HomeMy WebLinkAbout0004 MASHPEE ROAD - Health (2) 4
Mashpee Road
cotut it
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Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 4 Mashpee Rd r�l
Property Address - CZ
John &Tracy Regan r_
Owner Owner's Name
information is Cotuit �' Ma 02635
required for;every 7-15-15 -0
h
page. City/Town - State Zip Code Date of Inspection I
rA
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:when A. General Information
filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do.not Matthew F. Gilfoy "
use the return key. Name of Inspector.
B&B Excavation
ITV Company Name
14 Teaberry Lane
Company Address =
Sandwich Ma. 02644
City/Town State Zip Code
(508)477-0653 5113640
Telephone Number License Number
B. Certification
I certify that 1:have personally inspected the sewage disposal system at this address andt 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:;
Z Passes ❑ Conditionally Passes ❑ Fails
❑. Needs Furthe Y valuation by the Local Approving Authority
7-15-15
Inspecyrs Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or.greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or.different conditions of use.
t5ins•3/13 ,. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
m Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a
�M 4 Mashpee Rd
Property Address
John &Tracy Regan
Owner Owner's Name '
information is Cotuit Ma 02635 7-15-15
required.for every _
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary:-Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure.criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failtare criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
El Y ❑ N ❑ ND (Explain below):
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts.
w Tit1e 5 ®fficial inspection Form
Subsurface Sewage Disposal,System Form - Not for,Voluntary'Assessments -
4 Mashpee Rd x
Property Address ''.. .
John &Tracy Regan'
Owner Owner's Name,
information is
' required for_every. COtUIt Ma 02635 _ 7-15-15
page- City/Town - State Zip Code Date of Inspection
we
`B. Certification (cont.)
❑ Pump;Chamber pumps/alarms not operational:,System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System-Conditionally Passes (cont.): r_ "
❑ Observation of sewage backup or break out or high static water level°in the distribution box due
to broken or obstructed pipe(s) or due to a broken,`settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
broken pipe(s)are replaced ❑ Y ,� ❑ N ❑ ND (Explain below):
obstruction is removed . ❑ Y ❑ N '❑ ND (Explain below):
❑ distribution box is^leveled.or replaced ❑ Y ❑ N �.❑ ND (Explain below):
El The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
x . system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced .,¢ ❑ Y , ❑ N _]'ND (Explain below):
❑, obstruction is removed:. p. Y ❑ N ❑ ND (Explain below):
C Further Evaluation is Required b the Board of Health:
) q y, _
❑ 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.
0 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,prlvy,is,Within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
, c
i .4 ,.
}
Commonwealth of Massachusetts
4 W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�,M ,•''t 4 Mashpee Rd
Property Address f
John &Tracy Regan
Owner. =Owner's Name
information is
required for every Cotuit Ma 02635 7-15-15
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes'if the well water analysis,-performed at a'DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
`clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/z day flow
l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4 Mashpee Rd
Property Address
John &Tracy Regan
Ownef., Owner's Name
information is required for every Cotuit Ma 02635 7-15-15
page. Citylrown State Zip Code Date of Inspection
B. Certification (cont,) ,
t .
Yes No
❑ ® Required pumping more than 4'times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or'privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or
E] ® tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® . Any portion of a cesspool or privy is-less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
rY
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you mtast indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑' the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 s " ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4 Mashpee Rd ,
Property Address
r F . John &Tracy Regan ,
Owner Owner's Name
information is
required for every Cotuit Ma 02635 7-15-15
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
❑ Z Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of
❑ ® this inspection?
® ❑ . Were as built plans of the system obtained-and examined? (If they were not ,
available note as N/A)
a ® `, ❑ Was the facility or dwelling inspected for signs of sewage back up?
❑ Was the site inspected for signs of break out?
® ❑. Were all system components, excluding the SAS, located on site?
Z ❑ 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:
® El Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CM 15.203 (for example: 110 gpd x#of bedrooms): 355
t5ins•3/13 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4 Mashpee Rd
Property Address
John &Tracy Regan
Owner: Owner's Name
information i
required for every
Cotuif Ma 02635 7-15-15
page. City/Town State Zip Code Date of Inspection
D. System Information .
Description: } '
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
y
below
Water meter_readings, If available` last 2 ears usage d
see o
9 ( Y 9 (gp ))
Detail:
2013-(293GPD) 2014-(452GPD)
Sump pump? , ❑ Yes ® No
Last date of occupancy: current
cute
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
' t
Water meter.readings, if available: y
15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
4 Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4 Mashpee Rd
Property Address
John &Tracy Regan
Owner 7Owner's Name
information is required for Cotuit Ma 02635 7-15-15
,
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
I f t4.
Other(describe below):
General Information
Pumping Records:
Source of information: Pumper driver
Was system pumped as part of the inspection? ' ❑ Yes ® No
If yes, volume pumped: 1000
gallons
How was quantity pumped determined? tank size
Reason for pumping`
maintenance
d
Type of System:
❑ Septic tank, distribution box, soil absorption system
❑ Single cesspool `
❑ Overflow cesspool
❑ - Privy '
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
® Other(describe):
Tank; Pump chamber, d-box, leaching chambers
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM. 4 Mashpee Rd
Property Address
John &Tracy Regan
Owner Owner's Name
information is Cotuit Ma 02635 - 7-15-15
required for every -
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.) s
Approximate age of all components, date installed (if known) and source of information:
2007
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
2,
Depth below grade: "_ feet
Material of construction:
❑ cast iron Z 40.PVC ❑ other(explain): .,
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade: feet
Material of construction:
® concrete '❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
•
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 gallon
7
Sludge depth: c,,1
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
` r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4 Mashpee Rd _
Property Address
John &Tracy Regan
Owner Owner's Name
information is
required for every Cotuit Ma 02635 7-15-15
page. City/Town 'State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)'
Distance from top of sludge to bottom of outlet tee or baffle
• 29"
4„
Scum thickness
Distance from top of scum to top of outlet tee or baffle
6"
Distance from bottom of scum to bottom of outlet tee or baffle
13"
How were dimensions determined? measured
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
At time of inspection septic tank appeared to be in working order with liquid level equal with outlet
invert. Tank was in need of pumping and was pumped after inspection for maintenance.
