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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500
TRUDY CORE
Secretary
ARGEO PAUL CELLUCCI DAVID B. STRU_iS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
3 �o 'TIT _r
Property Address: '+� — n� Name of Owner J}Address of Owner: f�£�✓ i^�<' �e j G�
Date of Inspection:
Name of Inspector:(Please Print) W, ° � IV
I am a DEP approv ystem inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: - 6&✓r7 7--
Mailing Address: -4 K
Telephone Number: q
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
Conditionally Passes
Needs Further E aluation By the Local Approving Authority
Fails
l� `
Inspector's Signature: Date: M � y 7
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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 office of the Department of�Environmental Protection. The original should be sent to VM
system owner.and copies sent to the buyer, if applicable, and the approving authority. .
NOTES AND COMMENTS
t•}I 9g
�Ec�r�IEO
r,T 1 8 1999
1 TOWN OF BARNSTABLE
HEAL' DEPT.
v
revised 9/2/98 Page l of 11
A
i�� Printed on Recycled Paper
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 33 o����
Owner: � �—
Date of Inspection: ��;�_Z/9 '7
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
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.
Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty (20)years prior to the date of the inspection; or
the septic tank, whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health).
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping-more than tourtimes a year due to broken or obstructed pipe(s). Thesystem wilt7ass--
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
revised 9/2/98 Page 2of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Owner: Z_SA' ez—
Date of Inspection: le/7/ `J
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM
IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH.AND SAFETY AND THE ENVIRONMENT--
Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil:absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).-
3) OTHER
revised 9/2/98 Page 3of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address-
Owner: e�
Date of Inspections: �0/2/? y
D. SYSTEM FAILS:
You must indicate either "Yes" or "No" to each of the following:
I have determined)that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage into facility or system component-due to an overloaded orclegged-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 1/2 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 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.
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.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
►coliform bacteria, volatile organic-compounds, ammonia nitrogen and nitrate nitrogen. -
E. LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of,10,000 gpd or greater(Large System) and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply -
the system is-within 200 feet ofa-tributaryto a surfaoe•d6nk4ng•water-6upply -- - • __ -_
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA) or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further information.
revised 9/2/98 Page 4of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
+� 7 CHECKLIST
Property Address: ✓ 7 pep
/i Owner: e,6 ✓
Date of Inspection:
Check if the following have been done:You must indicate either "Yes" or "No" as to each of the following:
Yew No
Pumping information was provided by the owner, occupant, or Board of Health.
_ None of the system..components ba+webeen puw4wd4f atleast two weeks and•the system has baeo saceiviaQa�eswral 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.
The facility or dwelling was inspected for signs of sewage back-up.
✓/ _ The system does not receive non-sanitary or industrial waste flow.
✓ _ The site was inspected for signs of breakout.
All system components,A _ have been located on the site.
V _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles
or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System orrthe site has been determined based on:
_ Existing information. For example, Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
The facility owner(and.occupants,if different from.owner)..were.provWed,with informati on.nn t►a upper-rnaint n ^f
Subsurface Disposal Systems.
E
revised 9/2/98 Page 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
a L SYSTEM INFORMATION
Property Address:
Owner: 7—�/
Date of Inspection: 1 —/
FLOW CONDITIONS
RESIDENTIAL:
Designn flow: _g.p.d./bedr m.
Number of bedrooms Idesi 0 Number of bedrooms(actual):_
Total DESIGN flow
Number of current residents: J
Garbage grinder(yes Tp
Laundry(separate system) (yes o693Y If yes, separate inspection.required _
Laundry system inspec d ye r no)
Seasonal use(yes o
Water meter readings,if available(last two year's usage(gpd):
Sump Pump(yes o
Last date of occupancy.
CO MMER CIALIINDUSTRIAL:
Type of establishment:
Design flow:gpd ( Based on 15.203)
Basis of design flow
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:
OTHER:(Describe)
Last date of occupancy:
.GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection: (yes o o
If yes, volume pumped: gallons
Reason for pumping:
TYP 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)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components, date installed{if known)-and source of4aformation: _',. - f .�"P"U✓�� ���s
Sewage odors detected when arriving at the site:(yes oo_
revised 9/2/98 Page 6of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART,C
SYSTEM INFORMATION(continued)
Property Address: 3
Owner: Z-&)56�7—w
Date of Inspection:
BUILDING SEWER:
(Locate on site plan)
Depth below grade:_
Material of construction:_cast iron_40 PVC_other(explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting, evidence of leakage,-etc.) _..-
SEPTIC TANK:
(locate on site plan)
e
Depth below grade:
Material of construction:1concrete_metal_Fiberglass _Polyethylene_other(explain)
If tank is metal,list age
q_ ls.age_confirmed by Certificate of Compliance_(Yes/No)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: —.
