HomeMy WebLinkAbout0547 SANTUIT ROAD - Health Santuit Road
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
547 Santuit Road
Property Address
Lorantos
Owner's Name a (10 3 6
C 6 4-4 ` MA 026M 6/6/13
City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
A. General Information
1. Inspector: � ��
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
Telephone Number
B. Certification
c� o
I certify that I have personally inspected the sewage disposal system at this adr�e s and thgt the
information reported below is true, accurate and complete as of the time of thefiirt ection. Sw a inWction
was performed based on my training and experience in the proper function and rn intenance of on bite
sewage disposal systems. I am a DEP approved system inspector pursuant t Section47.5.34rof
Title 5(310 CMR 15.000).The system:
w CIO
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
w
6/6/13
Inspecto s Signat Date M
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how ow the system will perform in the future under
the same or different conditions of use.
547 Santuit Road•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�„ •By�� 547 Santuit Road
Property Address
Lorantos
Owner's Name
Barnstable MA 02635 6/6/13
Cityfrown 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:
Pumping suggested every 3 yrs to prolong the life of the system
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:
n/a
❑ 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
547 Santuit Road•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
INN 2
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
547 Santuit Road
Property Address
Lorantos
Owner's Name
Barnstable MA 02635 6/6/13
City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes(cont.):
❑ distribution box is leveled or replaced
ND Explain:
n/a
❑ 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:
n/a
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.
547 Santuit Road•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
Commonwealth of Massachusetts
. Title 5 Official ,Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M , 547 Santuit Road
Property Address
Lorantos
Owner's Name
Barnstable MA 02635 6/6/13
Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ 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 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:
n/a
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 '/day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
547 Santuit Road-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 or 15
Commonwealth of Massachusetts
Title 5-Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 547 Santuit Road
Property Address
Lorantos
Owners Name
Barnstable MA 02635 6/6/13
Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems(cont.):
Yes No
❑ ® 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..
547 Santuit Road•03/08. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
wM 547 Santuit Road
Property Address
Lorantos
Owner's Name
Barnstable MA 02635 6/6/13
Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
❑ ®. 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 up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ 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)]
547 Santuit Road•03/08 Title 5 Official Inspection Pond:Subsurface Sewage Disposal System-Page 6 of 15
r -
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
547 Santuit Road
Property Address
Lorantos
Owner's Name
Barnstable MA 02635 6/6/13
City/Town State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
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: 3
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes. ® No
Water meter readings, if available(last 2 years usage(gpd)):
Sump pump? ❑ Yes ® No
Last date of occupancy: Occupied
Date
Commercial/Industrial Flow Conditions:
Type of Establishment: n/a
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:
Last date of occupancy/use: Date
Other(describe): n/a
547 Santuit Road•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
547 Santuit Road
Property Address
Lorantos
Owner's Name
Barnstable MA 02635 6/6/13
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: No history given
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)
f
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed(if known)and source of information:
2003 per BOH record
Were sewage odors detected when arriving at the site? ❑ Yes ® No
547 Santuit Road•M/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
547 Santuit Road
Property Address
Lorantos
Owner's Name
Barnstable MA 02635 6/6/13
Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 12"feet
Material of construction:
❑cast iron ®40 PVC ❑ other(explain):
>10'
Distance from private water supply well or suction line: - feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade: 6„feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
---------------------------------------------=----------------------------------------------------------------------------
Dimensions: 1500g
Sludge depth: 3„
Distance from top of sludge to bottom of outlet tee or baffle >12'
Scum thickness 1/2
Distance from top of scum to top of outlet tee or baffle
. >2'
Distance from bottom of scum to bottom of outlet tee or baffle >29,
How were dimensions determined? measured
547 Santuit Road•03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
547 Santuit Road
Property Address
Lorantos
Owner's Name
Barnstable MA 02635 6/6/13
Citylrown 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.):
Pumping suggested every 3 yrs to prolong the life of the system
Grease Trap(lo
cate on si
te plan):
Depth below grade: feet
Material of construction:
❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain):
n/a
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
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
n/a
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):
n/a
547 Santuit Road•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
r
Commonwealth of Massachusetts
a Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M ,•�y< 547 Santuit Road
Property Address
Lorantos
Owner's Name
Barnstable MA 02635 6/6/13
Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank(cont.)
Dimensions:
Capacity:
gallons i
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.):
n/a
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert Level w/the bottom of the pipe
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.):
D-Box is 3' below grade and in average condition for its age.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
547 Santuit Road-0308 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15
X Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
'< 547 Santuit Road
Property Address
Lorantos
Owner's Name
Barnstable MA 02635 6/6/13
Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
n/a
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number: 2
❑ leaching galleries number:
El 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.):
Chambers were video inspected and appear to be 1/2 full at this time. No indication of past backup
547 Santuit Road•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal,System-Page 12 of 15
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
547 Santuit Road
Property Address
Lorantos
Owner's Name
Barnstable MA 02635 6/6/13
Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
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
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
n/a
547 Santuit Road•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
r -
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
547 Santuit Road
Property Address
Lorantos
Owner's Name
Barnstable MA 02635 6/6/13
City/Town State Zip Code Date of Inspection
'D. System Information (cont.)
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.
