-508 Assessor's Map\Parcel rAa p 3,T Designer: �h n ker, A (J f Isom PC— .' Installer: 3ae4a lop W C.rn•af Address: haw 1zr Address: P-0 (3ex 7014 ?� 1�oar1� Sfi IA!4b Inn ts GvS1crtS VV1i I(s on to 113105 /301-716/o /f j' s f was issued a permit to install a (date) (installer) ; 4 septic system at 13 2 S Mo cn 'S 1- Co tv + based on a design ftwn by (address) o - -o S p Lt c•, (a L saw . P. E, dated /_ O�Z;-�//oS cv (designer) W X I certify that the septic system referenced above was installed substantially ccording to the design, which may include minor approved changes such as lateral relocation of the distribution box.and/or septic tank I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow: WL ,j: STEPHEN yG ---���-- Al.I YNJ (Ins is Signature) t°NLa(7N Mo.30216 SS�Q51��ti�a esigner's Signature) . (Affix Designer°sStamp Here) 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_ I Q:Health/SepticMesigner Certification Foam 3-26-04.doc 002 U04//O z OF �y Town of Barnstable sawzr�rnlat�e, Board of Health � b 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,RS. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. October 26, 2004 Mr. Stephen Wilson, P.E. Baxter, Nye, and Holmgren, Inc. 812 Main Street Osterville, MA 02655 RE Variance for Septic System Ctruction ons t at 825 Main Street, Cotui A 35 63 Dear Mr. Wilson, You are granted a variance on behalf of your client, Donald MacKinnon, to construct a replacement onsite sewage disposal system at 825 Main Street Cotuit. The variance granted is as follows: 310 CMR 15.221(1): To place a reserve area only 3.7 feet away from the property line, in lieu of the ten (10) feet minimum separation distance required. This variance is granted with the following conditions: 1) No more than five bedrooms are authorized at this property due to the limited capacity of the proposed septic system. 2) The septic system shall be installed in strict accordance with the revised engineered plans dated September 23, 2004. This variance is granted because the physical constraints at the site severely restrict a location of the soil absorption system and reserve area. Since e y your W nejkiller, M.D. Chair n Q:NarianceGrantedW ilsonSingleV ariance r a 3 ,. 0I DATE: * ..... :. FEE: STABLE 1659+ Al ;EC SY % 23 / ` Town of Barnstable „.� SCHED. DATE: Board of Health - ' « 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P,H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION Property Address: 9Z S MSPA sttZx} , Caf o t't Assessor's Map and Parcel Number: Yho►n 35', PSI (e3 Size of Lot: 58l S. Wetlands Within 300 Ft. Yes Business Name: No_X Subdivision Name: APPLICANT'S NAME: (�l ,T. MG SRL yl n on Phone (7SI 1 741- TOO S Did the owner of the property authorize you to represent him or her? Yes ->C- No PROPERTY OWNER'S NAME CONTACT PERSON Name: 01, T. (a,l 14 eg t-I� Name: 5ttph�n A. W i(so" � P 8 3 a xkI' � N�c � Fl of►dl�v�cv� Address:_8Z S YY1c.,., St-v+e ct- Address: gilt, M&,h g}y,,,_f. Coiytt tjjV gLs OZlo3$ �S#zrvi llc, t mas,c. 026 SS Phone: Phone: (SOS) qZR-9/3/; ck>- /3 VARIANCE FROM REGULATION(List Reg) REASON FOR VARIANCE(May attach if more space needed) T—� ser-i:eti. 11.Z 21�1 ) "ro olle,.� a crrbnose D /1�at,�t.+� t^c do nJrbrrs�. fj 11r— in l�sV NATURE OF WORK House Addition X House Renovation X Repair of Failed Septic System 0 Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) C:\Documents and Settings\decollik\Local Settings\Temporary Internet Fi1es\0LK3\VARIREQ.D0C a a 4 Septmnber 21't,2004 Board of Hcahb Town Offices 200 Main Street 1il+=Mdg,Mauachusetts 02601 Re: 325 Main Stint,Cotuit Members of the Hoard, This letter is to inform you that I have authorized Stephen A.Wilson, P.E.to represent me for the variamm being requested at the above noted location. Sincerel D. an 92004-102 f Y Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman MAIL-IN REQUESTS NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Wayne A.Miller,M.D. Please mail the completed variance application form to the address below. Also include four copies of engineering plans, house plans, authorization letter, etc (see check-list below). In addition, please include the required fee amount (see fees at bottom of this page). Make $85.00 check payable to: Town of Barnstable. Our mailing address is: Town.of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 Checklist Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) $85.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date FOR FAXED REQUESTS Our fax number is(508) 790-6304. Please fax a completed application form. Also, you must mail the required $85.00 fee. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. In addition, please mail four copies of engineered plans, house plans, authorization letter, etc. (see check-list below): Checklst Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) $85.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) 31. . -- '� `6 " 42 _ �-14) • :,,Zpc 9 � teat - ZSOLs s aap , ,•\w as 64 _ 1o1611 s -Sp PL AA 0-51-C e 6► s.5►F .01c 2,w c 2 5q-1 G r 75 14 12 AC 1.00PI of a,, Z. OG L60O w J P - 16 0 5e .52 AC AS ac !PW. 51 8 - aac tp-s or- a9 . dAC-S is a'f' %seL r-,••l55 2M a MAY a s � 51 Z •,°,,,,+ t34 XAc a p 87 - Ac� 53 S4 <SK 86 �7y s s si30 MO R E E i "es 13 0 94 o ,:, - art , c ! •6p� 2. •G 14 1.79/1C lop 4p4C V 1 pI d .72� s. Abutters Map: Scale 1" 200' d BAXTER, NYE & HOLMGREN, INC. Registered Professional Engineers and Land Surveyors Abutters List Map Parcel Owner&Address 35 64 P. Salisbury 27 Pleasant Street Sharon,MA 02067 35 62 H. Goldman 220 Marlborough St.