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HomeMy WebLinkAbout0093 SHELL LANE - Health 93 Snell Larne Cotuit A= 019-098 Commonwealth of Massachusetts fY Title 5 Official Inspection Form , f hI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, x� 93 Shell Ln Q Property Address h>ti� Betsy Mellors Owner Owner's Name information is c required for every Cotuit MA 02635 7-26-18 . page. CitylTown • State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 5/4� 13a3� 1. Inspector: '^ Shawn Mcelroy Name of Inspector Upper Cape Septic Services .f + Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: 7 ' . - it, L ® Passes , ,•r ❑ Conditionally Passes , •❑ -Fails ❑ Needs Further Ev on by the Local ApprovingAuthority `-7-26-18 AsVe-ctor's Signature '` `Date' i The system inspector shall submit a'copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 r Commonwealth of Massachusetts ' Title 5 Official Inspection -Form Ni Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �. ? 93 Shell Ln Property Address Betsy Mellors Owner Owner's Name information is required for every Cotuit MA 02635 7-26-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: t ® 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: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" , N, ND for the following statements. If"not (Y ) 9 determined, please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑N ❑ ND (Explain below): t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection. Form o Subsurface Sewage,Disposal System Form -Not forVoluntary Assessments . fr; 93 Shell Ln Property Address Betsy Mellors } Owner Owner's Name , . r- information is ,. required for every Cotuit n; MA 02635 7-26-18 page. City/Town - , State Zip Code Date of Inspection B. Certification (cont.) r 1, , 3 _ - ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. j B) System Conditionally Passes (cont.): f. ❑ Observation of sewage•'backup or break out or high'static water level in the distribution box due to broken'or obstructed'pipe(s) or due to'a broken, settled or uneven distribution box. System will ' pass inspection if(with approval of Board of Health)- broken pipe(s) are replaced '❑ Y ❑W 4 ❑ ND (Explain below): ..� , El obstruction is removed' ' ';. ' ❑` Y' ,❑N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑Y' ` ❑ N "❑ ND (Explain below): i y �_(. �:+ 'fi ti "1' . '..a � 1• rA . ._1' � to -;:ii J7.A' r ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): C), Further.Evaluation is Required by the Board of,Health: ' ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1.'System will pass"unless Board"of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is`not functioning in a mannerwhich will protect public health, ' "safety and the environment:' "' '� ❑ Cesspool or privy is within 50 feet of a surface water '' ❑ ' " Cesspool or privy is within 50 feet of a'bordering vegetated wetland or a salt marsh t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts r� Title 5 Official Inspection Form hl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Shell Ln Property Address Betsy Mellors Owner Owner's Name information is required for every Cotuit MA 02635 7-26-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. 'System will fail unless the Board of Health (and,Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. . ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or'cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ' t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 cam` Commonwealth of Massachusetts r,_ . := ,�i , z p Title 5 Official InspectionForm. i-t Subsurface Sewage Disposal System Form,=Not for Voluntary.Assessments 93 Shell Ln Property Address Betsy Mellors Owner Owner's Name information is required for every Cotuit A-$I MA 02635 7-26-18 •, page. City/Town , State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El - ® 1, w 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. - EJ ®, t •Any portion of a cesspool or privy is within a Zone 1 of a