HomeMy WebLinkAbout0125 WATERFIELD ROAD - Health (2) 125 Waterfield RR
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
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TITLE 5
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 125 Wate�ield Road RECEIVED
Osterville, MA 02655
Owner's Name: Jane Piasecki - S E P 5' 2001
Owner's Address: Same _
TOWN OF BARNSTABLE
Date of Inspection: August 30, 2001 HEALTH DEPT.
-----------------
Name of Inspector:(Please Print) James M. Ford
Company Name: James M. Ford
Mailing Address: P.O. Box 49 Map: 119'
Osterville,MA 02655-0049 Parcel: 017
Telephone Number: (508)862-9400
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this`address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title.5(310 CMR 15.000). The system:
✓ Passes .
Conditionally Passes
N rther Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: August 31, 2001
The system inspector shall submi copy of this inspection report t6 the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in.the future under the same or.different
conditions of use.
Title 5 Inspection Form. 6/15/2000 page 1
Page 2 of 11 ,
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 125 Waterfield Road
Osterville, MA
Owner: Jane Piasecki
Date of Inspection: August 30, 2001
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 exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
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Page 3 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION. (continued)
Property Address: 125 Watetfield Road
Osterville, AM '
Owner: `Jane Piasecki
Date of Inspection: August 30, 2001
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
,5
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment: .
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a`surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than`100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified'laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and.nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
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Page 4 of 11
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OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 125 Waterfield Road
Osterville, AM
Owner: Jane Piasecki
Date of Inspection: August 30, 2001
D. System Failure Criteria applicable to all systems:
You must indicate either`yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone 1 of a public well.
✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
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.
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Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 125 Waterfield Road
Ostennille, AM
Owner: Jane Piasecki
Date of Inspection: August 30, 2001
Check if the following have been done: You must indicate`yes"or"no"as to each of the following:
Yes No
✓ Pumping information was provided by the owner,occupant,or Board of Health
✓ Were any of the system components pumped out.in the previous two weeks?
✓ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection?
✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ Was the facility or dwelling inspected for signs of sewage back up?
✓ Was the site inspected for signs of break out?
✓ Were all system components,excluding the SAS,located on site?
✓. Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth-of sludge-and depth of scum?
✓ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
✓ Existing information. For example,a plan at the Board of Health.
✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)].
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Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 125 Waterfield Road
Osterville, MA
Owner: Jane Piasecki
Date of Inspection: August 30, 2001
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 3
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate seviage system(yes or no): No [if yes separate inspection required] .
Laundry system inspected(yes or no)- No
Seasonal use(yes or no): No
Water meter readings,if available(last 2 years usage(gpd)): .-2000-82,000 gals.; 1999- 72,000 gals.
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: New system, never pumped-per owner
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank,distribution lox,soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Feb. 14196-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
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Page 7 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
T PART C
SYSTEM INFORMATION (continued)
Property Address: 125 Materfield Road
Osten ille, kM
Owner: Jane Piasecki
Date of Inspection: August 30, 2001
BUILDING SEWER(locate on site plan)
Depth below grade: ;
Materials of construction: _cast,iron ✓ 40 PVC _other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints;venting,evidence of leakage,'etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 12"
Material of construction: ✓ concrete _metal _fiberglass polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1500 gal.
Sludge depth: I"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 2"
Distance from top of scum to top of outlet tee or battle: 10"
Distance from bottom of scum to bottom of outlet tee or baffle: 12"
How were dimensions determined: Measuring stick -
Comments(on pumping recommendations,inlet and.outlet tee or baffle condition,'structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Both tees were present. The liquid level was even with the outlet invert. There were no signs ofleakage.
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top,of scum to top of outlet tee or,baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 125 Waterfield Road
Osterville, MA
Owner: Jane Piasecki
Date of Inspection: Aug-ust 30, 2001
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:.
Material of construction: _concrete _metal fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DLSTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
The D-box was level, and there were no suns ofleakaze or solids. There were no signs of failure or backup from the leach__
trench. The outlet invert to grade was approximately 32".
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 11
.OFFICIAL,INSPECTION FORM -.NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-.FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 125 Waterfield Road
Ostervft MA
Owner: Jane Piasecki
Date of Inspection: August 30, 2001
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
leaching chambers,number:
leaching galleries,number:
✓ leaching trenches,number,length: 2-31'x 4'x 2'(per as built card)
leaching fields,number,dimensions: _
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
The leach trenches were located, but not dug up. There were no signs of failure in the D-box. The bottom to grade was
approximately 5.
