HomeMy WebLinkAbout0027 SEAPUIT ROAD - Health 27 SEAPUIT ROAD, OSTER`'ILLE
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No----7� -Fitz_1 a_............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal Works Tonotrttr#ion 1krutit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
- Q �,cS�S �E..,�.,xaa. -•�?R.. f�y.�kr..��.�---•--------•- --------------------------------------•-•-------------•------------------------------------------
Location-Address or Lot No.'
.. 6.ka,1....4- cizi---------------•-------------•--.....--------------------- --•-••-• ---•------.--•.••.--•-•-•- .I...------,--------------------.....•...............
Owner Address
--------------=----------------------------------------------------------------- ----9-`� -T_o_ -�J_...!B
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder. ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
Other fixtures ................................................-
W Design Flow.............//V......................gallons per person per day. Total daily flow..............--_3J.O-.-.-..--_----gallons.
9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter__-___--:-_.--_- Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
►� Percolation Test Results Performed by.......................................................................... 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.........................
a
0 Description of Soil.........................................................................................................................................................................
x
U --------•-•-••--•--------------•-------------•-----------------------------------------------------•.......---------------------------••------------------------------•---....-----••....._--------•---.
---------------------------------------------------------------------------------------------------------------------------------------•------------•---------•----------...... ---- n
U Nature of Repairs or Alterations—Answer when applicable.._:1-.n1.� �9��__.._IOQp-_-GL�_---2..._.sTa�E_-AsEev.✓f/
w-� �► d« " ��'u - z07.m6lq...1°oo..6,S.T 41 ----------------------------------------•------------------......-•----••---
Agreement: �l
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the bo rd of health.
Signed------------- �...�. a
g Q 1- .. �j�` qI
Ike
Application Approved By ...........
---�-�-VN`11"�.` ......................................................----- ------- ---- ----ry
Dare
Application Disapproved for the following reasons- ----- ------------------- ------------------------------------................... ---------------------------------------------
-..........-------------------------------------------c-'-------------- --------------------- ---- ---------.--- --------- ---- ------...------------------------------.-------- .------..... ------...----------------- ----...--...
Permit No. --------..1.l-- ,43.../- --_-- Issued ------.--------------------------------- -----------Da.e-----
................ Dare
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0
No....7.�: Fps.. p............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH `
TOWN OF BARNSTABLE ) I
Appliration for Disposal Works Tonstrudion frrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( /an Individual Sewage Disposal
System at:
....... :J q o.._.-A'------y'�? =! . ..... .. - -• ---•-
Location-Address -...or-Lot No.1
........................................................... ----•---------- --. ..------..............................
Owner Address
-/3 c-.-------------=--------------------------------------------------------------• �....19 7"c��,J...Q�as e..A a
Installer Address '!
d Type of Building Size Lot_-_•------------------------Sq. feet
Dwelling—No. of Bedrooms..___......
___..._..•.•...............Expansion Attic ( ) Garbage Grinder ( )
`61 Other—Type of Building No. of:persons............................ Showers — Cafeteria
a
d Other fixtures --------------------------------------•-----------------•--------------------------------------------•--------.._......_...._....-------•---•--------
W Design Flow..............//0......................gallons per person per day. Total daily flow.._...._._...._._.3 .0....._._..._____gallons.
WSeptic Tank—Liquid*capacity............gallons Length_____________•-• Width................ Diameter................ Depth................
x
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed bY.......................................................................... Date........................................
Test Pit No. I................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........................ `
a •-••---•--•--•------------•-------•••••-••------------•--..........••••-••-•----•-•----••-•-------------------•-•-•-•-•-----•...............-•-•-•-•-•.......
0 Description of Soil...................................................................-----••-•-••-----•---••-----•-------•-----••----••...........•••--•---•••...............•---•-••-----
x
V ----------
--------------------------------
•----------------------------------
----•-------------
... ----------------
•------------
•------------------------------------
------------------
•---------------
----------------------------------------------------------------------------------------------------------------------------------------------•-----...------------------------------ -----------..... /
U Nature of Repairs nor Alterations—Answer when applicable..__ __G _..__sToE___AA ✓d
2;ST.n1- �gOo__ .err... Cial _._.ey-��J..........................
Agreement: i
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Signedy�;l .....� 4� ;
Application App oved By ........... .: . .. .40."-------------- ----
8 " Daze
Application Disapproved for the following reasons- ..........--------------------------------------------------------------- ------
---------------------------- ------------..............------- ................................................ .......................................................................... ........................................
e�r` Dare
Permit No. 7, - --,3---- -------------------- - Issued -------------------------- .....-----....--
! Datro e -,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Tex#ifira a of 01-I'omytianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ✓ ) E
by L
----.. ... -K -------
Installer '
ata2 ya. .c s+( . �---_--o ----------------_---- _Y'4�4s............................................------------------------------
has been installed in accordance with the provisions of TITLE 5 o The State Environmental Code as described in
.
the application for Disposal Forks Construction Permit No. ....... /-7: ...-4_3. --_---_ dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
.�.. /
DATE . ./....... Inspecto .- --------•------ ------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No....l� . TOWN OF BARNSTABLE
�., _
FEE.....-•O---•00--........
Disposat Works Tnns#r,}r#ion ramif
Permission is hereby granted................... ...----...................................---..........--•--•----......
to Construct ( ) or Repair an Individual Sewage Disposal Sys .
