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HomeMy WebLinkAbout0172 WHITMAR ROAD - Health 172 Whitmar Road Cotuit A= 056 073 1 y ri Commonwealth of Massachusetts Title 5 Official Inspection Form - Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification Important: / When filling out 1. Property Information: forms on the computer,use 172 Whitmar Road-Cotuit MA only the tab key Property Address to move your Timothy and Patricia Cronin cursor-do not Owner's Name use the return key. 172 Whitmar Road Owner's Address VQ Cotuit MA 02635 City/Town State Zip Code Date of Inspection: February 24, 2006 Date 2. Inspector: David D. Coughanowr, R.S. Name of Inspector Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364 0894 Telephone Number ,n Certification Statement: I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority February 24, 2006 Inspector'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 is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5-2264.doc•11/.2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 1 of 16- Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form A. Certification (cont.) 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: Inspector's Note==> Aseptic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: t5-2264.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form A. Certification (cont.) 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name Date of Inspection 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 ❑ 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: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5-2264.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (cont.): 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for 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: t5-2264.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form A. Certification (cont.) 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name 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 ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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 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.] 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. t5-2264.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name Date of Inspection 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. t5-2264.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 6of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ,M Subsurface Sewage Disposal System Form B. Checklist 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name 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? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, including 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(3)(b)] t5-2264.doc• 11/2C04 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 gpd Number of current residents: 2 Does residence have a garbage grinder? Removal of grinder is recommended. Yes No 9 g 9 g ® ❑ Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 348 gpd Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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: Last date of occupancy/use: Date Other(describe): t5-2264.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form C. System Information (cont.) 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name Date of Inspection General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age: 13+years. Certificate of Compliance issued 411192 (Board of Health permit#90-39) Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2264.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M C. System Information (cont.) 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer appears structurally sound with no evidence of backup or leakage into dwelling Septic Tank (locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No certificate) Dimensions: 10.5 ft x 5 ft x 5 ft(1500 gallon) Sludge depth: 4 inches Distance from top of sludge to bottom of outlet tee or baffle 30 inches Scum thickness 4 inch Distance from top of scum to top of outlet tee or baffle 8 inches Distance from bottom of scum to bottom of outlet tee or baffle 12 inches How were dimensions determined? Design Plan t5-2264.doe• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time but maintenance pumping is recommended within and every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. 