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0080 NICKERSON ROAD - Health
4 i< 80 N cker`son'ti;a e' � c�c r "Co 9 � z 4 r Pon O 62702 MR ao� i I � SZZ = r� S r s 5i f � f -77- lye G�J US�,�► �� �a� 5 �~ TOWN OF BARNSTABLE LOCATION SEWAGE# _EO i G_O3? VILLAGE 'i t ASSESSOR'S MAP&PARCEL 1 9_-9A INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY t$000 •4,(_. A:,I-/d LEACHING FACILITY- (type) `�tZL"7�[f_1 (size) 33-5 X- 0 •k3 J NO.OF BEDROOMS ,_3 `6 OWNER PERMIT DATE: 1 Y COMPLIANCE DATE: GJ }S 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) tt& Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Ano Feet FURNISHED BY L%�G /lt �r/�/wr+•-iv/r ! a ao L b �� h �� O --�, � n 6 � � � � .. .. � _ �, �, ti t i No. !D Fee HE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Nplifation for Misposal 6pstem Construction j3Prtttit Application for a Permit to Construct( ) Repair W�Upgrade( ) Abandon( ) W(Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,andI Tel.No. Assessor's Map/Parcel f 5��� AAA 019 Qn`9 'ref' Installer's Name,Address,and Tel.No. 5'o Zs-,7f7/-935'9 Designer's Name,Address,and Tel.No. Sv8'34a'YSS� ( r}o1v �VnS{rcxki vv�;�►-,c. Po E3ax'.b Y7 "e�PJ'i'r��Tii 934 ,5( �-v c,Va imn o a-cc q - I \Jaxmougi �;6�+ , oar.')5 Type of Building: Dwelling No.of Bedrooms 3 Lot Size Y3 46Q sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ..33 gpd Design flow provided qSS7 gpd Plan Date .-son, Number of tshe'e/ts Revision Date Title 1 a�� s i ���m (j !l�[,Clt¢�t/ n Ael. J CD f Size of Septic Tank (S'ooc j, �10 Type of S.A.S. (3��(x���ep �ect ��rn�a n� ,33 LA-A.b3 Description of Soil v5,ee—S_ �a /a o,g2 av Nature of Repairs or Alterations(Answer when applicable) Date last inspected: kgreement: The undersigned agrees to ensure the construction and mainten e of the afore described on-site sewage disposal system in accordance with the provisions o"ed of to place the system in operation until a Certificate of Compliance has been issued by th i Date Z/r Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued .-,.1V''— .'ti^.��...ri..t^+--- ,:-�7•"ar--. ^+-..�"^'r'v-�..�,,.�.•i..b'1"?-,,,r.'�r+'^.,F'r -�^'h"` i,r- .-'*....1� - -r tiy+r:.�..,rJR r `.w•; 1,•,. ,- . ,"•"n*..,•+.-v.. Fee /No. r3,' .3 3; HE COMMONWEALTH OF MASSACHUSETTS Entered in compute ' Yes f PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 1Rpplication f1 .Pis DsaY 6 stem Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) R"Complete System ❑Individual Components Location Address or Lot No. SO Neey Ad• Owner's Name,Address,and Tel.No. 9'78 �2a-3 Assessor's Map/Parcel /$� �} C'ac _+ ((;,h4.t�,t2' �rY� at: �n)j �rJ �'Installer's Name,Address,and Tel.No. Svc--7-1 -9 3 1W Designer's Name,Address,and Tel.`No. Soij1 34._- f.4v+f c M. ` t', rL.,c.F- U 9-, ,v�'u�i r_.�:I.;C� �,.r�.o7 Sri►,, ,�'r c 3 l4-�•+5�• l:1?ri t;a°Yin4.^. �«/1 f.t e aigtl Z i a G� Uaf)W11li4n � •�J - _ l^4 0 a4,) 5- Type of Building: Dwelling No.of Bedrooms ti 3 Lot Size t/3 40 N sq.ft. Garbage Grinder(• ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r' Design Flow(min.required) 330 gpd Design flow provided �/�,�� gpd Plan Date Tn n,, ;15.Q•B iR Number of sheets / `Revision Date Title f ,1 P -7 kc 26, � 1 � r� , Aj. �r.,�t Size of Septic Tank !t)()n 1(a Type of S.A.S. (' v'�r_ 0 i'nn�11 f��vtMA"nA 1. !_K/•� &301 1 C fa- 3 l T . ) .ri Description of Soil , [�4 ,fir, ! / J i r k,&y ,.J r Nature of Repairs or Alterations(Answer when applicable) t bate last inspected: - `A`�reement:' 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•Aot to place the system in operation until a Certificate of Compliance has been issued by this Board of Health 1 "igned /i c'��- �" �-a n� Date [ 7-CJ 41 Application Approved by /l/,! !