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0415 STARBOARD LANE - Health
4145`Starboard�L'ane; ` '=° �` `� ° f � � Osterville ��� ,,, � � �t s � � r� ,. A�= 167 �`�028 `-� 001��*Lo't�22� a''� � ' ' i a a-.�..'�v Q. �94'.- � m � y - � s�.eyp o: s� - c .:0�= -.�.�.C- � .v, ._ � _ .. __ _. i �, � .. � f Commonwealth of Massachusetts Title 5 Official Inspection Form . Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/16/2000 Inspection forms may not be altered in any way_ A. Certification Important:When filling out forms 1. Property Information. on the computer, �! ® fvl� use only the tab ! J fi�(0 p i LH d key to move your Property Address cursor-do not D i C t foq xk f AM 01%•S use the return Owners Name key SGI.w•s• - . Owners AddressVQ * Cityrrown State Zip Code Date of Inspection: 1. I-7, too 9 Date 2. Inspec//tor. /, fie,r ri&7 160 N Name of Inspector ' Company Name Le L Company Address state Zip Code Cityll•own , � Y YZ�-JBLZ Telephone Number _ rt i,1, I r� - - Certification Statement: I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: Passes ❑ Conditionally Passes' ❑ Fails ❑ s Further Ev atio by th Local Approving Authod r 1. j Z' Ins s signatu �te 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. t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal l System- Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form ' A. Certification (cost.) Property Address �Sfie�....�/� City/Town State Zip Code Owner's Name Date of Inspection , 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. Answer yes, no or not determined(Y, N, ND)in the❑for the following statements. If"not determined,"please explain. ® The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Farm Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cunt.) Property Address /� 0S .e cityrrown State Zip Code So••w �•^•1 9 - i - �'� owner's Name Date of Inspection t B) System Conditionally Passes(cunt.): © Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ( } broken pipe(s)are replaced ❑ obstruction is removed F ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s)_ The' system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed. ND Explain: C) Further Evaluation is Required by the Board of Health: E] 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 t5insp.doc•11/2004 Title 5 official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 I Commonwealth of Massachusetts ` Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cone) ; yet a' 34-a..Go L Property Address (9 CTe.n Cityffown r State Zip Code Owner's Name Date of Inspection C) Further Evaluation Is Required by the Board of Health(cunt.): 2, system will fail unless the Board of Health(and Public Water Supplier,if any) determinessystem that the s stem 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 aseptic 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 cmliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5, ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other t5insp.doc•11/20l)4. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cost.) Lt !s' Wa-, — Property Address At City/Town State ZipCode Sot, r� w►�J c/' - /7' 01_ Owner's Name Date of Inspection D)System Failure Crtterla 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 C] Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® E Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool ® C5/ Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: Any portion of the SAS,cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ® Any portion of a cesspool or privy is within a Zone 1 of a public well. [] Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds Indicates that the well Is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] Yes No The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system,fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. t5insp.doc,-11/2004 Title 5'Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cunt.) Property Address 0 S 49,, o/"�Q Cityrrown State Zip Code Soma.,-,S Owner's Name Date of Inspection 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"non 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- Title•11/2004 Title 5 Official Inspection Form:subsurface Sewage Disposal System Page 6 of 16 f Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist q !s S4N Lor.:c) Lh Property Address Citylrown f state Zip Code owner's Name Date of Inspection. 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(3)(b)] t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 f Commonwealth of Massachusetts cffdlfflff-�T Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information !j 1-57- f'4pu,,breIJ 1 Property Address cityrrown state Zip Code -'ot tA% 9- /7—O' l Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms(design): y Number of bedrooms(actual): ---44-- DESIGN flow based on 310 CMR 15.203(for examiple: 110 gpd x#of bedrooms): _yK Z Number of current residents: Does residence have a garbage grinder? [] Yes 09"No Is laundry on a separate sewage system?['If yes separate inspection required] es ET"No Laundry system inspected? ET Yes ❑ No Seasonal use? ❑ Yes E No Water meter readings, if available(last 2 years usage(gpd)): Z001 S 1qv (K Sump pump? ❑ Yes EX No z v _ Last date of occupancy: Date Comme ial/industrial Flow Conditions: Type of Es blishment Design flow(ba on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow( persons/sq.ft,etc.): Grease trap present? © Yes ❑ No Industrial waste holding tank prese. ❑ Yes ❑ No Non-sanitary waste discharged to the Titl system? ® Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Y C. System Information (cont.) 4Q.v 6 GCK� L N Property Address Q S'f(,�"f �C Cityfrown state Zip Code Owner's Name Date of Inspection " General information Pumping Records: Source of information: tilrT �� � f rar,( °r"s /�c Was system pumped as part of the inspection? ❑ Yes 2"'N"o If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank,distribution box,soil absorption system Q Single cesspool [] Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes,attach previous inspection records, if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ® Other(describe): Approximate age of all components,date installed(if known)and source of information: A91F 9 Were sewage odors detected when arriving at the site? ❑ Yes L No t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 C Commonwealth of Massachusetts Title 5 Official Inspection Form. Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cunt.) Property Address_/,, I ('�sTCNVi �1'e Citylrown state Gy Zip Code SG-t�✓I w�r J Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: feet Material of construction: El 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.): TrGlh"l Septic Tank(locate on site plan): Depth below grade: ! feet Material of construction: concrete metal fiberglass ®polyethylene other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of Er Yes ® No certificate) SX /O Dimensions: ' Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? '`� t5insp.doc•11/2004 Tide 5 Offiefal Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 i Commonwealth of Massachusetts, Title 5 Official Inspection Form ° Not for Voluntary Assessments - Subsurface Sewage Disposal System Form C. System Information (cunt.) Property Address City/Toownwn state Zip Code.._ Owner's Name Date of Inspection 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 k (2,4- d• rlyAd- �. �yc• I g�v,p! Oy�`r-- ty yLc /l/o Q�,i Gre a Trap(locate on site plan): Depth ow grade: feet Material of struction: ❑concrete 0 metal ®fiberglass ®polyethylene ❑other(explain): Dimensions: Scum thickness -- Distance from top of scum to top o outlet tee or baffle Distance from bottom of scum to botto of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, i et and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,eviden of leakage, etc.): Tight or Holding Tank(tank must be pumped at time o 'nspection)(locate on site plan): Depth below grade: Material of construction: ®concrete ❑metal ❑fiberglass ❑ lyethylene (1 other(explain): t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Farm Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) r�r S�owGr► h Property Address ^' City/Town l� State Zip Code Owner's Name Date of Inspection Tig or Holding Tank(cant.) Dimension 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.). Distribution Box(if present must be opened) (locate on site plan): S Z GY�oQi d� Qox Depth of liquid level above outlet invert •, 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.): H-ioR- 3 �l r r�cd1 = e�fia lCL k;Gov • ¢/�,� at �/ Svc. G, C= «,s: :m.e. o� I' vv Pump Cha r(locate on site plan): ; Pumps in worki order. ❑ Yes ❑ No Alarms in working once . ❑ Yes ❑ No t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) Property Address /- City/Town State Zip Code Owner's Name Date of Inspection Comments(note condition f pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: 1 ❑ leaching pits number: leaching chambers number El leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number. ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): �� r~ q ��, ✓QS�dio� t5insp.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) yipi .leoa Property Address _.__ .... - Crrown�Ot.wt Ns f State ` !7 _O Zip code Owners Name Date of Inspection Cessp is(cesspool must be pumped as part of inspection)(locate on site plan): Number and nfiguration Depth—top of li id to inlet invert ------ Depth of solids Jaye Depth of scum layer Dimensions of cesspool ` Materials of construction Indication of groundwater in ❑ Yes. ❑ No Comments(note condition of soil, igns of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, le v of ponding,condition of vegetation, etc.): t5insp.doc•11/2004 Title 5 official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont) Property Address Cityrrown State` Zip Code Owner's Name Date of ffispection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet Locate where public water supply enters the building. t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary.Assessments Subsurface Sewage Disposal System Form C. System Information (cost.) ql s Property Address Q� �� /(� Citylrown State Zip Code SGt,w►v,4 7-07 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water. y S .� a6 . "a.y"pY Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record 1e)i 4�j 41c9t,1 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: t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 I STARBOARD LANE OSTER VILLE, MA. ... A.M. 167/PART OF 28 ` ' EXISTING TIES (FEET) ,� HOUSE 1 2 3 4 5 6 �� . ..... ::� A 13. 5' 20. 9' 44. 9' 38. 9' 46 9' 55. 4' ` B 33. 6' 34. 8' 49 4 50. 3 54. 0 58. 9' Z - 2 2 DIB GRAVEL \ 1 ' 500GAL LEACH CHAMBERS OpERT .pR 'LOOD ZONE "C"_ SEPTIC CERTIFICATION RES ZONE- "RF-1 70 WN:OSTERVILLE SCALE-1"=10' EF.-28475H ELE'V N/A j CERTIFY-THAT THE ABOVE 11 jar YANKEE SURVEY CONSULTANTS SEPTIC SYSTEM IS LOCATED W of i P. 0. BOX 265 o y� UNIT 1, 40 INDUSTRY ROAD W,LUA , MARSTONS MILLS, MA. 02648 ON THE GR UND AS SHOWN � UEBERMAN v, TEL: 428—0055 a FAX 420—5553 ' 90 GIS.rsl' `/ � JOB `Fssror,at EN 8116/99 51781SEP WILLIAM LIEBERAZAN P.E DATE. BFR _____ i ` 310 CMR: DEPARTMENT OF EN:VIRON--\Sl"TAL PROTECTION 15.301: continued a nominee trust situation,whoever has authority to add a new beneficiary is responsible for the inspection. An inspection conducted up to three years before the time of transfer may y be used if the inspection report is accompanied by system pumping records demonstrating that the system has been pumped at least once a year during that time. k (4) Exclusions. Inspection of a system is not required at the time of transfer of title of the facility served by the system in the following circumstances: (a) a certificate of compliance for the system has been issued by the approving authority .Y within two years prior to the time of transfer-,or z (b) the owner of the facility or the person acquiring title has signed an enforceable agreement with the approving authority to upgrade the system or to connect the facility to a"sanitary sewer or a shared system within the next two years following the transfer of title, provided that such agreement has been .disclosed to and is binding on the subsequent f= owner(s);or �w } (c) the facility is subject to a comprehensive local plan of on-site septic system inspection d administered by a local or regional governmental approved in writing by the Department an entity, and the system has been inspected at the most recent time required by the plan. A , comprehensive local plan may prioritize systems to be inspected cn the basis of proximity ,. to water resources soil or geological conditions, age or size of systems. history of t performance,frequency of pumping or other routine maintenance activity,or other relevant _ factors, and may establish different schedules and frequency of inspection on the basis of such criteria, provided that all systems are inspected at least once every seven years by a System Inspector approved by the Department. 