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0283 MARINER CIRCLE - Health (2)
~ 283 Mariner Circle A = 039- 021. Co,tuit I F� r d TOWN OF EARNSTABSBWA Li: LOCt'�'ION', 3 /" A4SI SSOWS MAP Si;LOx . 'VILI:.AGE .: IXSTALLER'5 NAW&.PHONE NO SE l c T,aavr CAPA , �d` U77 3 /6U LEAC1It[+IO 1�ACILM.: (tea) "► (soda) IYA NO Ok''1'SlaDROOMSa. �iERN,IIT1 A'YI; .YCdW IASIQE:�?!��'E;.r.�. Sep"doo �stnnGu 8aivieer too FCA.- MaXi glum lju8tecl Gtpu�dwdtet Taljts to t(tc l3auotti oft-6Ghing Pki ity. l�lvaielatcc Sup�+tj UJullicd�eaGng Lxaciltty a�►y�iatls cx(st al:6 Wor.:wltlian 7Ap feet,af Iaaclung Facility) . t�'cy 'i>`/et9atit�and L.eac tng Faca tey(i�uriy WWmdb exist within 300 fe,e;: IeaaUirig! itity) bat Looi a �6 '13 " /03 '� Commonwealth of Massachusetts Title 5 Official Inspection Form i-1 Subsurface sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY 283 Mariner Cir 3> Property Address lU Jeannie Morin Owner Owner's Name information is required for every Cotuit ✓ MA 02635 3-8-17 page. City/Town State Zip Code Date of Inspection ry t.,a. 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. A. General Information8- 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address.and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3-8-17 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 OG�(/ 9 , Commonwealth of Massachusetts 1a=1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v% V 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303`or in 310 CMR 15.304 exist.Any failure'criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts a ;i Title 5 Official Inspection Form I ' �'f.;I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to,a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts ,a= Title 5 Official Inspection Form ' ,� Subsurface Sewage Disposal System Form Not for Voluntary Assessments 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for 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 Y/2 day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form � I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 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 16,000 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts tai Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system, received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 J t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposil System•Page 6 of 17 Commonwealth of Massachusetts r f Title 5 Official Inspection Form :wfl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No 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 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2017 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts 1a=1 Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 ,.•, zF 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 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: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons H s � How was quantity pumped determined'? q Yp p Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 1 Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form f ' 1f.;I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 283 Mariner Cir Property Address ��e Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2010 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30"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.): Good condition. Septic Tank (locate on site plan): Depth below grade: 24"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �F p.J! 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 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 20" Scum thickness 2" 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? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Fora .WN Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ``t�.�_;!✓ 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 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-3113 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts r f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 20-Arc 3616 ; Chambers ❑ 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.): Arc leach chambers were empty at inspection with no sign of back-up into d-box or surrounding soils. 