Grease Trap (locate on site plan): '
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins-3/13 s Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
M
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4 Mashpee Rd
Property Address
John &Tracy Regan
Owner : Owner's Name
information is required for every Cotuit Ma 02635 7-15-15
page. CdylTown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
IIII
❑ concrete ❑ metal ry ❑ fiberglass r ❑ polyethylene ❑ other(explain):
Dimensions-
Capacity: gallons
Design Flow:
gallons per day
Alarm present: , ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3/13 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
H Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 4 Mashpee Rd
Property Address
John &Tracy Regan
Owner Owner's Name
i information is required for every Cotuit . Ma 02635 7-15-15 a
-
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box-(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
0"
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
At time of inspection D-box is in working order with no sign of back up or carry over.
Pump Chamber(locate on site plan):
Pumps in working order: ® Yes ❑ No*
Alarms in workirdg order. ® Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not`required):
If SAS not located, explain why:
t5ins•3/13 ',Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
r
Commonwealth of Massachusetts
H Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4 Mashpee Rd ,
Property Address
t
` John &Tracy Regan `
Owner. Owner's Name
information is
required for every Cotuit Ma 02635 7-15-15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.) 4
- Type.
❑: teaching pits_. number:
E leaching chambers number:
2 (500 gallon)
❑ leaching galleries - number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool 4 number:
Innovative/alternative system
Type/name of technology: „
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
At time of inspection leaching appears to be in working order with no sign of hydraulic failure.
Chambers were dry with no sign of staining.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth —top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4 Mashpee Rd
Property Address
`'John &Tracy Regan
Owner Owner's Name
information is °
required for every Cotult Ma 02635 7-15-15
page. CityTrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions r,
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
l
t5ins•3/13 _Y Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
. Commonwealth of Massachusetts
Title 5 Official Inspection Form
ji Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4 Mashpee Rd
Property Address
John &Tracy:Regan
Owner 'Owner's Name
information Is:required forevery- Cotuit Ma 02635 7-15-15
.
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks: Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
hand-sketch in the area below
❑ drawing attached separately
-
Al- U-6-
S� z1.V
AZ-1y•b,
BZ•zs'
A3.43'
(tear
B Aq-4,
A
Bs.ZT.`_
C 4 Ii, I
4 a C6-SZ'
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
A ,
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4 Mashpee Rd
Property Address
r John &Tracy Regan
Owner Owner's Name
information is required for Cotuit Ma 02635 7-15-15
-
page. Cityftown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
Z Check cellar
® Shallow wells'
Estimated depth'to high ground water: No Gw 132"
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record.
4 If checked, date of design plan reviewed: 1-26-07
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health -explain:
❑ -Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high groundwater elevation:
Plan on file with BOH
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 • Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�,M 4 Mashpee Rd
5 Property Address
John & Tracy Regan `
Owner: Owner's Name
information is Cotuit ,t Ma 02635 7-15-15
required for every
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection.Summary: A, B, C, D, or E checked
® Inspection Summary D{System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
r
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
:i
a+ TOWN°QF BARNSTABLE
LOCATION y SEWAGE#,9p1)y) - 033
VILLAGE-Cn4v1-F ASSESSOR'S MAP&'PARCEL
INSTALLERS NAME&PHONE NO. Q 4 3 EXCatbA►or\ Sob 4-11-OG53
SEPTIC.TANK CAPACITY 1000 goLl - /000 qcx) popgp char-,Scr
`e
LEACHING FACILITY:(type)SDt>aQl c1,a S ( 2.) (size) I s'x*IS 'x a. r
NO.OF BEDROOMS 3
OWNER {R CoLipos'lanco
PERMIT DATE: /-3/ - O`7 COMPLIANCE DATE: ;
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY
V Ai- 3r6-
AZ'3y'w
BZ is
A3- y3'
Rcogrr DLJELL2nJ6 - 03, zo'e''
A a Aq• L
BS 27'b'
CS -
p B6
® G Ce,- Sz'
.x
TOWN OF BARNSTABLE
LOCATION, A/ k64_J 4A. rR D a-d SEWAGE #
VII,LAGE
�G� ASSESSOR'S MAP & LOT D/9
SEPTIC TANK CAPACITY NNY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
V t
BUILDER OR OWNER `��'� o o��a
w�
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between[h�e
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
:No.
THE COMMONWEALTH OF MASSACHUSETTS 1 ,."Entered in computer:
Yes
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLEi.MASSACHUSETTS
ZIpprication for Mfgpogal Opotem fCon!6truction- .ermit
Application for a Permit to Construct( , )Repair(grade( )Abandon.( ) El Complete System Individual Components
Location Address or Lot No. __e Owner's Name,Address and Tel.No.
04
L Gotv �wto
Assessor's Map/Parcel Co�
d �Z Ca 9 u 4—
Installer's Name,Address,and Tel.No. 5 01"t't7-010 5 3 Designer's Name,Address and Tel.2�
1ZObP.B-r G I IFDy• "g-t(3 EXC,AYftTtDl��C. � , �{a''''``'��w'Type of Building:
Dwelling No:of Bedrooms 3 Lot Size 0 Y1 Z sq.ft. Garbage Grinder( )
Other 'Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 7 3 0 gallons per day. Calculated daily flow J��� gallons.
Plan Date /f Z-6 O7 Number of sheets Z- Revision Date,
Title
Size of Septic Tank Fr l0-00 ,9a/ /S'—/4 Type of S.A.S. Z-S 2,0 e_AA +u ,t,
Description of Soil 7 `i`
Nature of Repairs or Alterations(Answer when applicable) Y-*v01X 0 �a r lz R-r�
ti !odo g 40 y�NA ��a -w v6 Z - s�o ,g.1-/ 6AA ,,L,:.� h zr'x i?x Z
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of Health.
