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0061 WHITMAR ROAD - Health
61 WHITMAR ROAD, COTUIT A= 057 116 it j I i I� 'i Commonwealth of Massachusetts : w Title 5 Official Inspection Form C Subsurface Sewage Disposal System Form - Not for Voluntary Assessments MJ r 61 Whitmar Road �y Property Address Peter& Linda McAndrews Owner Owner's Name information is ,. required for every Cotuit y MA 02635 1-18-18 page. Chy/Town state Zip Code Date of Inspection Ini-tuT11i 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. Important:When A l ng,out forms . General Information on thecomputer, ````0�S�AIpFrr, use only the tab 1. Inspector: key to move your ��� JAMES Imp s, G' cursor-do not ,lames D.Sears =�: use the return key. Name of Inspector Capewide Enterprises ��o.ee Company Name �,�( ' �F•. '�� �R, 153 Commercial Street ',111k,s trl Nil1111 `,������ Company Address Mashpee MA 02649 Cityrrown State ZIP Code 508-477-8877 S1623 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 51310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority X,_ 1-18-18 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to.the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This Inspection does not address how the system will perform in the future under the same or different conditions of use. t5its.doC•rev.W 5 We 5 Offinial Inspection Form:SuDsurtace Sewage Disposal System•Page 1 of 17 GoUj td �s l, a5ed YU dH LS'b 6 8 60Z 66 uer Commonwealth of Massachusetts Title 5 official Inspection Form } Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 61 Whitmar Road Property Address Peter& Linda McAndrews Owner Owners Name inform,etion is required for every Cotuit MA 02635 1-18-18 page. CityrTown Stale Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I 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: Note: Tank under raised deck. The system is a 1000 Gal, tank D Box and five chambers. Note: Old D Box and pit still tied into 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. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old` or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins.doc rev.6t16 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Z a5ed RJ dH L947 I. 8 602 6 6 UI? c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 61 Whitmar Road Property Address Peter& Linda McAndrews Owner Owner's Name information is required for every Cotuit MA 02635 1-18-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpstalarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below). ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 16.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doo-ray.Sol Title S Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 £ a5ed xed dH LS:b 6 8 60Z 61• uef Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Whitmar Road Property Address Peter&Linda McAndrews Owner Owner's Name information is required for every Cotuit MA 02635 1-18-18 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 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 weir*, Method used to determine distance: I **Th.:s 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 �ess 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 915PE is less than 6° below invert or available volume is less than Y day flow k EAt'#jP4 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage olsposal system-Page 4 of 17 b a5ed WPJ dH L947I 8102 66 Uef i Commonwealth of Massachusetts Title 5 Official Inspection Form i9 Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 61 Whitmar Road Property Address Peter & Linda McAndrews Owner Owner's Name information is required for every Cotuit MA 02635 1-18-18 page. City(Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000g pd. ❑ ® The system fad. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304, The system owner should contact the appropriate regional office of the Department. 15ins.doc•rev.6116 Title 5 Ofriial Inspection Form:Subsurface Sewage Disposal System I Page 5 of 17 g a6ed xeJ did L5b 6 91,02 66 Uef Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 61 Whitmar Road Property Address Peter& Linda McAndrews Owner Owner's Name Informrequired s Cotu It MA 02635 1-18-18 required for every page. CityrTown 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 NIA) ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 15ins.doc•rev.6116 Title 5 Official Inspection Form,Subsurface Sewage Disposal System-Page 6 of 17 g abed xed dH L9:t7 6 8 60E 6 6 Uer i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 61 Whitmar Road Property Address Peter& Linda McAndrews Owner Owner's Name information is required for every Cotuit MA 02635 1-18-18 page City/Town State Zip Code Date of Inspection D. System Information Description: 1000 Gal.Tank D Box and five chambers. 3 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 2016-183,OOOGa1 2017-138,000Gal's Detail: Sump pump? ❑ Yes ® No Present Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft, etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t51ns.dcc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 L a6ed xed dH 8547 1, 2 602 61 Uer Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,V 61 Whitmar Road Property Address Peter&Linda McAndrews Owner Owner's Name information is required for every Cotuit MA 02635 1-18-18 page.. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA 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 III inspection of the I/A system by system operator under contract I ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): I I 15ns.doc•rev.6116 Tide 5 Offdal Inspection Form:Subsurface Sewage Disposal System•Page 8 or 17 8 a5ed xed dH 85b 6 ME 61, Uer Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 61 Whitmar Road Property Address Peter& Linda McAndrews Owner Owner's Name information is required for every Cotuit MA 02635 1-18-18 page. Cityfrown State Zip Code Date of Inspection D. System Information (cons) Aporoximate age of all components, date installed (if known)and source of information: Tank and old pit /New D Box and Chambers 2005-Permit#2005-087. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): De nth below grade: feet Ma:erial of construction: ❑ :ast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pi Being is 4"PVC SCH -40. Septic Tank(locate on site plan): Depth below grade: 4 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is ace confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast H-10 Sludge depth: 1" t5ins.doc-rev.6116 Title 5 Offldal Inspection Form Subsurface Sewage Disposal System-Page 9 of 17 6 a5ed xed dH 65:b 6 2 602 6 6 Uef Commonwealth of Massachusetts Title 5 Official Inspection Form r; Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 61 Whitmar Road Property Address Peter& Linda McAndrews Owner Owners Narne information is required for every Cotuit MA 02635 1-18-18 page. cityrrown State Zip Code Date of Inspection D. System Information (cont) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0" 8 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-TapeSludge Judge 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 at working level. Tank and covers at 4" below grade. In and outlet tee's. No sign of leakage or over loading. Note: Tank under raised deck. 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.6116 Title 5 Oftal Inspection Form:Subsurface Sewage Disposal System Page 10 of 17 0 6 abed xed dH 65b 6 8 1,0E 6 6 Uer c Commonwealth of Massachusetts Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -ter 61 Whitmar Road Property Address Peter& Linda McAndrews Owner Owner's Name information is Cotuit MA 02635 - required for every 1 18 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.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): I Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.Uoc-rev.6A 6 Title 5 Moat Inspection Form:Subsurtace Selvage Disposal System-Page 11 of 17 6 abed xed dH 65:b6 860Z 66 Uef Commonwealth of Massachusetts Title 5 Official Inspection Form .i. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 Whitmar Road Property Address Peter&Linda McAndrews Ovuner Owner's Name information is required for every Cotuit MA 02635 1-18-18 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth cf 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.): D Box is 16'06"-22" Below grade. Box is clean and solid wltwo lines out. Note: inlet line has a PVC TEE. 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: 15ins.doe-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 2 6 abed xed dH 6917 6 21,02 61, Uef Commonwealth of Massachusetts Title 5 official Inspection Form �d Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 61 Whitmar Road Property Address Peter& Linda McAndrews Owner Owner's Name information is required For every Cotuit MA 02635 1-18-18 page. City/rown State Zip Code Date of Inspection D. System Information (cont,) Type: ❑ leaching pits number: ® leaching chambers number: 5 ❑ 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.): Leaching is five infiltrators( 10'x37')w/inspection port and vent. Chambers are wet bottom wino sign of over loading or solid carry over. 