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HomeMy WebLinkAbout0081 HICKORY HILL CIRCLE - Health 81"Hick6ry Hilly Circles °v' Osterville , RA=\120 103 I it I I I I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 83 Hickory Hill Circle - Property Address Eleanor Crossley Owner Owner's Name information is required for every Osterviile Ma 02655 8/2/2011: page. Cityrrown State Zip Code Date of Inspection p� 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. w Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. Capewide Enterprises Company Name 153 Commercial St. Company Address Mashpee Ma. 02649 City/Town State Zip Code 508-477-8877 SI 4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8/2/2011 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11110. rifle 5 Official Inspection Form:Sub ce Sewage Disposal S ern•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owner's Name information is required for every Osterville Ma 02655 8/2/2011 page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) 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 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 83 Hickory Hill.Cir. Osterville is served by a Title V septic system_consisting of a 1000 gallon septic tank,distribution box and a 1000 gallon leach pit. B) System Conditionally Passes ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old' or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•11/10 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 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owner's Name information is required for every Osterville Ma 02655 , 8/2/2011 page. Citylrown State Zip Code Date of Inspedion 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 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 t5ins•11/10 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 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owner's Name information is required for every Osterville Ma 02655 8/2/2011 page. CitylTown State Zip Code Date of Inspection 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 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 must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters -due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow 15ins•1 of o rtle 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 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owners Name information is required for every Osterville Ma 02655 8/2/2011 page. City/Town State Zip Code Date of 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. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified. laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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•11110 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 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owner's Name information is required for every Osterville Ma 02655 8/2/2011 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health. El ® 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: ® ❑ Existing information. For example,a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)], D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd t5ins-11/10 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 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owner's Name information is required for every Osterville Ma 02655 8/2/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No 1s laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes 0 No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: vacant 6+ months 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: t5ins•11/10 Title 6 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 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owner's Name information is required for every Osterville Ma 02655 8/2/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval ❑ Other(describe): t5ins•11110 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 Fonn.-Not for Voluntary Assessments '< 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owner's Name information is required for every Osterville Ma 02655 8/2/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Original system installed 1983 per town records �I Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): 8„ Depth below grade: feet Material of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions:. 