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 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 J Commonwealth of Massachusetts 1a=1 Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a% 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` �rti,!✓ 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A t 0 U +a7 t r- w Ac) -� �b � y A -� - ,57 ' 4 -41- 103 '6 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts :a= Title 5 Official Inspection Form i-1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY t ;F u J� 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 11' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 11'. Before filing this Inspection'Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts ;;; p� Title 5 Official Inspection Form I° Subsurface Sewage Di sposal osal System Form Not for Voluntary Assessments g p y ry 283 Mariner Cir Property Address Jeannie Morin Owner Owner's Name information is required for every Cotuit MA 02635 3-8-17 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 7 6 Commonwealth of Massachusetts U ' L+ , Title 5 Official Inspection Form � I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a: 164 Mockingbird Ln Property Address Ann Flynn Owner Owner's Name / information is Marstons Mills r/ MA 02648 3-17-17 required for 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. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3-17-17 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts • r Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �S!g ' 164 Mockingbird Ln Property Address Ann Flynn Owner Owner's Name information is required for every Marstons Mills MA 02648 3-17-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure,criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 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. P System will ass Y 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts �al Title 5 Official Inspection Form ' it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 164 Mockingbird Ln Property Address Ann Flynn Owner Owner's Name information is required for every Marstons Mills MA 02648 3-17-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. ` 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form f '> �•r I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 164 Mockingbird Ln Property Address Ann Flynn Owner Owner's Name information is required for every Marstons Mills MA 02648 3-17-17 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 suppN or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 9. _c ! 1 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 '/2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form :W! Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 164 Mockingbird Ln � Property Address Ann Flynn _ Owner Owner's Name information is required for every Marstons Mills MA 02648 3-17-17 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 El ❑ 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•3113 Title 6 official lhspection Form:Subsurface,Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts v :a=1 Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form Not for Voluntary Assessments 9 p Y rY 164 Mockingbird Ln Property Address Ann Flynn Owner Owner's Name information is required for every Marstons Mills MA 02648 3-17-17 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan afthe 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): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 _y t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form ��I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 164 Mockingbird Ln Property Address Ann Flynn Owner Owner's Name information is required for every Marstons Mills MA 02648 3-17-17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No 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 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: - , 3-2017Date 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 164 Mockingbird Ln Property Address Ann Flynn Owner Owner's Name information is required for every Marstons Mills MA 02648 3-17-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts �al Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 164 Mockingbird Ln � r Property Address Ann Flynn Owner Owner's Name information is required for every Marstons Mills MA 02648 3-17-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1980's Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ,. ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:.Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts a=1 Title 5 Official Inspection Form f �'�-'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a% 164 Mockingbird Ln Property Address Ann Flynn Owner Owner's Name information is required for every Marstons Mills MA 02648 3-17-17 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" 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 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts la� ! Title 5 Official Inspection Form I Subsurface sewage Disposal System Form -Not for Voluntary Assessments 164 Mockingbird Ln �rt Property Address Ann Flynn Owner Owner's Name information is Marstons Mills MA 02648 3-17-17 required for every page. Cityrrown 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts LL a=1 Title 5 Official Inspection Form f 1Vll,-i Subsurface Sewage Disposal System Form Not for Voluntary Assessments ```•W. 164 Mockingbird Ln Property Address Ann Flynn Owner Owner's Name information is required for every Marstons Mills MA 02648 3-17-17 page. City,'Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from pit. Pump Chamber(locate on siite plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ' �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �_�s!✓ 164 Mockingbird Ln Property Address Ann Flynn Owner Owner's Name information is required for every Marstons Mills MA 02648 3-17-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gal ❑ 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.): Leach pit in good condition and holding 24" of wter with stain line at 36" below inlet 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form �A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � ay 164 Mockingbird Ln Property Address Ann Flynn Owner Owner's Name information is required for every Marstons Mills MA 02648 3-17-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form -i `1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments W,_ !a/ 164 Mockingbird Ln Property Address Ann Flynn Owner Owner's Name ^T information is required for every Marstons Mills MA 02648 3-17-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately r D D A3 6 t r- 6,3 p 2 3 t c. Y— 0?cY' fl-4- 31 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts �aa Title 5 Official Inspection Form f u' ' 1,-1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 164 Mockingbird Ln Property Address Ann Flynn Owner Owner's Name information is required for every Marstons Mills MA 02648 3-17-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water t ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed.site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database - explain: You must describe how you established the high ground water elevation: USGS and town maps show no groundwater at 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 ' Commonwealth of Massachusetts I. Title 5 official Inspection Form � I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 164 Mockingbird Ln Property Address Ann Flynn Owner Owner's Name information is required for every Marstons Mills MA 02648 3-17-17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Town of Barn stable P# Department of Re gulatory Services Public Health Division Date 200 Main Street,Hyannis MA 02601 Date Scheduled I Time Fee Pd._/._(j U Soil Suitability Assessment for Sjq�efjsp��al, Performed By:- / f ee t0 Witnessed By: v.. LOCATION& GENERAL INFORMATION Location Address � G� U /�611lHltr �tic.