—Unit 5 Boston,MA 02116 35 59-1 P. Leveroni 2886 Main Street Barnstable,MA 02630 Ref #2004-102 Barnstable Assessing Search Results Page 1 of 2 4 ..,estG�..-..... 'w ':':.:' Home: Departments:Assessors Division: Property Assessment Search Results 825 MAIN STREET (COTUIT) Owner: WHEATLEY, MARY JO Property Sketch Legend Map/Parcel/Parcel ExtensionTSI 035 /063/ Mailing Address g WHEATLEY, MARY JO 825 MAIN STp. COTU IT, MA.02635 2004 Assessed Values: 4 Appraised Value Assessed Value Building Value: $111,400 $ 111,400 Extra Features: $2,900 $2,900 Outbuildings: $2,100 $2,100 Land Value: $414,200 $414,200 Interactive Property Map: ap requires Plug in: Totals:$530,600 $530,600 1 have visited the maps before Show Me The Map_ ,y �. April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: WHEATLEY, MARY JO 9/15/1983 3871/203 $30,000 2004 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $3,507.27 Town Fire District Rates Other Rates 6.61 Barnstable 2.01 Land Bank 3%of Town Tax Cotuit FD Tax $806.51 C.O.M.M. 1.10 Cotuit 1.52 Land Bank Tax $ 105.22 Hyannis 2.03 West Barnstable 1.36 Total: $4,419 Due to rounding differences these values may vary http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing... 9/22/2004 f Barnstable Assessing Search Results e 2 of 2 Pa;. g Land and Building Information Land Building Lot Size(Acres) 0.22 Year Built 1875 Appraised Value$414,200 Living Area 1638 Assessed Value $414,200 Replacement Cost$ 148,516 Depreciation 25 Building Value 111,400 Construction Details Style Colonial Interior Floors Hardwood Model Residential Interior Walls Plastered Grade Average Plus Heat Fuel Oil Stories 2 Stories Heat Type Hot Air Exterior Walls Wood Shingle AC Type None Roof Structure Mansard Bedrooms 4 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms Total Rooms 6 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL2 Fireplace 1 $2,300 $2,300 FPO Ext FP Opening 1 $600 $600 FGR2 Garage-Avg 275 $2,100 $2,100 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing... 9/22/2004 ' 6EWAGEJJINSPECTIONS �. LOCATION q�_ ly)a 9t DATE l VP;LAGE T h11 ASSESSOR'S MAP & LOT6. -Q INSPBCTOB r d. -Q j' L'RA, e;on .-L.nc. SEPTIC TANK CAPACITY I QQ cQ� LEACHING FACILITY: (type) (size) NO:OF BEDROOMS *' BUiDER OR OWNER FAILED INSPECTION OWNER MAILING ,_ADDRESS ,. i CI o , 1 TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE (`[j�[ai� ASSESSOR'S MAP LOT r-^ INSTALLER'S NAME & PHONE NO. Ei SEPTIC TANK CAPACITY J,l / LEACHING FACILITY:(type) � (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COZIPLIANCE ISSUED: VARIANCE GRANTED: Yes No "'� 9 '� ���- `�� � �, . ;= 4- Town of Barnstable P# 4 Ina Department of Regulatory Services s, ,,,R,grABLZ, : Public Health Division DateMAWL d 200 Main Street,Hyannis MA 02601 toss ,$ Date Scheduledi Time r i, Fee Pd. 100 w Soil Suitability Assessment for Sewage isposal Performed By:S}`gy h A' lb I sof i Witnessed By: J G ' J- LOCATION& GENERAL INFORMATIO Owner's Name Me Location AddressN. t�/�1R0, !vl I Address 9 ZS /72ca i't 65 / c Co �✓. �' a (4v, — Assessor's"4. ap/Parcel: Engineer's Name .Sa�r3o/?ty /4 , 130"4r, , ^)a- 15, I-Lelrmf✓w, #'U NEW CONSTRUCTION REPAIR Telephone# / Land Use 12G5 GQaKF►u ( Slopes(5'0) / �� Surface Stones Ak - Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) 1t'YAY M ww NICIt MON DRIVI$ --------------- ------------ Parent material(geologic) G 6 c14 t G cr1-�— Depth to Bedrock - Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: In Depth Observed standing in obs.hole: __ In. Depth to soil mottlos: Depth to weeping from side of obs.hole: ill, Groundwater Adjustment A. Index Well# Reading Date: Index Well level_ Adj.factor_ Adj.droundwater Level,e,, PERCOLATION TEST bate `I cr/TiMe--//'Colhy Observation Time at 9" Hole# Depth of Perc Time at 6" Start Pre-soak Time @ 'time(9"•6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ✓ ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\.S EPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil IOther Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) Gi�`-/2'� t5a.-cy l..ol W, ICE Y k 5/6 I2°- 1,-t�'' C 1►1cc4tv,tir .5aMc( DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. si enc %Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi tee o ravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. e Flood Insurance Rate Man: Above 500 year flood boundary No Yes Within 500 year boundary No k Yes Within 100 year flood boundary No X Yes Death of Naturally occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification rf I certify that on 4111.1, (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature Date 4 o Q:\.SEPTICU'ERCFORM.DOC ,.s � �- 0 FAILED INSPECTION 8123104 DATE--------- �Ia.�r� St._. � PROPERTY ADDRESS:_-8__25_-- - __--- ,1Ap ®.- Co,tuit, Ma PARC LT - 02635 On the above date, the septic system at the above address was Inspected. RE�E'7 This system-consists of the following: 1.. 1-1000 gaLeon ze/2�.ic tank., AUG 2 7 2. -dist,i.igution 9ox., TOWN OFBARNSTABLE 3.: 1-1000 ga. ion .e ac.h Based on mspecron, f ge Y the following conditlo s: HEALTH DEPT. 4, thus a tit�e �.ive .ie/�t'ic 3y,3tem,- (78code) .5 the ee/�t iC !6yntem .i's a hqdzau2ic_ L - i e in Qe` ing /�� • 6. 6)a.3te wate2 t,6 ovea inve2t ach/z /� SIG NATO RE � Comp any:_ mnr-.omLe�-aa-4-zloa,La-c" Address:---9ox 66—Cen e2vi 2e, (7a._ 02632 - (508)775-3338 ' Phone:------------------------- THIS C ERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY ,IOSEPH P. MACOMBER & SON, INC. Tanks:Cesspools-Leachfieids Pumped & installed Town sewer Connections p.0. Box 66 Centerville, MA 02632-0066 J 775.3338 775.6412 COMMONWEALTH OF MASSACHUSE'TTS OF ENVI• aNI ' NTAL AFFAIRS . I�ZCF� _. �&ECUTTVE�OF A DEPARTMENT'0F ... QI�NiEN'1`AL PRAT CTION A,� r 'TITLE 5 OFFICIAL INSPECTION TOII.M—.NQT FGRVOLUNT�.4RY�ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART-A CERTIFICATION. Property Address: 825 N a i n St.