1000 gallons Sludge depth: 511 t5ins-11110 Title 6 Officief 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 "< 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owners Name information is required for every Osterville Ma 02655 8/2/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 3.5' 21- Scum thickness 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? opened covers and took measurements Comments(on pumping recommendations,,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years as maintenance. Outlet baffle intact and in good condition,water level was at bottom of outlet invert, tank was not leaking and was structurally sound. 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owner's Name information is Osterville Ma 02655 8/2/2011 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No t Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): d *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 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 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owner's Name information is required for every Osterville Ma 02655 812/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert off Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was video inspected and was found to be functioning as intended. Cover is 1.5'below grade. 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-11/10 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 .�° 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owners Name information is required for every Osterville Ma 02655 8/2/2011 . page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1x1000 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was found to be dry at time of inspection with a stain line approx.2'from bottom. Cover is 2.5'below grade. 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i Commonwealth of Massachusetts mgm Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owner's(dame information is required for every Osterville Ma 02655 8/2/2011 page.e. City/Town 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.): t5ins-11/10 Tide 6 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 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owner's Name information is required for every Osterville Ma 02655 8/2/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately D Iro l ` �- � 3 �-/ 13` • f3-f 3 Z7 !33 yy r p/T A-y 3� O-V 33 ' t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yy< 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owner's Name information is required for every Osterville Ma 02655 8/2/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20'+ 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) ❑ 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: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealti��of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "( 83 Hickory Hill Circle Property Address Eleanor Crossley Owner Owner's Name information is required for every Osterville Ma 02655 8/2/2011 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary DD (System Failure Criteria Applicable to All Systems)completed ® System information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file. z t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLEc; � LPCATION ( /�,� ,, 1 , /� SEWAGE# D(Q - (to. VILLAGE JS�ef UI p ASSESSOR'S MAP&PARCEL 190 103 INSTALLERS NAME&PHONE NO. C"-e ln•t�Q �'n `gag �o�� SEPTIC TANK CAPACITY /000 5aG LEACHING FACILITY:(type) a? SUO C (size) 12 X 3-S NO.OF BEDROOMS OWNER rq S call PERMIT DATE: - w COMPLIANCE DATE: Separation Distance Between the: C Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility :NG 3 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 FURNISHED BY a Al v � I as.3 3a 30.0 TOWN OF BARNSTA BLE A LM'ATION r SEWAGE# VI LLAGE ASSESSOR'S MAP&LOT LO- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUU,DER OR OWNER PERMUDATE: 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 within 300 feet of leaching facility) Feet Furnished by f- 1�CKO�.Y CIlZCL . HILL I. . LLAC14 i% 10.7 • � .! 