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HomeMy WebLinkAbout0146 PINELEIGH PATH - Health 1l}6 PINELEIGH PATH, OSTERVILLE y MAP- Y 1 1. s I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 � r ABC 2 2 coxE p�OF� " retary �0 ARGEO PAUL CELLUCCI DAVID B. :BURS Governor ssioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART A CERTIFICATION Property Address: 146 Pineleigh Path, Osterville, MA Name of Owner: Steve Weiner Address of Owner: Date of Inspection: August 10, 2000 Name of Inspector: (Please Print) James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 Map: Telephone Number: (508)862-9400 Parcel. CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ✓ Passes Conditionally Passes Needs Further Evalua'on By the Local Approving Authority _ ails Inspector's Signature: Date: August 13, 2000 The System Inspector shall submi copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page Iof11 j Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 146 Pineleigh Path, Osterville, MA Owner: ,� Steve Weiner Date of Inspection:'' August 10, 2000 INSPECTION SUMMARY: Check A, B, C, or D: r A. SYSTEM,PASSES: ✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes, no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked, structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health) _ broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 146 Pineleigh Path, Osterville, MA Owner: Steve Weiner Date of Inspection: August 10, 2000 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b) THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil.absorption system(SAS)and the-SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 146 Pineleigh Path, Osterville, MA Owner: Steve Weiner Date of Inspection: August 10, 2000 D. SYSTEM FAILS: You must indicate either"Yes" or"No" as to each of the following: _ I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the'distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than'/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped— Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria, volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet 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 The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 146 Pineleigh Path, Osterville, MA Owner: Steve Weiner Date of Inspection: August 10, 2000 Check if the following have been done: You must indicate either"Yes" or"No"as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health. ✓ _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓ _ As built plans have been obtained and examined. Note if they are not available with N/A. ✓ The facility or dwelling was inspected for signs of sewage back-up. ✓ _ The system does not receive non-sanitary or industrial waste flow. ✓ _ The site was inspected for signs of breakout. ✓ _ All system components,excluding the Soil Absorption System,have been located on the site. ✓ _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: ✓ _ Existing information. For example, Plan at B.O.H. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)). ✓ _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. M , revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 146 Pineleigh Path, Osterville, AM Owner: Steve Weiner Date of Inspection: August 10, 2000 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom. Number of bedrooms(design): 5 Number of bedrooms(actual): 5 Total DESIGN flow n/a Number of current residents: n/a Garbage grinder(yes or no): Yes Laundry(separate system)(yes or no): No; If yes, separate inspection required Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last two year's usage(gpd): 1999-583,000 gals.: 1998-247,000 goals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: evd(Based on 15.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no) _ Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: None on file-per treatment plant. System pumped as part of inspection(yes or no): No If yes,volume pumped: gallons 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information: Sep. 26197-per as built card. Sewage odors detected when arriving at the site: (yes or no) No revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 146 Pineleigh Path, Osterville, AM Owner: Steve Weiner Date of Inspection: August 10, 2000 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting,evidence of leakage,etc.) SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 20" Material of construction: ✓concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) 4 Dimensions: 2000 gal. Sludge depth: 1" 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: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How dimensions were determined: Measuring stick Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Both tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. Reconunend installing riser to bring cover within 6"of grade. A rock wall was over the tank and the inlet cover was unaccessible. 