� Owner's Name SQun^e cw� Address Assessor's Map/Parcel; d 3 9— 021 Engineer's Name NEW CONSTRUCTION REPAIR r� Telephone# Land Use `2 u 5, , A 14- I Slopes(40) � t�-- n� rr Surface Stones A 0 A,,? Distances from: Open Water Body'_ to _ft possible Wet Area�2�,�,0'' �ft Drinking Water Well ft Drainage Way ft Property Line 21j ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes GIs Parent material(geologic) v ''0�� Depth to Bedrock 's Depth to Groundwater. Standing Water in Hole: o" 4, Weeping from Pit FAce Estimated Seasonal High Groundwater Method Used: DETERNUNATION FOR SEASONAL HIGH WATER TABLE Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from side of obs,hole: in, Groundwater Adjustment ft,Index Well# Reading Date: Index Well level-- ._a AdJ,factor,,,,,m,4 Adj.Groundwater Level PERCOLATION TEST bate ThugObservation Hole# Time at 9" Depth of Penc �z✓ �eSy — _ 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(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the .Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTl0PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# r Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. o n s i s tenry,J Gravell —1 Z 'A 5L 1 6Y(0h- t L (6 y fz 1- 3 DEEP OBSERVATION HOLE LOG Hole# �— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% rave ro -�Y SL DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, 1 Flood Insurance Rate May: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? e S If not,what is the depth of naturally occurring pervious material? Certification I certify that on Q (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 (Q QA EPT10PERC17ORM.DOC L TOWN OF BARNSTABLE VO�ICTION °.s3 M(zrtvv_n rc(,c SEWAGE# Lot®' .VILLAGE -0 ASSESSOR'S MAP&PARCEL '3q O Z � U INSTALLER'S NAME&PHONE NO. Q"A e, W$la 4�?,a�&AP ICI JW t, 928 S/Ua8 SEPTIC TANK CAPACITY lvo c�j lviol 1 <K% s k- 4 LEACHING FACILITY:(type) .90 Are 3(o l Le t+eo (size) NO. OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: l l of Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility, /w ptl 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 3 A z -0 Z �Y�3 33•S' /+N s?• J S3 l It o s s No. ! �� Fee 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zltlflcation for ]Disposal *pstem Construction permit Application for a Permit to Construct( ) Repair(>Q Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a!B'�, ;YI A 2 i n Q.uZ Gi rc,f P_ Owner's Name,Address,and Tel.No. G®Tu'sr 12_A nn*1e, sncwz%+1 Assessor's Map/Parcel 9- p 21 'Lb3 nn A,,,b.er c z rde Installer's Name,Address,and Tel.Na�T b ,at SG1 Designer's Name,Address,and Tel.No. IP o?"X - ) ( Q'``�1 t,voalb 12 Type of Building: Dwelling No.of Bedrooms Lot Size aa10pp - sq.ft. Garbage Grinder( ) Other Type of Building S%Qy � _No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3-60 gpd Design flow provided 3 SS. Lo gpd Plan Date ( ( l-L "Z t o Number of sheets Revision Date Title 2&3 0l"t rwy/ �! Size of Septic Tank 11000 Type of S.A.S. d ,�-�PSS te3o. —b-A Description of Soil Cap V64n ` c 34-3�` Nature of Repairs or Alterations(Answer when applicable) 6-4-b2 14, 1,13 Date last inspected: `,0 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He Si d ( Date I ( -- i2 -Z� 1O Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Q to Date Issued Li No. ` I U ! i y 4 Fee �U THE COMMONWEA�r 0—? MASSACHUSETTS Entered in computer:✓ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS r application for Disposal 60stem Construction Permit Application for a Permit to Construct( ) Repair(>6 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. aF'i 3 M A t2%'A 2✓L Ci rG 1 e Owner's Name,Address,and Tel.No. C.oTu*,-r' Se-A n n e, moa,n Assessor's Map/Parcel 34. O 2.1 m 40-,',e�, r. Installer's Name,Address,and Tel.No1q,. , y�1 Designer's Name,Address,and Tel.No. � -7 c- ? w.nw (lct, ✓Yll9 5^Ie Type of Building: Dwelling No.of Bedrooms 73 Lot Size L?O f OOc� sq.ft. Garbage Grinder( ) Other Type of Building Sinj2, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.req fired) 3 gpd Design flow provided gpd Plan Date III I -L Number of sheets Revision Date Title Z$3 ✓YIgfL,'jnai( Size of Septic Tank 6UO Type of S.A.S. 5 Xy-te5,, L od Description of Soil , Nature of Repairs or Alterations(Answer when applicable) 1 C?< o `. ; Date last inspected: Agreement: R ' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of--- Compliance has been issued by this Board of He Si d Date (D Application Approved by Date tl- / - "d Application Disapproved by Date - for the following reasons Permit No. 0 ° Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired K) Upgraded( ) Abandoned( )by %P.u/i r.