HomeMy WebLinkAbout0094 EVANS STREET - Health 94 Evans.Street
Osterville P
A = 142 085 K
I
COMMONWEALTH,OF MASSACHUSETTS'
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL`SYSTEM FORM
PART A .
CERTIFICATION
Property.Address: 94 Evans Street
,. • ' Osterville. MA 02655:
Owner's Name: Steve Curran
Owner's Address:
Date.of.Inspeetion: March 20,`2009
�I� 53�5
Name of Inspector:(Please Print);James M. Ford
Company Name: James M. Ford .
Mailing Address: P.O.Box 49
Osterville,MA 02655-0049
Telephone.Number: (508)862-9400
CERTIFICATION STATEMENT.
I certify that I have personally inspected the sewage'disposal system'at this address and4hat the information reported
below is true,accurate,and complete as of thi,time of the inspection..The inspection was performedbased 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 15.3.40 of Title 5(310 CMR 15.000). The system:
✓ Passes
C ` ditionally_Passes
ee s.Further Evaluation by the Local Approving Authority,
r
Inspector's' Signature: Date: March 23.!2009
The s stem ins o ector shall sub- t a co _of t is.inspection report to.the Approving AuthorityBoard of Health or
.. . Y.. p PY _ .. .P p. pI? g.
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
DER The original should be sent-to the system owner and copies sent.to the buyer,if applicable;and the approving
authority.
Notes and Comments
***This report.only describes conditions.atJthe time of inspection and under the.conditions of use at that,
time. This inspection,does not address ho*the system will perform.in the future under.the same or different
conditions of use.
Title,5,Inspection Form 6/15/2000 page 1„
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
Q
CERTIFICATION (continued)
Property Address: 94 Evans Street
Osterville, MA
Owner: Steve Curran
Date of Inspection: March 20, 2009
Inspection Summary.: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ I have.not found any infonnation N' ich 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 a`s.described in the"Conditional Pass section need to be replaced or
repaired. The system,upon completion,of tfie 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 inuninent. 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 c4d is available.
ND explain:
c
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
distribu6in box is leveled or replaced
ND explain:.
The System required pumping more than 4 times a year due to broken or obstructedpipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipes)are replaced
obstruction is removed
ND explain:
2
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Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 94 Evans Street
Osterville, MA
Owner: Steve Curran
Date of Inspection: March 20, 2009
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
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.aseptic 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 coliforin
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:
I
3
Page 4 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 94 Evans Street
Osterville, MA
Owner: Steve Curran
Date of Inspection: March 20,2009
D. System Failure Criteria applicable to all systems;
You must indicate either"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 than4 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 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. [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.]
No (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.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems,in addition to the criteria above) -
Yes No
e
_ 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
r significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR. .
.15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 1.1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
'Property Address: 94 Evans Street
Osterville: MA
Owner: Steve Curran
Date of Inspection: March 20, 2009
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 coniponents 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,excluding the SAS, located on site?
✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
✓ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface.sewage disposal systems ?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on`.
Yes No
✓ _ '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)].
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART.0
SYSTEM INFORMATION
Property Address: 94 Evans Streei
Osterville,-MA _
Owner: Steve Curran
Date of Inspection: March 20, 2009
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: 0 i
Does residence have a garbage grinder(yes or no):.. No
Is laundry on a separate sewage system(yes or,no): Wa. [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Unknown
COMMERCIAL/INDUSTRIAL `
Type of establishment:
Design flow(based on 310 CMR 15.203): "_,a gpd
Basis of design flow(seats/persons/sgft,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: Unavailable
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
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:
Date of installation 31212000 per as-built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 94 Evans Street n
Osterville. MA
Owner: Steve Curran
Date of Inspection: March 20, 2009
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: - cast iron _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 on site plan)
Depth below grade: . 12';
Material of construction: ✓ concrete __metal _fiberglass _polyethylene
other(explain)
If tank is metal list age`. Is age confinned by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1500 Qal.
