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HomeMy WebLinkAbout0116 RALYN ROAD - Health Cotuit F . . A 022 049 J f r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION . 5<s TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 116 Ralyn Road Cotuit MA 02635 Owner's Name: George Bozak Owner's Address: Same Date of Inspection: May 5,2006 Job#06-123 / }� 1 Name of Inspector: PATRICK M. O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779CD -t CERTIFICATION STATEMENT _ -- I certify that I have personally inspected the sewage disposal system at this address and that the information reported ; below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I Am€a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:,; `, • F_'% --X_ Passes S�#:' •��A'r ����': Conditionally Passes Needs Further Evaluation by the Local Approving Authority = A IC G� Fails = "� L •—+ Inspector's Signature: Date: 5/5/06 •�; J'3['F,1 �pQ'*� �F5 INSPEG The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Ithaettil 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. Notes and Comments: Leaching chambers have 1-2"of standing water with no high stains.Tank.is not in need of pumping at this time. ****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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 116 Ralyn Road,Cotuit Owner: George Bozak Date of Inspection: May 5,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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: 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 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: Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 116 Ralyn Road,Cotuit Owner: George Bozak Date of Inspection: May 5,2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a 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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 116 Ralyn Road,Cotuit Owner: George Bozak Date of Inspection: May 5,2006 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 _X_ 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 _X_ 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 pi e 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. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _X_ 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. IThis system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _No_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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 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 I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 116 Ralyn Road,Cotuit Owner: George Bozak Date of Inspection: May 5,2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ _ 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 back up X 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,material 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)] i II. Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 116 Ralyn Road,Cotuit Owner: George Bozak Date of Inspection: May 5,2006 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: unknown Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no):No [if yes separate inspection 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: 162,000 gal.=221 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):— Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: 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 _X_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 ob_tained 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: Compliance date:6/26/02 Were sewage odors detected when arriving at the site(yes or no): No I i Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 116 Ralyn Road,Cotuit Owner: George Bozak Date of Inspection: May 5,2006 BUILDING SEWER: XX (locate on site plan) Depth below grade: 2' Materials of construction:_cast iron _X_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: 1' 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: 10.5'long x 5.8'wide—1500 gal. