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HomeMy WebLinkAbout0033 WINTERGREEN CIRCLE - Health 33 WINTERGREEN CIRCLE, OSTERVILE A= 119 062 e TOWN OF BARNSTABLE LOCATION 23 (f�J'„SEWAGE VILLAGE ASSESSOR'S MAP&PARCEL INS �E�NA�NIE&PHONE SEPTIC TANK CAPACITY LEACHING FACILITY. (type) '<�e-b�Lw� (size) a IBC NO.OF BEDROOMS OWNER �K1.� PERMIT DATE: 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 �� <tt< �, A �' - -- - - -- -- - -�!.- I -�� � � � � . G _ � w . �- :� � � A e f :� ,� � �` s� �_ .7 � r C � ' r� t� �v� G� -W'. '�. �, �� .- ., � E W � TOWN OF BARNSTABLE LtCATTON ( J_ GZU(/,#A,lo SEWAGE # Vh_,LAGE ASSESS R'S MAP & LOT I�`ISI�CC7D�Q5"NAME&PHONE N0. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) _ ,ADi�L C',YGC�Z Cd J (size) �D NO.OF BEDROOMS BUILDER O OWNER PERMTTDATE: 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 _ �� ;�_ �� �� `�1 6-- �. s � . �,N � R i ��� t .. ��-.{- �� Commonwealth of Massachusetts Title 5 Official Inspection Formtn o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Wintergreen Circle Property Address Ernest&Janet Smith Owner Owner's Name information is required for Osterville every page. City/Town MA 02655 August 16, 2012 State Zip Code Date of inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms the \► computer,use 1. Inspector: only the tab key to move your Patrick T. Sullivan cursor-do not use the return Name of Inspector key. Ready Rooter Excavating Company Name P.O. Box 89 Company Address Forestdale City/Town MA 02644 State Zip Code 508-888-6055 S1 12843 Telephone Number License Number B. Certification I Certify that I have personally inspected the sewage disposal system at this address and that=the information reported below is true, accurate and complete as of the time of the inspection. TheinspQion 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 El Conditionally Passes r h�_ ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority -��' �----— August 20, 2012 Inspector's Signature `"' Date The system inspector shall submit a Copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10;000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if,applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official I Form:Subsurface Sewage Disposal System-Page 1 of 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Wintergreen Circle Property Address Ernest&Janet Smith Owner Owner's Name information is required for Osterville MA '02655 Au ust 16, 2012 every page. City/Town State Zip Code Date of inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years o)& or the septic tank(whether metal or not) is structurally unsound, exhibits substantial i9filltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank i eplaced 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 7ND nk is less than 20 years old is available. ElY ElN (Explain below): t5ins•11/10 + Trtle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Wintergreen Circle Property Address Ernest&Janet Smith Owner Owner's Name information is required for Osterville MA 02655 August 16, 2012 every page. City/Town State Zip Code Date of Inspection spec B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(;) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND.(Explain below): ❑ distribution box is leveled or r placed ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by a Board of Health: El Conditions exist which require fu er evaluation by the Board of Health in order to determine if the system is failing to protect blic health, safety or the environment. J 1. System will pass unles Board of Health determines in accordance with 310 CMR- 15.303(1)(b)that the sys m is not functioning in a manner which will protect public health, safety and the environ ent: l ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal SY$Wm•Page 3 of 3 , Commonwealth of Massachusetts Title 5 Official Inspection p tion Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Wintergreen Circle Property Address Ernest&Janet Smith Owner Owner's Name information is required for Osterville MA 02655 every page. City/Town August 16, 2012 State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. . ❑ The system has a septic tank and SAS nd the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS an a 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 t/wellwaalysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicate presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, proher failure