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Home My WebLink About1111 SANTUIT-NEWTOWN ROAD - Health E1111 NEWTOWN P4*D COT6T --- _ - A = aalo�- ors 1 i 1 �,,grtJ f-T WN OF TABLE LOCATION SEWAGE # VILLAGE � �t ASSESSOR'S MAP &Q& ®YS INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 6� o LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER 1� PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 GS cl� 3� r� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1111 Santuit-Newtown Rd Property Address Kolb Owner's Name I -Befnstable �14 MA 02648 4/15/13 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 31 V I Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: c7 �, ® Passes ❑ Conditionally Passes ❑ Fad , O ❑ Needs Further Evaluation by the Local Approving Authority C* -,> .0 4/15/13 Inspecto gat Date ^�1 The system inspector shall submit a copy of this inspection report to the Approving Autkto ity Xard of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. u II &-1 1 �j I✓ 1111 Santuit-Newtown Rd-03108 Title 5 official Form:Subsurface Sewage Disposal System•Page 1 of 15 f. 4 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1111 Santuit-Newtown Rd Property Address Kolb Owner's Name Barnstable MA 02648 4/15/13 City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any 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 1111 Santuit-Newtown Rd•03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w ' 1111 Santuit-Newtown Rd Property Address Kolb Owner's Name Barnstable MA 02648 4/15/13 Cityrrown 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. 1111 Santuit-Newtown Rd•03/08 Title 5 Official Inspection Forth: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 1111 Santuit-Newtown Rd Property Address Kolb Owner's Name Barnstable MA 02648 4/15/13 Cityrrown 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 Y 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. 1111 Santuit-Newtown Rd•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M . "< 1111 Santuit-Newtown Rd Property Address Kolb Owner's Name Barnstable MA 02648 4/15/13 City/Town 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 ❑ El 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. 1111 Santuit-Newtown Rd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1111 Santuit-Newtown Rd Property Address Kolb Owner's Name Barnstable MA 02648 4/15/13 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)] 1111 Santuit-Newtown Rd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1111 Santuit-Newtown Rd Property Address Kolb Owner's Name Barnstable MA 02648 4/15/13 Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 Number of current residents: 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: Sesonal 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 1111 Santuit-Newtown Rd-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Amu Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1111 Santu it-Newtown Rd Property Address Kolb Owner's Name Barnstable MA 02648 4/15/13 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Pumped 6 yrs ago per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): No indication of D-box Approximate age of all components, date installed (if known)and source of information: 1987 per age of the home Were sewage odors detected when arriving at the site? ❑ Yes ® No 1111 Santuit-Newtown Rd-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1111 Santuit-Newtown Rd Property Address Kolb Owners Name Barnstable MA 02648 4/15/13 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 71feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 616"Feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Cover raised at inlet to 2'of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 Sludge depth: trace Distance from top of sludge to bottom of outlet tee or baffle >12' Scum thickness trace 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 >211 How were dimensions determined? measured 1111 Santuit-Newtown Rd•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 1111 Santuit-Newtown Rd Property Address Kolb Owner's Name Barnstable MA 02648 4/15/13 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site 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 1111 Santuit-Newtown Rd•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1111 Santuit-Newtown Rd Property Address Kolb Owner's Name Barnstable MA 02648 4/15/13 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cunt.