/ . / , •, ,f�:':�lla �1 y , -5 Date f" Application Disapproved by / d t 3 V Y / Date ~ for the following reasons �. Permit No. �y`"` / Date Issued - THE COMMONWEALTH OF MASSACHUSETTS .BARNSTABLE,MASSACHUSETTS - Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(4Y) Upgraded( ) Abandoned b Alt'( ) Y try: ��rr4�l7)r��nl'1 �_,•�C at Nil e ko f f,- , w , eG�L' L+ has been cons cted ako)roan e with the provisions of Title 5 and the for Disposal•`System Construction Permit No. '" f J to Installer 2)or4cl f'r-1 Con5'6,rt nn l r-�� Designer #bedrooms Approved design flow gpd r The issuance of this permit sh/11 not be construed as a guarantee that the systemli ll functtion�as�de ign,.d. Date 7/4P I Inspector°`^ _._ 1 ... 5 . ________________________--____.- -____-------------------------- •'____'____ _-__-_______.______ _ No. Fee / THE COMMONWEALTH OF MASSACHUSETTS U�1 PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstrm Construction 3permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) ! Abandon( ) System located at a f u-j e- en_ a . �Ga-F t,t i fi" and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructt must b-competed within three years of the date of this permit. Date � Approved by 1 -Q�r 1�/�yMa� - ��-y�l • Town ®f Barnstable IF9E T Regulatory Services Thomas F.Geiler,Director +� BAMSTAWA � ' ,e Public Health Division 'Thomas McKean,]Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 �G Installer&Designer Certification Foram j Date: 'Sewage Permit# 2.0# - 039 Assessor's Map\Parcel f 9 Designer: DDWN CAPE E.1&W J6-1 Installer: LOrr) ( NMF4KJ[0�4 Address: N errzot Address: 4�z (�D YMA40M M 9Z, WA Mol 5 W9,F0Ne7 M f LL5;, MA 021A6 On ;Z)A)o Ile &Dr-�e,/0�4"06`J-z�,l,was issued a permit to install a .(date) p n (installer) septic system at 0 o I ' I Ckt<FV,,, l based on a design drawn by (address) ' PLS dated a�jf,rt� a (desi er) ✓I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relpcation 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. OF b1ggS� DANIELA. tiN o OJALA (Inst ' e) CIVIL cn No.46502 � r 4 o,SS O N A L (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL. BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLIE PUBLIC HEALTH DIVISION. THANK YOU Q:Health/Septic/Designer Certification Form 3-26••04.doc 1• _ bd Depaa;rLixapnt Of Regwaltoxy.Services Date Public Health-D' Won 77- 200 iYlain 5kroot,Hyannis MA 02601 t�7 Date Scheduled � 'z'1:ata ... l �. JC+"�¢1[�dl �!�©• �/� --/ o�. Pd SoilSuitability a .. Cx1gXAXAeI.:C'rJy:;��'"if^�,J..^-"_�_--_ :!✓e•.f,.s'Dq '�• �-•,,p� ,�p•��- F•..�-y�" - Witnessed-Ey: �P- . J4a�6..t�/1ATI+Ll�l�l q.A -,G..9 ",A,�LA,q:r.M' nrL!_e ?"17l.':J1@N 0010 t)1`i�l,�.Tl�►�_. �C' owner,s Natne MO Location AddXeSs ', address Asscssoz's lYaap/a'arccl: f /1 �ziginoer's Nazno�` 1;�/7y�. A e Np,WCC)NSTR.U.CTIOAI RZPA.IR aTelephone# J Land Use: �L-A u)y] 1 )slopes 96 / p uifacc Skoues Distanacsfrom: Open.WatarBody lop ti i?pssibleWetAreu fx Drinking WaterWcll �� FC Drainage fC 'Property Line + > `ft Other Ek � ' � 6(StCcoC name,dimensions of lot,exact locations of test halos Bcpero tests;locate wetlands n pxoxiznily to holes) • „ • PazentraateriAl(gerrlo�ic) G• ���t�� 0'�"_ '.._ � � _ lie kh t j3adracl �00 Depth-to amundwakcr. StandingWatcrin Hole. Weepingfiax Pltktqun I?stitzlated Seasonal 111gIt C3raundwakar IYTE . ���ATIO yl FOR 1.-E A'.1.p O 6'"1CAJLd RAA.GR Y'V•A;A,:IC!J,.d�)�TOLE, LdE, Mokhod Used: Depth Observed standing in abs.hole; lql .;Geptlz�ts?sQiI x>?gttlas. ifi, Dpp'th to wcepingfrmn side of:abs,hale: 'Ip�``c3tnttndwuterl�dJuekmank C. Index Well f RoadingDake: Indo�t'Ncll laYAl • .A,:dJ.i�t ktir, �, _r �?