HomeMy WebLinkAbout0521 MARINER CIRCLE - Health .524 Mariner Circle
(Cotuit 761
— A= 024-032-002 -
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection
Well Completion Reports
Well Driller
Please specify work performed: Address at well location: ,
New Well �� Street Number: Street Name:
r�
521 MARINER CIRCLE
Please specify well type: Building Lot#: Assessor's Map#:
Irrigation +1 024
Assessor's Lot#: ZIP Code:
Number Of Wells: 032 002 02635
Cityrrown:
Well Location BARNSTABLE
In public right-of-way: GPS
f,Ye North: West:
41.63937 70.44336
Subdivision/Property/Description:
Mailing Address:
click here if same as well location address
Property Owner: Street Number: Street Name:
MICHAEL ONEIL 521 MARINER CIRCLE
City/Town: State:
Engineering Firm: BARNSTABLE MASSACHUSETTS
ZIP Code:
02635
Board of health permit obtained:
f7 Yes (7°Not Required
Permit Number: Date Issued:
W2021001 01/07/2021
Massachusetts Department of Environmental Protection
Bureau of Resource Protection—Well Driller Program
,Ll"A Well Completion Reports(General)
Well Driller - General Well Form
DRILLING METHOD
Overburden Bedrock
uger Choose Bedrock—
WELL LOG OVERBURDEN LITHOLOGY
From(ft) To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition
stem drill rate of fluid
0 5 1 Silty Sand Brown t •Fast f`Slow
YES NO Loss Addition
_ _._ _ r r (" ("
=_ 25 I Fine To Coarse S: Brown Fast slow
YES NO Loss Addition
_... ...........-----------—.... .-.......
25 40 Fine To Coarse S + ,Brown t Fast Slow
YES NO � Loss Addrtion
40 80 Medium Sand Brown .� f"�Fast C'Slow
----------- YES NO Loss Addition
WELL LOG BEDROCK L ITHOLOGY
Drop in Extra fast or Loss or Visible Rust Extra
From(ft) To(ft) Code Comment addition of Large
drill stem slow drill rate fluid Staining Chips
Choose Code YES NO Fast Slow Loss Addition r Yes r Yes
ADDITIONAL WELL INFORMATION
Developed I 0w Yes r No Disinfected t Yes f'No
Total Well Depth 60 Depth to Bedrock
Surface Seal Type lNoneracture Enhancement
CASING 11 Is Casing above ground?
From To Type Thickness _ Diameter Driveshoe
�0 57 Polyvinyl Chloride mmmm Schedule 40 Yes
SCREEN 1 No Screen
_.-_ .........................................................................Ty ..................-................_......._......_..._....-........... ...._........................... -......................- .. .._.. --......................_............--......_...........
..........................._..............--........- ..._._.....
From To Slot Size Diameter
57 _ 8011 Stainless Steel Well Point - 0.010 F
WATER-BEARING ZONES ( DRY WELL
From--� To Yleld(gpm)
C'_—__1 80 ._ 12 7--:71
PERMANENT PUMP(IF AVAILABLE)
Pump Description Wire Constant Speed Horsepower
Submersible 3/
Massachusetts Department of Environmental Protection
Bureau of Resource Protection—Well Driller Program
Well Completion Reports(General)
Pump Intake Depth(ft) 56 Nominal Pump Capacity(gpm) 15
ANNULAR SEAL/FILTER PACK
From To Material 1 Weight Material 2 Weight Water Batches Method Of
(gal) (count) Placement
Choose Matenal Choose Material f —
Choose One
WELL TEST DATA
Date Method Yield(gpm) Time Pumped Pumping Level(ft Time To Recover Recovery(ft
(HH:MM) BGS) (HH:MM) BGS)
01/21/2021 j Constant Rate Pump �� 12 01 30......... 48... 00 01
WATER LEVEL
Date Static Depth BGS(ft) Flowing Rate(gpm)
Measured
01/21/2021 44 F12
COMMENTS
WELL DRILLERS STATEMENT
This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete
and accurate to the best of my knowledge.
WILLIAM Supervising Driller DESMOND,
DrillerURQUHART Registration# 877 Monitoring[M) Signature PATRICK,
DESMOND WELL
Firm DRILLING INC. Rig Permit# 0551 Date Job Complete 02/OS/2021
NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
ENVIROTECHLABORATORIES,INC.