0(5 A system shall be inspected upon any change in use or expansion of u _.sS of the facility ed, for which change or expansion a building permit or occupancy pernut from the local , building inspector is required. Unless the system is a cesspool,failing as set forth in 310 CMR 15.303 and 15.304(1),or a significant threat to public health,safety and the environment as set " forth in 310 CMR 15.304(2),upgrade of the system is not required if the system was designed to accept design flows resulting from the change in use or expansion of use. Upgrades to accept . increases in actual or design flow to any cesspool or to any other system above the existing approved capacity shall be in accordance with 310 CMR 15.352. Whenever an addition to an $ with no increase in design flow is s existing structure which changes the foot p print of a building proposed,the system inspection shall be an assessment to determine the location of all system components, including the reserve area,in order to ensure that the proposed construction will not be placed upon any of the system components. If official records are available to make a determination regarding location of system components, an inspection is not required for footprint changes. (6) Facilities where the total design flow generated on the facility equals or exceeds.10,000 gallons per day at full build out,shall be inspected by the last day of the calendar year pursuant n to the following schedule in accordance with the provisions of 310 CMR 15.006 and the applicable provisions of 310 CMR 15.300 through 15.354 or 314 CMR 5.00 and 6.00. Such F systems shall be reinspected during the fifth calendar year following the applicable year of initial . inspection listed below and then during every fifth calendar year thereafter. An inspection of a system conducted within 30 months prior to the last day of the applicable year of initial inspection may be used as the initial inspection, provide that a System Inspection Form approved by the Department is submitted to the Department within 30 days of th.inspection. Year of initial Basin in which system is located sz. p, 1997 Charles,Housatonic,Hudson(Hoosic),North Coastal,Ten Mile 1998 Blackstone,Chicopee.Connecticut,Nashua 1999 Boston Harbor(Neponset),Cape Cod,French&Quinebaug,Merrimack, Narragansett Bay/Mt.Hope Bay,Parker 2000 Buzzards Bay,Deerfield,Ipswich,Islands Millers,Shawsheen 2001 Concord (Sudbury, Assabet, Concord), South Coastal, Farmington. ;. Taunton,Westfield y „ NNE = , �j� Town of Barnstable P# 1 .2 2 Department of Regulatory Services Public Health Division Date 2 ) l xuas 200 Main Street,Hyannis MA 02601 ^. . Date Scheduled 0 Time I� Fee Pd. od Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: Q�✓ S-��� If LOCATION& GENERAL INFORMATION Location Address Ll f— S( Lj t7a, /L g9S T Owner's Name Address r a&t X Assessor's Map/Parcel: At 7 0 Engineer's Name F. {A.Opp,a NEW CONSTRUCTION REPAIR Telephone# SV r Land Use Y�ll'�et�tdia Slopes(g'o) Surface Stones if/ Distances from: Open Water Body ft Possible Wet Area S I C7S ft Drinking Water Well ft Drainage Way ti 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) z Parent material(geologic) �� - - - Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater ^ �� 5✓�` DETERMI�ON FOR SEASONAL HIGH WATER TABLE Method Used: �� Qr® (Vtn p� p Depth Observed standing in obs.hole: ___-in. Depth to soil mottles: e*,�® ��eV�"'in, Depth to weeping from side of obs.hole: in, Groundwater Adjustment _ B• Index Well# Reading Date: Index Well level Adj,factor„ __�:Adj.Groutldwater Level, PERCOLATION TEST ]date �.Z 9xtute �/e9M Observation l Hole# Time at 9" Depth of Perc q' Z �yd Time at 6" Start Pre-soak Time @ `00 01,00 'lime(9"•G'.') - End Pre-soak Rate Min./Inch `� L Site Suitability Assessment: 'Site Passed Site Failed: } Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Con iste c % ravel 2®—z� Alf �S 1uyc s Ia to tit o C'1 1A ed.Jo.d z.E- 6 y ifiv 4106w , DEEP OBSERVATION HOLE LOG Hole# v Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency M Grav 1 10 Y 2' -36- c✓ L S o l`�4�b �� DEEP OBSERVATION HOLE LOG Hole# � Depth from Soil Horizon Soil Texture Surface(in.) USDA Sail Color. Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C n iste c Gravel C- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, 1 ,•�4 �'S 10 yet 3[ wG loyi2V4 tia ZK-I2v C I /Vfi S� Z`5--y6 /v e✓�c P Flood Insurance Rate Man: Above 500 year flood boundary No _ Yes ._✓_ Within 500 year boundary No Yes Within 100 year flood boundary No, Yes Depth of Naturally dccurrine Pervious Material Does at least four feet of naturally occurring pervious�aterial exist in all areas observed throughout the area proposed for the soil absorption system? �'e- If not,what is the depth of naturally occurring pervious material? Certification I certify that on 10 � � (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 Ytraining,experrt`ise an xper'ence des ribed in 310 CMR 15.017. Signature 4 Date Z �9 Q:IS.EPTIC%PERCFORM.DOC STARBOARD LANE \\\\\ A. 111 .16 7/PART OF 28 �\ ,v EXISTING TIES FEET) o�. HD USE 1 3 5 6 b \\\ tn \\\ \ \ \\ A 13 5' 20. 9' 44. 9' 38. 9' 46. 9'� 55a 4 ' K R133. 6' 34, 8' 49. 4 50. 3 54. 0 58, 9' 19 O o D/B L H� 500GAL LEACH C11,4YE RS �`1 Y gov r p -- -- SEPTIC �.EI? IF. A TION ALOUD TONE C„ 'T' Tr RIBS ZONE. Rl�'-1 "__ TO WYV. OSTER I1ILLE' SCALE 1 "=10' PL. REF.*284 75H E'LE V NIA I CERTIFY TIIA-T THE 14B0 VE YANKEE SURVEY C0 V5't1LTAA TS Of SEPTIC S.YSTE111 IS LOCATED z��°`t% y , P 0.... BOX 265 o G UNIT.1, 40 IND USTR Y ROAD ON THE, GROU D AS SHOWN w�LLIAM MARSTONS 1vIILLS, MA. 02648 LIE13ERMAN en j' [39)10 ' TEL: 428-0055 pp - a ✓ J{ �oOIST 4; FAX 420-5553 _ Cy --- - - ------ ----- JOB ArILLIAM LIEBERMAN, PE' DATE. _8 /16/99 51781SLP : -�----- 1VUAfBER TOWN OF BARNSTABLE - �\L OCATION y/J� STic3o�t,Z,�. ea SEWAGE # 97 VILLAGE Jrnn.t & ASSESSOR'S MAP & LOT l 'J i INSTALLER'S NAME&PHONE NO. nj 1 SEPTIC TANK CAPACITY EACHING FACILITY: (type) size) NO. OF BEDROOMS BUILDER OR OWNER i PERMITDATE: COMPLIANCE DATE: — Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r 'r C 3� - /� W9 0 Q i 4 � U T--... \ TOWN OF BARNSTABLE :10N.&ATION /J'0' a SEWAGE # vrtAGE - ASSESSOR'S MAP & LOT .` , I INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY � �i,FACILITY: (type) � � d�cI(size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation-Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i A _0 y r� 20 o 0 v _ 17 Ci - 2 ©6 ,,Fee + No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V� Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprication for aigotal *pgtem Cow5truction Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location�r Lot No. 22 Owner's Name,Address and Tel.No, , -A/OD Cow��' � _W Assessor's a arcel Be A ( Sj r9Vj L_�,, 1°►'1 A Installer's Name,Address,and Tel.No.