1ZESE2VE �Vi1" Z6 3 L r' 9+7 TA ,:'Jjr�r :vd;"" ��. �I S(�n6• �`\�.51 t' 0A6� S. ro 1S usf 1. of t4c Y r / T S IU�d 0 l(.� b �o li of. 10 IAA yA v rf • � M/N/MU/t/J � c171nf SF-7-BACKK.2E.QURe-MFiI/7� No.. t_SJ �(Y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for ]h5pont *pftem QCow9truction i3ermit Application for a Permit to Construct O Repair�(f Upgrade O Abandon O ❑Complete System Xindividual Components Location Address or Lot No. et 4%Cj' m e (-i,4 ixx- C k. Owner's Name,Address,and -Tel.No. n t,�"0-4 1W �"P. - �?_., Fi£Ll) Assessor'sMap/parcel Installer's Name,Address,and Tel.No. �, � � Designer's Name,Address and Tel.No. 428- 40 US Type of Building: Dwelling No.of Bedrooms Lot Size 0'® sq.ft. Garbage Grinder ( ��A Other Type of Building No.of Persons :.3 Showers( vT Cafeteria( .4/ Other Fixtures L ufaQ� ► TC ^i �iN i l.�ayss0�`l Design Flow(min.required) gpd Design flow provided ` �� S gpd Plan Date A� 1141 0�0 Number of sheets k Revision Date Title O �� "-C, Size of Septic Tank y i "�, i , ®c'] Cat Type of S.A.S. -c 2 5 Description of Soil 3 ru\ Nature of Repairs or Alterations(Answer when applicable) 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 Certificate of Compliance has been issued by this Board of Ith. Signed Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. 2-006 1 Date Issued ±Y, 41 43/0 6 V /l[�� 11 No.. � Fee ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: � ' PUBLIC HEALTH DIVISION - TOWN OF BARNSTAIkE;aMASSACHUSETTS Yes 2pplication, for Migpog;a1 *pgtem Construction 3permit Application for a Permit to Construct O Repair Upgrade O Abandon O ❑ Complete System Individual Components Location Address or Lot No. el t4 t c kozy Owner's Name,Address,and Tel.No. F I EL1�5 1 Assessor's Map/parcel 1 p Installer's Name,Address,and Tel.No. ?i C�C-. 'i Cam- Designer's Name,Address and Tel.No. 53q- 99tvb Type of Building: - I' Dwelling No.of Bedrooms t Lot Size 1-40 0 sq.ft. Garbage Grinder �A, Other Type of Building- No.of Persons .3 Showers( Pj- Cafeteria ° Other Fixtures Design Flow(min.required) �Jb gpd" Design flow provided gpd Plan Date 4` , Ulo Number of sheets Revision Date r TitleL �JAC' . UGC�Gt�Q v Size of Septic Tank ��\c�-C 1 ,Goy Cc�� Type of S.A.S. .^ C��Ci11P 12 5r xZ` Description of SoilC - 4 Nature of�tepairs or Alterations(Answer when applicable) `� �� tl• 'Date last inspected: ` tr Agreement:i The undersigned agrees,fo 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 Certificate of Compliancl has been issued by this Board o He lth. Signed •../` Date /� Application Approved by Date �TK zo- ' ' Application Disapproved by: Date for the following reasons Permit No. .a-006 160 Date Issued i"t? 0(, THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTTIFY,that the On`-site Sewage Disposal System Constructed ( ) Repaired (�) Upgraded ( ) Abandoned(,,``',)by ` AV lw( V7 CiV�� �- at 8 l tku ow hi LL (24 KC. . ;; s ru (-LE has been constructed in accordance ,1 with the provisions of Title Sand the for Disposal System Construction Permit No. �4P /4,./k' - dated Y h�S Installer W03106 &TZtt*b5r-,S �,Z" Designer ( w 6aq ~ #bedrooms 46 17— Approved design flow gpd The issuance of this permit shall t}be constru d as a guarantee that the system�functio as designed. Date % / �s7� Inspector K. - ———————————————————— ——————————— No.2a& �(.�c� --- Fee I THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS .& 1i5po5ar;J§pgtem Con5tructiou. Permit Permission is hereby granted to Construct ( f ') Repair ( Upgrade ( ) Abandon ( ) System located at 6e13M p-Tt f ii c to r 1� Q i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. t t.,Provided: Construction must be completed within three years of the date of this permit. Date/ 4a Ldb Approved by 7 Town of Barnstable pF tHE Tp� o - Regulatory Services " Thomas F. Geiler, Director - - • &KIDIScna[.e, 9�AM� �0� Public Health Division rFn �°i Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: Shay Environmental Services, Inc. Installer: .