2 �
L. �T
Q �
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C' ,
547 Santuit Road-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M ,••�< 547 Santuit Road
Property Address
Lorantos
Owner's Name
Barnstable MA 02635 6/6/13
Cityrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: >12'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:
You must describe how you established the high ground water elevation:
per elevation of home
547 Santuit Road-03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 15
S 79°46'00,,E 150.00,
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LOT 35A 30.0'
23,400 SF' SAD
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56.70;
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SANICKI
"Icert�thatthedwellingsho ot° 28085 g PLOT PLAN OF LAND
this plan is as it actually exists on e°%. �s B LOCATED IN
ground and that it conforms to the f lw Vp COTUIT,MAS S.
Barnstable zoning re ulationsregardin PREPARED FOR
yard setbacks." — MARTHA LORANTOS
�- ! RL.S.
DATE:NOV.2,2007 SCALE: 1 =30
date.Nov.2,2007 CAPE & ISLANDS ENGINEERING
flood zone c[non-hazard] MASHPEE,MASS.
santuitrd547
TOWN OF BARNSTABLE
•LOCATION S ,�Sfg*&i °� �_ SEWAGE #'1 063-1 J
VILLAGE; ASSESSOR'S MAP & LOT D
INSTALLER'S NAME&PHONE NO` 4;',11 l' Cmellto . 1 12
SEPTIC TANK CAPACITY ,15 UCH �1 01
LEACHING FACILrI7: (type) G�"'- ��'� Qm (size)
.NO.OF-BEDROOMS
BUILDER OR OWNERV"( l 14 5' ®
PERM3ITDATE: COMPLIANCE-I
Separation Distance Between the: �� vt;
Maximurti,Adjusted Groundwater Table io the Bottom of Leaching.Facility Feet
tom, sn, . .
Piivate`Water Supply Welland Leaching Faclhty:(If any wells„exist ' .a
.; _ = -s., r - Feet
on site or within 200,feet of leaching facility) .
=-Edge of Wetland and Leaching Facility(If any'wetlands eiust
within 300;feet of leaching fa ty. ) = Feet
Furnished by ~ a
- �y
No. THE COMMONWEALTH OF MASSACHUSET*S FEE
BOARD OF HEALTH �✓
OF
APPLICATION FOR DISPOSAL S. TEM CONSTRUCTION PERMIT
Application for a Permit to Construct ( ) Repair ( ) Upgrade ( tAbandon ( ) - ff/complete System ❑Individual Components
M Location Owner's Name
�rlTMap/Parcel# Address
S Lode✓ Te phone#
Installer's Name �� Designer's NAne
Address Address
60,1 417_-)-�.z
Telephone# Telephone#
Type of Building: Lot Size ,, 0 Sq.feet
Dwelling—No.of Bedrooms Garbage Grinder ( )
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.required) 531 s gpd Calculated design flow :5-30gpd Design flow provided 4 gpd
Plan: Date _� - �' '� Number of sheets �_ Revision Date
Title n C, sc o� ti
Description of Soil(s) O` - V U-J��J , 3 6L- -v "- (
Soil Evaluator Form No. ame of Soil Evaluator 7.S6Uvvukx. Date of Evaluationl-L2-U�—
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE S and further ag of to pl ce the system in operation until a Certificate of Compliance has been issued by the Board of Health.
7
Signed e:' Date
� b 3
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
+ Y
20p 3- �3`I ,6H
;�. ' x r
ff NO. THE COMMONWEALTH OF MASSACI�;USE '$ FEE ICx�
'.
BOARD O F H E A LT F�_° _
OF N►fJ 1Li�'YJ .
APPLICATION FOR DISPOSAL SY TEM CONSTRUCTION PERMIT
j Application for a Permit_to Construct ( ) Repair ( ) Upgrade ( Abandon O [Complete System ❑Individual Components
Location Owner's Name
Map/Parcel# X Address
t !f� Lot 'e Te hone#
w 1 r M-a, c dti
Installer's Name Designer's Name
Address '- Address
Telephone# Telephone#
Type of Building: Lot Size �3o`-tom Sq.feet
Dwelling—No.of.Bedrooms Garbage Grinder ( )
Other—Type of Building No..of persons Showers ( ), Cafeteria ( )
Other fixtures r"
Design Flow(min.required 5 g'df Ca'1 '{laate--•esign flow 530gpd Design flow provided���gpd
Plan: Date , / { ' ry i 7 �
Number of sheets Revision Date
Title_ C. � .• Ld� I `
.
u 4
Descripti%on of Soil(s)11 d - 4^ Lo u,--,5lo i Zf)'' (kfe- -SaA_,4
Soil Evaluator Form No. Name of Soil Evaluator D. S 6-Y,4 71u_ Dafe of Evaluation't
' DESCRIPTION OF REPAIRS OR ALTERATIONS
. ';
The undersigned agrees to install the above described Individual"Sewage Disposal System in accordance with the provisions of •r
TITLE 5 and further agrees'not to pl ce the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed "A Date .
` o✓e9^ b. , y 3
Y }
t
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
No. �3-13 �u TH�� OMM*ONWEALTH OF MASSACHUSETTS�� +, FEE /()C� ��
I.