Sludge depth: 21'
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness:. 2"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 10"
How were dimensions determined: Measurinz stick
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Cement tees were present. The liguid level was even with the outlet invert. There did not appear to be any signs of leaka e.
GREASE. TRAP: None (locate on site plan)
Depth below grader
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 recomnmendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc):
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: 94 Evans Street
Osterville, MA
Owner: Steve Curran
Date of Inspection: March 20, 2009
TIGHT or HOLDING TANK: None.(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/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: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
The D-Box was normal
PUMP CHAMBER: None (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.):
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: 94 Evans Street
Osterville, MA
Owner: Steve Curran
Date of Inspection: March 20, 2009
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
ti
If SAS not located.explain why:
Type .
✓ leaching pits,number: 2-500 gal. charnberS 12.8'x 25'x2'yer.'as-built
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.):
The Chainbers were dry and clean There did not appear to be anv signs of failure.A cmnera was used for the inspection
CESSPOOLS: None' (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: None (locate on siteplan)
Materials.of construction
I
Dimensions:.
.Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
Page 10 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 94 Evans Street
Osterville, MA
Owner: Steve Curran
Date of Inspection: March 20, 2009
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.
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10
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Page 11 of 11
OFFICIAL INSPECTION FO
RM -NOT FOR VOLUNTARY ASSESSMENT
S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO
N FORM .
PART C
SYSTEM INFORMATION(continued)
Property Address: 94 Evans Street
Osterville, MA
Owner: Steve Curran
Date of Inspection: March 20, 2009
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 20+/- 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:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: Topographic and water contours snaps
Checked with local excavators,.installers-(attach documentation)
Accessed USGS database-explain:
You must describe.how you established the high ground water elevation:
Using Barnstable topographic and water contours maps, the snaps were showing approximately 20'+/-to Around water at this
site.
This report has been prepared only for.the septic systems and components described herein. This septicsystoit has been
inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will
function-properly in the future. There Have been no warranties or guarantees,either expressed, written or implied,
relating to the septic system, the inspection, this repot and/or any components of the septicsystent.which have not .
been located and inspected.
_ 11
• COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PR CT
AUG 2 8 2003
TOWN OF BARNSTABLE
HEALTH'DEPT.
TITLE S
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 94 Evans Street
Osterville, MA 02655
Owner's Name: John Healy
Owner's Address:
Date of Inspection: August 2, 2003
Name of Inspector: (Please Print) James M. Ford
Company Name: James M. Ford Map: 142
Mailing Address: P.O. Box 49 Parcel: 085
Osterville,MA 02655-0049
Telephone Number: (508)862-9400
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
Needs Further Evaluation by the Local Approving Authority
ZFs
Inspector's Signature: Date: AuRwt 4, 2003
The system inspector shall sub a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the'same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1 ,
Page 2 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 94 Evans Street
Osterville, AM
Owner: John Healy
Date of Inspection: August 2, 20U
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ I have not found any information which indicates that any of the failure criteria described in 310 CM -
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.
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:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 94 Evans Street
Osterville, M4
Owner: John Healy
Date of Inspection: August 2, 2003
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
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:
3
Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 94 Evans Street
Osterville, AM
Owner: John Healy
Date of Inspection: August 2, 2003
D. System Failure Criteria applicable to all systems:
You must indicate either`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 'h 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.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 1.5.303,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 System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes 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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 94 Evans Street
Osterville, MA
Owner: John Healy
Date of Inspection: August 2, 2003
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,excluding the SAS, located on site?
✓ _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ?
✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
✓ 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)].
5
Page 6 of 11
v
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION-'
Property Address: 94 Evans Street
Osterville, M4
Owner: John Healy
Date of Inspection: Ayg!st 2, 2003-
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: Varies
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): No
Seasonal use(yes or no): Yes
Water meter readings, if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Summer rental
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,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: New system-never pumped-per owner
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
✓ 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:
Mar. 2100-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 94 Evans Street
Osterville, AM
Owner: John Healy
Date of Inspection: August 2, 2003
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _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 on site plan)
Depth below grade: 12"
Material of construction: ✓ 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 S00 gal.