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 tSlns.doc-rev.6116 Tile 5 Official Inspection Form:Subsurteoe Sewage Disposal System-PaGe 13 of 17 £ abed xed dH 65:117 6 8 60Z 61, Uer Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 Whitmar Road Property Address Peter& Linda McAndrews Owner Owner's Name information is Cotuit MA 02635 1-18-18 required for every page. City/town State Yip 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 ponding, condition of vegetation, etc.): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 ti l, abed xed dH 00:9 6 9602 61, Uef Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments uq� 51 Whitmar Road Property Addws Peter& Linda McAndrews Owner Owner's Name information is required for every Cotuit MA 02635 1-18-18 page. Cityrrown 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 leas,,.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 i r �tb � `I Q c;x t �N) " ( UtD jo lNSP L I rr i HE6iE 00 ; ;N•�p roc o P,r V �.�`.: �T °..eBy�7 N k w � 1 IV 10 C ati,' l5ine.doc•rev,6116 Title 5 Olficiet Inspection Form Subsurface Sewage Dlsposel System•Page 15 of 17 g 6 abed xed dH 00:9 6 8 60Z 61• Uef Jan 19 2018 15:01 HP Fax page 16 r Q J' i (4111m]9aTTNR 10 n'I OOE VM. !0. )srX2 SptnI»M Ault jI)�R6��3wm:) n PUT PufnaMlo o8pa Joao ON ti(�!Mlo mrf no �rrra snag►dire tiT.w3HUjpa+j PuT(ISM Aldd^S»7eb om[td faMo4d evrgar''x)o to00g poe a19eL blempvoou')pmsn[pd 'aq)ilvmng oxms;a aotondog Alva z3NVI TaWm ul"O HO vacrme ~�'SYg00�Ta3H d0'OI1 VV DWI A=Vdvo XXV.13LLaas d n ^8t 'ON 3► ORd V SMN&VWTT LSM I IT L 57-LO"1 V avw SMOSMSY ' 1 f• 3J '(A . 0 80'Ynn9S v�l Jbw r Ye'J NOLl'e ` a SLtG '0H TIgVISNiIdHdONMOL i - Commonwealth of Massachusetts C9Title 5 Official Inspection Form �} Subsurface Sewage Disposal System Farm-Not for Voluntary Assessments 61 Whitmar Road Property Address Peter& Linda McAndrews Owner Owner's Name Informrequired tion s Cotuit MA 02635 1-18-18 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: 1 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: pate ❑ 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: No G.W. at 12* Bottom of chamber's 4'-6" below grade. Bottom of chambers at T-6" above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 a6ed xed dH 10:5 6 91,02 61, ueF i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments vv 61 Whitmar Road Property Address Peter& Linda McAndrews Owner Owner's Name information;s required for every Cotuit MA 02635 1-18-18 page. Citylrown 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.V16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 g I. abed xed dH 1,0:91 81.0Z 61• Uer r 5 —C lCa-, No. Fee y THE COMMONWEALTH OF MASSACHUSETTS, # Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEMASSACHUSETTS application for 3h9pood *potem Conotruction Permit Application for a Permit to Construct( . )Repair Upgrade( )Abandon( ) ❑Complete System >9�ndividuai Components Location Address or Lot No. W(.a1 Owner's Name,Address and Tel.No. TES tT� f4.q �D�F3pP��! �jQ 6Fn1 Assessor's Map/Parcel O Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ' -' q(pt,Q C 4P6W11DS EN)"` L-1—C i5veAy ENU. SACS �?ov ?voX -4ie3, CEPiTmoic.LGIt-1A 7a,PvflXaoZ�-i ��1=AtA�le� ,t-AA e,z� Qa -40AR Iteas Type of Building: Dwelling No.of Bedrooms 3 Lot Size 43.5(A sq.ft. Garbage Grinder(K))s, Other Type of Building MONE No.of Persons 4 Showers(1) Cafeteria( c-)— Other Fixtures Wit► k 1 LAX2140ky 331 Design Flow 3_3rO gallons per day. Calculated daily flow gallons. Plan Date A1 0 S Number of sheets 4 Revision Date a--' Title Size of Septic Tank ....ext6-r 1,00n *cr>ic Type of S.A.S. (8' X31, -rpx_�A CA Description of Soils- its \en Nature of Repairs or Alterations(Answer when applicable) -RP Q.r- -,O P_\Cm 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 Certifi- cate of Compliance has been issued bytWs Board of Health. Sig Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued �� No: a1 _ }�'..,} b + Fee ` (/a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,'MASSACHUSETTS ZIppYication for ;Miooal *pgtem Con.5truction Permit Application for a Permit to Construct( )Repair X Upgrade( )Abandon( ) ❑Complete System,XJndividual.Components Location Address or Lot No. �tP,• Owner's Name,Address and Tel.No., Assessor's Map/Parcel 0 5_4r 1 1)(o 5R Nt E Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. --Aq(ol•q dp1m at©6 EnJ7', LLC 15"AY ENO. .,JCS• P 0• 'j0)( -ji✓•, C1EJTrP_Q1LLr=, MA '7 D=?50jK V+ E,Vj4L 04TN��-e(A b 2(63- Aab—46ag v as3il� Type of Building: Dwelling No.of Bedrooms 3 Lot Size 43 S(,4 sq.ft. Garbage Grinder(NJ)* Other 'I)pe of Building NONE No.of Persons 4 Showers(✓) Cafeteria( r•) r Other Fixtures L AV A ro Rq , �-rc_"Ea S►► k 1 L.Av14MY 31 Design.Flow '3'0 gallons per day. Calculated daily flow 44;6 - 10 gallons. s Plan Date 3 1 AJ O S Number of sheets Revision Date Title y Size of Septic Tank X tST 1 Un C 0A *CC`1c Type of S.A.S. i b' )(15 r rA GK R—S Description of Soil 1 e .c "fib plc e., Nature of Repairs or Alterations(Answer when applicable) t'RP Qr --o tam °i - Date last inspected: r 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 Certifi- cate of Compliance has been issued by: is Board of Health. _ Sig ed �`' Date Application Approved b Daie 6 U :]M_ Application Disapproved for the following reasons Permit No. `� " C' [�` Date Issued __I> A G THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS T T!1 ERTTTV ♦ 'lA p Disposal � 'THiJ 15 1V CLY\i1, •, �liat UIv Or.-site sewage apOSal System onstrucieu( )tCepaiI'Cll (�UpgIAQCCl( ) Abandoned( )by at �� W Lk,tMA2 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Ca � Designer C"0 41,2,q f �, The issuance of this pe t sha not be construed as a guarantee that the system <ill ,unction as�gned. T Date yID S Inspe(cter No. Fee_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 1=ftpotal *pgtem Construction Vermit Permission is hereby granted to Construct( )Repair(/)Upgrade( )Abandon( ) System located at (4fJ, Co ki I i' _ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constr ction m st be completed within three years of the date of th' p rm't. Date: � Approved'b THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A�C(� I DATA TOWN OF BARNSTABLE . 'k -nON _�� (�+1,�fMar �`�c SEWAGE # �S ,097 GE_'� Ca 4kt f ASSESSOR'S MAP & LOT INS Lf R'S NAME&PHONE NO. SEPTIC TANK CAPACITY 10W LE;A- CHING FACILrrY: (type) iA F+1 fra.Abr (size) NO OF BEDROOMS BUILDER OR OWNER PERMTTDATE: . .3 0 S COMPLIANCE DATE: Separation Distance Between the: /1 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) "VO Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) '� Feet Furnished by A ��. ' ���� /r' �y� �.�` ,�, - � .� ��� � s 4. `�'�� o . ��� �,: ..� ,.. .... TOWN OF BARNSTABLE N I - SEWAGE #.. j kkE ASSESSOR'S MAP & LOT ER'S NAME&PHONE NO. ' SEPTIC TANK CAPACITY /0 1. �! ';: _�� ';EACHING FACILITY: (type) ` (size) 441Z NO.OF BEDROOMS pp!� BUILDER OR OWNER Whh'" PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) 4"Feet Edge of Wetland and aching Facility(If y wetlands exist within 300 fee o ac g facility Fe Furnished byla � --{� e ck l � 15 . E I TOWN OF BARNSTABLE > -JIV SEWAGE # AG1 ASSESSORS MAP & LOT INSTALLER'S NAME & PHONE NO. ..y SEPTIC TANK CAPACITY 'p t LEACHING FACILITY:(type) (size) _ NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER, i DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i \ Owl r/ \\ \ 19,4 6' n TOWN OF BARNSTABLE . LOCATION G���f r ���� SEWAGE # JU05' ,097 VILLAGE— Co fkt f ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NQ. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) —(size) /V iX 3? " NO.OF BEDROOMS_ ` BUILDER OR OWNER PERMITDATE: .3 V COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Ar6 0 �L Feet *Private Water Supply Well and Leaching Facility (If any wells exist on site or within.200 feet of leaching facility) 'V� Feet Edge of Wetland and Leaching Facility(If any wetlands exist N b within'300 feet of leaching facility) Feet Furnished by } .\ o i x. Town of Barnstable_. t"E Regulatory Services ,Thomas F. Geiler, Director BARNSTABLE, 9A `9; Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: f y fsm_ Installer: Address: �,(',, �( a� Address: � � On_3 _ Cwc;w I V16 was issued a permit to install a �-- date (installer) septic system at based on a design drawn by (address) �^ S "' ��lu `,�,CS z dated 3 I a �6 S (designer) I certify that the septic system referenced above was installed substantially according to__!2(the design, which may include minor approved changes such,as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. I taller's S ature) CARMEN, Vcs4cy. 9 SHAY Cn No. 1181 (Designer's Signature) (Affix De e,�. ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVIS N. 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. Q:Health/Septic/Designer Certification Form : ot f I 4 _ .. t Feet \� GARAGE _ — V. C Z Failed J j / Leach In t / f 0 y. oz EXISTING � XOUSE.; V� 87 5' s TESL `HOLE.41 t { t ELEV. 92.00 �?� � r 36 VENT ti` 1 At, 29 p 4 : N • r r r ,� PROJECT BENCH; MARK, �o TOP ;OF: FOUNDATION ELEV ,100 00 (Assumed) .- IG NbTE Nb: STRUCTURAL BEARING WEIGHT FROM DECK OR`.DECK tSU.F'PORT AIEI ERSSI:RVEb ON:SEPTTt;:TANK f • nrr.K.rc t t_EVATED'S", FEET;'ABOVE:'DECK AN .-- DATE;_3----- --- PROPERTY ADDRESS:61 . Whi tm�,� _______ ----------- ^_ 02635 on the aboye .date, I Inspected the 8eptlo system at the above address. This system consists of the following: 1 . 1 -1000 gallon septic tank. 2 . 1 -Distribution box. 1 -6 ' X4 ' Precast leaching pit.With stone 121X4 ' 6a3ed on my Inspectlon, I certify the following oondltlona. 4 . This is .a title five septic system. (78 Code. ) r '5 . The septic system is in proper working order 0 S at the present time. 6. The waste water is 18" -below the invert pipe o the leaching pit. SIGNATURE:, N a m e:_ l a,-1'(sS s m ktr__�U-------- Company;3o••Ph_P ` Hecomb.r-b Son , Inc , Address :_ Box—6 6_____________ __CencerviIle L 8--_02632-0066 Phone:___ ------- THIS CERTIFICATION 00es NOT CONSTITVTH A OVARANTY OR WARRANTY J6SEPH P, MACOMBER & SON, INC, TanX1.0111pool;•L chfI#IdI Pumped 4 Ina;tilled Town Sower Connsotlons � P.O. Box 6775.33J8ey1775,64122632-0066 ,r K ,per COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 , OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 61 Whitmar Road Cotuit.Mass. Owner's Name:Rob Roy McGregor Owner's Address: Sam - Date of Inspection: 0 1 DECEIVED Name of Inspector: (please print)Joseph P.Macomber Jr. Company Name: J.P.Macomber & Son Inc. MAR 2 2 2001 Mailing Address: Box 6 6 CRntervi 1 1 e,MaGG _ 02632 TOVvNUFBARNSTABLE Telephone Number: r0877F_333t3 HEALTHDEPT. CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported f below is true,accurate and complete as of the time of the inspection.Thy 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 ection 15.340 of Title 5(310 CMR 15,000). The system: •: Passes ` Conditionallv Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shag bmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page I f Page 2 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 61 Whitmar Road Cotuit,Mass. Owner:gob Roy McGregor Date of Inspection: _3/13/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D . A. S stem Passes: y eb 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:- Waste water is 1 8"_ below the invert pipe 'of the 600 gallon precast leaching pit. 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. )0 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: .,l0 Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health):. broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 61 Whitmar Road o ui ,Mass. Owner: Rob P.oy McGregor Date of Inspection: 3 1 3 01 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 envirorunent. 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 rL 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: A/6 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. ,_Q The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. A)6 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 supple well". Method used to determine distance -2/4444/►L "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION-(continued) Property Address: 61 Whitmar Road Co uit,Mass. Owner: Rob Roy McGregor Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No or ackup of sewage into facility or system component due to overloaded 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 distri jution box above outlet invert due to an overloaded or clogged SAS or cesspool ) 1,t,,OL,91 A./: _ Liquid depth in s%speed is less than 6",below invert or available volume is less than ''A 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. v� Any portion of a cesspool or privy is within a Zone 1 of a public well. _ v portion of a cesspool or privy is within 50 feet of a private water supply well. j��Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] —14—J&(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303.therefore the system fails. The system owner should contact the Board of, Health to determine what will be necessary to correct the failure. _ f E. Large Systems: fi To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes n�o� ' 1° the system is within 400 feet of a surface drinking water supply _ t 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 11 of a public water supply well P PP 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. . 4 Page 5 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 61 Whitmar Road ' o ui , ass. Owner: ROB ROY M-c—GREGOR „ Date of Inspection: 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 ? k✓ Have large volumes of water been introduced to the system recently or as pan of this inspection ? Were as built plans of the system obtained and examined?(If they were not available note as N/A) B/ 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,r luding 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: Ye no y Existing information. For example, a plan at the Board of Health. :/7- - Determined in the field (if any of the failure criteria related to Pan C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) I Page 6 of I I " OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 61 Whitmar Road Cotult,Mass. Owner: Rob Roy McGregor Date of Inspection: 3/1 3/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): ) Nwnber of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x a of bedrooms):II)d--,PV61.0 . Number of current residents: "K Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system ( es or no): (if yes separate inspection required) Laundry system inspected (yes or no): „ Seasonal use: (yes or no): Water meter readings• if available (last 2 years usage(gpd)): 1 t(QJj j 4"b�1 6� Sump pump(yes or no):Ji f ry NO ,p�.pv�,s Last date of occupancy: �M / ;Sprinkler System Present COMMERCIAL/WDUSTRIAL _ .. Type of establishment: Design now(based on 310 CMR 15.203): gpd Bans of design flow(seats/persons/sgft,etc.): Grease rrap present(yes or no): �/� Industrial waste holding tank present(yes or no):/L/( Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: �1 OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Jf}AlIC 1��Y Was system pumped as pan of the inspection (yes or n ): If yes. volume pumped: gallons . How was quantity pumped determined.) Reason for pumping: TYPE OF SYSTEM _VSeptic tank, distribution box, soil absorption system ` Single cesspool d.00verflow cesspool A26Privy AlShared 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 systegi owner) Nfl Tight tank N Attach a copy of the DEP approval Other(describe): Approximate age of all components, date installed (if known)and source of information: h)"1sf' Were sewage odors detected when arriving at the site (yes or no):Zjj' 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 61 Whitmar Road o ui t,M ass. Owner:Rob Roy McGregor Date of Inspection: 3 1 3 7 01 BUILDING SEWER(locate on site plan) Depth below grade:--- Materials of construcnon:�,cast iron PVC,q.pother(explain): Ali¢ Distance from private water supply well or suction line: 16'�O- Comments(on condition of joints, venting, evidence of leakage,etc.): Joints appear tight No evidence of 1Pakac1a Thp cvatew is vented /etfe through the house vent. SEPTIC TANK: ✓(locate on site plan) Depth below grade: _ Material of construction: %'concrete metal,�,afiberglassa,�?LpolyethyIene &,�bther(explain) AJiQ If tank is metal list age:dJQ Is age confirmed by a Certificate of Compliance(yes or no):4)h (attach a copy of certificate) / > / Dimensions: ��0 y/ �(,�>` Sludge depth: Distance from top o ludge to bottom of outlet tee or bafTle:i � . Scum thickness: Distance from top of scum to top of outlet tee or baffle: " Distance from bosom of scum to botioT of outlet tee 39 bafhe: . How were dimensions determined: I Comments(on pumping recommendation , inlet and outlet tee or 6affle condition. structural integrity, liquid levels as related to outlet invert;evidence of.leakage,etc.):__ _ Pump the septic tank n„al sarbage`dispesal is 'pres-ent— ' Inlet & outlet tees are J np l ace The t:,,k -}s strueturally and shows no evidence of leakage.Liquid level at the outlet inve It: is fifty one inches. GREASE TRAP (locate on site plan) Depth below grade:.