Scum thickness: rZ n N
Distance from top of scum to top of outlet tee or baffle: 3
r2
Distance from bottom of scum to bottom of outlet or baffle:
How dimensions were determined: ji�
Comments:
(recommendation for pumping, condition of inlet and outlet tees or-baffles, depth of liquid level in relation to outlet invert, structurat4ntegrity,
evidence of leakage,etc.)
GREASE TRAP-
(locate on site plan)
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:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation tv outlet invert, structural integrity,
evidence of leakage, etc.)
revised 9/2/98 Page 7of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 3 3 c4" - `L
Owner: G� CrL
Date of Inspection:
TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or 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/day
Alarm present
Alarm level: Alarm in working order:Yes_ No_
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches,etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note.if level and distribution is equal, evidenee of solids carryover, evidence of leakage into or out of box, etc.)
PUMP CHAMBER:_
(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.)
revised 9/2/98 Pages of II
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: �j�
Owner: &J /q
Date of Inspection: /6�Z(
SOIL ABSORPTION SYSTEM(SAS):
(locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located, explain:
Type:
leaching pits, number:_
leaching chambers,number:_
leaching galleriies,number:_
leaching trenches,number,length:
leaching fields, number, dimensions:
overflow cesspool,number:_
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.)
CESSPOOLS:_
(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 (cesspool must be pumped as part of inspection)
q
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.)
revised 9/2/95 Page 9of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address; 3
Owner: - p
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
pia x
r 37
y r
)
6 �d idt'J—r
fit
revised 9/2/98 Page 10of11
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
® SYSTEM INFORMATION(continued)
Property Addre : 3
Owner:
Date of Inspection: /J���,
NRCS Report name
Soil Type_
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater tQ Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed.Site(Abutting property, observation hole, basement sump etc.) .
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators,installers
Used USGS-Data
Describe how you established the High Groundwater Elevation. (Must be completed)
C � � &1 �S
revised 9/2/98 Page 11of11
0 AT ION SEWAGE PERMIT NO.
VILLAGE
119 0-77
INSTALL IN
AME i ADDRESS
e U I L D E R OR OWN R
D,A T E PERMIT ISSUED
DATE COMPLIANCE ISSUED / /�
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No.- • - .... Fiz$..............................
THE COMMONWEALTH OF MASSACHUSETTS
`- BOARD OF HEALTH '
----- 1.�. caw...............oF............11A..................._.... -Q'..��..-...------------..........---'-----
AVVftrFatiou for Dispii al Workii Tunitrurthitt. Urrutit
Application is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal
System at:
Location-Add r ss r Lot N
Owner reds
nsta ler Address
U Type of Building Size Lot.... ...Sq. feet
Dwelling—No. of Bedrooms.....�1....................................Expansion Attic ( ) Garbage Grinder ( )
PL4Other—Type of Building No. of persons............................ Showers — Cafeteria
Q' Other fi ures
. . ---------•-------------•------------ ............. .........................................
W
Design Flow............ ........................gallons per person4er day. Total daily flow____.____�l e..........._...._._._gallons.
WSeptic Tank—Liquid*capacity-�!/�l✓i.gallons Length___._ __ Width................ Diameter---------------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area....................sq. ft.
Seepage Pit No-------I------------- Diameter......1d._....... Depth below inlet......._....... Total leaching area.Z&7a..sq. ft.
Z Other Distribution box (/) Dosing tank ( )
aPercolation Test Results Performed by---JIA17,.4t1.1L46__4..... _'1G................... Date..... _-. ___`��__.-_-_-.
Test Pit No. 1_ _____________minutes per inch Depth of Test Pit......IZ......... Depth to ground water._NO ......