. y
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY:' None (locate on site plan) x
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition.of soil,signs of hydraulic failure;level of ponding,condition of vegetation,etc.):
Page 10 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: . 125_WaterFeld Road
Osterville, MA
Owner: Jane Piasecki
Date of Inspection: August 30, 2001
Map: 119
Parcel: 017
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
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Page 11 of 11 y
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OFFICIAL INSPECTION FORM - NOT'FOR VOLUNTARYOASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 125 Waterfield Road -
Osterville, AM
Owner: Jane Piasecki
Date of Inspection: -. -August 30, 2001
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 33, feet (Adjusted High Ground Water Level is 29.5)
Please indicate (check)all methods used to determine the higl ground water elevation:
Obtained from system design plans on record-If checked, date of design plan reviewed:
Observed site(abutting property/observation hole within•150 feet of SAS)
✓ Checked with local Board of Health-explain: topographic'&water contours maps
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high groundwater elevation:
The bottom of the leach field to grade was approximately 5. Using the Barnstable topographic map and the Cape Cod•
Commission water contours map, the maps were showing approximately 33'+/-to ground water at this site. Using the Cape Cod
Commission Technical Bulletin, the high ground water adjustment for this site(W W 29. Zone C, 7/01)was 3.5'.
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This report has been prepared and the system inspected and passed as of,the date of inspection. This report is
not a warranty or guarantee that the system will functionproperly in the future. There have been no warranties
or guarantees, either expressed,written or implied, relating to the system, the inspection and/or this report.
11
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33. 0 � G�oun c�w�ei �avv
TOWN OF BARNSTABLE
V_)'ATION LY 6VATV- l d� OZc SEWAGE # �S' /7(001
VILI'AGE 05re.-V.I ASSESSOR'S MAP & LOT // O/
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INSTALLER'S NAME&PHONE.NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) dt&s - 0'1 .(size) a x y x 31
NO. OF BEDROOMS
L �
BUILDER OR OWNER JAn� PI�1Se1�IC 1
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 ieaching facility) Feet
Furnished by 0n
A!- 30 "
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G'2; TOWN OF BARNSTABLE G�
`LOCATION — SEWAGE#
VILLAGE O S-F-C/L.0 l( ASSESSOR'S MAP&LOT/I 0/7
INSTALLER'S NAME&PHONE NO. eLi 1.y.cQ.i g
SEPTIC TANK CAPACITY cs J-0—,
LEACHING FACILITY: (type) (size) c)I k 31
l
R) NO.OF BEDROOMS 3
BUILDER OR OWNER
PERMIT DATE: 4—r2C0MPLIANCE 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
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No. -----
7
THE COMMONWEALTH OF MASSA USETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pprication for Digpogal *pgtem Congtructiou Permit
Application is hereby made for a Permit to Construct or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. )Iq QI'I Owner's Name,Address and Tel.No.
71B- 0 73+_
I tall is Name,Address,and Tel.No. Designer's Name,Address an Tel.No.
v luacc�vA 411-1or35 5)u C► ,.
l io S�BoAret> tjq a�t
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder( )16
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 33t gallons per day. Calculated daily flow 3a gallons.
Plan Date to 14 Ns Number of sheets J Revision Date
Title le�_ Q_Jsl �NL WrP_1L1kZ0b
Description of Soil �111rn
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of t e Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by t ' and of Health.
Signed ® 4a Date 2//q/,
Application Approved by
Application Disapproved for the following reasons
Permit No. + Date Issued
1� •' �...�t'�d- 1,�,,,,�4,��...ro � r"'. ♦,d . a.yy,�...n„._e..w .,.. '"� ,+-y„yy,�, ,.kR;'�wJ �„y„.-�pti .»'. 5�"'f14...�` .,e. •y+,.. _ ;.
WqNo. _ ((! Fee
-- .THE COMMONWEALTH OF MASSA USETTS �~ t ' t,
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS °' -
Z[ppYication for Miooal *pgtem Cori!gtruction Permit
Application is hereby made for a Permit to Construct. pp y or Repair( )an On-site Sewage Disposal System at:
f Location Address or Lot No. 19 o l Owner's Name,Address and Tel.No.