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle:30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" 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.): Tees are intact and clear,liquid level at bottom of outlet invert. GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): I 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.): i i Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 116 Ralyn Road,Cotuit Owner: George Bozak Date of Inspection: May 5,2006 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 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.): No solids or hieh stains aresent. Liquid level equal at bottom of outlet inverts. 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.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 116 Ralyn Road,Cotuit Owner: George Bozak Date of Inspection: May 5,2006 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _ leaching pits,number: —X_leaching chambers,number: Two 500 gal drywells. _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.): Observed 1-2"of standing water in 24"deer)chambers,a riser was installed as part of inspection to improve access to leachine chambers for maintenance and inspection. CESSPOOLS: No (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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 116 Ralyn Road,Cotuit Owner: George Bozak Date of Inspection: May 5,2006 SKETCH OF SEWAGE 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. Ral n Road ,� Driveway ..:.::::. :......:. 28 48 45 64 Page 11 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 116 Ralyn Road,Cotuit Owner: George Bozak Date of Inspection: May 5,2006 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 feet Please indicate(check)all methods used to determine the high ground water elevation: _Obtained from system design plans on record- If checked,date of design plan reviewed: _Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: _Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el. 15 and topo map shows property above el.50. COMMONWEALTH OF MASSACHUSETTS F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS W DEPARTMENT OF ENVIRONMENTAL PROTECTION OW I y Sy e TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 132 Ralyn Road Cotuit MA 02635 Owner's Name: Arthur Brennan Owner's Address: Same 7p� Date of Inspection: May 5,2006 Job#06-125 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 certify that I have personally inspected the sewage disposal system at this address and that the information repotted y: 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 D P, g P Y 1 QgV1111 fit approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The systemi, �����N OF/�JgS�i4,0 tt .� __X_ Passes _;+ • •, G Conditionally Passes _ TH K m Needs Further Evaluation by the Local Ap oving Authority - M Fail ` Q' LL. :co Date: 5/5/06Inspector's Signature, �''�i;�j' .�j;rTlF,\�• �o?�•`� 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. Notes and Comments: Tank has liquid only with no solids and not in need of pumping,leaching chambers are empty with no sidewall stains. ****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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 132 Ralyn Road,Cotuit Owner: Arthur Brennan Date of Inspection: May 5,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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: 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 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: it Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1.32 Ralyn Road,Cotuit Owner: Arthur Brennan Date of Inspection: May 5,2006 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: _ privy or Cesspool ri is within 50 feet of a surface water P p Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I 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 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 132 Ralyn Road,Cotuit Owner: Arthur Brennan Date of Inspection: May 5,2006 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 _X_ 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 _ _X_ 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. _X Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.