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HomeMy WebLinkAbout0621 MARINER CIRCLE - Health M Qr inerS MApN73 y - - - i Ogg Commonwealth of Massac husetts i ial Ins e Form Title OP Tt 50ffc p ction Subsurface Sewage Disposal'System Form-Not for Voluntary Assessments v 621 Mariner Circle Property Address Timothy Santos owner Owner's Na information is Cotuit MA 02635 January 14, 2021 required for every page. Citylrown 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 forma Important:When filling out forms A. Inspector Information 's 0 on the computer, Patrick T. Sullivan use only the tab key to move your Name of Inspector cursor-do not• Ready Rooter Excavating use the return Company Name key. PO Box 89 VS K=41 Company Address Forestdale MA 02644 City/Town State Zip Code 508-888-6055 SI12843 Telephone Number . License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. Passes 2. ` 8 Conditionally Passes 3. Needs Further Evaluation by the Local Approving Authority 4. Fails ., January 15, 2021 mv:�� - - 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7l26r2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 e , c Commonwealth of Massachusetts Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 621 Mariner Circle Property Address Timothy Santos Owner Owner's Name information is required for every Cotuit MA 02635 January 14, 2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and-all of 4 and 6. 1) System Passes: , ; ® 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: 2) , System Conditionally Passes: ' ❑ one or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determinedt" (Y, N, ND)for the following statements. If"not determined, please explain. 1 The septic tank is metal and over 20 years o d* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or filtration or tank failure is imminent. System will pass inspection if the existing tank is replaced th a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspecti n if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank i ess than 20 years old is available. ❑ Y ❑: N- " ❑ N (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts - � Title 5Official Inspection Fo rm ' . rm . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 621 Mariner Circle Property Address Timothy Santos " Owner Owner's Name w information is Cotuit s MA 02635 January 14 2021 required for every � ry page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cunt.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break ut or high static water level in the distribution box due to broken or obstructed pipe(s) or due t a broken, settled or uneven distribution box. System will pass inspection if(with approval of Bo rd of Health): ❑ broken pipe(s) are replace ❑ Y ❑ N ❑ ND(Explain below): ❑. obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is lev ed or replaced ❑ Y ❑ N ❑ ND(Explain below): The system required pumping more than 4 tim s a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval oche Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3 Further Evaluation is Required 4the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: - II. - t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 621 Mariner Circle Property Address Timothy Santos Owner Owner's Name information is required for every Cotuit MA 02635 January 14 2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the syste /andab tioning • a manner that protects the public health, safety and environment: ❑ The system has a septic soi absorption system (SAS) and the SAS is within 100 feet of a surface water s tri tary to a surface water supply. ❑ The system,has aseptic AS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septicd SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septicd SAS and the SAS is less than 100 feet but 50 feet or more from a private water sll".Method used to determine d 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. c. Other: - 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of"effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/2612018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 621 Mariner Circle Property Address -Timothy Santos : Owner Owner's Name information is Cotuit MA 02635• January 14 2021 required for every ry page. City/Town State Zip Code Date of Inspection C. Inspection Summary(cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) .Yes No ❑ _ Z. ' 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 1/2 day flow ' Required pumping more than 4 times in the last year NOT due to clogged or El ® obstructed pipe(s). Number of times pumped: ❑ - Z . - Any portion of the SAS; cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ,❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well: ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal collform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 9pd. The system fails. I