MA CERT. NO.:M-MA 063
8 Jan Sebastian Drive Unit 12
Sandwich,MA 02563
(508)888-6460 1-800-339-6460
FAX(508)888-6446
Client Nante: Desmond Well Drilling Location
Address: PO Box 2783 521 Mariner Circle
Orleans, MA Cotuit, MA
02653 Lab Number: DW-210270
Collected By: Desmond Well Drilling, Inc. Date Received: 01/22/21
Sample Type: Well Specs: Irrigation 60/44
� � �Locntton Sortrce- z Date Collected Tlnte Collected , � "Cotnnrenls '� � � •-�
Analysis Requested Units Recommended Limits Analysis Result Alethod Date Analyzed Analyzed By`
Total Coliform CFU/100mL 0 0 SM9222B 01/22/2021 KF @ 16:15
pH pH units 6.5-8.5 5.51 SM 4500-H-B 01/22/2021 SD
Specific Conductancen umhos/cm 500 460 EPA 120.1 01/22/2021 SD
Nitrite-N mg/L 1.00 <0.006 EPA 300.0 01/22/2021 SD
Nitrate-N mg/L 10.0 1.70 EPA 300.0 01/22/2021 SD
Sodium mg/L 20.0 87 EPA 200.7 01/24/2021 KB
Total Iron mg/L 0.3 0.02 EPA 200.7 01/24/2021 KB
Manganese mg/L 0.05 0.113 EPA 200.7 01/24/2021 KB
Comments:
Low pH indicates high corrosive characteristics.
Sodium level is not a health hazard, but if on a low Sodium diet,consult a physician before drinking
Over a lifetime,the EPA recommends that people drink water with manganese levels less than 0.3 mg/L and over the
short term,EPA recommends that people limit their consumption of water with levels over 1.0 mg/L
All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met,
unless otherwise noted at the end of a given sample's analytical results.
We certify that the following results are true and accurate to the best of our knowledge.
Water meets EPA standards and is suitable for drinking forparameters tested.
..........
Date 1/25/2021
Ronald J.Saari
Laboratory Director
BRL=Below Reportable Limits *See Attached Page 1 of 1
❑Certification is not available for this analyze for potable water samples..
No. ` '. 0 1 Fee �
BOARD OF HEALTH
.TOWN OF BARNSTABLE
01ppficatiou -for Yell Cou5truction J)ermtt
Application is hereby made for a permit to Construct k), Alter( ), or Repair( an individual well at:
Location-Address Assessors Map and Parcel
IVt�C_Li�G�e l (�Ylel.l in" , UA O- �� �
U2-G 3
Owner Address
� Y �Yu� �1 l►i , 1 ht. iRr�..p bar C3('�..ct ,, lce
Installer-Driller Address
Type of Building V
Dwelling ( ^a��
Other-Type of Building i No. of Persons
Type of Well jY rtCU►h 6)3 `191 y® M, Capacity
Purpose of Well k Y r'kC4 (,
Agreement:
The undersigned agrees to install the afore described individual well in accordance with the provisions of the
Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the
well in operation until a Certificate :)f Compliance has been issued by the Board of Health. i
Signed 1_d 16 2-07.0
Date
Application Approved By M , T k ( AL-� 1� f
Da
Application Disapproved for the fcllowing reasons:
J a �1 Date
Permit No. V l c, d�� 0 0 ( Issued
Date
--------------------------------------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well ConstructedX), Altered( ), or Repaired(
- )
by De,,SnP,,Ly '1A
Installer
at
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
No. \lam 00 1 ` Fee
c.+ BOARD OF HEALTH
TOWN OF BARNSTABLE
ZippYicatiou for eYr on trurtio hermit.
Application is hereby made for a permit to Construct Alter( ); :or Repair( an individual well at:
0.
k,
I.ation-Address Assessors Map and Parcel
M 1( VIA 1 ( Y1el �1 Mxq kyux urck , Uu Vt+ �kxA 02G3Z
Owner Address
S�'Y��nGI well �r�ll+�� 1►n�• kCk�,4 la Cr Qc�- OfLeCLV\C— M k QZCeS3
Installer-Driller `` Address
<0�f wo
Type of Building
Dwelling �om C,-"C
Other-Type of Building No. of Persons
Type of Well -�)Y r 1 GIC�1 6 Y� �t PVC Capacity - -� �— ---
Purpose of Well '1 r Y k 6M�t
16Y)
Agreement:
The undersigned agrees to install the afore described individual well in accordance with the provisions of the
Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the
well in operation until a CertifIcate ofCompliance has been issued by the Board of Health.