[ _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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 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 Address: 132 Ralyn Road,Cotuit Owner: Arthur Brennan Date of Inspection: May 5,2006 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ 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) _X_ 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? X _ 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: 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)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 132 Ralyn Road,Cotuit Owner: Arthur Brennan Date of Inspection: May 5,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection 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: 55,000 gal.=75 gpd. Sump pump(yes or no): No Last date of occupancy: One year prior to inspection. COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: 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 _X_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: Compliance date for leaching system: 1/8/04 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 132 Ralyn Road,Cotuit Owner: Arthur Brennan Date of Inspection: May 5,2006 BUILDING SEWER: XX (locate on site plan) Depth below grade: V Materials of construction:_cast iron _X_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: 6" Material of construction:_X_concrete_metal_fiberglass_polyethylene —other(explain) Iftank 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 gala 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.): Tank has liquid only,not in need of pumping at this time.Tees are intact and clear with liquid level at bottom of outlet invert. GREASE TRAP: No (locate on site plan) Depth below grade: .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: 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 I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 132 Ralyn Road,Cotuit Owner: Arthur Brennan Date of Inspection: May 5,2006 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 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.): No solids or hiizh stains observed,liquid level at bottom of outlet pipes. 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.): Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 132 Ralyn Road,Cotuit Owner: Arthur Brennan Date of Inspection: May 5,2006 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _leaching pits,number: _X_leaching chambers,number: Three 500 gal drywells. 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.): Observed no standing water or sidewall stains. CESSPOOLS: No (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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 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.): Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 132 Ralyn Road,Cotuit If Owner: Arthur Brennan Date of Inspection: May 5,2006 SKETCH OF SEWAGE 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. Ivi ad 1 F ater Service t7� rwewa�y .......... ............. ................ K-0: r .... . t� .... . .......... ............... ........... ... ............ 4 ........... 