have determined that one or more of the above failure El Z criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or" o"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 4 feet of a surface drinking water supply ❑ ❑ the system is within 00 feet of a tributary to a surface drinking water supply ❑ ❑ * the system is to ed in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) o a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Forme u Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 621 Mariner Circle Property Address Timothy Santos _ t Owner Owner's Name « information is required for every Cotuit MA 02635 January 14, 2021 �, page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ; If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. . You must indicate "yes"or"no"for each of the following for all inspections: Yes No ' ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ,® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? - ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A f ®, ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. El Determined in the field (if any of the failure criteria related to Part C is at issue ® approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/eMl8 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection F� orm p Subsurface Sewage Disposal System Form -Not for Voluntary Assessments' 621 Mariner'Circle Property Address Timothy Santos Owner Owner's Name s information is Cotult MA 02635 January 14, 2021 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: . . Number of bedrooms 3; o s (design): - .Number of.bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 GPD+ Description: Number of current residents: T 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit?_. - ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2019=26 GPD 2020= 31 GIRD Detail: Property has seen very light use in last several years. r , Sump pump? ❑ Yes ® No Lastkdate of occupancy: October 2020 - Date t5insp.doc-rev.7/262018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 621 Mariner Circle Property Address Timothy Santos Owner Owner's Name information is required for every Cotuit MA 02635 January 14, 2021 page. Cityfrown _ State _ Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., et Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank presen . ❑ Yes ❑ No Non-sanitary waste discharged to a Title 5 system? ❑ Yes ❑ No Water meter_readings, if availab Last date of occupancy/use; Date Other(describe below): 3. Pumping Records: Source of information: Owners records: Pumped Oct. 2020 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons II How was quantity,pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 t. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 621 Mariner Circle s Property Address Timothy Santos Owner. Owner's Name information is Cotuit MA 02635 January 14 2021 required for every �/ , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® ' - Septic tank, distribution box, soil absorption system ❑`' Single cesspool ` ❑ ° Overflow cesspool ❑ Privy r. ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: System installed 12/01/1980. Certificate of Compliace on file at Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ` ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: n/a feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26r2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts - (o Title 5 Official Inspection Form - a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 621 Mariner Circle Property Address Timothy Santos Owner Owner's Name information is required for every COtUIt MA 02635 January 14, 2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below 14"grade: feet Material of construction: ® concrete. ❑.metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5'x 4.5'x 5' 1000 gallons Sludge depth: ' Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness Distance from top of scum to'top of outlet tee or baffle 101, Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Dip tube and tape measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet pvc tee and outlet concrete baffle in place. Tank was pumped in October. Very light solids. Outlet access is an inspection port. Risers bring covers_ within 6"of grade. Recommend maintenance pumping every two years with full time use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 621 Mariner Circle Property Address Timothy Santos Owner Owner's Name information is required for every Cotuit MA 02635 January 14, 2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from to 'of scum to to of outlet tee or baffle top 'of from bottom of scu to bottom of outlet tee or baffle Date of last pumping: s Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 18 a Commonwealth of Massachusetts 11 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments h -621 Mariner Circle