- 77 . Cn I Owner's Name: Mrozy. 4164949e.Y- —� Owner's Address: Date of Inspection: Name of inspector: (please print) l32uce l acu Ihte2 Company Name,,�. �-S°M pv t -n Ltt c. Mailing-Address: C , .ab4..02632 Telephone Number: .5 0 8-77 : 33 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system.at this address and that-theInformation 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•�Ite sewage disposal systems.I am a DEP approved system inspector pursuant to;Eection.15:340.of-Title 5(31.0�CMR I5:a00). The system: Passes -conditionally Passes Needs Further Evaluation by the Local Approving.Authority � Fails Q Inspector's Signature: The system inspector shall submit a copy of this inspection•reporCto the.AppioAng Authority.(Board of Health or DEP)within 30 days of completing this inspection.If the system:is.a,shared syqtetn or has a design flow of 10,00 gpd or greater,the inspector and the system submit�e report to the appropriate regional•offree of the DEP.The original should be sent to•.the system owner and copies sent to the buyer,if applicable,and the approving authority. ; Motes and Comments ****This report only describes conditions at the time of inspectidn and under the conditions of use at that -^ **** This inspection does not address how the system will perform in the future under the same or different thhe.conditions of use: .. _ em cnnnn Dade 1 . Page 2 of 11 OFFICIAL INSPKTION;FORM—•NOT FOR�VO UNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM.INSPECTION:FORM. PARYA CERTIFICATION.(continued) Property Address: 8 25 Main S t. Co.tu"i.t, Ma." Owner: Maau jo 1dhp_n.tl/oy Date of Inspection: R/�3/n¢ Inspection S.tin mary: Check A;B�C,D ar.E/ALWAY'SEcomptleWall of Section,.0 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: L a / g rLnO 0 .noP_d + 1O 9P �aRCLCIPC� B. System Conditionally Passes: no 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 Healtfi,will pass. Answer yes,no or not.determined(Y,N,ND)in the for the following statements.If"not determined"please explain. R o The septic tank is metal and over.20 years old*or the septic-tank(w:hethermetal.ornot)isstructurally unsound,exhibits substantial..:infiltration or exfiltration.or tank failure.isteminent. 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 Jeaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n n Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled-or uneven distribution box.System will pass inspection.if(with approval of Board of Health): broken.pipe(s)are replaced. obstruction is removed distribution box is leveled or replaced ND explain: n a _ 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 pipes)are replaced '- obstruction is removed ND explain: Page 3 of 11 f O1E'FICIAL INSPECTION FORM Y NOT-ITOR VOLUNTARY ASSESSMENTS SUBSIVJRFA CE SEWAGE DISPOSAL SYSTEM INSPECTION.=FORM PART:A . . CERTIRCA-MON'(dontinued) : Property Address: 825 (lain St., . o az , 11ta., Owner:. Nagy 7 o P7Tea e Date of Inspection: 812310410 C. Further Evaluation-is.Required by the Board of Health: no Conditions.exist whichre quire further...e.valuation•by the•Board_ofHealth:in order-to Attermineifthesystem is failing to protect public,health,.safety or the environment. 1. System will pass unless'Board of Health determines4h accordance with 310-CMR 15:303.(l)(b)that the system is not functioning in.a-man ger which will•protect public health,safety and the.environment: no Cesspool or privy is within; feet of asurface water Cesspool or privy is within 50 feet of-a bordering vegetated wetland or a salt marsh. 2. System will'fail unless the Board-of Health(and Public Water Supplier,if any)determines:that the system is functioning in a mariner that protects the public health,safety and environment: n o The system has a septic tahk and soil absorption system(SA•S).and the SAS is within 100 feet-of a surface water supply or.-tributary to asurface water supply. no The system has aseptic tank and SAS and the!SAS is within a Zone 1 of apublic water-supply. n� The system has a septic tank and,W and-the-SAS is within,.50 feet of a private water.supply well. as The system has a septic tank and SAS and the-SAS is less than 100 feet..but 50 feet oF;niore fiorn a private water supply well".Method used to determine distance- "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from-pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm,provided that no other failure criteria are triggered.•A copy of the analysis must bey attached to•tbis form. 3. Other: Page 4 of 11 OFFICIAL INSP.ECTIO•N FORM—NOT FOR.:YOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 825 Main St.; o u i Ma., Owner: MaILU �n Ldai.t_.P_n_u Date of Inspection: 3 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to.each of.the:fo1lowin0or.all:inspections- Yes. No x Backup of sewage-:into facility:or..system component due.to averloaded.or clogged SAS.ar.cesspool Discharge:or-ponding of effluent to the surface.