public well. � ❑ °'�0 ' '' Ariy°portion of a cdsipool'or privy is'within 50 feet of a private water supply well. ❑' *"®"s '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 =,,.f;••�, Y, „ ,,- ,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- The system faiis.'l have'determined that one or more of the above failure .,,The exist as'described in 310 CMR 15.303,therefore the system fails. The r-, ,, ,.,� •t� system owner should contact the,Board of Health to determine what will be - tr �; ,•necessary to ocorrect,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: ' ,r t,. i � ,. a ": .. ..t:; ' ,• <T:.. _ 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 F ❑ ❑ 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 li of a public water supply well If you have answered "yes"to'any question"in Section E the system is considered.a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form �l Subsurface Sewage Disposal System'Form -Not for Voluntary Assessments 93 Shell Ln Property Address Betsy Mellors Owner Owner's Name information is required for every Cotuit MA 02635 7-26-18 page. City/Town 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 El ® 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? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® .❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): . 3 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of-bedrooms): 330 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts ;r r r Title 5 Official Inspection Form - i�l Subsurface Sewage Disposal System Form -,Not forVoluntary,Assessments .; 93 Shell Ln .,- Property Address , Betsy Mellors - Owner Owner's Name information is required for every Cotuit . MA 02635 7-26-18 page. City/Town State Zip Code Date of Inspection D. System Information �,� Description: r. tiz, f A Number of current residents: 0 Does residence have a garbage-grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) "' r • "' `'` Laundry system inspected? .,t,-" 1; • 3 r3,P. ❑ Yes ® No Seasonal use? k {fi,�, tr ,' r t� ►, a �} ��;:,+k,. ►._ k, ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail Sump pump? . ; ~ux' � ,, .� f.;, ;r~ ' ❑ Yes ® No 2018 Last date of occupancy: + �, ` -:,ff i�" Date k Commercial/industrial Flow Conditions: Type of Establishment: } Design flow(based on 310,CMR 15.203), ;c Gallons per day(gpd) t ,: ,Basis of design,flow(seats/persons/sq.ft.,•etc.):,:._ : {��,f•r•., ' T _ f,.. .e t' �.I, �.x l ` 114 Grease trap present?.,,-,.,F,,� ❑ Yes ❑ No Industrial waste holding tank present? M , k#. i •.. t ,.) ;: ..* +-. El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? • •+ ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17' Commonwealth of Massachusetts o + Title 5 Official Inspection Form , 1.4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` 93 Shell Ln Property Address Betsy Mellors Owner Owner's Name information is Cotuit MA 02635 7-26-18 required for every ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date , Other(describe below): I General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: i 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): t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts d - f Title 5 Official. Inspection :Form ' ! ',I Subsurface Sewage Disposal System Form -Not,for"Voluntary Assessments V . 93 Shell Ln cf. t .r Property Address _ Betsy Mellors r Owner Owner's Name :x information is required for every Cotuit ,: MA 02635 7-26-18 L: page. City/Town State Zip Code Date of Inspection D. System Information (cont.) x_ •. _;2 r _ : . ' ,. :_. Approximate age of all components, date installed (if known) and source of information: 2010 Were sewage odors detected when arriving at the site? -' ," ❑ Yes ® No Building Sewer(locate on site plan): , - r -'}• ti•*i ; r..'::' 1811 Depth below grade: . feet Material of construction: - El-cast iron"" '' ® 40 PVC i r ❑'other(explain):' Distance from private water supply well or suction line: ' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: . r, 12 '. -feett Material of construction: ® concrete ❑ metal ❑ fiberglass t,•❑ polyethylene ❑ other(explain) T If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No r Dimensions: t u 1500 gal Sludge depth- _ t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts ,w. Title 5 Official Inspection Form it Subsurface Sewage Disposal System form Not for Voluntary Assessments 93 Shell Ln Property Address Betsy Mellors Owner Owner's Name information is required for every Cotuit MA 02635 7-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) -: - .i Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good working order with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts ;.; Title 5 Official , Inspection Form` F 4 a I Subsurface Sewage Disposal System Form -Not for,Voluntary Assessments: R 93 Shell Ln Property Address , Betsy Mellors u Owner Owner's Name information is required for every Cotuit MA 02635 7-26-18 page. City/Town 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.)` .. t `i•, ^ t. ... � ... a: fit. .. , 11 f••* !I /.. i * 1V 'ZI .\. #:. '4r 1 I J' F ,-•i_�..t h Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: fa , Capacity: gallons Design F , a. ..r rr M.,. tiw. rt, ,�,1 . , ; •low: gallons per day Alarm present: ❑ Yes ❑ No ' Alarm level: --Alarm in working order: ❑ Yes ❑ No Date of.last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts r I1' Title 5 Official Inspection Form. �rW'i Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1r✓, ,> 93 Shell Ln Property Address Betsy Mellors Owner Owner's Name information is required for every Cotuit MA 02635 7-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened)(locate on site plan): f Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box etc.): Good condition with water at working level and no sign of back-up from field. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ 'Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located explain why: P Y t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System'•Page 12 of 17 Commonwealth of Massachusetts '_ Ft ,• L. '` T Title 5 Official Inspection Form • r • 4, 1 ��, p i�t Subsurface Sewage Disposal System Form-Not for-Voluntary Assessments K. 93 Shell Ln Property Address Betsy Mellors J 'g Owner Owner's Name information is required for every Cotuit MA 02635 7-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ' ❑ leaching pits number: ® leaching chambers - - number: 20-arc36's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields to number, dimensions: ' ❑ overflow cesspool r,number:.,, ❑ innovative/alternative system Type/name of technology: Comments (note conditionlof soil; signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): , Leach field in good working order and empty at inspection with no sign of back-up. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 tTitle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17, i Commonwealth of Massachusetts ` Title 5 official Inspection Form -�► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 93 Shell Ln Property Address Betsy Mellors Owner Owner's Name information is required for every Cotuit MA 02635 7-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of pondirig, condition of vegetation, etc.): t t5ins.doc rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 II Commonwealth of Massachusetts ;:, _ , •,, � ..', f�, C Title 5 official Inspection Form I Subsurface Sewage Disposal System Form =Not for�Voluntary,Assessments 93 Shell Ln ! +� Property Address Betsy Mellors Owner Owner's Name information is , required for every Cotuit MA 02635 7-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ,, Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately d f t U n, �... ,4; t, ��. r f+w 11 `�_. t ;.r�° ,P' .F . _ e ,.,a. .!- .J�• `,t"r..r F t J: vim. `.: r ); 3 a •7'� 'tJ:�' J' ... ..a lr" iE. t.. J,^.r -:2 •_ �. 