criteria are triggered,A copy of the analysis must be attached to this form. 3. Other: F D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No , ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6° below invert or available volume is less than day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 4 Commonwealth of Massachusetts Title 5 Official Inspection Form ' . Subsurface Sewage Disposal System Form'-Not for Voluntary Assessments 33 Wintergreen n Circle Property Address Ernest&Janet Smith Owner Owner's Name information is Osterville required for MA 02655 August 16, 2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100.feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system i within 400 feet of a surface drinking water supply ❑ ❑ the syst is within 200 feet of a tributary to a surface drinking water supply ❑ the s em is located in a nitrogen sensitive area (Interim Wellhead Protection Are IWPA) or a mapped Zone I l of a public water supply well If you have answered " es"to any question in Section E the system is considered a significant threat, or answered "yes" in ection D above the la Y r e system has failed. The owner or operator o 9 Y of large P Y r9 system considered significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 33 Wintergreen Circle Property Address Ernest&Janet Smith Owner Owner's Name information is Osteryille required for MA _ 02655 August 16, 2012 every page. Cityrrmn State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: F 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): 496,GPD t5ins•11110 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 6 of 6 Commonwealth of Massachusetts TTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Wintergreen Circle Property Address Ernest&Janet Smith Owner Owner's Name information is Osterville required for MA 02655 August 16, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 2010=411 GIRD 2011= 394 GPD Detail: High water usage in summer months due to irrigation Sump pump?. ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 C /3) Gallons Per day(gPd) Basis of design flow(seats/pe Grease trap present? ❑ Yes ❑ No Industrial waste holding tank ❑ Yes ❑ No Non-sanitary waste discharge ? ❑ Yes ❑ No Water meter readings, if avail t5ins•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 7 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments rl 33 Wintergreen Circle Property Address Ernest&Janet Smith Owner Owner's Name information is required for Osterville MA 02655 every page. City/Town August 16, 2012 State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: _Ready Rooter Records: Pumped 09/02/2009 Was system pumped as part of the inspection? El Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® . Septic tank, distribution box, soil absorption system - ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 8 of 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Wintergreen Circle Property Address Ernest 8t Janet Smith Owner Owner's Name information is required for Osterville MA 02655 August 16, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System installed 11/15/1995. Certificate of Compliance on file at Board of Health Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 28" feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of,leakage, etc.): Septic Tank (locate on site plan): 18" . Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene y ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach'a copy of certificate) ❑ Yes ❑ No Dimensions: 11.5'X 5'X 5.5' 1500.gallons Sludge depth: 1 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Wintergreen Circle Property Address Ernest &Janet Smith Owner Owner's Name information is Osterville required for MA 02655 August 16, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 36" 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 12" How were dimensions determined? Tape measure and dip tube. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet PVC tee and outlet concrete baffle in place. Liquid level at outlet invert. Recommend maintenance pumping fall of 2013. Risers bring covers within 6"of grade. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ poiyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of tf totop of outlet tee or baffle Distance from bottomcum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11110 Title 5 Official Inspection Form:Subsurrace Sewage Disposal System•Page 10 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s 'y 33 Wintergreen Circle Property Address Ernest&Janet Smith. Owner Owner's Name information is required for Osterville MA 02655 August 16, 2012 every page. Cityrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ lene f erglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No . Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): 4 Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Wintergreen Circle Property Address Ernest&Janet Smith Owner Owners Name required urmation ired for Osterville MA 02655 August 16, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): One inlet,two outlets. Equal flow. No solids carryover present. No sign.of high water staining over outlet inverts. Riser brings cover within 6"of grade. Pump Chamber(locate on site plan): Pumps in working order: El Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump cha /, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Wintergreen Circle Property Address Ernest&Janet Smith Owner Owner's Name information is required for Osterville MA 02655 August 16, 2012 every page. Cityfrown State. Zip Code Date of Inspection D. System Information (cunt.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, 'length:, 2-40'X 4'X 2' ❑ 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.): Trenches inspected with camera. Empty at time of inspection. No high water staining over 1/3 of lines. No sign of past hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration . Depth—top of liquid to inleXow Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater i ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13 i Co mmonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Wintergreen Circle Property Address Ernest&Janet Smith Owner Owner's Name information is required for Osterville MA 02655 August 16, 2012 every page. Cdyrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): ' Materials of construction: Dimensions Depth of solids Comments(note condition of so/hsydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of.14 f f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 33 Wintergreen Circle Property address Ernest&Janet Smith owner OwnWs Name inion is requiredq&ed for u9 Osterville MA 02655 August 16, 2012 emy page, Cityrram State Zip Code Date of Inspecbm D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, Including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I ; EO I f r , 45ins-lino Tide$Oifi w Inspection Four:S6mutaee Swam Disposal Syswn-Pape 1s of 15 . t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Wintergreen Circle Property Address Ernest&Janet Smith Owner Owner's Name information required for rts Ostefville MA 02655 August 16, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells i Estimated depth to high ground water: >6feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: June 22, 1995 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: ma.water.usgs.gov terraserver-usa.com You must describe how you established the high ground water elevation: Test hole to 12' (elv= 39) found no ground water(1995). Base of SAS at elv=45.25.Accessed local ground water contours and topo mapping. No high ground water in area of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 16 Commonwealth of Massachusetts ° Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _ Sv 33 Wintergreen Circle Property Address Ernest&Janet Smith y Owner Owner's Name required information for rts Osterville MA" - 02655 August 16, 2012 very page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist, ® Inspection Summary: A, B, C, D, or E checked Y - ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 17 toT I TOWN OF BARNSTABLE LOCATION 3 11 f"I-Ae n C: SEWAGE # 9� 0e J V11LAGE OS e'er✓i'llF ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 'o�►� , A. A* /1, SEPTIC TANK CAPACITY `SO LEACHING FACILITY: (type) (size) Y10 -4 -Y�OVX a",OeP NO. OF BEDROOMS BUILDER-?OR OWNER �� �,•,o S PE D TE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by l� -C t 14 r �SSESSO�SNIAPNO;,�, � _ PARCELN� No. L � FEE Z A5 _4d THE COMMO WE�ALTH OF MASSACHUSETTS f� hS `� MASSACHUSETTS cNyyfi afiv t for Visposal �*Vstera Tons#rur#tan errait Application is hereby made for a Permit to Construct(Z-Y'or Repair( ) an On-site Sewage Disposal System at: Location ddress or Lot No. Owner's Name Address and Tel.No. ZOr+�('�e�9' �'C-E� G" t r�� ©�����LJ'�R l7 �S "✓�dr'�2 Z4;,,52--0 G3_7 Ins ler's Name,Address,a d T I o. Designer's