37 38 23 32 32 • Page 1 I of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 132 Ralyn Road,Cotuit Owner: Arthur Brennan Date of Inspection: May 5,2006 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 feet Please indicate(check)all methods used to determine the high ground water elevation: _Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el. 15 and topo map shows property above el.50. h ,t THE COMMONWEALTH OF MASSACHUSETTS FEE / BOARD OF EA�L�TH OF u-I APPLICATION FOR DISPOSAL SYSTEM CO�TRUCTION PERMIT truct Application for a Permit to Cons ( Repair ( ) Upgrade ( ) Abandon ( omplete System ❑Individual Components lf� , Lpcation�/� Owner's Name rM�a�p/Parcel# Address Lot# Telephone# Installer's Name Designer's Name Address Address Telephone# Telephone# Type of Building: Lot Size 2a D5�) Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) gpd Calculated d sign flow 30 gpd Design flow provided- , '!-gpd Plan• Date � umber of sheets Revisi n Date Titl Descriptio of Soil(s) - Loou �- � '� _QOwit, ���- -s� Soil Evaluator Form No. Name of Soil Evaluator i 56k—t� �Date of Evaluation a -��- DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to ins II the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further s not to ce the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date t�.I �7 c, FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 s1 l t �• �.,-t.,•n. _,ne.q r _ 1 .-�_ ,,,('.1r4..•.� No 000--41"� THE COMMONWEALTH OF MASSACHUSETTS FEE ,AV 4. 4 t�M BO'ARDT Clf EALTH _ % ` qr OF - - APPLICATION O-R DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct (Repair ( ) Upgrade ( ) AbandonV.({ mplete System ❑Individual.Components , L nation Owner's Name C__)p/Parcel# / Address .i Lot# �x r is /v9 Telephone# • 4 Installer's Name Designer's Name Address Address Telephone# Telephone# Type of Building: Lot Size �� 1 Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons (o Showers ( ), Cafeteria ( ) Other fixtures r Design Flow(min.required) '.t� gpd Calculated design flow gpd ' Design flow Provided Plan• Date `0'k Number of sheets , Revision Date } Title - 4 Dn A " �. Descriptio of Soil(s) La i—1 e (O Soil Evaluator Form No. Name of Soil Evaluator lb P 16�Date of Evaluation ra -02t7 D.ESCRIPTION OF REPAIRS OR ALTERATIONS , The undersigned agrees to ins II the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not tc,,pldce the system in operation until a Certificate of Compliance has been issued by the Board of Health. E °' ; Signed Date a.I� cl i FCIRM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. zoo V —dA� THg COMMONWEALTH OF MASSACHUSETTS FEE - ��nStJ BOARD OF HEALTH - CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Comv`14ment(s) Complete System The undersigned hereby certify that-the_Seewj'aage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned - ( ) has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and.the approved design plans/as-built plans relating to sapplicatio -AOP,0 O `dated Approved Design Flow (gpd) Installer T' a! i„�"/✓"�' Designer: l Inspector Date b r?6 v The issuance of this certificate shall not be construed as a guarantee that the system will function as designe . FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE 0-0) b(A BOARD OF HEALTH - DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is'hereby granted—to to Construct /" Repair ) U grade (_ ) .Abandon ( ) an individual sewage disposal system at IZA( i ate' C,=� � � as described in the application for Disposal System Construction Permit No. WW .,V'ZW---Glr�3s,dated" ;L7J--LS Provided: Cornst uction shall be completed within three years of the date of this p it.All loca°f conditions must be met. Date Vy Board of Health C, FORM 2 - DSCP DEP APPROVED FORM 5/96 rhYJ iX 1 C FORM 1255 (REV 5/96) Y H&W HOBBSB WARREN TM PUBiISHERS-'BOSTON ... "IX �� - . --- 73 rho w i1 of na.-HStab L ..` Department of I ealtli,Safety,and EnvironmentTt Services VE Public Health Division Date2- � � 367 Main Street,I lyannis MA 02601 BARNaTABEZ ` q "ren39. 0. Date Scheduled t'L / Time C'� :Fee Pd. CCU D Soil Suitability Assessment for Sewage Disposal Performed By: U _ l• YL� Witnessed By: .