Signed .0 Date I-Al-0-7
Application Approved by Date
Application Disapproved or the following re o s
Permit No. Date Issued
y
Fee
THE COMMONWEALTH OF MASSACHUSETTS .Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
t ZippYication for Miow6ar *rae"m Construction Permit r
Application for a Permit to Construct( )Repair'( Pgrade( )Abandon( ) O Complete System O Individual Components
Location Address or Lot No. �� lM / p �,a a Owner's Name,Address and Tel..No.
Assessor's Map/Parcel ` ' Y f/(D iG✓r� CU
S �
Installer's Name,Address,and Tel.No. 5 0 S- 4-17-hb 5 3 Designer's'Namq,Address and Tel.No.
1UbP�Qr (��l.Fby- $t3 EXCtNVHT►0N TN G , � � :��^^ �f
I�tTEH4C `I W �-oe�sr����c S°Fo �-
F
Type of Building: "
Dwelling No.of Bedrooms 3 Lot Size 3 0 y�Z sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow ??0 gallons per day. Calculated daily flow 1 gallons.
Plan Date Number of sheets Z Revision Date
Title
Size of Septic Tank F k /6 6 0 9 a/ !��� Type of S.A.S._T' ° Z- S�G 5 / G l7 d e, f
` Description of Soil ell S y
" Nature of Repairs or Alterations(Answer when applicable) y e,21a CP
Date last inspected: 1y
Agreement: -
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of Health.
Signed (s7 Date
Application Approved by r Date
Application Disapproved for the following reas s r `
_ a
(
Permit No. 'P Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( pgraded( )
Abandoned( )by
at / has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. ded
Installer �U be t �I I Lf-o V - G t G C`i c. Designer 6. L N A RR I (�TON
The issuance of this permit shall not P6 construed as a guarantee that the system will functionn �(as` e}es�igned.
Date Inspector
1
No. 1V f)�_OU Fee
— THE COMMONWEALTH OF MASSACHUSETTS
0 r Z PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mi.5poga1 *p5tem Cow5truction Permit
Permission is hereby granted to Construct( )Repair( �rade( )Abandon( )
System located at G�z/
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction ijiust be compl ted within three years of the date of this grin .
l
Date:' 1 Approved by
Town ®f Barnstable
Regulatory Services
l . Thomas F. Geiiler, Director
• BARIQSfABM -
MASS. Public Health Division
abg4 1
ra�+A Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: 3 7 Sewage Permit# -- assessor's MapWarcel
Designer: &(2" E, ypt,rr/r., y,��S-- Installer:
Address: 9 L e-o(c� fZO_l-e LJrn - -- Address: -
_/�-
On was issued a permit to install a
(
date) .__ --------- _---_-- —
- (installer)
septic system at L{ lNltl,f��e-e r7co�, 41 c —_ - based on a design drawn by
(address)
n 6, i0f, dated -
(designer)
1 certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
IN
or
GLEN
_ ^
(instal ier's Signaa ) --^ ERIG m�
� HARRING!T ON
No. 1070
All e A "
( S e �--
esfgner' ( . e Designer tamp Here} —_..
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTI1. BERTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC REALTH DIVISION. THANK YOU.
Q-. f{ealth/Septic/Designer Certification Norm 3-26-04.doc
COMPLETE •
■'Complelfitems 1,2,and 3.Also complete Wnat
item 4 if-Restricted Delivery is desired. ��A ent
■ Print your name and address on the reverse X v ❑Addressee
so that we can return the card to you. '. Recei a PH ted Nani C. Date of Delivery
• Attach this card to the back of the mailpiece; rY(�O i � C '0 /,J
or on the front if space permits. l v
D. Is delivery address different from item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑No
L"Tmrs Patrick Capobianco
R �� ���r'Maslipee �`oad- ''
Cohut, MAi.,02635 3. Service Type
❑Certified Mail ❑Express Mail
❑ Registered ❑Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
�. Restricted Delivery?(Extra Fee) ❑Yes
2. Article rfro er le7005 1160. 0000 , 0191 2625
(Transfer from service label)
PS Form 3811.February 2004 Domestic Return Receipt 102595-02-M-1540
UNITED STAT :i �95kl%r✓tGE?� Ts9't
Page ' s 3'aid�
a
• Sender: Please print your name, address, and ZIP+4 in this box •
PUBLIC HEALTH:DIVISION
TOWN OF BARNSTABLE
200 MAIN STREET
hYANNIS,mASSACHUSSETS 02601
ilf}iifif}�lill3�i}f!!!!��l�!!��ltfti�}3ltt}l�i�f;4iT!3}}�t)t! v
� a
Ln
ru u�
Ill
.a
r
C3 Postage $ . 39 r
c O
0 Certified Fee O S ` ;
0p Return Receipt Fee t Postmark
(Endorsement Required) ryr� Here�, -
O Restricted Delivery Fee
.D (Endorsement Required)
r=1 Total Postage&Fees $ f► fir' J
u7
C3 Sent 4- l
--------------------- - -------------- --------------
�heet, ----
or PO Box No. J�i .
City State,ZIRM xQ-`-'�-'-�-------------------------
�a
:rr r,
Certified Mail Provides:o A mailing receipt (asiane a)aooa aun ones Wood Sa
c A unique identifier for your mailpiece
o A record of delivery kept by the Postal Service for two years
Important Reminders:
o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail&
o Certified Mail is not available for any class of international mail.
o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured or Registered Mail.
n For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is
required.
e For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted-Delivery".
o if a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. if a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail.
IMPORTANT:Save this receipt and present it when making an inquiry.
Internet access to delivery information is not available on mail
addressed to APOs and FPOs.
I
f _
Town of Barnstable
F1HE-lp� .
Regulatory Services
swRivsTnai E Thomas F.Geiler,Director
MASS.