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 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): t5-2264.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name Date of Inspection Tight or Holding Tank (cont.) 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.): Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert At 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.): D-box appears structurally sound with no evidence of leakage in or out. Some solids in sump. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2264.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments r^M Subsurface Sewage Disposal System Form C. System Information (cont.) 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan; excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils above leaching pits appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. One pit was uncovered and found to contain 22 inches of effluent in a 4 foot precast leaching pit. No staining at cover interface or in overlying soils t5-2264.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 13 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form C. System Information (cont.) 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5-2264.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ,M Subsurface Sewage Disposal System Form C. System Information (cont.) 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name Date of Inspection 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 w4hin 100 feet. Locate where public water supply enters the building. LEACH LEACH O PIT 2 O PIT 3 O 0 0-BOX a SEPTIC TANK a LOCATIONS e A B C 25 FL EXISTING 2 214.5�f t 36 f E DWELLING 3 31 Ft 34 FL # 172 4 39.5 FL 36 f E W Z J W F 4 3 I . WHITMAR ROAD NOT TO SCALE t5-2264.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 172 Whitmar Road Property Address Cotuit MA 02635 City/Town State Zip Code Timothy and Patricia Cronin February 24, 2006 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 25+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: 8/6/90 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database - explain: Barnstable GIS maps You must describe how you established the high ground water elevation: Approved design plan on file with the Board of Health shows bottom of system to be 4 feet above the bottom of a witnessed test pit in which no water was encountered. Town of Barnstable GIS Department records indicate that the property is over 25 feet above groundwater table. t5-2264.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 ki I vEg 99 9 . � z OS 0 3 9 1999 _.. _._.. p ,'. �BORTOLO TTI CONSTRUCTION;'1NF -45 INDUSTRY ROAD,MARSTONS MILLS, MA 648 508-771-9399;.508-428-8926 ,FAX: 508-428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . . CERTIFICATION Property Address: 6P�J_,j Date Of Inspection ? Inspector's Name: O ner'..s Na an Address: c---; CERTIFICATION STATEMENT: I Certify thatI`have_personally Inspected the Sewage Disposal Systeir at this address and that the Informa- tion reported below is true,accurate and complete as of the time of Ir<opection. The Inspectioin was perform- ed based on my Training and Experience in the Proper Function and .Maintenance of On-Site Sewage Dis- posal Systems.Th system > t Passes ' } Cond�tionally P s Needs Furt r alu io the Local Approviig Authority Failure Inspector's Signature Date: TheSystem Inspector shall submit a eopy of this Inspection Report tv,the Approving Authority with Thirty (30)Days of'completing'this Inspection.'If the System is a Shared System or has a`Design`Flow of 10,000 gpd or greater,the Inspector and the System Owner shall submit the Report to'the appropriate Regional Offie of the Department,ofEnvironmental Protection' The Original should be sent to the System'Owner and copies sent to the Buyer,if applicable and the Approving Authority. INS '` t t. A) SYSTE i:PASSESO 11 I have not found any Information which i ndicates that the System violates any of the fail- ure criteria as defined in 310 CMR 15.303. Any Failure Criteria not evaluated,are indi- • • r-�,PJ� � r..