+d).:Cltx?utltiwritel Laval , JE'JiG7f.3.C'OLATION TEST OUservatiorz ' Hole# I 'IiAnp•at.9" Depth ofk'erc. J /IQ ` Time At6': Start Fro-soak Time - • R.ate,Min.11ich Site SuitablIlty,Asacssraez�t; Slto y'wod Sztp,Failcd: Additional xesling Nodded(:YIN) Original. Public health Divislou Obserktioa H01Q.Data To Bz Completed on B ack--- ---- • **'tlf percolatiba test Is to be conducted withamk 100' of'6' edamd,you must first notify they Barnstable +Coaaservatim,Davis1on at least one(1)week prior to k eeni axig• r�:�s>~>?TzclPz�z�c.Pol�vz'.poc � liu9o�CGPI�.s '. Depthfrorn Soll.Nnrizon Soil.Texture Sdil Color Sail, Other Surface(in.) , (lYSbA) (Nlunaeil) Mottling' (Structure,Stonee;Boulders, o i tcncy,"9�'Cravell a-za F; C 20-2-6 A- L s INA VZ • � i��'®:.q:.n13'9L:W�.'$'9'.tJ�:9:JLYJ.4°d tJLll.�Y.L'r�,.8.i�.�ly' �9���YY' �^ Drpth*am Sall Horizon S'ailTexture Sall Color Soil Other Surface(in) CUSDA) (Mlunsell) Mottling (Structure,Stones,'Bouldefs, oasis m 9'S Grave Depthfrom SailIlorizon SallTexturc Soil Color Soil Other, Surface(in.) ('USDA) (munsoll) Mottling (Structuzo,Stones,noulders. Co h to a t3 e MP OIBBERVA' IONROLV+ Lela Role Depth from Sail HatIzon SollTaxturc Sall Color Boll Other Surface(in.) (IJSDA) (Nlunsell) Mottling (Structure,S�oaw,Boulders. • Ca ' tett b ,, �Yund;L�lslnranr;��l�.afelt`�C�.�n / •• . Abovr5na,yeak,flwdboundary No Yea Within906yearhoundary. No vet Yes ' Within 100ymr flood boundary No. -_- �.c��h�f'hratct�a.Yyy'(�ccclrxin���'er�r�or�s�1a.��r%r�Y Does at least four feet of naturally occurring pel'vIous rna 6tiltl waist ztt all aretis nb5e-,VVO 1 thrpughnat th6 area proposed for the soil absorption systoml Tf not,what is the depth of ha urally occurring�Iousial's,.. x certify that on �/ 1Z (date)I have�passed the soil.evaluator exarninatidn approved by the Da aitment of BnvirollmentaIFroteotIon and tllattho above analysis wa:s_perfb med�by me consistent with . the requifcd training,exportise and experience described in�10 CUR 15.017. Signature - ti ti Town of Barnstable Barnstable Regulatory Services Department a,-at>I'micacff„ � 3AF2NSTABI4 i 1 1 9q, KAM Public Health Division m �fD N4A�# 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1730 0001 4987 6391 . December 12, 2017 SYMONDS,,CHARLES G 9 LANGSFORD ST GLOUCESTER, MA 01930 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 80 Nickerson Road, Cotuit,MA was inspected on 11/29/2017 by Frank Nunes III, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system,"Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the-invert pipe (per Town Code 360 20h). You are ordered to repair or replace_the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\80 Nickerson Road Cotuit.doc • �1�ram, Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA"02601 Mom: 508-8624644 R.icbard scali,Dircaar FAX: 508-790-6304 Thomas A McKean CEO Feb 6, 2007 Rev. 5111116 DEADLINES TO'REPAIR FAMED.SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15,000) An`Z'marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA I ❑Discharge or ponding of effluent to the surface of the ground . ❑Pumping more than 4 times during'the last year not due to clogged of obstructed pipe. ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE(1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool-within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis."(This system passes if the water analysis on YEAR DEADLINE CM C;9; esspoo ❑Any"conditionally passed systems (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) o Leaching pit or cesspool with high liquid level, <12"below inlet'(per Town Code §360-9.1) <eaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS•doc 0/9 -off . Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ire 80 Nickerson Rd. Property Address Pw"� Symonds Owner information Owners Nam is required for y -c' every page. Cotuit Y MA 02635 11/29/17 , City/Town State Zip Code Date of Inspection �r.+ Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: t Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 . 