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): 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 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 D-Box per as built Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 1111 Santuit-Newtown Rd•03/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1111 Santuit-Newtown Rd Property Address Kolb Owner's Name Barnstable MA 02648 4/15/13 City/Town 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: The leach pit was not directly observed due to excessive depth. The area was probed and soils are dry and compact. The pit is also in close proximity to a steep slope with no signs of breakout Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The leach pit is approximately 7' below grade and probing gives no indication of a raised cover. It is suggested that the cover be raised for inspection and maintenance purposes 1111 Santuit-Newtown Rd•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1111 Santuit-Newtown Rd Property Address Kolb Owner's Name Barnstable MA 02648 4/15/13 City/Town 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 1111 Santuit-Newtown Rd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 4 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1111 Santuit-Newtown Rd Property Address Kolb Owner's Name Barnstable MA 02648 4/15/13 Cityrrown 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. E � 51� . 571 1111 Santuit-Newtown Rd•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments d� 1111 Santuit-Newtown Rd Property Address Kolb Owner's Name Barnstable MA 02648 4/15/13 Cityrrown 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: >15' 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 1111 Santuit-Newtown Rd•03108 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 A :f No .....�� . Fss. �............._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 2.................oF.. �'yi" s.7 ._P . ApplirFation for Disposal Works Toustrurtion Famit Application is hereby made for a Permit to Construct (X) or Repair (� ) an Individual Sewage Disposal System at: t -S9!Y�vi f�G aws/ �� l0 ...................................................... -- Locati -Addre or Lot No. xgrc y .._. gig H. ...... - --...._..._.. �_ )Owner Address ...... .42 Installer Address Type of Building Size Lot.�r�3,,�__ 3o.Sq. feet U Dwelling—No. of Bedrooms................................. .Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria G" Other fixtures ...................................................... W Design Flow.....................�'.__-5.......___..gall.ons per person �r dam. Total daily flow--- Z -__._____-__-____gallon. WSeptic Tank—Liquid capacity?° gallons Length.t..�.__. Width'�__�q Diameter________________ Depth_s-_7.._. x Disposal Trench—No. .................... Width........ ..._._.... Total Length...................Total leaching area....................sq. ft. Seepage Pit No-------/........... Diameter.Z�- :G.•-. Depth below inlet-."�. . Total leaching area._.t?.A!...sq. ft. Z Other Distribution box ( X) Dosing tank ( ) / '-' Percolation Test Results Performed by. ' Date_._.....__ aTest Pit No. 1....... _.minutes per inch Dept i of Test Pit--- Depth to ground Test Pit No. 2....... -._minutes per inch Depth of Test Pit--- Depth to ground water.... Me/-------------------------------------------•---------------•---------------�Z.--•-----...... ---------------- •--—--�--•--+f--•o- g/ Ox(W� Description of Soil----a----�0N 4/.r.f......../r ................................0-!�r..----- .......... . - -------------• •-------------------- -•= - -• - . a .. ............... .............. ... •••.. ••• .............�Q--......_ .------. t .a d-'y -'�r� -----_-----•----••-- UNature of Repairs or Alterations—Answer when applicable............................................................................................... -•--------------------------•-------........----•----------•-•--------------------------•---------------••----------------------------•----------------•----•----------•--••••-----------......•--••--•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE, 5 of the State Sanitary Code—The under7rhealth. :e agrees not to place the s em n operation until a Certificate of Compliance has b d by the boa01 Signed-- -------- •..... ............ .--•-----•--- •---...__ _......_.... Date Application Approved By............ ...... .: ..........................•---------...............--.... _•_0--.�-I.S `R ...... Date Application Disapproved for the following reasons-------------•----••----•--------------------•---------------•-•------------------------•-----••---•-.........._ --••-•---•----•-----......-•---------•.....................................................•--------•--...