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Installer's Name,Address,and Tel.No. Designer's Name,Address an Tel.No.
k K� Utt_.Aca A 4`11-10135 EP6L EJ131�V, �►.1G. ►JC•
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Type of Building:
* Dwelling No.of Bedrooms 3 Garbage Grinder( )Nd
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other._Fixtures
Design Flow 33b gallons per day. Calculated daily flow 33� gallons.
Plan Date 10 14 NAS Number of sheets Revision Date
Title P�(I� `�IS't•E�� `.�1C FbP- Mk V-103b0 t C..( k
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Description of Soil &—h)
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
f Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by,t and of Health.
Signed O n, Date ,.
Application Approved by. s
Application Disapproved for the following reasons ,
PP . PP g
,Permit No. Date Issued
_- — -ice- —:_—�--- =j:.:._—=___- --�--a
r THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS
Certificate of (compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System'installed( or rep'aired/replaced( )on
by dkp for
ashas been constructed naccordarice
,gin---.
with the provisions of Title 5 and the for Disposal System Construction Permit N . ated
Use of this system is conditioned on compliance with the provisions set forth be o
No. ll/ Fee J
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"- THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS
i� 0 tem construction Permit
Permission is he by granted.to rv/z ro (A
to construct( )re air( ' )a O sit S wa a System locat d at. a
and 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.
All construction must be completed within two years of the date below.
Dater"� Approved by
P
I8/11/2021 ShowAsbuilt(1700X2800)
TOWN OF BAR1NSTABLE
L . TION/Xr L 4r,P, (J�.- R.0 SEWAGE# qf-176a
VILLAGE OS'•efV.I 'ASSESSOR'S MAP&LOT f/ /
INSTALLER'S NAME&PHONE NO. )
SEPTIC TANK CAPACITY /5'17D f'•>al.
LEACHINO FACILITY:(type) TG..dUz — of (size) aX ql 3 f
NO.OFBEDROOMS 3T
BUILDER OR OWNER . 414_ .RATe.e4l'
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to theBottom of Leaching Facility Fcet
Private Water Supply Well and Leaching Facility(If my wells exist
on site or within 200 feet of leeching facility) Feet
Edge of Wetland and Leaching Facility(If my wctlao&exist -
within 300 feet of caching facility)1 �• Feet
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https://itsqldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=119017&sq=1 1/1
- GENERAL NOTES :
INVERT. ELEVATI-ONS : DESIGN CRITERIA :
ACCESS COVERS MUST BE WITHIN
9• MINIMUM. INVERT AT BUILDING: 29. 00 DESIGN FLOW:
6' OF FINISH GRADE
I'. THIS PLAN /S FOR THE DESIGN AND CONSTRUCTION 104.0 3' MAXIMUM COVER
OF THE SEWAGE DISPOSAL SYSTEM ONLY. FIRST 2' TO
INVERT IN SEPTIC TANK 98. 65 BEDROOMS AT 110 G. P. D. PER
je
4•PERF PVC
BE LEVEL INVERT OUT SEPTIC TANK: 98. 40 BEDROOM EQUALS Q G. P. D.
2, ALL CONSTRUCTION METHODS AND MATERIALS AND oo.z SCHED 40 MIN. 2. OF
4• PVC ( �-PEAsroNE INVERT IN D1ST. BOX: 98. 20 NO
MAINTENANCE OF THE SEPTIC SYSTEM SHALL 07 26 -,"a GARBAGE GRINDER
CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL SCHEDULE 40 a ;� _ - �Q INVERT OUT D I ST. BOX: 26. 00
BOARD OF HEALTH REGULATIONS. 99.098.65 2-3'X 31 LL2'pY 94 60
h � INERT IN LEACH TRENCH: 96. 76
EEP' 314' - 1 112• DIA. SEPTIC TANK REQUIRED:
J. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER S INVERT END LEACH TRENCH: 96. 60,_.,�.;. OUTLET LEACH TRENCHES wasHEa sToNE 330 G. P. D. X 200x - 660 GAL ,
/0 MIN. D BOX
r,
AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 1500 GAL BOTTOM OF LEACH TRENCH: 94. 60 SEPTIC TANK PROVIDED: 1500 GAL .
THAN 3' IN DEPTH SHALL BE CAPABLE OF WI TH- SEPTIC TANK 6' CRUSHED STONE BASE ADJUSTED GROUND WATER: NIA
STANDING H-20 WHEEL LOADS.