13010 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 11/29/17 Inspector's ignature 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 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'r 80 Nickerson Rd. Property Address Symonds Owner information Owner's Name is required for every page. Cotuit MA 02635 11/29/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check'A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts rs Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Nickerson Rd. Property Address Symonds Owner information Owner's Name ; is required for every page. Cotuit MA 02635 11/29/17 - City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< 80 Nickerson Rd. Property Address Symonds Owner information Owner's Name is required for every page. Cotuit MA 02635 11/29/17 Citylrown 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 Y2 day flow t5ins.doc-rev.6/16 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 ti 80 Nickerson Rd. Property Address Symonds Owner information Owner's Name is required for every page. Cotuit MA 02635 11/29/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No . ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection 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.doc-rev.6/16 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 80 Nickerson Rd. Property Address Symonds Owner information Owner's Name is required for every page. Cotuit MA 02635 11/29/17 City(rown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back u ? ® ❑ tY 9 P 9 9 P ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): N/A Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): N/A t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Nickerson Rd. Property Address Symonds ' Owner information Owner's Name e reqevery page. Cotuit MA 02635 11/29/17 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Septic tank to leach pit Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Seasonal Last date of occupancy: Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 80 Nickerson Rd. Property Address Symonds Owner information Owner's Name is required for Cotuit every page. MA 02635 11/29/17 City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped July 2017 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): No D-Box t5ins.doc•rev.6116 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 s 'r 80 Nickerson Rd. Property Address Symonds Owner information Owner's Name is required for every page. Cotuit MA 02635 11/29/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Per age of the home Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 0 3.611 Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 3' Depth below grade: feet Material of construction: Z concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-10 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: trace t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Nickerson Rd. Property Address Symonds Owner information Owner's Name is required for every page. Cotuit MA 02635 11/29/17 CityrTown 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 >12 11 Scum thickness trace >2" Distance from top of scum to top of outlet tee or baffle ' >211 Distance from bottom of scum to bottom of outlet tee or baffle 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.): H-10 tank is about 1/2 under a deck, the outlet cement baffle has corroded and fallen off, the inlet has a raised cover and hatch thru deck for access, excessive root intrusion at the outlet removed at time of inspection,effluent level is normal 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Nickerson Rd. Property Address Symonds Owner information Owner's Name is required for every page. Cotuit MA 02635 11/29/17 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins.doc-rev.6l16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts _ . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Nickerson Rd. Property Address Symonds Owner information Owner's Name is required for every page. Cotuit MA 02635 11/29/17 City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Nickerson Rd. Property Address Symonds Owner information Owner's Name e reqevery page. Cotuit MA 02635 11/29/17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries' number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Pit is 2' below grade, staining and muck above the last set of weep holes, excessive root intrusion of sidewalls 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Nickerson Rd. Property Address Symonds ; Owner information Owner's Name is required for every page. Cotuit MA 02635 11/29/17 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I Privy(locate on site plan): Materials of construction: Dimensions T . Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 .Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 80 Nickerson Rd. Property Address Symonds Owner information Owner's Name is required for every page. Cotuit _ MA 02635 11/29/17 Citylrown 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 Y . E � A Ld �3�{ C51 N 0 _1�76 5 CkN t5ins.doc-rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM �' 80 Nickerson Rd. Property Address Symonds Owner information Owner's Name is required for Cotuit MA 02635 11/29/17 every page. - Citylrown State Zip Code Date of Inspection M System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar 4' ❑ Shallow wells ; >12' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS)- ❑ Checked with local Board of Health-explain: ❑; Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 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 80 Nickerson Rd. Property Address Symonds Owner information Owner's Name , is reqevery page.ge. Cotuit MA 02635 11/29/17 every p 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No.---- .... F:ng...0.................... THE COMMONWEALTH OF MASSACHUSETTS 9 BOAR® OF HEALTH i"N _ f F� � i' - OF...... - �. ..-.........._.........--.. -- Appliraation -fair Ubipoii al Workii Croat,51rurtion Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: --------------------------- --•-•••....-•••••. .. :..._.. Location.Address or Lot No. _ Y�_cy__ �.s.... ._ ,. .Y3 t►_�. ... -••--•......--•---•• ------------------------------------------- Owner Ad r ss Installer t,W 9 Address Q Type of Building III����G(` //���� Size Lot----------------------------Sq. feet U,- Dwelling—No. of Bedrooms -___..._. r _______________________ Expansion Attic Garbage Grinder____ P ( ) g ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) I, PL4Other fixtures ---�0------------------------------------------------------------------------------------------------------------------------------------------ } W Design Flow_...�Z- ___________________________gallons per person per day. Total daily flow___-__3__-_d-_.-___._-_.._.__--..gallons. w Septic TcinkW Liquid capacitvkQ.6"---gallons Length................ Width................ Diameter_-----------.. Deptli._.._.____------ Disposal Trench—No....____ >. _. _ td ________________ Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pk No.�...h._®__�_____ iame erg................ Depth below ; let__ f ------- Total leaching area.._._.____..._.. .sq. ft. z Other Distribution box ( ) Dosing tank ( ) D / /7 Z Percolation Test Results Performed by-------------------------------------------------------------------------- Date--------------- ------•------ Test Pit No. 1................minutes per inch Depth of Test Pit------.............. Depth to ground water. 4, .. (� Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water_..._._..-___________.._. --------••---------- ------------- tJ x Description of Soil--------- --------- '�K.=c. C�7s ..A.........Z----•------- u. d - V ................