�.:;cated below. :3,., � . .s ,. , .. . . � B) SySTEnCONDITIONALLY PASSES:., One or,more:System;Components need to be Replaced or Repaired. The System,upon completion:.of,.the Replacement or Repair,Passes Inspection.:.'; i Indicate;,yes,:nor,or:not.determined(Y,-N,OR ND). Describe bases of,determination in all instances. If"not determined",explain why not. The=Septic,Tank is-Metal,Cracked,Structurally Unsound,shows Substantial4nfiltration or exfil- ' 1; tration,or Tank Failure is iimminent. The System will Pass Inspection if Existing Septic Tank Replaced with a.;conforming'Septic.Tank as Approved by the Board Of,,Health. Sewage Backup or Breakout or High Static Water Level observed in the Distribution Box is due to r7� brpkew9robstructed pipe(s)or due to:a broken,settled or uneven Distribution Box. The System will pass Inspection if(With Approval of the Board Of Health):`; SUBSURFACE SEWAGE,DISPOSAL SYSTEM OSPECTION FORM PARTbA- CERTIFICATION(continued) h ;,a Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken#pipe(s)are replaced `Obstruction is•removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. a• ^ ;a-.1)SYSTEM<WILLPASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 4SNOT FUNCTIONING IN A MANNER WHICH WILL.PROTECT:THE, PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:,. Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC'WATER SUPPLIER,WA; PPROPRIATE).DETERMINES;THAT THE SYSTEM I.S.FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND.SAFETY AND THE ENVIRONMENT: The system has a septic,tank and soil absorption system and is within 100 Feet to a surface a ;, ; water:supply or tributary to a surface.water.supply. t, r tJt =a�, The systembas aseptic tank and soil absorption system and is with a Zone.I of a public water,,supply.well.• system has aseptic tank and soil absorption system.and is within 50 Feett of a pnyate . k' f water supply well. The system has a septic tank and soil,absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well water analysis 1bT,,,co1i1brmp-s. bacteria and volatile organic compounds indicates that the well is free from poUut►on from r= the facRity and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less �D)$YSTEMTAILS:'t 7 a, I have determined that the system violates one or more of the following failure criteria as defined � s in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health`'` t atv should be`contacted to determine what will be necessary to correct the failure: Backup of sewage into'facility or'system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent to the;surface of the ground'or surface waters due to an overloaded or clogged SAS or,cesspool., Static'liquid level yin the distribution box above outlet,invert due;to an overloaded or clog- 77, " ` ged�SAS'or�oesspool' }` . . h 4L;iquidpdepth in cesspool is less than.6"below invert or available+volume'is less than 1/2 tff +% td8y'floW 4[•C K �.� .f: +- a. ' pi:t ... .., v r: r ,,r.4 jp.•. .'"4 Required-pumping more than 4 times in the last year NOT due to clogged or'obstructed pipe(s). Number of times pumped -2- ` r 1 gL k'". - d *-• �' � �`t�1 SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART A `CERTIFICATION (cowinucd) °;Anyportion of the Soil Absorption System,cesspool,or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. PP Y• . "I Any portion of a cesspool"or privy.is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 Feet'of a private water supply well. a ., AA l Any portion of a cesspool or privy'is less than 100 Feet but greater than 50 Feet from a private a' water supply well with no acceptable water quality analysis. If the well has been analyzed ` to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ' compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FARS: - . The following criteria apply to a large system in addition to the criteria above: s The design now of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety;and the environment because.one or,more of the following ; conditions exist:. The tern is within 400 Feet of a surface drinking water:supply, . ,. _."y, 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 Well head;l'roteetion Area (IWPA)or.a mapped Zone II of a public water supply well The,owner or operator of any such system shall bring.the system and facility into full,comPli with,thei grnun water treatment program requirements,of 314 CMR 5.00 and 6.00..Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMx „a -PART B CHECKLIST ._ -^ , * max= ,+ . _. r• .. .. qq _ Check if the followinghave breen:done ,; 49 ✓Pumping information was requested of theowner,occupant,and Board of Health %None of the system components have been pumped for atleast two weeks and.the system has, , T ,been receiving normal flow rates during that period....Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓"As-built plans.have been obtained and examined. Note if they are not available with N/A. ?. facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary„or industrial waste flow"', ✓fhe site was.inspected for signs of breakout. loll system components,excluding the Soil Absorption System,have been located on site. "; ✓The ept c tadc.manholgs wete;uncovered opened,.and the interior of the.septtc tank was m s 'for co ndition of baffles or tees material of construction,dimensions d th`of fl uid � of sludge;depth of scum. q ' site has been determined based on ' The stze and location of the Soil Absorption System on th e existing information or approximated by non-intrusive methods. -3- SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C.. , SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL Design Fl ow: gallons Number of Bedrooms: 5 Number of Current,Residents: 0? Garbage Grinder: Laundry Connected To System: Seasonal Use: /,'U Water Meter ," vailable: Last Date'of Occupancy ' COMMERCIAIJLNDIISTRLAL •"ADC) Type of Establishment: Deslgn Flow: = sallons/day Grease Trap Present:'(yes or no) Industrial Waste Holding Tank Present: " Non-Santta 'Waste Discharged To The Title V System: Water Meter Readings,"If Available:' Last Date of Occupancy:, OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION Y PUMPING RECORDS and source of information: �QAL�.�d��1 s Yirx�-eOC System Pnmpod,as part of ins, qqn: if yes,volume pumped Reason for pumping ti s , TYPE, $SYSTEIV - .' SeSeptic Tank/Distribution Box/Soil Absorption System . Stngle�;..Cesspool ;. . Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other(explain): y) ' .mod Pf�pks„3 it 7 S'a'kFa °rt..y .f R. ..j f• ROXIMATE AG of all components,date installed(if known)and source of jitformation. .. . Sewage,odors detectedwhendarriving at the site: A_X) -4- SUBSURFACE SEWAGE,-DISPOSAL,SYSTEM-INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK:__ Depth below grade, Material of Construction: oncrete metal FRP_Other: Dimisions:lD.S'X&`1C_S­1 Sludge Depth:.,AT ' Scum Thiqkness: 2,S' Distance from top of sludge to bottom of outlet tee or baffle: g Distance from bottom of scum to bottom of outlet tee or baffle: Ow iw CT 60 e,". * 4 Comments: (recommendation for pumping,condition of inlet and outlet tees or yLatlles,.depth of liquid /:level in.relation to utiet invert,'structural integrity,evidence of leakage, etc.) /. + AJ GREASE.TRAP:_ f— DepthBelow Grade Material of Construction:_concrete_metal_FRP_Other,, ; (explain):, { Dimensions: Scuim Thicknes§ Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,,condition of inlet and outlet tees or'baflles depth of ligtiid level in relation to outlet invert;structural integrity,evidence"of leakage etc,) TIGHT"OR HOLDING TANK: lid Depth Below Grade: Material of Construction: concrete metal FRP Otlter,(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments: (condition of,inlet tee,condition of alarm and float swi(ches,etc.),- DISTRIBUTION BOX: Depth of liquid level above outlet invert: A,(�G>{�Q ,v� Comments: (note if I el and distribution is equal,evi nc of solids carryover,evidence of leakage into 0 out of box,etc.) a .. •w _ • .. . ,. ..n.,. P .wx .E,,.a. by w a.....v—+...