(e f<�f�G✓p/��2S at NL42-i of L e Go-k l has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. )0 `yT dated 11 - /5- Installer C4(e,,,,,,U U44 e,i Designer ^���RRn,� 1.J,�✓cKS #bedrooms 3 Approved design flowfasdesig p gpd The issuance oflthi3 permit shall not be construed as a guarantee that the system will unction ned. n� Date `) ( p Inspector � (( No. D rj t d ` YSOI Fee Uv� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Bisposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(4) Upgrade( ) Abandon( ) System located at -,7 3 X4A t,),e.r &j'�O e 6..o4i`r and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date ' 15-— (0 Approved by /� 11/22/2010 11:32 5084775313 ENGINEERING WORKS PAGE 01 Town of Barnstable Regulatory Services Thomas F. Geiler,Director l l Public Health Division ' Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fitt. 508-790-6304 Date: 1 22 t 6 Sewage Permit# Zo i a- � . ag yS Assessor's Map/Parcel -Q Z. ` Inst4lle_r&Desizuer Certification Form Designer: Fc+f-v-_r% MC -t Installer: C.Ct YJ ✓'0& Address: vw� i.�-e.{�r� �/V�c�+�(S n C, ,Address: { - Q x. rL W e�2iS S a� fzq On t l l Za to C 0&issued a permit to install a (date) (installer) septic system at 144 rt vce-1 Cf-Af " �4-y., based on a design drawn by (address) (designer) I certify that the septic system referenced above was installed substantial) according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stnpout (if required) was inspected and.the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component . of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if re inspected and the soils were found satisfactory. ��H of PETER T. MCE.NTEE taller's Si ature) CmL No' 35109 0 8T a� NAL Signer's Signature) (Affix tamp Here PLEASE RETURN_IQ"BARNSTABLE PjMLIC HEALTH.DIV 510N. CERTIFICATE OF COMPLIANCE WML NOT BE ISSUED UNTIL BOTH THI§ FQRM AND AS- BUILT CARD ARE RECEIVED BY Tom;,BARNSTABLE PjjV C HEALTH DIVISION. M&M YOU. gAofficc£ornts\de3igmr=6ficndon fbrmdoc LO AT N SEWAGE PE 7� !T N0. �V i CAG E I N S T A LL 'S NAME i AD0RES BUILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED /,&_. /, � r n17 ON a � P o of I - No.._._....... 11-:. F> ...................... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /0 ....................OF......&.E'/g4l ......... Applira#iuu for Dispuual Works (go-mitrur#iun rprmit Application is hereby made for a Permit to Construct (/N< or Repair ( ) an Individual Sewage Disposal System at ............... k � ��Tl� --------••--------. .......------------..........-•---........-•----•-- r...-.... p_....- �._.. � Loc ryd res t N�,� ....(.-..• ........... � - ...:.............•---•-•--•- -•---•...•-•--- ---;....__. ............................. aW �f '!C :.�!7/.5.................................. ...........dress............._......................._..... ..... .... .... .... Installer Address d Type of Building Size Lot.. V _____Sq. feet U Dwelling—No. of Bedroom Expansion t�ttic ( ) Garbage Grinder ( )t•. ------------ (� aOther—Type of Building `Al- --- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------•-/-------••-------------•-----................................................................................................ W Design Flow..........ur.,! .......................gallons per person per day. Total dail viow__.... .3 ........................gallons. WSeptic Tank—Liquid capacity/43...gallons Length_. . .._.. Width_�7�. ..... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. f . . i Seepage Pit No........ .......... Diameter..... .-__.:-_. Depth below inlet n---_._.. Total leaching area.s��.�. Z Other Distribution box (�) Dosing t nk ( ) py `-' Percolation Test Results Performed by.._,".-? ftidC� (?�� � .... Date... . _ a -------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---_�t_ L14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ODescription of Soil_...... ....._. �Q! `:. -•-••----------------------------------------------- x ---a.3.6........L & ----•--•-- - ----------•------------------•------------•--•-------------------.--------------•-••-------------- 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 iI LE . 