Signed -'u . - 1.16(ZOzo
Date
Application Approved By 1 r`IG�C�� ✓ !L'� j� i
Date
Application Disapproved for the following reasons:
Date
Permit No. 'i i `�} --�
w ���� ' V �. f Issued'r �
r / Date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed'(,(), Altered( ), or Repaired( )
by. SMU Y1 wt\� 0 Y1C
Installer
at �)-21 MGY Y tt - C 1 I-C.I-e- co11 1 "
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
BOARD OF HEALTH
TOWN OF BARNSTABLE
{
lVell Con.5tructton Permit
No. W Fee Cl41
Permission is hereby granted to 1 k rfA
Installer J t
to Construct(4 Alter( ), or Repair O an individual well at:
No. CI(d ir- ; 0 kVkV07
Street
as shown on the application for a Well Construction Permit No. 1A) 0;� (—D0( Dated .
Date 1 Approved By 1 k M W!At .-744
W
O?
LOT 3
44;7 73..S.Ir
i
2' STONE
ALL ABOUND
3 HOLE 1000 GA,
D80X LEACHING .P T
1p
X 1000 GA.
o , EFrlc .TANK.
BULKHCA
DECK
7�7'.- _-- ----.
34
1
RELY v. .5
races, 1 '
3.67'47'45"
109.54P
W--- W--._ —
'— G -,
W, , L=88.04'
fir�"'1N--��--�•_W u�-�,..—�..,,G__ ^�__.;e.�_.
LO 1
1 184
Qv!
LOT 3
+S m= NOTES:
-2. SSSESSCIRS NU SER: ;F24-03:'-002-521
3. ZONWJ DIS1d1CT. -Rf ..
LEA e??' 1 4-rua6ci HA, NI;!
ARD Z _
_ 5 EL VAT;ONS SFa W ARE BASED ON THE k-?IONAL
_ %E(NjE-fc VLR—.ICAL DATUM,
tr h. REFERENCE, PL4N 900K 482 PC, 'a
1 x
\`. X Tart,
� 8\31\931 AM11ON OF MEASURED ELEVADONS S7H MOM
1 DATE DESCRIPTION Prawr4Checked
RE VISI '0NS
PLOT PLAN FOR LOT 3
PRE?ARED FOR
COTUIT TRUST
MARINER CIRCLE
::Salta;: BARNSTABLE', +Ass-
�__ SCALE: 1'-20 DATE:8i31i93 i
holmes and mcgroth, inC.
t- civil engineers end land surveyors
-22 200 main street `
falmoulh, me. 02540. 508) 548-3564
..,•x<::-� DRAWN: CHECKED:
JOB NO: 931BG DWG. NO: 55--3-14 SHEET 1 OF 2
'COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL-AFFAIRS
DEPARTMENT OF:ENVIRONMENTAL PROTECTION
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TITLE 5
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGEDISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 521 Mariner`Circle .:
Cotuil MA 02635:
Owner's Name: Cheryl O'Neil
Owner's Address:
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Date of Inspection: November 2: 2011
Name of Inspector: (Please Print) James M.Fond
Company
Name-James M. Ford
.Mailing Address: P.O.Box 49
Osterville,MA 02655-0049
Telephone Number: (508) 8624400
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of 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
eeds Further Evaluation by the Local Approving Authority
F ils
Inspector's .Signature: Date: November 7, 2011 .
The system inspector shall su t a copy of his inspection report to the Approving Authority(Board of Health or
DEP)within 30 days.of comp ng this inspection. If the systemis 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.
' Notes and Comments
****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.
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Title 5 Inspection Forni 6/15/2000. page 1
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Page 2 of 11
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OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
j PART A
j CERTIFICATION (continued)
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j Property Address: 521 Mariner Circle
Cotuit.MA
i' Owner: Cheryl O'Neil
Date of Inspection: November 2, 2011
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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.
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Comments:
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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.
Answer yes,no or not determined(Y,N,ND)in the 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.