`�A�TW� 1b 7^6 Z- Designer's Name,Address and Tel.No. j �°j •0 dS���( coo 000 14q 1. ,St e-,/IF Co�?5i1e.T e�JTS _® 4 0 z V D0S�P_y F-0^® iWe"P" ��t�� a'f 2'g T CO5��' Type of Building: Dwelling No.of Bedrooms Lot Size '72-7'Ltcl sq.ft. Garbage Grinder( ) Other Type of Building #ASi: • No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow `f'YO gallons. Plan Date d 2 . 17 Number of sheets Revision Date 2— Title Rom: �� Size of Septic Tank ---Type of S.A.S. Description of Soil S �-- Nature of Repairs or Alterations(Answer when applicable) s Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Co n &tlace the stem in operationuntil a Certifi- cate of Compliance has been is 51 b _�'s-BeaaLQf Health. Signed ^ Date Application Approved by Date Application Disapproved for He following reasons Permit No. — Date Issued 9 w.. . ♦ �s.. ^ -AM r it I.,YF"iv".5.(..i. t.i'`}w.�f"'•r- - .. . -.-1.yM4.11`'.. 41, THE COMMONWEALTH OF MASSACHUSETTS En"tered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSAC.HUSE S 0(ppficat on fo:r.3-Di.0o'al 6p.5tem Congtructiori,=,Vermit, Application for a Permit to Construet( Repair(\ )Upgrade( )Abandon( ) '❑Complete System ❑Individual Components Locationereor Lot No. 2 2 Owner's Name,Address and Tel.No.ND -' �oT - N - ,Asses sor' arcel So A R A Installer's Name,Address,and Tel.No.?A-0_74, Designer's Name,Address and Tel.No. oov Goo 1uy yl jKCi`— Su°favFy" (o0Svc.-rs1kAJTS Type of Building:' Dwelling No:of Bedrooms 14 Lot Size '727 liq sq.ft. Garbage Grinder( ) Other Type of Building 1ASJ� No. of Persons Showers( ) Cafeteria Other Fixttires Design Flow 4,C gallons per day. Calculated'daily how" y v o t M f 'gallons. Plan Date_'lki qR Number of sheets Revision Date Title S rrV_:�' L—k!!J a r, f Size of Septic',Tank /<00 `fit ' Type of S.A.S. t Description of Soil 1 S G G ?L N- Nature of Repairs or Alterations(Answer when,applieable) 1 ..lf, � , Date last inspected: Agreement:' : The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5,of the Environmental Co an �n t to lace the stem in operation until a Certifi- cate of-Compliance has been issued by this-Board of Health. i w Signed 'E Date r Application Approvefty Date - Application Disapproyed forte following e'asons i Permit No. (0 - Date'Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS - Certificate. of Comp lance �� THIS IS TO•CE hat the O` si e S w s o a yst Constructed( ,'�)Repaired( )Upgraded( ) Abandoned( )-by. - 1 � at /a sA. r"Ahas been constructed in'accordance with the provisions of Title 5 and d the for Disposal System Construction Permit No. dated Installer Designer nl C_. . The issuance of this' h ofle construed as a guarantee that the syst. ill function as'des Date Inspector i No. / Y 6 ----- -; •Fee— r� c 1 La THE COMMONWEALTH OF MASSACHUSETTS -,. PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS liqu al 6pgtem_ Construction hermit Permission is hereby granted to Construct( ""}Repair'( )'Upgrade( )Abandon System located at L U- 7- 4_,4AIg, QST-FX y L-F� #41 A t 3 U n d as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to -Comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three,years of the date of this permit. Date: Y 7� Approved by 3 J�lJ 4 Fee C1V i — No. TH&COMMONIWEALTH OF MASSACHUSETTS Entered in computer: r Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Migo!ml *p6tem Conl5truction permit Application for a Permit to Construct( ) Repair( ) Upgrade Al Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. ZZ Owner's Name,Address,and Tel.No. r/�s s 0 sue` tS Assessor's Map/Parcel 'M -7 PHz ID Z8-W i �5) 50,g. *qb iOlf—W LLL-�/"�I Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. f} / ojr Gl t-/�940 / 7D MILLS, MA 4� 965 /►1AM ,�ls MiLL �+- - o � Type of Building: f Dwelling No.of Bedrooms /Lot Size 7Z/ 7� sq. ft. Garbage Grinder o ) Other Type of Building 1>64,W No.of Pgwsons Showers(, ) Cafeteria( ) Other Fixtures 0 Design Flow(min.re uired) 0 gpd Design flow provided -7II gpd Plan Date J®� Number of sheets Revision Date x/A Title P19WOS9l7 W'7C f// 4-7Z�__ Size of Septic Tank /Wa Type of S.A.S. L GN G► 6H kg_ Description of Soil6.1 - /1'1 o S,+,Jr-) Nature of Repairs or Alterations(Answer when applicable) AQQ117&J or (1) ut 4 c~&a- Date last inspected: Agreement: The undersigned agrees to ensure the constru enance o e afore-described on-site sewage disposal system in accordance with the provisions of Title o e it Code and not to place the system in operation until a Certificate of Compliance has been issued by this B r 1 Signed Date z © " 0 Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. ,-)-00 5 -AD Date Issued `mil �U'�01Y Fee 106 r 'Entered in computer: E-COMMONWEALTH OF MASSACHUSETTS , r I Yes PUBLIC'HEALTH ®1 ISION - TOWN OF BARNSTABLE,lk 1 1 CHUSETTS application for Digont *p9;tCm Con5tru•ct onk erm t Application for a Permit to Construct( ) Repair( ) Upgrade( j Abandon( ) ❑.Complete System ❑Individual Components Location,Address or Lot No. 10T dAdt,D Owner's Name,Address,and Tel.No, t Assessor's Map/Parcel M,+P 6 Q� Q�,(//f(.��j rC. ��'/t♦ Installer's Name,Address,and Tel.No. U f2!/v�5 r Designer's Name,Address and Tel.No. AAWOJr c _ A-u� 7 LEA . L_AJ AIW, 77)Ai& MILL 44 .Type of Building: t Gj Dwelling No.of Bedrooms E� Lot Size 7Z/ 1 / sq.ft. Garbage Grinder (4) ;if Other Type of Building Dwf LLin/ta- No.of Pe.sons Showers(4) Cafeteria( ) Other Fixtures !"1 t (I : Design Flow(min.required) gpd Design flow provided 711 gpd Plan Date 9/191 Number of sheets Revision Date ,t)A Title fgOPOSW S5CP77C U14-IZ Q-- Size of Septic Tank Type of S.A.S. Ls A(o&j4r 6t6m(stctZ— Description of Soil(, w f1°ltl n,. Nature of Repairs or Alterations(Answer when applicable) 4,,vtno j or 0) (,..kAr—a Cmt�&...12_.. yS v! A7 =► L,t T r wJt !l fL(,r, &1L fz,aC t-j - f7-i31J y, Date last inspected: Agreement: The undersigned agrees to ensure the constru f on and-rrraM enance of'tlle-afore described on-site sewage disposal system in accordance with the provisions of Title ii of the ron®m�ntal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o i,all .Signed Date 9 3 Q - Q9 Application Approved by Date; Application Disapproved by: Date t for the following reasons r Permit No. -3 aV 1 Date Issued �y'" THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (V) Upgraded ( ) Abandoned by )by(� at "/p - J ,r i�rr�> C- has been constructed in accordance G^ d with the provisions of Title 5 and the for Disposal.-System Construction Permit No, 2ool- ,1�J dated r3 Installer Designer j #bedrooms Approved des'igm-flow )OU _ gpd The issuance of this permit shall not be construed as a guarantee that the system(ill functi;n as designed. Date « I t 1 0()� Inspector No. Fee [ op. � -THE COM1VItONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=i!9po5at 6p5tem CCong4rUctiott Permit Permission is hereby granted to Construct ( ) Rep air (1/) Upgrade ( ) Abandon ( ) System located at h5LP"" —"L and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. n Provided: Construction must be completed within three years of the date of this permit.t/Date M �ik-Approved by t a f Y41 TRANS.NO.: CITY/TOWN: 0S72F?