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: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural'integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 146 Pineleigh Path, Osterville, AM Owner: Steve Weiner Date of Inspection: August 10, 2000 TIGHT OR HOLDING TANK: None (Tank must be pumped prior to, or at time,of inspection) (locate on site plan) Depth below grade: Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain), Dimensions: Capacity: gallons Design flow: gallons/day Alarm present: Alarm level: Alarm in working order: Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: ✓ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) The box was located, but not dug up There were no signs of failure in the leach system. 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.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM-INFORMATION (continued) Property Address: 146 Pineleigh Path, Osterville, MA W Owner: Steve Weiner Date of Inspection: August 10, 2000 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan, if possible;excavation not required, location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits,number: leaching chambers,number: leaching galleries,number: 4-500 gal. drywells w/4'stone(per as built card) leaching trenches,number, length: leaching fields,number,dimensions overflow cesspool, number: Alternative system: Name of Technology: A Comments: (note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.) The drywells were dry. There was no scum line. There were no signs of failure. The bottom to grade was approximately 7'. CESSPOOLS: None (locate on site plan) Number and configuration: ' ' Depth-top of liquid to inlet invert: ; Depth of solids layer: Depth of scum layer: : . F Dimensions of cesspool: F Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection). f 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: Continents: (note condition of soil,signsof hydraulic failure, level of ponding,condition of vegetation,etc.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 146 Pineleigh Path, Osterville, MA Owner: Steve Weiner Date of Inspection: August 10, 2000 Map: Parcel: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Q i WAS► i O 3 e, G� O a Aa- 63 S y A-3 (o f33- 3y revised 9/2/98 Page 10of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 146 Pineleigh Path, Osterville,.MA Owner: Steve Weiner Date of Inspection: August 10, 2000 NRCS Report name , Soil Type n Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep, x. SITE EXAM Slope Surface water Check Cellar Shallow wells w Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation. , ✓ Obtained from Design Plans on record . Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions ✓ Checked with local Board of Health Checked FEMA Maps Checked pumping records { Check local excavators,installers ' Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) " The bottom of the drywells to grade was approximately 7'. A perc test was done when the system was installed, and no water was observed at 10'. There is no high groundwater adjustment for this site in Oyster Harbors according to the Health Department. 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. revised 9/2/98 Page 11of11 TOWN OF BARNSTA ;LE LOCATION ( SEWAGE # VILLAGE as' �e, r Vj'/l(,PO MAP&LOT D7/-00f ova INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY f P �LEACHING FACILITY: (type) `I E n � ao Cep���wzl�s size) Ll, L X [3 2 e� ,4 NO.OF BEDROOMS" BUILDER OR OWNER A rI/a, Ln-sLn)olt o r? PERMITDATE: COMPLIANCE DATE: f tea' 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 I b-5 L64 ISO Li 11 � . sm s r 9 THE COMMONWEALTH OF MASSACHUSETTS FEE Xe- � 3 BOARD OF HEALTH ASSESSORS w ti OF ��r r� .s• � /> /e- PARCEL NO APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application