-----•-------------•-----------------------------------------------•------- ......-•--••-••- Datz PermitNo........ .... ..{� ............... Issued....................................................... Date r .5�6 Fimx........................No, THE COMMONWEALTH OF MASSACHUSETTS BOA ?F HEALTH --;,a W/�/ _ -W, ..................................OF...45 " 74 ....................................................................................... Applir tttiou for Disposal Works Tonstrurtion "Ipamit Application is hereby made for a Permit to Construct (X ) or Repair an Individual Sewage Disposal System at: ................................ ...............................................,��;'K7.......................................... Loca� ddre or 0. ....................... ...................................... ----------7--------------------------------- --------------- ..................... ..... Address .................... ............................ .............. ............... .................................................................................................. In Address C/? 73 U Type of Building Size Lot..._...:! feet Z_ Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder PL4 Other—Type of Building ........................... No. of persons.........._..........__.____ Showers Cafeteria Otherfixtures ......................................................................................... ................» .............................. Design Flow.............................................gallons per person ppr day. Total d4�iy 4ow.......................................... W 0 4 ... Diameter................ Depth. .0�w. 9 Septic Tank—Liquid capacity/-a"-----gallons Length-ep... Width.-/.....c) .............. W Disposal Trench—No. .................... Width......_..,,_:_...... Total Length....... .,.._. ...._ Total leaching area........__:.......sq. ft. �4 /S/ e —0 -3Z_3 Seepage Pit No....../........... Diameter.................... Depth below inlet.......--........... Total leaching area..................sq. ft. Z Other Distribution box ( X) Dosin tank ( ) 4 /Z_X/ r/"', 5 Percolation Test Results Performed by.....IZ" --/ _Z_ ....f--------- --------------------7.. .... ......... Date................... ..minutes per inch Depth of Test Pit. /V(/ Depth to ground water......... Test Pit No. I.............. --- ---------- rX4 Test Pit No. 2----_---------minutes per inch Depth of Test Pit...... Depth to ground water........................ ................................ ................ Su 01�f -------------------------7,107"'p,50......--------------- 0 Description of Soil............. 721. ............ ZVI ---------------------- ......iV' U ...................................................................................................... C.,� -n C. e- -------------------- W ------- ---------�-,--:;��-;----; ;, ............... ------------------------------------------------&kt..........e.5��............................................................................................................... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T12 5 of the State Sanitary Code The. nde srii5�agrees not to place t/�/� u r' rther he s to in by the 0 r operation until a Certificate of Compliance has d ie boar health. Signed............ ..... ..... .......................................................... .......................... D to Application Approved By....... _r-L ....................................................... ... e......... Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo............*�.12........ I.............. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD—Of HEALTH ........ ........C>.Vw.....OF........ ...................................................... ....... .......... Tntifiratr of Tompliaurr THIS LS_T0 CERTIFY That t!;,e Individua. )�e ........... A 1 DisZG I S stem constructed tructed or Repaired b . ...... .......... ..................................................................... Instal at. - --- - � _ Q3-- - A- ....... .....................................................................has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as describedin the application for Disposal Works Construction Permit ....... .... dated... ...:S_14P�co........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W I�LL FU14CTION SATISFACTORY. DATE........j(,01912&............................................ Inspector......... ----------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD('O_ F-,kiEALT . ...........................\/.........OF.......... . ................ ....................... N ..................L_,j FEE.:t_._)..(:).......... Disposal Works Tons •udion Prrm-t Permission is hereby granted---------------:,::�.......... . . ............... tge y........................... to Constrt or Repair an Individual SleZ Disposal SysZ "L L 4 /71 P, C\ at No.. :��J...... .................... ... ......................................................................................... Street as shown on the application for Disposal Works Construction Permit No,��.,, ... Dated..... .—). ................ ....................................................... DATE--------- WARREN.. ..........�Z211914e(o........ Board.of Health FORM 1255 H1111 INC.. PUBLISHERS COMMONWEALTH OF MASSACHUSETTS .............. EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS John Graci DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813• TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE-DISPOSAL SYSTEM INSPECTION FORM PART A j CERTIFICATION Property Address: 1111 NEWTOWN RD. COTUIT MAP 026 PAR 045 Name of Owner SHEILA DISHMAN (��►� Address of Owner: SAME D "� V ® O LC.r Date of Inspection: 11/29/99 Name of Inspector:(Please Print)JOHN GRACI Ypftor 1999 I am a DEP approved system Inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) Company Name: n/a Mailing Address: n/a 8 Telephone Number: nla L 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 Inspection.The Inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The inpection Is based on criteria defined in Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Further Evalu on By the Local Approving Authority performing at the time of the Inspection.My Inspection does _ Fails not imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: Date:12/2199 The System Inspectors II submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspecti n.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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS ` THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING THE SYSTEM NOW AND MAINTAINING EVERY YEAR. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM = PART A CERTIFICATION(continued) Property Address: 1111 NEWTOWN RD.COTUIT MAP 026 PAR 046 Owner: SHEILA DISHMAN Date of Inspection:11129/99 INSPECTION SUMMARY: Check A, B, C, or D: _ A. SYSTEM PASSES: _ I have not found any Information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any.failure criteria not evaluated are indicated below. COMMENTS: System passes Title V Inspection B. SYSTEM CONDITIONALLY PASSES: n1a 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. Wa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was Installed within twenty(20)years prior to the date of the Inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiitration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. ' n& Sewage backup or breakout or high static water level observed in the distribution box is due to broken o6obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass Inspection if(with approval of the Board of Health). _ broken pipe(s)are replaced _ obstruction is removed distribution box is levelled or replaced nta 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A , CERTIFICATION(continued) Property Address: 1111 NEWTOWN RD.COTUIT MAP 026 PAR 046 Owner: SHEILA DISHMAN Date of Inspection:11/29/99 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 HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1 b THAT THE SYSTEM NOT FUNCTIONING IN A IIR EM IS MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is within 50 feet of a private water supply well, , _ The system has a septic tank and soil absorption system and the SAS 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 free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm,Method used to determine distance n&-(approximation not valid). 3) OTHER nLa revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1111 NEWTOWN RD.COTUIT MAP 026 PAR 045 Owner: SHEILA DISHMAN Date of Inspection:11/29/99 D. SYSTEM FAILS: , You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of th e followingfailure conditions itions exist as desc ribed in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an 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 1/2 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 n&. X Any portion of the Soil Absorption System,cesspool or privy Is below the high groundwater elevation. X Any portion of a 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 I 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds,. ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(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: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. I revised 9098 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1111 NEWTOWN RD.COTUIT MAP 026 PAR 046 Owner: SHEILA DISHMAN Date of Inspection:11/29/99 Check if the following have been done:You must indicate either"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 None of the system components have been pumped for at least 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 or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. . X The septic tank manholes were uncovered,opened,and the Interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at Issue,approximation of distance is unacceptable) [t 5.302(3)(b)1 X The facility owner(and occupants,if different from owner)were provided with Information on the proper maintenance of SubSurface Disposal Systems. w -yy v revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1111 NEWTOWN RD.COTUIT MAP 026 PAR 046 Owner: SHEILA DISHMAN Date of Inspection:11/29199 FLOW CONDITIONS RESIDENTIAL Design flow:-M g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):3. Total DESIGN flow: 0 Number of current residents:2 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no)jM Seasonal use(yes or no):JLQ Water meter readings,if available(last two year's usage(gpd): n/a f Sump Pump(yes or no): NQ Last date of occupancy: n(a CO M M ERCIAL/INDUSTRIAL Type of establishment: n(a Design flow: n&gpd(Based on 15.203) Basis of design flow: n& Grease trap present:(yes or no):_M Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ . Water meter readings.if available:nLa Last date of occupancy: n(a OTHER: (Describe) nLa Last date of occupancy: n& GENERAL INFORMATION PUMPING RECORDS and source of information: - 1998 BY BORTOLOTTI System pumped as part of inspection:(yes or no):NQ If yes,volume pumped n/a gallons Reason for pumping: n(a 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nla APPROXIMATE AGE of all components,date installed(if known)and source of Information: 1986 Sewage odors detected when arriving at the site:(yes or no): NO revised 9/2198 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1111 NEWTOWN RD.COTUIT MAP 026 PAR 045 Owner: SHEILA DISHMAN Date of Inspection:11129/99 BUILDING SEWER: (Locate on site plan) Depth below grade: fiLC Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: nza Comments: (condition of joints,venting,evidence of leakage,etc.) nla SEPTIC TANK: X (locate on site plan) Depth below grade: !z Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nta If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): No Liza Dimensions: L 8'6"H 6'7"W 4'10" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 3E , Scum thickness:4 Distance from top of scum to top of outlet tee or baffle:SL Distance from bottom of scum to bottom of outlet tee or baffle: J-C . How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND,RECOMMEND PUMPING SYSTEM NOW AND THEN MAINTAINED EVERY ONE YEAR. GREASE TRAP: a (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene other(explain) Liza Dimensions: nl3 r Scum thickness: nza Distance from top of scum to top of outlet tee or baffle:•.Liza' Distance from bottom of scum to bottom of outlet tee or baffle nze ' Date of last pumping: nza Comments: , (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) f revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1111 NEWTOWN RD.COTUIT MAP 026 PAR 046 Owner: SHEILA DISHMAN Date of Inspection:11/29/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,Inspection)' . y (locate on site plan) Depth below grade: Wa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain)` nLd _ h, Dimensions: Wa Capacity: n/a gallons Design flow: Wa gallons/day Alarm present: NO Alarm level:jil& Alarm in working order:Yes_No_ NQ Date of previous pumping: n& Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n(a .r DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:Wa Comments: (note if level and distribution Is equal,evidence of solids carryover,evidence of leakage Into or out of box,etc.) n1a ti PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): MO " Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) nta revised 912t96' Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1111 NEWTOWN RD.COTUIT MAP 026 PAR 046 Owner: SHEILA DISHMAN Date of Inspection:11/29/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-Intrusive methods) If not located,explain: nla Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: _nLa leaching galleries,number: jila leaching trenches,number,length: nLa leaching fields,number,dimensions: nLa overflow cesspool,number: Wit Alternative system: nla =r Name of Technology: jVA Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALL SOUND AND FUNTIONINC PROPERLY THE PIT WAS 3/4 AT THE TIME OF THE INSPECTION CESSPOOLS: _ (locate on site plan) h Number and configuration: nLa Depth-top of liquid to inlet invert: n1a _ Depth of solids layer: nLa Depth of scum layer. n/a Dimensions of cesspool: Wa Materials of construction: n/a Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)Na Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nla PRIVY: (locate on site plan) Materials of construction:n/a Dimensions:nla Depth of solids: flla w Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nLa , revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1111 NEWTOWN RD.COTUIT MAP 026 PAR 045 Owner: SHEILA DISHMAN Date of Inspection:11/29199 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a g �9r � AA 6aa5 P revised 9098 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1111 NEWTOWN RD.COTUIT MAP 026 PAR 045 Owner: SHEILA DISHMAN Date of Inspection:11/29/99 3 r - NRCS Report name: nLd Soil Type: n& Typical depth to groundwater: jita USGS Date website visited: n1a Observation Wells checked: NQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps - _ Checked pumping records _ Checked local excavators,installers X Used USGS Data r ., Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revised 9/2/98 Page 11 of 11 SYSTEM PROFILE NOT TO� SCALE TOP FON. F- EL . - `' p,. , FINISH GRADE Z , FINISH GRADE OVER FINISH GRADE OVER DIST. BOX -33 • FINISH GRADE OVER SEPTIC TANK 3 a :o.o�•o, LEACHING PIT ��o 71VARIES — e:. 0: ' O V.0.'40:p:t o:�:'.'''°.n:�e. °-�:o o.�: :i:e :e' i,d'n�e:i•�O 3 " OF ?/B" - 1/2" PRECAST CONC. OR :d" p: SHED PEASTONE ?iP BRICK 6 MORTAR O L: ••:1� ••1.•.1. o OUTLET PIPE LEVEL `• TO ?2" BEL OW GRADE FOR 2 FT. MIN. d.• e...p.•p;:0: ... � .. .,. •e .ob:'•o: :; :a o :6.• :d. °.. •'d:b:4e: 'o:e�a4.po.;.°:e,;e Co rp %77t7— � •" 0•O �•� :m 30. G/ � e:::,.;••%..'o••.: :o;'•'A-•.'•'�,�� .°r 33CX7 ? ''=::.�:r•... C. I. OR PVC TEES ,y9 o•e,o�: o. i4/j4to-oip-a :° :D.'p•.�e.Q. A. BSMT. FLR. != �> U GALLON 1 EL . o DIS TRIBU TION BOX °o:•c�:.o°:o: '�: °oo. o PRECAST CONCRETE :a INSTALL ON LEVEL BASE 3/4" TO 1-?/2" 44 PRECAST O p °~ .p•, :A H— /0 REINFORCED 1 .,..•c.•.o..b'.:o'.'.. WASHED o. j_ CRUSHED CONCRETE '+ g:p•o• .�•o-q•:o•..e:a:: o- o,a c.e•o•, p•,:a:op•e::.::.'a : d a, 'e:c:'o: STONE .b:,o:• ,b;.o.e�.o:o o'•.o,•p,o:,•o• o,'•;o.o•••e.a o•:o•o•.• .o.'.:o:.•o•c:o• 'i '. SEPTIC TANK H— /0 REINF. INSTALL ON LEVEL BASE NOTE: EXCAVATE TO ELEV. .0 OR LOWER TO REMOVE ALL IMPERVIOUS — BREAKOUT CAL COLA TIONS• MA TERIAL BENEA TH THE L EA CHING AREA INVERT B LEACH. PIT-20.0 REPLACE EXCA VA TED MA TERIAL WI TH SLOPE B ELEV. 20.0-0.26 CLEAN, CLA Y FREE SAND j MIN. PROTECTIVE DIST. REO'D.-39' , PROTECTIVE DIST. Pr90VIDE0-.eg• EFFECTI VE DIAMETER i GENERAL NOTES L EA CHING PI T 1 . AL L EL EVA TrONS SHOWN ARE BASED ON INSTALL ON LEVEL BASE 2. AL L PIPES IN THE S YS TEM MUST BE CAST IRON OR SCHEDULE 40 PVC. OBSER VA TION PIT 3 L = 3. THE BOARD OF HEAL TH MUST BE NO TIFIED WHEN CONSTRUCTION IS COMPLETE PRIOR g TO BA CKFIL L ING PERCOL A TION RATE: j' 4. ANY CHANGES IN THIS PLAN MUST &E APPROVED °- MIN./IN. BY THE BOARD OF HEALTH AND CAPE 6 ISLANDS WI TNESSED B Y- 1 SURVEYING CO., INC. 7 1k4'l:vlf A 5. MA TERIAL S A f i ND INSTALLA TION SHALL BE IN COMPL IANCE WI TH THE STA TE SA NI TARP BRD. OF HEALTH DESIGN DA TA CODE - TITLE V - AND LOCAL APPLICABLE DATE., RULES AND REGULA TIONS T` �`s a .\\\ 4 S;i � r-- atl P? l i - v ® � 6. NORTH ARROW IS FROM RECORD PLANS AND NUMBER OF BEDROOMS wbae: t� _ - - R? � � IS NOT TO BE USED FOR SOLAR PURPOSES 4 a� GARBAGE DISPOSAL �a PRECA T CONCRETE 4 ' 7. FLOOD HAZARD ZONE za k a' DAILY FLOW 1 � LEACH N6'PIT 1 r B. WA TER SUPPL Y T,,; .- r.., SEPTIC TANK REO 'D. SEPTIC TANK PROVIDED I coo -., 1 000 SAS c o Z j - L EA CHING REOUIRED o PRECAST SEPTIC s "? � S,If-DEWA LL AREA S. F.CTA I I \ 1 1 1GPS. F.X G/S. F. D Z, r2�.. BOTTOM AREA S. F.LEGEND - s. F. x GIs. _ , ,;. GPD ��`; ,` , ° ` „ ' i �'�` N, wA+ /✓° w.�", LEACHING PROVIDED GPO PROPOSED EL EVA TION EXIS TING CONTOUR OBSERVATION PIT SINGLE FAMIL Y RESIDENCE 6 O DISTRIBUTION BOX\-T r ; o 4� PROPOSED SEWAGE DISPOSAL S YS TEM /,v 0 ! a O3 r PREPARED FOR �. o o SEPTIC TANK ` ti t / �b` I, H. FRONGIL L O G S. DISHMAN IRP I RESERVE ' LOT 3 SANTUI T — NEW TOWN ROAD � r>AVVED BARNSTABLE — M. MILLS — MASS. PIPE INVERT ELEVA TION R e5 PLOT PLAN DATE: ,ter b CAPE PE 6 ISLANDS SURVEYING, INC. SCALE., ? _ ,,r,. r SCALE AS NO TED P. O. BOX 334 MAP SEC PCL LOT HSE . r,. PLAN NO. s :r ¢ TEA TICKET, MASS. y