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HomeMy WebLinkAbout0035 CARLOTTA AVENUE - Health 35 Carlotta Avenue Hyannis F/R A = 248 235 r e � Commonwealth of Massachusetts Title 5 Inspection Form Official I p ection . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. lug ..�-S Gar/07/,, Property Address /✓t �h �aNsleyr ✓T Owner Owner's Name information is ���e required for �FYJN/f L , t9d w every page. Cityrrown State Zip Code Date of Inspe tion 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. ImpoWhen filling A. General Information When filling out forms the computer, r,use 1. Inspector: only the tab key /J to move your cursor-do not Name of Inspector use the return key. Company Name /JOX �oc a Company Adds ,/�� fo asf�A tw City/Town State Zip Code .Sod 77S - 77 Z74 Telephone der License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority gwv� /"X&- . �/CP//a Inspect is 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. t5ins•09!OB Title 5 Official Inspection Form:Subsurf ce Sewage Di pos I -System Page 1 of 17 Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments `< J s CGiY�o 4I/L Property Address Gil'✓1 er/r h Owner Owner's Name r information is required for Niapiv? ad.6 0 9 AX/ /0 every page. City/Town State Zip Code Date of4rispectibn B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/ always complete all of Section D A) System Passes: <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: 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): (Sins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3S Property Address Q✓1 �//h Owner Owner's Name )//,^, �information is required for �Nhs Vd&0/ /01� /A P every page. City/-Town State Zip Code Date of Insp ction B. Certification (cont.) 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 qu ed 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. I. 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 15ins•0910E Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments h Property Address �Ah l2Vi� Owner Owner's Name � /� information is / /9 ON N,S ,!f required for every page. City/Town State Zip Code Date of I spec ion B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ �/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ L� 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 '/z day flow 15ins•09f08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,,-p, C7 Ar, Property Address / f Owner Owner's Name information is GN✓I i t 00-6 0i q �-iv ' required for every page. CitylTown State Zip Code Date ot Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 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. ❑ I� 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- 1 0,000g pd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ the system is within 400 feet of a surface drinking water supply ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r�oLla� Property Address �a e✓,h Owner Owner's Name information is "/ -An n S Oa GO/ /Ap required for every page. City/Town State Zip Code Date o Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No R(' ❑ 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 recent) art of Elthis inspection? Y Y or as P E Elthe If Were as built plans of the system obtained and examined? ( Y were not available note as N/A) L�'! ❑ Was the facility or dwelling inspected for signs of sewage back up? 5? ❑ Was the site inspected for signs of break out? L✓l ❑ Were all system components, excluding the SAS, located on site? L�' ❑ 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: L'� ❑ 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): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is required for #040t? 1I 061601 /p� ohl /-p every page. City/Town State Zip Code Date of Inspection D. System Information Description: / /000 ` 411. / S4t 1"', 6H ��oh �a Number of current residents: Does residence have a garbage grinder? ❑ Yes 2No 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)): Detail: Sump pump? ❑ Yes No 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: 15ins•09/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3S Property Address ✓i Zvi✓t Owner Owner's Name information is A-11 g✓�hlS /�/► wl;0 1required for �-�� d` every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information f Pumping Records: Source of information: 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 S tem: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. Other (describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 � 3S car A z4h/�.e_ �Property Address Owner Owner's Name information isLrequired for G hh er _ '!L Qd f'O 1 V every page. Cityfrown State Zip Code Date of Insp ction D. System Information (cont.) 1-'*.'W1 - Approximate age of all components, date installed (if known)and source of information: o20oe"� /mow 0 Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: cast iron 40 PVC ❑ other(explain): Distance from private water supply well or suction line: /0 feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade. feet Materia of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: -5 X Sludge depth: 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Ave, Property Address r alnce�/h Owner Owner's Name information isA /f�,a 0a 601 required for G+N✓I/1 ���7 �WIV every page. Cityrrown State Zip Code Date o Insp ction D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle D tic SCN 11.1 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 Q How were dimensions determined? le? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): _ n _- Co J.4io v? /lib 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments z S C�-lo Al Property Address / Owner Owner'§Name information is a Nd f �' © (Pig/ 7 b 0 required for A every page. Cityrrown 011 State Zip Code Date of InslSection 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.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•09/013 - - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address ' Cr r►ge dry'! Owner Owner's Name information is Q N✓J!S t60/ d-� �� required for every page. Cityfrown State Zip Code Date df Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert �y>o� 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.): 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name information is a07Wf D��p/ a1 bop rewired for 144 every page. Cityfrown State Zip Code Date df Inspection D. System formation (cont.) Type ✓ 20.E0 s � VLf-- ❑ leaching pits number: ❑ 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.): Gtn(=� .S0'1/ (�lPavi ancl dim 410 S44_r 491r J4 c4cii-.l c a, lure- , Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins:09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System,-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Z_av► .2d/7 Owner Owner's Name ll / 11 information is a M h f OLDha required for Al every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5ins•09f08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r� 3� ��io4 P4-- Property Address Owner Owner's Name //�� information is required for -.//u A✓4/s 004 V every page. City/Town State Zip Code Date of Inspec ion D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least t permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where ublic water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately I U, L0 142( Du Aj 93 -ate l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 15 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form :V e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments • ?S C;r/a#e, Jive- Property Address , �Gi n ✓!h Owner Owner's Name information is Aq Od601 Al required for 6i N�'1/fevery page. Cityfrown State Zip Code ection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells n Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting!property/observation hole within 150 feet of SAS) L7 Checked •th local Board of Health -explain- I "s 14 A ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established,the high ground water elevation: z� ,,4 -S- e Krti ji."J-4,. Before filing this Inspection Report, please see Report Completeness Checklist on next page: t5ins•09/08 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusietts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '� �� ✓to{� �9f, � Property Address Owner Owner's Name /�information is required for Aa M /'/Y Da 6 of 9 , i9 N !l every page. City/Town State Zip Code Date df Insp ction E. Report Completeness Checklist inspection Summary: A, B, C, D, or E checked (inspection Summary D (System Failure Criteria Applicable to All Systems)completed Sys em Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file k t5ins•09/M - Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page t 7 of 17 TOWN OF BARNSTABLE LOCATION ,3� Z:,d ra b TTA A SEWAGE # "ILLAGE 3 ASSESSOR'S MAP &&LOT �7 INSTALLER' NAME&PHONE NO. Z,Ab ,'ti,< 7:J /" SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ✓ `a' '" � C (size) NO. OF BEDROOMS_ / BUILDER OR OWNER— PERMIT DATE:/3;:� 2Z-" COMPLIANCE DATE: /O ; -3 ` (o Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Lea ing Facility Feet Private Water Supply Well and Leaching Facility (If an wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetl ds exist within 300 feet of leaching facility) Feet Furnished by -cam f�: �---- �� a � � • �-- .. �� �c- O o �..._. ' �� 0 w No.--� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for "zpozal *potem Construction 3permit Application for a Permit to Construct(( )Repair(xNx) pgrade( )Abandon( ) C7 Complete System CRIndividual Components Location Address or Lot No. 35 Carlotta Ave. owner's Name,Address and Tel.No. Assessor'sMap/Parcel Hyannis, MA 02601 Irene Smith Installer'��iame, dres T4.No. Designer's ame Address d Tel.No. Wm. to�inson Septic Service �a>r'ren 1 `eyer P.O. Box 1089 43 Vine St. Duxbury, MA 02332 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building re s i d .nt-i a l No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) we will install a new Title-5 leaching system to the plans of Darren Meyer dated 9/20/02. 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 by this B lmd o alth. Signed� rf����,i 4 Date/� Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued !: Jbj . )*44 No--��- Fee$5 0_00 � V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Yication for "gogaf *pgtem Congtruction Permit Application for a Permit to Construct( . )Repair(x grade( )Abandon( ) O Complete System E :Individual Components `Location Address or Lot No. 35 Carl of t a Ave. Owner's Name,Address and Tel.No. Assessor'sMap,1:7cel _ ' 'Hyannis,11"% MA 02601 Irene Smith .- .-' Installer's, ame,Address'ah Tel.No. Designer's a Address d Tel.No. m.�-�:.._lZo ins n Septic Service I� ` ren and P.O. Box 1089 43 Vine St. CRnterville, MA 02632 Duxbury, MA 02332 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building r_esi denti al_No.of Persons Showers( ) Cafeteria( ) Other Fixtures ` Design Flow gallons per day...Calculated daily flow gallons. Plan Date Number of sheets/ I Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil; P- f.w. Nature of Repairs or Alterations(Answer when applicable) we will install a new Title-5 Teaching System to the plans of Darras Meyey dated 9/20/02. 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 by this Bo d of ealth. Signed i! _�. L Date,//j Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued Smith THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( x)o Upgraded( ) Abandoned( )by Wm. " E. Robinson Sr, Septic Service at 35 Carlotta Ave. , Hyannis, MA 02601 has-been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.v -/W1 5dated Installer Wm. E. Robinson Sr. Designer barren ever, _ The issuance of thi pe shalj.,not be construed as a guarantee that thely-tem will function as desi nedv �} ' Date A U InspectorR f 414 A -,) ✓�� J P V 1.1PQ Smith THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migpogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair(xx)Upgrade( )Abandon( ) System located at 35 CArlotta Ave. , Hyannis, MA 02601 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:Cons ction must be completed within three years of the date of'thispe'�r�mt'. Date: Approved y _,.�?% - TOWN OF BARN-STABLE LOCATION rs a Tf�7 SEWAGE # C3 VILLAGE 3 ASSESSOR'S MAP & LOT INSTALLER' NAME&PHONE NO. &4 '4 N<< SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ', `a' `" C�v C (size) /;.—�S , NO. OF BEDROOMS_ 41— BUILDER OR OWNER � 2j PERMIT DATE:1�6—)4 �`2-- COMPLIANCE DATE: lCJ `� �'3 ` <O Separation Distance Between the:, Maximum Adjusted Groundwater Table to the Bottom of Lea ing Facility Feet Private Water Supply Welland Leaching Facility (1f an wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetl ds exist within 300 feet of leaching facility) Feet Furnished by it �6M , ® a J I i 350 MAIN STREET TEL (508)775-2800 WEST YARMOUTH MA 02673 (800)698-3993 FAX:(508)778-9628 Septic Service Mechanical p ec anical Services Pumping& s` Heating& Plumbing Installation Fire Sprinklers Since 1930 July 16, 2002 Town of Barnstable Board of Health ,5o 35' 200 Main Street �1 Hyannis, MA 02601 (5b / RE: Irene Smith-35 Carlotta Avenue, Hyannis A & B Canco has performed a Sub-surface Title V Septic Inspection for Mrs. Irene Smith at 35 Carlotta Avenue, Hyannis. It was