Zo CAS 1 E ter o c�
at No........................................................ f.. --••---••�-•-•-•-----.. !Q_i.........}' ...........................................
Street
as shown on the application for Disposal Works Construction Permit No. :.. Dated..- :.
...------••••-•.................
�y Board of Heilth
DATE.. la _,�..' 1,
FORM 36508 HOBBS 8 WARREN,INC..PUBLISHERS - -
h
No----- Fss.... ...... ....0-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal Works Tonstrnrtion jhrmit
Application is hereby made for a Permit to Construct ( ) or Repair F) an Individual Sewage Disposal
System at:
27 Seapuit -Road Osterville
. ............- - ....--------••-----------.. ..........--•-•--•--••---....------......--•-----•------......-----------------------......_------
Location-Address or Lot No.
.S LT it_wInc.. John Gaston
......- -------------- - - ..............
Owner Address
W J.P.Macomber Jr.
Installer Address
Type of Building Size Lot............................Sq. feet
U DwellingX No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building RES No. of persons ...... Showers — Cafeteria
C4 yP g P ( ) ( )
Q, Other fixtures ..................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width---..-..---_--- Diameter--.--........... Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.---.---.---.------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
�' Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit----.--............. Depth to ground water.---..-------.-------..-
f% Test Pit No. 2................minutes per inch Depth of Test Pit--...--............. Depth to ground water..--.....--.............
P4 ..............................................................
..........
.-......
...----------------
-....
--•--------------------------..-.-..-----•-----------
0 Description of Soil....................... ------------------=-------------------------------------------------------------------------..........-----
x Sand... G•rave S
U --------------------•----------•-•-.......--•---......--------------•-••-••--------------•-----•--------•-•-----------------
------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------.
U at r o Re a' or A1tera 'ons—A r wh li ble.--- ----- - ----- • ------------------------------------------------------------------
1-��0 g�a �on an 1-1 �'� gal�c �i `�eachlrig pit:
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--••----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has ben ' sued by the bo d of alth.
Signed ------------------- ---6L3/9..1...............
...�.... - --- --" ----- - Date
Application Approved By --- -- / V ---------------------------------------------------------------------
Application Disapproved for the following reasons- ------------------------------------- --------------------------------------------------------_-------- .................
........................................
Date
Permit No. l -a��--------------------------------- Issued
Date
No...... _ .. Fizz...�....3°.. 00
t THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..TOWN OF BARNSTABLE
Allp iratiun for Uhipaiial Warks Tunatrurtiun Frrutit
Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal
"System at:
` '7 Seapuit Road, Osterville
•..............._-- --_.............-•• - -- ......__...... ............................................................................................
Location-Address or Lot No.
_Seapuit_Inc._ "ohn . Gaston ...... ._... - ...... -•--- •- .............:
Owner Address
J.PsMacomber..Jr...................................................... ...........................•--._....-----•--------•---.......-----•-•••....•---------•--•----••---
Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling X No. of Bedrooms................22_..........................Expansion Attic ( ) Garbage Grinder ( )
pa-I Other—Type of Building ....REs............... No. of persons...__.._2................. Showers ( ) — Cafeteria ( )
a'
� Other fixtures -----•---------------------------•------------------------------------------•----------------------------------------------------•----......----•----
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
04 W Septic Tank—Liquid capacity............gallons Length.....,........... Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length_.-__._.___.-___-_-- Total leaching area--------------------sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth .below inlet.................... Total leaching area..................sq. ft.
Z ` ' Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by--_------------- =-----•-----•---....•-----••.........••----------.... Date........................................
Test Pit No. 1.._._..._------minutes per inch Depth of Test Pit.................... Depth to ground water........................
(T4 Test Pit No. 2.................minutes per inch Depth of Test Pit.......:............ Depth to ground water........................
G�
vOx. Description of Soil........................ apid-�--GraveI-----------------•------------------------•--------------...---•--------------------.................•----
. ..--••----•-------------------------------------•---•---•----•--------------------••-----------------••-••---•--------------•-------------------•.....•--•--...------•-----•-••.•-•••-•-----------------
-----------------------------------------------------------------------------------------------------------------------------------------------------•---------•--.........:.....--•--------------------
V Nat re of Repair or Alters ions— ns er when a plicable.________ ______ i_.__...__..___..___...
1-1000 gaflon tank; 1 10U0 gaYl-n leaching pit:
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of b9alth.
4
Signed. , - . ----------------- .... 3/9i,... --......
l ..-..^ L?/Iy Dme
Application Approved By ---------- / 75-----
r ' � ce
Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------- ------------- ---------
Dare
PermitNo. .....Cj.-.. �J� Issued s......----"---�...----"---....- .......................Date................................----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of C1omY' lia re
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed`( ) or Repaired (XXX )
by-- J.P.Macomber Jr.
---------------------------------------------------------------------------------------
lmrdler
at ........,--..27..Seapuit Road Osterville
- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit NO. .......5/.-..,3.33....... dated ...............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. \__10
DATE------. ).-. 1
t ------ Inspector ---------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ,
�r TOWN OF BARNSTABLE 0.00
No....,t/l:..�JJ FEE........................
Roplisal Works fullkunstrurtivit rrrntif
Permission is hereby granted J P Mcomber Jr.
' .. a...............
to Construct ( ) or Repair ZCX.T an Individual Sewage Disposal System
at No._�7...Seapuit•.River Road 0sterville
.......... ... ------------------•----------......................................................