�9✓��y LOCATION & GENERAL INFORMATIO LL Location Address ! Owner's Namcmcyr {a Q_I„QJ)t�T_.C�k-r Address Assessor's Map/Parcel: m eo_A� Engineer's NameC&P, NEW CONSTRUCTION V1 REPAIR TelephoneN ' 50S-Lh _10'2_ Land Use W o e d�`7 Slopes(%) �p Surface Stones 14'11"4e' Distances from: Open Water Body fi Possible Wet Area R Drinking Water Well tl R Property Drainage Way P Y Line n Other n 'SKETCH:(CH Stre t name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) I � 7 3 S I Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Ilole: Weeping from Pit Face Estimated Seasonal High Groundwater DETE RMINATION FOR SEASONAL HICII°WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to soil mottles: Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well N Reading Date: Index Well level Adj.factor Adj.Groundwater Level - a PERCOLATION.TEST gate` Time. Observation Hole N 'rime at 9" Depth of Pere Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./Inch Z - Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Al _ - Original: Public Ilealth Division Observation Hole Data To Be Completed on Back---j Copy: Applicant DEEP 013SEIZVATION HOLE LOG Mole # � Depth liom Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Bouldcres. Consistency, Gravel) sa"•t s!G Z � 3 0 � � .., �oYA yd r�l�w -T DEEP OBSERVATION HOLE LOG Hole# U Depth from Soil Ilorizon Soil Texture Soil Color Soil . Other Surface(in.) (USDA) (Munscl!) I Mottling (Structure,Stones,Boulderes. Consistency, or v l p Z 3 d L,� �o iL I Ao Zl DEEP OBSERVATION HOLE LOG Holc# Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,iloulderes. Consistency.°o ravel h t DEEP OBSERVATION HOLE LOG Hole.# Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistent % 'ravel I Flood Insurance Rate Man: Above 500 yell 119od boundary No— Within 500 year boundary No Yes Within 100 year tlond boondary 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 and experience described in 310 CMR 15.6,17. IS Signature _ Date /--Z''�`= $� /0 E c_ `nnTOWN OF BARNSTABLE �t4�u K SEWAGE # Zd6Z,-O(IG LOCATION q \ y / . VILLAGE �v r ASESSOR'S MAP & LOT 776.-9os'c{ INSTALLER'S NAME&PHONE NO. ELL, " SEPTIC TANK CAPACITY 1SOc9 j LEACHING FACILITY: (type) 6 �u2r Z (size) NO.OF BEDROOMS 3 BUILDER OR OWNER ^ PERMITDATE: COMPLIANCE DATE:—A Separation Distance Between the: Maximum Adjusted Clroundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) urnished by y 3 y A i TOWN OF BARNSTABLE �T ®g e' LOCATION Il(a \4���Kd. SEWAGE # Z06Z-U(oC, VILLAGE G.7yy t ASSESSOR'S MAP & LOT / �76 INSTALLER'S NAME&PHONE NO. f L 905 c{ SEPTIC TANK CAPACITY �SUy 1 LEACHING FACILITY: (type) C-\aw.5er5 �Z> (size) Saa NO.OF BEDROOMS 3 BUILDER OR OWNER :V PERMITDATE: 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 Z8 -L 01- bz.=j3��2�, �3 4(0 3� y 3 y� - TOWN OF BARNSTABLE � ,LOCATION � �Y/'� ��� SEWAGE # n!?6 VILLAGE Co t ASSESSOR'S MAP & LOT f 1� �'S NAME&PHONE NO SEPTIC TANK CAPACITY /500 LEACHING FACILITY: (type) Ch ► s J (size) �� ��✓' NO.OF BEDROOMS BUILDER OR _ PERMITDATE: . C®JP� DATE: eJ 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by _ k k _ ��� o�� ': � y� �� �� SYSTEM PROFILE TOP OF NOT TO SCALE FOUNDATION FINISH GRADE EL. 79.5 FINISH GRADE OVER FINISH GRADE OVER EL. 78.0 SEPTIC TANK 78.0 DISTRIBUTION BOX 78.0 FINISH GRADE _ o OVER TRENCHES 78.0 RISERS TO 6" _ ^ o y OF FINISH GRAD PRECAST CONCRETE �4=' `= '' / °i •� ,'•1 O'O.1 '",./V _��. vC I11�1'�•I'�r r'o r'b r. 3"MAN. RISERS TO 6" _�-�` b 500 GALLON DRYWELLS MIIv.sLOPE 1% OF FINISH GRADE OUTLET PIPE(S) LEVEL H-10 REINFORCED LOADING 13" FOR 2'( MIN.1% SLOPE TRENCH LENGTH = 25'-0" _ 6„ m- IvtIN.sLOPE 1% ° 9 BEYOND MrN C DRYWELL LENGTH = 8'-6" 13"MIN. 14" o 0 o- •.d 75.00 ✓- .r 6"SUMP o M 74.75 74.67 o -4- PVC OR CAST IRON TEE ; •,f ,o:l 74.50 °'� 1 *�o o , •� R, 1 ,o•, ' f tom! r -•- ,«•,' Oi-,�A