fora Permit to Construct (Jr) Repair ( ) Upgrade ( ) Abandon ( ) - []Complete System ❑Individual Components 4 / /0 e% jg v4 e r-+9 Localiun Owncrs Name Map/Parcel ri Address Lot N Telephone# stal me Designer's Name ���/%p�,��y�A •s Address i Telephone 8 Telephone# Type of Building: Lot Size iP ` 4C-N -€mot Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) e:5 O gpd Calculated design flow-6-3-0 gpd Design flow provided 59Z gpd Plan: Date 7"—/7— 97 Number of sheets Revision Date Title S`iN f . /'9/�csoal.o, e �'!t�a,�,as ems/ w+ e Iowa Q f s Description of Soil(s) -ey�� Zu 4� ,Meef 54 ,e/ -,'VeW —1=i k� °��Kcl Soil Evaluator Form No. Name of Soil EvaluatorP- saa k/ Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to i II a ab ve cribed I dividual Sewage Disposal System in accordance with the provisions of TITLE 5 an agrees no ac the ys operatio until a Certificate of Compliance has been i sued by the Board of Health. Signed Date C� � Af i :;? d FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 bJ� r^ s +es 0. -ra ...� . •,- '�"w-.. '- r ,`-_ - ,�,r. _ - -,r„.. .. .w.;mrti•_j. s •. �. _ THE COMMONWEALTH OF MASSACHUSETTS 2 BOARD OF HEALTH ,.. 01 A w APPLICATION FOR DISPOSAL SYSTEWONST-RUCTION PERMIT Application for a Permit to Construct (X Repair ( ). Upgrade ( )'Abandon ( ) - ❑Complete System ❑Individual Components B' GH T4.- �� Owner's Name Map/Parcel# qys Address Lot# Telephone# I -Iallc tmc Designer's Nainc t r{ d A es� ..,,/ Address R Telephone'#' Telephone# d / 2 7- df Type of Building: Lot Size --sg4e®t ` Dwelling—No.of Bedrooms Garbage Grinder ( ) ! Other—Type of Building No.of persons Showers ( ;), Cafeteria ( ) ' Other fixtures I' Design Flow(min. required) ��A gpd Calculated design flow gpd Design flow provided gpd Plan: Date 7 17- ?7. Number of sheets Revision Date Title Via.", /%w/�.•s:.a/�a s � �✓ /��.oms � �.+�/aFr.c ��.�..se � 1�rs1�►-s... Description of-Soil(s) oVeIt JOn W AVeW- e/ Soil Evaluator Form No. Name of Soil(Evaluator-P. S'ea.v/e le,' Date of Evaluation_T'/S'-Q ! DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to i s lat' tthe a ve d cribed I dividual Sewage Disposal System in accordance with the provisions of TITLE S an rther agrees no ace the ys/m' operatio until a Certificate of Compliance has been issued by the Board of Health. Signed Date / 7 / FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. ,. THE COMMONWEALTH OF MASSACHUSETTS FEE s , • r BOARD ,OF HEALTH ;J CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed(,�,Repaired( ),Upgraded( ),Abandoned( ) by: //yrr (n� !J pp�� (Y at ! �b t l/y ` e\,)iI pA trh (0 (2U4( `�- h'as been installed in accordance with the provisions-of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.�F g',datedy V 4 . Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee LF a the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No,?'/ THE COMMONWEALTH OF MASSACHUSETTS FEE„�>� Prb BOARD OF HEALTH DISPOS�A L SYSTEM CONSTRUCTION PERMIT P Permission is hereby granted to Construct Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at lq� Plw e )V_ Zet mV 14( I? as described in the application for Disposal System Construction Permit No. dated - 1 Provided: Construction shall be completed within three years of the date of this permit.All local cos must be met. Date '"` Board of Heal tsh.—�a�� FORM 2 - DSCP DEP APPROVED FORM,5/96 FORM 1255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS- BOSTON ' /' � Town of Barnstable P# .?!Z Department of Health,Safety,and Environmental Servi - s Public Health Division Date 7 367 Main Street,I lyannis MA 02601 aARve ABM 04, sbs Date Scheduled 7.,/ z7 -� Time`!�' Fee Pd. �(��� � ArEp ,, /` Soil Suitability Assessment for Sewage Disposal Performed By: Z �' -, Witnessed By: t ee' , LOCATION& GENERAL INFORMATION Location Address LI h P� Owner's Name U)('41 �W✓�, ,kxn-W-mn o CY Address Assessor's Map/Parcel: Engineer's Namu p Q Q- NEW CONSTRUCTION' �V/ (REPAIR Telephone# ��J�'� Land Use V o of s Slopes(%) 11—�1-4 f Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) � U Z s v (y 07(0 Ll Parent material(geologic) a✓94 Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERIVMINATION FORSEASON ALH161t WATERTABLVI Method'Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment R. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level! PERCOLATION TEST date f��' 7Ttme':::: Observation Hole# / Z Time at 9" Depth of Perc �8 y Time at 6" Start Pre-soak Time @a Zo Time(9"-6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back---� Copy: Applicant DEEP OBSERVATION HOLE LOG Hole # / Depth from Soil Ilorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel) y2 Z/z /Q d� ZQ` 43 hO' /Q V/? N� i sa✓ DEEP,OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munscl!) Mottling (Structure,Stones,Boulderes. Consistency,Ye Gravel) .v /a A-, . Ley /o yo Z- 4A,w �v DEEP OBSERVATION HOLE LOG' Hole Depth from Soil Horizon Soil'texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Ilorizon Soil'texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.°° ravel i Flood'Insurance Rate Matz: Above 500 year flood bcunda:y No- Yes Y Within 500 year boundary No Yes + Within 100 year flood boundary No r Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? y e S If not, what is the depth of naturally occurring pervious material? Certification I certify that on 711�y (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature � � - Date 7 ' 1 4 ' l � I _ � s - Cc� �co o. , D � G4-1 ra I - - 134.07 +. _ ;•s,s*,:.: GySrcK Hw.aoa5 II yj�� �. - � GoLF GO.i`i►d •. 1-2 I�� 1,00ACI qY M 4-V I � 1,oyc 11.00AG ` - - i ste Az�W-4-1 ® . g 1-6 1.07AC I�Gou COUR ) I 4-a . 1.7 I.ZZAr- a. 1.07AC - ' I.00AG 4-9 1-9 1.00A4. s baa�a ® 1-10 •_2 I:OOAC PREPA D-UNDER THE IXRECTIDN OF THE BAR STABLE BOARD OF ASSESSO "S VIS AI MAP INC. YASSA.• USETT,S..., CONNECTICUT No To 5CALE FINISH GRADE TOP FNON. FINISH GRADE OVER OVER TRENCHES 7.5; 3 EL . �G FINISH GRADE 7s o - 7-y-sue FINISH GRADE OVER DIST. BOX P14SEPTIC TANK %" , c�aa.: 12'" MAX. Q. '4•b a r e.a An w'::�.a'ooP'o'optrba '••.a ! `' oab •,e.•r•.� 'o Ar °q TOTAL LENGTH OF TRENCH OUTLET PIPE LEVEL O.'O'•PO A 3a l/'!) FOR 2 FT. MIN. D•.��Q .� V E-Ir ApL OR PVC TEES 72 � �.�a 7 C. I. b.� 7/, • a• 6h ' A. DIST I UTION BOX 0:.4; Poop GALL ON , _ _ _ _____ ____ „___ BSMT FL . P..o.o RQ INSTALL ON LEVEL BASE 500 GALLON DR YWEL L S EL . 9� ° PRECAST CONCRETE 4�ve.e �• t 0 REINFORCED �.e�,4 0 0;��,o�•eo;a..p :o' e�►:o. ar:o��4 "4;.:4X�Q: TRENCH SECTION SFPTIC TANK INSTALL ON LEVEL BASE NO TE• r EXCA VA TE TO ELEV. "'/. OR LOVER To REMOVE ALL IMPERVIOUS fi�1fic��iin i �rJ;a rr, r � � MA TERIA L BENEA TH THE L EA CHING AREA 4" DIAM. 12" MIN. c REPLA CE EXCA VA TED MA TERIAL WI TH 3" OF 1/9"-1/2 1 a c PA HE T CLEAN, CLAY FREE SAND WA EAST E �7 7a� a• •a• o •e. D P ON s � A•Q•.• mob,• 3140 — 1-1/2' WASHED CRUSHED STONE °o$, a:AO GENERAL NO T E S TRENCH MID TH i s SHOMN ARE BASED ON ASSUMED, NUMBER OF TRENCHES i 1. ALL ELEVATIONS E SYSTEM MUST BE CAST IRON NUMBER OF DRYWEL L S 4 _ G 2. ALL PIPES IN Th OR SCHEDULE 40 PVC. OBS �' A TION PIT r ` 3. THE BOARD OF HEAL TH MUST BE NOTIFIED P-8971 ��p� WHEN CONSTRUCTION IS COMPLETE PRIOR o \ PERCOLATION RATE.' TO BACKF..ILLING 4 4 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED BY THE BOAR© Of.; HEAL TH AND CAPE G ISLANDS WITNESSED B Y.• SURVEYING CO., INC. G.DUNNING ,. 5. MA TERIALS AND'INS TALLA TION SHALL BE IN BARNS BRO. OF HEALTH DESIGN DA TA C0MPL LANCE WI Th4 THE STATE SANITARY DA TE.' JY UL 15„1997 CODE — TITLE V ,AND LOCAL APPLICABLE ° N RULES AND REGULATIONS y_ � __ >h'' NUMBER OF BEDROOMS 5 z �bM 6. NORTH ARROW IS !FROM RECORD PLANS AND �,y ,, , IoyR a/-r GARBAGE .DISPOSALNO N IS NOT TO BE U..,ED FOR SOLAR PURPOSES �� � _ s � �!� .� - 550 GAL cry G � 7. FL OOD HAZARD ZONE C (NON HAZARD) �, y Ci , y r� DAILY FLOW �.�y 2000 GAL WA TER SUPPLY TOWN WA TER SEPTIC TANK RED 'D SEPTIC TAIVK PROVIDED 2000 GAL ti, e-e4 i U w 550 GPO. LEA CHI NG REQUIRED c? n .5 J • � ZO ;., 20 EWA L L �RE74 = 220 1 3 Ui G N \ N � c< • �, G! S.F.X.�G/S.F. = GPD. •, �53TOM AROA 74553 S.F. w S.F.X G/S.F. GPD ,. LEGEND G•s; S �zQ" . '� �;«-ti ,r a„ a a '' LEACHING PROVIDED 572 GPD -i' PROPOSED EL EVA TION --�''� — -- Ex STING CONTOUR 1NGL E FA M•.ZL Y RESIDENCE � OBSERVA TION PI T DISTRIBUTION BOX ��� r� PROPOSED SERA GE DISPOSAL S YS TEM i w�4(�f 6�1 yeti �,E _. -.. . f PREPARED FOR 143'g2 „E o o SEl9TIC TANK ,c SILL IAll�ll 9MARY GUARENTE L O T 16.9 (HOUSE NO. 146) PINEL EI GH PA TH RESERVE AREA O y S TEi9 HA RBOPS — CO T UI T — MASS. DAVID eo , PIPE INVERT ELEVATION j CHAP LES .s s 1 n, CAPE ,G ISLANDS ENGINEERING '` Fc� ? 5�� ' � SCALE AS NOTED 133 FAL MOUTH ROAD — SUITE 2E �s PLOT PLAN Gj �f % SCALE. s PLAN NO. 5 n ,,,� 3a, y �� � ;t: r , MASHPEE, MASS. MAC' EC PCL LOT HSE ;��;�; ,