4.1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 --------•----•------ ------------------•-•------------'-•-..._.________._......I.._ .................................._-• -•-----___"
C7 l t i
O Description of Soil Q•��� -7v ....��v � �= �� 12 ( _..S N? .
x
W
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
V Nature of Repairs or Alterations—Answer when applicable..............................•..._..........__..__.........................................._..
-
K
Agreement: a C
The undersigned agrees to insta the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The tNdersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n ' ued by t of health.
7
gnd ---••• •-• -J -------.... ...... l D ._ ...
Application Approved B
PP PP Y--------- ----------------- ---------------••-•------------------------------•---•--- ---------------- L -G- ----•-
Date
Application Disapproved for the following reasons------------------------------------------------------------------------ ........................................
------------------------------------------------------------------•........--------...-•-------•..........--•-••---...._..•--•--------------..._..--....................................................
Date
PermitNo.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliraa#ivat for Bispvii al Iforkfi Tons#raufivat Prrutit
Application is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal
System at:
---------•- ..-----• -•-- ------------
Location-Add ess r Lot o
---...................; r<� : ����� � E........ .._.�•l=� ................ R L�n� ,. .. - ------------------------------------. ------------------•--
Owner Address
W
Installer Address
Type of Building Size :�;._��� ....Sq. feet
Dwelling—No. of Bedrooms.._.-�...................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Otherfxtures __________________________________
W Design Flow...............?._........_
----gallons per person per day. Total daily flow........ ......................gallons.
04 Septic
W Tank—Liquid Disposal Trench No capacity�l 'W adthns Lengh Total L ng hidth...----- _Total leaching area_-Depth__._._.sq. ft.
Seepage Pit No...... Diameter.....Ik?-l-------- Depth below inlet............... Total leaching area.z��d9...sq. ft.
Z Other Distribution box V Dosing tank ( )
~' Percolation Test Results Performed ...... ..................... Date.... .......
,aa Test Pit No. I.......... per inch Depth of Test Pit..... ......... Depth to ground water.ltiL�'_.:..'........
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
--•----- ----------•-•--.....-••••-•••••••••••-•••..........-•••••-•-•--_•-••••...........•--•---•---•-•---•--.....-•--••-•••........--•-----.-----
O Description of Soil s �� '/ r - .....�;? ._.I C.... ......................2 �
x
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 TITIS 5 of the State Sanitary Code— The ndersigned further agrees not to place the system in
operation until a Certificate of Compliance has b e s sue by e d of health
ed._ � --
ApplicationApproved BY...................................................................................-..............
Date
Application Disapproved for the following reasons:-------•-----------------------•------------•------"---•------------------------------•-----••-•--•---•-•-..._..
--•--........-•---------•...................•---•---•---------•--•--••--•-••••----•-•---•----
Date
PermitNo.......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
_. BOARD OF�HEALTH
. '............OF.....f- � = •.•' ... .----. ....ff.............
Tntif iratr of ToutpliFaatrr
THIS IS
TO C RTIFY, That the Individual Sewage Disposal System constructed or Repaired ( )
by .�.f-= �/. =1--------------------------------------------------------------•.....------------.
•- j. �- Installer
at -1--�-zz= --•----------------------
- >
has been installed in accordance with the provisions of TITIZ 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... dated-...............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..................................... .................. Inspector---.-/_.��._�..1'''................................................................
THE COMMONWEALTH OF MASSACHUSETTS
- BOAR F HEALTH
Ile
OF...f. �,, ... . ........... wr'w- al
No. ............... FEE._> '....•..........
Raposat Works Twuatutrudivat ramit
Permission is hereby granted..., _ � - ?--
------•-•-----•-••••-•••..............
to Construct (�) or Repair � )fan Indivi ua1 Sewage Disposal System
atNo....1 ,P �fl...............:..!1----.........-•--•-••----•--•-----..-------"----......-------------------------•-------•-----------------------------•--...........
Street /
as shown on the application for Disposal Works Construction Permit N u___`t 'I__ Dated------- C.` .............
Board of Health
DATE..................... ..........................................................
FORM 1.255 HOBBS & WARREN, INC.. PUBLISHERS
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BENCH MARK DATUM WV. Af. WARWICK .0 ASSOC., INC.
P DOMESTIC WATER SOURCE Taw A'Q.- 801 #OR M FAL MOUTM .