R�-szsb�- BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Components) El Complete System
The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( )
1
by: t L
at 5`("7 Sa111 T" I
has been installed in accordance with the provisions of 31 C R 15.00 (Title 5) and the approved design plans/as-built
plans relating to pplicati n No:2 `�3�(dated �/ 3 CG 2 Approved Design Flow (gpd)
j Installer / /JI [ l�(� 3
Designer: Inspector — Date
�.. r W-
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
NO. Z003-13�( THE COMMONWEALTH OF MASSAC'HUSETTS FEE (QO
&11- ,Ks4J;;,CSZ_ BOARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to Construct .( ) aii ( Upgrade ( ) Abandon ( ) an individual sewage
disposal system at ST? Sir , as described
in the application for Disposal System Construction Permit No. -ZQ6 3-t- y dated y 3 G 3
j Provided: Con ru tion shall be completed within three years of the date of this permit. o c n ust be met.
Date �> Board of Health
FORM 2 - DSCP DEP APPROVED FORM 5/96
FORM 1255 (REV 5/96) H&W HOBBS&WARREN PUBLISHERS- BOSTON
-
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TOWN OF BARNSTABLE �
SEWAGE #
LOCATION•
d ASSESSOR'S MAP & LOT
VILLAGE f
INSTALLER'S NAME&PHONE NO. `t �` '�h' �t"x' ✓L
SEPTIC TANK CAPACITY
✓ ar�'yn6c�:�
LEACHING FACILITY: (type) `'" `� cc s c (size)
NO.OF BEDROOMS
BLm DER OR OWNER
PERMIT DATE: �{13�b� COMPLIANCE DA':E:
Separation Distance Between the: Feet
Maximum Adjusted Groundwater Table to_the Bottom of Leaching Facility
Private Water Supply Well and Leaching Facility (If any wells exist Feet
on site or within 200 feet of leaching facility)
exist
Edge of Wetland and Leaching Facility(If any Feet
within 300 feet qf 1 hing fa " ty)
Furnished by
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PA S
FABLED INSPEC!ON
13ORT.OLOTTI: CONSTRUCTION, INC 44�T�� �O
45 INDUSTRY ROAD,MARSTONS MILLS,MA 02648 s�F fs 00
5084-71-9399 508-42878920,` FAX: 508-428 9399 ,
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SUBSURFACE..SEWAGE DISPOSAL SYSTEM INSPECTION,FORM
PART A
CERTIFICATION
Property Address: / & ,
Date Of Inspection. (20 Inspe is Name:
ner's Name and Address
CERTIFICATION STATEMENT•
I Certify that I have personally Inspected the Sewage Disposal System at this.address and,that the informa-
(ion reported below is true,accurate and.complete as of the time,of Inspection The Inspection was perform
ed based on my Training and Experience in the Proper Function and Maiutenance.of On-Site Sewage Dis-
posal Systems.T.he.system•
Passes:
Conditionajer
s es. .
7Needs Fu alua 'ol the Local Approving Authority.:
--------------
Failur
I_nspector's Signature Date:
The.System Inspector shall submit a copy of this Inspection Report to the Approving Authority with Thirty.
(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.Ins pector and.the System Owner shall submit he Report the appropriate Regional Office of
the Department of Environmental Protection. The 0 iginal should be sent to the,System Owner and copies
sent to the Buyer,if applicable:and the Approving Authority.
INSPECTION SUMMAR_ Y:
A) SYSTEM PASSES;
I have not found any Information which indicates that the System violates..any of the fail-
ure.criteria as.d`efhied in 310 CMR 15.303. Any Failure Criteria not evaluated are indi-
cated below.
B) SYSTEM CONDITIONALLY PASSES::
One or.more'System Components need to be Replaced.or Repaired Thee System,upon
completwn of:the Replacement or Repair,Passes Inspection.
Lndicate yes,nor,.or not determined(Y,N,OR ND) Describebases.of determination in all instances. If"not
determined",explain why not.
.The Septic Tankj Metal,Cracked,Structurally Unsound,.shows % stantialaInfiltration or exfil=
tration,'or Tank Failure Mmminent: The System will Pass Inspection:if Existing Septic Tank
is Replaced;* nforming Septic Tank as Approved by the Board Of Health.
Sewage Backup or Breakout or High Static Water Level observed m the Distribution Box is due to
broken or obstructed pipes)or due to a broken,.setiled or uneven Distribution B.ox. The System,.
will pass Inspection,if:(With Approval of the.Board Of Health):
1'-.
SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Broken,pipe(s)replaced
Obstruction is removed
Distribution Box is leveled or replaced
The System required pumping more.than four 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.
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 the Public Health,Safety and the Environment.
1)SYSTEM WILL PASS UNLESS BOARD OF HELATH DETERMINES THAT THE
SYSTEM IS NOT FUNCTIONING IN'A MANNER WHICH WILL PROTECT THE
PUBLIC HEALTH AND 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:APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION-
ING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
T ie':system.has a Septic Tank and Soil Absorption System and is within 1.00 Feet to a Surface.
Water Supply pr.Tributary to a Surface Water Supply.
The System has a Septic Tank and Soil Absorption System and is with a Zone 1:of a Public
Water Supply Well...
The System has a Septic Tank and Soil Absorption System and is within 50 Feet of a Private
Water Supply Well.
The System has a Septic Tank and Soil.Absorption System and is less than 100 Feet but 50.