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or baffle: 31"
Scum thickness: 0"
Distance from top of scum to top of outlet tee or baffle: 10"
Distance from bottom of scum to bottom of outlet tee or baffle: 14"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage.
GREASE TRAP: None (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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
I
Page 8 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 94 Evans Street
Osterville, MA
Owner: John Healy
Date of Inspection: August 2, 2003
TIGHT'or HOLDING TANK: None (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/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: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
The D-box was level. No solids were present.
PUMP CHAMBER: None (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.):
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: 94 Evans Street
Osterville, AM
Owner: John Healy
Date of Inspection: August 2, 2003
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
,
If SAS not located explain why:
Type
leaching pits,number:
✓ leaching chambers,number: 2-500 gal. chambers 12.8"x 25'x 2' per as built card
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.):
The chambers were dry. There were no signs of failure. The bottom to,grade was approximately S'. 1 used a video camera to
Perform the inspection.
CESSPOOLS: None (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: . None (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.):
9
I
Page 10 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 94 Evans Street
Osterville M4
Owner: John Healy
Date of Inspection: August 2, 2003
Map: 142
Parcel: 085
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.
/q Q
a 1
0
3
A n
1 3y ao
a ag ay s Y
3 33 3o
y 39,E 3r,
� 3G 3g
10
v
• Page 11 of I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:. 94 Evans Street
Osterville, MA
Owner: John Healy -
Date of Inspection: August 2, 2003
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 20 +/- 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:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: topographic and water contours maps
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You mast describe how you established the high ground water elevation:
Using the Barnstable topographic map and the Cape Cod Commission water contours map,the maps were showing approximate
20'+/-to groundwater at this site.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report.
11
No FEE 0-0
� of
COMMONWFALTH Of MASSAC14USETTS
Board of Health, 'FQSCk WC, , MA.
APPLICATION FOR DISPOSAL SYSTLM CONSTRUCTION PERMIT L-Ob
Applica 'on f r a Permit to Construct(�Repair( ) Upgrade( ) Abandon( ) El Complete System ❑Individual Components
Location tv Nw s fZ T Owner's Name SU&
Map/Parcel# A55l35,V_r3 tntjP 4Z Address
Lot# og� Telephone#
Installer's Name ' Designer's Name /Qp�s
Address Address MMZc,.T0"5
Telephone# Telephone# 47 _C)p
Type of Building Lot Size /Z24.0O sq.ft.
Dwelling-No.of Bedrooms 3 Garbage grinder VA.
Other-Type of Building No.of persons Showers ( ),Cafeteria ( )
Other Fixtures
Design Flow(min.iZquired) �33� gpd Calculated design flow 3 Design flow provided gpd
1
Plan: Date Number of sheets Revision Date
Title i G eL6\
Description of Soil(s) Q-Z" ?DP Alm 3U�C�ICo; `���—13z'� Mi71 et fh '" O C i �lf, c 1NNP
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation Z2
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
furthe Vvk
o place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signe C Date
Inspections
% I _y a= FEE ��
- _ 11 { V
Board of Health, �1.� :. 1VlA. {fit
APPLICATION FOP, DISPOSAL §YSW`CONSTRUCTION PERMIT
Applica •on f r a Permit to Construct(�RepairO Upgrade( Abandon( ) 7❑'C"ompllete System ❑Individual Components
r k
Location �sx Owner's Name
Map/Parcel# A55f 550 r2 S m ph 4Z PAR $S Address d ,!
Lot# 5 Telephone#
t Installer's Name 0 Designer's Name YAPS
Address Address 1 U,> R`!y, ("AfLS u.`v, A
Telephone# Telephone# 47 _�S '
Type of Building Lot Size sq.ft.