9� F1639.. � Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
January 10 2007
Mr&Mrs Patrick Capobianco
4 Mashpee Road
Cotuit, MA 02635
ORDER-TO COMPLY WITH'STATE ENVIRONMENTAT CODE;Ti-t1e-5 -
- - The septic system owned by you located at 4 Mashpee Road, Cotuit, MA--was last -
- inspected November P 2006 by Patrick M. O'Connell a certified septic inspector for
the State of Massachusetts.
The inspection of your septic system showed that your system"Fails"under the
guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: -- -
System is in hydraulic failure
You have 2 years from the date of the system failure to bring the system into compliance.
_ -- - If there are any questions about.this.reminder,.please.feel free to contact the Barnstable
Health Department.
B TABLE HEAL DEPARTMENT
Thomas A. McKean, R.S., C.H.O.
Agent of the Board of Health
I
i
COMMONWEALTH OF MASSACHUSETTS
= EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
v
• � d DEPARTMENT OF ENVIRONMENTAL PROTECTION
M
yt
� y�Y
V
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL-SYSTEM FORM
PART A
CERTIFICATION G l Q5
Property Address: 4 Mashpee Road
Cotuit MA
Owner's Name: Pat Capobianco
Owner's Address: Same
Date of Inspection: November 3,2006 Job#b6-303
Name of Inspector: PATRICK M.O'CONNELL
Company Name: SEPTIC INSPECTION SERVICES CO. I ""
Mailing Address: 189 CAMMETT ROAD
MARSTONS MILLS MA 02648
Telephone Number,. 508-428-1779
CERTIFICATION STATEMENT "
I certifythat I have yinspected ' 'C3
personally the sewage disposal system at this address and that the informal ion reported E�
below is true,accurate and complete as of the time of the inspection.The inspection was performed base on my 4:_
training and experience in the proper function and maintenance of on site sewage disposal systems. I amla DEP
'approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
OF
Passes
. �
Conditionally Passes
__ Need her Evaluati y the Local proving Authority _ "t m
_X ails M.
01
L G'',
l �
Inspector's Signature:
Date: 11/3/06 �'%,�T( •FR,riF���,�02���•�•
The system inspector.,hall submit a copy of this inspection report to the Approving Authority(Board of ealth orlilt
Al
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow f 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional offi a 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: Leaching field in hydraulic failure.
****This report only describes conditions at the time of inspection and under the conditions of use it that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUB113URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:.4 Mashpee Road,Cotuit
Owner: Pat Capobianco
Date of Inspection: November 3,2006
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes..
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
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.
ND explain: 4
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or clue to a broken,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain: „
f
Page 3 of I I
• OFFICIAL INS
PECTION
PE CTI _ON
SUB' FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSUR
FACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:,4 Mashpee Road,Cotuit
Owner: Pat Cap-obianco
Date of Inspection: November 3,2006 _
C. Further Evaluation is Required by the Board of Health: s
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.
I. 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 frail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply. .
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria 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:
Page 4 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:4 Mashpee Road,Cotuit
Owner: Pat Capobianco
Date of Inspection: November 3,2006
D. System Failure.Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
.Yes No
—X_ _ 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
_X_ _ 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_day flow
_X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
_X_ Any portion of the SAS,cesspool or privy is below high ground water elevation.
_X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
Any pofion of a cesspool or privy is within a Zone I of a public well. .
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicate:i 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.]
_Yes_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 115.303,therefore the system fails.The system owner should
Health to determine what will be necessary to correct the failure. contact the Board of
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to
large systems in g Y addition to the criteria above)
yes no
— _ the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have answered".yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
Page 5.of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Addressr 4 Mashpee Road,Cotuit
Owner: •Pat Cap0bianco
Date of Inspection; November 3,2006
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?
_X Have large volumes of water been introduced to the system recently or as part of this inspection?
Were as built plans of the system obtained and examined?(If they were not available note as N/A)
Was the facility or dwelling inspected for signs of sewage backup?
Was the site inspected for signs of break out?
Were all system components,excluding the SAS,located on site?
X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the
condition of the baffles or tees materia
l of construction,dimensions,depth of liquid,depth of sludge and depth of
scum?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes no
_X_ Existing information.For example,a plan at the Board of Health.
_X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of
distance is unacceptable)[310 CMR 15.302(3)(b)j
Page 6 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 4 Mashpee Road,Cotuit
Owner: Pat Capobianco
Date of Inspection;, November 3,2006
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):No
Is laundry on a separate sewage system(yes or no):No [if yeinspection required)
Laundry system inspected(yes or no):
Seasonal use: (yes or no):No
Water meter readings, if available(last 2 years usage(gpd)):.Two years total:67,000 gal.=91 gpd.
Sump pump(yes or uo): No
Last date of occupancy: Currently Occupied
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgfft,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:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records: Tank pumped 10/17/06
Source of information: Owner
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
_Single cesspool
Overflow cesspool
Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank —Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information:
1973 .
Were sewage odors detected when arriving at the site(yes or no): No
Page 7 of 1 I
I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:,4 Mashpee Road,Cotuit
Owner: Pat Capobianco
Date of Inspection: November 3,2006
BUILDING SEWER:XX (locate on site plan)
Depth below grade: 1'
Materials of construction:_X_cast iron _40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: XX (locate on site plan)
Depth below grade: 3"
Material of construction:_X_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:8.5'long x 5.2'wide—1000 gal. j
Sludge depth: 0"
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: 0"
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined: STICK WITH HINGE FLAP.
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Liquid lever at bottom of outlet invert no evidence of leaks.
GREASE TRAP: No (locate on site plan)
Depth below grade: _
Material of construction:_concrete metal fiberglass_polyethylene_other
(explain): —metal
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUB:iURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 4 Mashpee Road,Cotuit
Owner: Pat Capobianco
Date of Inspection: November 3,2006
TIGHT or HOLDING TANK: No (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.):
DISTRIBUTION BOX: XX (if present must be opened) (locate
P ) eon site( plan)
)
Depth of liquid level.above outlet invert: 0"
Comments(note if box is level and distribution'to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of g box,etc.):
Liquid level d
Previously at t- n p v ou of box.