Feet:or more from a Private Water Supply Well,unless a Well Water.Analysis:for coliform
bacteria and volatile.organic.compounds indicates that the Well is from pollution from
the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm.` u,. .
D)SY TEM FAILS:.
!'have.determined that the System violates one or more of the following Failure Criteria as defined
in 3 0 CMR 15.303. The basis for this.determination is identified below. The Board of Health
sho ld be contacted to determine what will be necessary.to correct the failure.
Backup of sewage into facility or system component due to an overload.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 clogw.
ged,SAS or.cesspool.
Liquid depth,in cesspool is less than 6"below invert or available volume is less than 1/2
day flow.
Required pumping.more than 4 times in the last year,NOT due to clogged or obstructed
pipe(s). Number of times pumped
- 2 -
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .FORM
PART A
CERTIFICATION(continued)
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater
elevation.
Any portion,.of a.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 wi(hin.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. If the well has been analyzed.
to be acceptable,attach copy of well:water..analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen._
E) LARGE.SYSTEM FAILS:
The following criteria apply to a large system in—addition to the criteria above:
The design flow of a system is 10,000 ggd.;or gr..eater(Large System)and the system is.-a significant.:
threat to public.health and safety and the environment.because one or more of the following
conditions exist:
The system is within 400 Feet of a..surface drinking water supply,
The system is within 200.Feet of a trkbutary to.a surface drinking water supply
The system is located in a nitrogen sensitive area Interim Wellhead.Protection:Area .
(IWPA)or a.mapped Zone 11'of a public water supply well.
The owner or operator of any such system shall bring_the system and facility in o::full compliance with the ..
groundwater treatment program requirements of 315.CMR 5.00 and 6.00. Please"consult the local
regional office of the Department for further information.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTLON FORM
PART B
CHECKLIST'
Check if.the following have been done:
Pumping information was requested of the.owner,occupant,and B.o.ard of Health.
_ one of the system components have-been pumped for atleast two weeks and:.the.system:has
been receiving normal flow rates during that_period. Large volumes of water have not been
� introduced into,the system recently o.r as part of this inspection.
V-As-builtplans.have been obtained and:.examined..Note if they are not available with N/A.. .
`I he.facility or dwelling was inspected for signs.of sewage back-up,.
he system does not receive non-sanitary or industrial waste flow,
c/.The site was inspected for signs of breakout.
e -All system components,excluding the Soil Absorption System,have been located on site.
—,Zre septic tank manholes were uncovered,,opened,and the interior-of the septtc tank.was in-
spected ,
s ected for condition of baffles or tees material of construction,dimensions,depth of liquid;
P
� / depth of sludge,depth of scum.
V The size and location of the Soil Absorption System on the site ias been determined based on
existing information or approximated by non-intrusive methods,
- 3 -
SUBSURFACE SEWAGE .DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(continued)
he facility owner(and occupants,if different from owner).were provided with information on
:tbe proper maintenance of Subsurface.Disposal System.
SUBSURFACE SEWAGE DISPOSAL SYSTEM.,INSPECTION FORM
PART C,
SYSTEM INFORMATION •�: ::_ ..,..� .. -.�.
FLOW CONDITIONS
RESIDENTIAL:
Design Flow:V,9-0 gallons Number of Bedrooms:_Number of Current Residents:
Zktea�yl—
Garbage Grinder: Laundry Connected To System: Seasonal Use:
Water Meter Readings,.if a ailable:
Last Date of Occupancy
COMMERCIAL/INDUSTRIAL:/U-
Type of Establishment:
Design Flow: gallons/day Grease Trap Present: (yes or no)
Industrial Waste Holding Tank Present:
Non-Sanitary Waste Discharged To The Title V System:
Water Meter Readings,If Available: Last Date of Occupancy:
OTHER:. (Describe)
Last Date of Occupancy:
GENERAL INFORMATION
PUMPING RECORDS any source of information:
System Pumped a5 part of inspection:/' ----- I yes,v ume pumpe gallons
Reason for Pumping:
TYPE.OF SYSTEM: ,.: ..
Septic. Tank/Distribution Box/Soil Absorption System
ingle Cesspool
Overflow Cesspool
Privy
Shared System(If yes,attach previous inspection records,if ally)
Other(explain):
APPROXIMATE AGE of all components,date installed(if known) and source of information:
Sewage odors detected when arriving at the site: A
-4-
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
GENERAL-INFORMATION. (continued).
SEPTIC TANK:,, �'
Depth below.grade: Material of Construction: concrete . metal FRP Other
(explain)
'Dimensions:- Sludge Depth: Scum Thickness:
Distance from top of sludge to bottom of outlet tee or.-baffle:'
Distance from bottom of scum_to.bottom of outlet tee or baffle:
Comments: (recommendation for pumping,-conditioin:of inlet and outlet.tees or b4flIps,depth.o.f liquid level
in relation to outlet invert,structural integrity,evidence of leakage;etc.)
GREASE TRAP:
Depth.Below Grade: Material of.Constructiow, . concrete metal. FRP Other
(explain):
Dimensions: Scum.Thickness:
Distance from top of scum,to top of outlet tee or baffle:
Comments: (recommendation fo.r pumping,condition of inlet and outlet tees or baffles,depth.of.liquid level,
in relation to outlet invert,structural integrity,,evidence of leakage,etc.)