- Address:. P.O. Box 627 Address: • Ccj__�013:4 East Falmouth, MA 02536 On 6,b Q ec 1 � o , was issued a permit to install a _ dla_te4 (installer) septic system at based on a design drawn by (address) Shay Environmental Services, Inc. _ dated y-I L5h6 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or' 1 certified as-built by designer to follow. ' �yjN OF 4480, CARMEN �q, � E. . . (Installer's Signature) SHAY No. 1181 . GISTEF' . SANITAR\P� esigner's Signatur (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM a AV ,hereby certify that the engineered plan signed by me dated I A�0(0 , concerning the property located at B I \A k 6 kCR-Y M meets all of the following criteria: ' • This failed system is connected to a residential dwelling only...-There.are.no commercial or business.uses,associated with the.dwelling. • The.soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests.at the site,without a health agent present. • There is no.increase in flow and/or change in use proposed • There are no variances requested or needed. • The.bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation +adjustment for high G.W. Z> DIFFERENCE BETWEEN A and B 1 , 91 SIGN1 D : DATE: _/ 1 14A Opp NOTICE Based upon the above information- a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. M 25 gASepdc\percexemp.dcc ' F0e. ?� i TOWN OF BARNSTABLE �� LOCATION f 1411,1 of SEWAGE# o(B - i co$ ' VILLAGE 0:3 e"r,tJl p ASSESSOR'S MAP&PARCEL 1.10 143 _ INSTALLERS NAME&PHONE NO. a(Jf' W t6U `Z'r`V (.,�o SEPTIC TANK CAPACITY - 14?00 qO- LEACHING FACILITY:(type) Q S,00 C (size) I NO, OF.BEDROOMS o OWNER ht 5' C / S PERMIT DATE: COMPLIANCE DATE: Separation Distance Beiween the: Maximum Adjusted'Groundw ater 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 leaching facility) Feet FURNISHED BY t i 1aa � ss A --7 3a 30.0 (39r. J -7 `` a No.:.'� .....' Jd ..�.�....... Fs�.. THE COMMONWEALTH OF MASSACHUSETTS OARD OF HEALTH -------.OF ....... :� `........... Os rvo i Appliratiuu -for 'i.ipuuttl Workii Tote urtion VPruiit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal $ ISyst d , ------------�� ma' s Vs Location-Add �5�' / �t No. r Address W8 -dn U ....... --•••------•......••-•-••---•••--•-•--•---. Installer Address Q Type of Building Size Lot,/_t_.�8 _----Sq. feet U Dwelling—No. of Bedrooms-------------1.............................. Expansion At ' ( ) Garbage Grinder Xelt5 aOther—Type of Building ll'--_-._ No. of persons ......... Showers ( ) — Cafeteria ( ) dOther fixtures ---- ----- ----------- ------------------------------------------------------------------ ---------- W Design Flow________________�d.................gallons per person per day. Total daily flow------- _____......__................__.---gallons. W Septic Tank—Liquid capacity,-*6..._..gallons LengthTotal Length idth-:---------��--Total leaching area Depth---------------- Disposal ft. x Disposal Trench—No. .................. Width-------------------- g g q. 3 Seepage Pit No-------/......... Diameter.__,g��46F_-- Depth below inlet ._.._ ...__.. Total lea�ltil�g tt_r-fit . ........ ......sq. ft. Z Other Distribution box ( Dosing tank ( ) 41 �G� ��`'� 1�""'— Percolation Test Results Performed by.................................................�JO.---------7— 7G W ---- - ----- Date........................------------ Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water---------............... (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.......--_-----.___--.- -- — r r� - ;-�----------------------- OxDescription ofSoi -_�--- ----- `----- %----------- -.-- --- - �t V ----------------------------- ---------------------- W ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------------------------------------_--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions.of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate-of Compliance has been iss the bo o ealth. r, gned..... � Date Application Approved By-----`n----j---- Date Application Disapproved for the foilowing reasons_________________________________________________________ -------------•----"---.--•--------- -------------- --------------------------------------------------------------------------------------------------------- ------------------ Date PermitNo......................................................... Issued........................................................ Date No............. Fus...-.l..Q r +' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _. ....... OF........ ........................ .............................. Appliration -for Uhipoottl Works Towitrurtiou Vrroiit Application is hereby made for a Permit to Construct (..-)or Repair ( ) an Individual Sewage Disposal System,: , ram-� ' .�r_ �' / - �' �., ......... _.s� - ' Location-Addregg� or Lot No. ........................................................................ -------------•---•••-•--••-•-•••-•_-..____..__._..._..--------••••-•-•------•---------........-•-- Ownlr Address ._ Installer Address U Type of Building Size Lot,."' ----Sq. feet �-+ Dwelling—No. of Bedrooms............... �------------------------Expansion A�oc ( ) Garbage Grinder ,( Other—Type of Building �'9141 ell------ No. of ersons-----------&-?---------- Showers Cafeteria th g ----------------------•• •---------------....._....--•---...._ .. ( ) — ( ) Q Other fixtures --------- W Design Flow................ .................gallons per person per day. Total daily flow-.----- l-------_-_-------_..........gallons. WSeptic Tank—Liquid capacity,"0°6.-gallons Length..... .......... Width.__.._-.-_.-_ Diameter-----_-._....-_ Deptlt................ x Disposal Trench—No--------------------- Width-------------------- Total Length-------------------- Total leaching area...............-----sq. ft. Seepage Pit No.......1--------- Diameter.._.4-f_ .. Depth below inlet________ ____ Total leaclih gar -1 ....._.._..-_---sq. ft. z Other Distribution box ( Dosing tank ( ) d�` /0C, �'-'� 4_ `Z.7`.7G Date-------- a Percolation Test Results Performed by..................................................... ,a Test Pit No. 1----------------minutes per inch Depth of "lest Pit.................... Depth to ground water................._..__.- �14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ --------------------•----- ------ Description of Sail = ..... _. i . )� V _...................../---_-----r�----- �rl!l*-r .._Q.. -G L ;� W ------------------- -------------------------__.._..........._........-..-------------------------------------------._.-----------......_.._-.-.......---------.-....-....---..._....__-._.-------------------------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ---- ----------------------------------------------------- --- ----------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss d'by the board of/hea' lth. Date Application Approved BY 1 /-C� --- _ G-------- Date Application Disapproved for the following reasons:............. -------- -------------- •--------------------------------------------------------------•--------------------------•---------•------------_...--------------•---------------•------....-•-•----------------..----------------•---- Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................OF......A .......`.. . r—�... .5. r . Q.,rdifirate of fIIJoutplittaur THI,�- ! TO CE>RTIFY,t%hat the Indivi Sewage Disposal System constructed ) Repaired ( ) by '/ .� Installer ,� /f/ at------------------�---•-------------��------ - !� --.��.... ..r I - �/i /.'1---. has been installed in accordance wits the provisions of Ar�le 1 I of The State Sanitary Code as described in the application for Disposal Works Construction Permit No... v '�~�9 U ---------- ------------------- dated- �.2..-..-.7-L.....--••------• THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--•-•/ - '._. Inspector..: : THE COMMONWEALTH OF MASSACHUSETTS 1} -- --�--^ BOARD OF HEALTH/ ,,r .......................I.................. No. .. -•• FEE-•A...... Binpoiittl ork �ootrortioatrrot # Permission is hereby granted------------- . • •---•-•-------•-•-•-•------•-•--••------ ••-----•••-------------•-••--•••-------------------•--•------_-•--- to Construct Q� orrRepairk)/n Individual Sewgge Djsposal System f f - --------------------------------------••-----••-•----•---•••-----•- Street as shown on the application for Disposal Works Construction P t f��- ..: Dated... :2 U.^-.7G-•--••---•-- - DATE.../--_- /.... Z�............................................. Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1 HicKoay C l i2CLE 10 rC- -7- 9+7Llev ox Z7 - 7E o t xr ` C fr, F4 ` PA+/ SANPr psi / 4//v/�U/s� Nd dvA7-F-a ms u/L.D//vG 5 E7-,c3ACA-- 20 ' F20NT /O' S/Z7E /p ' 7ZE 4Te P2o,ao 5ED I200MS • SEP T/C 5 y5 TEM COnJ5 T2 UC T/ON - '514A L-C. COnJ,=02n4 TO MA SS 0e-5/GN FLOW -300 GAL CIA y � ENV/,e0AJMG--NTA4, CODE T/TLF Q An/O_ TOt.�/N OF 13.41 N57''At3G. L G A C,�/ 2r4 TE � Z M/N 11AIC,U. P2oPo5�D A/E.dLTN .Q�GUL,4 T/ONS p' TOP OF ,P20�05.E V L EAC14 A AEA 2-)Q FO UNDAT/ON • /M,oc.2✓"0us co vae MANHOLE GoVE,� TO _�X7TEND TO TO r->2EVEAJ7- W/ T,y/N I' Or F/N/5/-IED 61ZADE, =2pM /A/F/1-722A7-/il/6 � /8"CO✓G-i25 � I � S TOnJE D/577. C Q" 0X / 2/"N/i�?L- C<IST G3 — � 3..M/N , M/^/�I1.�u/1/ _ 6 M eJ -�, 3 /�I.,V 4 �/A. T�i7 4` D/a. /O L Eq e.c/ �--- -�--- --�— /GNT P/TCN F"W LINE 1" _tLL < �� ,N ��rc�/ _ P/7- � /O"MiN y /¢" �4 �fOoT 2^ Mini �,rc,�i ��¢'- �2"D/A. -Y_ Min/ /�"/-.00T /000 WA I©CQ 7.00 SHEO.' 7.S - - /A j1,=-Z r �• 3 A GA 1-404 C Sro AlE /NVEeT CA P.4�n// TY /NVE2T b a A�� SE,oT/G TA.V•e �.'�Q FlEv. A1ZOUn/O 7 ZS CWATG1zT/GHT) 630 BdTTOM O /NVE.QT P/T#/ 0,30 /,v vE er /v0 GA,e,5AGE G,2J"Df,2 -C Cf 20' MiA/iMuM Z' S/ TE AL A Al 5,: fir;C 7/h✓4G 7D r3 G A 41A.4 LOC.4T/O/l/ O_ .STET21//LLE M.45.51= /p' F�1C3� �' tJ/Lr�/�/v i�A/r� ,e EFE,e E-nICE- �N Pr 4A.1 800X- 22/ T.4 's� � SEAT/C 7-AA-IA" j�/ST,2iBUT/ON 80.1� CS DUTLETS) An/D LE.4C.Ll A10 i=>/T". ro .BE OF .�Ei�/FO.�CED CO.VC2ETE C0n/ 5•/2E TE 957,2EAJ457;LY 3000 P•s/ l/A/. 4MA VY 2D ! STEEL ,. 20000 3Y C. 10. S A-/O,�T / at1�.or,yeR H-/O LOAD/.vG "/4 TO,ey L,4NE R CRAIG 3�' VEWAY ^ o7- TO 5E L0 47-ED SHORT .I � O✓Ee _5Y57-E,M UNLE55 H= 20 � /l/N/S , /l�Q SS. No. 27483 �. -TCE,2 T/FY TAIA T 7/,/c tST FC-)0,V DA 7-/0 n✓ L O C-4 7/0ffs CO/�2 r2CC,7-• A 5 140 L-,.J/t/ C'On.j,/=C7 !' tl lAl E� M//'rAl T/4C- 8CJ // Z,>/AjG vE 76A<=/c 0,4 TE AI E,4 L 77-1 A OEe v 7- 47 _-3o VENT PIPE `o Least 24 Inches tale SECTION A A ALL GUILT PM FttOY THE � �F �V 10' min. from *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. Schedule 40 PVC w/Charcoal Odor FNter Existin Foundation house to s tic tank Aa�s �Mer ,,, tee PROFILE VIEW OF LEACHING SYSTEM! sEr������ tr CONCRETE COVER 9 tank covers must be D-BOX ewer rtMist be within 8' of rniistW yrode TOP OF FOUNDATION = ELEV. 100.00 (Assumed) 6 finished �� within e' of finished grade �� j _ / r within L over SAS- ELEV-10100 3-s'OUTLET } '' + Orade over SepticTank-100 00 Crads over D-Box-102 /�°"' /t'to I rA',tines A.•set shown o/r/r'-//lt sl.eMi!r-eun lolmoUl5 +� a s � NiSPECiION Dover must be SS' ' f 1r DIET OUTLET within 6 in. of finiehed S- 0.02 3 OLE H 20 T of SAS-Etev.�7 00 10• EXIST. S•0.01 a Gteotsr s- 0.010"per foot 3 Nmdnim Cow t 'r r ExtsT. ' to 1,000 GAL 32, f r o 0 0 0 0 0 o ts6' 4' - SCH. 40 Tee/ ,owns' rRDN ExTST.nxpmi rn n SEPTIC TANK g �, �w ; e Effadtw 0 C3 C3 C3 C3 C3 C3 o o ^ PLAN SECTION CROSS-SECTION CONCRETE FULL FovltoA c H-10 io 100 o o + 2 tlnfts Q 8s• = 17' , 0 0 0 0) o, w 3.5= �-3.5'N =►1 9 ¢ v 6 In.of 3/4--1 1/2- 6 > > 3 HOLE H-20 DISTRIBUTION BOX , ' N, SYSTEM PROFILE meted sto o a 2' r Effec e►+9 + NOT TO SCALE 'saooe , Not to Scale - EffectNe Vkfth I. f zoiRow►s,YlyiCnewryelEOfMAVfEQ c c o SOIL ABSORPTIDN SYSTEM (SAS) 6 y, 4-1 1e/2' m 500 - C H-20 LEACHING UNITS / WIGGINS PRECAST GENERAL NOTES WI NOTE: ALL COMPONENTS MUST HAVE RISERS TO THIN 6" BELOW GRADE compacted Bottom of Test Male 2 Elev.- 09.00 Not to Scale 1. Contractor is responsible for Digsafe notification, VERIFICATION v Obs. Groundwater - Test Hole 1 Elev.= NONE OBSERVED and protection of all underground utilities and pipes. 2. The septic tank anj distribution box shall be set level on 6" of 3/4 -1 1/2" stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation O by Carmen E. Shay - Environmental Services, Inc. Q C WA�� 5. The contractor shall install this system in accordance 1 - with Title V of the Massachusetts state code, the approved plan PERCOLATION TEST j CC ,GN( OF and Local Regulations. f L L o Fool R o� 6. If, during installation the contractor encounters any Date of Percolation Test: ARIL 5, 2006 f f �4 � soil conditions or site conditions that are different Test Performed By. CARMEN E. SHAY, R.S., C.S.E. t L from those shown on the soil log or in our design Results Witnessed By: WAIVER (BARNSTABLE B.O.H.) installation must halt & immediate notification be SHAY ENVIRONMENTAL SERVICES, INC. i V 769' made to Carmen E. Shay - Environmental Services, Inc. Percolation Rate: Less Than 2MPI 030" R 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. 