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ND explain:
Observation of sewage backup or breakout 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
II. ND explain:
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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):
i` broken pipe(s)are replaced
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obstruction is removed
i, ND explain:
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Page 3 of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 521 Mariner Circle
I: Cotuit,MA
Owner: Cheryl O'Neil
Date of Inspection: November 2, 201,1
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
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
i private water supply well". Method used to determine distance
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"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.
3. Other
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Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 521 Mariner Cir&le
Cotuit MA
!' Owner: Cheryl OWeil
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Date of Inspection: November 2. 2011
D. System Failure Criteria applicable to all systems:
You must indicate either"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.
j ✓ Liquid depth in cesspool is less than 6"below invert.or available volume is less than%z day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
. of times pumped
✓ Any portion of the 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 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.]
No (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 System:
To be considered a large system the system must serve a facility with a design flowof 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following.criteria apply to large system,.in addition to the criteria above)
,E Yes No
the system is within 400 feet of a surface drinkingmater 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
I' 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 fail edsunderSection D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
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Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
j CHECKLIST
Property Address: 521 Mariner Circle
Cotuit,MA
Owner: Cheryl O'Neil
Date of Inspection: November 2, 2011
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?
1- —
4,
— ✓ Have large volumes of water been introduced to the system recently or as part of this inspection
I n/a Were as built plans of the system obtained and examined? (If they were not available note as N/A)
j ✓ Was the facility or dwelling inspected for signs of sewage back up?
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Was the site inspected for signs of break out?
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Were all system component'§.,,excluding the SAS,located on site?
,/ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected .for the condition
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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?
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The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No -
�' ✓ = 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:atissue approximation of distance
is unacceptable) [310 CMR 15:302(3)(b)J.
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Page 6 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
I'
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
1 Property Address: 521 Mariner Circle
Cotuit,MA
Owner: CherTI O'Neil
Date of Inspection: November 2. 2011
f FLOW CONDITIONS
(. RESIDENTIAL
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
Number of current residents: 2+
Does residence have a garbage grinder(yes or,no): n1a
Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required]
.Laundry system inspected(yes or no): No
j Seasonal use(yes or no): No
Water meter readings,if available(last 2 years usage(gpd)): Unknown
Sump Pump(Yes or no): No
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Last date of occupancy: Currently
I COMMERCIAL/INDUSTRIAL
Type of establishment:
Design.flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present.(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
i Last date of occupancy/use:
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j OTHER(describe):
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GENERAL INFORMATION
Pumping Records
Source of information: Unknown
Was system pumped as part of the inspection(yes or no): Yes
If yes,volume pumped: gallons--How was quantity pumped determined?
L Reason for pumping: Maintenance
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
j, Single cesspool
j Overflow cesspool
Privy
is 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
j obtained from system owner)
j Tight Tank Attach a copy of,the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Installed on 5125194-yer info on file
j Were sewage odors detected when arriving at the site(yes or no): No
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' Page 7 of 11
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OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
j' SYSTEM INFORMATION (continued)
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Property Address: 521 Mariner Circle
Cotuit;MA
Owner: Cheryl O'Neil
Date of Inspection: November-2. 2011 _-
BUILDING.SEWER(locate on site plan)
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Depth below grade:
Materials of construction: _cast iron _4.0 PVC other(explain):
I Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc:):
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SEPTIC TANK: ✓ (locate on site plan)
�t Depth below grade: 4"
Material-of construction: ✓ concrete metal _fiberglass polyethylene
other(explain)
If tank is metal.list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1.000 gal.'
Sludge depth: 2"
Distance from top of sludge.to bottom of outlet tee or.baffle: 30"
Scum thickness: 10"
Distance from top of scum to top of.outlet tee or baffle: 6"
F Distance from bottom of scum to bottom of outlet tee or baffle: 10"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.).
Tees were present The liquid level was even with the outlet invert There did not appear to be any signs ofleakaze. The tank ivas
pumped after the inspection
GREASE TRAP: None (locate on site plan)
Depth below grade:
j' Material of construction:._concrete _metal _fiberglass _polyethylene _other
(explain): . _
Dimensions:
Scum thickness:
Distance.from top of scum to top of outlet tee or baffle:
�I Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
I Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc:):
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Page 8 of 11
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OFFICIAL.INSPECTION;FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION.(continued)
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Property Address: 521 Mariner Circle
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Condt.MA
Owner: Cheryl O'Neil
(' Date of Inspection: November 2, 201I
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TIGHT or HOLDING TANK: None (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/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
' Date of last pumping:
Comments(condition of alarm and float switches,etc.):
i
{ DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
j: 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.):
The D-box:was hornial:
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
is
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Page 9 of 11
!' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
i
Property Address: 521 Mariner Circle
Cotuit,MA
Owner: Cheryl O'Neil.