Street Cp
as shown on the application for Disposal Works Construction Permit NO._?Z.J,:-, Dated..........................................
L p Board of Health
DATE ...../.-. i......
FORM 3850E HOBBS 6 WARREN.INC..PUBLISHERS
TOWN OF BARNSTABLE
LOCATION Z.7 PSc?gpG/� / l SEWAGE #
VILLAGE QS I L'V V/ ASSESSOR'S.MAP Cr LOT
INSTALLER'S NAME PHONE NO.\,) r/J �'JhlG�y� 6 Pr ? elk. �-,2-c
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) i`1� (size)
NO. OF BEDROOMS_ ' ^PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER . ,,, _c
DATE PERMIT ISSUED: ---'? jq.
DATE COMPLIANCE ISSUED: /m ��� ' 7 f
VARIANCE GRANTED: Yes No
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TOWN OF BARNSTABLE
4-10CATION d? Sk/�.�'�i/T /Zo SEWAGE # -o33
ILLAGE ASSESSOR'S MAP & LOT /i8 0
INSTALLER'S NAME&PHONE NO. Tl?
SEPTIC TANK CAPACITY C
LEACHING FACILITY: (type) /1T (size)
NO.OF BEDROOMS
B&UMDER-9R OWNER AoX' 'J 1,f e-
PERMIT DATE: — 3 5 - 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
-t
S_
� 1' �-S-
�_ 611
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` �
r �' �
r on �F
�j
TOWN OF BARNST LE
LOCATION 7 �"� / v SEWAGE # T9
{kVII,LAGE_ ASSESSOR'S MAP &LOT/ *
INSTALLER'S NAME&PHONE NO. }
SEPTIC TANK CAPACITY G�f LEACHING FACII,rrY:_(type) 6-,-0 /�LLL K (size). j
NO.OF BEDROOMS
BUILDER OR OWNER i
PERY.IT'DATE: 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 le Ching facili ) Feet
Furnished by
0 � .
1 J..
Z'f
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ASSESSORS MAP N0
PARCELNO: -/_2?
No. L+ _Lee —ere
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS
tent er ZIppYtcation for Migpogaf *pg Construction Writ
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No.
2-1 SLApq\T aoA.� "��S�� C-Z"�l�E kAO'M C`-s
04516Z\1\L_(.`U I Afs F-0-IOX 196Z Q`W— V' "4 AAA
Installer's NameAdd re and T 1.No. Designer's Name,Address and,,T/el.No.
5� 5 ILL.S'a /�L�l.�Z�`OCR 5�✓
Type of Building:
Dwelling No.of Bedrooms 4 Garbage Grinder(R/A
Other Type of Building No.of Persons Showers( ) Cafeteria 4A)
Other Fixtures
Design Flow gallons per day. Calculated daily flow 440 gallons.
Plan Date 3 15' 10 Number of sheets L Revision Date 3 Z SG
Title
Description of Soil 0'�-," G "5" -5' A - �.34"'67 ,"KI NVM -Cze►92L dada 34-p/z0'G
}tJQ f:1e�}jEQ KAJ`C-. TP Z b y `jamI/U>rt7tU4�1 CitZAySE �1fRVt7 �Q -�3V
Uo CuAT£62 E&K,,
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 o Titlqof Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has bee 's by t ealth.
Signed Date
Application Approved by
Application Disapproved for the following reasons
Permit No. Date Issued E7`T 1! 4,
t
No. iia � � f .�^"=-=-"lice-/�
THE COMMONWEALTH OF MASSACHUSETTSG1 r
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS J
2pplication for Migogal *p.5tem Cowaructiou Perron
S0645ooio4
Applicatiodis hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No.
2'1 5£APm 1T �tzop.3�
Installer's Name Add e and T 1.No. Designer's Name,Address and Tel.No.
��� YAt'lk.£.L �vcsv£"l Coa►s�t,-rb.��"C5
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder(4.4
Other Type of Building No. of Persons t, 'Showers( ) Cafeteria 4A)
Other Fixtures
Design Flow O gallons per day. Calculated daily flow 1440 gallons.
Plan Date 31/5 q(o Number of sheets _Revision Date
Title ;.
Description of Soil 1!� , �� a :5 AM r01WA -C,0&(Z L SAtvD Z0,-C.:
No L�,ArE2 to, ?'/-� Z 6'= 3" n- 3 /raf_ /o SI"Q -ytnCtbtuwt COAi4sZ
G Uo LU41-kle kAx—
�� 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
1' in accordance with the provisions 11by
Title of e Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has bee iss t ' Bo •f^I3ealth.r
Signed Date
Application Approved -
Application Disapproved for the following reasons
I
Permit No. � / Date Issued ""
i
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS S TO CERTIFY,that the On-site Sewage Disposal System installed or repaired/replaced(. )on 47
by s for
as has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. �- l7 dated "'2���5
Use of this system is conditioned on compliance with the provisions set forth o :
CTC,,u���'"� •s,..
No. % Fee //��
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
ligpogal *pgtem Construction Permit
! Permission is hereby granted to .
to con ct )'repair(. a On-site Sewage System located at i Q, " '
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his •er duty to
comply with Title 5 and the following-l'6cal provisions or special conditions.