Property Address r Timothy Santos Owner Owners Name information is e .every COtuit quired for eve 'MA -02635 January 14, 2021 page. Cityrrown State Zip Cod_a Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.)' Alarm present: ❑ Yes ❑ No ` Alarm level: -Alarm+in working order: El Yes El No Date of last pumping: Date Comments(condition of alarm and floa switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No ,9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .621 Mariner Circle Property Address Timothy Santos Owner Owner's Name information is Cotuit MA 02635 January 14, 2021 required for every ry page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition,of pump ch tuber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® 6'xw/2+' leaching pits number: e stone. ❑ leaching chambers number: leaching galleries number: El leaching trenches , number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts (o ,Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments f 621 Mariner Circle r Property Address m -Timothy Santos Owner -owner's Name information is required for every Cotuit MA 02635 January 14, 2021 page. Cityrrown State Zip Code Date of inspection D. System Information (cont.) t _ 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit dry at time of inspection. Light,staining 18" up from base. Clean stone visible in sidewall. No sign of past hydraulic failure. Riser brings cover within 6" of grade. r 12. Cesspools (cesspool must be pumped as part of inspection)p(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 Comments (note condition of soil,/ofsinslic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.R 2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 ` Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 621 Mariner Circle Property Address Timothy Santos Owner Owner's Name information is Cotuit MA 02635 January 14 2021 required for every rY page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.). i 13. Privy(locate on site plan): r Materials of construction: Dimensions Depth of solids Comments (note condition of`soil, signs of by raulic failure, level of ponding, condition of vegetation, 4 etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 621 Mariner Circle Property Address Timothy Santos Owner Owner's Name information is required for every Cotuit MA 02635 January 14, 2021 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at-least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below 0 drawing attached separately I i o ` -3 a ,1 Tea s 3 -7 ` 0 3 t5nsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 621 Mariner Circle Property Address r Timothy Santos ` Owner' Owner's Name information is ry Cotuit MA 02635 January 14 2021 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam`. ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >5 feet Please indicate all methods used to determine the high ground water elevation: ;® Obtained from system design plans on record If checked, date of design plan reviewed: 1980 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: maps.massg is.state.ma.us/oliver.ph p You must describe how you established the high ground water elevation: Test hole in 1980 found no high ground water. Accessed local ground water contours and topo mapping. Ground water>15'. Base of pit at 8.5' below grade. No high ground water in area of system. . i Before.filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/Made Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 • 9 _ • _ - c ..r, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 621 Mariner Circle Property Address• - Timothy Santos Owner' Owner's Name information is required for every Cotuit MA 02635 January 14, 2021 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® `B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate ' 4•(Failure Criteria)and 6 (Checklist),completed , ® D. System Information': - For 8: Tight/Holding Tank—'Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.728I2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No. 1003!-00/� ' FEE COMMONWEALTH Of MMSACHUS ETTS i Board of Health MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) - ❑Complete System Individual Components Location ` Mr `�• Owner's Name Map/Parcel# MAP A?> 0 Address Lot# -k\F vA1 Telephone# ' 46 Installer's Name lc�RCS Designer's Name V; Address Address Telephone# by — 1 Telephone# Su Type of Buildings ir- :a1 Lot Size CZ I, -60.S sq.ft. Dwelling-No.of Bedrooms QA1sT — C\Ql1 Garbage grinder (A/6 Other-Type of Building 1&\eSC-,JL No.of persons Ca Showers�),Cafeteria (4 Other Fixtures L1twIC.