Name,Address an4Tel.No. u:q-1tiv� 5 ► h >7 sir CA a Type of Building: Dwelling No. of Bedrooms Garbage Grinder( � Other Type of Building No, per Persons Showers( ) Cafeteria( ) pOther Fixtures Design Flow �`� G` a� gallons per day. Calculated daily flow J gallons. Plan Date Number of sheets Revision Date Title _ A Description of Soil �J�GY� 10ly�� p`-8�o� GL`l "��. p1o�— 1qn Nature of Repairs or Alterations Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance s be, n issued b 's Board of Health. Signed 5 r Date w Application Approved b Date Application.Disapproved for the following reasons 77 Permit No. Jt_o; Date Issued ���� ��- - t - r No. -9 -FEE, THE COMMOF JWEALTH OF MASSACHUSETTS MASSACHUSETTS &AVyliration for Visposal *Votern Cgunstrurtiun ]Jrrmit Application is hereby made for a Permit to-Construct( or Repair( )an On-site Sewage Disposal System at: 2cat4joydress or Lot No. Owner's Name,Address an Tel.No. O �{K�,e,,f r'"�'� C� � tc._ •-e �R t� /1��6�2. R t7 v S''Ir✓�t I �Q. d� y;,0j-oG3� Installer's Name,Address,and Tel. o. Designer's Name,Address an Tel.No. � r ` �`� d� rJc� Cam. Mv1P :5 r 7 7 T(X- C N / 4l 1 ? �6 r. � '.'i r !`f) 1 �'!r. a(F? N14.✓C�Ic/tis t/ 0. 1!/`��J� +V y. Type of Building: 11� Dwelling No. of Bedrooms Garbage Grinder(1"� Other Type of Building No. per Persons Showers( ) Cafeteria( ) pOther Fixtures Design Flow �` C' gallons per day. Calculated daily flow Cl P gallons. Plan Date Number of sheets Revision Date Title S, /W-s- Description of Soil &e::e •✓Ijonn (1k lb# 8 P— 9d 14 1`7yf Nature of Repairs or Alterations Answer when applicable) Se A Al . Date last inspected: r Agreement: r The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental-Code and not to place the system in operation until a Certificate of Compliance s been issued byjt is Board of Health: "- Signed f Date Application Approved b Date . "— Application Disapproved for the following reasons Permit No. ! J� Date Issued l ^� THE COMM�O]NW ALTH OF MASSACHUSETTS ,y GL.✓oet S I Ct l'P . MASSACHUSETTS Certiftrate of ( antyliance _ THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed (1 or repaired/replaced( ) on by _4t-3n 41, AA 1741 for 10 A 1,, (`� I-- R n 170 at tz:4*3; "t t-er q I C t C-(`e. () >�e vz, has r een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on compliance with th provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This Certificate exxpi es on (- DATE —✓ `" Inspect>_r ' 1' THE COMMONWEALTH OF MASSACHUSETTS No, 10 S7I'" , MASSACHUSETTS FEE �ts usixl s#ent C�unstrudion 1ernttt Permission is hereby granted to J OV\ier A�1.jt> to construct( for repair( )an On-site Sewage System located at 7 � tiyr✓_Irr**L_ lit 0 IBC (,P ' c7 ? ` `�L t" 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 e c omelete�ithi re ofthe date below. DATE '7 a/�" Approved r FORM 1255 Rev.3/95 A.M.SULKIN CO.-BOSTON,MA .w.. .. y' 01" -1190 BORTOLOTTI CONSTRUCTION, INC. , 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 508-771-9399 508428-8926 FAX: 508428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: Date of Inspection: ., 9 In tor's Name: ner's Name and Address: o -&14 CERTIFICATION STATEMENT: I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal sotems. The System. ✓" Passes Conditionally Passes Needs Further uation B e Local Aproving-Authority, Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional, office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY , A)SYS M PASSES: I have not found�any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system, upon comple- tion of the replacement or repair, passes inspection. ' Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water.level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health). - 1- _ a , i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .' `PART A a ' CERTIFICATION(continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced Obstruction.is removed - C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1)SYSTEM WELL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN.A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is.within 50 Feet.of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WELL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE.SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 4 The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. ' The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or,less than 5 ppm. D)SYSTEM FAILS: ' I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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 clog- ged SAS.or cesspool a; ,Liquid depth in cesspool is less than G"below invert or available.volume is less than 1/2 day flow. . . Required pumping more than.4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. k Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to `a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 Feet,of a private water supply well. Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed ble attach co of well water analysis for coliform bacteria,volatile organic to be accepts copy Y compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large systen►in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant. threat to public health and safety and the environment because one or more of the following conditions exist: The.system is within 400 Feet of a surface dunking 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 Il of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program'requiremenls of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B14t ; _ CHECKLIST Check if the following have been done: Pumping information was requested of the owner,occupant,and Board of Health. - .:�,�None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As-built plans have been obtained and examined. Note if they are not'available with N/A. ETdhe facility or dwelling was inspected for signs of sewage back-up. system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout: °'•;_, All'system components;excluding the Soil Absorption System,have been located on site. _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was in ' T' 'spected foe condition of baffles orltees material of construction,dimensions,depth of liquid, _ /depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) Thelacility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS Design Flow: llons Number of Bedrooms: 3 Number of Current Residents: Garbage Grinder: Laundry Connected To System: 1 Seasonal Use: ,cad Water Meter Readings,if vailable: O Last Date of Occupancy - /)C)" Type of Establishment: Design Flow: aallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: (! t System Pumped as part of inspection: /JCS If yes,volume pum Gallons Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other(explain): APPROXIMATE AGE of all components,date installed(if known .and source of information: , Sewa odors detected w en arriving at the site: d -4- SUBSURFACE SEWAGE DISPOSAL SYS'rEM INSPECTION FORM GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grad Material of Construction: concrete metal FRP Other (explain) Dimisions:j0,5'X&'X6-* Sludge Depth: o� ' Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: , Distance from bottom of scum to bottom of outlet tee or baffle: // .1 IF Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in lation t outlet invert, structural integrity,evidence of le age.etc. ' / c> AiAJ .i GREASE TRAP: J_� s Depth Below Grade: Material of Construction:—concretemetal_FRP_Other (explain) Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or b•tflle: Comments:'(recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural;integrity,pyidence or leakage,etc.) 4 R j TIGHT OR HOLDING TANK: Depth Below Grade: Material of Constructiow—concrete ntelal FRP=Other(explain) Dimensions: Capacity. gallons Design Flo«: gallons/day Alarm Level: _ Comments:(condition of inlet.tee, condition of alarm and (loat switches, etc:) DISTRIBUTION BOX: Depth of liquid level above outlet invert: ` Comments: (note if h7el and d_istribi tion is a ual,evid c�ds carryover, evidence of 1 ge into 0 out of box,etc. PUMP,CHAMBER: A.0, _.. 6 .. . Pump'is in wo'iking''order Comments: (note condiiion-of pump cha fiber,condition"of pnnips and`app�rtentuices; s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SOIL ABSORPTION SYSTEM(SAS): V' (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type Leaching pits,number: Leaching chambers, number: Leaching galleries,number: Leachingtrenches,number,length: � � 1 Leaching fields,number,dimensions: Overflow cesspool, number: Commen :(note condition of soil,si Ygns of hydraulic failure l%=ondition of vegetation, etc.)7 Ll! Q /GCM0— O '� � CESSPOOLS:,,J� Number and configuration: Depth-lop of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) i -6- SUBSURFACE SEWAGE DISPOSAL' SYSTEM INSPECTION FORM PART C r SYSTEM INFORMATION(conlintied) SKETCH-OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benclimar`ks." Locate all wells within 100 Feet. &WAY— DEPTH TO GROUNDWATER: Depth to groundwater: ��� Feet Meth of D �!