TIGHT OR HOLDING TANK.,
Depth Below Grade: Material of Construction: concrete metal FRP Other77777777
(explain):
Dimensions: Capacity: gallons Design Flow: , gallons/day
Alarm Level:
Comments: (condition of inlet tee,.condition.of alarm and float switches,etc.)
DISTRIBUTION BOXY/
Depth of liquid level above.outlet invert:
Comments:(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or
out of box,etc.)
PUMP CHAMBERS//%
Pump is in working order:
Comments: (note condition of pump chamber,cond�tton of pumps and appurtenances,etc
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
SOIL ABSORPTION SYSTEM(SAS):r j
(Locate on site.plan,if possible; excavation not required,but may be approximately by,non-intrusive
methods)_�=f:•not determined to be present,explain:.
Type:
Leaching pits,number: t Leaching chambers,number: Leaching galleries,number:
Leacahing trenches,number,length:
Leaching fields,number,dimensions:
Overflow cesspool,number:
Comments: (note conidtion of soil,signs of hydraulic failure level of ponding,condition of vegetation,etc.)_
CESSPOOLS:
n Y
Number and configuration: /' / ' Depth-top of liquid to inlet.invert:
Depth of solids layer: 2 Depth of scum layer: Dimensions of Cesspool: TOY
Materials of construction: Indication of groundwater:
Inflow(cesspool must be pumped as part of inspection)
Comments: (note condition of soil, igns of by aulic fai ure,level of ponding,condi 'on of vegetation,.
etc.) ` ' i
0-717,126 o. (.
PRIVY:''"
Materials of construction: Dimensions:
Depth of Solids:
Comments: (note.condition of soil,signs of hyddraulic failure,level of ponding,condition of vegetation,
etc.)
- 6 -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to.atleast two permanent references,landmarks or benchmarks.
Locate all wells within 100 Feet.
n I.
1
DEPTH. TO. GROUNDWATER:
Depth to groundwater: Feet
Method of Determination or Approximation-
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DATE;_ ��A' ^'_DIi REVISED
1 - - 1.
• - � DRAWING NUMBER
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GsH1VSRAL N(::>TSSe L-MCaSAID E
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W/ICE+UATER SWELD
4 9 9 AT IL'O.C.WITH VY B.S.BS +PLASTER EACH SIDE. ELEVATION!FRAMING)
MAT
r-a OV R T'V TYPICAL F
K P F R ON�CDX 8 EA7HMG WITH TING DRAWING
FwapwHrarrTEa ANp VY BLUEBD.+PLASTER ON INSIDE
O W/D)(ISTG 110�TEo ALIGN, pW EILpMgpE TEO BEN,V2pURgC,Air
PLASTER cOORDI TE W/ BEET t SECTION HARKER
SW�TECNMG`OF LIOGHT FXTURES.INSTALLATION. D
ON eowar Te�IWeaN 1 NJ-6- NOT IN CONTRACT
I=S BTRAPPMd a�pINp ON TTWyyEK PAPER gC7pApLRd7NIpAN7E WITH 0 ECR PLApUC7EMINT AND
eR 9IDErAII BNEATHNG CONCEALED TELEPHONE�OpR NI G. To
AND FIELD DET. FIELD DETERMINED _
4 M.BATH BEDROOM -DOOR SIZE LABELS 30/B-9'-O•x t'-B'.DOOR
2=t PLUMBING CALL µ ��QxT -FLOOR AND BASE FINISH AS SELECTED BY OWNER. VJP. VERIFY M pELD
' FMroH FLOORING ON W%R-0 MBULATION WALL _ ppppRR
> D/P TIG SIlDFLOOK BE SIMILAR FRAMES.HARDWARE AND ALL TRIM TO SEEM= .
G4PA/NALLeO BBUU MIL C g�Ng�KpC IW {�g 7E KEW WALL
• !�2�A pp pp// RUL 8 AMDORE6ULATIONBLLOTHER APPLICABLE LOCAL
AND ANC)IORLLB&ra SILL SEAL EXISTING WALL
ro)aao DR R-M INS ECTION9,APPROVALS.PERMITS,ETC. - -
' smau- _ -CONTRACTOR SHALL BE RESPONSIBLE FOR ALL
CRAWL SPACE To r •a ox P
. S'FROST YV.LL ON CONT - -ALL DIMENSIONS TO BE VERIFIELD IN BY
�p•Wipe,� THL LONG CONTRACTOR AND HOMEOWNER NOTIFIED IMMEDIATELY a I/2'LALLY COLUMN
OOTNG TWA OF ANY DI..FANCIES AND DISCUSS OPTIONS
LONG UP BEFORE ANY ACTION REGARDING CHANGES.
CONTRACTOR TO LOCATE SMOKE DETECTORS AND SOLID WOOD POST
-_-- HAVE LOCAL FIRE CHIEF APPROVAL OF LOCATIONS.
3 BUILDING SECTION 4 ROOF PLAN
AI SCALE: 1/4• s 1'-0• AI SCALE: 1/8• P-O' - -
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is2 OWNER _
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ti 22 x w Bn�I EXISTING.BASEMENT
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CRAWL SPACE
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HALL
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- CARPET--------------------
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2a o �J 2/e21W veWA 01-032
t�
2 FOUNDATION PLAN ��
AI SCALE: 1/4• - 1'-0• I FIRST FLOOR PLAN - PROPOSED
. AI SCALE: I/4' I'-0• .