PUMP CHAMBER: No (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.):
x
Page 9 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 4 Mashpee Road,Cotuit
Owner: Pat Capobianco
Date of Inspection,. November 3,2006
SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required)
If SAS not located explain why:
Type I
—leaching pits,number:
—leaching chambers,number:
leaching galleries,number: t a
leaching trenches, number, length:
leaching fields;number,dimensions: One 20 x 20 field.
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.): Two of thrc;e lateral lines are collapsed and third line is full of standing,water.
CESSPOOLS: No' (cesspool must be pumped as art of insp
ection)pection) (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 or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
x
PRIVY: No (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.):
V
Page 10 of 11
OFFICIAL INSPECTION FORM
SUBSURFACE SEWAGE DISPOSAL S LSYSTEM INSPECTION FORM R VOLUNTARY ASSESSMENTS
PART C
SYSTEM INFORMATION(continued)
Property Address:4 Mashpee Road,Cotuit '
Owner: Pat Capobianco
Date of Inspection:: November 3,2006
SKETCH OF SEVIIAGE DISPOSAL SYSTEM
Provide a sketch 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.
Mashpee Road
M � � ater
F t 'P Lt,4 yt
ervice
f 4 i,g M( Crt
..ip�:%�
+1"a t.
�y.
k
:::::._.�:::::...::::::::::•:.is ii:4i;,, ... ;::.�:::::::::::::.:::.:..,.........ii:iii:ii:;jj:i:4:iii:i::•:::
.......:::......
.i : :........ .............. :::::::::::::w:i':?:??^ii:i:':•i::�:�ii:''r'::::is;'.it4:•ii;L:vi'
�a:
r ..............
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Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address 4 Mashpee Road,Cotuit
Owner: Pat Capobianco
Date of Inspection: November 3,2006
SITE EXAM
Slope None
Surface water None
Check cellar Dry
Shallow wells None
Estimated depth to ground water
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:
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
i
You must describe how you established the high ground water elevation:
A perc test will be performed prior to repair to determine groundwater elevation.
Town of Barnstable P#
Department of Regulatory Services
Public Health Division Date /
200 Main Street,Hyannis MA 02601
�. Date Scheduled Time Fee id. aU
Soil Suitability Assessment for Sewage Dis o l
1 �
Performed By: �/�.�. �, �C�.r✓'c h.4 /��� P•5• Witnessed Bye\\-
LOCATION& GENERAL ORMATION
Location Address M t�.
y O er's Name C I'6 lA4,,G o
� �, /Load
—. Address
AssessoesMap/Parcel:0� Engineer's Name ���/atec��dhi S,`
NEW CONSTRUCTION REPAIR Telephone#
Land Use 2" Slopes(%) 3 —S surface Stones
Distances from: Open Water Body- 7.,,r6o ft Possible Wet Area ft "Drinking Water Well ft
Drainage Way ft Property Line ft Other ft.
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes)
f
�v
i
0
3 0-0
Parent material(geologic) �" Depth to Bedrock r
Depth to Groundwater. Standing Water in Hole: / ` �[Weepiinnjg^from Pit Fpcc
Estimated Seasonal High Groundwater DETERNANATION FOR SEASONAL HIGH WATER TABLE
Method Used: 910 /a . p L
Depth Observed standing in obs.hole: in. Depth to s911 mottles: - 3
Depth to weeping from side of obs.hole: in. Groundwater Adjuatment D
Index Well# Reading Date: Index Well level .. Adj.factor Adj.Groundwater level
PERCOLATION TEST —IM2 Time
Observation 2 Time at 9"
Hole#
Depth of Pere. �73 Time at 6"
Start Pre soak Time @ Z 'nme(9"-6") ---
End Pre-soak
v Rate MinJlnch r.2
t
Site Suitability Assessment: Site Passed Site•Failed: Additional Testing Needed(Y/N)
Original: Public Health Division • Observation Hole Data To Be Completed on Back----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:\SEPTIGIPERCFORM.DOC
DEEP-OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistencv. ray
/(!U
26'l Zo 1 /lit-F t0 ?eS
DEEP OBSERVATION HOLE LOG Hole# Z
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consisten %Gravel)
L
l6 'Zw G
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color. Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistencv.%Oravell
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Co si e
.r
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes - .---/
Within 500 year boundary No= Yes 'V
Within 100 year flood boundary No— Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system. --
If not,what is the depth of naturally occurring pervious material? -
Certification
I certify that on ��(date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training,expertise d ex ennccee described in 310 CNR 15.017.
Signature
G'J� Date 1 .Zd�,
Q:%SEpnCUPERCFORM.DOC
_�3 s'_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ® HEALTH
OF......... ... . --- -----
Appl ration for Bhiposal 10orko Tomitrurtion Vautit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Swage Disposal
------------
L ation- ress r Lot No.
er `. Addr s
a .` ------ 6e - ----- - _--------------- ----- -
Installer Addr ss
QType of Building aSize Lot.... Sq. feet
U Dwelling V No. of Bedrooms--------- .......................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ---------------------------- No. of persons............................ Showers — Cafeteria
fixtures
--- - -------------------------
Other'W Design Flow------................zra allons per person per day. Total daily flow____._...__.......__...._..._..gallons.
WSeptic Tank—Liquid capacit _ lions Length................ Width---------------- Diameter................ Depth__.______--__---
x Disposal Trench—No..................... Width.................... Total Length-------------------- Total leaching area-__-`�---_--_--sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by...........................................-----------.................. Date----------------------------------------
,� Test Pit No. 1................minutes per inch Depth of Test Pit____________________ Depth to ground water--_-_________._.__.-__--
fTq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
P4 ----•-. -. ....................--------------------------------------------........................................................