(i,4 , Material of construction: concretehrA_metal fiberglass t/�olyethylene4aothei (explain): r1�9 Dimensions: {l.- 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: 111W Date of last pumping: 11M Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet urvert, evidence of leakage, etc.): Grease trap is not present 7 Page 8 of I I r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION(continued) Property Address: 61 Whitmar Road Cotuit,Mass. Owner:Rob Roy McGregor Date of Inspection: 3/13/01 TIGHT or HOLDING TANK:A&&(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: V Material of construction: concrete A�A_metal A&Lfiberglass polyethylene ,v,4 other(explain): A1,4 Dimensions; Capacity: gallons Design Flow: Af gallons/day Alarm present(yes or no):_&_ Alarm level: 4 Alarm in working order(yes or no): _ALDate of last �L pumping: } P _ Comments(condition of alarm and float switches,etc.): Tight or holding tanks are not present. DISTRIBUTION BOX: if present must a opened)(locate on site Ian Jz_( p t b open )( 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.): Distribution box has one lateral No evidence of soils carry over No evidence of ea age into or out of the box. PUMP CHAMBER:, (locate on site plan). Pumps in working order(yes or no): A),4 Alarms in working order(yes or no): _Ay Comments(note,condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is not present. 8 . Paee 9 of 1 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 61 Whitmar Road Cotuit,Mass. Owner: Rob Roy McGregor Date of Inspection: 3/13/01 SOIL ABSORPTION SYSTEM (SAS): locate on site plan,excavation not required) If SAS not located explain why: �eaching pits. number: � leaching chambers, number: ` leaching galleries,number: __tt , leaching trenches,number, length:d .AZQ leaching fields, number,dimensions: —44 overflow cesspool, number: innovative/alternative system Type/name of technology: ,;rl; ll Pe, Comments Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Loamy sand- to sand.No signs of hydraulic failure or ponding,Soils are dry.Vegetation is normal. CESSPOOLS•f ��(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: _ Depth—top of liquid to inlet invert: 1644 Depth of solids layer: Depth of scum laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): -.eyt Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Cesspools are not present PRIVY(locate on site plan) Materials of construction: Dimensions: V,94 Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ` Privy is not nrPsPnt z 9 • , Page 10 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION (continued) Property Address: 61 Whitmar Road Cotuit,Mass. ' Owner: Rob Roy McGregor Date of Inspection:3 13/01 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. ro 1 Wh�fmar !Zd C'o�-'u,t , 33 77 Il t$ 25 - - - 10 Page I I of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propem. Address: 61 Whitmar Road Co ui , ass. Owner: Rob Roy McGregor Date of Inspection: 3 13 01 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 4tgeet _ Please indicate(check)all methods used to determine the high ground water elevation: Obtained from s stem desi plans on record-If checked,date of design plan reviewed: served site abuttin roe bservation hole within 150 feet Of SAS) hecked with local Board of Health-explain: /9�1 Ti9irl $ jz�l�7' 6.410/ �hecked with local excavators, instal ers- (attach documentation) ccessed USGS database-explain: L�•1f A,122:�� �d ��Jl--'E' ��✓et kez You must describe how you established the high ground water elevation: C;;hraty & miller Mode 19 /1F194 ll r ',r+nr+•-n•rr.-�-.en.-mr•ntrrrs�.nr.xr�*rr.�e••n�ni�m'enrt*+fr�rwy r�r�mn1en 'I'OHN OF Barnstable BOARD OF HEALTH SUBSURFACE 9FWAGF DISPOSAL SYSTEM INSPECTION FORM - PART D •- CEliTIF1CATION T••••. —T. r.--:-n.•nrn•nr.11r1Ri1retl'r'.'/1'.r-•.'1"R.mt:•s R+rRr`I'�Ta+Af m'+nl/�tts7sr7 nnrinlmrArr►-r1-r+'.+r.—.rrrr-•- -. -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 61 Whitmar Road Cotuit,Mass. ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Rob Roy McGregor PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macdmber & Son Inc�` ' COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City - Stat• ZIP COMPANY TELEPHONE ( 508 ) 775 3338 FAX ( 508 790 - 1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . C h sec'{(j- one : System PASSED The inspection ;Yhich I have conducted has not ,found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 161303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED The inspection which I have con Meted has found that the system fails to Protect - the Eiublic health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on 'PART C - FAILURE CRITERIA of this inspection form , e yy Inspector Signature - 'Date copy of this ce t.ification must be provided to the OWNER, the BUYER One Whore applicable ) and the DOARD OF HEALTH. * If the inspection FAILED, the owner or oporator shall upgrade the ayetem within one year of the date of the inspection , unless allowed or required otherwise asqprovided in 310 CMR 16 , 305 , partd . doc F D AT E:_41?L11---- PROPERTY ADDRESS:_61 Whitmar Road _______ OS✓� __ Cotuit �) 10 Mass . 02635 ------------------------ On the above date, I inspected the septic system at the above address. This system consists of the following: A. 1 -1000 gallon tank. B. 1 -600 gallon pit. C. . 1 -distribution box. Based on my inspection, I certify the following conditions: A. This is a title five septic system'. B. The septic system is in proper working order at the present time. C. 4'Leaching pit cover needs 'tobe raised to within 7" of grade. SIGNATURE:-- Name:_7-P_Macomber Jr_ Company:_J•P•Macomber_& Son Inc. Address:_ sox 66 Centerville,Mass . 02632 --------------------- Phone: 5 0 8--115=333B---------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 • ' S draft 1113195 SUBSURFACE SE«'AGE DISPOSAL SYSTEM INSPECTION FORM Address of property to ( h ki h-,/�r7-- Owner's name (and/or resident) . 'G L j Z f}(3 CTj+ JO;�1u Jv 1 Date of Inspection 4 /-7/qs PART A CHECKLIST Check if the following have been done: v Pumping information was requested sted of the owner, occupant, and Board of Health 1� t None of the system components have been pumped for at least 30 days and the / system has been receiving normal flow rates during that period. Large volumes /UvS� ho of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained. tmA-�e�r �-� Al The facility or dwelling was inspected for signs of sewage back-up. v The site was inspected for signs of breakout. —T All system components, excluding the SAS, have been located on the site. 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. v The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. v The facility owner (and occupants, if different from owner) were provided with rth information on the proper maintenance of SSDS. draft 1113195 9 _ SUBSURFACE SENVAGE DISPOSAL SYSTENI INSPECTION FORM PART B SYSTEM MFORIIIATION FLOW CONDITIONS If residential .3 number of bedrooms of, lLe4-0 Cf,dr d�'-`4e- noa cinumber of current residents n -cjgarbage grinder, yes or no w/A::e� $C hoirb laundry connected to system, yes or no N,> seasonal use, yes or no k/A-A, yewf 1"0 If nonresidential, calculated flow: Water meter readings, if available:j9 9� �1 �D Y���w tg9 " W pD0 1 g s 9�Last date of occupancy GENERAL INFORMATION —roping records and source of fo ation: System pumped as pan of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system �eptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed, if known. Source of information: ` £ST1"4k- .` /U yc-u r5 0✓ Lem old Sewage odors detected when arriving at the site, yes or no /O draft 1113195 SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFOMIAT10N continued SEPTIC TANK:��5 b�O 0 (locate on site plan) depth below grade: material of construction: V concrete _metal _FRP _other(explain) i dimensions: 11/'�"1 9 1C 4, sludge depth k.. ��.�1�?� ,31- /t vLz distance from top of sludge to bottom of outlet tee or baffle scum thickness �v distance from top of scum to top of outlet tee or baffle distance from bottom of scum to bottom of outlet tee or baffle 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,. recommendations for repairs, etc.) yes i t bg-FTQ"e- CAS 16z-- DISTRIBUTION BOX:y�5 (locate on site plan) M9 depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc.) �' D &4 r draft 1113195 11 PUMP CHAMBER:_ JU.