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. q I N D�TRAPPMG OVEN�EtlIAL�L 840=.1T�IIG ER
M.BATH BEDROOM
c
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5 $�eDRo8� m:N L; ca•mAu
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=
CRAWL SPACE 7o eYOI�oLho°Mo IN&!L. -
. r�RODT BALL ON CONT. .
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3 BUILDING SECTION
AI SCALE: 1/4• -w 1'-0* .
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n
1
6
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1 22'-W Q
2 a cal oal P.T.I -
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ACCESS DOOM T
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wad aaw Nw
Q Ljyes 2.X a en._I?;' __ EXISTING BASEMENT
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CRAWL SPACE
. CONC.taLAD ON GRAVEL
DOTN'
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L[----------------------------------------
2 FOUNDATION PLAN A3
. AI SCALE.1/4' 1._0
,
lst.FLR. SYSTEM PROFILE
EL.78.3 NOT TO SCALE
FINISH GRADE FINISH GRADE OVER FINISH GRADE OVER
EL. 75.5 SEPTIC TANK 75.0 DISTRIBUTION BOX 74.3 FINISH GRADE
OVER TRENCHES 74.2
:,A^ \RISERS TO 6, A
OF FINISH GRADES— �( i r r
'� v b PRECAST CONCRETE
� -�'_—� ,, , .''°:f`r:`�'f���f f �. ,•^oe �Or ' Or�,•,•r® r r, r-r
' - o RISERS TO 6 b' - 0 REINFORCED LOADING
3"MIN. 11
H OUTLET PIPE(S)
' ° =° OF FINISH GRADE LEVEL
-� --51 MIN.SLOPE I/o -
3" - ` •� FOR 2'( MIN.1% SLOPE TRENCH LENGTH = 25'-0"
6" ' MIN.SLOPE 1% ° Q BEYOND
> - MIN. O DRYWELL LENGTH = 8'-6"
`� 13"MIN. 14" SUMP
6" '• Q o o °, o o °, , ° r. °r '
71.35 70.85 MIN.
PVC OR CAST IRON TE;�
:1 L: 'q 0:/ i �, r•�0]_.�. •r2.� 1, ci rr'._D�d.•. ,,b• ' ,,OT,_..�J� � 0- ,r rf ', 'r---p.l'1
GAS BAFFLE: 6 'b'•--.�(`•'7 b° mow, to ,f,, o: °b. b°`( L` w �p1 .•o.:b° ;`--�- +v,°
DISTRIBUTION BOX 70.00
10 '/ 11 :1 •V IO:f 1 e0:1 r10. •'.l" 10.1 �
> MINIMUM INSIDE DIMENSION 12" 3/4"- 1-1/2" DOUBLE
0 1500 GALLON w :A 314 - 1-1/2 DOUBLE
o: o Q Q OUTLET INVERTS 2 BELOW INLET INVERT WASHED CRUSHED WASHED CRUSHED 4'
- PRECAST CONCRETE — MINIMUM CONCRETE WALL THICKNESS 2 STONE
0a :�: STONE
y o INSTALL ON COMPACTED LEVEL BASE
H-10 REINFORCED
1
�4 TRENCH SECTION
f. °•1��..�IOr C•'Q , f0,, I *,, ,,``��" •!\IOr, •,, ,O1 ..,,a'ff ,,0N ,f 01',f ,,0/:''°�1 f.•�
NOTE: EXCAVATE TO =C= STRATLi,!1 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 4" DIAM. 36,MIN. 3"OF 1/8"-1/2"
MAX. DOUBLE WASHED
47
PEASTONE •
'
�� ; 1 Deaeh •0 f 'r 0
;,,a: 3/4"- 1-1/2" DOUBLE
48" 5'-2" " ' WASHED CRUSHED
&_unding b� STONE
TRENCH WIDTH
Cotuit
13'-211
w,; / S °• • �. 10 NUMBER OF TRENCHES 1
r /ba _; f NUMBER OF DRYWELLS 2
_ on} ,• �', t K;. GENERAL NOTES:
1. ELEVATIONS SHOWN ARE BASED ON ASSUMED OBSERVATION PIT
2. ALL PIPES IN THE SYSTEM MUST BE CAST IRON
. �, � ,�, 4e ,/,' OR SCHEDULE�0 PVC.
` LE V P 1 Q427
3. HEALTH H A32EN.j• Nirc & ISLANDS ENGINEERING PERCOLATION RA-iWE: < 2 MIN./IN
I, 1\1 '� MUST BE NOTIFIED WHEN CONSTRUCTION IS. WITNESSED BY: SAM WHITE
CESSPO L _ COMPLETE PRIOR TO BACKFILLING.