©f the:ground or.surface waters due to an overloaded or clogged SAS or cesspool x _ Static liquid level in the distribution box above outlet invert due to an:overl'oaded or clogged SAS or cesspool _ x Liquid depth in-cesspool is less than.6"below invert or available volume is less than'h•.day flow um in Required more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number q pumping g of times pumped x Any portion of the SAS,cesspool or privy is below high ground water elevation. x Ariy..portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface T water supply. x Any portion.of a cesspool or privyis within et Zone:l of a.public well.. _ x Any portion of a cesspool or privy is within.50 feet of a private water supply well. _ x Any portion of a cesspool or:•privy is less than 100 feet but g;eater.than 50 feet from a private water supply well with no acceptable water quality analysis..[This:system.passes if the well water.analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution;_from.that.facility and:the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm,provided that no other failure criteria are•triggered•.A'copy of the analysis must be attached.to this forM..J ue.6 (Yes/No)The system fails.I have determined that.one or..more,of the:above.failure::criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner.should contact the Board of Health-to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the:systtm must.serve.a facility with a design flow of 10100.0 gpd to 15;000 You must indicate either"yes"or"no"to.each of the following: (The following criteria apply to large systems in.addition to the criteria above) yes no ' _ x the-system is within 400 feet of a surface drinking water supply x the system is within 200 feet of a tributary to a surface drinking water supply x the system is located in a nitrogen sensitive area(Lnterim 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM PART $ CHECKLIST Property Address: 8 2 5 Main St., o u.c ¢.. Owner: Many ao eu , ey Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each,of the following: Yes No x — Pumping,information was provided by the owner,occupant,or Board of Health x Were any of the system components pumped out in the previous two weeks? ' x Has the system received normal flows in the previous two week period? - x Have large volumes of water been introduced to the system recently or as part of this inspection? x Were as built plans of-the system'obtained and examined?(If they were not available-mote is N/A) x Was the facility or dwelling inspected for signs of sewage back up? x — Was the site inspected for signs of breakout? x _ Were all system components,excluding the SAS, located on site? x Were the septic tank holes uncovered,opened,and the interior..of the tank inspected for the condition ft — man of the baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and Ae pth of scum? x _ Was:the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site.has been determined based on: Yes no, x — Existing information:For example,a plan at the Board of.Health. " x Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance - is unacceptable) (310 CMR 15.302(3)(b)J 5 Page 6 of 11 OFF.;-IAL AgSPECTI°O`N F,GRM'-NOT FOR VOLUNTARY ASSE. SNIENTS SUBSU IRFACE SEWAGE DISPOSAL�SYSTUM%INS'PECTION FORM PART.0 SYSTEM INFORKATION Property Address: 825 Main St.,. o T u.7 , (7a. Owner: Naat/ 7o GIlzeat fey Date of Inspection: FLOW CONDITIONS RESIDENTIAL . Number of bedronnis(design):•_,._. ,Npmber of bedrooms.(actual): DESIGN flow based on I io adG 15.203':(for example:'I I0 gpd z�#-of bedrooms): 3 x /0-3 3 0 yi d Number of current residents: .: Z Does,'residence have a garbage grinder(yes or no): n o Is laundry on a separate sewage.system.(yes or.no):.Ro_ [if yes separate inspection required] Laundry system inspected(yes or no):i Seasonal use: (yes or no):�,.o Water meterreadings, if available(last 2 years usage(gpd)): Sump pump(Yes or no): Last date of occupancy:-gn COMMERCIAL X- 4 TRIAL Type of estab� nt: RQ. Design flow; on 310 CMR 15.203): na gpd' Basis.of dsin'`flow(seats/persons/sgft,etc.):, na Grease tra resent(yes or no):is a Industrial waste holding tank present.(yes or no): na f Non-sanitary waste discharged to the Title 5 system•(yes or no):na Water.meter readings,if available: na Last date of occupancy/use: . na OTI�ER(describe):. GENERAL INFQATION Pumping Records Source of information: .a•'!.,Macom&ea and son Was system pumped as part of the inspection(yes or no):-moo If yes,volume pumped: ?5 0 0 allons--How was quantity pumped determined? m e a s u a e d Reasonfor.p.•umping: mg.. TYPE OF SYSTEM , x Septic tank,distribution box,soil absorption system _Single cesspool —Overflow cesspool, _Privy _Shared system-('yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative•technology.Attach a copy of the current operation and maintenance contract,(to be obtained from system owner) —Tight tank —Attach a.copy•of the DEP.approval _Other(describe): Approximate age of all components,date installed(if known)and.source of information: 1990 f Were sewage odors detected when arriving at.the site(yes or no):n o 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 825 Main S.t., Co.tu.it, Na.� Owner:Aaau go ,l prof Le y Date of Inspection: 8/2 3/0 4 BUILDING SEWER(locate on site plan) Depth below grade: 8" Materials of construction:_cast iron _40 PVCx_other(explain): Distance from private water supply well or suction line: 10 t Comments(on condition of joints,venting,evidence of leakage,etc.): ao int_i a/z/zeaa tight.-No evidence oe -leakage., em ven y ed th-lzough houze. ven e" SEPTIC TANK: _(locate on site plan) Depth below grade: 7 2" Material of construction: x concrete_metal_fiberglass._polyethylene _other(explain) If tank is metal•list age: n rz certificate) Is age confirmed by a Certificate of Compliance(yes;or no):_(arch a copy of "- Dimensions: 8' 6".bong 4' fi0'h.igh 5' 7"h.igh Sludge depth: t 2 a c e Distance from top of sludge to bottom of outlet tee or baffle: 0 Scum thickness: t r a c e Distance from top of scum to top of outlet tee or baffle:t a a c e 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.): enk .iz . zbzuetuaaii sound.