All construction must be co ple 'thin two years of the date below. C
i
Date: ! Approved by /� O
s
CERTIFIED SEPTIC SYSTEM REPORT g� Nov 2 :T �✓,4�_
L a
LOCATION
y
. 27- SEAPUIT '•RD .-,
OSTERVILLE, MA r_
MAP. 118 PARCEL 124 ;
PREPARED FOR
SELLER
SEAPUIT , INC
CIO MS . . CAROL : SWART2 � ,. Eb,
UNIT 3C
1645 FALMOUTH RD
CENTERVILLE , ,MA`, 02632
BUYER 4
MR. JAMES.� ROCKER
P .O . BOX 496 .
OSTERVILLEi MA 02655 ,t
PREPARED BY
. HILLIARD HILLER
P .O . BOX 250
a „ CENTERVILLE, MA 02632
508-778-1472
Commonwealth of Massachusetts
Executive Office of Environmental Affairs :
Department of - r
Environmental Protection r.
William F.Weld A.
Govamor
Trudy Coxe .
s�cntary,EOEA ,.-
David B. Struhs r
Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
- CERTIFICATION,
S�,*i/r Ra `oSTL/1ulGLE ' Address of Owner.,
Property Address: � "
Date of Inspection: //�7/q (If different) /o'•�s• c /lot %5�i9.QT
Name of Inspector: t//Z41AWO
Company Name, Address and Telephone Number: �p� �oX aSo -/G 91 fi9G�,wT/Y /C2
kfA !'�G�1z L.Eif/(/l�4 d/6G
CERTIFICATION STATEMENT
1 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 ,m_y training and experience in the proper.function and ;
maintenance of on-site sewage disposal systems. The system: -
L-11asses
_ Conditionally Passes } `
_ Needs Further Evaluation By the Local Approving Authority- -
_ Fails
Inspector's Signature: Date: /1�J,3A7_
f
The System Inspector shall submit a copy of this inspection report to the Approving,Authority'within thirty (30)days of completing this.
inspection. If the system is a shared system or has a design flowof 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 ano copies sent.to the buyer,,if.applicable and the approving authority. M
INSPECTION SUMMARY:
Check A, B, C, or D:
A] SYSTEM PASSES: r �.
I have not found any information which indicates that the,system violates any.of the failure criteria as'defined in 310,CMR 15.303.
Any failure criteria not evaluated are indicated"below. '
B] SYSTEM CONDITIONALLY PASSES:
. a
One or more system components need"to be replaced or repaired.FThe system, upon completion of the replacement or repair,
passes inspection.
a
Indicate yes; no,^or not determined (Y, N, or ND).. Describe basis of determination,in`all instances.'If*noYdetefmined", explain'why not)
The septic tank is metal, cracked;structurally unsound, shows substantial infiltration or exfiltration, or tank failure is.`
imminent: The.systern will pass inspection_ if the existing,.septic tank is replaced with a conforming septic tank as
approved by the Board of Health.
(revised 8/15/95) 1
One Winter Street .:•; .Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-SM k
i, Printed on Recycled Paper
•
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION'(continued) _ is
Property Address: ?7 SFi9�U�� �� OST�/ly/GGE iw l
Owner: $�Arov�r, /iVG
Date of Inspection:
ES continued PASS .
B SYSTEM CONDITIONALLY ( ) , . ..
l _
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
• .. � •
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: 4.
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 THAT THE SYSTEM IS NOT FUNCTLONING.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 APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH•AND SAFETY,-AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet toxa surface water supply of tiibuiary to a
surface water supply.
_ The system has a septic tank and soil absorption system and is within'a Zone I'of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system hay a septic tank and soil absorption system and 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 a
ppm
D] SYSTEM FAILS:
I have determined that the system violates one or more'of the following failure criteria as defined 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.
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. 2 .
trevised 8/15/95)
SUBSURFACE SEWAGE DISPOSAL S YSTEM'INSPECT O FORM D S
PART A
CERTIFICATION (continued) r
,
Property Address: a2 S4CAPvir 4,0 GtST�/lvl�G� �s,g h
Owner: S APviT� iwG -„
Date of Inspection:
D]SYSTEM FAILS(continued): z
Static liquiddevel in the distribution box above outlet invert due`to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool'is less than 6" below invert or available volume is less,than 1/2 day flow:' .
Required pumping more than 4 times in the last,year NOT due to clogged or,obstructed pipe(s)
_ Number of times pumped
Any portion of the Soil Absorption System, cesspool.or privy is below the high'groundwater elevation."
Any portion of a cesspool or privy,is within 100 feet of a'surface water supply or tributary to a surface water supply.
Any portion of a cesspool or,privy is within a Zoned 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 feetfrom 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' '
Ej LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 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:
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 11 of a
public water supply welli
The owner or operator of any such system shall bring the'systerri and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 8/15/95) ,3 r
. _ _ .r, air
SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM
PART B u
CHECKLIST ,
F�
Property Address: 7' QD 4157FiW4,,/44 C
Owner.
Date of Inspection: i015 5` ,
Check if the following have been done: r
/Pumping information was requested'of the owner, occupant, and Board ofHealth. .
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.
AefAs built plans have been obtained and examined. Note if they are not available withtN/A.
r/The facility or dwelling was inspected for.signs of sewage back-up. r
i/The system does not receive non-sanitary or.industrial waste flow e
✓The site was inspected for signs of breakout.
AZ'AII system components, excluding the Soil Absorption System, have been located on the site.