observed that the leach pit had a stain line at the top of the pit. The owner acknowledged a prior back up. In addition the distribution box needs to be replaced. The homeowner would like a second opinion as to the high water _ mark issue. A & B Canco will excavate the components prior to Department visit. Thank you, LA-X� Richard K. Cannon RKC:akb + COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r i Vey` 350 MAIN STREET WEST YARMOUTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A [--RECEIVED CERTIFICATION MAP 248 PAR 235 Property Address: 35 CARLOTTA AVENUE �U L 2 2 2002 HYANNIS,MA 02601 Owner's Name: SMITH,IRENE TOWN OF BARNSTABLE Owner's Address: 35 CARLOTTA AVENUE HEALTH DEPT. HYANNIS,MA 02601 Date of Inspection JULY 8,2002 r (� Name of Inspector:(please print) RICHARD K.CANNON b td O Company Name: A&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 MAP Telephone Number: 508-775-2800 PARCEL. CERTIFICATION STATEMENT LOT 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 X Needs Further Evaluation by the Local Approving Authority Fails Inspect Signature: Inspector's Si �c Date: PC The PY system inspector shall submit a co of this inspection report to the Approving Authority(Board of Y P 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 tot he 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 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A CERTIFICATION (continued) Property Address: 35 CARLOTI'A AVENUE HYANNIS,MA 02601 Owner: SMITH,IRENE Date of Inspection: JULY 8,2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: N/A 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: B. System Conditionally Passes: N/A _ 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 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: _ 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: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 35 CARLOTTA AVENUE HYANNIS,MA 02601 Owner: SMITH,IRENE Date of Inspection: JULY 8,2002 C. Further Evaluation is Required by the Board of Health: X X 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 salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of 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: SEE ATTACHED LETTER Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 35 CARLOTTA AVENUE HYANNIS,MA 02601 Owner: SMITH,IRENE Date of Inspection: JULY 8,2002 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due town overloaded or clogged SAS or cesspool X Liquid depth in pit is less than 6"below invert or available volume is less than�/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) SEE (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as LETTER 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: N/A To be considered a large system the system must service 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 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 is 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 35 CARLOTTA AVENUE HYANNIS,MA 02601 Owner: SMITH,IRENE Date of Inspection: JULY 8,2002 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X Were all system components,excluding the SAS,located on site? X 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 X 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)has been determined based on: Yes No X Existing information. For example,a plan at the Board of Health. X 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)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 35 CARLOTTA AVENUE HYANNIS,MA 02601 Owner: SMITH,IRENE Date of Inspection: JULY 8,2002 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): N/A Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CM 15.203): Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1977 PERMIT 77-294 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 CARLOTTA AVENUE HYANNIS,MA 02601 Owner: SMITH,IRENE Date of Inspection: JULY 8,2002 BUILDING SEWER(locate on site plan): X Depth below grade: 18" Materials of construction: Cast iron X 40 PVC other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): X Depth below grade: 17" Material of construction: X concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,000 GALLON Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 28" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How were dimensions determined: ASBUILT Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT LEVEL.OUTLET BAFFLE,OUTLET COVER 16'X1'.TANK SHOWS SIGNS OF BEING OVERLOADED AT ONE TIME.OUTLET LINE IS ORANGEBURG. GREASE TRAP(located on site plan) N/A Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 CARLOTTA AVENUE HYANNIS,MA 02601 Owner: SMITH,IRENE Date of Inspection: JULY 8,2002 TIGHT or HOLDING TANK: N./A (tank must be pumped at time of inspecti on)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): DISTRIBUTION BOX IS CEMENT, 16"X21".BOX IS 3' BELOW GRADE.BOX HAS ONE LINE IN,ONE LINE OUT.BOX IS NO GOOD AND NEEDS TO BE REPLACED. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 CARLOTTA AVENUE HYANNIS,MA 02601 Owner: SMITH,IRENE Date of Inspection: JULY 8,2002 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: I 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.) LEACHING IS ONE 1,000 GALLON PRE CAST PIT.PIT AND COVER 3'/z' BELOW GRADE.WATER LEVEL IN PIT IS 6"FROM INLET LINE.HIGH STAIN LINE IS 2"FROM INLET LINE.PIT IS NOT LEACHING AND NEEDS TO BE REPLACED. CESSPOOLS: N/A (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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) Title 5 Inspection Form 6/15/2000 9 Page 9 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 CARLOTTA AVENUE HYANNIS,MA 02601 Owner: SMITH,IRENE Date of Inspection: JULY 8,2002 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. r� 3 \ �D d 54 0 Title 5 Inspection Form 6/15/2000 10 Page l 1 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 CARLOTTA AVENUE HYANNIS,MA 02601 Owner: SMITH,IRENE Date of Inspection: JULY 8,2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 28.8 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet of SAS) X 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: GIS 48.8 GROUND 20.0 GROUND WATER 28.8 5 -6 r y Bv/%,r, PST Title 5 Inspection Form 6/15/2000 11 f pernfts Permit#: 995930.1 j Date I; 11/4/99 Hauler Name m "17 s � Prod Smith _ , zft Str t.. Carlotta Avenue ` Villa IlHyannis , u � � SourceSe ..ptic out of town disposal I 1�1 C-E D S P�-u Y-7-�-f2 +;�F \1 to-k.�'4v I t;lj LOCATION SEWAGE PERMIT NO. VILLAGE - 0 I N S T A LLER'S NAME & ADDRESS B UIIDE R OR OWNER c'T �oy .ec,/lS� �//P/ fJ /j�yi�lf✓�/S DATE PERMIT ISSUED j /Z,.2 DAT E COMPLIANCE ISSUED `�� � � z . c� �n o �I �, ;� ,_ .. ASSESSORS MAP: -2-4`j TEST HOLE LOGS NOTES: PARCEL : 2�j j i � 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH THIS PLAN I995 MASSACHUSETTS TITLE V & TOWN OF klFs� SO I L EVALUATOR : &l M Yvt e C9 , M�}y� FLOOD ZONE: C WITNESS : cl? Fj PAS j�p�-� r' BOARD OF HEALTH REGULATIONS. REFERENCE: DATE: SEF 7EMBe(Z 20 Z.oa 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, p�r� i,apk PERCOLAT I ON RATE: G,2 "" ln1GI-t SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO 0.?qPd,/_ } INSTALLATION. 3 TH- IL. 46cj TH-2 1 3) THIS 0 ONLYPLAN SHALL ANDHABL NOT FOR SEPTIC BE USED FOR SYSTEM PROPERTY ATION LINE Sl DETERMINATION. Lol"&Y 4 4�'zz- 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS S�D 101�' /(, SPECIFIED OTHERWISE) LOCATION MAP `N'1 S) Dt 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A VM GARBAGE DISPOSAL. SA-71)0 -2.SYIf c- 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON pe M(2-15 , V 0 s (I X b) VA709 1 kln)L C-�, r"A4 31 U eA4 e- l S Z I I ALtrvVJ A BASE OF 6"OF CRUSHED STONE. V4 F-Et?vtKeo �' 7) EkIS7N(_ G PIT- 10 8C- Pvr►�t�F-D (ki6gP fsb G s�-A Af-Ajovvt) ELV' w1 s _ _ �l � SEPTIC SYSTEM DESIGN FLOW EST!MATE ... -_._rf.5..°.. ..., _ #L�.�_._.7 __P_ I✓Z ____... 3 BEDROOMS AT fro GAL/DAY/BEDROOM - 330 GAL/DAY ._,.� SEPTIC TANK ov t t 330 GAL/DAY x 2 DAYS - .660 GAL I ' USE Imo) GALLON SEPT I C TANK -c--Kl S77� - Y'G L { SO i L ABSORPTION SYSTEM S I DE AREA: f 2S z 1 t2 2.] Z X O• I BOTTOM AREA: 25 k 1 Z X 22 2 I aos-1 I NG 3 l3 1 . 1 � l I SEPT I C SYSTEM SECT ION �330 �1�'l� r� TUF'45.1 v '(B'I ,Gt;Yi'i�✓ EL 45.1 �u G i . _�-_•-- . G y ti1�tN 6 h�Sh ade v le /' �l ENS�y3fih �r� 2.S �-�- .f S �/* '� 14 x�. Z"-S�.°free P f o�''J• lz I(I�71l� (r "►'� vow � � �� 7 `- ' y ra'S �r 1 `� (low 7� � / GAL -5t 0 , D-BOX 101 10 ti( !1 y SEPT I C TANK /ew/� � �2. 4 -t z � � 3 � BeNCH MAlqK m 0? Top of r�ouND/--rnolJ ELF-VA-17ON 4 46,iS SITE AND SEWAGE PLAN N OF AIAs �2-41 o� EN �' 31 rZ4 �6� LOCATION : 35 C,49Z,0719— . EYER Q c it/ 2 � No. 1140 `��- 7> a PREPARED FOR lge:IVE P 5 407-f r R% �-- J,' ---- SUN lf$•,""`� 7(j C -t SgNITAR�PN 0 DARREN M. MEYER, R.S. SCALE- ZO / 43 VINE STREET E DATE: vLL0Y' Z U DUXBURY, MA 02332 Z DATE HEALTH AGENT (781) 585-0293