Dwelling-No.of Bedrooms 3 F, Garbage grinder(l.r)i•
Other-Type of Building 1 No.of persons Showers yp g p (,Cafeteria ( )
Other Fixtures
Design Flow�(min.required) 330 gpdf Calculated design flow 3 Design flow provided 3S 8 gpd
Plan: Date I Z 20 19.7 Number:of sheets Revision Date
Title 1 C.
Description of Soil(s) ®- Z" TPP A 5U 501E �� - 1`3z `' CYL1�I 1;7 A. N➢
Soil Evaluator Form No. Name of Soil Evaluator J)44• M It- �J .- Date of Evaluation 7Z Z CO
� yr
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
furth"es o place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signe Date
0
Inspections
r i
- - V-JZLKq—
No. �O f FEE
COMMONWEALTH 01 p U
Board of Health, 1--AVL*1 SL (A,13 l£. MA.
b CERTIFICATE OF'COMPIIANC E
r
Description of Work.—L)Individual Components) ✓!7 Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired( ),Upgraded ( ),Abandoned,( )
at f- o L R. /� � ! i _✓
has been installed in accordance with the provisions4-310 CMR 15.00 (Title 5) and the a proved desi n plans/as-built plans relating to
application No. 9-977 , dated Approved Design Flow 37 (gpd)
Installer '11d. ' ,
Designer: Inspector). ��A . h1pte:/ ti
The issuance of this permit shall not be construed as a guarantee that the V em function as designed.
lJ �s
No.C =� FEE 1&20
COMMONWEALT14 ®F MASSACHUSETTS,
Board of Health,'�W V V+-Z - MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at AS 5&550e:S Mf 14kZ- f A?-,. g 5- as described in the application for
Disposal System Construction Permit No. ��' �7 , dated Z!
Provided: Construction shall be completed ' in hree years of the date f is it. al conditions must be met.
Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date oard of Health
TOWN OF BARNSTABLE
LOCATION Ns Rd SEWAGE # 99 7
VILLAGE �Sf�r�� � ASSESSOR'S MAP & LOT J"y;Z
INSTALLER'S NAME&PHONE NO. J°
SEPTIC TANK CAPACITY /5 'o
LEACHING FACILITY: (type) 3005, (size) 12J Y--�2 5 X Z
NO.OF BEDROOMS
UII D OR OWNER - /`� Co sf���.fioh
PERMITDATE: COMPLIANCE DATE: a
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
i Furnished by
i
------------
IJ
;
/C , ve z
10
f
TOWN OF BARNSTABLE
LUC EITIO' N EVAAS Sr SEWAGE #
VU,LAGE G�✓� !�'�- ASSESSOR'S MAP & LOT Iq
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY f Sn
LEACHING FACILITY: (type) a" �t/fl ��� G (le) �o�•�'X v't rX NO.OF BEDROOMS
BUILDER OR OWNER 0�A
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leachin facility) Feet
Furnished by Far,-j
� 4
r 3y ao
a a9- ay. s
3 33 30
y 39a, 3s ,
sr U. ISO,
TOWN OF BARNSTABLE
LOCATION %lyuHs SEWAGE # 9y 7"T
VILLAGE ®S�f�r, �J�/� ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. J 0�n �917'�b G/a2 -y T`/S
SEPTIC TANK CAPACITY
tEACHING FACILITY: (type) 6 f2 otid�/ems (size) /,7J3X,�5'XZ
}
NO.OF BEDROOMS 3
i
UILD OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet!�):
Edge of Wetland and Leaching Facility(If any wetlands exist 40
within 300 feet of leaching facility) Feet
Furnished by
j
T31Y
3 9 G
r"1 /3
BENCHMARK. LOT 107 LOT a yE;
EL LOCUS
=114.0(ASSUMED
TOP OF C.B.
416 c B.