FLOOD ZONE. N o nJ F-1 A z A +t p Ile, t�IA S: 4 � /�+ R
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riECTIJN IVCT TO SCALE ShGcvl 2 a f z
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1 I:;UrIII ,\I l[L � —� BRICK AND MORIAH CUURSES AS HEO'0` TO BRING
COVER TO GRADE
2' /B TO WASHED PEAS TONE FREE OF IRONS,
i P/NFj i-i 7 FINES AND OUST /N PLACE
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3 .. TO /%2.WASHED CRUSHED STONE.FREE OF
OPENING WITH 48
;,,` •'(p IRONS, FINES AND DUST /N PLACE
.-, •• i•. OUTER DIAMETER
j AND l314" INSIDE ;•
• DIAMETER t
r . ' 1. CONCRETE TO BE 4000 PSI 28 DAYS
2. REINFORCED WITH 6 x 6 NO. 6 GA. W.W.M.
# ! 3. 2'AND 4! SECTIONS ARE AVAILABLE FOR
GREATER DEPTH REQUIREMENTS
4 ' 2 — i ---s'0" 2 —' 4. NUMBER OF PITS REQUIRED atJe
MIN to - NOTE: EXCAVATE TO ELEVATION 3Z•o OR
EFFECTIVE DIAMETER T---
(NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL
WATER TABLE - LOAM AND CLAY BENEATH PIT. REPLACE
i Cal oN�� EXCAVATED MATERIAL WITH CLEAN
I TYPICAL PROFILF_ GRAVEL TO DESIGNED GRADE.
---�� :L—. IB STD. LT WGT C.I.MH COVER
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4��8/T FIBER PIPE
.;.:I 4 CLPIPE OUTLET LEVEL
TIGHT JOINT
DWELLING FLOW_LINE 0 TO FIRST ✓O/NT
,v /4„ 0 0 I I U�0 1 1 1
44, k �2 ti� 1 10 , 00 1 1
�7 C.I. TEE ;, ' z2I i i1.000 00 0 1 1 r
L}2�0 ''STD. PRECAST CONC. s�2 �)$ D/SL BOX TO BE q Z,QO P 0 00 O 0 0 1 .
DOD GAL.SEPTIC TANK INS TAL L EO ON LEVEL, '1 8 0 O 0 0 0 1 I
11
STABLE BASE � :1 000 0 0 1
\SEPTIC TANK TO BE 1 000 00 0 ( I
`. it loO Oa 11
INSTALL DON LEVEL, i 00 0 0 0 1
STABLE BASE. 1 0 i 1 0 0 O 0 0 0 1 i
LEACHING BASIN , 1 ON O 0 0 0 1 „
BASE TO BE LEVEL 0 1 O O 0 1 1 r-,1..
• �jh,0
SOIL AND P£RC. DATA
PERC. RATE �� 2 MIN. /IN. TEST PIT N0. P 3�Z3 TEST PIT N0. 2
� Top �vi�SoP � 0
TEST BY :
WITNESSED BY: �� �l �o{zDP ►.J� �I�rIJO
TEST PIT GR. EL.. 4A-• c7
DAT E G? -ZCv - �{ I I •
Z t�o 6-4 le0p. wAf 6 3� y
DESIGN DATA GFNF.RAI_ NOTES
t • BEDROOMS ':;?" NO HEAVY EQUIPMENT TO RUN OVER SYSTEM.
DISPOSAL SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD
EST. TOTAL DAILY EFFL.-�_20GPD. PRECAST REINFORCED CONCRETE UNITS.
SEPTIC TANK . GA ALL. SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE
1. TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE,
SIDEWALL AREALtGAL./SQ.FT. MINIMUM REQUIREMENTS FOR,/THE SUBSURFACE DISPOSAL OF
BOTTOM AREA 1-61''_GAL./SQ.FT. SANITARY . SEWAGE EFFECTIVE ON JULY 11 1977.
LEACHING REQUIRED 172•1 SQ.FT. ANY CHANGES TO THIS PLAk MUST BE APPROVED BY THE BOARD
ACTUAL LEACHING AREA OF HEALTH.
2���0.FT AT .COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE
BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION.
PITCH ALL SEWER LINES 1/4" / FT. UNLESS INDICATED OTHERWISE.
SE106E DISPOSAL SYSTEM
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I WM. N. WARWICOY 8 ASSOC., /NC.