-No evidence o .Peakage.-Iniet and outlet teen ate .in eaee,�Uate)z eevei high in Zan GREASE TRAP:n o(locate on site plan) Depth below grade:n a Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: HE Scum thickness: n a Distance from top of scum to top of outlet tee or baffle: ' n a Distance from bottom of scum to bottom of outlet tee or-baffle: n a Date of last m P�� g: nn Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 2eaze taa,2 not a2zent.� TWA C TnenAr}inn Rnrm Kii v,)nnn 7 Page 8 of I I OFFICIAL IN-S.PECTIO-N FORM—NOT FOR VOLUNTARY ASSESSMENTS k'ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION(continued) Property Address: 825 Main St.� Ma.., Owner;•(7ri n � Date of Inspection: TIGHT or HOLDING TANK:no (tank must be pumped at time of inspection)(locate on site plan) Depth below.grade: na Material of construction: na concrete rza metal na ftberglassng_polyethylene na other(explain): Dimensions: n Capacity: rta gallons Design Flow: n ez gallons/day Alarm present (yes or no): n(7 Alarm level:_n q Alarm'in working order(yes or no): Date of last pumping: nn Comments(condition of alarm and float switches,etc,): t-'qht. 02.lzodr.g not DISTRIBUTION BOX:Ye-3 (if present must be opened)(locate on site plan). Depth of liquid level above outlet invert:yet Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc,): _ d—gox ha-6 one eateaai -no evidence o,e -eeakage .into oa out o 1 zoiidz ca22uova/ PUMP CHAMBER: no (locate on sife.plan) Pump's in working order(yes or.no): na Alarms in working order(yes or no): na Comments(note condition of pump chamber,condition of pumps and appurtenances, pump chamge.z not ' /22e.6ent., 8. Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INNSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: 825 Ma.irz St.- o uit. lrla.- Owner:.Laj o Nheat.�ey Date of Inspection: n. SOIL ABSORPTION SYSTEM(SAS):y e�3.(locate on site plan,excavation not required) If SAS not located explain why: Located bee, 2age 10. Type x leaching pits,number: . leaching chambers,number: 0 leaching galleries,number: 0 leaching trenches,number,length: 0 leaching fields,number,dimensions: 0 overflow cesspool,number: 0 innovative/alternative system Type/name of technology: e v e co 8 c o d e) Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): zy.ztem .3how.3 zignz o� h d2au.e.ic . a.i'eurze.-ve e-ta.t-i CESSPOOLS: no (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: nu Depth—top of liquid to inlet invert:n a Depth of solids layer: Depth of scum layer: n n Dimensions of cesspool: rza Materials of construction: n n Indication of grooundwater inflow(yes or no): na Comments((note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Ce.3.6/2ooi not /2aehent.- no locate on site plan) PRIVY: ( Materials of construction: na Dimensions: na �. Depth of solids: a Comments(note condition of soil,signs of hydraulic,failure,level of ponding,condition of vegetation,.etc): p aivy no.t /2/zebent.' 9 Page 10 of 1 OMCIAL INSPECTTON'FORM-- TOT FOR VOLUNTARY.ASSESSMENTS SII$SI.REA:CE SEWAGE,:DISCI?.DSAL SYSTEM.INSPECTION ORM r PART 0- SYSTEM INF-ORMATI.0N(continued)' Property. Address: 8 2 5 Main S t. o uz Ma., Owner.: M a a y a0 ea s y Date of Inspection: SKETCH OF-SEWAGE-DISPOSAL SYSTEM '�ovide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells.w�thin 100 feet.Locate where public water supply enters-the building. 3 i n 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION(continued) Property Address: 825 Main St., a., Owner: Malty o wneazley Date of Inspection: 4 An, SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) n o Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: u,3ed: ahe2.t and m.i.PPea mode-012116194 g2ound watea above •sea �eve� uzed •7echn.ica.e gueje:t-in 92-000-1 date#Z anua2y 799 annua /?anrFPJ3 o� g2ound wa.te2 eievat ions. f I High Groundwater Adjustment 1 .8 per Frimpter Method , Therefore, the vertical separation distance between the bottom of the leaching pit and the adjusted ground- �_ - --� water table isafeet. T41a 5 Tnvv%m tin"Rnrm 4/1 9/')Ann 11 r :,•,�„,;,'-•,.,.�„-r,,,�-r,...,���,-�T,:w,-.-,�..,�,m.,m.•u�.�"•� [20AItU OF 11EALTII TOWN OF Sl1ElSU[�FACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION s+�+�•+nsrrnrnv+rmrrrm.•.-nrrr.r..•.,r ••rt•s-r•:'::•-�.+iz•'.-snr.-m•n:frrnr:Rsr-rrn�-r.—:hr. rcrraessner"��+R+��^^�'�"'�� -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED 825 Main z.t., Cotui.t, Ala. � STREET ADDRESS ASSESSORS MAP , BLgQK AND PARCEL # 035-063 Malty ao Ohea.tiey OWNER' s NAME I PART D - CERTIFICATION NAME OF INSPECTOR Bruce Macalli COMPANY NAME Joseph P. Macomber & 1� n COMPANY ADDRESS Box 66 Cent r 09637 - Street Town 'or City Stag LIP COMPANY TELEPHONE ( 508 775 3338 FAX ( 508,E 790 1578 R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal. system at this address and that the information reported is true ,. accurate, and omplete as of the time of ,inspection ► The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems Check one : Systeni PASSED ' ducted has not found any information The inspection which I have co which indicates that. the system fails to adequately protect public health or the enviro:iiment as defined in 310 CMR. 16 . 303 ► Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this. form . System FAILED* f The inspection which I have con trcted has found that the ,system fails to Protect the j)ublic health and the environment in accordance with Title . 