1 t5ins.doc•rev.6/16 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts w. Title 5 Official Inspection Form Y_IFi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 93 Shell Ln Property Address Betsy Mellors Owner Owner's Name information is Cotuit ' MA 02635 7-26-18 required for every page. City/Town 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: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Shell Ln Property Address Betsy Mellors Owner Owner's Name information is required for every Cotuit MA 02635 7-26-18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable P#_ 13 3 Department of Regulatory Services a � a Public Health Division Date r; a� 200 Main Street,Hyannis MA 02601 Date Scheduled_11' a lI Time--F 0 Fee - i Soil Suitability or Assessment f Sewage� • " i , wage asposal Performed By:-- h.LOA. --y 0 �n with d By: V-/ LOCATION& GENERAL INFORMATION Location Address/'_9 r3 S t I /_n.C, Owner's Name 11 Address Q'3 L Assessor's Map/Parcel: l� r Engineer's Name G � W 7d'­IN NEW CONSTRUCTION REPAIR .'fwi. n 0 Telephone# D Land Use ?�lde r� i Slopes(%) °l �' 1 / Surface Stones fl,o Distances from: Open Water Body ? i�1 jA ft Possible Wet Area t t7� ft Drinking Water Well Drainage Way ft Property Line iO ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Lac►s-h�� 3 �3�rdd�-, tie S ll 1. k�. z _ t Parent material(geologic) Depth to Bedrock 7 2"4 ® t Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to soil mottles: N lA in, Depth to weeping from side of abs.hole: -1 �in, Groundwater Adjustment I {. Index Well# t -29 Reading Date: II_ IL-is Index Well level R,S i Ad,factor y J l � Adj.droundwater Level;l•Z PERCOLATION TEST bate tl I tt�� Time JO loo AM Observation t � Hole# Time at 9" Depth of Perc �� it Time at 6" Start Pre-soak Time @ 0,00 'lime(9"-6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTICU'ERCFORM.DOC tt� • �a 'r DEEP-OBSERVATION HOLE LOG Hole#—rP-1 Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Co i ten M- %Gravell L O,J 2 312 S" In 2 DEEP OBSERVATION HOLE LOG ,Hole# _� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling } (Structure,Stones,Boulders. onsi ten % rave ah- ll N L - 6 '-M So"a JD ob" - 3�" �s hI� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes -Z Within 500 year boundary No , Yes Within 100 year flood boundary No Z Yes. Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on . 0 2 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required traini•g,expertise and experience described in 310 CMR 15.017. Signature Date ( 1 Q:WEPTiC%PERCFORM.DOC r� No. s Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Applicatiou,for aigogar *pgtem Construction Vermtt Application for a Permit to Construct( ) Repair( ) Upgrade(v11 Abandon( ) Complete System ❑Individual Components Location Address or Lot No.�� �,��\ �.-mu�� Owner's Name,Address,and Tel.NoA: Assessor's Map/Parcel .C�`c`. `l , <ra `�~� �o�J g �s� Installer's Name,Address,and Tel.No. R=A�s Ye 'Designer's Name,Address and Tel.No.��•���Q `�>d t3® <sc IS-7 s��- -�c�ss p.o.�m ae__10 tr�bv- Type of Building: Dwelling No.of Bedrooms Lot Size ��a 6� sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '3 1 Q gpd Design flow provided 3 1S",� gpd Plan Date t ( Q Number of sheets l Revision Date Title Size of Septic Tank A0,k&-, Type of S.A.S. IRDS AQ_-_ 3 G'(G Description of Soil 5e C_- A,, Nature of Repairs or Alterations(Answer when applicable) ,� ill �� l gyp® �d(��� sc a,-r_ '�D ')© Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. op Signed `''�� Date 0 .(0 Application Approved by D A Date a Application Disapproved by Date for the following reasons Permit No. 0 Q e 7 b.S Date Issued 0 Fee U(J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIV; ISION TOWN OF BARNSTABLE, MASSACHUSETTSYes ZIpphration for otar .tern Dio �tCon.5truction. � p hermit v • Application for a Permit to Construct(;) Repair( ) Upgrade(X Abandon( ) [ Complete System ❑Individual Components Owner's Name,Address,and Tel.No. Location Address or Lot No.