��ttJM {�1-�C�ror� �af��c . L13►�N `X Design Flow (min.required) 33lb gpd Calculated design flow 3'50 Design flow provided '7u• gpd Plan: Date 0 d. Number of sheets Revision Date i Title a. ��DDe �. _T;c UWZPX ,F Description of Soil(s) � vv Soil Evaluator Form No. 1 Name of Soil Evaluator C%kj%ri•t±� +�HWY Date of Evaluation O� DESCRIPTION OF REPAIRS OR ALTERATIONS At� �A The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the tem i eratio Certificate of Co pliance has been issued by the Board of Health. Signed-:`f Date No. y FEE _ , COMMONWIA LTII Of MA'S�ACIIUSETTS t . r f Board of Health, SNC-�O\-Q MA. APPLICATION 'FOR DISPOSAL SYSTEM['1[ CONSTRUCTION PERMIT l ',-Application for a Permit to Construct( )`Repair Upgrade( Abandon( - ❑Complete System Xndividual Components /r Location >+ C ��CCl\R C Owner's Name J' \ Map/Parcel# M AP '� Address 1'+Cftc�c��e � Lot# A�1- C-�18 Telephone# t f(p Installer's Name RC S v C� Designer's Name u;c ` S�C Address O I�r R (cbI Address :Fb ,l. F t �� 0a5 b Telephone# b� - _ �3 a Telephone# SL(g . O = Type of Building C1-- n,� Lot Size � �1 �s sq.ft. ' Dwelling-,No.of Bedrooms qXi S'f C\el-\Qi1 -- Garb$ge grinder Other-Type of Building Ted nc y No.of persons Showers�),Cafeteria (✓� Other Fixtures Design.Flow (min.required) �j"3 b gpd Calculated design flow ' !)Q Design flow provided 1-10.40 gpd Plan:-Date C) o� Number of sheets Revision Date Title �t C7652 G S S�M mC f`�D �e.t> v pC, Description of Soil(s) Soil Evaluator Form No. ti o� Name of Soil Evaluator V-t,3 SO AY Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS c C4GCk-,C�C' �\CT-,. The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place thhee system ig�operation until a,Certificate of Compliance has been issued by the Board of Health. Signed Gam' Date /a2 3� Q t FEE L J D COMMONWEALTH OF MASSAC14USETTS Board of Health, Or PS�tn MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: /�� /2 L /r/r/l at !J e� / / dL /r✓ !L �. G �i C !S ?e- I % 1 has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. �100 3 00 , dated 103 . Approved Design Flow (gpd) Installer n A �a Designer: Inspector: " Date: 63 The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. � FEE COMMONWEALTH OF M � HUSETTS Board of Health., �� F e DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair(--�) Upgrade( ) Abandon( ) an individual sewage disposal system at e� e 2 C /22 n�f as described in the application for Disposal System Construction Permit No J(/D , dated Provided: Construction shall be completed vAb thi three years of the date p m' 1 local c ditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health ' FORM 11 — SOIL EVALUATOR FORK Page 1 of No.: Date: 12/12/02 COMMONWEALTH OF MASSACHUSETTS Barnstable , Massachusetts Performed By: Carmen E. Shay Date: 10/28/02 Witnessed By: Waiver Location Address or#621 Mariner Circle Owners Name: Mr.Jon Paul Delise Cotuit,MA Address and #1793 Seminole Ave,Bronx NY, 10461 Lot# (Map—23,Parcel 34) Telephone Number: New Construction : X Repair : OFFICE REVIEW: Published Soil Survey Available: No ❑ Yes ❑ Year Published: Publication Scale: Soil Map Unit: Drainage Class: Soil Limitations: Surficial Geologic Report Available: No❑ Yes❑ Year Published: Publication Scale: Geologic Material: (Map Unit): Landform: Glacial Outwash Flood Insurance Rate Map: Above 500 Year Flood Boundary: No ❑ Yes Within 500 Year Flood Boundary: No FX I Yes ❑ Within 100 Year Flood Boundary: No I Yes ❑ Wetland Area: None National Wetland Inventory Map (map Unit): Wetlands Conservancy Program Map (map unit): Current Water Resource Conditions (USGS): Month Range: Above Normal ❑ Normal Below Normal ❑ Other References Reviewed: USGS Topographic Map DEP APPROVED FORM 12/7/95 ' FORM 11 SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No.: #621 Mariner Circle, Cotuit, MA On -Site Review Deep Hole Number: #1 Date: 12/12/02 Time: 10:00 AM Weather: Sunny, Cool Location (identify on site plan): Refer to Sketch Landform: Outwash Plane Position on Landscape (sketch on back): Refer to Sketch Distances From: Open Water Body N/A feet Drainage Way N/A feet Possible Wet Area N/A feet Property Line 25' feet Drinking Water Well N/A feet Other DEEP OBSERVATION HOLE LOG Depth From Soil Soil Soil Soil Other Surface Horizon Texture Color Mottling Structure, Stones, (inches) (USDA) (Munsel) Boulders, Consistency, % Gravel 0" — 5" AB Loamy 10 YR 3/2 None <5% Gravel, Friable Sand Friable 5" — 36" BW Loamy 10 Y/R - None <5% Gravel, Friable Sand 5/6 Friable 36" — 48" C' Medium 2.5 Y 7/4 None Medium Sand, 10% Sand gravel, Loose 48" — 168" Cs Medium 2.5 Y 8/4 None Medium Sand, <5% Sand gravel, Loose Parent Material (Geologic): Glacial Outwash Depth to Bedrock:None encountered Depth to Groundwater: Standing Water in the Hole: None Weeping From Face: None Pefl—ated Seasonal High Water Table 168" Assumed — No groundwater Observed DEP APPROVED FORM 12/7/95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No.: #621 Mariner Circle, Cotuit, MA Determination of Seasonal High Water Table Method Used: ❑ Depth observed standing in Observation Hole- N/A inches ❑ Depth weeping from side of Observation Hole: 168 inches (assumed) ❑ Depth to Soil Mottles: None inches ❑ Groundwater Adjustment: None feet Index Well Number: Reading Date: Index Well Level: Adjustment Factor: Adjusted Groundwater Level: N/A DEPTH OF NATURALLY OCCURING 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: Yes CERTIFICATION: I Certify That on September 17, 2000, (date), I have passed the soil evaluators 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:\a.