Date of Inspection: November 2, 2011
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan;excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 1 6'x 6'(1000 QaIJ
leaching chambers,number:
leaching galleries,number:
! leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system. :Type%name of technology:
Cormnents(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
1 The leach pit had 4'6" of liquid on the bottom. The scum level was at the same level.There did not appear to be any signs of
! failure. The cover•was 12"below.
CESSPOOLS: None: (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:
Dimensions of cesspool:
! Materials of construction:
Indication of groundwater"inflow(yes or-no):
Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: None (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.):
h
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Page 10 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
!'• PART C
SYSTEM INFORMATION (continued)
I
Property Address: 521 Mariner Circle
Cotuit,MA
Owner: Cheryl O'Neil
!
Date of.Inspection: November 2. 2011
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage.disposal sysfem 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.
GAMqC
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9 Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 521 Mariner Circle
Cotuit,MA
Owner: Cheryl O'Neil
Date of Inspection: November 2. 2011
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 40 +1 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)
✓ Checked with local Board of Health-explain' topographic and water contours»tads
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using Barnstable topographic and water contours reaps the maps here showing approximately 40'+/-to groundwater at this
site: -
1
This report has been prepared onlyfor the septic system and components described herein. This septic system has beery
r7tspectetl and passed as of the date of ii.'rspection. This report is riot a warranty or guarantee that thesystem will
firirction properly in the fixture. There have been no warranties or guarantees, either expressed, written or implied,
r•elatbig to the septic system;the inspection, this report and/or airy components of the septic system which have not
k been located and inspected:.
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}
A �ARNSTABLE
�
L AT'�ON '�°t 31MOrihw or C/rclo ---SEWAGE # 93 ' IKS-2
VILLAG', San rw.f co i/ � 6
ASSESSOR'S MAP 6 COT
i
INSTALLER'S NAME 6t PHONE NO. J04m ,� /9,0It.0-
SEPTIC TANK CAPACITY /000 S T
LEACHING FACILITY:(type) /67p0 Lof
(size)
NO. OF BEDROOMS -01 PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER J,
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:_!' o
f /VARIANCE GRANTED: Yes No v
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ol
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3
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�'�f�f�w°IVtOb.BA'RNSTABLE
LO AT;ON -0:3/war/rl4pr Orclo SEWAGE # 93 s 65�2
VILLAGLSG"ra. Cm�ui� C v �° .�
ASSESSOR'S MAPnn& /LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY /®Olq S 7-
LEACHING FACILITY:(type) /p00 (size) 6 'X /O
NO. OF BEDROOMS :1 PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER J, s"p�y
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No �/
�'. ,
�. . F �► ��
� � � � � �
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No...` .....`;✓� Fics......P-0..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........701n/�'✓.................O F.........&A RIV S TA.196!_--
...............................................
Applirativit for UWposal Works Tungtrurfiutt Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
Nov e # .S21 G o T 3 MAg,nv,Eg C i14 c c F__
................_..........................._...........- -....................... . • -- - - -.........._.__.... ........----
Location.Address — or Lot Nn_
C o TUI T TRUST _ Z.l 'Rt''ZB,' G i]A2; 7o/uS•i1!1/L L-5, PO A
......................_..........._....---•----- ...................... . - --- -- -- -
Owner Address
a . .......................................... .....
.............A..----..
Installer Address
Type of Building Size Lot.... - :KZ!......Sq "feel
U 'e
.� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers
a —Type g ............................ ---- ..._ ( )--- Cafeteria ( )
dOther fixtures ............................................. ..........-----------•-----•-------•--••..................... ...---•--
W Design Flow.................................55-._...gallons per person per day. Total daily flow........-�...33.0........
.--...-----------gallons.