� sc, Assessor's Map/Parcel Installer's Name,Address,and Tel.No. L4`Designer's Name,Address and Tel.No. ( ><2� 's ll Type of Building: Dwelling' No.of Bedrooms ' Lot Size ( �� (� sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ` Design Flow(min.required) 3'j Q gpd Design flow provided 3 6:5— gpd Plan Date l l( I Number of sheets Revision Date t Title x 'Size of Septic Tank 1 S ,A Type of S.A.S. Description of Soil v Nature of Repairs or Alterations(Answer when applicable) A� ��r]v�`C./r � - QO?'C ee .,tick �© t��s �12.C.-.3C(�� �C d�,L./` �.(,�.,� n.•.�`t3.1` � i f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ✓ �'✓- Signed ��"' -�_..--• Date � � '� � �c) Application Approved by Date // d i Application Disapproved by' Date for the following reasons Permit No. .e tl U /b Sr Date Issued / 23 p 77 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance t THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded;(v/') Abandoned( )by ��.de-Q-,?R— at �� 5�.f `\` m„* has been constructed in accordance l with the provisions of Title 5 and the for Disposal System Construction Permit No. 0/U - 4�b dated 1/ b"? G l Installer s_a��� I--� Designer #bedrooms Approved desigTfflotw 3.30 gpd The issuance of this e !it shall not be construed as a guarantee that the system�t l ct`on as desi un gned. Date / Inspector v ' No. E)!t) -.�/ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS r lwigpogal 6p5tem Con,5truction permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade (vl)- Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Constructio7 must be completed within three years of the date of this ermit; Date I I a3 o Approved by 4'j: /n _!"pS4k,Pf �ln weer ` o ��t( (i lit CoP �'G� S r'� f, t iffC/n r r 11A fir✓ Permit Number: Date: } s Completed by: r HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 13 ,5WI I f A(e_ ( .Lk Lot No. Owner: Address: Contractor: Address: Notes STEP 1 Measure depth to water table } of to nearest 1/10 ft. ................9.... .Date............................ mon / y/Year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OA Appropriate index well............. m�wa� OBWater-level range zone ......................::............................. STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to water level for index well ............................ 0 month year , STEP .4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 213) determine water-level adjustment ............... ..........................................................................STEP 5 Estimate depth to high water by subtracting the water- , level adjustment (STEP 4) from measured depth to water levelat site(STEP 1) ............................. ....................................... ...................................... { r r Supplement Table 5.. Potential water-level rise, in feet,for use with index well Mashpee MIW-29 WATER ZONE A ZONE B ZONE C ZONE D LEVEL 5.7 0.0 0.0 0.0 0.0 5.8 -0..1 .0.1 0.1 0.2. 5.9 • 0.1 0.2 0.3 0.3 _ 6.0 0.2 0.3 0.4 0.5 6.1 0.3 0.4 0.5 0.7 6.2 0.3 0.5. 0.7 0.8 6.3 0:4f 0.6` 0.8 1.0 6.4 0.5 .0.7 0.'9 1.2 6.5 0.5 0.-8. 1 .1 1 .3 6.6 0.6 0.9 1 .2 1 :5 6.7 0.7=•- 1 .0• 1.3 { .1 .7 6.8 0.7 1 .1 1 .5• 1.8 6.9 0.8 1 .2' 1 .6 2.0 7.0 0.9 1 .3 1 .7 2.2 7.1 0.9 1 .4 1.9 2.3 7.2 1.0 1 .5 2.0 2.5 7.3 1.11 1 .6. 2.1 2.7 7.4 1.1 ; 1 .7 2.3' 2.8'' 7:5 1.2 1 .8 . . 2.4 3.0 x 7.6 1.3 1 .9 2 5. 3.2 7.7 1.3 2.0. 2.7 3.3 7.8 1j4 2.1 2.8 3.5 .7.9 1.5 2.2 2.9 3.7 8.0 1 .5 ' 2.3 3.1 3.8 8.1 1 .6, ' 2.4 3.2 4.0 8.2 1.7` 2.5. 3.3 4.2 e: 8.3 1.7 2.6 3.5 4.3 8.4 1 . 2.7 3.6 4.5 8.5:, 2.8` 3.7 , 4;7 , 8.6 1 .9 2.9 3.9 4.8 . 8.7 2.0 3.0 4.0 5.0 8.8 2.1 3..1 4.1 5.2 8.9 2.1 ,3.2 4.3 5.3 - 9.0 2.2 3.3 4:4 . 