0
Description of Soil:......... ...__....
x
W -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable.------------------------------------•---_:__----_-_••-•_--_-_____---.-____.-.______--.--___.-..
---------------------------------------------------••--•-------•--•-----------------------•-----------•------------------•--------------------------------------------------------------- .............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Dis osal System in accordance with
the provisions of Article XI of the State Sanitary Code—The under ig ed rth rees not-to place the system in.
operation until a Certificate of Compliance has been issue e b r of h alth
Signed - -- -------------- -------- ................................
Zle
Application Approved By........... •. = //�' te ^`�--
1
Application Disapproved for the following reasons--------------------
•-----------------------------------------------------------------------------------------------=------------------------------------------------------------------------------------ ------------
Date
Permit No. Issued > ---------
ate
--- --------- ---`- .---- -• -
No:-t 1v................. Fizx: .....................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® ® HEA ' !H
Appliration for Uiipoiial Warkii Tonstrurtiou Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an IndividualASwage Disposal
Y
S s t Xf. iat..�_g ._�".•.aE. °!. �� •f .ns ..,_.6. !-•
N
e L ation-- ress Y / r Lot No.
Un
y* a r44. ,
�` er Addr s
_ s
li
nstaller Addreress �.
UType of Building Size Lot___ ...Sq. feet
Dwelling14 No. of Bedrooms.......... .......................Expansion Attic ( ) Garbage Grinder ( )
a`1 Other—T e of Building No. of ersons______________________________Showers —
YP g ---------------------------- P ( ) Cafeteria ( )
Otherfixtures --------- ------------------------------------------=----------------
------------------ ---
w Design Flow_______________________,r _.______-----gallons per person per day. Total daily flow_______. _....___.____.__.-__gallons.
WSeptic Tank—Liquid capacit t` __ lions Length--------------_ Width_________--.-._ Diameter---------------- Depth-_.__________---
x Disposal Trench-No_______.............. Width.................... Total Length.................... Total leaching area--- -------sq. ft.
Seepage Pit No-------------------_ Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by__________________________________________________________________________ Date........................................
Test Pit.No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f3� Test Pit No. 2................minutes per inch , Depth of Test Pit.................... Depth to ground water____________________--_-
Descriptionof Soil-------- yv --'mz--•------•--------------------•----------------___---------------------- ---------------------------------------------
x
w
-------------------------------------------------------------------------------------------------------------------------------------------------=-------------------------------------------------
: -----
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 Article XI of the State Sanitary Code— The undensigped �lrth grees not to-place the system in
operation until a Certificate of Compliance has been isssuug�b/�1 e b ro of h lthr"
ed -" - ------ ---
- ---------------------------------
signDate
Application Approved BY-• ��� ''r � - +! j y- -
�. � Date
Application Disapproved for the following reasons: -----•...
.. --------•--•-•-------------------•-----•---•-•---------•-•••-
Date
Permit No...................................... Issued.-- 1D ............................"^o"
ate
THE COMMONWE
ALTH OF MASSACHUSETTS
BOARD� HEALTH
P ..., ............OF........i .....444czr.'..............................................
Trriif iratr of Tompliatirr
T1f jS IS,rTO CERTI the Individual Sewage Disposal System constructed ) or Repaired ( )
by . ' . •-----
a 'Install r
ate t � '• ..............
has been installed in accordance with the provisions of Article XI off The State Sanitary Code a described in the
PP P -----'�-------°`�"� dated.:---- � ..
application for Disposal Works Construction Permit No._.__._.._ _ ---------_- ___ __-__
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL PUNCTION SATISFACTORY.
14
DATE.- .. Inspector Inspector s �� " - +
___---------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OT HEALTH
f �..;.
No.•-_.0. _.. ........... ,, ............. FEt _..............
!?tki, To tr
n Permit:
Permission s`hereby granted._____ ; _� , � __._ .__ _____-_____
to Constr t or Re • it ( ) 41,rldividual S wa Dis al Sy
at No._
Street / �
as shown on the application for Disposal Works Construct on Pe, n ft No f_ _��_� Dated____ J � �'- A"
3�d�_�{'� ---------
_---------
_
Boar of Health"
DATE......L. ----- I--.- -----• ��
FORM 1255 HOBBS'& WARREN. INC.. '"PUBLISHERS - ' -
SITE PLAN
`Y N
N
SCALE: 1"=20' '�!F �I.�zzAlrrs SAY � School Street
BENCH MARK ON TOP OF REAR GARAGE �, C.�S C,0
DOOR THRESHOLD ELEV.-100.00' ASSUMED c 429 SANT'UIT 1�OAU
019--c,i 4
LEGEND r 'E-;IT1.-.. �1
1 ` �,rtJGk'�gC1
marsh eel
O PROPOSED
UMP CHAMBER , Q Road
0 o EXISTING 1000 GAL
H-10 SEPTIC TANK N x 9s.u'
X 104.46 DENOTES EXISTING `
SPOT GRADE
95 EXISTING CONTOUR X 1oa42' "COTUIT"
DEEP TEST HOLE
i 0CU<�
APPROX. LOCATION f~
PROPOSED WATER LINE S%CAI_E, A SHOWN
99-W GENERAL NOTES
�� x 101.56, 1. ADDRESS: #4 MASHPEE ROAD, COTUIT
�f'�.111 .A5 �� 2. ASSESSORS NUMBER: 019-152
i--251 X 13'W X 2.0' D k 3. DEVELOPER'S LOT: LOT F
leaching trench using 2 10642' x 100•0(' 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN
H•••1 G' 500•-Qgo1lan chambers ON THE GROUND INSTRUMENT SURVEY.
with 4' of stone all around. , 5. TOWN WATER IS PROVIDED TO SITE & SURROUNDING PROPERTIES.
:'•`: `' 8E c t 6. REFERENCE PLAN: PLAN BOOK 256 PAGE 46
EXISTING SAS TO
PUMPED AND TO BE LEO r 7. WETLANDS ARE LOCATED AS DEPICTED ON THE SITE PLAN.