WSeptic Tank—Liquid capacity�QOO gallons Length..B`4?...._.. Width.A4.!0"... Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.......... .......... Diameter....W........... Depth below inlet....... .......... Total leaching area...Zk:7.....sq. ft.
Z Other Distribution box (jC) Dosing tank
'-' Percolation Test Results Performed by..........M:.3:--- ,_.___-•-..,_.................. Date... .........
Test Pit No. 1.....2....._._minutes per inch Depth of Test Pit------ Depth to ground water.A./4?`(!E_,_.....
114 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P+ •---------------•-- •••••-----------------------...---- •.----- ----....•-------------•......----•._......_..-----•••---------•----------••--_.....
O Description of Soil.....4..' 3_._:Loq►vi3 a -4___Si/ SO/,� �g-rz _ S!F?�_D...............
U ---------------------------------------- ---------------------
•--------------
•-•-------------
-------------------------
•------------
.----------------
W
UNature of Repairs or Alterations—Answer when applicable..........................................................:....................................
-•.....................................••-•---.....-•-•----...............-•----•----------.........----•--•--••-----------------•---......----•-------•---------------••--•----•--..................._.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of CompLeh en' sued by the oard of health.Signed . ..-----............................................................... -:_.... ..-- Date
Application Approved By .............. ;..�. �f.... �-e .. ..9J'1
Application Disapproved for the fo lowing reasonf: ...........................'-----..............................................--'- .....................-----.............. -------
................. .....................'-......................'---.................................---..................----------............................---........................................ ........................................
PermitNo. ....... t�". ..5� ....................... Issued .--'---..........------------..............................'
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN .q R�S T.4 r3C E
..........................................0F........ 1..............................................................................
Appliratinn for Biipusal Works Toustrnr#inn rrrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual. Sewage Disposal
System at
1 k�+rs� t S2l G 0��' 3 MA9)IvEg C//ZCC F
................__.._.....--••--••-•-•-•-•-•---..._.............--•-•--•----..........._....... --......-- .........._......---.......--•--.....................................................
Location Address or Lot Nn
....................___CaTU/T-- T UST••------......_.............._... ...............21-.,_!QT_2&__ % rvN..: . iGG�•.��v,A.
Owner Address
.........--•------•-----.SOI_iN r AkTv......................................•- ..........-----......._....................-_ .......-•-•-------..................•--........... -
Installer Address
Typo of Building Size Lot.... • ?I-r�........Sq. feet
Dwelling—No. of Bedrooms................7a........................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ..............................................................................---•-•-•--•---...........----...--••--.............................---•-
Design Flow.................................575 ..._gallons per person per day. Total ><ly flow.......33 .-........................gallons.
Septic Tank—Liquid capacity.MeP .gallons Length. 'o....... Width._!?/'... Diameter................ Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.......... .......... Diameter....)D............ Depth below inlet......G......... Total leaching area...267.....sq. ft.
Other Distribution box (X) Dosing tank
Percolation Test Results Performed by..........M:.A:... ............................... Date... .........
Test Pit No. 1.....2........minutes per inch Depth of Test Pit...... ......... Depth to ground water...IIQI!!C........
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
.................................................................
l �z ...-------..... ............. ........ ...
Description ofSoi1....A.' 3.�.:�.°a!'1�..-. t t L,. .. I Spa.
• > ....... .................................................................
-•.......................................•-•--••---••---........••••••••-•.........................-•-...........................................•••-•--•••••...............................•••---.--•--
••-•-------•---•--------•--•---•....................•----•---••----............;.........----••---•-----••---...........................................................................................
Nature of Repairs or Alterations—Answer when applicable...............................................................................................
...............•---..........---------........--•---.....--•-•---...--•-•-•-•--.........................----........-•----......................................................•-•••...................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance s en issued by the board of health.
Signed . :.
........................
Date
Application Approved By ................................� / �..ti��'...` ',. ,. .. ,. ..:... ........................ ;�ife'....a J�
Application Disapproved for the following reasons: ........................................................................................................................................
............................................................................•------........................................................................-----------.......................................... ........................................
Dare
PermitNo. ..................... f.: :M.t,...a r)......... I9sued ......---........------...........---.......--••-•------....-------•
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
rt P �� -'-..: ...........................
(9er#ifirttte d ontpliUnre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) Repaired ( )
by........................................................................................................•------.................-----.............................=........................................................................-----......