5.5 Table 2. Potential water-level rise,in feet,for use with index well Barnstable AlW-?47-Continued WATER ZONE A ZONE B ZONE C ZONE D •LEVEL 30.7 6.7 10.0 13:3 16.7 30.8 6.7 10.1 13.5 16.8 30.9 6.8 10.2 13.6 17.0 31.0 6.9 10.3 13.7 17.2 31.1 6.9 10.4 13.9 17.3 31.2 7:0 10.5 14.0 17.5 31.3 7.1 10.6 14.1 17.7 31.4 7.1 10.7 14.3 17.8 31.5 7.2 10.8 14.4 18.0 31.6 7.3 10.9 14.5 18.2 31.7 7.3 11.0 14.7 18.3 31.8 7.4 11.1 14.8 18.5 31.9 7.5 11.2 14.9 18.7 32.0 7.5 11.3 15.1 18.8 32.1 7.6 11.4• ` 15.2' 19.0 32.2 7.7 11.5 15.3 19.2 32.3 7.7 11.6 15.5 19.3 32.4 7.8 11.1 15.6 19.5 32.5 7.9 11.8 15.7 19.7 32.6 7.9 11.9 15.9 19.8 32.7 8.0 12.0 16.0 20.0 32.8 8.1 12.1 16.1 20.2 32.9 8.1 12.2 16.3 20.3 33.0 8.2 12.3 16.4 20.5 33.1 8.3 12.4 16.5 20.7 33.2 8.3 12.5 16.7 20.8 33.3 8.4 12.6 16.8 21.0 33.4 8.5 12.7 16.9 21.2 33.5 8.5 12.8 17.1 21.3 33.6 8.6 12.9 17.2 21.5 t, t Town of Barnstable Regulatory Services _Thomas F.Geiler,Director SAS ~ Public Health Division A`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Date: 3° 10 Sewage Permit#VOCO`�� Assessor's Map/Parcel. O►q d`►� Installer&Designer Certification Form Designer: Lir)"-T PA_�p Installer: �w� Address: LSN Uty-�VWY-kn3 Address: (pt, 6-01, 2,030 Te���k eke M-A �WI-A 0.,rg 3 On ( a3 tdC-Q�eo�r\ .c. was issued a permit to install a (date) ( sisttaller) septic system at CA3 based on a design drawn by (address) Lr\�,a dated 11) i2) i- lql tv. t► z3 J�o (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if require ected and the soils were found satisfactory. �;�oF;.;ys LINDA J. R (Installer's Signature) U C 1 `� o. t n,n I .T"IbE�``G�`� esigner'sSignature) (Affix Des i Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice forms\desipercertification form.doc .77 /,, /'1'O'Wlk!OF SARNSTABLE PT V1 AS ESS0WS MAP&L U.A �1.Eii'S NA M&PIA016'. rtc�r cA��►ci� � . . moo. LiEACklTt+t©1I�,lEir1ItI+T€Y•'{typa� r.C 3 . (SfJte), . .�,.».. i. 'UHMER OR : P g'F 2�.TEt Cowa)C.1.A lgcE stre►tiou�#s6nr►�a 8stvee�fk�: ,. tvlaxienum;Adjusd Grouacfwterblefo the Bcittamb� E+lnB LEI I' 1va8e 1 fa�:r 5ti ly vowaad 1[.wbing l.1idm y'0f77 . e y+��1ls exist .8gfl on sate_ae Wftiup 2At) eot p 1+ucbin fi3 Eii r,n�vVet d Qad L,eAc@tu►g ±aclllcy; any WOa tl�exist Bye. uittaiss:'10(f feed p�f cbfas�'adli�►? ' punitsh [7 t .3 Ii p - n 3 fig' 4y 44, . ft �! J G TOWN OF BARNSTABLE ^LOCATION \� ���,1( L�aw>e. SEWAGE# VILLAGE �..�\c�`� ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.��,,,-Q., 94,�y=,A, a. C-,m7-T7?- SEPTIC TANK CAPACITY tACd rq�,�6i6 LEACHING FACILITY: (type) LcoAt.,,N C14".VA1iNCJ-4(size) -4S-`k 1k ' 'k NO. OF BEDROOMS _ OWNER `�.<. 1e r;v� L.,:s6C.,Q PERMIT DATE: 1 O COMPLIANCE DATE: V—)t6c, Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) IGO Feet FURNISHED BY cup. r SIP Lis Q �� �S i I J J � i I t TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. x�Sfr�� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 2 (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER A DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED.- VARIANCE GRANTED: Yes No On, TOP Of FOUNDATION 24"diameter concrete covers rar5ed to within 6'offim5h rade TWENTY(20)ADS All (3G I GBD2)LEACH School St TUIT, EL=49.9 g 4'PVC VENT (or as noted) tnspectron Port and cap with magnetic t 4 CAP BY'5WEETAIR' CHAMBERS IN BED CONFIGURATION IN FOUR(4) MA marking tape to withrr,3"of grade ROWS OF FIVE(5) UNITS EACH J 3 MIN 3 Fasting EL=48.QmmJ EL=48.5f fL=48.5-49.4(maxJ 2 5' �9- i a, 5.0' 5.0' 5.0' 5.0' 5.0' w 3 � 18"min Cover for / f "5'5od kerrroudl.(5ee Note,* 476+ H-20 Loading 46.4 t 71 /� c v �' ' f m hoc N17 b Rci 47.25 46.62 i f' 46.37 46.27 46.lD 46.00 I(�J/ N LOCUS (5ee Note AP/) (V / , _ Gas Baffle J MW 45.10 + p� _ Shell Ln 5.0'_ OX I f�' N Ba tier Ln rZ Longest Run TWBNTK(20)ADS ARC36(36/65D2) 4+ /;j/ Hull Ln N 31' --4 }-- f0' /0' LBACH CHAM25t7K5/lV BED EL-40./t e5bmated High Groundwater DB-6 CONFIGURATION W/T-H FOUR(4)ROWS l.9'+ /nspectior Port(5ee Note#4) / '' F' ��', vent 1500 GALLON ' (1-1-20 Rated) OF FIl/E(5)CHAMBERS -4-EL=38.2+Observed Groundwater �% ,7 SEPTIC TANK D-BOX LEACH CHAMBERS Ift=37 7- Bottom of Test Hole SITE LOCUS (11-20 Loading) PLAN VIEW NOT TO SCALE � FLOW FROM LE SCALE: I" = 10' \ NOT TO SCALE \ I .) A55c55or'5 Map 0 19 Parcel 098 \ 2.) Deed Book 1442G Page 18 CONSTRUCTION NOTES HIGH GROUNDWATER LEVEL CALCULATIONS: \ 3.) Plan Book Page - \ 4.) This property 15 not in a Zone II of a I .)ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE, TITLE 5(3 10 Cl Depth To Water Table (I 1-1 2-10): 9.1'± (EL=38.2±) _ Top o{Banwn9 Public Water Supply _ _ 1 5.000): STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, Appropriate Index Well: MIW-29 _ - 5.) Flood Zone: C UPGRADE, AND EXPANSION OF ON-51TE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND Water Level Range Zone: A(0-2) FOR THE TRANSPORT AND DISPOSAL OF 5EPTAGE. AND THE LOCAL BOARD OF HEALTH Current Depth To Water Level For Index Well(10/10): 8.5' REGULATIONS. Water Level AdJu5tnrent: ±) 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE 15 POTENTIAL Estimated Depth To High Water: 7.2'± (EL=40. I LEG E N D FOR VEHICLES OR HEAVY EQUIPMENT TO PA55 OVER IT SHALL BE DESIGNED TO WITHSTAND AN H-20 LOADING. IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE EXISTING SPOT GRADE ATMOSPHERE. 24x5 PROPOSED SPOT GRADE SYSTEM DESIGN CALCULATIONS 18"Tree EX15TING CONTOUR 3.)TO MINIMIZE UNEVEN SETTLING, ALL SYSTEM COMPONENTS SHALL BE INSTALLED ON A 140' 24- PROPOSED CONTOUR STABLE MECHANICALLY-COMPACTED BASE ON 51X INCHES OF CRUSHED STONE. 5EWAGEDP516NFLOWREQU/RED:3BEDKOOMD0,fLL1N69 W WATER SERVICE LINE //O GPD/BEDROOM-330 GPD REQUIRED 4"Maple ��tt 4.) COVERS OVER THE INLET AND OUTLET TEE 9v 5 OF THE SEPTIC TANK,THE DISTRIBUTION PARCEL O OVERHEAD UTILITY LINES BOX, AND THE SOIL ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN G"OF FINAL GRADE. 5EWAGEDE5/6NFLOWPROVIDED: 7W6VTY(20)A05 UNIT5INBED u UNDERGROUND UTILITY LINES LEACHING FIELDS, TRENCHES, AND OTHER 501L ABSORPTION SYSTEMS WITHOUT ACCESS CONFIGURATION IN FOUR(4)R0915OFF1Vff(5)UN1T5 EACH. Area= 15,2GO S.F.± E' c GAS SERVICE LINE MANHOLES SHALL HAVE AT LEAST ONE(1) INSPECTION PORT CONSISTING OF PERFORATED 4" PVC PIPE PLACED VERTICALLY TO THE BOTTOM OF THE 501L ABSORPTION SYSTEM WITH A Vt =L(330/0.74)1(4.a FT2/FT)/5.OLFJ = - - TOP OF BANK /6.9 AD5 UNIT5 REQUIRED(20 PROVIDED) Ewstrn9 p 5e tic Com anent to be- i � LIMIT Of WORK CAP,TIED WITH MAGNETIC MARKING TAPE, ACCESSIBLE TO WITHIN 3"OF FINAL GRADE. p Abandoned(5ee Notes#20 d 2/) T 355 GPD PROVIDED>330GPD REQUIRED Deck �-/�� EDGE OF CLEARING 5.) PIPING SHALL CON515T OF 4"SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID i -"- FENCE ON A MINIMUM CONTINUOUS GRADE OF NOT LE55 THAN 2% FROM THE BUILDING TO THE j PatioTill SEPTIC TANK, AND NOT LESS THAN I%OTHERWISE. - - - SEPTIC TANK CAPACITYREOUIRED: 330 GPD X 200% = 660 GPD REQUIRED - _ TEST HOLE LOCATION 5EPT-IC TANK CAPACITYPROV/DED: PROP05fD 1500 GALLONSEPTIC TANK y 5T SEffiIC TANK G.) DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4"DIAMETER D5 DISTRIBUTION BOX SCHEDULE 40 PVC(OR EQUIVALENT) LAID AT 0.005 FT/FT. UNLESS OTHERWISE NOTED. LINES A'GAKBAGEDf5P05AL 1.5 NOT PERMITTED WITH TH15 DE516N FLOW N SAS SOIL ABSORPTION SYSTEM SHALL BE CAPPED AT END OR AS NOTED. Existing 3 Bedroom Reserve RESERVED FOR f~UTURE USE 7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO(2) FEET BEFORE Enclosed DwellingCIDJ UTILITY POLE PITCHING TO THE 501L ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATER TESTED BadPorch Top of Foundation Garage ® CATCH BASIN TO ASSURE EVEN DISTRIBUTION. EL=49.9 fs �t p x FIRE HYDRANT Bad O 6.) GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE ---- _ ® DRINKING WATER WELL STRUCTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL. open N CONCRETE BOUND Blow Fxrstmg Septic Component to be Abandoned 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE `� Second Floor y � 1�„„_�--�'� _ (5ee Note#20) SEWAGE DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. x O 10.) IN ACCORDANCE WITH 3 10 CMR 15.22 1, ALL SYSTEM COMPONENTS SHALL BE atb m Sid Pkndtr � � -Stone Wall N N INSPECTION NOTE: MARKED WITH MAGNETIC MARKING TAPE. � BENCHMARK CerelB+e Top Corner Concrete ' Proposed 5A5 PRIOR TO FINAL INSPECTION BY THE ENGINEER,SYSTEM 1 1.)THERE ARE NO KNOWN WELLS WITHIN 100'OF THE PROPOSED SOIL ABSORPTION EL=50.00(Assumed Datum) Existing p (See Plan I/iewJ NEEDS TO BE COMPLETE INCLUDING BUILDUP FOR COVERS. SYSTEM. md� � Mill! Gravel Removal Gravel Drive m q (5ee