BARNS. BOARD OF HEALTH
,,�„ ,�µ„�.,,�,��.��, 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED -
� —_— � - � � - � DATE: MAR.12,2003 -
BY CAPE & ISLANDS ENGINEERING AND THE BOARD S Z9°46'0(f', OF HEALTH. 0 DESIGN DATA
� E .1Sp.0p1
5. MATERIALS AND INSTALLATION SHALL BE IN
COMPLIANCE WITH THE STATE SANITARY CODE =A= LOAM
_ 10 YR 2/2
�/] 611 NUMBER OF BEDROOMS 3
REGULATIONS LOCAL APPLICABLE RULES AND
GARBAGE DISPOSAL NO
30.01 6. NORTH ARROW IS FROM RECORD PLANS AND IS =B=SANDY LOAM DAILY FLOW 330 GPD.
NOT INTENDED FOR SOLAR ENERGY PURPOSES: 10YR 5/4
SEPTIC TANK-REQUIRED 1500 GAL.
7. WATER SUPPLY: MUNICIPAL WATER SYSTEM. 36° SEPTIC TANK PROVIDED 1500 GAL.
1 o - 8. FLOOD ZONE C [NON-HAZARD] LEACHING REQUIRED 330 GPD.
9. FLOOD PANEL: 250001-0021 D DATED: JULY 2,1992
23.09 10. THIS PROJECT DOES NOT INVOLVE ANY PHYSICAL
00 GROUND DISTURBANCE OR VEGETATION REMOVAL SOIL ABSORPTION SYSTEM CALCULATIONS:
w 62 3, S M WITHIN 100' OF WETLANDS,INLAND OR COASTAL =C= MEDIUM SAND
o s.00' BANKS OR FLOOD HAZARD ZONES. 10YR 7/4 SIDEWALL AREA = 152 SF.
1� ►�-+ EXISTING �� _3 152 SF. X .74 G/SF. = 112 GPD.
BOTTOM AREA = 329 SF.
6\7 329 SF. X 0.74 G/SF. = 243 GPD.
NO GROUNDWATER
i LEGEND 120,1 LEACHING PROVIDED = 355 GPD.
52 PROPOSED CONTOUR
SEPTIC UPGRADE & ADDITION
I OUSE N0.541 I �\ /x �\ -—-52-—- EXISTING CONTOUR
I LOT 35 p, PROPOSED SEWAGE DISPOSAL SYSTEM
L I w ^��� \�\ ® OBSERVATION PIT
F
3 �0 PREPARED FOR
❑ 'DISTRIBUTION BOX '
i $1, \ ti MARTHA LORANTHOS
L=��S o 0 0 SEPTIC TANK HSE.NO. 547 SANTUIT ROAD
_ COTUIT,MASS.
N7681 GHT F ► / �� SOIL ABSORPTION SYSTEM `
34 p0'1 AY / of PLAN NO. 032403 SCALE: AS NOTED
56.70, �`�s. .T
RESERVEAREA �o�a� DAVd� �� FILE NO. 162BA DATE: MAR.24,2003
CHARS , '�� SEPTIC FILE NO. 72 PCS FILE: santuit rd 547
22.26 PIPE INVERT ELEVATION SAIV'CKI
i 28085
z z z ���,��'�£cisrEnti° ,�`% CAPE & ISLANDS ENGINEERING
PLOT PLAN o 0 0 L L o`���%�
7 9 35A 547 R 2 800 FALMOUTH ROAD, SUITE 301C
SCALE: 1"= 30' MAP SEC PCL LOT HSE � -. _ ', ' MASHPEE,MA 02649 (508)477-7272
1st.FLR. SYSTEM PROFILE
EL.78.3 NOT TO SCALE
FINISH GRADE FINISH GRADE OVER FINISH GRADE OVER
EL. 75.5 SEPTIC TANK 75.0 DISTRIBUTION BOX 74.3 FINISH GRADE
:.. OVER TRENCHES 74.2
_OF
TO 6 —•I_
OF FINISH GRAD r PRECAST CONCRETE
11 ,• p'
3"MIN. , f _ o RISERS TO 6 --�'' 500 GALLON DRYWELLS
H-10 REINFORCED LOADING
OF FINISH GRADE OUTLET PIPE(S) LEVEL
TRENCH LENGTH = 25'-0
MIN.SLOPE 1% 31, FOR 2'( MIN. SLOPE
vi
6" ' MIN.SLOPE 1°/f, ° BEYOND
0 MIN. O DRYWELL LENGTH = 8'-6"
= = 13"MIN. 14 - -
" '.1. ,O:( " •4 p0,:1, ~�7.• `' `/ ✓'1 �i:f '•1 ,Oa �T4, • f
71.35 70.85 MIN. 16'SUMP '� o q
f �_ 70.47 1 1 ..0 1
TEES70.60 ` :1 70.30 "L f.',
- < PVC OR CAST IRON .,
GAS BAFFLE �ajo I.