GAS BAFFLE � -b •b o ��, .,o, r• r ,o �J a. oil.._-J_„ o .;o,. ., r 1 . DISTRIBUTION BOX 1500 GALLON w ,a MINIMUM INSIDE DIMENSION 12" 3/4"- 1-1/2" DOUBLE EL.72.2 - _ _ a OUTLET INVERTS 2 BELOW INLET INVERT 3/4 1 1/2 DOUBLE. PRECAST CONCRETE MINIMUM CONCRETE WALL THICKNESS 2" WASHED CRUSHED 5 2, WASHED CRUSHED 4' `, INSTALL ON COMPACTED LEVEL BASE STONE STONE BSMT.FLR. H-10 REINFORCED a ELEV. 72.0 of 16- _ BOTTOM PIT#1EL.67.0 1° 1 rpQ'yp ; d F- ,, ,,- i ' „ ,, c , ,r' TRENCH SECTION ION `0,:1 'Y ,'O °• 1 CIO •� �' 1 0 �� 0 r 0 r ',° 1'0 _° 1'O °`�,:i. NOTE: EXCAVATE TO =C= STRATUM IN ORDER TO SEPTIC TANK REMOVE ALL =A= & =B= IMPERVIOUS MATERIAL INSTALL ON COMPACTED LEVEL BASE WITHIN 5' OF THE SAS. REPLACE WITH CLEAN, „ CLAY-FREE SAND 9 MIN. 3" OF 1/8" - 1/2" 4" DIAM. 36" MAX. DOUBLE WASHED PEASTON .�/'014. M n j ,,�i �__�,.,7�ry;o n f^. r{ _ t-r,' 6` •,. 6', _ ''p ',f.r ''b I r- ,, n- 48" 3/4 - 1-1/2 DOUBLE 11 1 11Y 48 5-2WASHED CRUSHED STONE TRENCH WIDTH a 13'-211 n , �I J• , r ,� `era �c a;�k .y.. I �' lS NUMBER OF TRENCHES 1 b GENERAL NOTES: NUMBER OF DRYWELLS 2 �-S '; �. =�� , : �?a 1. ELEVATIONS SHOWN ARE BASED ON ASSUMED _ °'� , .1 . ' , ,r° AL PIPS" T -*- ., . .� , II� .L PIPES IN THE SYSTEM MUST BE CAST IRON LHSE.N, 4 OBSERVA I ION PIT .104 OR SCHEDULE 4Q PVC. n 9 :>ii `�_ 3. HEALTH AGENT/CAPE& ISLANDS ENGINEERING P-10 153 , 4v ,QN MUST BE NOTIFIED WHEN CONSTRUCTION IS PERCOLATION RATE: < 2 MIN./IN COMPLETE PRIOR TO BACKFILLING. r � r " WITNESSED BY: D.STANTON a�r> i ,' > N Pt; 4.ANY CHANGES IN THIS PLAN MUST BE APPROVED ,F. *, a � �"' _ - ,. r, .-,o BARNSTABLE BOARD OF HEALTH µ , BY CAPE & ISLANDS ENGINEERING AND THE BOARD I HYD.SPN. T,M. _ �,,, OF HEALTH. DATE: JAN.29,2002 DESIGN DATA ; EL.79.0 // 5. MATERIALS AND INSTALLATION SHALL BE IN 0ll PITS#1 &#2 SAME 171.82' COMPLIANCE WITH THE STATE SANITARY CODE =A= LOAM [TITLE V] AND LOCAL APPLICABLE RULES AND 10 YR 2/2 REGULATIONS. 2„ NUMBER OF BEDROOMS 3 6. NORTH ARROW IS FROM RECORD PLANS AND IS GARBAGE DISPOSAL NO \�loo I'`Y �� NOT INTENDED FOR SOLAR ENERGY PURPOSES. =B= LOAMY SAND DAILY FLOW 330 GPD. 7. WATER SUPPLY: MUNICIPAL WATER SYSTEM. 10YR 5/6 i ► 8. FLOOD ZONE C NON-HAZARD SEPTIC TANK REQUIRED 1500 GAL. ��--, [ l 3011 SEPTIC TANK PROVIDED 1500 GAL. Q � � 26.00' � 10. THIS PROJECT DOES NOT INVOLVE ANY PHYSICAL LEACHING REQUIRED 330 GPD. I \ �> i #1 GROUND DISTURBANCE OR VEGETATION REMOVAL lol `��' I I WITHIN 100' OF WETLANDS,INLAND OR COASTAL SOIL ABSORPTION SYSTEM CALCULATIONS: `� WATER SERVICE w —— BANKS OR FLOOD HAZARD ZONES. j �— — — — — Q I —- /� =C= MEDIUM SAND S a a N � o Q I r-- 1 / o`�o 10YR 7/4 35 © i _ I i // SIDEWALL AREA = 152 SF. a ,— 20.00' a ls' 000 / �s 152SF. X .74G/SF. = 112GPD. �tD BOTTOM AREA = 329 SF. ' DRIVEWAY a __ / �N11 EIT 329 SF. X 0.74 G/SF. = 243 GPD. N 30' -/l N �, LEGEND 120° NO GROUNDWATER EL.PIT#2 67.07 LEACHING PROVIDED = 355 GPD. I 48.00' / ®#2 a p 52 PROPOSED CONTOUR SINGLE FAMILY RESIDENCE -—-52-— EXISTING CONTOUR / N LOT 10 PROPOSED SEWAGE DISPOSAL SYSTEM 22,257 SF. OBSERVATION PIT PREPARED FOR I `\ �` ❑ DISTRIBUTION BOX McSHANE CONSTRUCTION 169.531 �� o p o SEPTIC TANK HSE.NO. 116 [LOT 101 RALYN ROAD J F ----- --- �g------- ? , 9� °' COTUITNASS. SOIL ABSORPTION SYSTEM PLAN NO. 021102 SCALE- AS NOTED �ISENO R�sERVE RESERVE AREA o ��' �_' FILE NO. 158BA DATE: FEB.11,2002 cli 126 22.26 PIPE INVERT ELEVATION SEPTIC FILE NO. 71 PCS FILE: RALYN RD 0 0 0 CAPE & ISLANDS ENGINEERING PLOT PLAN 22 49 10 116 11 _ 1 ��A, ,s .�,.,1°rFS' ,fi 800 FALMOUTH ROAD, SUITE 301C SCALE: 1 - 30 MAP SEC PCL LOT HSE MASHPEE,MA 02649 (508)477-7272 I SYSTEM PROFILE NOT TO SCALE ! TOP OF FOUNDATION FINISH GRADE FINISH GRADE OVER FINISH GRADE OVER EL. 79.5 EL. 78.0 SEPTIC TANK 78.0 DISTRIBUTION BOX 78.0 FINISH GRADE ` OVER TRENCOES 78.0 � _RISERS TO 6" _ =A^ OF FINISH GRAD o 0 -, .o �. , . � r PRECAST CONCRETE �o -,.,� ,'� o, `� 500 GALLON DRYWELLS I _ RISERS TO 6 b' _ H-10 REINFORCED LOADING 3 MAN. OUTLET PIPE(S) LEVEL OF FINISH GRADE =�V o MIN.SLOPE 1% t FOR 2'( MIN.1% SLOPE TRENCH LENGTH = 25'-0" 3" 6rr .