\ \ S8 0 7'5O„W _ �1 2 _(fnd)
100 00 _ - m. .. P
co; ti ►.. I U1 3 �,
e
ASSESSORS MAP 1421
US
2
LOC
— ` ,9 PLAN REF. f.18366. I,'
10
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R..GA of
E ,.
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RI \ 17 \ LOT SETBACKS.
p •
,
\ � � ti 9 FRONT 20'
28., SIDE 10' z x
Ili 11 1s �,�to
BACK 10' i
_ � TOP •p ; , . �7`B\ = ,
co OF. 114 ' FLOOD ZONE.-
rr� n „C»
\ u FLOOD INFORMA TION SHO WN ON
�, W p HUD MAP 250001 0016 D
' \ 1 3 BEDRO WATER PROTECTION ZONE.• AP
SITE & SEPTICE PLAN
#2
1 6 1 0 0
1►1 - 45� l / I PROJECT LOCH T/ON
y . Wo 11 ABBE RS LOT 85
a LOT 54 EVANS STREET
ARE =15 400�Q' FT. l /
o ! - /A OSTER VILLE, 'MA.
09
/ / , 99 / / / APPLICANT
y io8 • .1387�30 E /- SUE & JOHN HEAL
2 � �
YANKEE SUR VE Y CONSUL TAN TS
cn P. O. BOX 265
' • _; r UNIT 1, 403 INDUSTRY ROAD
x
0� MARSTONS MILLS, MA. 02648
11 LOT 8� v y° PH. 508 428-0055 - FAX 508 420-5553
Of , t < ) )
V.1 1 OF
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A ��P,H tigs� „ ,
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i .aEW
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MEMNON
32Mi WILLtAr-A
. LIEBcRf%4 Hi; REV.• IREV.•
�fOS�� ,o P No. 239/1 O
°l,sc`STE¢G`�� JOB NO. 52179 SHEET 1 OF 2
81 NAL O;`
.114. 0
N
TOP OF FOUNDATION. '20' `MIN.
µ 10 MIN. T ,
CONCRETE COVERS
• SCHED P`V.C •
. MIN. PITCH 1/B PER FT 2"LAYER OF w
EL=113' , .7 1/ _1/2"
/.. i i . i i ♦ / / / "t' c a f;' CONCRETE COVER B"
k
G - WASHED ONE
u k 6" AIAX / �: /"/ i
" W ST1')
' 4" CAST IRON PIPE '
�� . .. / � 113
(OR EQUAL MINIMUM
PITCH 1 4 ' PER FT y= - R. 3 MAX: D
/ '
s
' m E AN ;. < SA
17.
FLOW LAVE GEL=110.ON
,. 10
8'
*:, INVERT 1 4" y r o°0 0= o 0 0 0
_,. MIN. �2 ,� oo
110.4 w 1 ° o`oo •00000000
y o °' oo.00~0000000 0 °
t. $ _ o 0 0 .o o" o 0 0 0 0 0 0
'� CAS o 00
-BAFFLE N T ° 107
INVERT
• L °
y ,.' INVERT `' EL.=-109.. 75 3.y I VER V S INVERT' ,o° ° o 'o o`o 0 0, 0 0 0 0 0 0°° _
_ 6 UM �O EL. .2
ry --- °
F EL.— 110.0 ----- ------ 4.
�..
' A CHAMBERS
7, U
• ,, (7V BE PLACED ON f7RA! BASE) # 5 AL " €
E
, TIN •. t
- D IS RIB O
,
, a C H 00 !NC
. . w LL k.
ECHANICA Y COAlPACTED OR 6 OF S7t7NE
N
a _-15-02__G ON r TESTED
. . .BOX A
ti ALL S m TO BE WATER 12 B X 25 yTRENCH 1R7RMATION n2 ri
, . , SEPTIC_ TANK AD U a
N T 6. STONE
D d:
F MORE UTLET
w `
A ON
BSORPTION
:. ,
DOUBL/E4`'WASHED STt7NE
• t. aw
SYSTE'M SAS a
. .n PROFILE �OF . r
-
. .