6/1he septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected(or condition of baffles or
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
VThe size and location of the Soil Absorption System on the site has been determined based on existing information or w
approximated by non-intrusive methods. ,
Wihe facility ov ner (and occupants, if diffe ent f-om ow e•) wereprovidedr-with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 8/15/95') 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C i
SYSTEM INFORMATION
Property Address: a2
Owner:
Date of Inspection:
FLOW CONDITIONS- <:
RESIDENTIAL
Design flow: Gallons s
Number of bedrooms: a
Number of current residents: o;Z
Garbage grinder (yes or no):�W ,
Laundry connected to system (yes or no):YFS"
Seasonal use (yes or no):_AA>
Water meter readings, if available: So e^o>a 6,ofG .:� IW-; — S�2, L 7 ociy Gish,
Last date of occupancy:
COMMERCIAUINDUSTRIAL: '
Type of establishment:
Design flow:_gallons/day -
Grease trap present: (yes or no)_ r
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:
P cy.
GENERAL'INFORMATION .s «
PUMPING RECORDS and source of information: '
System pumped as part of inspection: (yes or no)�.e
If yes, volume pumped Qallons F '•'
Reason for pumping: Y. ,
5 r, •
TYPE OF SYSTEM
t-"' Septic tank/distribution' box/soil absorption,system
Single cesspool
Overflow cesspool s. t
Privy
Shared system (yes or no) (if yes, attach.previous inspection.records, if any) "
Other(explain)
APPROXIMATE AGE of all components, date installed (if known] and source,of information: S .V/e�
Sewage odors detected when arriving at the-site: (yes or no) G' "
,f. n ,n
(revised B/15/95) 5 y
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C.
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection: /V7/9,v
SEPTIC TANK: !/ r ? <• - ;
(locate on site plan) r
Depth below grade: /0, ..
Material of construction: concrete _metal _FRP _other(explain)
Dimensions: 510
Sludge depth:
Distance from top of sludge to bottom of,outlet tee or baffle:z "
Scum thickness: D + +
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
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.) T1'/,u/' pT�,�'S G �ta CsEc�
GREASE TRAP•_—
(locate on site plan) r
Depth below grade: S
Material of construction: concrete metal FRP other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of <rom 1- bottorrr.ot outlet tee or bafiie ,
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 B%15/95) - 5 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection: /11719s `f
TIGHT OR HOLDING TANK:_ '
(locate on site plan)
Depth below grader
Material of construction: _concrete_metal _FRP—other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day a
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION. BOX:L/
(locate on site plan)
Depth of liquid level above outlet invert:— 0—
Comments:
(note if level and distribution i_, evidence of so!id! carryover, evidence of leakage into or out of box, etc)
t•
PUMP CHAMBER:
(locate on site plan) R
Pumps in working order.(yes or no)
Comments: r
(note condition of pump chamber, condition of pumps and appurtenances, etc.)'
(revised 8/15/959 y
s
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 7 SL�PviT /l o `a6llz"f//�G�f �toI '" f`
* ,r
Owner.
Lo,,1,-
Date of Inspection: /�7/�!S
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible; excavation not required, but may be approximated,by non-intrusive methods)
If not determined to be present, explain:
Type: leaching pits, number:L µ
leaching chambers, number:_ #
leaching galleries, number: F _.
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) -]^oTi`�C - �fG'
CESSPOOLS
(locate on site plan)
- ., a . . Ys' ,. • f R - .i.
Number-and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer: `
Dimensions of cesspool:
Materials of construction: M'
Indication of groundwater:
inflow (cesspool must be pumped as part of inspection) '#
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY .
(locate on site plan)
Materials of construction: a -Dimensions:
Depth of solids: s `
Comments:'(note condition of.soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.)
,
,
8
(revised 8/15/95b
,
a -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART'{
SYSTEM'INFORMATION (continued)_
Property Address: 977 Sew/r RD bSTt,Cr//GG Z
Owner:
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM: -r
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' r
. .. Z_
n - ... " • h r • - •.
DEPTH TO GROUNDWATER
Depth to groundwater al t feet r
method of determination or approximation: SH✓ws T/ "r
3�'-r, THE : 0*7' . [,v/�5 8,'33'. dhE!>_ ' TH/ o/j5r:fr�6o ��.Iyzx�Ti?44x
� i�� sri�•y s G,.-.o Tr'/ /br X L,�- T' ?try -G'S Cs. ,
Lb�/Qk G%/vim /S 6—
(revised 6/15/55) 9
P' -.r
f
Commonwealth of Massachusetts V_
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
27 Seapuit C
Property Address
Joan Ahrens
Owner Owner's Name
information is
required for every Osterville Ma. 02655 08/12/2016
page. City/Town State Zip Code Date of Inspection
IV
N
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.
Important:When A. General Information 2
filling out forms C/# //q,33
on the computer, 7
use only the tab 1. Inspector:
key to move your
cursor-do not Michael T Bisienere
key the return Name of Inspector
Y
Cape Septic Inspections
Company Name
624 Old Barnstable Road
Company Address
Mashpee Ma. 02649
Cltylrown State Zip Code
508-280-3356 S13938
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. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
��`✓�« 08/12/2016
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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
y
r
�<L Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
27 Seapuit
Property Address
Joan Ahrens
Owner Owner's Name
information is
required for every Osterville Ma. 02655 08/12/2016
page. Cltyrro in 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:
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 2 of 17
s
� Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M vyp 27 Seapuit
Property Address
Joan Ahrens
Owner Owner's Name
information is required for every Osterville Ma. 02655 08/12/2016
page. City/Town State Zip Code - Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
um s/alarm p p s are repaired.