5 , 310 CMR 15 , 303 , and as specifically noted on PARTwC - FAILURE CRITERIA of this inspection form . i nature Date �23"0/K Inspector S S � `� ne copy of this certification must -be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall up.grade ' the system. within o'ne year of the date of the inspection, unless allowed or required otherwise Ias provided in 3:;10 CKR 16 , 306. E gartd .doc VARIANCE REQUESTED: 1 . LEGEND .' .. PC TITLE V 15,221 (1) I EXISTING PROPOSED Nosy' s ` 1. TO ALLOW THE PROPOSED RESERVE AREA TO BE 3.7' 0. r;:, • _� . - " Stake & Tac Set/Found ••. ``"' :' :yar :- ,o FROM A PROPERTY LINE IN LIEU OF 10 • Mag Nail Set Found o Concrete Bound ® Gas Gate '•• `� a Electric Meter •• : Cat �, Variance Granted by the Board of Health on October 12, 2004 1 0 Catch Basin • r. o ° x 1�, PLAN BOOK 576 PAGE 65 ^ Water Gate ' •� N PETER G. SALISBURY ® Gas Meter .y '�•:;: ••a,o BI ,: . ''� x 102 0 ;� ® Telephone Riser co -0- Utility Pole s �03 . / 7� Contours •+ • Cr. _ ' i02. iC'r_.54. P - x 103.1 a X 100 `�� . � �• • • b r j r OST O Ral Spot�IC� '�'_ Test Pit rode .• �' �sb IP a LAWN x 103,3 / Concrete y .' •t LANDSCAPED AREA 102,5 129 70. EOP Edge of Pavement • r y ro -� id PUN S 9 t 'o EXISTING GARAGE S �.�• Pq 63 �03 -_ F.F.E. Finish Floor Elevation LOCUS MAP c TO BE REMOVED N.T.S. `� , ✓ APPROXIMATE LOCATION OF EXISTING SOIL PIPE ---- -- ! - GARq E /�/� TOTAL PARCEL AREA 4' �'OST ZONING DISTRICT: RF F,F;� = 1 p 67. ✓ ✓ /, / 9.083t SO. FT. n Rq►L OVERLAY DISTRICTS: r ;' ,�<? s ///✓ / 0.21t ACRES �i GENERAL NOTES : AP (AQUIFER PROTECTION) , z zi ,,,� 3 Opp ✓ ✓/, /� P / / t02.2 �. 10�_.4 PROP / ` / G iJ2,8 RPOD (RESOURCE PROTECTION) 'Q1 s,} " � " ' � PIPE ! ' �/ c -" c PRIMARY BENCHMARK DATUM: ASSUMED • G7 x 102.5 y ',r ''`'•''tid ,Y'4?�'�` d' ra. / �� , , LAWN S ,� �> a za _;n PROM / /� l / / //�� ' 10�.' \ s� b. ^ TBM = MAG NAIL SET IN SIDEWALK ® ELEV. 101.76' FRONT SETBACK 30 SIDE & REAR SETBACK - 15 Z ao �5.0' � X RA //% / / /�/�/ / // / �� c �O27 a W LOCUS PROPERTY IS SHOWN AS: TEST PIT " ;: ' ,�' :,. " ' / / /,WDop S'fiRy� / 0i,� o ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH • ' 4 4 �" �t``i u '` ' /N AME 0 / //� k '� TITLE V OF THE STATE SANITARY CODE DATED MARCH 31 1995 x 102.2 18.0 r x:- r�-� � pF 82S/ / x - �L G ASSESSORS MAP 035 - PARCEL 063 � � _n o, LNG � l� Cgrn / E = 104. � // / / 1e2.5 ANY LOCAL RULES APPLICABLE. DEED REFERENCE: ` LAWN �t� //% �J//// 20', // / /; wq� 10?; e DEED BOOK 3871 PAGE 203 WHEATLEY PLAN BOOK 43 PAGE 3 2 j` t°r r ,�, ��� / / ' %�� / 3 3 x 102A ( ) N/F HARVEY GOLDMAN. ET ux 15.2' `�" `' �Y E`; * 4 ��✓ ? / �� / ' ! / x 02 ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING s NI ` 10`'-- :� ` " `�'�'�' / / ' / / w IN 0 Ir,2,q BY DESIGNING ENGINEER 1 CKERSON DRIVE `1 '° `-' 1 000 GAL ti PLAN REFERENCES: 1c2.a Jf ' ° r4 ,\SEPTIC TANK w �Wt0 2,2 10L. Y` a ' / /� / W W ,� WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, i / x PLAN BOOK 42 PAGE 3/2 r t Oc..c PLAN BOOK 573 PAGE 77 x 1� �53 ;� '` �`� oepK / / / ✓-C.>✓ 401 20 O' I .0. NOTIFY THE ENGINEER & BOARD OF HEALTH AGENT PLAN BOOK 576 PAGE 65 �, %y �+ 5�r 's' � : 4 1 / / MIN. M#V. PLAN BOOK 438 PAGE 99 �� 15•4 ��':�x' �„� ;; O.0 101.E ��,/; ��j o a m oy THESE ELEVATIONS MUST NOT BE CHANGED WITHOUT WRITTEN 1 000 GAL / iJ 373 / 0 112.' APPROVAL BY DESIGNING ENGINEER COMMUNITY PANEL NUMBER 250001 0018 D J LEACH PIT /' ^ t02.1 :C12 2 0 1 j L k /�/ x 102 r, 4 a H ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4w PVC., SCH 40 THE FLOOD INSURANCE RATE MAP DEFINES D-eo F i ,L Y": / / ;^' - - -_--- / THIS AREA AS ZONE C v, x x:. �/ / _o I: z z o J 0ti N % ?o �'-- m I �\ THE INTERNAL PLUMBING OF THE HOUSE WILL HAVE TO BE a01 ` / PROPOSED '°t'7 p 0,y MODIFIED FOR THIS PROPOSED SEPTIC SYSTEM. PROPERTY OWNER (PER ASSESSORS): o k 101.3 D-BOX 10- 1 I-�' �`�% ? / -� ~'� 102,2 101.8 EXCAVATE AND REPLACE ALL UNSUITABLE MATERIAL SURROUNDING MARYJO WHEATLEY D 10.0' � � '� SURROUNDING .THE LEACHING FIELD FOR A DISTANCE OF 5', PER 825 MAIN STREET MIN. Aj /' ' ' ✓ ' -"i.a ✓1 J ✓ ✓ / •' < <�l 310 CMR 15.255. COTUIT, MA 02635 / x �0 i01,•+ R x, } a 4 ; 6'x35 a �' LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND W ✓ ., s 4s S , 4 iZ t ,, Y "b .- .*fi� .>• { t• < PROPOSED RESERVE ? C / SHOULD BE VERIFIED IN THE FIELD BY THE APPROPRIATE x VENT = ��i PROPOSED lu;�A.S` UTILITY COMPANY PRIOR TO ANY CONSTRUCTION. SOIL LOGS DATE:9/l0/1004 I -- _ M1 ,�1e1be �" 101.- LOCATION OF EXISTING SEPTIC SYSTEM IS APPROXIMATE. N LAWNS IOC - ,- P#=P10,816 ____- - moo 1r,1,- PER INSTALLERS TIE CARD BY J.P." MACOMBER. ENGINEER: BOARD OF HEALTH AGENT: x ,01.5 ' CLAMSHELL 100:� 1oo.-4 z c ON RECORD AT BOARD OF HEALTH. 11 DRIVE \ ~``� 10' 101.s Steve Wilson Dave Stanton �o� r0o.�' c �oo.s x - * ? _ 100:r 7.24' (SET 42/3/2) a 1. F)CISTING _Si PTtC SYSTEM TO BE: PUMPED AND REMOVED. TEST PIT I 10 O.'s i00 5- _ _ _ - a, G.S.E. 102.3t 239>41 _ , GRAVEL DRIVE d THIS PLAN IS BASED ON AVAILABLE RECORD INFORMATION AND • w 356 65, 12 p g�Ay H PLANS AND AN ON THE GROUND FIELD SURVEY eY THIS FIRM 00000 0 I s 864632' DRIVE ,0 R _ _ _ _ _ _ . 101.1_ 1`' ON 9�08/04. �T GvL"RSON o. _ _Ap Sandy Loam _ _ _ _ _ _ _ - - - - - - -' TBM: MAG NAIL SET GRAVEL DRIVE i00.7 _ _ - - - - , 10;,5 (HELD) D EL SE 0IN SIDEWALK D) 6 10YR2/2 I - _ - .