-VfLLC, APPLICANT: --v YG ADDRESS: f.r S'7,49ffp f i/C DESIGN FLOW: 's—S-0 gpd REVIEWED BY: Qpv' t• t rri ,.gJ, DATE: N/A OK NO GENERAL Legal boundaries denoted 310 CMR 15.220(4)(a ] Street,Lot,tax parcel number and lot number noted on plan [310 CMR 15.220 4 u Locus Provided 310 CMR 15.2204(t ] ✓ Plan proper scale?(1"=40' for plot plans, 1 20'or fewer for components) 310 CMR 15.220(4)] Easements shown 310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for ✓ upgraded--i not, a variance is required 310 CMR 15.412(4)] Location of impervious surfaces(driveways, parking areas etc.) 310 CMR 15.220(4 d ✓ Vol, Location all buildings existing and proposed 310 CMR ✓ 15.220(4 c Location and dimensions of system components and reserve areas. 310 CMR 15.220(4)(e)] S stem Calculations 310 CMR 15.220 4 . dailX flow ✓ septic tank capacity(required andprovided) soil absorption s stem(required andprovided) whether system designed for garbage grindet ✓ North arrow 310 CMR 15.220 4 -✓ Existing and proposed contours 310 CMR 15.220 4 f,✓ Location and log of deep observation holes(existing grade el.on each test) [310 CMR 15.220(4)(h ] Names of soil evaluator and BO13 representative [310 CMR 15.220 4 h and QJ Location and date of percolation tests(performed at proper ✓ elevation?) 310 CMR 15.220(4)(i)] Percolation test results match loading rate? 310 CMR 15.242 ✓ Certification statement bX Soil Evaluator 310 CMR 15.220(4 ✓ Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3)and 310 CMR 15.220 4 n Address. (9ST. Sheet 1 of 7 G� t � N/A OK NO Location of every water supply,public and private, [310 CMR ✓ 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case ✓ / within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins ,/f located within 50 ft. 310 CMR 15.220(4)(1)] tater lines and other subsurface utilities located [310 CMR 5.220 4 m if water line cross see 310 CMR 15.211 1 1 ) ✓ W� . Profile of system showing invert elevations of all system f components and the bottom of the SAS 310 CMR 15.220(4)(o)] Stamp of designer 310 CMR 15.220 1 and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft.of lot line) [310 CMR 15.220(3)] ✓ ✓ Test Holes adequate(two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2)or as ✓� approved for an upgrade under LUA at 310 CMR 15.405 1 Test hole adequate to demonstrate four feet of suitable material? 310 CMR 15.103 4 Test Holes adequate to confirm adequate groundwater separation? ✓� 310 CMR 15.103 3 Benchmark within 50-75'of system 310 CMR 15.220(4)(g)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not>36"deep(unless Local Upgrade jApproval or LUA requested) 310 CMR 15.405 1 Address S Six,4 va"� -L�^, 0 S 7 Sheet 2 of 7 f ' N/A OK NO SEPTIC WANK Size OK? 310 CMR 15.223(t)] ✓ Inlet tee located ten'inches below flow line 310 CMR 15.227(6 ✓ Outlet tee 14"or 14"+5"per foot for increase fl depth [310 CNM 15.227(6)] Outlet tee with gas baffle or approved filter 310 CMR 15.227 4 c/ Note regarding installation on stable compacted base [310 CMR 15.22g 1 Separation between inlet and outlet tees(no less than liquid ✓ depth) 310 CMR 15.227 2 Inlet/Outlet elevations at least 12"above high groundwater (except as described 310 CMR 15.227(5))or permitted for upgrades under LUA 310 CMR 15.405 1 k Minimum cover 9" (Tanks buried more than 9"must have risers on all openings and on the d-box) [310 CMR 15.2228(1)and 310 ✓ CMR 15.232(3)(0] Three access covers(inlet and outlet must be 20" or greater)- middle access at least 8" b 7/07 310 CMR 15.228(2)] Access to within 6 " of grade -one port for systems<1000gpd, I two for s stems>1000 gpd 310 CUR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR f 15.228 2 > 10 fl from building foundation 310 CMR 15.211 1 ✓' Buoyancy calculation Re uired/Done 310 CMR 15.221(8)] ✓ f1-20 Where appropriate? 310 CMR 15.226(3)] ✓ I Setbacks from resources 310 CMR 15.211 Multi-Compartment Tanks ; Required when other than single-family dwelling®r flow>1000 d 1310 CMR 15.223 1 b First compartment 200%daily flow, Second compartment 100% daily flow 310 CMR 15.224(2)and 3 "ull pipe through or over bade, outlet of each compartment with as baffle or approved filter 310 CMR 15.224(4 Address 41 S 31"6a4 �y` . 037 Sheet 3 of 7 N/A OK NO BIDING SEWER AND OTHER PILING Located at least ten feet from any water line?[310 CMR 15.222(2)] Disposal piping at least 18" below water line(when water and ✓,�/ sewer cross see 310 CMR 15.211 1 1 Cleanouts required/provided? 310 CMR 15.222(8)] Thrust blocks s ecified in force mains?310 CMR 15.221 6 c ✓ ` Slope of sewer line not less than 0.01 (1/8"/R) 0.02 preferable 310 CMR 15.222(6)] Proper pitch on all runs?(.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9)and 310 CMR 15.252(2)(c)] Siphonproblem/ leachfield below Rump chamber ✓ Endca s or vent manifoldspecified? ✓ Size and orientation of discharge holes specified?(not smal er than 3/8"not larger than 5/8") [310 CMR 15.251(8)and 310 0% CMR 15.252(2)(M Materials specified (310 CMR 15.251(5)specifies various pipe / �ypes allowed) �l DISTRIBUTION BOA Stable compacted base [310 CMR 15.221(2)and 310 CMR 15.232 2 a Splash plate or baffle tee required on inlet/provided?(when pressure sewer to d-box or steep pitch of gravity sewer) [310 �J CMR 15.323 3 a Riser if deeper than 9" 310 CMR 15.232 3 Inside minimum dimension 12" 310 CMR 15.232(2)(b)] ✓ Minimum sum 6" 310 CMR15.232 3 e Watertight cover if<2000gpd);waterproof manhole if>2000gpd 310 CMR 15.232(3)(d)] ✓ PUMP CHAMBERS _ Capacity(emergency storage above working=design flow)? [3 10 ✓ CMR 231 2 Proper setbacks 310 CMR 15.211 same as septic tanks `✓ Watertight 20-in minium access manhole at least 20"MOST BE TO GRADE 310 CMR 15.231(5)] Service components accessible(not too deep with piping, disconnects accessible Alarm floats-alarm on circuit separate from pumps specified? -/ \ Exceeds two units must have two pumps operating in lead-lag mode. 310 CMR 15.231(6)and 8 Stable Compacted Ease 310 CMR 15.221(2)) 1, Buoyancy calculations needed?Provided? 310 CMR 15.221 8 Address -3 -a p oa,01 Sheet 4 of 7 N/A OK NO SOILL ADSORPTION SYSTEMS SAS GENES Calculations correct? 4 feet of naturally occurring material demonstrated?[310 CMR ✓ i 15.240(l)] ! Required separation togroundwater? 310 CMR 15.212 I Aggregate specified as double washed 310 CMR 15.249 2 ✓ r System Venting required/provided?