° MIN.SLOPE 1% o Q BEYOND ` o MIN O DRYWELL LENGTH = 8'-6' r 0` n 14rr - ` 6rr.SUMP'� c,r°• � ''o' ~�' r. .�' , , .ejo i.o 'r t ' r. r li a'r \� 75.30 75.00 13 MIN. �F MIN/ ,o, a 7467 b ` r 7 PVC OR CAST IRON TEE 4 oz� GAS BAFFL a 16 DISTRIBUTION BOX 74.20 y,-�' .° w ': MINIMUM INSIDE DIMENSION 12 3/4 - 1-1/2 DOUBLE 3/4 1 1/2 DOUBLE 0 1500 GALLON a :A OUTLET INVERTS 2" BELOW INLET INVERT WASHED CRUSHED 5 2, WASHED CRUSHED 4 o< -a STONE PRECAST CONCRETE � MINIMUM CONCRETE WALL THICKNESS 2 STONE INSTALL ON COMPACTED LEVEL BASE ! BSMT.FLR. ;o__;o-;�, 6' BOTTOM PIT#lEL.67.0 H-10 REINFORCED p ELEV. 72.0 'a; \ - ,Q TRENCH SECTION t y. eo'1 r i •r •r r:..'r r i r1 '1 0 r.•°• r, ,• .�'' ', � r o', r r.r' 'r 1\ 6,, 'n or, r fir. . r0 , ,,0� r ',0 r 'r0:/l :i '' :r - � NOTE: EXCAVATE TO =C= STRATUM IN ORDER TO - - - - 9 MIN. 3 OF 1/8 1/2 SEPTIC TANK REMOVE ALL =A= & =B= IMPERVIO:JS MATERIAL - INSTALL ON COMPACTED LEVEL BASE WITHIN 5' OF THE SAS. REPLACE WITH CLEAN, �� rr ,� CLAY-FREE SAND 4" DIAM. 36" MAX. DOUBLE WASHED PEASTONE V, (� 6 , r �,f0 •0 r,.r •al .�0 � ,_,1F (�JtS � .. . br^.r,�. A'f� r, �,;j° 0..•.��I,O,�L' ,o ,•�,,r,r -� ,; 4 - < � .�•,., =�- ., ., _, . ,r �'o•• 3l4 - 1-1/2 DOUBLE r_2rr WASHED CRUSHED 48 i 'r 5 r, STONE TEN H WIDTH 131-211 NUMBER OF TRENCHES 1 GENERAL NOTES: I NUMBER OF DRYWELLS 2 ' 1. ELEVATIONS SHOWN ARE BASED ON ASSUMED -�•'�!�� �t f +4, ,��,� y, 2.ALL PIPES IN THE SYSTEM MUST BE CAST IRON OBSERVATION PIT OR SCHEDULE 40 PVC HSE.NO.104 y, 3. HEALTH AGENT/CAPE & ISLANDS ENGINEERING P 10,'!53 I y� yam, \a✓ s MUST BE NOTIFIED WHEN CONSTRUCTION IS PERCOLATION RATE: < 2 MIN./IN COMPLETE PRIOR TO BACKFILLING. WiTNESSE BY: D.STANTON 4.ANY CHANGES IN THIS PLAN MUST BE APPROVED BARNSTABLE�BOARD OF HEALTH BY CAPE & ISLANDS ENGINEERING AND THE BOARD HYD.SPN. \� -"- MR OF HEALTH. rr DPITS#A&.29SAI DESIGN DATA EL.79.0 / 5. MATERIALS AND INSTALLATION SHALL BE IN COMPLIANCE WITH THE STATE SANITARY CODE =A= LOAM i 171.82 [TITLE V]AND LOCAL APPLICABLE RULES AND 10 YR 2/2 NUMBER REGULATIONS. 2" GARBAGEODISPOSAL BEDROOMSNO 6. NORTH ARROW IS FROM RECORD PLANS AND IS =g- LOAMY SAND DAILY FLOW 330 GPD. M NOT INTENDED FOR SOLAR ENERGY PURPOSES. 7. WATER SUPPLY:MUNICIPAL WATER SYSTEM. 10YR 5/6 SEPTIC TANK REQUIRED 1500 GAL. i I 8. FLOOD ZONE C [NON-HAZARD] 30" SEPTIC TANK PROVIDED 1500 GAL. �►'--� 10. THIS PROJECT DOES NOT INVOLVE ANY PHYSICAL LEACHING REQUIRED 330 GPD. Q 26.00' n „, I G� #1 GROUND DISTURBANCE OR VEGETATION REMOVAL � \ j \ WITHIN 1 00' OF WETLANDS,INLAND OR COASTAL SOIL ABSORPTION SYSTEM CALCULATIONS: BANKS OR FLOOD HAZARD ZONES. =C- �� WATER SERVICE q 00 —, —) = MEDIUM SAND �- — — — — — I I / 10YR 7/4 SIDEWALL AREA= 152 SF. N x O W I r'---, /- � a�. 35' ° o Q i i / 152 SF. X .74 G/SF. = 112 GPD. oil BOTTOM AREA = 329 SF. --� 20.00' a� 1s 000 i i �// .1, W 329 SF. X 0.74 G/SF. = 243 GPD. cn 4 c -—j I M � �` LEGEND 120" NO GROUNDWATER EL.P T#2 67.� LEACHING PROVIDED = 355 GPD. DRIVEWAY ———— cry I 48.00' #2 52 PROPOSED CONTOUR I / I Q SINGLE FAMILY RESIDENCE EXISTING CONTOUR � �N LOT 10 PROPOSED SEWAGE DISPOSAL SYSTEM i 3 / 22,257 SF. �� OBSERVATION PIT _ � � - PREPARED FOR I \� ❑ DISTRIBUTION BOX 1 ' MCSHANE CONSTRUCTION 16953, �� � ,;° HSE.NO. 116 [LOT 10] RALYN ROAD o 0 o SEPTIC TANK a _ p COTU IT,MASS. o SOIL ABSORPTION SYSTEM H , PLAN N0. 021102 SCALE: AS NOTED kN0 RESERVE RESERVE AREA N ' „ ,^� "` ' FILE NO. 158BA DATE: FEB.11,2002 SE. N r SEPTIC FILE NO. 71 PCS FILE: RALYN RD .126 22.26 PIPE INVERT ELEVATION '% ' z z CAPE & ISLANDS ENGINEERING 22 49 10 116 o o / 800 FALMOUTH ROAD, SUITE 301C LAN cf ", '� �� 1 MASHPEE,MA 02649 (508)477-7272 } PLOT P� MAP SEC PCL LOT HSE SCALE: 1 = 30 ` w ` , �,�a�o. 4.''