OBSERVED GROUND WATER: N/A SOIL ABSORPTION SYSTEM REQUIRED:
4. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR PROF I L E NOT TO SCALE BOTTOM OF TEST HOLE *2: 88. 30 DESIGN PERC RATE _5�MINIINCH
APPROVED EQUAL. SOIL TEXTURAL CLASS
5. BEFORE CONSTRUCTION CALL 'DIG-SAFE'. EFFLUENT LOADING RATE - 0. 74 GPDISF
1-800-322-4844 AND THE LOCAL WATER DEPT. 330 GPD I_0. 7_4GPDISF 446 S. F.
FOR LOCATION OF UNDERGROUND UTILITIES.
N
6. VERTICAL DATUM IS: ASSUMED
PROVIDED: 2-3 'WID ._ 3/LONG X 22 •.DEF_p
LEACHING TRENCHES. A - 458 S.F.
7. FOR BENCH MARKS SET. SEE SITE PLAN.
8. NO DETERMINATION HAS BEEN MADE AS TO SOIL TES S T h I T (J A ! A
COMPLIANCE WITH DEED RESTRICTIONS OR ZONING
REGULATIONS. IT SHALL REMAIN THE CLIENTS INDICATES - INDICATES
RESPONSIBILITY TO OBTAIN ALL PERMITS. SPECIAL PERCOLATION OBSERVED
PERMITS. VARIANCES ETC. FOR THIS PROJECT.
TEST GROUNDWATER
TP* I P- 8 SCo9 TPa 2
GRND EL, 99.3 GRND EL 99.3
G.W.EL. N/A G. W.EL. NIA
0- HORIZON TEXTURE 99.3 0• HORIZON TEXTURE 99.3
i
�............................. _J. .. .........................
A
. 6. - `, }r' _ l 0 - -. _ ... 10 ........ 98.5\ 9B 5
tloo.7 r \\ h LOAMY p LOAMY
D
rt \ \
SAND
99.0+ 97.3- 96.6+ lot.o SAND
TCH eastk 32• 30'
96.8n ........... 96.6
RIM-99.12
MED-COARSE MEDIUM
r toes 102. ► r C C
to .s i t SAND SAND
r . \ 41
l I50 64L
3 --- ~� \ \ SEA TANX
\ \ Y \ -8oX sf0 t
(h �✓ `96,7 /961 \ r \ q` Tf\ 2 \\ \ S 102.5 t !
1 r jI i +�tt�w+i1 a a�•' N A I®, c� 4 4i : +o�32,Ot 3\�\ \\ f
NO WATERL0T 7 f I i -a4- 120' 89.3 !32' NO WATER
"� oa. 101.
!�a23590 S.F 94.o ; i i I 100.6094.T
88.3
:rr� I I: ► r ~ �\ �i DATE: SEPTEMBER 26, 1995
t �to�__.�� \�` 1 ,+ TEST $Y: STEPHEN HAAS
✓ / ✓ I r 99.if I t 2-j'X 3t'X 2'DI*P \ 02.4+
ENCF / 9SY4. i j r J r LOCH TRENCHES ✓;`
A , F rt- , , r WITNESSED BY: DONNA M I ORAND I
97.4+ � 96.1, N 87*06 i40' I _.. ► l04.6 \. i kf 2
„ 94.5 �` � . g3' ;9g.o, I-- r � �. , PERC RATE: MIN/INCH
to2.7 .�
GARAGE 102.28 F' T / S Y S 7T E/trl D E \S / (:a/V
q
14-'4 �r ,/� �r
F0STE•RVI LLE >
T . 4'✓`FR Qa
O
P R E•P A R EL7 F-O R
am Top RR8
EL-104.7T
MICAH
LOCUS oN0
O SR E•ED S H I L L. R D . UIV / T / 0 . H ),A IV/V / S . MA 0.2601
CLI
` S< -A
e�ut r Rp 6 j t 'i 'f °
It
"
;' ? � e ; ; w .�"14GL ,SLIh'T-r�'Y ING 8� 'NG IN �-'E'R ING . ING ,
x ;rep '
±`" •+ Gt. ;nA S"B G�'
�klf x czn n t sd 2 1►
5� 30 S .y
iF (" >
,
S
0 15 3O 60
L C MA P
J OB 0. 9530 V C
N 2 FIELD R 8/PDR CAM SAH/CFW CHECK: CFW R , _SA
D N H
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