�0� r" FORM 12 ' - PERCOLATION TEST Location Address or Lot No.: #621 Mariner Circle COMMONWEALTH OF MASSACHUSETTS Cotuit , Massachusetts Percolation Test Date: 12/12/02 Time: 10:30 AM Observation Hole #: #1 Depth of Perc 36" — 54 Start Pre-soak 10:28 AM End Pre-soak 10:38 AM Time at 12" Would Not Hold 24 Gallon Presoak Time at 9 Time at 6' Time (9-6") Rate Min./inch < 2MPI * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Performed By: Carmen E. Shay Witnessed By: Waiver Comments: Would Not Hold 24 Gallon Presoak - <2 MPI Site Passed X ' Site Failed DEP APPROVED FORM 12/7/95 Sep - 20-01 13 : 62 BARNSTABLE HEALTH DEPT 5087906304 P . 02 srzs;ot l\•OTICE: This Form Is To Be Used For the Repair Of Failed F Septic Systems Only. PERCOLATION TEST AiYll SOIL EVALUATION EXEMPTION FORM 1, hereby certify that the engineered plan signed by me concerning the property located at meets all of.the �„l!o�4•�ng ::^,feria: This failed system is connected to a residential dwelling only. There are no -ornmercial or business uses associated with the dwelling. T-ne soil is ciass;`ed as.CLASS I and the percolation race is less than or equal (o 5 n: ij(es der rich. The applicant may use historical data to conclude this. fac: or may conduct tests at the site without a health agent present. There :s no increa=,e in flow and/or change in use proposed • i here ate no vanances requested or needed. • The boucm of (he proposed leaching facility will not be located less than fourteen l,) fee: MVC the maximum adjusted goundwacer table elevation. fr\djust the a oundwater cable using the Frimptor method when applicable) Please complete the following: 1 ,a.t "Cop of Ground Surface Elevation (using CIS information) _tea.._ 1 3` G W E levac.or, cd;ustmcn( For high G.W. jAi}.. �rFT-FkE`NCF BETVJ'EE"q A and B S:G)rED DATE: J� NOTICE Basec jpon. tr.e above :r.forTnacion, a ccoair permit will be issued for bedrooms Ta„n m do 1,c6uctnal bedrooms are authorized to the future without en;tncerec ept _ sys(e^1 plans. _ --- — a �r_im!rlacf pcacc.xmp Permit Number: Date: Completed by: I HIGH GROUNDWATER LEVEL COMPUTATION i l I. Site Location: t_� MC<- -ClU Lot No. I Owner:_ J0R3Q„Jk. ���gQ Address: lbv7 Contracwr: ,r1u, Addre Notes: I STEP 1 Measure depth to water table to nearest 1/10 fi. .............................................................................. Date �a- VA I ! month tlay/Year '��"�r� I STEP 2 Using Water-Level Range Zone i I and Index Well Map locate site and determine: i OAppropriate index well..................... Of3Water level range zone..................................................... I I STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to water level for index well ........................... mon h/yaar STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth i to water level for index well (STEP 3), and water-level zone (STEP 2B) } determine water-level adjustment .......................................................................................... i I STEP 5 Estimate depth to high water by subtracting the water. I level adjustment (STEP 4) i from measured depth to water level at site (STEP 1) ............................................................................................................. I I I i i Cape Cod Commission: USGS Well Data -November 2002 Page 1 of 2 United States Geological Survey Observation Wells As a service to Cape officials, engineers and other interested parties, the Cape Cod Commission publishes monthly groundwater data gathered by its Water Resources Office. The water level measurements shown below are taken monthly from United States Geological Survey (USGS) observation wells and compiled during the last week of each month. They are published as soon as possible thereafter. Listed below are nine out of the 61 wells measured across Cape Cod by the Commission's Water Resources Office. These nine are employed as index wells to be used with Technical Bulletin 92-001 to predict high groundwater levels. For your convenience, we've also provided links to USGS national and state data. See the last column in the table and the footnotes below. For further information, please contact Hydrologist Gabrielle Belfit at the Commission offices (508-362- 3828). November 2002 Site Departure from Number**' Location Well No. Water Record Record Average** (links to IS( Level High LowMonthly Overall national water-level database) Barnstable 230 25.6 20.5 26.6 -1.1 -1.9 413956070164301 Barnstable 24W 27.4 20.5 28.6 -22 -2.9 414154070165001 Brewster BMW 21 13.4*** 6.9 13.6 -2.6 -3.2 414518070020301 Chatham CGW138 25.4 20.9 26.6 -0.8 -1.4 414100070011101 Mashpee MIW 29 9.2 5.6 10.0 0.0 -0.6 413525070291904 Sandwich ZIS2 47.8 45.9 482 -0.2 -0.5 414418070241601 Sandwich ZDW 54.6 45.8 55.1 -3.8 -4.5 414124070265901 Truro TSW 89 12.1 10.2 13.0 0.1 -0.1 420206070045901 WellfleetW 12.2 7.3 12.8 -1.1 -1.7 415353069585401 http://www.capecodcommission.org/wells.htm 12/11/2002 (,00 CATION �o SEWAGE PERMIT NO. +,'"' �� ��� C mac, _ VIILLLAGE e INZSA L L E R'S N4ME i ADDRESS t U I L E R OR OWNER DATE PERMIT ISSUED 9, 2- 3_ DATE COMPLIANCE ISSUED � ,/�` �, � t V� � ,� �I � � � � � li l% ss d� No................