�.aN e_<a n _ v,' n .. PUMP CHAMBER.- Pump"is m wor order:itang } -Comments:(note condition of pump chamber,condition of pumps and appt rt ances,,etc.)':: =ti `- -5- r . i SUBSURFACE�SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.0 SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS):_ (Locaitte on site"plan,if possible;excavation not required,but may be approximated by non-intrusive,,, methods) 1f not determined to be present,explain: f ' Leaching pits,number:Leaching chambers, number: Leaching galleries,number: �.,gLeaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool;number: Co :"(note condition of soil, igns hydraulic f ilure level of ponding,condition of v etation, A , C)I+SSPOOLSj - .. 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(cesspool must be pumped as part of inspection) Comments:(note condition of soilk,signs of hydraulic failure,level of ponding,condition;of vegetation, etc.) Materials of construction: Dimensions: Depth of.-Solids: Comments:.(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) i -6- �.. ._SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION(continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks: Locate all wells within 100 Feet. 1-31 A ..7w� 'r� �:., Irt'2`,i ik- ry Slu} !. Y �✓Y*I yA� ��,tif.. . 3 DEPTH TO GROUNDWATER: Depth to groundwater: Method of terminatiop or Ap ma 'on;Feet W -7 4F S INGLE FAMik-:Y o1-1 S ` hl o C--ASL131.LC C �Is two`-=•;'\` -DA �-Y F ScP T 1 c -17A Q L _ 44a TAQK— �2EAKgcJT d d.�al�A"t�.ou pIStP0SiAL Pi—i V5F— loco G-(AL b s,D.w/A A =('') Ib`S = 376 s. IF z� 3-7L s.F. 2 S- Z * 73 - 1 S L -,F� b �E �rz�� I �, � ISc, = 7, T r�L �E s►o = I c 9 G. P. D - T-oT� �A I(4 FLo\,� C"p. p hC12.C�;� l'aTioly RATE �` + lNc►-I 1,`7 � ti'rA;. 02 LESS - TEST . HOLE # F Sod-U ZDEC_.. 1q ►ci eS 7- Imes C,_,.,jLoQ `T3Ae-r'j. 3. o, N . F.G. = S�.e TOP FND.= F.G. l it t i/:�ii-�,�t/./i •. 2 4" SCHED. 40 000 P.V.C. INV. 1000 GAL.F ( DIST. INV, INV. ° a GAL. dooLEACH PIT 'D BOX SEPTICWITH 4 TANK goo 3/4" TO INV. INV. 00 WASHED 64 ��� STONE CL'147'-- PROFILE }� s° f IY�>R. , 6' 4 1 _a t ;., +� � SULL,!VAIV r a. NO . SCALE No. 29133 1[30-fT0N\ CLcr LAW ;1 •+,^: CER TIFIED PL 0 T PL A N I CERTIFY THAT THE PROPOSED FOUNDATION LOCATION C© +:-,',T SHOWN HEREON COMPLYS WITH SCALE. DATE THE SIDELINE AND SETBACK REQUIREMENTS OF THE TOWN OF PLAN REFERENCE BARN.STABLE AND IS NOT LOCATED L T (THIN THE FLOODPLAI P1 DATE : 7�Z� �� t .r �,,.�=��___ BAXTER 8 NYE, INC. THIS PLAN IS NOT BASED ON AN REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE OFFSETS 8 CIVIL ENGINEERS SHOWN SHOULD NOT BE USED TO OSTERVILLE, MASS, DETERMINE LOT LINES. APPLICANT is y s I Lo-1 r7 54, a 24-4: 19 " 1 5 , 3 41 v j M s2'9 4 A MM guaa 0 5 i 1 4� - TO. V p;st z° � I> IQA v vaWe. 1 QRq - yr�T I ,�.r } M H sa- I , / L07- 19 s¢' qb I z s¢ OF OF k4 PI TER RICHARD 6 SULLIVAN W. �' Pdo..29733 TOWN OF BARNSTABLE op LOCATION l 7ca SEWAGE �S VILLAGES 1 ASSESSOR'S MAP & LOT ft- INSTALLER'S NAME & PHONE NO. C e L SEPTIC TANK CAPACITY 1 5-60 GA L 7)q,` LEACHING FACILITY:(type) �— q! (size) t NO. OF BEDROOMS �,� PR4VA-T-E—WL OR PUBLIC WATER BUILDER OR OWNER ,C. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: .Yes No V A 3(o \ �� r '4 No..len - THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 4 n ------------ � ..........OF...... .................... --------------------•-------------•--- VVliration for Bhipmoal Works (1=31rurthin Frrutit pplication is hereby made for a Permit to Construct ()() or Repair ( ) an Individual Sewage Disposal ... stem at: ``'' k �' ---------------- i^ Locaon Address � O o: .......:...•.... ....................-- ----- ----- G er 4? ��{/��(p y�/AA %'/�� Address .... Installer Address �� / Type of Building �. Size Lot....__.._.�.................Sq. feet U —No. of Bedrooms... ........... .............