� ate on site plan) pumps in working order, yes or no Comments: (note condition of pump cha ber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc.) SOIL ABSORPTION SYSTEM SAS):__)6�_�5 (locate on site plan, if possible; Oxcavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type leaching pits and number g/ Zc�l y,7- 0 leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of pon ding, condition of vegetation, recommendations for maintenance or repairs,etc.) _ 74 VizcC U� L IZt 7'crn - - �/ /}w r I I �� draft 1113195 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued CESSPOOLS: '� v (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 w materials of construction indication of groundwater inflow (cesspool must be p mped as part of inspection) Comments: (note condition of soil, signs o hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) PRIVY: (locate on site plan). materials of construction dimensions depth of solids Comments: (note condition of soil, signs o hydraulic failure, level of ponding, condition of vegetation, recommendations. maintenance or repairs,etc.) draft 1113195 13 SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORA'I PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' :..... _ - DEPTH TO GROUNDWATER > depth to groundwater method of determination or approximation: i draft 1113195 SUBSURFACE SEWAGE DISPOSAL SYSTEAT INSPECTION FORNI PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not) Backup of sewage into facility? 12,,io,� Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above.outlet invert? ba Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? Vo Pumped 4,times or more in the last year? number of times pumped 11 ,Vo Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltr anon. tank failure imminent? Is any portion of the SAS, cesspool or privy: NU below the high groundwater elevation? within 50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? Y A> within a Zone I of a public well? within SO feet of a bordering vegetated wetland or salt marsh? within SO feet of a private water supply well? � less than 100 feet but greater than SO feet from a private water supply well with no acceptable water ualit analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform } bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. draft 1113195 15 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Ru iu 4t L) J. L,4 L-) 1 4-C/4 r Inspector Number ---- �- p ( -j'4v��y '�'�'� Company Name Rc,,J,A ( A 41/� c.C 12 C Company Address fox Z��4 w yA /�► d 2 ��� Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information complete as of the time of inspection. reported is true, accurate and comp P Check one: I have not found any information which indicates that the system fails to _r adequately protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature Date Original to system owner I K1Y Copies to: Buyer (if applicable) .proving authority ASSESSOR'S MAP NO. g PARCEL 104 R T di:' j LOCATIAWikf &1 SEWAGE PERMIT NO. Led T` P-S' h /T 3 4-- VtLLAGE I N S T A LLER'S NAME i ADDRESS 0 U I L D E R 0R OWNER D A T E PERMIT I S_S U E D DrAT E COMPLIANCE ISSUED �� Y�� _ �� �� .. •--• �� , ry .. � — � . — �� x �" � o �� f .� �� 1 _ FRic ,gip THE COMMONWEALTH OF MASSACHUSETTS `,/,RCEL ;_ AR® LT PARCEL. :` I (0 LOT ..------fOO .......OF... ... LU - A ltrtttann for Day aii al Work C�nnitrnr ann rrnttt Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Sys ern at: ._ ____ .... - r-� v oe �o _ _� __ r. t �o. .........�7.._. ..T. .G...._. ... _.lam ...............................1.. -. �?...._m_ caner Address •----_ -� .. .. f ----------- -----•-------•--•••••-••-•---------•-•----------•-••.• _. nstal er Address / Type of Building Size Lot............ . ...... q. feet U Dwelling—No. of Bedrooms.........._..- .....Expansion Attic (//X/ Garbage Grinder (/ Other—Type of Building ..... No. of persons............................ Showers — Cafeteria Q' Other fixtu ............................ ---------- w Design Flow.,._.... �..5.................... allons per person per day. Total daily flow...... 12..............gallons. WSeptic Tank—Liquid capacity/D allons Lengthk.-6-P... Width ._ Diameter--.----- .- Depth _A. x Disposal Trench—No. .................... Width...ss....��........... Total Length.._--........... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.....1.'�..... Depth below inlet...�'..� Total leaching area... .. q. ft. z Other Distribution box ( ) Dosing t ` ,c� '-' Percolation Test Results Performed b ...... .. .....r?-U�1.cl/)- _.. Y "- / ,aa Test Pit No. 1--------;L.minutes per inch epth of Test Pit... ......... Depth to ground water.... 140 (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------..-------.------- P4 •-•....•-•••----------------••-•••••-•••-••-••••-•--•••----.........••-•-----•-•-•-•----•-----------f-_-- v�F 17 O Description of Soil...... �•-----...1�. M..#L...5 �.� � ......... �Ul�S�_.. x -• w w UNature of Repairs or Alterations—Answer when applicable............................................................................................... ..•---------------------------------•-------•-------------------------•-•-....--------------••--------------------------------.--------------------------------------------------------.....•.......•-- Agreement: The undersigned agrees to install the aforedescribed Individual T Sewage Disposal System in accordance with T�'Is�• the provisions of TTIL- 5 of the State Sanitary Code--The undersign e -u ther agrees not to place the system in operation until a Certificate of Compliance has been • ed the boa d f h h.Sign d .. .. .... ....... ........................ Application Approved By.... .. .. . - -- .. .. ---- . ........ 0 Date Application Disapproved for the following reasons-------------------------------------------------............................................................... ........--•--------------------------••-•---------•----------•------------------.........--•---------•----•--•-••-•-•••..-•-•---••••----•---•-•-••-------••-•••-•••--•••----•••-----•••••-•••--•-------- Permit No..... • ... 1 Date------------ Issued---------------------------------•----------- ---------- ,� Dst,, ....�!�,. A �`.0�(� THE COMMONWEALTH OF MASSACHUSETTS Fps /......... 01MARD o / . �. .........._. Appliraffo t for Biupuii al Worku Tumtrurtivat Urrutit Application is hereby made for a Permit to Construct ( or Repair ( } an Individual Sewage Disposal r Sys em at• `' - _ -...... 7TLLt` Ae Gam-: .......... --- ---- .-.-----e1�--.n�.._ � �n) Addressnaller Address '' // iy d Type of Building Size Lotf"�`.___.- J__ .__._. q. feet U Dwelling—No. of Bedrooms............. _-___Expansion Attic (/S�61 Garbage Grinder (/'I Other—Type of Building No. of persons............................ Showers W yP g ---------------------------- P ( ) — Cafeteria Other fixtu ------------------- --------------------------- w Design Flow.........S-___ ____________D ._gallons per person per day. Total daily flow------ ._..�- .................gallons. __(-/g W Septic Tank—Liquid capacity allons Length.-.6_... Width '. 4?_ Diameter....... :__• Depths__ _. x Disposal Trench—No. .................... Width-.--_-- ........... Total Length.............. Total leaching area....................sq. ft. Seepage Pit No......./........... Diameter.....,1-.4... Depth below inlet..—?.*... Total leaching area....3 ft. Z Other Distribution box ( ) Dosing tk _ '-' Percolation Test Results Performed by.___.��/ �...._.?-U ...... :_ __.. Date..Ip�-_f���` ._S. Test Pit No. 1_...__. -_minutes per inch Depth of Test Pit..4.A......... Depth to ground water-_-.��___ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix . 6 .................... ..................f_.....-- ----- -------- Description of Soil.. ------.J04 Q--�t.........p� -v��•�O( -1 _ > U ✓�. w UNature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------------------------------------•---------------------------------------------------.....•'---_'--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with TT�•1�LE the provisions of .� 5 of the State Sanitary Code— he undersigne u titer agrees not to place the system in operation until a Certificate of Compliance has been ed y the bo d f h- th. oe Sign d ...... -1- -• ' e---•- Application Approved By..- -- -- ---�`=-��'-�----"------• "-- - -- �'^-•- --{-- .:... -------•- •-•--Date Application Disapproved for the following reasons------------------------------•-----••-••---•-•--•------------•--•-•--•---------•---...---•----•------..._--•--- ..........................•........._..------------•----•------••----.-•-------•••-•---'-...•------'•-'- .................... ��. Date Permit No. �Cj y --------- Issued . THE COMMONWEALTH OF MASSACHUSETTS Vv BOARD OF HELTH .....�...... .....L..X........0F.....BA/FJV.S1.A.1 .........6 .... Trrtifirtttr of Tompliattrr THIS IS TO CE TIF , That the Individual Sewage Disposal System constructed ) or Repaired ( ) by-------- --- - ---- --------------- ---------------............... ----•----...........--- has been installed in accordance with the provisions of T T " 5 o ee. � -- r/-3- -- -----------------•- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE DATE.......-•-------...�.Q . ..