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beeryssued by 4k boa of hea th. Signed --- ----•- -- - --------------•----•---.•---- ati'" ------- ApplicationApproved By---------------------•---•••••---•--------•••-._.......--•----•-••----------------•-•........._. ........................................ Date Application Disapproved for the following reasons--------------------------------•----•--------------.....------------------....-•------------------•-•-----.._... .............................••--•-•--•-•----•-----------.....-------------••----------------•----------.---------------------------•---••---•--•••------------------••••------------••---••----------•- // Date Permit No......................................................... Issu ,l 7~ .. Date 1 , No. ......_....__...... Fes ......._............... THE COMMONWEALTH OF MASSACHUSETTS �,. BOARD OF HEALTH ............................ ...OF...../jf f /t/-5 �/_f/l.Gr-r-... ApplirFatio'n for Disposal Works Tonstrurttnn Prrutit Application is hereby made for a Permit to Construct N or Repair ( ) an Individual Sewage Disposal System at• /J / Loc tior� ddress or Lot No. I n � Owner Address 1 1r- Installer Address UType of Building > Size Lot..:1 •'. n.....Sq. feet Dwelling—No. of Bedrooms._... �.................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building 1)A_s`f11X711 ... No. of persons..........6;.............. Showers ( ) — Cafeteria ( ) dOther fixtures --------•---------------- ...........--------•-----.....-------•----•--•---•-------•------••---.......------------...-•••-----.....----........---- W Design Flow...........`-..`? ......................gallons per person per day. Total daily,flow........r. .............................gall ons. WSeptic Tank—Liquid*capacity,,ffC0..gallons Length../.' `�.. Width._Z. :_._._. Diameter................ Depth................ x Disposal Trench—No..................... Width.._........._...... Total Length.................... Total leaching area--_------..-__---•--sq. ft. Seepage Pit No......... .......... Diameter...... .......... Depth below inlet... .-2.......... Total leaching Z Other Distribution box (/ ) Dosing tank ( ) '-' Percolation Test Results Performed by....f�� '!�! _j� ... '.......:'•%�!��Ljt................. Date...��/.._ �� .a a .... . ............. Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.._-___, i . f=1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------•..............................................•--......-----•...........-•••••--•---•--......................................................... D Description of Soil....... ...:. .........IrO Oe Ux t_.:..?��......... :��:...._......------•-• .../..---------••------•......................................................................... ......--- W ------------------------------------ j..._//t...----•-�J�f -•----- ................................................................................................................... -�'.`r.-----------------------------------•-----------------------------------..._..------..........------. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -••----------------•------------•---•--••--•----------------------------•--.....------......---......----•-•----•-••------------------------••-•-------.... ............................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been..•issued by Ye boad of health. Signed-- ............................ .. ...... �f . Dat-e' -------- ApplicationApproved By.................................................................................................. -•----------------..................... Date Application Disapproved for the following reasons-------------•------------------•------------•-•----•--....--------------..................................... --------------------------------------•--•--------••-------------•---.....-•--------....•--••-----......_.. Date. PermitNo......................................................... Issued_..................................................... - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF.... <. _)/�........................................... At %antifiratr of f�unt�lt�tnre � TH,PS IS TO-CERTIFY, That/the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by - j `mac U�J �'Ft-ICI�L2'I'a1l Installei -------------•------•-•---....