_--'-3:.._» =— *+ Fss...-�.................... THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH fQ�iJ ..............OF......:G7 _�a Appliration for Disposal Works Tonotrurtiun Permit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System a� .................................... .............................. - ess+ nn or L—W ot No. .. »...._.... n r ........................... ........................�.�. ................. W .. .... ............................. ..........................................................................0....................... InstallerAddress Type of Building Size Lot.;4.-��--- ...Sq. feet U Dwelling—No. of Bedrooms..._.._.. 13.......................... Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of BuildingGy� L/ No. of persons Showers ( ) — Cafeteria ( ) Other fixtures -------------------•-------•----•----------•------•-••-•-----•------•---------......-•-----•-••---•-••----•-•....: --------------------- W Design Flow.............. .................gallons per person per day. Total daily flow......2-30.._...._...._..........gallons. WSeptic Tank—Liquid capacity./.gallons Length,l®.�_.._.. Width.S.--4_.._ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length___.....-......f....Total leaching area___........._...ssq..ft. Seepage Pit No............./...... Diameter....g�.__..... Depth below inlet...2_.1-.�....... Total leaching area.��e5_, Z Other Distribution box (� ) Dosing to ( ) Percolation Test Results Performed by.._.l___�4f?f !'f!..... ..•................................ Date_.-..........���Q__.. lip— Test Pit No. 1___.............minutes per inch Depth of Test Pit.................... Depth to ground water __ VA r=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water/ -6 P4 -- xDescription of Soil..... •------..........................------------••--•---------------•-----------------••--------•--- .�. _... ----. -----•-•--••--•---•-•-•••------••-•------•----••--...••---••------••-•-•---•--•----•------•-•--•---•-•••... W --------------------------------tea=�yy---------, ::. 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 TITIZ 5 of the State Sanitary Code—The under igned further agrees not to place the system in operation until a Certificate of Compliance h&bee *ssued[ by th and ealth. Signe ----=-. - •----•-----•--• -••- -- ........ , -�!I ... Dale Application Approved B � Application Disapproved for the following reasons:............................................................................ --•---......_.Date............ — ...................................•---•....•--••••-------•---.............-•-••-------•.....•••-----•---•-•--•••--•••-••-----•--------••-•-----••-•---••----•-•-•-•-•-•-•-----•-•--••--•----•••--...... 1 Date _ _l Permit No......................................................... Issued_..,( ---- ................... Date Date No................._..... Fps....-3.................... THE COMMONWEALTH OF MASSACHUSETTS �- BOARD OF HEALTH Appfira#ion for Elispaao al Works Tonstrnrtinrt ramit Application is hereby made for a Permit to Construct ( ) or Repaif ( ) an Individual Sewage Disposal System at: '� (�///�1 / J ... ...... ._. ............. 7 L anon-A $ress' 1 or Lot N /•-- •, GL Installer Address Type of Building Size Lot_��.��._��._._Sq. feet �.� Dwelling—No. of BedrobWms............ ______________________________Expansion Attic ( ) Garbage Grinder ( ) p-I Other—Type of Building'$ 0 '___ _=:.____ No. of persons.........j�?............... Showers ( ) — Cafeteria ( ) 04 Other fixtures ...................................................... ................••-•••---•--•-- d W Design Flow...............55 .................gallons per person per day. Total daily flow........_?1 ......................gallons. WSeptic Tank—Liquid capacity-4 gallons Length_XV6 ..._ Width_.S'...!�--- Diameter________________ Depth................ x Disposal Trench—No_.................... Width.................... Total Length.................... Total leaching area....................sq. ft. i Seepage Pit No------------- ------ Diameter-----1 Depth below inlet.... _3....... Total leaching area._;) Z Other Distribution box ( ) Dosing tajik ( ) a Percolation Test Results Performed by....... ......................................... Date...... •... - ____ CJ._.. a Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water_.