Note,3'l 9) 12.) FROM THE DATE OF THE INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL w RECEIPT OF THE CERTIFICATE OF COMPLIANCE, THE PERIMETER SHALL BE STAKED AND First Floor ' ip_2 4 G Vent Parcel 99 FLAGGED TO PREVENT USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. v , 29.0 Town Water FLOOR PLAN 20 Oak ,P , 13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS t'yt 48xG ANY CHANGES SHALL BE APPROVED IN WRITING CONSTRUCTED AS SHOWN ON PLAN. BY `r g N= O THE DESIGNER. Survey Mork by. TO SCALE G"Maple 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF CC A �' H Land .Sere ceS THE BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT TE✓T HOLE LOG `� 140' 18"Pine 818 Route 28, Sulte 3 THE SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE '' 48 Mest Yarmouth, MA 02673 PERMIT AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE 15 REQUESTED. Leaching Pb- (508) 737-1777 11�1!' 2a11• anmland0comea8t.net Catch Basin 15.) LOCATION OF UTILITIES 15 APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE Test Hole#I (EL=47.3±) FOR DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR Catch Ba5rn REVISION I 1/23/10: Added Second Test Hole Data and Location. TO COMMENCEMENT OF ANY WORK. THI5 INCLUDES, BUT 15 NOT LIMITED TO, REQUESTS TO Depth Layer Soil Class Soil Color Comments A4 DIG5AFE, ANY PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. 5 h e I I La ICI Pe � "�q�, Prepared for: 0"-5" A Fine-Medium Sandy Loam !OYR 3/2 y 1 G.)CONTRACTOR SHALL VERIFY THAT ALL WA5TEUIl ARE CONNECTED BY WATER TESTING 5"-22" E Fine-Medium Sand 1 OYR 5/1 A,. G �,• ' Catherine Lind WITHIN THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. 22"-32" B Medium Loamy Sand I OYR 4/G � ^ .� 17J CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF 32"-1 15" C I Fine-Medium Parcel i 4G Sand !OYR 5/G Perc @ 47" 93 Shelf Ln., Cotutt, MA 02G35 ANY SEPTIC SYSTEM COMPONENTS. Parcel 149 .` r Proposed Sewage D15po5a1 System Town Water �,� �I5T Town Water 18.) INSTRUMENT SURVEY CONDUCTED FOR PROPOSED WORK ONLY. SITE PLAN SHALL NOT Test Hole#2 (EL=47.3±) +�� AL 93 Shell Ln., Cotuit, MA S �'� BE USED FOR STAKING, OR ANY OTHER PURPOSES. Depth Layer Soil Class Soil Color Comments I CERTIFY THAT I AM CURRENTLY APPROVED BY THE DEPARTMENT OF Prepared by: 19.) SOIL REMOVAL: ALL TOPSOIL("A" LAYER)AND 5UB501L("B" LAYER)SHALL BE REMOVED ENVIRONMENTAL PROTECTION PURSUANT TO 310 CMR 1 5.01 7 TO " A F"4 me-Medium Sand FOR A DISTANCE OF FIVE(5) FEET LATERALLY FROM THE SOIL ABSORPTION SYSTEM DOWN O y Loam I OYR 3/2 CONDUCT SOIL EVALUATIONS AND THAT THE ANALYSIS HAS BEEN �ITE PLAN 4' 20" E fire-Medium Sand OYR 5/I TO THE CLEAN SAND LAYER(EL=44.G+). AREA TO BE BACKFILLED WITH CLEAN SAND, PERFORMED BY ME CONSISTENT WITH THE REQUIRED TRAINING, MEETING THE SPECIFICATIONS OF 3 10 CMR 1 5.255(3), AND COMPACTED TO MINIMIZE 20'32" B Medium Loamy Sand !OYR 4/G EXPERTISE, AND EXPERIENCE DESCRIBED IN 3 1 O CMR 15.017. I #w, 32"-1 15" C I fine-Medium Sand I OYR 5/G SETTLING. FURTHER CERTIFY THAT THE RESULTS OF MY 501L EVALUATION AS = INDICATED ON THE ATTACHED 501L EVALUATION FORM, ARE ACCURATE SCALE: 1" 20' 20.) EXI5TING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN AND IN ACCORDANCE WITH 310 CMR 15.100 THROUGH 1 5.107 SAND AND ABANDONED IN PLACE. AREA TO BE COMPACTED TO MINIMIZE SETTLING. DATE OF TESTING: 1 1112110 .: SOIL EVALUATOR: LINDA J. PINTO, P.E., C5N ENGINEERING 0 20 40 GO 2 1 .) WA5TELINE FOR EXISTING CESSPOOL IN THE BACK OF THE HOUSE TO BE CONNECTED IN BOARD OF HEALTH AGENT: DAVID STANTON, BARNSTABLE HEALTH DEPARTMENT P.O.Box 2030 a Phone:(508)299-3250 THE BASEMENT TO THE PLUMBING IN THE FRONT OF THE HOUSE. PLUMBING TO BE PERCOLATION RATE: LE55 THAN 2 MIN/INCH IN "C I"LAYER L SCALE I"=20' Teaticket,Mid 02536 Fax(SOS)548-5478 COMPLETED BY A MASSACHUSETTS LICENSED PLUMBER. GROUNDWATER ENCOUNTERED @ 109"(EL=38.2±) Lh4a J. Pinto, C&HJfYed Soft li'valuator C:\CSN\RR-ShelllRR-Shell-SOS Plan.dwg Date: I I/12110 Scale: As Shown By: LJP Check: MA I Project No.CSNO 126