-•--------------•---•--•......•--------------------- has been installed in accordance with the provisions of T �l� 5 of he State Sanitary Code as described in the application for Disposal Works Construction Permit No.._E....7..��.............. dated------ ..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��// � ................ .....................OF...... , ....................................... ................................ No........... ..... FEE........ Disposal Marks TWnlrnrtion ramit Permission is hereby granted......4. !...........................r z � , . :. ...................•••• to Construct or Repair ( ) an Individual Sewage Disg`al System at No... r_ ....f.� :. --..:• =r.......... �< '�'L'�Street as shown on the application for Disposal Works Construction Permit o............. .... Dated.......................................... DATE..../------ C/1/ -------------•---- --/•------�.......---------•--•----....--•----•---. Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS r LEGEND N EXISTING CONTOUR �oG X 100.98 EXISTING SPOT GRADE f� Of —W EXISTING WATER SERVICE —G EXISTING GAS SERVICE ; --&H.-W— UNDERGROUND WIRES z(D �o r < TEST PIT S�oo�ef 0fe LOCUS c BENCHMARK J'� � Rd \� Dee LO O QgOCO S� LOCUS MAP NOT TO SCALE tZ .V �j MARINER CIRCLE 98.93 edge of povement 99.90 99.88 99.74 _--------N�52-28'53" E 125.00' `-Q Stone (LOT 5,7) X 101, Driveway APN 39-q21 `.\ 20,000 S.F.f �� 101.89 101.94 � � 100, 1 \� 9 R MP 9,32 91'S I@ e �ZqCKADE FENCE X 101.59 102.12 i 96.99 - �0),40 /i 97.900 _J r \ / r �`��- ,EXISTING GARAGE l01,02 HOUSE(#283) d T.0.F.=103.5f ch r � r 96.00 - `9cS / r _ WALKOUT --95,84 � 99.98 Z~`_ I 1 96.60 / ao C+ (n 196.08 DECK r r 0 � � r 6 Jr o 0 w o i 0 X97.73 o v oV oo r X 96.4 0 97.03 \ ��' r \v/ 96.65 m , , TP-2 r / .54 \ �� 96.96 /V /TPA 1 + M.33 BENCHMARK SPIKE SET Vsj yip/ 4-� ��, �� EL.= 96.96 (Assumed) 95.2 EXISTING SEPTIC TANK / /4�/ ��� ---9a-- (TO REMAIN) 11 ,33 / INTOP V.(OUT)OF A94.36f=95.69 9Q\ SHED I SHED EXISTING LEACH PI T �,94.03 TO BE PUMPED & FILLED X 95.09 W/SAND AND ABANDONED 94.05 92, - -------- 92 S 52'28'53" W ��P��� OF Mgss9�yG o PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN M CIVIL 283 MARINER CIRCLE, COTUIT, MA No. 35109 Prepared for: Capewide Enterprises, P.O. Box 763, Centerville, MA 02632 APF S�o/SAV@� �� Engineering by: SCALE DRAWN JOB. NO. OWNER OF RECORD virm MORIN, JEANNIE Engineering Works, Inc. 1"=20' P.T.M. 242-10 283 MARINER CIRCLE 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. COTUIT, MA 02635 (508) 477-5313 11/12/10 P.T.M. 2 of 2 4 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL.92.8 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT INSTALL INSPECTION PORT OVER END UNIT T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE E F.G. 95.0(MAX.) EXISTING F.G. EL.=97.Ot F.G. EL: 95.5t Dim MAINTAIN 2% GRADE (MIN.) OVER S.A.S. ' INSPECTION L = 33' L = 6'(MAX) PORT S=1% (MIN.) @ S=1% (MIN.) (1 MINIMUM) 40 4"SCH40 PVC 4"SN1 PVC s" 1D"I s 14" 10.75" TO EXISTING 48" LIQUID INVERT LEVEL ADD GAS BAFFLE INV.=92.77 PROPOSED INV.=92.60 4 ROWS OF 5 UNITS AT 5.0'/UNIT = 25.0' INV.=94.36t D-BOX INV.=92.4 SOIL ABSORPTION SYSTEM (PROFILE) EXISTING EXISTING SEPTIC TANK ESTABLISH VEGETATIVE COVER BACKFlLL WITH CLEAN NATIVE OR PERC SAND TO TOP OF CHAMBERS BREAKOUT=TOP NOTES: TOP ELEV.=92.83 t 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=92.40 INVERTS, PRIOR TO INSTALLATION. 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=91.50 GRADE ON A MECHANICALLY COMPACTED SIX 2.83' INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF EFFECTIVE WIDTH=11.3'3) INSTALL-INLET & OUTLET TEES AS REQUIRED. T.P. EXCAVATION OR G.W. EXISING SUITABLE 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE NO G.W., EL=85.0 = MATERIAL AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. USE 4 ROWS OF 5-ADS Arc 36HC UNITS WITH NO SEPARATION BETWEEN EACH ROW & NO STONE SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S. SOIL LOG DATE: NOVEMBER 8, 2010 (REF# P-13,130) SOIL EVALUATOR: PETER McENTEE (SE#1542) WITNESS: DAVID STANTON-HEALTH AGENT GENERAL NOTES:1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL Elev. TP- 1 Depth Elev. TP-2 Depth BOARD OF HEALTH AND THE DESIGN ENGINEER. 