----------••----•-------- -----------•-----------------------------------------•-•---------------------------------•• •----•-•-•---•----------------------•-----•----•----------------- W --•-------••------------------------- ----------------------- --••-•-••••----•--•--------------•----------------------------•--•----------------------------------------------------------------.-----. UNature of Repairs or Alterations—Answer when applicable................................................................................................ -- ----------------------------------------------i------ ----------m-------- 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 undersigne4f -ther agrees not to place the system in operation until a Certificate of Compliance has een 'ssued by the oard ofh. Signed--•• -- ----- ..-----• --•-. --------- ------•--------• —---------------------------- Date Application Approved By--- -----------. ... _.._.. 7 ate Application Disapproved for the following reasons----------------- --- -- ----------------------------------------------- -••---•-----------------•---•--•----•-•-------------------------•------------ ---••-•--•----------------•----•---••_._.---••---------------•--------- -__,Date PermitNo......................................................... Issued. ... ..................... Date F>s. .......... THE COMMONWEALTH OF MASSACHUSETTS r 99 BOARD OF HEALTH OF.:................................... . "' , Application -for li,ipuiitt1 Works Tomitrurtilan Vrrmit Application.is hereby made fora Permit to Construct ( ) or Repair (j() an Individual Sewage Disposal • System at nwSo�� . p, Cv '3.0 1'1 - ----------•----- •-•---•-•--•---------•------•-••...........................•••-•-••-•-----•----..._..--••--_..__ Locati n.Address or Lot No. ,...:_ , I.L.A'........ ................... . Owner A •-ress----------................................. a -�.A... V_- --- 1`4,< n" ......................,. . -•------••...............------ Installer d W4 " ; Address Q Type of Building d Size Lot............................Sq. feet U Dwelling—No. of Bedrooms---------- •--_-_-_-_-_Expansion Attie '( ) Garbage Grinder ( ) Other—Type of Building No. of ersons____________________________ Showers Cafeteria Q' Other fixtures ____ d ---------------------------- ------ -•---•---------------------•--•-•--•--•--- Desi n Flo ... ...................................... Mons er erson er da Total dail flow....._.... ._Q..0..._.................. W g �' �a11g P P P Y Ygallons. 9 Septic Tanki�Liquid capacitAA4.4...gallons Length---------------- Width...:............ Diameter................ Depth................ xDisposal Trench—No::..____• __ c i i _________________ Total Length.................... Total leaching area._:.................sq. ft. Seepage Pit No.j.Q.�._�_•:'..�iarme e1 �... Depth below inlet_... f .._.._._. Total leaching area__ ______________sq. it. Z Other Distribution box ( ) Dosing tank ( ) 6 / / 71� aPercolation Test Results Performed bY------- ------------------------••-- •-------- ---•--•-•-•-•-•.._ Date........................................ Test Pit No. 1________________minutes.per inch Depth of Test Pit-_--..__•__-•-_____. Depth to ground water/._R*d�___2�_.. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------i - : ;f y .;f ro ls-rR =- ---------------- x Description of Soil �..`_..� ` ` .. ------- -- ----------------- U -------------------------=------------------'-------------------•-------••------•---------•--••---•-•••-•-•••••••--•-----•----•--•---•-•-----•--•-•••-- .............................................. U ------------......................................................................................................................................................................................... V Nature of Repairs or Alterations—Answer when applicable----------------------------------------_.._._•--.