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page,3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
27 Sea uit
w p
Property Address
Joan Ahrens
Owner Owner's Name
information is
required for every Osterville Ma. 02655 08/12/2016
page. Cityfrown 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 Y2 day flow
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
27 Seapuit
Property Address
Joan Ahrens
Owner Owner's Name
information is required for every Osterville Ma. 02655 08/12/2016
page. Cityrrown 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. f
❑ ® 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•3113 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
27 Seapuit
Property Address
Joan Ahrens
Owner Owner's Name
information is
required for every Osteryille Ma. 02655 . 08/12/2016
page. Cltyfrown 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
❑ ® 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): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): >330
t5ins•3/13 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
,.•'' 27 Seapuit
Property Address
Joan Ahrens
Owner Owner's Name
information is
required for every Osterville Ma. 02655 08/12/2016
page. Cltyrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection
information in this report.) ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonal use?
❑ Yes ® No
Water meter readings, if available (last 2 years usage(gpd)):
Detail:
In 2014 276,000 gallons were used and in 2015 332,000 gallons were used
Sump pump?
❑ Yes ® No
Last date of occupancy: occupied
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
w •° 27 Seapuit
Property Address
Joan Ahrens
Owner Owner's Name
information is required for every Osterville Ma. 02655 08/12/2016
page. Cityrrown 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 27 Seapuit
Property Address
Joan Ahrens
Owner Owner's Name
information is
required for every Osterville Ma. 02655 08/12/2016
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:
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 36"feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank (locate on site plan):,
Depth below grade: 24"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: standard H-10 1500 gallon
311
Sludge depth:
t5ins•3/13 Title 5 Offidal 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
27 Seapuit
Property Address
Joan Ahrens
Owner Owner's Name
information is
required for every Osterville Ma. 02655 08/12/2016
lug
page. City/Town
State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle apx. 35"
Scum thickness 1"
Distance from top of scum to top of outlet tee or baffle apx. 5"
Distance from bottom of scum to bottom of outlet tee or baffle _apx. 12"
How were dimensions determined? sludge Judge
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
I would recommend the new owner put the tank on a maint. plan with a local septic pumping co.
based on the future use of the home.The Barnstable Health Dept. has a list of local pumping co.
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
27 Seapuit
Property Address
Joan Ahrens
Owner Owner's Name
information is
required for every Osterville Ma. 02655 08/12/2016
page. Cltyrrown Stat
e 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
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
R
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.•�' 27 Seapuit
Property Address
Joan Ahrens
Owner Owner's Name
information is required for every Osterville Ma. 02655 08/12/2016
page. City/Town 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
0"
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box,etc.):
At the time of the inspection there no signs of solids carryover or evidence of past hydraulic failure.
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.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 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
y 27 Seapuit
M
Property Address
Joan Ahrens
Owner Owner's Name
information is required for every Osterville Ma. 02655 08/12/2016
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
® leaching fields number, dimensions: one appx. 20 x20
❑ 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.):
I ran my camera down each of the leaching pipes and at the time of the inspection there were no
visable signs of past hydraulic failure.
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•3/13 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
i
•�
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
27 Seapuit
Property Address
Joan Ahrens
Owner Owner's Name
information is
required for every Osterville Ma. 02655 08/12/2016
page. 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.):
I
t
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
•'' 27 Seapuit
Property Address.
Joan Ahrens
Owner Owner's Name
information is required for every Osterville Ma. 02655 08/12/2016
page. City(rown 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
y
r,26 6
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
M1
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
27 Seapuit
Property Address
Joan Ahrens
Owner Owner's Name
information is Osterville Ma. 02655 08/12/2016
required for every
page. City/Town 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: 10 plus feet
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:
I augered a hole to 10 feet to show five plus feet of seperation.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwea
lth th of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
27 Seapuit
Property Address
Joan Ahrens
Owner Owner's Name
information is
required
wired for every Osteryille Ma. 02655 08/12/2016
page. Cityfrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (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
S, � . S
5
Fey T
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS
OCATION_ 22
ILLAGE5����CL�- DATE
PPLICANT �� � x��- FEE/099 v-d .
DDRESS A:5'� ���'C y f�s��1��[ TELEPHONE NO. (Non-refundable)
NGINEERGI�45-e—'<•doz TELEPIJONE NO. Sr-�.�L .
ATE SCHEDULED
scant's signature)e2,
• • • • • e o 0 0 0 0 • o • e o 0 0 0 e • o e • • •e e e • e e e•,s • . . ... . . .
� • • • • • • e e ••'• • • • • • •e• e• • • e e • • • • • • • •
ASSESSOR'S biAP 6t LOT NO: ��� �ZI (` 50I-�L L06G
UB-DIVISION NAME DATE /'Z_- 2 — TIME�c7
XPANS ION AREA
: YES NO '� ��s o ENG IN_EER:'N
OWN WATER WELL BOARD OF HEALTH
_A��'c EXCAVATOR
KETCH: (Street name,etc• ,dimensions of lot, exact location of test holes and
percolation• tests, locate wetlands in proximity to test holes)
• NOTES:
ERCOLATION RATE: Z �e A]•,/ '
EST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION:
3H ® - V 1
C
2 2
4 4 _
57295 v ` s
6 �: ..... _�__. .. _�_.. .