(system under driveway or t >36"deep) 310 CMR 15.241 Inspection ports specified and within 3"final grade? [310 CMR Vol' 15.240 13 Breakout requirements met?(No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document OAI.EERIES,PI`fS,CIIAM ERS 310 CMR.15.253 Chambers and Gal, in trench configuration supplied with inlet evea 20 f. 310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to rade 310 CMR 15.253(2)] '��-' AgINgate I'minimum-4'maximum. 310 CMR 15.253 1 b ✓ 2' sidewall credit maximum 310 CMR 15.253(1 a ✓ In bed configuration, inlet eveg 40 s .f. 310 CMR 15.253 6 / TRENCHES 310 CMR 15.251 Width T minimum Y maximum 310 CMR 15.251 1 b ✓ f 100 feet-maximum len h 310 CMR 15.251 1 a ✓ ; Minimum separation 2x effective depth or width whichever greater 3x if reserve between trenches 310 CMR 251 WWA Situated along contours 310 CMR 15.251(2)] ✓ Breakout OK? 310 CMR 15.211 1 4 and Guidance Document BED SAS aximum size of bed or field 5000 lg-d ,., . . minimum 2 distribution lines 310 CMR 15.252 2 a ✓ Maximum separation between lines 6' 310 CM R15.252 2 d / Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6"minimum, 12" maximum. 310 CMR 15.252 2 Separation between beds 10'minimum. 310 CMR 15.252(2 ✓ Bottom area used in calculations only 310 CMR 15.252 Address q lS t h, OS Sheet 5 of 7 N/A OK NO DID THE PLAIN'INVOLVE Pressure Dosed System ? provided pump and piping calculations as required 310 CMR 15.220(4)(0] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2)and I/A Remedial Use Approvals] If used in gravelless system-make sure jet is directed as not to scour soil interface Guidance Document Inspections once per year(systems<2000 gpd)or quarterly >2000 dgood to note on plan 310 CMR 15.254(2 d Construction ire fill -Did the plan specify that the fill shall meet the s ecification of 310 CMR 15.255 3 ? Impervious barrier and/or retaining wall ? Guidance Document Impervious barrier installation must be supervised by designer 310 CMR 15.255 2 b Retaining wall must be designed by Registered professional ` Engineer 310 CMR 15.255 2 a Side slope not exceed 3:1 ? 310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2)and \ Guidance Document a At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 2 e Cravelless$ stem I/A Approval L040 .r Check DEP Approval letters for credits and design conditions ./ If used with pressure dosing do not allow pressure discharge to scour soil interface t/ Alternative S tie System 111A A MW setters Was DEP Approval Letter provided and/or have you i reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? 1 Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits I Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Variances Are the variances listed on the plan? [310 CN M 15.220 4 RLS Stamp necessary on plan if a component is within five feet of roe line 310 CMR 15.412(4)] p New construction or increased flow proposed- [Refer to 310 CMR 15.414 Address L4 t S J 0(MO" /i, oil- Sheet 6 of 7 N/A OK NO Nitro en Sensitive Areas 1s the system in a Designatea Nitrogen Sensitive Area Gone I1 fo ra a public supply well)? [310 CMR 15.214,310 CMR 15.215 and 310 CMR 15.216-also refer to Policy regarding upgrades of such existing s stems Is the system proposed on the same lot as served by private well? ✓ 310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR ✓ 15.216 1 Miscellaneous j. Pumping to septic tank? 310 CMR 15.229 Shared S stem 310 CMR 15.290 ✓ Address / f-key IA, Q S l Sheet 7 of 7 Town of Barnstable Regulatory Services ,• , Thomas F. Geiler,Director MASS.snxtvs-rnsc�. � - Public Health Division 16.19. 'OrFnrnar° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# Assessor's Map\Parcel W, W7 Pw. 0 ZR-0 Designer: �� In ry •E(R.rr�.�{oh, R. Installer: t_r +oSe � 4 its�Y &L46� Address:" 9 Lk,la 11ofe LW . Address: r _ On �( ��� ;�%GfL"LS ��r was issued a permit to install a (date) (installer) ' septic system at 41r Jv ��, �Ja �l6�C based on a design drawn by (address) >c� '/ /� 0 Gig'. F"Ard j,[6t.,, 0i"S• dated (designer) y I certify that the septic system referenced above was installed.substantially according to the design, which may include minor approved changes such as lateral`relocation of the distribution box and/or septic tank. - I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State.& Local Rkeizulations. Plan revision or certified as-built b signer to-follow. N OF MAS q 1 o� GLEN yam ERIC o HARRINGTON con (Installer's Signature) " No.1070 ' Pe� . N�T.AR esig is gnature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc TOWN OF BARNSTABLE LOCATION ��� I?,�cr� LUN SEWAGE# VILLAGE S ASSESSOR'S MAP&PARCELb� 0 �30 INSTALLER'S NAME&PHONE NO. ()(A C SEPTIC TANK CAPACITY 1 SJC)-0 nn LEACHING FACILITY:(type) (TO (DW (size) NO.OF BEDROOMS OWNER PERMIT DATE: —,gyp COMPLIANCE DATE: /4/ d� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY L 3-7 1l; i 2 D 3 CIQ r \ ,ate\ Ar 46 51 '45 311. 66 40 4 \ 40 61 g A �� NCO itt V✓1 �� 'I _ L < 3 :try .:� .•, .....: a.. ., r d^�a,- s �..�.=.• ��,�. �!<`.. - - o Ct va--C-FL4MAPOWENT ' > �E� C.B. (FND) wr F BARNSTABLE 2099 JUN 29 AM 8* 33 . r. x" Q �z. Utz... .F �'§�\. "' cP aE� Wires vw i $ a m O . ♦ ! SJ P raW.u, F q Est. M`':5 1 4: Xs�po � eo'n caoa:sy ,o, am9er n}.. & r., . a H vreo .riF o LOCUS MAP , LOT 21 DT®®A,4 PLAN REF- 284 75H ®D ®a CERT REF 156170 ® 0r_1;1,' � as ASSESSOR'S MAP- 167-028-001 ® �G''✓ `RFc hGs ® ZONING. "RF-1" -1 �STEPHEN �l SETBACKS. 30'-15'-15' 4 J. FLOOD ZONE: "C" E 00YL 4 PANEL NUMBER: . 250001 0016 D :t- N x A DATED. 07—02-1992 1 i ` PLOT PLAN OF -LAND CB LOCATED AT c.e (IND) S 88-48'44" E 150.00' c.e.. (FND) (FND) 415 STARBOARD LANE 15 f�f:� 15.14ft PROPOSED SHED OSTER VILLE, MA. ;01 34.3 34.5ft � PROPOSED 3 0 .ot LOT 22 3 / ALJ DDITION AM 167-028-00I _ PREPARED FOR: S 72750.2 SQ. FT. Sg�2 1.7 ACRES , ________== GRAVEL — DICK SAMMIS _ DRIVEWAY — — _-EXISTING__ Q r. MAY 6, 2009 _.. � 0 _==___ f r REV MAY 11, 2009 j === --==-======--- ��.s Q REV- ---------- _= _ o� Cn REV Ca - YANATE'CD LAND SURVEY FND PROP cv GRAPH IC SCALE ALE PROPOSED I , CO., INC. GARAGE EXPANSION r 40 0 20 40 80 32I6ft L .. x_,nN rJv M 40 INDUSTRY .ROAD C.a _._.----=-- ._ F �_ � .--- , ._ "..:_ -.: d �Q MARSTONS MILLS; MA 02648 (FND) S 88'48'44" E 169.10' e. TEL' 508-428-0055 FAX 508-420-5553 1 inch = 40 ft. - (�+D) - SHEET 1 OF 1 JOB,¢' 54511 JF/SH f LF LIL -T-4 1-4 I v 1 ICE(+T ELF �t-Tton� I R f � I� Lt FU I fI I_ L-1 � �s,-rz E��v.��-10 — 2 Ni T II J w i _ w n- FFP YF r x CI C I Ll I II ' F2On)T F' s��rev I l /LIAfl S M45TE2 PrED 200M ' A-�f7 r'7 p.J SCALE:/ APPROVED BY: 1 r- DRAWN E BY 4EFT LEVA TIDN DATE:s.�f OI t REVISED II DRwWeNG NVMBER gLpG. �✓t[L CO VG /L/v ioFj f I. j ZG Sl itfa �'nl .