-_-_-_-________-_____---__-..._.--_--:----_.... ---------------------------------------------------------------------------------•=-----------------------------------------------------............------------------....--••..............•-•----_.._. 1 . Agreement: Sf^` 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 undersigned f ther agrees not to place'the system in operation until a.Certificate of Compliance has.. een issued by theloard of th. Signed... .. ---••• •-• -'--•-..916.•• D e Application Approved B 1 -- -� == .7 /�PP PP Y � 'Date Application Disapproved for the following reasons:----•----------- .............................. -•-•---•----•-•-•---•--------•-•---------------------------- ....----•-...-•----------•-----•---•-•-----------------------•--•-•------------•------ ........................................................................................................... Date Permit No......................................................... Issued--- 7 f~ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................OF... R ..................... Trrtifiratr of f ILImp ittita HIS IS TO CERT_jFY, That the Individual Sewa e Dis a stee constr ted or Repaired ( ) 1/�by.... ... �4 icl ..Er -: . ---------------------•-•-•...•. Install .. .................................................... p( l erp� has been.Finstalled in•accordance with the provisions of Artic e I o e State Sanitary Cod as des ribed in the applicafion for Disposal Works Construction Permit No. '.... _ 0......_._... dated.._. .._i'�.._-'.... ... ................ THE ,ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE®,A A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ' DATE......... inspector...'._._._. THE COMMONWEALTH OF MASSACHUSETTS Wr: BOARD F. HE TH OF / _ Uinvur�tt Work, 1111 rrrmit Permission 's ereby granted.:._._ - . ,� -- to Const t ( ) or repair ( ) a I divid 1 a e� i po.,al System at No. It ----- ` .. . .. Street .. as shown on the application for Disposal Works Construction Permit No.......... ........ D. �. _..:. /,.__x :- = . . f .�• �� � (�` � Board of Health ti DATE.../...: •+---------------------------------•--•-- , FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS \. • - 1, fF .... LL SYSTEM PROFILE MALL SYTE AR ED WITHC MAGNETIC TTAPEAOR BE NOTES COMPARABLE MEANS FOR FUTURE LOCATION. School PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) 1. DATUM IS NAVD 88 St. ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 2" PEASTONE OR GEOTEXTILE 4" SCH40 VENT WITH 2. MUNICIPAL WATER IS EXISTING VIEW CQtZ,LLt \ TOP FOUND. EL. 37.0' FILTER FABRIC OVER STONE CHARCOAL FILTER AS `c 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. �Q 33.0' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 32'-33' SHOWN PLAN PITCH BACK TO VV SAS, Bay NOTE: 2" MIN. WALL NO LOW POINTS. 4. DESIGN LOADING FOR ALL PROPOSED PRECAST PRECAST H-10 THICKNESS REQUIRED B ear LOCKS OR UNITS TO BE AASHO H-2Q (H-10 TANK) shell RISERS (TYP.) PRECAST RISERS Or At 2'0 4"OSCH40 PVC MORTAR ALL ` 6" MIN. SUMP PIPES LEVEL 1ST 2' COMPONENTS H-20 5. PIPE JOINTS TO BE MADE WATERTIGHT. " 12" MIN. INT. DIM. 4' (TYP.) 4aE Hull ENDS SID Pine Ride 10" 1500 GAL H-10 " P °° °° _ °°. ' °°°°° 6 CONSTRUCTION DETAILS TO BE IN ACCORDANCE 14 WITH 29.92' TEE SEPTIC TANK TEE °°°°°°°° ooa� 0 aoaa omao_0 -aooa >°°°° 967 ° ° ° ° ° ° ° ° 310CMR 15.000 (TITLE 5.) ° ° o 0 0 o WATERTEST D'BOX °o°o aooaaooao nm�1 a©o�Ia000aaaa °a°o°o° °000000000p0 'O°°°°°°° I�I�I�I�I�I�I�I�I�I�IJ I�©IJ I��I�I�I�I�I�I� °°°°°°° Locus GAS BAFFLE:.` °°,°°,°°°o FOR LEVELNESS c�i >0000°o°000 oa��a�ooaao aooa000�a�a .00000000 °°°°°°°° 00000000 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 4' LIQ. LEVEL (ACME OR EQUAL) 28.30 28.13 ° ° ° ° ° ° ° ° 26.0 NOT TO BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. .0p�p�pOp�ppp�p�p�p�pOpOp�p�p000p0p�p�pQp�p0p0 y 000°o°o0onono�o1opo°00000�o�o0,o„o°o„o°o0000. 