745 . -- —
Y
x n ,, -, . , •"� 'BOTTOM, OF TEST 1YOLE ELEV
t SEWAGE .. DISPOSAL SYSTEM E
_
O S ER 8 ELEV
s _
4 TI 0 E W
NOT To scaLE OBSERVA` ON ° H LE1 LEV=
w,
n
- N O ER VED TABLE 7 6970
x
rB
PERCOLATION RATE'S -_ MIN./ INCH,AT__'___ .INCHES � OBSERVATION HOLE 2- ' .'ELEV.=_109 _
DEPTH HORIZ TEXTURE COL OR_;, MOTT", OT HER' DEPTH :. ORIZ TEXTURE COLOR MOTT OTHER.
M
A
1
k
r 2 0" 4"
a D�S
. O" 4" . TOP AN UBSOIL' • 2 TOP AND•SUBSOIL
+, 4"_ 2" M,TO:+FINE" SAND 24"-132" °
2 13 _ MEDIU ME
.. � � DIUM TO FINE SAND
ry, GENERAL NOTES: ,. d t�
., p '
e F
a.
,
i .. -
1 ALL ,WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E P.
) - .r,c .,..„r `'.� u .. ,.:q�. '�:« • m. c ;r: s t is �•:; .
TITLE' S' AND THE TOWN OF _$AI�N,�'TABLE—__- RULES,'AND 1V0 WATER'°E'NCOUNTERED, ?`NQ.. WATER ENCOUNTERED .,u `1
REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. .; r. o- °n . { _ r Y A » of uq�y
2) ONE COVER ON SEPTIC TANK SHALL BE BRO LIGHT TO
,SOIL , TEST `�,�
WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12 h DATE OF' SOIL,TEST Q, ' 7/22/86 wn «.;SOIL 'TEST' DONE BY JH. °`MILNE'`
3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF ; �'s WITNESSED BY.`; ' 'T ' McKEAN ' LIEBEWAArq
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN "�
10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE $`F - :° Y D�'SIGN `CALCULA TIONS. �0 ��ISTE%a��'
USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. '. = �ss�+A j
t
<.- ,
4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL
INSTALL k NUMBER OF BEDROOMS
BE MORTERED IN PLACE. f°(2)`500 GALr LEACHING .CHAMBERS ,' , GARBAGE DISPOSAL
NO
WITH° 4' STQNE ALL AROUND TOTAL ESTIMATED FLOW
5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE. WITH ` . �£ F -
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO 1 8 6 X 25.. `X 2 `DEEP ^ ( I10__GAL/BR./DAY x 3___ ' BR.)';" 330 GAL�DA Y
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. `'< REQUIRED SEPTIC TANK CAPACITY 1500 —GAL
6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR . ,j _•.
IS TO CALL "DIG— SAFE" A T 1—800—322—4844 A T LEAST'''72 HOURS SOIL CLASSIFICA TION .
PRIOR TO COMMENCING WORK ON SITE. 'NOTIFY .YANKEEr"SURVEY 24 HOURS .
3 . .K.• ; DESIGN PERCOLATION RATE ." .�� 2 MIN./IN.
7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS PRIOR TO SEPTIC•,INSPECTION. EFFLUENT LOADING RATE . 74 GALIDA Y/S.F
SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. � y ' � a„4' LEACHING CAPACITY (AREA X RATE) 338 GAL/DAY
8) PARCEL IS IN FLOOD ZONR C___ ,M P. RESERVE LEACHING CAPACITY . 338 GALIDA Y
9) LOT IS SHOWN ON ASSESSORS MAP 142_ AS PARCEL =`85 f _ «' (25 X 12.8 X 74)f(,25f25f12.8 +12.8 )X 2 X 74)
°{ :. SHEET 2_of 2 JOB NUMBER _52179-------