T:1 6- `., ;'.' ; ..,,;. 8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS.
G f k 9. UNDERGROUND UTILITIES WERE LOCATED BY DIGSAFE
9
fi
a t
►S„"GSAS '...5 Design Calculations
Number of Bedrooms: 3 Existing
Garbage Grinder: NO, GRINDER NOT ALLOWED WITH THIS DESIGN
x A Septic Tank Capacity Required: 330 gpd X 200% = 660 gpd
Septic Tank Provided: EXISTING 1,000 gallon
x 99.9s, Leaching Capacity Required: 330 Gal./Day
BECK .M . � Leaching Area Required: 330 Gal./(0.74 Gal./Sq.Ft.)=446 Sq.Ft.
1oz19 j ��' Proposed Leaching Area Provided: 25' X 13' X 2.0' = 479 SQ.FT.
rn Total Leaching Capacity. 355 gpd > 330 gpd. req'd.
GAS METER
CONSTRUCTION NOTES
103.01' X `'l
€ ... ..ty� 99.79' 1. Contractor is responsible for Digsafe notification
L�j rn/ and protection of all underground utilities and pipes.
/
r' i II/ •,.._ 2. The septic tank ist Ibut on box shall be set
L
P
� level on 6 of 3 4 11 2 stone.
3. Backfill should be clean sand or gravel with no
d/
stones over 3 in size.
f?
........ ..............................................
.......................................................
,� ........ ................................................. ......................................... ,r..,.. A.,-This rVSt^m !S St,!h,'eCt to i^3p?c.{inn r,nr ;r `-I!�`:i.on
by Glen E. Harrington,
..... :::.YI VEwL..
R.S.
5. The contractor shall install this system in accordance
with Title V of the Massachusetts Environmental Code
and the Regulations of the Town of BARNSTABLE.
_
6. Provide an Acme Precast H 10 1,000 GAL. SEPTIC TANK as um chamber,
99. e' , P, P
2 on H-10 distribution box. DB-5 and 2--500 gallon H-10 leaching chambers or equal.
7. No vehicle or heavy machinery shall drive over the
septic system unless noted as H-20 septic components.
8. Install gas baffle or equal on septic tank outlet tee end.
9. All existing inverts and site conditions shall be verified by contractor.
:....OT I" 10. BOARD OF HEALTH AND DESIGNER ARE TO INSPECT AND CERTIFY INSTALLATION.
..................
AREA _ 30,492± Q., �...�.
11. The existing SAS shall be pumped and backfilled.
99.36'
1P. fnd.
P11574
Perk Test - -
Depth to perk hole 55" - 73" ' S.53'
24 gals added in less than 15 minute soak period
Use <2 minutes per inch for design purposes
l��g1 } OFryIq PROPOSED SEPTIC SYSTEM UPGRADE
PERK TEST & SOIL EVALUATIONr�• 4 EN �
DATE OF PERC TEST & SOIL EVAL.: JANUARY 9, 2007 /1D IC ��W FOR
TEST PERFORMED BY: GLEN E. HARRINGTON, R.S. 0R -' B & 6 CONSTRUCTION
WITNESSED BY: DONALD DESMARAIS, R.S., HEALTH INSPECTOR cn
EXCAVATED BY: RICK GILFOY, 8 & 8 CONSTRUCTION 0 107 AT
s FGIgTE� � #4 MASHPEE ROAD
Test Hole Test Hole ,' ��P
x... `.,..w.,.l.:.:n.�.w:..... ........._:.�.. .." ... .... ,.. .irA BARNSTABLE (COTUIT), MA
DEPTH SOILS ELEV. 7EP SOILS ELEV. - WWI AOOM." 6;
o 98.78 o05.05 / �l -- 'x:. z-:...-:-..._:_.._ PREPARED BY A { I':. i 4
'°'"' mm GLEN E. HARRINGTON R.S.
n r
6• LOAMY sArro i 10. Lawn wo a< ! i l 14"
Bw i Bw err _ '
7.1!"4ro w � �-� 9 LEDA ROSE LANE
28• LOAMY SAND 98.81 29" Lo�wv SAND
5"wEL R>r!t�PORCE;3 �'R£G:.�1'CONCRETE
- 2. H-•10 :30; qcA, _h�,rrtbt-:rn MARSTONS MILLS, MA 02648
atanetnq Gw 94.2 `: ,� //LT
v TEL: 508-428-3862
115• '� met 95.48
„ED.-M ?126• °"°'"9 e4.a H-10 500 GALLON 0HAMBEH FAX: 508-428-3862
SAND I " "E NOT 7'a S{:h!>.::
1 - +Ma/+ IOM 4 SCALE: 1��=20 DRAWN BY: GEH JAN 26, 2007
USE ACME P�ECA5T OR EQUAL
DATUM: ASSUMED FILE: B&BCAPOBIANCO SHEET 1 OF 2
;NV b3:1�£:L L0101 - 130'v'd 09 8 LO 6Z I NO10Nl1dbVHWIIVN3 ), -M
i
i
NOTE': AL..(... PIPES ARE. (<? BE 4" S= HE.I.)UI..E 40 P,V,(',. E,XCE:P.T. THE'. 2" I.)IAM, SC'H.40 FORCE MAIN
*NOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK CUTLET T>.-_EE.
i
,
5 HOLE
LIST,Box Exls:in Grade I
Finished crude over systern=2% slope away � ,s�������x �p Sex
a I
Yf 1>viEt�E.lx�fS'. t #t:�nE�shami
Min. 2--1/8--1/2' 1 min. I
r•• cGwc rwsi be max. E
Purr' ,? ?,?it7ry b er' cc Cover must be �� w:?#dn G of rilisbod gM40 wiWe—waehsd stone
Existing House; Septic' f ank c-ov'rs must be to finished grade 5�" n� rrx 2' Fl�TErt F Too Peaatone Elev.-103.50'
f�=
...