� - to0.5 ' _ - - FENCE San Loam - - - - .._. -� 6 STOCKADE B 10 YR 5/6 g 86.46'S2w) W 353.20' SECORD> « 353.12' 0F1ELD> 100.2 -15 w f 12 ,�« 101.5 3 '•�'0 0 5 4r CB SEAL FND 6' STOCKADE FENCE C Medium Sand (HELD LINE) / P g / 10 YR 4/6 -� e W 144" a - 101. � �jH OF AIgSs�c PERC O 54' LOT 1 / o`* TE E y� PLAN BOOK 438 PAGE 99 RATE- <2 AIIN/IN � '•` � UNABLE In SQAIC N/F PETER LEVERONI h N No�.90218 90 9�ST�4 Q NO WATER ENCOUNTERED �Ss�ONAt CB DH FND 825 Main Street /o Cotuit, Massachusetts PREPARED FOR J U NOTE. IF AREA OVER SEPTIC SYSTEM IS UNPAVED, MANHOLE COVER & PROPOSED SYSTEM WAS REVIEWED BY BOARD OF HEALTH DESIGN SCHEDULE ELEVATION DOAAId J. MacKinnon FRAMES ARE NOT NEEDED. ADJUST CONCRETE COVERS TO 60 AND APPROVED ON OCTOBER 12, 2004 40' FINISHED FLOOR ELEVATION - HOUSE 104.20 Q BELOW FINISHED GRADE 4' ' TTILE SEWER INVERT AT FOUNDATION 99.4 00 SEWER INVERT INTO SEPTIC TANK 98.7 Leaching Area Requirements Septic System Design SEWER INVERT OUT OF SEPTIC TANK 98.4 - °' SEWER INVERT INTO DISTRIBUTION BOX 98.2 5 BEDROOMS A7 110 GPD/BEDROOM = 550 GPD 4' 4' 12' `" SEWER INVERT OUT OF DISTRIBUTION BOX 98.0 B��1D NYE SEWER INVERT INTO LEACHING SYSTEM 97.5 NO GARBAGE GRINDER �' `�:'= R ENGINEERING & SURVEYING � F.F.E. 104.20 �:' - N FlN�Hm cw�E = 102 f TYPICAL SYSTEM PROFILE BOTTOM OF LEACHING SYSTEM 95.5 > ' o yr NOT TO SCALE WATER TABLE: NONE OBSERVED AT EL 90.3 - PERC RATE = 2 /1 MIN. / INCH (CLASS 1 ) I _ 48' Registered Professional MANHOLE COVER AND FRAME Engineers and Land Surveyors M ' " (ADJUST TO GRADE) LIAR = 0.74 GPD/S.F. PLAN OF 4• PC va�1r PRECAST LEACHING CHAMBERS 812 Main Stet, Osterville,Massachusetts 02655 a_ FM&a � OVER TANK olst MMHOLE r FRAME MIN. LEACHING AREA OF SAS.: NO SCALE Phone- (508)428-9131 Fax-(508)428-3750 Cn •' FINISHED GRADE OVER D. BOX : 101.5t N c;�tW OvM 550 GPD 0.74 GPD S.F. = 744 S.F. MIN. MANHOLE E AND N x LEACFNNG TRENCH = 101.5t 4 MIN / / o 4" SCH. 40 PVC '3 min. 4w SCH. PVC FIRST 2' (TO BE LEVEL) PROPOSED SYSTEM: COVER TO GRADE a w - 1 w 10 0 10 20 Fthen O 2.Ox (IF UNDER PAVEMENT) A }¢ .'. ASHED STONE }_= TYPICAL) 0 2.oz oL2• (m w sIOEWALL (48'+12')(2')(2) = 240 S.F.s.F. t -. 9 (min) Cover SCALE IN FEET Y<;K: O 2.0% 10. E 6• SUMP 4" SCH. 40 PVC 36w (max) Cover BOTTOM 48 X 12 = 576 S.F. `� - TOTAL = 816 S.F. {• .. SCALE: 1" = 10' o •.r• -■rr ..: :. 1 �- -� OONCREEIE LEACHING cwweERs c:oNNECTION 20PEASTON .:: �;,,..•,}::M'� . DATE: 09/22/04 • e DIA. PN'(. •: K;... q' {• ... ..M` '� Air.• 1e.. REINFORCED 6 CRUSHED 24 12 - s~ ,;,: o T<<:_ -s<.�.-.. w w s3 {.f -11�-��A••�r" "� Y °�. �'•": REV. DATE: REMARKS w .f :•..., �/'�'�/� y::t's'S<.,'C3�i7`:.�,!.=•r.-�•••�: i1'��+�-J }''.i.,"•i• •t 1 •f•�t.2:i. .. STONE T - . .. ....••• '+'-•,,.,-,:.� �.r.,: ,-. =,.t,: - o 0 0 0 0 o PROPOSED RESERVE: �`' ? `<:�':• -"�'�.:., '';`" • DEPTH ,;�, r_:.: :: •- %-..�: •t _.- - ••v ! / .•} ...Mom. t 'i . �' •1 • i. 4. Y".. _ •� rs..•:. ..t .>.. .r= j•~Sfr -t � -.��:--:�_.. 1 9 23 04 Separate ' -: •y.: ::. sIDEWALL (38+6)(2)(2) 184 S.F. - .' - - Garage 12 ` ��' - ' 4' 4 4 2 10113104 B.O.H. A royal N 1 . :,� • _ o -�' .,-" '• ••'':�.� '•� �..." BOTTOM 35' X 6' 210 S.F. 12 -3- 10 24 05 Revise Tank Location i �• _ , EL. 97.5 374 DRAWING NUMBER o AIN ASHED STONE X 2 0 2,00o GALLON SEPTIC TANK DISTRIBUTION BOX LEACHING CHAMBER TOTAL = 748 S.F. CONCRETE LEACHING_CHAMBER DETAIL o: 2004 2004-102 surve worksnt 2004-102SP4.DWG No Groundwater Observed O Elev. 90.3 N H-20 H-20 H-20 (H NO SCALE G) 2004-102 i o - ---------- ---. ' ' :•� r T; �' ; VARIANCE REQUESTED: I LEGEND •' � �:'•• ,• �"• ,- .tea�� ,. TITLE V 15.221 (1) I EXISTING PROPOSED ' Noisy $ 1. TO ALLOW THE PROPOSED RESERVE AREA TO BE 3.7' Stake & Tac Set Found • . .'` �wa► - , FROM A PROPERTY LINE IN LIEU OF 10'. • Mag Nail Set/Set/Found n o Concrete Bound 0 •a r� f�'., d I Ld 0 Gas Cate . 0 �. WC a Catch Basin Electric Meter • =; 3 o x 102,9 PLAN BOOK 576 PAGE 65 ^ 04 Water Gate a. ,e•` .Btu ' N/F PETER G. SAUSBURY Y 99 Gas Meter a t v:• ; g ® Telephone Riser ' ' p x lo�.o °D -0- / Utility Pole " h o • . , f ? ` 4 POST - _ X 100 : 10 2,5 Contours do R Spot Grade P ` m '�� FENce - Test Pit O•°d N LAWN x 103 3 '`.: fir" LANDSCAPED AREA 0.'.5 / ` Y .'� 129.70• Conc. Concrete PLAN DOOKEOP Edge of Pavement 0 ',7 EXISTING GARAGE S 81 PA ss �o� - - F.F.E. Finish Floor Elevation TO BE REMOVED E LOCUS MAP- � - 102,8 '� . 102.8 N.T.S. " �, 1,02.8 i/ D ' - - / GARq AM ZONING DISTRICT: E TOTAL PARCEL AREA - ` 4• J W OVERLAYDISTRICTS F W F. :,1Q 8T 9,083t SO. FT. ^ POST RAIL Ct: AP (AQUIFER PROTECTION) 102,4 , PROpO 0.21t ACRES M 1G2 E GENERAL NOTES : RPOD (RESOURCE PROTECTION) $ f SOIL PIP O G c --- �'� PRIMARY BENCHMARK DATUM: ASSUMED x io2.sLAWN FRONT SETBACK = 30' SIDE & REAR SETBACK = 15' b o ? ' EOM GAR !/ /� 102,4 `���- TB = MAG NAIL SET IN SIDEWALK ® ELEV. 1 1 7 Z 15.0' �` � :�'�, TO HpUs f /t i ��/ / ; i� c 102.7 / a s 0 6 LOCUS PROPERTY IS SHOWN AS: TEST PITS '% SOD t�2 STORY ';// oy c +n a ``� ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN A 102,E '� �; � r`f .. i �AME p / , �/ M M of / o ACCORDANCE WITH ASSESSORS MAP 035 - PARCEL 063 X 102,2 18.0 , ;� / FF No, g25i WNG , x -'`� c TITLE V OF THE STATE SANITARY CODE DATED MARCH 31,1995 CA •E / i j�, to_,.� ANY LOCAL RULES APPLICABLE. ti rrrc f 1 O4?0. , 1� W e 7 LAWN r 1L1c.; y DEED REFERENCE: V i 102 7 i� DEED BOOK 3871 PAGE 203 (WHEATLEY) PLAN BOOK 43 PAGE 3/2 \ � � / 102,8 ALK a ti 15.2' ! / /�/j x .0,�,;; x 10214 ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING N/F HARVEY GOLDMAN, ET ux /� / /� w w �, oy 102.4 . BY DESIGNING ENGINEER �118 NICKERSON DRIVE + 1 000 GAL i PLAN REFERENCES: 102.4 lo� l .,sLsPTtc TANK / w � 102,2 1G�.2 GARA�, w 0 PLAN BOOK 42 PAGE 3/2 102 -= W„(� R �, y. o2.L cv w94 WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, PLAN BOOK 573 PAGE 77 � 1,C) W 'I M�OQD DE 2 /. 