• 7 ���• 'S�C/ a ^•
5- 9
' 1p 10 '
11
Cl
•.
!�Z
12 72
:.. .
13
13
iU d Gv��-��L.
��"L
14 14 ..
15 _.. _.. _... ...
16 16
SUITABLE FOR SUB-SURFACE SEWAGE: • LEACHING FIELD_LEACIUNG PITS__.
LEACHING TRENCHES
UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS:
NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED -ON PERC TEST APPLICATION
'ORIGINAL: COMPLETED IN ENTIRETX BY P. •E. AND RETURNED TO BOARD OF HEALTH
COPY: RETAINED BY APPLICANT
TOWN OF BARNSTABLE
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS
ASSESSORS MAP NO. R118 PARCEL NO. 124
ADDRESS; 27 Seapuit Rdad VILLAGE: Osterville
SEAPUIT, INC. PO Box G Ostervil.le
CONTACT PERSON JOEL P. DAVIS PHONE NUMBER 428-2191
LOCATION OF TANKS:. CAPACITY: .TYPE OF' FUEL AGE: TYPE: LEAK
OR CHEMICAL; DETECTION _
residence 270 heating oil 33 m SYSTEM:
t
DATE OF PURCHASE OF EACH: 1. 9/55 2. 3. 4. 5.
DATE 'OF FIRE DEPARTMENT PERMIT:
TESTING CERTIFICATION SUBMITTED: PASSED C DID NOT PASS
aV
PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD.
W � .
5'FA (w IT 1?o R
r
I F.P. 292
CGnlilii1o11fuc,iltij of `,JilIj53MC1111grtfs
Department of Public Safety—Division of Fire Prevention
APPLICATION FOR PERMIT FOR REMOVAL AND TRANSPORTATION TO APPROVED TA.N ARD
1;20899
C.82 S.40 M.G,L.
To: HEAD OF FIRE DEPARTMENT 'DIG SAFE N U M E R
Barnstable
C,ti 88492203 _
,1-275 #2 Fuel Oil Start Date 1/20/89
In accordance with the provisions of Chapter 148, GG.l . as ppro ided .in
Section 38A Application is hereby made by L.C.)2. A ervlces
p t Name of Person,Firm or orpora ion)
_ 381 Old Fal. Road, Marstons Mills
L �( ress
7 For permission to remove and transport underground steel storage tank(
s) .from
27 Seapuit Road, Ostetville
Street address city or town) Gasten Res.
FDID#Q1920 _ to approved Tank Yard!; J.T. - ^Grant
State clearly type of
inert gas used in _
steel storage tank rype of inert gas use
Name of Person, Firm, Corporation disposing tank J.T. Grant
Date issued - re�.� p 1/20/ 19,' 89 BY -
Date of expiration 19 paid/due ignatu e of Applicant
ICE V4LLEY z c
.. RO4D
L;1T RD- � !
2 SEaP �5 f� t
N87 24 09"W SEAPUIT ROAD C) L j"�Ig�IO�
120. 46' EvcE i
TRA YELLED
100.39, of _ 17 27: -- N89 40 09"W wAY 205.85'C.B. WATER ` .
.2 or (BRO , CA CB y ,
'U !nd C.B. �� CB. c7 ` ✓1 .
( )/ (Ind) J (Ind) L �
b o / 104' � EL=102.16 \_
- \ �\ TAG BOLT �
\`
50' BUILDING N % , EXISTING \ \ y (ASSUMED)
RESTRICTION HSE #z� C,
LINE �s• 1 ` 18 %„ (TO BE RAZED) LO T / y LOCUS 4441 P
12.
PROP 102
PROPOSED .69.1. 26 HOUSE 37, 28 a:::::::ai ' 1 p0 T
a
108 o�
ss
PA
oa 47E � �' Th' — S83 36:�2 s2 \ n PS� 9T�i9ll� N
CATCH
No. MOB
so -a BASIA' cr� AFGtsy. -
LOT
R = 50. 00' o
C° , / L = 23. 4 7' Qz o
01
1 0 , • \
r�• � � n� •,ice, \ �PR, OJEC T 0CA TION
j
LOT 7-2� SEAPUIT ROAD
`- S87 47 45'E 144.148' OSTE_I�VILLE; MA.
Al, o' JOHN G
LANDER -CAUL APPLICANT DISTINCTIVE' �ID�VIE
i� S
No o P. 0. BOX 192
s,cIszNAL���G��,�` OSTER VILLE, IlIA. 02655 j
- YA NKEE SUR I/E Y CONSULTANTS I 1
- -P. 0. BOX 265
ASSESSORS MAP 11-8 GRAPHIC SCALE - UNIT 11 408 INDUSTRY ROAD
PLAN REF. 50 y 25 50 100 200 MARSTONS MILLS, NIA. 02648
15055 H PH (508)428-0055 — FA X(508)420—5553
d
RES. ZONE. "RF--1" . s SCALE. 1 "=50 ' FDA TE- 3115196
FLOOD ZONE. "C" IN FEET
1 _ inch 50 . f t. REV. REV. 3, 6
5 _
JOB NO. 50904 SHEET.1 OF
_ r
tE
.F. ELEV.'=110.0
0'min.