Installer
at ............................4- ....... .......M... -(..........C.e. r ........... ...... t C.......................
...
has been installed in accordance with the provisions of TITLE 5 of Th State Environmental Code as described in
the application for Disposal Works Construction Permit No. ..................... 3.......t.��...�..adated .............................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.......r pe �.:.
�....................•------• Ins ctor ...................... .............
I
LOT 4
N 56°07391) E -�
184.71'
1
a
C
O rn P
oo EDGE OF BITUMINOUS P VEMENT
m
1
w
LOT 3 Cn
44,773 S.F. w
N �
N NOTES:
� o
N
2' STONE r, 1 . HOUSE NUMBER: 521
ALL AROUND', 2. ASSESSOR'S NUMBER: 024-032-002-521
3 HOLE 1000 GA. 3. ZONING DISTRICT: RF
DBOX LEACHING PIT 4. FLOOD HAZARD ZONES:
14' S6 5. ELEVATIONS SHOWN ARE BASED ON THE NATIONAL
\cw o GEODETIC VERTICAL DATUM.
LF 6. REFERENCE: PLAN BOOK 482 PG. 78
\ X 74.1 -]. � �
o �� SEPTIC TANK
Cn
CA \��LF N BULKHEADS' .
W DECK 77
O � ,
o 34
m \ 73.
d-
HOUSE
75.5
75'± 73.6 \�
e �
—X 7 4--L—
c�
8\31\93 ADDITION OF MEASURED ELEVATIONS SDH MBM
DATE DESCRIPTION lDrownIChecked
_
R E V I S I O N S
_WG_G_G- 10954,
'W_W-W_G _G _ X 3.7
PLOT PLAN FOR LOT
VIA- _ _G- _G'_G----G.__ R=366.78' \ 3
W W W W--__W__._ �G--' G G _ ,
W--___W� W G:WG L-88.04 ___G___•.•-- PREPARED FOR
G--G— G G`G G G G COTUIT TRUST
w—W—W--W—W—�---W--W—W—W—W—W
MARINER CIRCLEIN
SANTUIT BARNSTABLE MASS.
�f SCALE: 1 "=20' TDATE: 8/31 /93 ~�
�, . holmes and mcgrath inc.irL we "l MICH.Ar-L G. �
r civil engineers and land surveyors
I =" ICIVI
10 0 20 '� `� 200 main street , 13
r_ 0.
-� falmouth, ma. 02540 508 548-3564 STI
SCALE IN FEET DRAWN: SDH CHECKED: r.7,,.- ass'°'
7
FILE:93186PP.owc JOB NO: 93186 DWG. NO: 55-3-14 SHEET 1 OF 2
Finish grade above and adjacent to system shall slope away at a min. of 2%. SOIL TEST
4" diam. cast iron or Schedule 40 PVC pipe (tight joints). - Date of soil test: AUGUST 19, 1993
Test taken by. M.B. McGRATH
20' min. distance (building to edge of leaching system) Results witnessed by. JERRY DUNNING
10' min. dist.
Percolation rate: 2 MIN. IN.
GENERAL NOTES Ground water NONE ENCOUNTERED
First floor elev. = 75.47
1) No change to this system shall be made unless
Removable covers within approved in writing by holmes and mcgrath, inc. SOIL LOG
-- - 12" of finished grade 2) Subject to inspection during construction by the
S = .02 Board of Health and holmes and mcgrath, inc. NO 1
Dist. box 3) Heavy construction equipment shall not travel
over dis osal s ern Burin or after construction. EPTH SOILS ELEV.
emovab e cover P Ys 9
S=.02 -- Cl bkfill 4) Disposal system to be constructed in accordance 0 74.4
2 Clean ac with Title 5 of the State Environmental Code.
level I .: .. ,... ,...: 2" layer of 1/8" to 1/2" 5) A copy of these plans must be kept on the site 0.3' LOAM 74.1E
02 ui eve ° ° .o ° during the time of construction.S o 0 0 °c°�°o washed Stone
0 _ _ 0-0- °` C: ° 6) A copy of these plans must be furnished to the SUBSOIL
d o cv eu - - °C c o 4.0' 70.4t
SEPTIC TANK N a- °�° o contractor constructing the disposal system.