20.o, � /_..'10.0, �a NOTIFY THE ENGINEER & BOARD OF HEALTH AGENT PLAN BOOK 576 PAGE 65 ` / ` e y PLAN BOOK 438 PAGE 99 15.4' [ l.a 101.E 101 �) / MIN MAN O SU onI p /i o / m y d, / THESE ELEVATIONS MUST NOT BE CHANGED WITHOUT WRITTEN QR N 3� COMMUNITY PANEL NUMBER 250001 0018 D 3� m 102 APPROVAL BY DESIGNING ENGINEER U` 1 i j PR / / IoP.0 a h 102,1 102,2 Oy THE FLOOD INSURANCE RATE MAP DEFINES 01'` ` �j' N `- -____ _- `� / ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4" PVC., SCH 40 THIS AREA AS ZONE C N x LEA,LEACH PIT/ D-Box „� Q p % O - l 01y 0i.� \ ; oI ! N ! i ? o '�- I THE INTERNAL PLUMBING OF THE HOUSE WILL HAVE TO BE ? o iol,l PROPOSED PROPERTY OWNER (PER ASSESSORS): 10L 7 p ON, MODIFIED FOR THIS PROPOSED SEPTIC SYSTEM. 0 1oi,s I LAWN x D-BOX ti �► N �� 102.2 MARYJO WHEATLEY , 101.8 �, EXCAVATE AND REPLACE ALL UNSUITABLE MATERIAL SURROUNDING 825 MAIN STREET .. 10.0 , , , , " , 1018 I SURROUNDING THE LEACHING FIELD FOR A DISTANCE OF 5'. PER MIN. 1 COTUIT MA 02635 Z ` r 3 e / 310 CMR 15.255. � - x 101,E ' W i01,4 S,p,g " , N a - � LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND PR PROPOSED RESERVE 6 x35 �, SHOULD BE VERIFIED IN THE FIELD BY THE APPROPRIATE VENT _ Pi SOII, LOGS DATE:9/20/2004 i•. j' i- i L �� / �/ I UTILITY COMPANY PRIOR TO ANY CONSTRUCTION. N LAWN,'� I , i ,� i i ,, � ; � -...._ .__ 6� h P#=P 10,816 loos - _,� _ ,����� 101.7 101E _ j LOCATION OF EXISTING SEPTIC SYSTEM IS APPROXIMATE. PER INSTALLER'S TIE CARD BY J.P. MACOMBER. ENG]NM: BOARD OF HEALTH AGENT: x 101.5 I CLAMSHELI 100.E 100,9 Z c ON RECORD AT BOARD OF HEALTH. Steve Wilson Dave Stanton 101 - 1ao,r; . ; ! DRIVE \ 100,j 00.1 101 4 ' 101,8 SET p 42/3/2) '- - - - - 1o1.s 11 EXISTING SEPTIC SYSTEM TO BE PUMPED AND REMOVED. TEST PIT 1 100.8 _ _ _ _ _ _ _ _ - - - - M i0i7.5 100.r a�- r''IS -PLAN.,I'S BASED-ON AVAILABLE RECORD •It�FO.�iMAT1Ea1�►2A�D r - GRAVELDRIVE \ae - , G.S.E. - 102.3t �za9.4- - - N W .�, 12' PAsswAY '� N PLANS AND AN `ON THE GROUND FIELD SURVEY BY THIS FIRM ON A ..._ - S 8s 48 52 KERS p N DRIVE ,�u,8 - -\ i01,i ON 9/08/04. Ap Sandy Loam NIC _ _ _ _,«-. - _ _ _ _ _ _ _ =� _ 01,:�N 10 YR GRAVEL DRIVE _, ..., _ _ `:. THM: MAG NAIL SET _ _ SET IN SIDEWALK 6 2/2 � _ _ � 100.? - _ _ _ _ - - `, iu1,. CBDHFND _ _ _ _ 100. (HELD) EL 101.76' (ASSUMED) B Sandy I 10 YR 5a6 X ioo.s � CORD> N 353.12' �1ELD> �'�' "" 6' STOCKADE FENCE / S 86'46'52" W 353.20 QtE 100.2 / �.� � � lOLS1 12" CB SEAL FND 6 STOCKADE FENCE C Medium Sand (HELD LINE) t I I ,M Of 'N r 144" 10 YR 4/6 � ae W 1.3 ,TOM Of \ ^ v STEPHEN yG PERC O 540 LOT 1 / 29874 RATE- <2 MIN/IN PLAN BOOK 438 PAGE 99 E N/F PETER LEVERONI y UNABLE TO SOAK q S' a°"p 21e CV - ��- S/ t+ \, NALEj No WATER ENCOUNTERED 9 oY CB DH FND / 825 Main Street Cotuit, Massachusetts PREPARED FOR NOTE: IF AREA OVER SEPTIC SYSTEM IS UNPAVED, MANHOLE COVER & PROPOSED SYSTEM WAS REVIEWED BY BOARD OF HEALTH DESIGN SCHEDULE ELEVATION Donald J. MacKinnon<' FRAMES ARE NOT NEEDED. ADJUST CONCRETE COVERS TO 6" AND APPROVED ON: 40' BELOW FINISHED GRADE. FINISHED FLOOR ELEVATION - HOUSE 104.20 LL SEWER INVERT AT FOUNDATION 99.0 4' TITLE _ SEWER INVERT INTO SEPTIC TANK 98.7 Leaching Area Requirements Septic System Design Plan SEWER INVERT OUT OF SEPTIC TANK 98.4 _ SEWER INVERT INTO DISTRIBUTION BOX 98.2 5 BEDROOMS AT 110 GPD/BEDROOM = 550 GPD 4!--- ' + _8' 4' 12' SEWER INVERT OUT OF DISTRIBUTION BOX 98.0 F.F.E. 104.20 SEWER INVERT INTO LEACHING SYSTEM 97.5 NO GARBAGE GRINDER '2 - •:2. -- FINISHED TYPICAL SYSTEM P - - BAXTER NYE HINC.PROFILE 95.5 & OLMGREN IlV .-..- ..-. .- . GRADE to2t BOTTOM OF LEACHING SYSTEM - NOT TO SCALE WATER TABLE: NONE OBSERVED AT EL 90.3 - PERC RATE = 2 /1 MIN. / INCH (CLASS 1 ) I_ 48' I Registered Professional c- MANHOLE COVER AND FRAME LIAR = 0.74 GPD S.F. PLAN OF Engineers and Land Surveyors r ...- (AWUST TO 4• PVC VW / 812 Main Street, Osterville, Massachusetts 02655 MANHOLE COVER FRAME MIN. LEACHING AREA OF SAS.: PRECAST LEACHING CHAMBERS r No SCALE Phone - (508)428-9131 Fax - (508)428-3750 FINISH® GRADE OVER TANK 01.St v> �. FINISHED GRADE OVER D. BOX • 101.5t rj z FINISHED GRADE' OVER LEACHING lout 4' MIN 550 GPO/ 0.74 GPD/S.F. = 744 S.F. MIN. 3 min. FIRST 2' (TO BE LEVEL) PROPOSED SYSTEM: COVER MANHOLE FRAME DE AND a 10 0 10 20 j 4" scHi ) PVC -Y tA 4N SCH. 40 PVC then O 2.ox (IF UNDER PAVEMENT) /� - 1 N >�N (.,� J'._. d2, O 2.Ox pL2 (m' N SIDEWALL (48 +12)(2)(2) = 240 S.F. WASHED STONEEMMI 0 2.ox -� 9 (min) Cover SCALE IN .FEET py� BOTTOM 48 X 12 = 576 S.F. 10• P Tl} INSTALL 6 P 4 SCH. 40 PVC • GAS BAFFLE - 36 (max) Cover r• • 'r :•'. �-�-'� CONCRETE LEACHING CHAMBERS CONNECTION TOTAL = 816 S.F. 2NPEASTON " - ' � 122. .. '. . �,-_ . ,. .R :�-L-� ,.,,.:r,;.' :A. ^•• . L�'�'a ;.••�'• SCALE: 1 10 DATE: 09/22/04 6• CRUSHED 4 DLA. PVC r :._t�� sF;"•;, .,a".• _ .<:N .•. �` _ .r•:. DATE: REM • :,.. .; N ,.. -..�:Y - � s..- ARKS �, REINFORCED -f STONE T -.:. _ 24 12 =,�..;;�_. :,ems::.. . �� o o �z.� ..s ►•-: 0 0 0 0 0 o EFFECTIVE - ;.:s. : Y;_h.� ,.t;fir:; ?� "^; i3 =; - REV. PROPOSED RESERVE: .Y�►+�•_,: ,.:,f .w �,r - .•. s• ..-..-..;- Riff;j••:<I y Gr +2c. t +j.•:<.l�':1 �:•-e ss ,^.'DEPTH12* .. ��-. ��=•-- �° �`• ;;: .-<:_:=: ...� .'- :r- K`_ ';:; • -1 9123104 Se orate Garage ,. �.., Co. •:. �; .: ,� .,•.. •�• SIDEWALL (36 +6)(2)(2) = 164 S.F. '.'.- �. ;. '=•;.=. N 12 ' : .. BOTTOM 35' X 6' = 210 S.F. 4 4 4 C� • 12' t 31" EL 97.5 374 5' MINV_11� STONE X 2 DRAWING NUMBER N 2,000 GALLON SEPTIC TANK DISTRIBUTION BOX LEACHING CHAMBER No Groundwater observed o Elev. 90.3 TOTAL = 748 S.F. CONCRETE LEACHING CHAMBER DETAIL 0: 2004 2004-102 serve worksht 2004-102SP2.DWG o H-20 H-20 H-20 CIA (H 20 LOADING) 2004-102 NO SCALE -