95.5 A 0" 95.5 A 0" 2. ALL. WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SANDY LOAM SANDY LOAM 1 OYR-4/2 - .- _ _-.10YR 4/2 OF THE STATE ENVIRONMENTAL-CODE,TITLE--V; AND ANY APPLICABLE ` ' 94.5 12" 94.7 10" LOCAL RULES AND REGULATIONS. B B 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR SANDY LOAM SANDY LOAM TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 10YR 5/8 10YR 5/8 DESIGN ENGINEER. 92.5 36" 92.7 34" C 36" C 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING PERC FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 48" ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF MED. SAND MED. SAND THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 2.5Y 6/4 2.5Y 6/4 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. 85.0 126" 85.0 126" 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING PERC RATE <2 MIN/IN. ("C" HORIZON) CONSTRUCTION. NO GROUNDWATER OBSERVED 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 63.25" REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFlLL. 16" r - IV 34.5" 1 i i . TOP VIEW DESIGN CRITERIA 60" END CAP END CAP NUMBER OF BEDROOMS: 3 BEDROOMS FRONT VIEW SIDE VIEW SOIL TEXTURAL CLASS: CLASS I END CAP DESIGN PERCOLATION RATE: <2 MIN/IN REAR/TOP VIEW NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW DAILY FLOW: 330 G.P.D. TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. DESIGN FLOW: 330 G.P.D. 4640 TRUEMAN BLVD GARBAGE GRINDER: NO in HILUARD, oHlo 43o2s LEACHING AREA REQUIRED: 330 Arc 36HC DETAIL ak ( ) = 445.9 S.F. ADVANCED DRAINAGE SYSTEMS,INC. 74 PROPOSED SEPTIC SYSTEM UPGRADE PLAN EXISTING SEPTIC TANK: 1000 GALLON CAPACITY PROPOSED D-BOX:: 1 INLET, 4 OUTLET (MINIMUM) 283 MARINER CIRCLE, COTUIT, MA USE 4 ROWS OF 5-ADS Arc 36 UNITS WITH NO Prepared for: Copewide Enterprises, P.O. Box 763, Centerville, MA 02632 SEPARATION BETWEEN EACH ROW & NO STONE Engineering by: SCALE DRAWN JOB. NO. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) Engineering Works, Inc. 1"=20' P.T.M. 242-10 (Arc36HC Units) 20 UNITS x 5.0 LF x 4.80 SF/LF = 480.0 SF 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74(480.0 S.F.) = 355.2 G.P.D. (508) 477-5313 11/12/10 P.T.M. 2 Of 2 f ` h s+j 1�1 :lot r. k FIL. ELEV.. FINISH GRADE ,-5-4gn FINISH GRADE FINISH GRADE— �top of —� FOUND. OVER TANK = J OVER Piz = 4n ,t ., , CHIMNEY BLOCK IM8 - 4" V.C._ _ ,, v+r+eRe rrEEDFM = BACKFILL 3 PEASTONE v v CJ _ - t j C O o '. CE1.LR FAR 2Q0 GALLON " ' - " °° o O 0 O o , ° 3✓4° TO 1-I/2 Ek E_`iC .As�S.s'2 REINFORCED CONC. Y P ° t14 . o O 0 O O 1 0 y � CRUSHED STONE a ° o 0 O O �/ v1' 1, d + O \ yo e A 4 • • o ' o e e• . • • DIST. BOX � ( jJ p �( v a O 0 O o v+ � t — T v e i ' o O Q O o ��� �r h A� r- TO BE LEVEL ' r � o o o Q O o ° BOTTOM OF P17 ' ' ,�i,, /HIV ~`� AND STABLE) i; a 10 O O O o ° , ELEV. = 7 SYSTEM PROFILE ( NOT'TO SCALE) LEACHING -PIT Q Ev'ifraa°ssaar -CRITERIA A MOM"R OF W OR OOM'3 !(00.00 GALLONS ' PER DAY 1 R> GARBAGE QRINDER E. N� TOTAL DAILY FLOW = a o zZ��,. : f• , M LEACHINB AREA PROVIDED= '5 Q 55 (=_2►� � �`� rl t a�� tit/�0►.t ;t;,. �.rZ;;,E'.�►.�.,zic 7Tx4,z7, ��k �, L;� �,� _ ;�.;::, SEf�T1c- SOILS LOG + f PIT rt c l�0 .C70 a� g Lv T �� 1....C. ' PROPOSED SEWAGE ti DISPOSAL SYSTEM uo k PROPOSED DWELLING Ij r . ttilSPlEC T Eq �_ �..r, AA r��,��,T 12���s, �a, i�*�,�., - �E �.;. ..�.t �3 8,&C t► �VA-F,t� C�'G�r�arT�MASS. PERCOLATION RATES Zi N1�Wil SN uF MA sv SCALE: AS NOTED DATE ,yam 9 C3T�Gu71r ��I f Y� OF At qs�� o��►� t _ R�.L.Ev/►-Tlca�, © 1�tsL t�ATVM ��rr� . y NOR MAN G� CEO' 19GI?�S' 1f'c�><I�.�' T .t:'T' 3g GROSSMAN u Z — L,bT Si-iGW lit UrJ S�LAI'.� —TUG3G 140 S!-IEeT kio, noRn�t o, 12705 �, :u:>> 0 2 G CEAT 4 w Wo'r !*-a F�� PL�•.t eJ • ," 41 � �, lac '�'T �-.�e;.u. 'SG�o �� 1 ssiouL� � NORMAN 6ROSSMAN P.E., R.L.S. ` y 226 HOLLY POINT ROAD GENtERVILLE, MASS. K. �: . . .�.:"1:•:�'�� '4^, e� ?'� F ,�3t:.:L�:ar ...:2 a .'9t; vx. .Ynhr';J.'d:'.+, wn++Y.rsw.I4...W.+.-_... +,`- -. J , ,.....- - ...