--.....Expansion Attic ( ) Garbage Grinder Old) PLO Other—Type of Building U/VODI/Q�No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .................................... Design Flow.............././Q......................gallons per 1444en per day. Total daily flow.............!. ..................gallons. WSeptic Tank—Liquid capacity-? 0m...gallons. Length----12.. Width.A.14. `.... Diameter................ Depth...&.......... x Disposal Trench—:\o..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter....AP.......... Depth below inlet....6_1......... Total leaching area..S3.y..sq. ft. zOther Distribution Lox ( ) Dosir3g to (�1.4 Percolation Test Results Performed by ---- --•------------------ Date.-----------------------------------•-- r Test Pit No. 1.......�....minutes per inch Depth of Test Pit---- y_...-__.. Depth to ground water-..-----Dy�----- G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................---. .--•--•-------- ----- ----••-•-• ••-••---••----• -------•------- ------.... Description of Soil••Q-•---a--••- ---••-....... •.@ .•----� /0•-.&------. -- ...... c, 1 ..�.1 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 LE T r1R the provisions of i T T 5 of the State -'tar Code—The undersi n f titer agrees not t pla c he system in ope ion until Ce sate of Comp ' e h� �s k a h. -� Signed. .... _... _-- ----• ED ate App ication Appro red BY 5r&n- -----•-----------------•------- ----- Da e/ZS Date Application Disapproved for the following reasons:................................................................................................................ .......................................................•-•-•---•-•------------------------.........•-•---•-----•._.........--------•••-----•---•••--•--------•----•---------•-•--•---•---••--•••-•••-- 9 Dat . . e PermitNo.-------- .��---- ------�f`•-l----•----------__ Issued-------------------------------•--....--------- ...... Date FEE:.../.... � " THE COMMONWEALTH OF MASSACHUSETTS 5 BOARD OFiHEAL H .------..OF..._..3)'/-1 i4/, ?t� .._.... ApphrFation for Uiipoii al Work.5 Tonstratrtion rrraatit Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage -Disposal System at ." Loc/'yyiAddress �}+. pr Loi �o ✓ Jlxazl er ..... PJI"✓l _........_..... ;?y .. Address ..... t ......... _ .. ................. , ........................................ Installer Address `� U' Type of Building i• 4/ Size Lot____ �?__________________Sq. feet ,.a Dwelling—No. of Bedrooms___.. t .................Expansion Attic ( ) Garbage Grinder k'd) 6& I p-,- �� Other—Type of Building��b1L1.,3__._._;_..i`/)� No. of persons............................ Showers ( ) Cafeteria P1 Other fixtures ...............................•• . --•-----•-----------•-•- ••-•-••--•--..---.--_-• •••. --•-•- W Design Flow............. .O......................gallons per f)eF6@n per day. Total daily flow.............YY0 gal ------------ W Septic Tank Liquid capacity" ' ---gallons Length__- _.____ Width. '. ?P`.._ Diameter_______________ Depth.._ �lons. _..____. x Disposal Trench—No..................... Width__..........._.... Total Length..........i....... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.... ........ Depth below inlet.... :............ Total leaching area...5,3./._sq. ft. z Other Distribution box ( ) Dosing tank ( . y `-' Percolation Test Results Performed ._....... ~'........................................ Date_______________ ,..1 Test Pit No. 1_ : ,',_....minutes per inch Depth of Test Pit.... .. .......... W �p p � � Depth to ground water____. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............____---____- O .......................... Description of Soil 1 '1 � �1 &�t � r /f):! {; ---------•---•.-•-- -••••...••---•----••-------------- W UNature of Repairs or Alterations—Answer when applicable-------------------------------_....................................................._.......... -------"-----------------------------•---------------------------•----•----------•------•--•---•-•--•-------------------------------------------------------------------•-•---•...............