LEV.= 108_Of
4" CAST IRON OR C ELEV.= 108.Ot
SCHEDULE 40 P.V.C. CONCRETE COVERS
4 CAST IRON OR END IA-
CAPS SCHEDULE.AL 40 PIPESRFORATED PLASTIC' PIPE
SCHEDULE 40 P.V.C. 5' ON CENTER 12 min A 3" LAYER OF
DIST.=VARIES SLP.=0.02 SLP.=0.005
CONCRETE COVER DIST.=39' WASHED STONE
105.00 FLOW LINE INVERT DIST.=5.4'. SLP.=_Ol -- 0. _80 Q,0 p.�. 0 WAS E i
ELEV.=---- ELEV.= 1--- - -- INVERT ELEV.= 103.5 00000,00 000000000000000000000000000000000000000000 000000000000000000000c
10" MIN. ig" o_o_o_o o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_ _o_o_o_o_o_o_o_o_o_o_
ELEV.= 103.75 ELEV.= 103_6 -- ELEV,= 103.52 o"o s" LAYER OF
4" CAST IRON OR -- r) QC)U vOvOV00000000000000� 00000 (�0000000000pC`` /4" TO 1-1/2"
SCHEDULE 40 P.V.c. DISTRIBUTION BOX 0 ,0 O O�OnOnOn 7 OHO O, O O O O 0 WASHED STONE
IF MORE THAN 4' OF COVER, ELEV.=-102.5
A
USE H-20 LOADING USE STONE .
I
1500 GALLON SEPTIC TANK TO BE WET TESTED IF TO LEVEL THE
TO BE PLACED ON MORE THAN ONE OUTLET. BED AS NEEDED. 23
6 OF STONE OR TO BE PLACED ON j
MECHANICALLY COMPACTED SOIL. 6 OF STONE OR
BOTTOM- OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV
USE A TANK WITH THREE COVERS.
MECHANICALLY COMPACTED SOIL * j
USE H-20 LOADING SOIL-TEST DONE BY: BAXTER & NYE EDGE OF PE'TLANDS H AT ELEVATION
WITNESSED .BY: ED BARRY ____
IF MORE THAN. 4' OF COVER. ------------ 780 AND IS APPROMUTE GROVArDIVATER
> PERCOLATION RATE: __2---MIN/INCH P# 8619OF
TEST HOLE 1 DATE: L2_07_95
ELEV._108_5 o v o;o o;o `o o v o v o d�sHEDsroxE
PROFILE OF °°°a°o o°0°°° 6- VYER�°FZ-
DEPTH HORIZON TEXTURE COLOR MOTT. OTHER o 0 0
TO-
arorze ;
SEWAGE DISPOSAL SYSTEM A 4' PERFORATED PIPES-r�, OF
NOT TO SCALE O-3 O SECTION A—A � '�
p m N O 3-6' A AIEDIUAI LAP = LEY G ,
O
GENERAL NOTES: 8-34' B N COARSE
r 34-120' C E SAND SSE MAL
1. THIS PLAN IS FOR THE CONSTRUCTION OF A NEW SEWAGE DISPOSAL SYSTEM.
2. PLAN' REFERENCE LC 15055H LOT 7 BARNSTABLE REG. OF DEEDS. I
3. THIS PLAN IS FOR THE INSTALLATION /REPAIR OF SEPTIC SYSTEM I
AND NOT TO BE USED FOR. SURVEYING AND ZONING PURPOSES. NO CATER ENCOUNTERED DESIGN DATA: j
4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P.
TITLE 5 AND THE TOWN OF barnstable RULES AND REGULATIONS
FOR THE -SUBSURFACE DISPOSAL OF SEWAGE.- NUMBER OF" BEDROOMS
5. ALL COVERS TO SANITARY UNITS SHALL- BE BROUGHT TO WITHIN
TEST HOLE 2 DATE: 12=07_95 ELEV._101____ i
12" OF THE FINISHED GRADE. DEPTH HORIZON TEXTURE COLOR MOTT. OTHER GARBAGE DISPOSAL -NONE_(0
6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE TOTAL ESTIMATED FLOW -_44Q_____ GPI)SAME, UNLESS NOTED BY FINAL CONTOURS. 0-3' O
7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE _ ( ,11(L=_ GAL./BR./DAY X - ___ BR. )
OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR N
WITHIN 10' 'OF DRIVES OR PARKING AREAS. H-20 LOADING 3-B" A O SEPTIC TANK CAPACITY 15QQ_ GAL__
SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING, LEACHING AREA REQUIREMENTS
AREAS UNLESS .NOTED. 6-34' B N COARSE .
8. ANY MASONARY UNITS USED TO BRING COVERS TO .GRADE SHALL GAL SIDEWALL AREA 0___'_ /S F.`
BE MORTARED IN PLACE. _ E SAND '
9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH 34-132' C BOTTOM AREA _�Q_0 _ GAL/S.F.
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. . LEACHING CAP.(BOT. & SIDEWALL)__4.44 GAL.
10. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF NO WATER ENCOUNTERED
ALL UNDERGROUND UTILITIES PRIOR. TO ANY EXCAVATION. ' RESERVE LEACHING CAPACITY -444 _-_ GAL.
APPLICANT: RICHARD JEAN DATE:. March 22 1996
SHEET 2 OF 2 JOB # 50904 .