,SOX 601 - 'NORTH fALMOUTh'
MASS. 02336 - (617) 563 -?6J8
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..... ,.��,.,. . „�,. W8. A. .Ji'AR..Ib'ICK 8 ASSOC., INC.
DOMESTIC WATER SOURCE ROX 801 - IKQR rN FA MOUTH .
I FLOOD ZONE. N�� - t 1 A z A t�G7 ���� PASS" 0e338 165-S6 Se
-7/7 f-,)-`�-GTION 11107- TO SCALE
71
C� W'il CO Vf P
BRICK AND MORTAR COURSES AS REog, To 8RINa
�2 74 COVER TO GRADE
4
OW L1. -0 WASHED PEA 5 TONE FREE OF IRONS,
-i P/fi FINES. AND DUST IN PLACE
WASHED CRUSHED STONE FREE OF
OPFNING WITH 4Y,9' 4 TO
IRONS, FINES AND DUST IN PLACE
OUTER DIAMETER
A 1414" INS/Di
DIAMETER
I CONCRETE TO BE 4000 PSI 28 DAYS
2. REINFORCED WITH 6 x 6 NO. 6 GA. W.W.M.
3. 2'AND 4! SECTI-ONS ARE AVAILABLE FOR
V, GREATER DEPTH REQUIREMENTS
4`0 6'0 4. NUMBER OF PITS REQUIRED at-Jlr--
I
MIN. EFFECTIVE DIAMETER NOTE: EXCAVATE TO ELEVATION ;iZ-,9 OR
/Nor To EXCEED .3 TIMES EFFECTIVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL
WATER TABLE LOAM AND CLAY BENEATH PIT. REPLACE
(iIj EXCAVATED MATERIAL WITH CLEAN
TYPICAL PROFIL F- GRAVEL TO DESIGNED GRADE.
18"STO LT w6r C.l.MH COVER
G4 1�9)
4"81r FIBER PIPE
4"c.I.PIPE r16Hr JOINT OUTLET LEVEL
DWEL L INGFLOW LINE 00 TO FIRS)" JOINT
14' 1 10 00 64
Z. 1 10
it 000 00 11 tt
c.I. TEE
7, dZ.W STD, PRECAST CONC. 42,-) r 80 ro BE if 000 00 1 1 1 1
100 GAL.sEpr1c rANI(-. if 000 00 5 1
INS7AL4ED N LEVEL,
it 000 00 0,1
5TA84F BASE It goo 00 1 1
\SfPT1C TANK TO 8E it 600 00 1 1
INSTALLED ON LEVEL, it 100 100 1 1
STABLE BASE. tIt 6 0 O 0 0 6 1
t1000 0 0 1 1
LEACHING BASIN 1 0 1 1 BASE TO LEVEL1 0 0 1 1 tL.
SOIL AND PERC. PATA
TEST PIT NO. TEST PIT NO. 2
PERC. RATE MIN. I N. 0— 0
TEST BY : -Of--Q� 4'e-1-P
WITNESSED BY: v_or_i c-xIr-E-4[z9 , 10� IM-0 r
TEST PIT GR. EL. 4A-- '5
DATE 'b 4
DES16N DAT,4 GFNERAI. NO TES
BEDROOMS NO HEAVY EQUIPMENT TO RUN OVER SYSTEM.
DISPOSAL SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD
EST. TOTAL DAILY EFFL��OGPD- PRECAST REINFORCED CONCRETE UNITS.
SEPTIC TANK -GA L. ALL. SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE
TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE,
SIDEWALL AREA --"2` GAL./SQ.FT. MINIMUM REQUIREMENTS FORJHE SUBSURFACE DISPOSAL OF
BOTTOM AREA I-0'-GAL./S0.FT. SANITARY SEWAGE EFFECTIVE ON JULY 11 1977.
LEACHING REQUIRED "-1 SQ.FT.. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD
ACTUAL LEACHING AREA OF HEALTH.
Z&7-aSQ.FT AT COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE
BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION.
PITCH ALL SEWER LINES '/4" / FT. UNLESS INDICATED OTHERWISE.
SEWA GE DISPOSA L SYS TEM
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71
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923417
SCALE AS INDICATED DATE 7 -
WM. 14. WARWICA' 0 ASSOC., INC.
8OX 801 - NORTH FA4MOUrS
AMISS. 02.556 - (617) 56S -2638
P.ROFESSICA1,4L EN61NEER