�N TISFACTORY. ` SYSTEM WILL FUN T ' Inspector.. ..& 4. THE COMMONWEALTH OF MASSACHUSETTS BOAR O F E /� i !G�U�V.........oF..... /� ,.� No. � �.,i! ...... --......-- •-- FEE... ........ Disposal Varkii Tonstr w'it rrattit Permissionis hereby granted............................................................................................................................................. to Construct ( or Repair (� ) an Individual ewage isposall('-ystem 'j at No..... ....---p� f-:1 j .::r.. 1. lu -- C .)--- f !--•�-------•-- Sueet as shown on the application for Disposal Works Constructio mit N .._ '�� ated...0 __..._. ..(,............... DATE............. Bo r o Health FORM FORM 1255 HOBBS,& WARREN. INC., PUBLISHERS ....�..�...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �. .................OF.....1.6. .?!._r �------.......----.....---...._..------ .ppliration for Roposaf Works Tnntrnrtion ramit Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal System at: g— .Location-A sip ....�. .... .-.... -.... :.... •-•-•••-•.... ........ or l�.Nk.9S�.. `..._ .. .... U•. ! d Owner Address Installer Address U Type of Buildi2g,,— Size Lot. .b_� "---Sq. feet Dwelling—No. of Bedrooms.............. ..................._..........Expansion Attic ( Garbage Grinder ( g aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtu�re�s-. ........................ -------------- --•-------------------------------------•-------------.... -----....----------- W Design Flow.................!` .............•---•gallons per perso der day. Total daily 9()w..-------� ------------------.lens.L, WSeptic Tank—Liquid capacityk ..gallons Length- ." .._.. Width.477..�..._ Diameter.-". Depth.... x Disposal Trench—No..................... Width_............ Total Length.................... Total leaching area....................sq. ft. ,,Seepage Pit No.•-•.---_--I....... Diameter.._... -_. Depth below inlet.%31 5......... Total leaching areal O.a...sq. ft. Z `Other Distribution box ( ) Dosin ) i �+ �— a Percolation Test Resu}ts Performed by... ........... .............. Date._....:._.___ �3L.d�'3'L--Lo Test Pit No. 1________________minutes per inch Depth of Test Pit---1.6......... Depth to ground water_._____._:..._.._. ._.. rs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------•------------••--------•-•---- ...... �....... ---.--------•- --- Description of Soil.......-.:a .---•-•--• ---.!t01�-✓.��.'. t .� .7!n4 '� ... t �.... x c.� ----.--- ------------ •------ •---------------- ------------------------------------------------- ------- •----------------------------------------------------------------------------------•---------------- W VNature 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 ilT1li 5 tate Sanitary Code—The undersigned further agrees not to place the system in operatio u ' a Certi c e of C pl' nce has been issued by the board of health. S� ..............................• ................................................ --••--•-------------••--•------- A hcatio Approved J /3af PPPP y-•----.... --••••--------------•-•------••--•--•--.........-----•......_. .� Date Application Disapproved for th following reasons:--•-•--------•--------------••---•-•------••-----•-.....--•---....••-•--------------....._..........-----••••- .....-----•----------------------------------------------------------------------•---------•----....----•-•----------------•----••-----•---------------------••••----•----------•-------•--•---••-•-•--- Date PermitNo...... .. ..._..................--....------ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O EALTH �I .........OF........................ h.s.................�............. LOrrtifiratt of TompliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( . ) or Repaired ( ) by---------------------------------------------------... ------------------------ -------------••-•-----.---•-•---.-----------........ d n taller at 1 t'1.Y k. .. C .! has been installed in accordance with the provisions of TI of The State Sanitary Code as de•cribed in the application for Disposal Works Construction Permit No--------- _.... _ dated. {�a�/----------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... No._.76-� Fizis............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................................... .................OF..... .............. Appliration for Dispoiial Works Tomitrurtion Upprmit Application is hereby made for a Permit to Construct O or Repair an Individual Sewage Disposal System at: "V 6� I . .... ... . ............... ...... ................ .... .................. Location-Address or Lot No. ............... ......... ...................................................... ...................................... Owner Address ........................................... ................................................................................................. ...................................ins;a r Address -7 -11 Type of Bluildiv,--- Size Lot-":4 Sq. feet U Dwelling—No. of Bedrooms____________________________________________Expansion....... Garage Grinder ................Expansion Attic Other—Type of Building ............................ No. of persons_____..__._________.___.____ Showers Cafeteria P4 Other fixtures ....................................................... Design Flow..................��-Z� a)!::�...................gallons. ._..__....._._____gallons per persop-per day. Total daily flow_..__._... 04 Septic Tank—Liquid cap acity ..gallons ,Length " ..... Width.l.-_0.... Diameter--- -—-------- Depth... & Disposal Trench—No;____________________ Widths .............. Total Length..,:__---------- Total leaching area--------------------sq. f t. Seepage Pit No..... ....... Diameter....... ........... Depth below inletl��!............. Total leaching area;�'..'a...sq. f t. Z Other Distribution?box Dosing,-tank -i '#AIJ Date...............I ...... Percolation Test Results Performed by..... J e, -7 ....%..... .... .......:....................... is Test Pit No. I...�....-��minutes per inch Depth of Test Pit...L-N......... Depth to ground water.'��' ..... .. .... - ------------- �r4 Test Pit No. 2................niin-ufe"s per inch Depth of Test Pit_..___.__._________. Depth to ground water._____._.._.__.__._._.__ Rai .......................4..........i...;,'........... ------------------------ ram_ 6........................................ ............................. 0 Description of Soil......�e -------------------------- ............ ..... .....................:.............................................................................................................................-.......... ...................................... U W ....................................................................................................................................................................................................... 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 TITIZ- 5 ta e Sanitary Code— The undersigned further agrees not to place the system in .1" C I I 'Vio.. L le,( ce operatio u ;ia erti ca off=r ian has been issued by the board of health. .......................................................................... .......................... ApplicationApproved By-- - - -_________---_________------------------------------------------------------ --------1.W....... Date Application Disapproved for th following reasons:............................................................................................................. ........................................................................................................................................................................................................ Date PermitNo.._....5-"rC-?----------------------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O"EALT% 114h g L Q- ............... ...... 0 F......... ..... .........................., .............................. Tvrdifiratr of TI-Impliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by-------------------------------------------------- ............*------------------------------ ------------"------------------------------------------*------------------- jr _ ller to at.................................................... .............. .............. --------------------------------------------I............. r. has been,installed in accordance with the provisions of TIZ-19-5 of The State Sanitary C�.'�_ s de,cribed in the ap for Disposal Works Construction Permit No..... t ... plicahoii dated------ i........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................ Inspector...............................71%�Z ----------------------- ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE T ..........(a*n...... .......0 F..................Noe�A FEE........................ * Permission is hereby granted...........................'Aue..............-��. ,."kx-`ft5. 5. .!-.Q.............................................................. to Construct or 'R an Individual Sewage Disposal System atNo..- �.y....... .........T-,A, .t.............................. ------------ Street-- as shown on thftpplication for Disposal Works Construction Permit No.. -.:I?Z-Dated..... 6P............... ............ ----------------------------------------------- Board of Health DATE..................... --- --------------------------------- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS -- v • &T� ��.^c--tom �a. M `1 i r Ft.,C�u.l -\\oX3= 330 6pP 5F , 'f74UL -3Zo x t-5= 4dvG(kt-g PISRJ, SA�� ►1= U-.;,c- 600 43 E TTr-)H= L54X, ,b G F 1 Z54 • ° � I tcxsEPP �•'� RaX p� WILLIAMC. G¢o �1000 6 U- d N Y E y`w PETER No. 19334 �, fit; SULLIVAN N0. 29733 ., , CID TO I? Filua u \2-lci•�� �� LZZI 2c, w - tbdb I I I I •4 If3tn7 ,rru�r T 14' S mod c�•o.��o►..�-�,'c 'i~�1�1�^�-C7T p: • 4 =CSC) mac- 4 '�• BCo vwj � Mtug f;.1►.�cN ���' l._., c ,c• 39,��d �- ►"�E�►OI�L y E c. 1; c.�rz.-ri'�� ''r�4AT `c�� PP-c�P l�usE�,���� �c-��s�e-•c� �� su��t�oes � � M�'L`(5 �li�`Ct•�'1; •6 t'plr 1.1l�� �V� Z���t L-r M,p� g '.���.. �. �7 5 tJC3T' T►•�►s�.c t is ��ac--�.s�7au�f.1.t1..�s� �--� �ll`�-->� ►�~r+tE��rx��v`�.,�i d1. ' ut�t�r.,�r��� ��s�-s 61 b, f _ io-r Lc t15.. . I I I � \) \I ! . . I - I I I I I I � . I 1.�__ I -. -11, I -- .-. I I - I . I � I I I � � � - .1 . I I � - - I , I � / I I I � I 1, � � i I � -; . I I I I I I, I I I I I I I I I I 11 I � I I I � , � I -::.� . I I I � I I I I � I I I.. I . � I i I I I I I I 1 . . I I � � � � I I i I � I � � I 1, I I I � i I . � I I � � I I . I I I . I � I . . 11 t I I I 11 I I i I i I 11V 11AN;T Wt;,N1,q-�, ,�;��--I , ; �.A 1, �i I ,�C;�_ � '. I I,.;- 11�, ,� � 1 � ,�,i�.. 11 ,,� I I , � I 1 2-18' DIAM. ACCESS MANHOLES ; 11. -11 4,- ., .11 � I I �`11 . �, - � �, ,,,�� ,O I - t - 1. I I � � il'. �,` 1, , I ,, t I 11�, 0� 4'� I I� �we�1 I I — 81 — ,I I �� � I., - I I , � � ,.;, ", 'I r - �Id ,�: !�,.�,%, ! I I, , , � ��,, i I , I I '. , 1� .1 - , .1'... - . �'.- 11 � \'.�1 114"�, I. I 11 11 . . - �,:,. . �t, �_� , , -,L��, ,.* — �.�;-.: ,I , I 11 � . � : ,..�� ,�---- _, , � �,i 1, -111* - ; 11 . I , �.'4� -,7.: . � �. I il -�11_1 . , -1. , , C�,, 4 � I I I ; 1� �k � le 17' � , 4 1, .1 "I. 11 *c *�, ,�:", I . III. "I. ` Z � I � I I,. � I;:1 ' I_,- , -i's -, _�,,,,,, '),� �, ,I,�, -, I , ( , . - ,��- ,^1 I I �- i --, , --I'� /, --," — I I i :,:I ,I I 11.-� ,1. )� f %I % ," 10" ,,, " ,�� 1), � -A /��_ 111�_ .1 , . 7 ��,o � �', �, � I , , � * `�r,-*�,,,. - ",T ,,r I'll , 'I SECTION A L'�, I'�*. 'It, I � , -,, . , I A�� " - . .,��1, ,� �, ' ', *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V�C, ) I INLET ....1� I ._,�','-' __1 A � , , ,� 10' min. from— I — /� I". �,I, " VENT PIPE (0 Least 24 Inches tall) � PROFILE VIEW OF ADDIITON-TO LEACHING SYSTEM 7� ? � . � I�i r 0�-,,It t,�,,_ ,9- I I 1, I — I - , � .1 1E, ,*!'_,/* J� X61 %Nhftrnar RA'- - ______, �,� � Existing Foundation I house to septic tonk � I 7 OUTIET I r , "I ?� Schedule 40 PVC w/Charcoal Odor Filter ,, 1i .'q '_�11 ,�% ., I� , V�-o 1 i .! - - "I-1 v: i ��, - Septic tank covers must be I t:� � :� ? ,- "t i I �11 , , I I I"� e4. �� �,,,� - �i C. . �, I TOP OF FOUNDATION = ELEV. 1 00,00.(Assumed) 3* of 1/8" - 1/2* Washed Peastone I 11 - 010 I I v�,�, �; I, �,P,A,, `-�� "YL. t I . within 6 in. of finished grace !. I THE ACCESS COVERS FOR THE SEPTIC TANK, . � P ; � I . , . � - � ��, ly I,�g I 4 Grade over Septic Tank- 93.00 Grade over D-Box - 92.DO do over SAS - 92'00 3/4" to 1 1/2 * Washed Crushed Stone � � , �, "', i" . ,:1 � . - � I '. DISTRIBUTION BOX AND LEACHING COMPONENT "� I. ',� . ,I I . 4 , I SET DEEPER THAN 6 INCHES BELOW FINISHED 'L� � " 11 " ',I � A � ,�,:.' ,� �'� :% I I , V "' I .1 . —- Z, - F`,'6,.f7.,Z-,1,;7=.!7- �,-,,.t,7.!�7-'7- I_J 11 "�!1� ')1�'Ir ".11 "It'.", il I A\ X/-"*' —-- 117 GRADE SHALL BE RAISED TO WITHIN 6" OF 11, , . 't 4 11 1, I 1 4---.. __ I I , 1T__1___ I : FINISHED GRADE- % I / .11 I , - I I, \ I , " ! STEEL REINFORCED PRECAST CONCRETE ,,� - 1, -1 'It, ! I S . D.,02 1*1�%�, �_ 11 ... '� _ �, ." , I I Z 4 " - 3 HOLE H-10 Top Load - EIPV. -90.10 - " " " �z "_ , ".", 1�.. 1� 1, I I , ,I DIST. BOX 3 Ma, IF , INSTALL TUF-TITE GAS BAFFLES OR EQUALS 1, I 11, 1, ; I r� - ; � - I 4_U EXIST. . . . . PLAN VIEW � I I "', I _2� ,� S-0-01 or Great., � I i , 11 ,�. i .; 14* � � IF,�- I � I I - I . . _� - 'i k'� I �, I E=L21K .T ...; 1,000 CAL. S= O.D1* per foot A J If , &KI" . �� - .T SEPTIC TANK 0 au . I Z 0 Effectys Depth 3-24* REMOVABLE COVERS ! (02C,24FRard%t%ixi"&,C,,-W�;02,X NAWTIE12 , -� 1 FROM EXIST. FOUNDATION / UXJ � 0 � I X � ,� -, X I I I womb /_ I _\ I I W .1: I to 20 , . � . .a.". 0� 0 n ro i� 5 Units III b,d�' = 30' r- I r___1 i — I I � II* . un, � I � - .I� � � " > fl. ,HI-10 " � 0 00 I , T`,.1'A:t_:-,�,..--1-.,�-" .. �., �, ,,. . , ..� . �" .. �.. - I CONCRETE FULL FOLINDATIOJ 4) > 11 11 6 an . r___�' 0�83 (4 inches) 3' 3' 1� � ,-, .; ..,- ,-, � . .1% I W :�. - - 5 0) 00 I I I I .. .. i - � - . -I"' t:� :�' 00 _L_i��i I I .1 _J 3" min. clearance 1, .Ir . I Z I 0 11. . 0 - - 1. I ., i3' INLET I � 6 In.of 3/4*-1 1/2" -6 11 > 0 �J`7 InT_ ..� � �I i SYSTEM PROFILE' 11 - I INLET;_�4 8* min. _.12:_n12, iniet to outlet . . ..; .- 5 compacted stone 5 ad � 7 P5'— .4 --- — �zj=__E3 OU TLE T - 1. Contractor is responsible for Digsafe notification C 5 5 1 `: , "; Liquid leveT ... :: 11 I , .2 a) t. min., -. . ., ; `,_� . , ! I I ; Not to Scale - C a) 0 _L!,�A I EffectIve Length 7, 1 ... .1 I ". T and protection of all underground utilities and pipes. � I � . >; _5 — — 4' 'I , 1%.: 17 t." ". : 15- -7- 2. The septic.tank anq, distribution box shall be set 0. I I�� 5 .E �r_ 4' -72J 5 I I . SOIL ABSORPTION SYSTEM (SAS) 5- -7- ' __ e fi - � . I .� ! ,I : 16 5 -, ��I E a . I -�' . level on 6 of 3/4'-1 1/2" stone. I I " , � . E _�. I ,U � I ..I 41 - . -a" min. .-,; I 4) - - 1 . 0.s.". ,`� 3. Backfill should be clean sand or gravel with no � . � 6 In.of 3/4"-1 1/2" 'a (1) I INFILTATROR HIGH CAOACITY (H-20 LOADING)/ GEORGE O'BRIEN 0 .., :. u Gap h ;� . I . . J compacted stone Effective Width . �. 1:2 . .� ... � I 1�: ..j . I I ",'. , ...i; stones over 3" in size. I I �I LL I � � ." ." 1 4 4. This system is subject to inspection during installation ! I � NOTE: A' COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE 0 (OR EQUIVALENT) Not to Scale . '14-a I � I I -0 Bottom of Test Hole I Elev.-82.00 CO i ' 1. �.% ::. - ! , tl�a..2a,�n�,n�er - C1 120.........11 IGHT OF I " /EFFECTIVE HEIGHT IS 10" !. W" � , -- ,.-.,-:,� 170 by Carmen E. Shay - Environmental Services, Inc. . . __2�L�,.�, .7.,1i!7., :,.,,:�7",F. 1. ..:,� .� NOTE: OVERALL HE NFILTRATOR IS 18 . �77= - ,_*�_,:_. I., .;�. � I I � I I � B.-O. - 4' -10" 5. The contractor shall install this systemAn accordance � t ; � I ; � END—SECTION with Title V of the Massachusetts state code, the approved plan i I I � i I I . ; I I and Local Regulations. i //\\ ! 4 � � � I 1 6. If, during installation the contractor encounters any I I . / I I / I � I � I soil conditions or site conditions that are different � / I ! . i TYPICAL 1 000 GALLON SEPTIC TANK I / I � i from those shown on the soil log or in our design � I / I : I I NOT TO SCALE i / installation must halt & immediate notification be . I I i I - � I � `_� f; I I made to Carmen E. Shay - Environmental Services, Inc. . I I / I � I I / � I I ! I . . � 7. No vehicle or heavy machinery shall drive over the � : I I I I I I septic system unless noted as H-20 septic components. I / 1, � I —PERCOLATION TEST I I / I 1 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. ! / �, �, 9. All Distribution Li�nes shall be 4" diameter Sch, 40 NSF PVC pipes. t I I 11 Date of Percolation Test: DECEMBER 19, 1985 , 11 I //I � Test Performed By. PETER SULLIVAN - BAXTER & NYE 10. All solid piping, tees & fittings shall be 4" dicmeter I � / I � � I / I � ( I Results Witnessed By. Barnstable BOH I Schedule 40 NSF PVC pipes with water tight joints. I � � I I � I I I � I / I i I Excavator: UNKNOWN ; , 11. SITE and Surrounding Properties are Connected I / I I � Percolation Rate: Less Than 2 min./inch 0 24" BELOW GRADE. I i I I / I I : � � to Municipal Water. � I � I I I I I I , � ____ i I I . / I I I � � � � Test Hole i i I / I I " I � � / � � I I I I � �____-___ ---No,.- 1.-- ,- i � ! I I __ � - // � I ; DEPTH SOILS E�EVI I NOTE7 � ; � - . I I . I NOTE: CONTRACTOR TO NOTIFY DIGSAFE A�D I I . I i � I 0 � 92.001, THE PROPERTY LINES ARE APPROXIMATE AND i I / � CONTRACTOR TO VERIFY LOCATION OF ALL UTILITIES i I COMPILED FROM THE PLAN BYBAXTER & NYE of OSTERVILLE, MA 3 � Loom:y Sanc I I / 11 i PRIOR TO EXCAVATION. � 1, ; � I / � i I ENTITLED "CERTIFIED PLOT PLAN OF LOT 25 WHITMAR ROAD, � ! � I � I � i I I , 0. i ! i / (;) \ : i -6.1 . A's 91.50 COTUIT, MA" DATED APRIL 24, 1987 � � � / C� . \ . ! i i AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN / �cb "\ I � co I I ; Loom,y Sand I I 11 , - I I IT SHOULD BE USED FOR NO PURPOSE OTHER THAN I / // 'b ----------- -, ! 