•i i .44 MSyrmttl v: K ca 131 wtaer e v i `I j g 7=j o SLOW I I 540 cc I s� k¢A4 laW.i.l N[�•� YCfc'(Y,w/�ooa. ..'�. • .. ` a� V7 a •,a ,;, !!• _ —;-- •—-- --- --- �-� --" ---. '-- , - I -_---__-_I-•_ _-----i-____i .. - � _ F � I - � ... 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Dr{od TO iC 1 • «.u.aeeaD 4. flpE. .. • • , _ 'ILIYIlL Tq'6^4yGf I _ . • � I -. {,. z, GARAGE _ . _,I '•.. _ .. .. � .. .- - L.. n.rrrN uMYatf'TO"ii .peo. lewTli To•Y ' • I �� { �' • � .T' r II � _ l 1WTI:.♦:N+W.TE 4 MfesKD I♦ P+NQt.' _ v 7,:fWHBING.NSTVQIf � t�efT i.aTurlL M Arteara0 4� to . , � r �• � ' fir.. - •[ i� -. M Y i 4- qrr 1 1 , �' a. ,T�J CY DooR I D C' 'C•u•1�ma' 3 • .. .. � , 4 ' , 1 I I t i • I I I . , , _ 1 I A ' r,,. •,j.. - �° .01 mirNw ff�a.O.gINr�Y f dif .i•tll�w�'POII•f10�. - _ { X, -.1CYML�JREa1Q[MCC - _ .. .. , - .t , .. y . '�T,cRbl\1C0 NIeHC D.FE M•� ., - emir f x N WETLAND VEGETATION SYSTEM PROFILE ROUTE 28 -ak- Existing Dwelling Not to Scale 6e - First FI. Elev.=109.61' PROPOSED , C.B fnd - 5 HOLE H-20 ai .AIL. DIST. BOX Finished grade over sstem=2� slope away One chamber cover shall be , P. Existin Grade 9 y P y within 6 of finished grade Existin Grade = 99.5 t - - CELLAR Septic tank covers must be D-Box cover shall be Provide 4" dia. observation port Min. 2 -1/8"-1/2" Double-Washed Stone s River Road -� WALL within 6" of finished grade within 6" of finished grade to within 6" of grade or geo-textile filter cloth Bum S I T E ;IL 5=.01 min. Level for 2' S=0.01 ft/ft To of Peastone Elev.=96.5't EXISTING . 22� = 1500 GAL. 105 SEPTIC TANK ® L"7 ® �f C7 24" ° •' Ex.=10O.25 = p Existin H-10 = 0` C ® ® ® t= Bottom of Lgacb_ -- Install Gas Baf le V. E .-100.42' 16. Facility Elev.=94.0' o �p� Ex.=104.25' or equal _ " " 1 e 3/4 -1% Double-Washed Stone 5' Min. Req'd., 6t' Provided a 6" OF 3/4"-11/2" STONE LEACHING CHAMBER 6" OF 3/4"-11/2" STONE Hole #1 ev.= 7.87' "OSTERVILLE" LOCUS _Design Calculations NO SCALE , 90fJ# N Number of Bedrooms: Total Room Count= 11 divided b 2 and rounded down = Bedrooms. GENERAL NOTES y , b Garbage Disposal: Not Allowed with th%�y�e�n 1 . ADDRESS: #415 STARBOARD LANE, OSTERVILLE Septic Tank Capacity Required: 580 Gal./Day x 200% _ gals 2. ASSESSOR'S NUMBER: MAP 167 PARCEL 028-001 3. DEVELOPER'S LOT: LOT 22 Septic Tank Capacity Provided: 1,50,9 gallons (Existing) (� 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN ON THE k�/ GROUND INSTRUMENT SURVEY. Leachin Re5. TOWN WATER IS PROVIDED TO THE SITE & SURROUNDING PROPERTIES. g CaPacity uired: 5-W q y O Application Rate for <2 min./inch = 0.74 gal/sq. ft. �.� 6. NO WETLANDS ARE LOCATED WITHIN 150 FEET OF THE PROPOSED SAS. Proposed Leaching Structure: 1-16.5'x13'x2' Leaching Trench v ��� >> 7. UTILITIES WERE LOCATED BY DIGSAFE #20093502833. Bottom Leaching Area Provided = 208 Sq.Ft. 8. REFERENCE PLAN LAND COURT PLAN 28475H Side Leaching Area Provided = 118 sq. ft. REFERENCE PLAN: "PLOT PLAN OF LAND LOCATED AT 415 STARBOARD Proposed Leaching Area Provided = 326 sq. ft. LANE, OSTERVILLE, MA, PREPARED FOR DICK SAMMIS, MAY 6, 2009" Leaching Capacity Provided =326 sq. ft X 0.74 gal/sq.ft.=241 gpd. SCALE 1 "=40 BY YANKEE LAND SURVEY CO., INC., MARSTONS MILLS, MA. Total Leaching Capacity Provided =241 gpd. + 470 gpd = 711 gpd. > 550 gpd required. 9. THE PROPERTY IS NOT LOCATED WITHIN A ZONE II GROUNDWATER CONTRIBUTION AREA. Q 10, THE PROPERTY IS LOCATED WITHIN THE MASSACHUSETTS ESTUARIES PLAN (MEP) ZONE. J � CONSTRUCTION NOTES 1 . Contractor is responsible for Digsafe notification s� and protection of all underground utilities and pipes. 2. The septic tank and distribution box shall be set �o �� 0q level on 6„ of 3/4"-11/2 stone. � 3. Backfill should be clean sand or gravel with no �c2 1 stones over 3" in size. 4. This system is subject to inspection during installation to Glen E. Harrington, R.S. 5. The contractor shall install this system in accordance with Title V of the Massachusetts Environmental Code. 6. If, during installation the contractor encounters any soil conditions or site conditions that are different from those shown on the soil log or in our design the installer shall halt installation and immediately notify o Glen E. Harrington, R.S. C.B fnd C.B. fnd o N o 0 0 7. No vehicle or heavy machinery shall drive over the LOT 22 °3 w `� septic system unless noted as H-20 septic components. ` - C.B. fnd AREA= 72749' sq. ft. 150 0' 8. Install Tuf-rite gas baffle's or ;equal on septic tank outlet tee, if necessary. 107.15' 9. All piping shall be SCH 40 PVC. 89.18' septic etback 10. No wells are located within 150' of proposed SAS. � 10 .75 X 12. The Contractor shall notify the' Board of Health and the Designer 106 5' x 08 at least 24 hours in advance to inspect and certify the system. 87.77' 1 0.46' x 13. Existing H-10 DB-3 D-Box to be replaced with Acme Precast H-20 DB-5, or equal. B. PROPOSED 14. This design plan shall be utilized for the proposed septic installation only. PROPOSED POSED SAS ga g ADDITION 15. Install observation port in SAS as shown. 1 H-10 500 GAL CHAMBER 92 10 06� WITH 4' OF STONE ALL AROUND 9� w 108.85' 109.80' 0 7.5 10815' brick :::, Patio 010 LIJ :::.::::. .................... 97.43' z N Q ' no. 00 97.3 ' :�: O ::::: .08 ����4 5 ' :: EXISTING GRAVED �QS fI /PWELLIIIJG RIVEWAY rst f „���� :::::.:................ '2 T.H. #2 101.96 102 1•ele v- ry A 9 1 �� 2 Q SITE PLAN .. ............. .......................... .. 112.23 a , 05.84' cellar O SCALE: 1 - 20 ivaii� .............. CONTOUR LNTERVAL=2' T.H. #1 37 X 113.410 0 M ku H. #4 m CD B.M. 100.00' (ASSUMED) ON T.H. #3 9 .54' 104.78' 1a7, 1' Sa o , Q CORNER OF BRICK PATIO. 9 .66 :;;,.:::.:... brr k eiev.�10g82 82 (� .... pa Io PA I ISED ON � 98.7 S e EXISTING �► 102.81' D BOX, GARAG ::.Note:.:�1, _:::...... 107. E� 114.06' X 1 4.75' SOIL EVALUATION & PERK TEST 12692 °S 0 r ery C.B. fnd e o °r a ...... X 10 05' 113.78'p er 114, ca e Date of SOIL EVALUATION: AUGUST 28, 2009 o SeA ° o Evaluation Performed By: Glen E. Harrington, R.S. 1r09 ° se o Z Excavator: Joyce Landscaping Ts�Tq,�e �boQk A o 3.5 E&SSAS topr remain 11 D N Percolation Rate: < 2 mpi assumed, 24 gals applied during presoak IN C1 OF T.H. S #1 & #3 t .0 0q� W - Witness: David W. Stanton, R.S., BOH Agent °�� 28� q, 0s 11 w LEGEND: �. oo PROPOSED SEPTIC SYSTEM UPGRADE per 11 X 114.40 J e, N 00 114.12' PREPARED FOR Test Hole Test Hole Test Hole Test Hole Existing 1500 GAL. H-10 No. 1 No. 2 No. 3 No. 4 169.10 septic tank JOYCE LANDSCAPING a DEPTH. SOILS ELEV. DEPTH SOILS ELEV. DEPTH SOILS. ELEV. DEPTH SOILS ELEV. PERK C.B. fnd C.B. fnd Existing Post & roil fence AT. TEST �1 DEPTH: 44 62 415 STARBOARD LANE 0 98.37` 0 98.37' 0 98.98, 0 98.98' BEGIN SOAK. 00:00 r, Approximate location of END SOAK 14.25 MIN -G G Approximate line (OSTERVILLE) BARNSTABLE, MA FILL FILL A, LS A, LS TIME: 14,25 MIN.