6? below fin,shed gr-113de ry
IS
I
^ oot000 Leo
IS
a ny # s 2b' rend ev.= 46'
Existing /aTe\ _ �•. s LEACH TRENCH ,na .)
�..............+. t
~Ear.3/�v ,l2•Sms,. AC?&ISTED OW ELEV.-9 5.46' (top of MOTTLING) I
SMT. YI, elev. 10 i.€3C y <«z EXI 3TIN%j I
1,000 GAL.. G`<Y Elev.-94.�a' (C3tas�rvvd sto#=dlrlq i#i JEST HOLE) I
II SEP T:IC TANK L
I..I..... 0 M I
�X 24 DIAMETER I
6" €F 3/4'•....11/2" STONE Pump u COVER To
,91 C:,AI�ff3El � FINISHED GRADE I
.�....................�.( � SY5�E« M P. ,O
3/4"««11` „ LIF•I� OUT CHAIN
6" OF 2 STONE Not to Scale
I
I
I
EXISTING GRAD
I WI « E ..... ....1.... .. ....<1..<1 ...1..... ..
2. *8" IIAM, ACCEESS, Pvdal1 C;I«t:S a I
I I , s r
l .. « s. PROVIDE I ME`1 ER S SRM 4/ '0 f'i.I�., I `� V{)LT, E
.. ..y., ..... ................ �`• ... E `f` a '2 '�tK' ' ..•^"'" .... t E, ,� .,. ,M..
v.k.. ., •, '.Ty i- #Z €'.'i€E {" t' l' f i f'�~' OU.71..E INVE:RE «.,_EV.=99,41•'
..............w:.........w............ ,....... ...................« (
. .... .. , . a SINuME : I:ASS, SIJ�..MER"I•,_,E_E. ,�,I`YEI .«.APAI�LE. O. PASSING NG INLET INVERT �`m m„«
�•, ....«««..._.�.«:.. ««.�. •• A t�il'�IMt, I�," SOLID �.w. C. 2" I"Jr=,t�.ETI�R OR �`CiUA' ° T
« � ..............................
i
i
2. USE: MEY RS CE1 1 SW SIMPLEX ELECTRIC I C;..�: al<s 3:: t,tir.!ri
,,,..•«... a CS✓' O « p•�hNEL INT`OOre I�'Il',3 i'Y�Sw t.7 sa�1 Vl 3I I...E .«.. �� cIc �� ;`•� E
�'R P1 4 , 2• i ' c (t`",�cEE �„ �2L 1�1;..��U'•'.`E)f1 AR�^ g [' EQ/•Y126" {�i"{ �•�IiJ �:ES'_.:`i, ?••,LR Ib$ i.lELi�E.jAi
1,! _ i 24 F€I�. Rc,�:3re�e StarE�gc� I I 2" SWING CHECK VAL E�'R.V.C. I
IN: } I IOUTLET 3. PLlt�1P SHA L 3E IP�ISTAL D IN STRICT COMPLIANCE
F
�! T';
WITH MANUrACTURER'S ` PED:CATIONS. I k ,•-
• I ............ ... .. .. .A HIGH WATER ALARM EEYEV.:::i3'7.52' 1
u 4. ALARM "HALL �.,ONSI�.�i Q ' AUDI9LE' S113NAL & I •° .
RED WARNING LIGHT TO i.:E IN STAI LED IN BUILDING I Wc�" 2" PUMP
i==€JA€?�> C:P€�:�� kLEv.��Tr ;3�A 1
I I «
AND POWERED BY SEPARATE CIRCUIT FROM 7 i I
� �_, ,M _..�•« .•. n Y - CIRCUITS i c I I �I �'t16AP f34"F Et.E 1.=96.77' i
f• �' ..R............n..«..........nR......n...................i.....w..............x......................... „ERuJET,. TO PUMP, I E «.. ..,........................................................................«�
5, DOSE. VO UME=4 DOSI.S P'�R DAY= 440 GALf4 L?Ci: ES=110 GAL.fLi:1SE
STEAL REINFORCED PRECAS= CONCRETE 4' z
6. EI...ECTRICAL. PERMIT REQt IR"-D OR AI..ARM POWER TO PUMP. I °
Pi
PLAN VJEW
2-24" REMO'VA aLE COVERS ' `1..1. i E PLIMP CHAMBER EL EV.:w95.44'
yPA - - ............................................................................. :
.....
Q..' ";_�.•'."'•e'. .w'. •;° a a i• ..•....... N :...`''.x.,.:..n.....k....• A'. , :i•y.................. ..........
pi ......1� : • ,. R• ••A� .... _ 10
)S of
*Y;/4{ 4 1 f/". .S..o L.F.
f 32 Y Iii
fl
Min, #clearance; I,
2
d I
6" r7 #2" min, inlet to aEtIE i
INLET B LET
1QUI level
PUMP
UVP DETAIL.
iE I i
Nott,USG4:IG-' «�«.««.«.,..,««.�«.«« «««.«_..«.««,««««««««..,......««................
LIgvid depth :e j P��HOFM4 PROPOSED SEPTIC SYSTEM UPGRADE 1
'• � - E?
l V E•x .a;'� . I �®may N
;: E B B CONSTRUCT:T•ION
RRI GTO AT
I
.•,,............................................................. >P ............................................................,.E «.
o. 070
t3_t; i ------ 4' 10" 9 0 4 '+ ASHP E 3.JAD j
. } � �':•, :.., � .. } _ T I �'�^�rA���� BARNSTABLE (COTUIT), MA I
� ...�a
_-� ... _ ..........._....... _«.................._............«......«...................................................................................................................................
I _ r i .. B
LAN E
E MA 02648
TEL: 508---423- J862 1
FAX: 508- 42B--3Sr".s2
SCALE. t 20 [)R AW N 8 : GE H JAIL€. 26> 2007 I
MATl1M: ASSUMt FILE: t;wrrBCAPOQIAN L� SHr..I T 2 C)I 2 I
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