__ !�{ f l/U�l/ �, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water .____________________. a ••- . - �- --------- -- ---_-•- - --------------------------------------------- --•-•-•-"------___-.----•----•--•--------•-----•---_-_.-- Description of Soil---•-o' _ • -�x '- ...............................................................................- ------------- -. v �................................................. __________________'___-__-...._.__._.___.__.._____._.______-_-_____.______.________.__._._______.___.____..____._.V Nature of Repairs or Alterations—Answer when applicable............................................................................................... .."-----------•-"---------------"-.........-"--------""-----------------••••-•••--•-•-•-•••--•-•_...•-••-_._....•••-••---•--•---••••••--••••--••-•---•••---•••----•••••••••••••••••••••••...........-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIZ 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 the& and of health. Signed••-- .-:• •••••• ----" -----------------------------...------------ Application Approved By-••--• . ••------• ------T....... Date Application Disapproved for the following reasons:.............................................................................................................. _...._..-•---•-•••••--•-•-••--•-••••••---••---•••--•-•••---...----•-•-•-••....--•••••----..._..•••••---••.__....-•----•....•------•••------•-----••••••••••••-••-•-••------' -----•--• -•-----._..... Date PermitNo......................................................... Issued-........................................................ Date J THE COMMONWEALTH OF MASSACHUSETTS BOARD ,OF HEALTH { /c.u ! /�ccf a ifiratr of TompliFanrr TH4 IS TO CEO I Y, Th t e Indiv ual Sewage Disposal System constructed ('V or Repaired ( ) --, __••-•••••-• ---------------------•------------------------- •------------- I tatter ' J ` y9 ---------- ----•-----•---•------- has been installed in accordance with the provisions of T �+ 5 of The State Sanitary Code as describe in the application for Disposal Works Construction Permit N ._lF / ___ "_ ______ dated---.�'_"'_.2.3`__"'_CC)............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE ` 4 SYSTEM WILL FUNCTION SATISFACTORY. DATE.......... .�._1...C �. ......"-•"---------"-"-----•"---. Inspector....... .................. THE COMMONWEALTH OF MASSACHUSETTS ,�-- BOARD OF� HEALTH ........OF.......... .. ....................................... d '- No.......�i3..S7.. FEE.. ---­---------- �ta��raa�aalaar �nna�#rn�.;iiaan rrntt� Permission is hereby granted...... ....._ ___.t_.!'`:i�. ). 4.E�`. . ....................................................................... to Construct (,!) or/Re air,( ) an I diyidual Sewage Dispos System atNo........................ ... �.. ... 2�1h<-` ................-� n. � ­­--- ............. c ..... Street i ___ �+ as shown on the application for Disposal Works Construction Permi "___ _______�_ ed__��a.�'�Q"._.._._....._.... .......... .............. (/J•► �� '.`DATE...... ........ Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS _ SECTION A -A A >• = 2000 +/- 10' min. from - ALL OUTLET PIPES FROM THE [house to septic tank "NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V,C. PROFILE VIEW OF ;ADDITION TO LEACHING SYSTEM DISTRIBUTION BOX SHALL BE Existing Foundation t2" - Septic took lovers mutt he SET LEVEL FOR AT LEAST 2 FT. CONCRETE COVER .nthin 6 in. of finished grade 3" of 1/8" - 1/2" Washed Peostone + Grocit over Septic Toll - 99.15 �Grode over D-Bo. - 99.00 �--Grade over SAS 99.00 3/4" to 1 1/2 Washed Crushed Stone _ 3 - 5-OUTLET '�"" '"•`'��'. 2" A RID 3 Al-MQUUTS J H Rp D 15.5" OUTLET a 12' INLET S . o.02 3 HOLE H-10 r ! ? DIST. BOX 3' Mo:.num Cover 6` 8 rtner Cirri Mo 2• ti H to* EXIST. s.o.o1 Top of SAS - EFev. -96.00 j__.....� r1101 foot ,s!s _ n Moo 9 EXIST, PIPE u1 -0 1,000 GAL. ... 3 rin Dr. FROM ExIST. FC{LRIDATIDN w SEPTIC TANK n 18r 2' Ell Depth 4" - SCH a0 T y 1.75• �J H-10 PLAN SECTION CROSS-SECTION SI CONCRETE Slr6 FOUNDA ' to o ' Marier o CirCte ., s 4 Units @ 6' = 24' SYSTEM PROFILE 6 n.of 3/4-„/2" li t' 1' STONE UNDER CHAMBERS 3 HOLE H-10 DISTRIBUTION BOX ^/"\[�compacted stone3NOT TO SCALEL❑CUS �"I ^�1(' 1Not to Scale - • it 4`> 4' 4' > 30' > c ° 2.5 y Eftective Length -- 6 in of 3/4'-1 1/2' c 1D' compacted stone - Effective Width In SOIL ABSORPTION SYSTEM (SAS) CULTEC MODEL' 125 (H-10 LOADING)/ SHOPEY PRECASTE GENERAL NOTES (OR EQUIVALENT) Not to Scale 1. Contractor is responsible for Digsafe notification aottnm-4!