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. (3) UNITS REQUIRED Nantucket ALL AROUND PRECAST STRUCTURES 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 33.50' X 12.83' 9. COMPONENTS NOT TO BE BACKFILLED OR Sound b CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION. (15.221 [2]) o HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. ( 4 % SLOPE) ( 6•5% SLOPE) 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP ( CALLI G DIGSAFE (1-888-344-7233) AND 16.0' BOTTOM TH-1 VERIFYING THE LOCATION OF ALL UNDERGROUND & SCALE 1"=2000'f LEACHING NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF FOUNDATION- 17 SEPTIC TANK 21 D' BOX 15' FACILITY WORK. .VARIANCES., FOR SEPTIC SYSTEM REPAIRS WHICH MAY ASSESSORS MAP 18 PARCEL 99 BE IMMEDIATELY GRANTED BY THE BOARD OF 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL *THE INSTALLER SHALL VERIFY THE HEALTH AGENT OR BY HEALTH INSPECTOR BE REMOVED BENEATH AND 5' AROUND THE LOCATIONS OF ALL UTILITIES AND ALL PAPERWORK AND HEARING REDUCTION PROPOSALS PROPOSED LEACHING FACILITY. BUILDING SEWER OUTLETS AND APPROVED BY THE BOARD OF HEALTH REVISED ELEVATIONS PRIOR TO INSTALLING ANY DURING A PUBLIC HEARING HELD ON DEC. 10, 2013 12. EXISTING LEACHING FACILITY SHALL BE PUMPED LEGEND PORTION OF SEPTIC SYSTEM 2) FOR ALL SYSTEMS THAT HAVE NO INCREASE IN SAND.AND REMOVED OR PUMPED AND FILLED WITH CLEAN FLOW - SYSTEM COMPONENT INSTALLATIONS 99 PROPOSED MORE THAT THREE FEET BELOW GRADE EXISTING coNTouR WITH` PROPER VENTING (PIPED TO THE ATMOSPHERE) SYSTEM DESIGN: X 99.1 EXIST. SPOT ELEV. AND WITH H-20 LOADING, BUT IN NO CASE SHALL -[99]- PROPOSED CONTOUR THE SAS BE LOCATED MORE THAT SIX FEET BELOW GRADE. GARBAGE DISPOSER IS NOT ALLOWED 198°41 PROPOSED SPOT EL. TH1 ' EXISTING 3 BEDROOM DWELLING _q� TEST HOLE S8 •1 DESIGN FLOW: 3 BEDROOMS © 110 GPD = 330 GPD 37 ' SLOPE of GROUND USE A 330 GPD DESIGN FLOW UTILITY POLE � � • f SEPTIC TANK: 330 GPD (2) = 440 FIRE HYDRANT USE A 1500 GAL. SEPTIC TANK NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING ^� 0 LEACHING: SIDES: 2(33.5 + 12.83) 2 (.74) = 137 GPD VL TEST HOLE LOGS �ti �� TH1 0 BOTTOM 33.5 x 12.83 (.74) = 318 GPD 1� TH2 25Y `� n TOTAL: 615 S.F. 455 GPD ENGINEER: DANIEL E. GONSALVES, SE #13587 ,� X V WALKOUT EXISTING w � � � N ,� DWELLING �o USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) SILL 29 WITNESS: DONALD DESMARAIS RS 1 WORK ?It'�'�1 .0 TOF = 37.0 w WITH 4 STONE ALL AROUND DATE: 1/12/18 LI MIT ._�< N LINE (0 DECK PERC. RATE _ < 2 MIN/INCH N SIL zo FE E CLASS I SOILS P# 15571 �a 19 ti� 21 G G r MA ELEV. ELEV. 2� 2 O / APPROVED DATE BOARD OF HEALTH / �,� O / 0 27' 0 27' GRASS/ O DRIVE FILL ALL \ 20" 24" TITLE 5 SITE PLAN PR P. NT TH C RCO FIL B CRE INA PLAC ENT Y 29 o LOT 2 OF A A CO ACT TH EO R ^�� LS LS ON ATION / 43,602 S.F. rr `` #80 NICKERSON ROAD 10YR 3/2 ,� 10YR 3/2 ° 35 �V 26�� 28 �.. COTUIT, MA B B BENCHMARK: , CEMENT BOUND PREPARED FOR LS LS / • =36.3' NAVD88 B RTOL TTI CONSTRUCTION/ „ 1 OYR 4/4 „ 1 OYR 4/4 , „ O O 38 23.8 40 23.7 ,••' N56'S7 52 SYMONDS DATE: JAN. 25, 2018 C C �� REV: FEB. 23, 2018 (SAS LOCATION) PERC g6 H OF M,qs o����/�```•°`c�� ��'`�a . off 508-362-4541 as �` M/CS M/CS �5 6 o CJALA C7ANIELA. �� �G� CAN! L. �c� fax 508-362-9880 CIVIL (D o A. I downcape.com No 46502 �v � A � • • • 2.5Y 7/4 2.5Y 7/4 ;`c., �° �� N, `'r` Bowl! cope ed /deer/I!8 /IIc. 8 132" 16' 132" 16' s^�JGT01 �'�� �n N civil engineers BOA !yN E S yC) 4 g s NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' _ Nw\rw ,e land surveyors C 939 Main Street ( R to 6A) 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 17-471 C J 9 e 04 1 U 62 d Il, w @@ i } '. l�il �4' R4• 4 � t 1 a j i