- UNABLE TO SOAK, g 20" 96.70' 18" 96.87' 9" 10YR3 1 98.23' 11" 1OYR3 1 98.06' USE rt MPI FOR DESIGN PURPOSES Approximate location of water line 23" OYR3/1 96.45' 24 10YR3/1 96.37' Bw 13w PERK TEST #2 OWNER: R I C HAR D & SARAH SAMM I S DEPTH: 30-4e" Existin rock retaining wall oamy son loamy son BEGIN SOAK: 00:00 g g �H4F w w 1 OYR6/6 10YR6/6 END SOAK 12:00 MIN. oamy San oomy sandTIME: 12 MIN.- UNABLE TO SOAK. PREPARED BY: ; „ . „ . „ , " , USE <2 MPI FOR DESIGN PURPOSES 36 10YR6 6 95.37 36 10YR6 6 95.37 25 96.90 24 96.98 X 114.12' Spot top4 shot Glen E. Harrington, R.S. 44'� w 30„ 9 Ledo Rose Lane e.r C1 c1 "'e�` c1 c1 Soil Evaluation Certification 99 Existing topo contour ::.:::::: 174 Marstons Mills, MA 0264$ .:.,.,...: medium medium medium medium I certify that on October, 1995, 1 hove passed the soil evaluator " sand sand 48" sand sand examination approved b the DEP and that the analysis was performed by Tel: 508-428-3862 62 PP Y Y 2.5Y16 4 2.5Y6 4 2.5Y6 4 2.5Y6 4 me consistent with the require r lning, a Ise and experience described r�l Q• Fax: 508-428-3862 / / / to 310 CMR 15.017. 111'A' 126" 7.87' 120" 8.37' 1 132" 87.98' 1210" 1. 88.98' �� SCALE: 1"=20' DRAWN BY: GEH DATE: Sep. 19, 2009 GLEN E. HARRINGTO . R.S. No Observed Ground Water No observed Ground Water DATUM: ASSUMED FILE: JoyceSommis SHEET 1 OF 1 WETLAND 1 S CUDDLR VE'''ETA TION ''�`` I �° BA s RIVER- 7 GENERAL NOTES ♦♦���, 1) ALL 4'ORKMANSHIP AND MATERIALS SHALL CONFORM "0 D. E P TITLE 5 AND THE TOWN OF _ R? STLF____ RULI > AND REG ULA TIONS FOR T.HE SUBSURFACE DISPOSAL OF . J�` WA GE F' TIC TANK SHALL BE BROUGHT R I / .) JN c- OVER ON S'FP ° W[7HIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" �� 'V SYSTEM SHALL ?E CAPABLE OF .9L1, �OMPONENTS OF THE SANITARY WTrHSTANDIIVG H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN Q) �- 10 FT O.F DRIVES OR PARKING AREAS. H-20 LOADL�IG SHALL BE r y � 'r OF DRIVES OR PAR1�ING AREAS. LOCUS' IIIAP ` L,SED UNDER OR Wl� HIN 10 FT -s zr) ANY M4#_ ONARY LTVITS USED TO BRING COVERS TO 6 RADE SHALL cif j i BE' MORTERED IN PLACE ��� ' � LAND COURT >) -VO DETERMINATION HAS BEEN .MADE AS TO COMPLIA.VCE WITH / LOT 21 `-- DEEDED OR ZONING REGULATIONS. OWNER/APPLICAN I' IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE A 'THORIT Y. ,o° 6� UIKS- SHO WN ARE APPROXIMATE ONLY, EXC.A VA TI !N CONTRACTOR � � LAND COURT rRT LOT 22 PLAN RE'F. 284 �5h' ) TLITI � Al' �, ZONING.- PF 1 " IS TO .ALL DI�G— SAFE'" A7 1 -- 800--322-4844 I_ ,AST 7� HOURS � � AREA = 72i49f xS�' F / / r• FLOOD ZONE' PRIOR TO COMMENCING WORK ON SITE. y 0 .1 VTRA CTOR IS TO VERIFY GRADES ..AND ELEVATION S A WELL AS � � o� � SITE CONDITIONS PRIOR TO COMMENCING WORK" ON . 'ITE �, CoC B 8) -PARCEL IS IN FLOOD ZONE'__ "C„-___—_. ,� j 6 0` 5884844 "E 1.50. 00'/ < < 16/ PART OF LO, 26 9) .LOT IS S [IN ON ASSESSORS MA AS PLRCE � 9) .LOT IS SHO ktW AS LOT 22 ON LAND COURT PLAN 28 175 H. a 1 DE,,S T CIG-z A L C U LA TIO- , S. / � o , o �_1 �- — `� ��1 TL' SE& P TIC PL_Z,4 y i l o ! � 4 ss� / �� -J ° �� t r'NUMBER OF BEDROOMS — —.. — �'�, °' i c °coo ' ,' �- PLAN OF LAAl) BA GE DISPOSAL . . . . . . . . NC �� �- PROPOSED r ! �r I - GARBAGE — — � / 0 4-BEDROOM 4 or �::;;' �/ c !fir ,� c � LOCA TED LV- TOT.AL ESTIMATED FLOW / / / HOUSE / 4 44C' CAL/'DAY , / / �1 �F,L OF FOUND !! i �� �!/ g 440 GAL./BR., DAY x BR.) --_--_ _-- --- ---- / t 0,5yTER VILLE, ALI 160, ' C TN TY ---I?E SEFT KFUTp PREPARED FO-R. OIL CLASS IFICA TION . . - �W � � � 1� 5 RYA1� 'SIGN PERCOLATION RATE �, 5 MIA T/IN. �� o � � � -- . 74 , � o ` -� / /TP ~s �'' JANUARY 12, 199�' EFF'L DENT LOADING RATE' _ GA Y/S. F T / 02 / o GAR , / o ti i , vPnLE REVISED FEBRUARY 5. 199"_. LEACHING CAPACITY (AREA X RATE) 465 GAL/DAY LAND COURT LOT 23 1 �� / 0 0�/ `� / I �¢°. R�'�' 0� ' �`/� ahB GRAI"HIC SCALE RESERVE LEACHING CAPACITY . — _ 465 GAL/LAY ` 3C (3` 5 X 12 5 X . 74)f(35. 5�-35. 5-c-12. 5+12. 5 X . 74 X 2) o w U so J ~ --- ---- - - --- --- INSTALL THREE (3) ACME - S88°4844 "E' --'- _ 169. 10' `---- CB �, � IN FEET 500 GALLON LEACHING I inch o f CHAMBERS WITH FOUR FEET DIRT DRI VE DOUBLE WASHED STONE SIDE'S AND ENDS 1 1 SPACED ONE FOOT APART 12 5' BY 35. 5' SOIL TEST � PROFILE OF DATE OF SOIL TEST 12111 8 SOIL TEST DONE BY BR(ICE R S SEWAGE DISPOSAL SYSTEM WITNESSED BY: JE'RRY DUNNING P , 9346 NOT TO SCALE MID Oy FO UN_)A TION t 0£'SER V,4 TION HOLE 1 F,LE'V. _ - 20' MIN — --- ---- - *G'RA,�)E' TO ELEVATION 93. 5 ' --- OR t �`E EA'ISTING GRADE -- \ _ DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 10 MIN. VENT AS SHO WN ur CONCf.'ETE COVERS 4' SCHEDULE 40 P. V. C. _ -7 MIN PITCH 1/8 PER FT. ?" 0„ 3 0 ORGANIC 6 1/LA YER20F VENT. 3 6 A SAND Y LOAM 2 5 Y6-1 L. _�2 E� — 93 , CONCRETE COVER WASHED STONE 6"- 36" B LOAM) SAND b"D 2. 5 Y5-6 } MAX' / WALE / / / / / / EL. =96 36 -50 Cl FINE' ,SAND 2 5 Y7-�3 ,�- r �r 4 ' SCHEDULE 40 P V C _ 1 60 66 C2 ��IL T Y CLA Y 2. 5 Y6 4 (OR EQUAL) MINIMUM C-- --L— CLEAN SAND 91, 66 -150' C3 i FIATE SAND 2. 5Y7-3 L—_ ---- — PITCH 1/4 PER FT 10. 0 , 1 �; MIN. ----- ----- -- -- - — FLOW LIATE — ----___ 5_0 -- �C T j EL= 90.S ----- I14 GE'RT EL. _-`91=Cl--- ' 10„ , - 1 MAX R N -- — - --- NO W��TER -- - 14 "� i —' �111 �8��1 1MIN , T r '19. 0 ----- ° ° onEDoa � o ° ° 1/I_VVERT LEVEL �j L'FFLE - - / 6 SUM --- ° °� o C1 C] [� C7 C� °°° ° — 88' 'N OF INV.�RT ��. = 90. <�"'� LN[ RT INVERT ° / ° o — — ----- — -- — t M� `90_ 5_ EL. =90 _ 4 REMOVE ALL IMPERVIOUS MA 1 ERI�L 4 ' OLISE R VA TION HOLE 2 F'LE'V =__ L2--— INVERT/ FROM Cl TO C3 x ` DISTRIBUTION TRIBUTII.�N 9O. O REPLACE WTH CLEAN SAND ALL c.�ER fiND / � 4N�L�iAM (TO BF, PLACED ON FIRM BASSI PERCOLATION RATE __<5 _ �LII1�: INCH AI __8�L_ INCHES LIEBFRMAN MECHANICALLY COMPACTED OR 6" OF STONE BOX TITLI' V TO FLEV 5' DEPTH_ HORIZ TEXTURE COLOR MO TT. O TH_ER_� sT �``��w♦ 1500 GAL.L OVS i TO BE WA TER TESTED --------- — 35.5 * X 12 5' TRENCH FORMATION — FSSi°ti `EN SEPTIC TANK rF MORE THAN ONE OUTLET 0?, 3 A ORGANIC ! » � � - 0 3 -6 A SANL?�' .LO�'.rLI 2. 5Y6-1 PLACE ON 6 STONE 314" TO 1-1/.2.. SOIL A RS0RP TI0 -`,y; `� 6„-3s" B LOAMY. s.41�'[� 2. 5 Y5-6' 'A1 rKEE S UR VE Y CONSULTANTS DOt)BLE DASHED STONE SYSTEIf SAS) ' 36"-96 Cl FINE ,SAND 2 5Y7-3 PERC UNIT 1, 40 INDbSTRY ROAD (SA �� 96"-108" C2 SIL T) CLA 1' 2. 5 Y6-4 P. 0, BOX 265 BOTTOM OF TEST HOLE OR U��'GS 1=1�OBABLE Y�A TER TABLE ELLS V =__- 77. 5 08 '- 162 C3 FINE ,SAND 2. 5 Y7-3 AfARSTO%'VS MILLS, MASS. 0 2648 A`0 OBSERVED WA TEN N TABLE' (12/15/98) TF'L. 428--0055 F1�X 4 20--5553 TER _ SHEET I OF 1 J# 51781 X GM.