_Issts_1_Elea_&f99______ NOTE: OVERALL HEIGHT OF INFILTRATOR protection of all underground utilities and pipes.FILTRATOR IS t8' /EFFECTIVE HEIGHT IS 12" 2. The septic tank and distribution box shall be Set level on 6" of 3/4"-1 1/2" stone. z-ts' DAM. AccEss MANHOLES3. Bockfill should be clean sond or grovel with no -- stones over 3" in size. 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc, 5. The contractor shall install this system in accordance o with Title V of the Massachusetts state code, the approved plan ' and Local Regulations. < THE ACCESS COVERS FOR THE SEPTIC TANK. INLET .— DISTRIBUTION BOX AND LEACHING COMPONENT - 6. If, during installation the contractor encounters any f l OUT ET SET DEEPER THAN 6 INCHES BELOW FINISHED soil conditions or site conditions that ore different GRADE SHALL BE RAISED To NATIitN 6" OF FINISHED GRADE. from those shown on the soil log or in our design `r INSTALL TVF-TITE GAS BAFFLES OR EQUALS installation must halt & immediate notification be t. ' :-• '- �•,. 50 E 57, 25 E made to Carmen E. Shay - Environmental Services, Inc. STEEL REINFORCED PRECAST CONCRETE N �d 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. PLAN VIEW 132.20' , 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. 3-24" REMOVIIABLE COVERS 25.00 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. t 10. I r a diameter :.�, :: •;": : 4" — 00- ------------------------ PROJECT BENCH MARK p with t tight joints. 1 All sold piping, tees & fittings shall be 4" - -: _ Schedule 40 NSF PVC pipes th water ti h o' . 3" ^^" �' �^Ce - TOP OF FOUNDATION 11. Municipal Water is Connected to The Residence and Abutting 13 f}—NUT r.' ELEV. = 100.00 (Assumed) INLET 8 mn.T_j?__min inlet t0 outlet 6• muY. _ —`~— )� Liam d reve� OUTLET - __ -` Properties Within 200 Feet. ` s= LOT #28 £ 4 min, THE PROPERTY LINES ARE APPROXIMATE AND o Liquid co.Bola uid depth 21,305 Square Feet +/- --100 COMPILED FROM THE SURVEY PLAN GENERATED BY ROBERT E. RAYMOND,SURVEYOR. OF BARNSTABLE, MA - ' ENTITLED PLAN SHOWING FOUNDATION LOCATION, LOT 28 • 8`-D" 4' -'o" MARINER CIRCLE, COTUIT, MA", DATED FOCTOBER 19, 1980, TEST HOLE #1 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN CROSS SECTION END—SECTION ELEV.= 99.00 ¢ IT SHOULD BE USED FOR NO PURPOSE OTHER THAN USE EXISTING 1000 GALLON H- 10 SEPTIC TANK ---�30' THE SEPTIC SYSTEM INSTALLATION. '- Failed. � OJ ,4 X. Leach Pit NO: TO SCALE � LEGEND EX15T 7000 gal. � Septic Tank �•„ c: 4z.5 D-BOX � <-�"•`'° DENOTES PROPOSED PERCOLATION TEST 27' � F1 04X 11 SPOT GRADE Dote of Percolation Test: DECEMBER 12, 2002 Test Performed By CARMEN E. SHAY, R.S., C.S.E. DECK y CA Lr` X 104.46 DENOTES EXISTING Results Witnessed By: E. Waiver ( Barnstable B.O.H.) N `� l SPOT GRADE EXCAVATOR: Shay Environmental Services, Inc. 1 Percolation Rote: Less Than 2 MPI 0 PL PROPERTY LINE Test Hole EXISTING al)I�i t f e'" ��� S`�' No. 1 EXISTING 2 BEDROOM 0/GA PROPOSED CONTOUR DEPTH- - SOILS ELEV.' j RAGE-SLAB HOUSE — — — — — 0 99.00' � �, —97 EXISTING CONTOUR #621 LSa Sand t5lh �" ® DEEP TEST HOLE & 10 YR 3/2 a� lU V PERCOLATION TEST LOCATION 0"-5' A, 98.60 i G 99------ ----------------- --�- - - '- ------------------------------------ ----99 6 FOOT STOCKADE FENCE Loamy Q Sand I ?i •---• 10 YR 5/6 5 36" B. 96.00 p - Medium98-------- --------------- --F--- ----------�--T- ---------------------------- - 98 Sand _J 2.5 Y 7/4 i _ C, 9500i 0 P SOT P LAN Medium ' Sand 2.5 Y 8/4 as"- 156 C' 85.001 Perc #1 125.00' Depth to Perc: 36" to 54" 12d 44' 40" w OF PROPOSED SEPTIC SYSTEM UPGRADE IPerc Rote= Less Tha 2 MPI _---------- ------ PREPARED FOR 97---------------------------- ------------------------------ 97 Groundwater Not Observed MR . 0 N PAU L D E I S E No Observed ESHWT ADJUSTED H2O Elev. = None AT MAJ?I2V-Ai-zT7-' CL" CL_AU # 621 MARINERS CIRCLE Design Calculations (40 FOOT RIGHT "OF WAY) COTU IT, MA Number of Bedrooms: 1 Equivalent to 110 GoL/Day (330 Gol./Doy Min. per Title V) t; �� fti ems, PREPARED BY: .�. Garbage Grinder: No E. SHAY Leaching Capacity Proposed: 330 Col./Day Minimum (Min: Per Title V) Septic Tank - 3 x 330 Col./Day = 660 USE 1,500 GAL, Septic Tank. �� - SOIL ABSORPTION AREA: Using percolotion rote of <2 min./inch THERE ARE NO WETLANDS WITHIN 200' OF THE PROPERTY. 81 o ENVIRONMENTAL SERVICES, INC. Bottom Area: 0.74 gal/sq. ft. x 300 sq. ft. = 222 gallons Sidewatl Area: 0 74 gal./sq ft. x 160 sq. ft. 118._40 gallons - �� /. P.O. BOX 627 Providing: = 340.40 gallons EXISTING LEACH PIT TO BE PUMPED & FILLED IN PLACE 0 20 40 50 GfSTG .. /• EAST FALMOUTH, MA 02536 OR REMOVED IF FOUND TO BE NECESSARY TO INSTALL NEW SAS. IT w. _• v' �i"� Y. j Use: (4) CULTEC MODEL 135 UNITS, HAVING A 1' EFFECTIVE DEPTH, NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE TELFAX 508-548-0796 TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, 3' OF WASHED STONE SCALE: 1"=20' DRAWN BY: CES DATE: Di 1 S, 2002 ON THE ENDS AND t' OF WASHED STONE BENEATH THE ENTIRE SAS. 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