Foundation ~ o o o -0 oc �' 0 7) Before backfilling, the contractor shall notify
1000 GAL.' r W Precast ° 2 ft. of 3/4" to 1/2" washed stone
design II II ,�-�-� II `� II a� concrete :°c 6 o all around recast it, providingan holmes and mcgrath, inc., or the Board of Health
by others 4) � � � > s a', � -, leaching oo,� o effective diameter of 10 ft. Agent to inspect the system as constructed.
0 pit oC a ° 8) If the contractor encounters any variation between SAND
� oC o the existing conditions shown on the plan and the
�° > 0�0Q0
'c > °o o°°°°o Elev.= 64.2 conditions encountered on the site, or any soil
condition different than shown on the soil log, or
i any adverse soil, the contractor shall immediately 12.0' 62t
10'diamet�r contact holmes and mcgrath, inc. Holmes and
PROVIDE 12" LAYER OF I\ i mcgrath, inc. will examine the soil condition
Not to Scale COMPACTED GRAVEL UNDER'' 3'f and report to the owner any suggested revisions.
THE DISTRIBUTION BOX
Elev.= 61 f
BOTTOM OF TEST HOLE
THE CONTRACTOR SHALL EXCAVATE 4' BELOW
THE BOTTOM OF THE LEACHING SYSTEM TO CONFIRM
THAT THE SOILS ARE CONSISTENT WITH THE SOILS
FOUND IN THE TEST HOLE. IF THE SOILS ARE NOT
Design Criteria CONSISTENT WITH THE TEST HOLE RESULTS,THE
CONTRACTOR SHALL IMMEDIATELY CALL THE ENGINEER.
Number of bedrooms: 3 Equivalent to 330 gals/day
Garbage disposal unit: No
Leaching area — capacity required: 495 gals/day
Side area proposed: 188 sq. ft.
Bottom area proposed: 79 sq. ft. .
Total area proposed: 267 sq. ft.
Proposed leaching capacity: 549 gal/day
Water supply: Town
Precast concrete units: H-10 loading design
8'-6"
ALL ACCESS MANHOLE COVERS FOR
o SEPTIC TANK, DISTRIBUTION BOX,
i AND LEACHING STRUCTURE SET MORE
THAN 12" BELOW FINISHED GRADE,
INLET ` OUTLET SHALL BE RAISED TO WITHIN 12" OF
\ FINISHED GRADE.
,• . — �.
STEEL REINFORCED PRECAST CONCRETE FRAME COVER
OVER "T'S' WHERE REQUIRED.
PLAN VIEW 8\31\93 ADJUSTMENT OF INVERT ELEVATIONS SDH MBM
PRECAST CONCRETE DATE DESCRIPTION DrawnChecked
3" 3
TANK RISER WHERE I 0
REQUIRED
REMOVABLE COVERS
' 4" INSTALL TUFTITE SPEED LEVELERS PLOT PLAN DETAILS
3" min. clearance required ALL OUTLET PIPES FROM THE
q i� INLET "T" ON ALL OUTLET PIPES
INLET 8 2" min. inlet to outlet 6" min SDETnLIEVELOFOROAT LEAST 2 FT. 12" CONCRETE COVER OF PROPOSED SEWAGE DISPOSAL_ SYSTEM
OUTLET
10" min. �— - PREPARED FOR
Liquid level E 3 - 5" OUTLET
COTUIT TRUST
a i �' � ` + KNOCKOUTS FOR LOT 3, ANCHOR DRIVE
LC)
0 0 0 i i 15.5" OUTLET r �� 1 28" INLET IN
SANTUIT BARNSTABLE MASS.
8" 6" 8.. 12
Y ... + ...a ,. Fw aA
15.5" SCALE: AS SHOWN DATE: AUG. 17,1993 �'��EtF f{f� ° •�
8'-0" 4'-10" 1.75"
PLAN SECTION CROSS—SECTION holmes and mcgrath inc. , ,, PiCHAIFLB. J
CROSS—SECTION END—SECTION
�Jcrh?;TH t W
civil engineers and land surveyors s CIVR
TYPICAL 1000 GALLON SEPTIC TANK 3 HOLE DISTRIBUTION BOX 200 main street ,
falmouth, ma. 02540
NOT TO SCALE NOT To SCALE DRAWN: SDH CHECKED,��
JOB NO: 93186 DWG. NO.: 55-3-14 SHEET 2 of 2