-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of SIT:s=, 5o h S Code— The unders tf 1 frher agrees not to place jthe system in oper ion until Cer sate of Comp h eu-isey "'ie lth. r r`' - , et•� Signed.!.:� ��.. Date Ap ieation Approved By........... _ r - Dante _ Application Disapproved for the following reasons:...................................................................................................:,_:-------_ .........................................................-•--•-•--------....-------------•-------------'---"----"-•--"-"--"----•----------------------•---------------------"-----------...--- ...... Y Date No.--•--"• J- ..�.. Issued__._...... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................:OF.................................. ........ ...................................... Lrdifiratr of Toutph aorr S R Y, That the Indiv}*al Sewage Disposal System constructed (,` ) or ,Repaired ( ) d ry Installer ..--- v. _...- -•- has been installed in accordance with the provisions of Ti I Tl 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... ...... .,Y_ ..... dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................r .._...L......_ ............................ Inspector.................- =-r ••- .................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH r f,�,, ..O F... �� e j C_ '� .... .... ...... ......... ....... .. .. ...............•••....... No..... .�. ..yy.. FEE.. �............. Diego Workp T #ruction rrotit n.. •."-•............................................. Permisston is hereby granted..:.____. _ ..... -_:..::..._ . _ >� , to Cons et (yo' ) or Rejj{nn{ai a t Indivi�uaL Sewage pos System 7, d /4 1w at No.__ _.__._. _ --- Lw7 `� _ .� d ------`- r ,u Street as shown on the application for Disposal Works Construction Permit No Dated.......................................... Board of Health DATE---------'-� --------•-••...................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS M/i -r2 _ O �c -b ova 4,dr r Ix 11WAu Sour 4lrL-r X cj4zr,454 =, i co _ a r r7l .1 M 124 �r 4=74 , a REVISIONS BY SEPTIC SYSTEM INVERT ELEVATIONS DESIGN CALCULATIONS CL CROSS— SECTION PROPOSED TOP v DIST. BOX IN FOR A BEDROOM HOUSE WITH_L, GARBAGE DISPOSAL OF FOUNDATION �t DIST. BOX OUT-........., 51 i� SEPTIC TANK, Y.150 X SEPTIC TANK IN LEACHING SYSTEM IN ----_"^' USE A � � s; r � GALLON TANK lu LEACHING P/T,USING -6 X P/T W/ STONE f' S/DEWALL : HEIGHT X 2 X TT X RADIUS �\ -- 47 �c� VF t: X 2 X tT X FLOW U S.F X Z­ �' GPD/S.F. _ _ GPD l,( LOCUS MAP EXIT �� SEPTIC TANK OUT BOTTOM; TT(RADIUS)2 LEACHING SYSTEM BOTTOM L t(J TT f` 2+ t._,�� S.F X I . , GPD/SF. jr GPD S.F. : TOTAL GPD �► DESIGN FLOW c'' GPD Pitch 1/4' Per Foot (Min.) RESERVE -L GPD - ----"" 1 0 2% GRADE (MIn.) �;•l�`JPT',oti off' o .• •. . '-��' ' , — 3"MIn. 2' Min. 2 of y8 �2 washed stone Q 2 Min. G li LAID - LEVEL QF0R � 4-0"Liquid DIST. BOX 7 g' G ►D Lavel o B u Pitch 1/8 I'Per Foot • o� LLJ GALLON SEPTIC TANK �• —� ,I Fad �OZ' /, 4„ Schedule 40 P.V.C. /4 -i /2.01 '7 Washed Stone n Or Equivalent NOT TO SCALE i. LEACHING PIT TYPICAL CROSS- SECTION L 1 zo W • r R � ` Lis w --y, ,�` , ��,��v� i Q � NOTES a '•� (. Tat14" VJ ELEVATIONS SHOWN ARE IN FEET ABOVE! Z ACCESS COVERS OF THE SEPTIC SrS T,E 1,rf ARE TO BE WITHIN 12 "OF PRGio05ED Gri.;. L. zj ,. x S 4, ;;r' "., THERE /S TO BE ONE FOOT OF GROUIVUCOV£H �" Q T At v,L— ° :t '°" OVER THE SEPTIC SYSTEM. _ f . - ca 0 �c_A� 1 �� CONSTRUCT/ON OF THE SEPTIC Sr5 7"L M i 0 T T LI = CONFORM TO THE STATE SANITARY CODE A, ., TITLE Y ANO THE TOWN OF � !i`71 � BOARD OF HEALTH REGULATIONS -__.I DESIGN LOADING OF SEP TIC SYS TFM SEPTIC TANK H - — STNENGTH D157: BOX H - c rHENGTH \ R, LEACH/Na P/TRH- '� " STf7ENGT}/ Lif `j f �P w (IF *A _SOIL TEST DATA i 04e� 1.,���+�'�o to �4J f�e �, 4:;?,�'b r�a�'°'-'` �'�•�..,,,_ ©`� ��� n(p GF3AwN cJ� �f\n �! GCH (QED KEY -�� _?i, .: , DATE f I ... EXISTING ELEVATIONS X EX!S 7iNG CONTOURS SCALE JOB NO. PROPOSED CONTOURS — - -- Qto ' d'� uS TESTPIT !:OCAT►Or: SHEET WATER FOUND k WATER FOUND UT=CITY P01 -a- TEST MADE TEST MADE ' MAVSNcL'E: WITH WITH jA`'C.; t J- DATE AGENT,,,�i_:a:,7-FtF'.1 , ©Q�q o OF HEALTH PERC. RATE ; LESS THAN MINUTE PER INCH DROP OF SHEUTS .E