6 G I s 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. i 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. Test Hole Test Hole TEST HOLE1 �`; I ELEV 103 1 0 10. All solid piping, tees do fittings shall be 4" diameter No. 1 No. 2 �4 I ' Failed T Schedule 40 NSF PVC pipes with water tight joints. DEPTH SOILS ELEV. DEPTH SOILS ELEV. O i /Leach Plt �0� 11. Municipal Water is Connected to The Residence and Abutting 0 103. 0 102. P r / Properties Within 150 Feet. Loamy Ley 4" PVC Sand Sand Vent / / ` ) �O A THE PROPERTY LINES ARE APPROXIMATE AND / v 10Y3/2 COMPILED FROM THE SURVEY PLAN GENERATED BY o"-s' A 02.2 ,o r 3/2 ��A, 101.25 p_Bo, i /�'� 0,� CR SHORT, INC. of YARMOUTH, MA, ENTITLED •. �. , / /�� �.•� CERTIFIED PLOT PLAN OF LOT 60 HICKORY HILL CIRCLE, OSTERVILLE, MA Lm Sand Loamy t'' '�j i CATCH_J L DATED AUG SEPTEMBER 20, 1976 Sand 104--- BASIN -J do THE DEED DESCRIPTION ( BOOK 2438 PAGE 109) I: 10 8./6 to YR 5/6I . IT SHOULD BE USED FOR NO PURPOSE OTHER THAN 9"- 3Cr 100.5 Be . .,. / / 9"- 30" 99.50 E t N z / /®� THE SE M INSTALLATION. Sand Sand r' �Zi to i 1� 1 /' / f _ ► I k � __i EXISTING LEACH TO BE PUMPED OUT AND 23 T 7/4 2.s Y 7/4 I_� z = ' 1 1'00ST. c /' FILLED IN PLACE. 36'-156 90.00 30"-156 C, 89.00 l •. "al /' ! ' O-^000 GALLON SEPTIC TANK NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE ^� FROM THE EXISTING LEACH PIT TO BE DISPOSED OF AS PER BOARD OF HEALTH SPECIFICATIONS. TEST HOLE #2 _4 ELEV.= 102�150 � �1 NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY C / ASSESSORS hTAP`-4Z0 PARCEL 103 EXISTING E L G i XISTING GARAGE Z BEDROOM : ------ ----96 / Perc #1 _____ HOUSE �'; _ w DENOTES PROPOSED Depth to Perc: 36" to 54" LOT #21 #8 f 'O 104X 1 Perc Rate= Less Than 2 MPI SPOT GRADE Groundwater Not Observed No Observed ESHWT ----__ __-_-__-_-_ ----94. x 104.46 DENOTES EXISTING ADJUSTED H2O Elev. = None ' �/ i� DECK --__ _-- 92 SPOT GRADE 96"� i PL 90 PROPERTY LINE 96 PROPOSED CONTOUR ' PROJECT BENCH MARK -gq EXISTING CONTOUR TOP OF FOUNDATION -- --- 2-16" MAM. ACCESS MANHOLES i ' - ELEV. = 100.00 (Assumed) % ® DEEP TEST HOLE & PERCOLATION TEST LOCATION `f = LOT #60 - 6 FOOT STOCKADE FENCE f f,700 Squmv Feet \ + THE ACCESS COVERS FOR THE SEPTK:TANK, - INLET 1 1 DISTRIBUTION BOX AND LEACHING COMPONENT \ ouT.ET SET DEEPER THAN 6 iNa.lES BELOW Fwasi ED GRADE SHALL BE RAISED TO 11111TMN 6' OF �/ • FM65HED GRADE 3 _: INSTALL'W-TITE GAS BAFFLES OR EQUALS 9p 111 P LOT P LAN STEEL REINFORCED PRECAST CONCRETE � Z B PLAN VIEW OF PROPOSED SEPTIC SYSTEM UPGRADE d � o PREPARED FOR 3-24• RfliOVABIE COVEIRSMS CAROL S. FIELD c ..}..._. 4. .r:; 3- min. clearance _.'r .: r AT RLET 6- m-1- 2-min, kid to outlet e- ' TNOTE GRADE OVER SAS TO BE CUT DOWN TO PROVIDE NO MORE THAN #81 HICKORY HILL CIRCLE aun.ET . '� ��" ;5 r 5 SET OF COVER OVER SAS. _ r Kitchen/ Bedroom 0 S T E R V I L L E MA s• -7• ; s5 b g 4"b depth Design Calculations Dining r a PREPARED BY: Number of Bedrooms: 2 Equivalent to 220 Gol./Day (330 Gal./bay Min. per Title V) o � o , ,'- Garbage Grinder. No ® m m XRi RM�'N E. SHE! Y s'-W Leaching Capacity Proposed: 330 Gol./bay Minimum (Min. Per Title V) E- CROSS SECTION END-SECTION Septic Tank : - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL Septic Tank. Living NVIRON.KENTAL SERVICES, INC. SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch Bedroom Bottom Area: 0.74 gal/sq. ft. x 300sq. ft. = 222.00 gallons Room pF P.O. BOX 627 USE EXISTING 1000 GALLON H-10 SEPTIC TANK Sidewall Area: 0.74 gal./sq. ft. x 148 sq. ft. = 109.50 gallons , $ `, EAST FALMOUTH, MA 02536 Providing: = 331.50 gallons 'iNVITA NOT TO SCALE Use (2) PRECAST 500-C UNITS. HAVING A 2' EFFECTIVE DEPTH, TEL/FAX 508-539-7966 TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES AND 1st Floor 2nd Floor SCALE: 1"=20' DRAWN BY: CES DATE: APRIL 14, 2006 4' OF WASHED STONE ON THE ENDS. 2 BR HOUSE FLOOR SCHEMATIC PROJECT#SD897 FILENAME: SD897PP.DWG SHEET 1 OF 1