0:) � ! � I I I I � I � . . C INSTALLATION. . � Cb* 11; I T � � I I ) i . i / (1� � I 'I I I I � 6'-24" b. ,90.00� � I I Is, � I � LOT#26 I I I i ! i � !\ I . � i I I Medium / I � � � � I � I � // i \ ; - / i \ 1, I I � Sand i I / 1 \ � I � ! . i � � 1 4_� \ \ I � � . NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE � � � i � I / � \ i � FROM THE EXISTING SEPTIC SYSTEM TO BE DISPOSED I - � / I \ \ f : 24�"-168* C, 8 2.00' i I � :�:\ \ I : EALTH SPECIFICATIONS. ! �-% / ! \\ \ . 1 ; ! i m� . / \ I � : I I I I I N \ � : � I 1 I Ll- / ! , \ I \ I . i i I EXISTING LEACH PIT TO BE PUMPED DRY & I / ! \ \ ; : : : I � (D \ 11 � i ; I i FILLED WITH CLEAN FILL MATERIAL. 1 7 k-- � I 11 -090 1 : I I � ; i I I I : I . i I i I -Z _\ :! I I,--- ,Vol ! � � I I ", I - i � I C , - I / ! I : _� 11 I � I -_ I I . t�� � I � - ; � I / ! I i I / � I i t I . I i � . / . � i I I / � I � / I t ASSESSORS MAP - 05 J �_ 9� 7 ---- I I / ! f , . I I � I / � ; f � 0 I � i ! I � I I � I / . � I I I I I ; I / I I . 0 I i � I I I I I I I � I / I I t __J ! ZONING - RESIDENTIAL ! I L-L I I I � I I I ; I // I � � I I I I I � I I � /I i I I . ! � / Perc #1 I . I I \ I I � I / - I I I I / . : \ I I / . Depth to Pe,c: 32" to 50" I �� zo , I ! � I I ! I I I ! - I I I \ I I I ! / I � I \ 1, Perc Rate=<2 min./inch � � 1, � 1-1 / I � I \ I I I I / � : . I I I i I I I � I I / " I I I I I � I . i / Groundwater Not Observed THERE ARE WETLANDS LOCATED WITHIN A -200' k,-�DUS ; , � I I - � I / 11 I I_. I,,--- \ ,� '_, i I, I I .__ 1 - - I I -- 1- - I. � --- -- - --- I- I—-- _ -, - ,--_______1 I -1- / BOTTOM OF TEST HOLE Elev. 120" i -, 11 _ - �, � I I � -, - -------,-----� I--I I� � -_ � __- - - -�- -�_� �� - - z.--- -- - -, -- , �� - 11. -1-,________, � --I" _ _ . -------_----�.-.-------------"---,- ,-----, I --------� ____1______/ I - - ---- -____ , - � - �� E;ev. - !`,�ty Adju-stment Requlr�ed. . OF THE PROPERTY AND ARE AS SHOWN I - - -, . � I I // I '. 11 N" I I i, I . �I, I I I I I ( I I // I I - I ADjUSTED ,v- I - I I -1----I . I -1 - 1-1 .1 ___- �---I I -.-- 11_- .__- I � -11, - I I I I�- ,_ - - ---_ - --- �) I / . 11,� I I � I I I I I / I I � , � 1 1 1 1� I I i . / I � : � I I � I , I � I / I I 11, � I ) / I I I I I I I LOT#25 I I . I I / . . I - I I I I 1, . i I . I . i � I / I I I/ I . I ! : I / ----------� � / . ! I J I I I 1 43,564 Square Feet +/_ I `�, � I 1 7 1 . / I I ALL OUTIET PIPES FROM THE I I I � . � � I I � I I /- --- � // I rASTRSUTON BOX SHALL BE ;; 12" - CONCRETE I . I i I I I I � � I I � I I . . z . SET LEVEL FOR AT LEAST 2 FT. COVER LEGEND I � I I I I I / -) I / I I f I I i .,/ � / . �,.I ...1 - -A � .. __1 ,.A .� . � I � I ."! 1 3- 5"OUTLET �7.,;. - :. I I 11 i I -------- I I // ,4, ", --��I ,*,, KNOCKOUTS I.1 ,*,:: i I � ,� I I I I L-T 1, � I. T I I I I, / � ..," I .-_ - 5. 1, i I � _�, I .1 . / 't - -Iis. OUTLET ,� 12' INLET t ! - I I 11�_ i I . I t I 1 7�, - TA�', � I I - I \ GARA CE � " \� I ,, . , I ____ � \ I \ / :. I ____ . ASP / , , .� ,I i � / 11 - \ \ I :;..�� ,,�t;.!� DENOTES EXISTING _" . . ______ I \ 4�� \ I / . I 7` I - X 104.46 i I I I k I -- I I 011�/ \ � I � / _I5.!5"— , 14 I 1, i I \\ ______ I I I I I . 11 I tzt), \ I C.) ., / 4* - SCH. 40 .75. i � I \ / I I ; /I \\ I /.1" 11 I ---------, \\ I W-1, (\ // I PLAN SECTION CR MON PL PROPERTY LINE I I Q I I - \ I I I I I � I I \ I / I I - I \ IZ5, / t I t \ I .�_> I �. I -1--�_ \ `%, // I i I I . \\ :i / _ Failed _�) � I I I I , \\ I Cc 3 HOLE DISTRIBUTION BOX - H-10 LOADING -Uf�-- PROPOSED CONTOUR i / � / I ! I - - 0 I I I � , \ � I � i /I \\ ; // ,� Leach PIt Qr I I I I � 11 I _�,� \\ I �/I // // NOT TO SCALE ' I � i 1 1 /11 � I I \11 ! I 0 --i _\_� 11 � I I � I 1\\ \\ I // � 97- - - - - -97 EXISTING CONTOUR I I " I // / 0 (J \ 11:� . I I/ I I / I LJJ I I I � \ � . `1 r � I , Q It I I � \ \\ / � � 11 , / __� I I \ \ / ^ i I I \ I � I I'� C) . - i \ , / I \\ : 1.":, // I 0 �t�,*,I D-Box () I I 1. I �__ ( I- \ - \1 / I Design Calculation MIN= DEEP TEST HOLE & 1 1 � I \ I � I � ,.5�4.-P�( Z , - I � � I I I 11 I . \\ I I / 1� L-JMM � I I \ I I I I" " 'T I I � I : I � 11 � -- PERCOLATION TEST LOCATION I I \ I I . I �"-,?�- � I i I . ,I ,- 'i. . �, I I N \ � I ; �..�,.. `0 I . I I � � EXIS TING ,I ( I \ i I I I I I I \ I\ I i I I .. . I . 11 I I I i , \\ , ____ 71 � I I I \ I �.....�11 11 "'' �1�� I I I /� N BEDROOM - - . I . � 9ff � I - � I . . "I I - i I I :- . � �, , , � Number of Bedrooms: 3 Equivalent to 330 Gal./Dcy (330 Gal./Day Min. per Title V) I FENCE � \ \ � I If'.. . 01 I " I I , I -1 � I - 44 � , - ,� - W : � � ' I 11 I � I I I i , < , � 0 1 � , - cc \ \ \ I I -,-,."t, 4 ..?O.. I � � " I 11 - .ROUSE , , I 11 411;,IC/ , , I \ Garbage Grinder: No I I I I I I M \ \ \ , ..t.,.�, �J I I'10: � ,�, � I I I I �I �I I I I I I I I � I I .11 I I � I 11 I ,� I r,4 � I I / - '�11' �::N Leaching Capacity Proposed: 330 Gal./Day Minimum (Mir. Per Title V) I I I. . I � \\ \\ I I I I,�.� , I'� I I � 1 I I� I .1 1 #61 ,, I I I I � 4164. -,t,qe I I // 11 \ I I I -� I , Septic Tank : - 2 x 330 Gal./Day - 660 'USE EXIST, 1,000,GAL. Septic Tank. I PRIVATE DRINKING WATER WEL' L I I � I I - I , f . i � ' I I i , , TION AREA: Using percolation rate of <2 min./inch I I I-, I `q� r ,1 � 11 � , -_ / \ I � I It \ \ �: - ' 37 25' .!�,. - I -It- I N I I- , 44, SOIL ABSORP _1!�_ i I ; I \ TE�T HOLE #11:, '-'-'ill . :I I I � 1, I , Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. = 273.8 gallons . I I \ I . I 1,, I---------- I � / , �_ I 0 � . I I I I , , I � \ ELEV�-, 92.00 :�1,4 " �t, - . / REVISIONS � ;1..,; 11 I I � / �-_ i I I � I \ I - � 76' 1 � I / ,, � \ I "I'll": , Ji � � I I - �L_ Sidewall Area: 0.74 gal./sq. ft. x 78 ,sq. ft. = 58 gallons I... I 11 / I � I \ I . I I I I , . I I � 4 � � I _-Z I Providing: = 331.80 gallons i r I \ , I I -1 L 1, t - � I "I I 1, � . , / ' 'I I : I � 0 1 � I I � I - I - VENT PIPE I I I , ,�, � . I I I ly I r / DATE: DEFINITION I I . -7- 1 . i 1. I I . . - NO, \ I 1 � I I I I � - I I I I �� � I I I I � I I I \ I I I I / ,.. - I ---- 1 , , I, / � I - ,�� I I \ I \ � I I" I , I , , i I :�y Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, , I , I I 11, .1 I "11 I .. I I I I / , . I � I \ I I . I I �1' I � - - 11 I . 1- - �� I � I � " , y I � . k I 1 I , I . I I I I I I , I I , I A.- I � 1 3 BR System I � , I I 11: : I " I N"I,ZUR � . .1 I I I , TO BE USED WITH 4,0' OF,;WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE 1 1 per, Ownerl I " I 1: . � I / t, I - � / .,� - / I , I � I , , . I I -T� , - I I ,f I I I � I I I 1�19 � ' 11 r , / � � 11 I I 'A I / . I I 0 1 1 ; 11 `t I I 0.40'A , � I . � . . I t . " I I 1___1A I , / I I 4.Z I ON THE ENDS. 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I I ELEV. = 1 00.00 (Assumed) ,, � I� ,I- I I �'': , - :, , I I , , k, I I I I I I I 1� I I I I I I I I , � I � L � I I I I : � f I " ; I I I I I I � �, �r I' ll 11 1, -, , I �_ � � I I . � - I I — OR - I I I � � TOP ,OF FOUNDATION ,� 11 1"� .— I . , , , . �� � I r . !'f I � I I I � I I 11 , I I � — -�, � � 1- 1. I "I"_ I � "'' "' ' " ' I I , I PREPAR -ED F 0 1 � I I I — I I- . 1 1 11 ; I I" 11 � 11 I 0. I i I I � "" J, — ,et_ , , I � / I ' ll, I � � I � I . I I I I I I I 1.11 — � 11 I � � I , '11 I _�� 11 11'' 11 / I I I I � � I I ' 'I I 11 - I I I � ,� 11 I . I I I I I I ,� I I " . I ,�, � �, , / � � I I I I � I I I I ' 'I I 11 � E DISPOSAL SYSTEM 1 1 1 � Ir � � I � � � I - 1� I � I I 11 - I , _� 11 � — �/ 11 I I 11 I � I 11 � I I � I I ,� . I I I I � 1 - 1 I I 111. I 1. � I . �_ � -, I - 1� (I I 11 .11 I I I I � I I 11 � � I I I 1, � 1 . � 1 " - I " - � � I I I - I � - .,� � ,� - .1 � - � I I � I � I - I I'll , � . I I I I I I I I I � . I I � 1� ''I .1 I - I i 11 I I � I I ' ' I I I .11 � I I " I � J I 11 1, _,_ , - I I . 11 '1�11 �` � I , I � . .1 . I . � I I I - . 1 I i � I � I I I I � - . I I I I �_� . I I � � 3 - I I . I I I I OF I 1 1. I I I I I I I I I I'll I I- .. 11 I . 'I',11 r I NOTE: NO STRUCTURAL BEARING WEIGHT FROM DECK , i _: 1, I - �I — , t�I � �t 11 - I I � � . I I I n : I I I I -- I - I I I � � � I - ' .. I I I � T I 1, I . I � ; I- I I I . � - � , � - _',I I I I - I . . -I , i I I I � � I I I � . .1 . I I 11, I 1,I � I -I I � :_i PPORT MEMBERS 08�tRVEO ON :SEPTIC."ITANk. � � I 11 11 I I , I I . � I I I I I I . � I I I DEBORAH J . BREEN I I I 11 I � I, 1� 1, : � � ,Y� , I ,� I 11 �, � �, I I � I . 11 I I I - I .- I ' ' I -1 1. . I . / : , I I � I I � I I I I I 1� I � — '__, �, I — , � I � � - . I � . I � . #61 WHITMAR ROAD I I . 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