DISTRIBUTION BOX a
1.
w -'; MINIMUM INSIDE DIMENSION 12" 3/4 1-1/2" DOUBLE
=' p 1500 GALLON J :A OUTLET INVERTS 2" BELOW INLET INVERT WASHED CRUSHED 3/4 - 1-1/2 DOUBLE 4,
o WASHED CRUSHED
PRECAST CONCRETE MINIMUM CONCRETE WALL THICKNESS 2,1 STONE STONE
INSTALL ON COMPACTED LEVEL BASE
H-10 REINFORCED M
TRENCH SECTION
f.•,, `,,.a. O,• :�e:l f.' ,, f,d '1 ` �, 'r ol, •'I °�,,. I® , 0� , p , ,,°1.'e• `f.•a
NOTE: EXCAVATE TO=C= STRATUM N ORDER TO
SEPTIC TANK REMOVE ALL =A= &=B= IMPERVIOUS MATERIAL
INSTALL ON COMPACTED LEVEL BASE WITHIN 5'OF THE SAS. REPLACE WITH CLEAN, 9"MIN. 3"OF 1/8"- 1/2"
CLAY-FREE SAND
4" DIAM. 36"MAX. DOUBLE WASHED
-- PEASTONE
t
O .• •. ,
1.6.. 3/4" 1 1/2" DOUBLE
�; t�: �• }, 4 11 51.2,1 o WASHED CRUSHED
STONE
TRENCH WIDTH
r7 ,
Cptuit 13'-2"
le/iI ° ..• NUMBER OF TRENCHES 1
GENERAL NOTES: NUMBER OF DRYWELLS 2
gym+ u•
a ::...
7 •' a .. 1. ELEVATIONS SHOWN ARE BASED ON ASSUMED
A OBSERVATION PIT
'. 2. ALL PIPES IN THE SYSTEM MUST BE CAST IRON
OR SCHEDULE 40 PVC. P-10427
3. HEALTH AGENT/CAPE & ISLANDS ENGINEERING PERCOLATION RATE: < 2 MIN./IN
MUST BE NOTIFIED WHEN CONSTRUCTION IS
�• A
WITNESSED BY: SAM WHITE
: COMPLETE PRIOR TO BACKFILLING. BARNS. BOARD OF HEALTH
CESSPO L ___ 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED DATE: MAR.12,2003
.Y h,V•.41,WeMWoYatil[„Yl tw r'.RO ryy,LiLl:tllr Ow4lH r.rW
S ° BY CAPE& ISLANDS ENGINEERING AND THE BOARD DESIGN DATA
E 150.001 OF HEALTH. 0"
5. MATERIALS AND INSTALLATION SHALL BE IN =A= LOAM
COMPLIANCE WITH THE STATE SANITARY CODE 10 YR 2/2
[TITLE V]AND LOCAL APPLICABLE RULES AND 61, NUMBER OF BEDROOMS 3
REGULATIONS. GARBAGE DISPOSAL NO
—767 30.01 6. NORTH ARROW IS FROM RECORD PLANS AND IS =B= SANDYLOAM DAILY FLOW 330 GPD.
_ — '' t',I NOT INTENDED FOR SOLAR ENERGY PURPOSES. 10YR 5/4
� � � I D SEPTIC TANK REQUIRED 1500 GAL.
7. WATER SUPPLY: MUNICIPAL WATER SYSTEM.
� � o � �� / 36° SEPTIC TANK PROVIDED 1500 GAL.
8. FLOOD ZONE C [NON-HAZARD] LEACHING REQUIRED 330 GPD.
° 9. FLOOD PANEL: 250001-0021 D DATED: JULY 2,1992
10. THIS PROJECT DOES NOT INVOLVE ANY PHYSICAL
GROUND DISTURBANCE OR VEGETATION REMOVAL00
SOIL ABSORPTION SYSTEM CALCULATIONS:
�O r� 62,31 g N46' WITHIN 100' OF WETLANDS,INLAND OR COASTAL =C= MEDIUM SAND
0()
S. ""
BANKS OR FLOOD HAZARD ZONES. 1OYR 7/4 SIDEWALL AREA= 152 SF.
152 SF. X .74 G/SF. = 112 GPD.
Exisrn3c G BOTTOM AREA = 329 SF.
Z N lAt r ELE S 3 \�
329 SF. X 0.74 G/SF: = 243 GPD.
t 36. \ 6. 1 0/ LEGEND 120° No GROUNDWATER LEACHING PROVIDED = 355 GPD.
I
52 PROPOSED CONTOUR
\ SEPTIC UPGRADE & ADDITION
No.547 I �( -—-52-—- EXISTING CONTOUR
110"t i �� \ PROPOSED SEWAGE DISPOSAL SYSTEM
L
OT 35A 7\\"`\ OBSERVATION PIT �" ` ;
O SF• I '� �/ e41a'g� PREPARED FOR
23140
p DISTRIBUTION Box `' MARTHA LORANTHOS
HSE.NO. 547 SANTUIT ROAD
o 0 o SEPTIC TANK
_ COTUIT,MASS.
IV 7681�GI'IT OF /—� SOIL ABSORPTION SYSTEM
340011 W Ay ,.- PLAN NO. 032403 SCALE. AS NOTED
56 70, O 1� 4g0N OF
/ '� !' RESERVE RESERVE AREA o��� FILE N0. 162BA DATE: MAR.24,2003
co3Ir�) SEPTIC FILE NO. 72 PCS FILE: santuit rd 547
S� 22.26 PIPE INVERT ELEVATION S2e085
z z z AFC/STEg��' CAPE & ISLANDS ENGINEERING
o O O �y�NgL L 800 FALMOUTH ROAD SUITE 301 C
PLOT PLAN 7 9 35A 547 '
5 5 5 .,fl.,l .„ MASHPEE,MA 02649 (508)477-7272
SCALE: 1 - 30 MAP SEC PCL LOT HSE ` ` ` Ct