^� on or ppro4 m ati on: . ,0X11pA /1'A' /K ,0a�QJ! , 07-12-1995 09:14AM FROM YANKEE SURVEY TO 5403022 P.01 y ; APPLICATION FUR PLRCOLATIUN TLt;T AND UUSERVATION e1T.3 / LOCATION a ') �Z E N cLEL� NO. -8 `•� ®� VILLAGE /LLC Lip / DATE APPLICANT V I D Mo=o FEE GT/crw Jf� TELEPHONE NO. (Non-re€undable) ADDRESS c� OAS R!!�C.E D ��/�,_ _ { ENGINEER TAGS_ ';`ANDLOS CAUGH TELEPHONE NO. DATE SCHEDULED (Applicant's signature) ASSESSC)[t'S�biAF6L0'fNO:e%%' � 6� OeO � "eeO'••eeee.......e.n...ee.e..._.. SOIL LOG SUB-DIVISION NAME Dsiery; I e yriCAA)J DATE f)(9— 915 TIME •�� —�r ,4 280 P + — EXPANSION AREA; YES NO .5C-A ENGINEER TOWN WATER_/PRIVATE WELL L2-7:,t BOARD OF HEALTH. EXCAVATOR SXETCH: (Street name.etc.,dimensions of lot, exact location of test holes and percolation tests, Iocate wetlands in proximity to test holes) NOTES: a (� Z.o+ PERCOLATION RATE. TEST HOLE NO: ELEVATION: 'PEST HOLE NO: E• ELEVATION: - 2 0 2 la��. 3 6 IJ p Y b� 6 7 ,« tD 7 10 lo qI4 to ' li 4,0 Il 12 12 13 �1F.DTo ;of- 13 14 1 14 '15 1 � O 15 \ c� 16 oUt3 lL' 16 I� SUITADLE` FOR SUB-SURFACE SEWAGE: LEACHING FIELD_LEAGFtING P11'S LEACHING TRENCHES v, -- UNSUITABLE FOR SUB—SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION JRIGINAL; COMPLETED IN .ENT7RETX BX P. F,, ANDRE-TURNED TO 80ARD QF HEALTH COPY: RETAINED BY APPLICANT TOTAL P..01 0. ooti OS' 00 1-9 , C3� O CS�� 9 �9 50 be o b Cl d / Z . o cD. o - r x \ \ o CID b � o Iaoa� 2 n pco 1 00 Sll3�� ►� O ►� 1 � b . 01 0 � 50 N,) �y O d ��On; � Ol�jlti OO Q) rl O � � h TOP OF FOUNDATION 20 MIN. 10' MIN. - CONCRETE COVERS 4"'SCHEDULE 40 P. VC _ MIN. PITCH 1/8 PER FT. 2"LA YER OF 1/8„-112- VENT NOT REQUIRED 1 6 ,� / , , CONCRETE COVER _51.0 WASHED STONE RISER �1�" AUX 4" CAST IRON PIPE (OR EQUAL MINIMUM rj PITCH 1/4 ' PER FT RISE CLEANLSAN;D -\412 FLO W LINE — 48. INVERT 1M N 19 49.0 INVERT LEVEL ° °°0 0 0 0 0 0 0 0—48.50 INVERT r ° ° o 0 0 aD 0 0 0 0°Oo INVERT EL. INVERT o 0 EL.= 48. 75. EL.= 48.0 — EL.=_47. 75 0 000 0 0 0 0 0 0 0 0 .0 0 DISTRIBUTION _ INVERT ° ° ° ° ° o ° o ° ° 0 ° ° (YO BE PLACED ON FIRM BASE) 6" STONE — 4 7 5O ° OR MECHANICALLY COMPACTED BOX EL.--- o ° °00 o 0 0 ° ° o o ° =45.25 15_0_0___GALLONS SEPTIC TANK F O WATER TESTED 40' IF MORE THAN ONE OUTLET � PLACE ON 6" STONE OR SOIL ABSORPTION MECHANICALLY COMPACTED 3/4" TO 1—I/2" PROFILE OF WASHED STONNE SYSTEM 6S4, INSTALL 2 TRENCHES 40 LONG, 4 W SEWAGE DISPOSAL SYSTEM IDE & 2 DEEP BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV.= 39.0 _ NOT TO SCALE NO OBSERVED WATER TABLE (7127195) ELEV. = 39.0 _ OBSERVATION HOLE 1 ELEV,= 511.-0 _ OBSERVATION HOLE 2 ELEV.= 50.0_ PERCOLATION RATE <5 _ MIN./ INCH AT 6QL INCHES PERCOLATION. RATE <5 _ MIN./ INCH AT __-_ INCHES DEPTH flORIZ TEXTURE COLOR MOTT. OTHER DEPTH UORIZ TEXTURE COLOR MOTT. OTHER 0-3" 0 ORGANIC 0-2" 0 ORGANIC 3-9" A LOAMY SAND 10YR2.518 2-6" A LOAMY SAND 10YR2.518 GENERAL NO TES 9"-24" E SANDY LOAM 10YR6/6 6"-30" E LOAMY. SAND IOYR6/6 24"-60" Cl MEDIUM., SAND 10YR7/4 30"-120 C MED. TO FINE 60"-144" C2 MEDIUM TO FINE SAND 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. SAND TITLE 5 AND THE TOWN OF _ BARNSTABLE—_ RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. NO WATER NO WATER 2) ALL COVERS TO SANITARY. UNITS SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. DATE OF SOIL TEST JUNE 22, 1995 SOIL TEST DONE BY , JACK LANDERS—CAULEY 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF, WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN WITNESSED.IBY: EDWARD BARRY y 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE PERC NUMOER P-8524 DESIGN CALCULA TIONS.' USED UNDER OR WITHIN 10 FT.' OF DRIVES. _OR PARKING AREAS. ' NUMBER OF BEDROOMS . 3 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL GARBAGE DISPOSAL . . . . . . . . NO BE MORTERED IN PLACE. a TOTAL ESTIMATED FLOW 5) NO DETERMINATION HAS BEEN MADE AS TO ,COMPLIANCE WITH- ( —110—_GAL./BR./DAY x __3__ BR.) 330 GALIDA Y DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. REQUIRED SEPTIC TANK CAPACITY 1500 GAL 6) UTILITIES SHO WN ARE APPROXIMATE ONL Y, EXCA VATION CONTRACTOR SOIL CLASSIFICATION . . . 1 IS TO CALL "DIG— SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS DESIGN PERCOLATION RATE < 5 MIN./IN. PRIOR TO COMMENCING WORK ON SITE. EFFLUENT LOADING RATE . . . . . . . 74 GALIDA Y/S.F. 7) CONTRACTOR IS- TO VERIFY GRADES AND ELEVATIONS AS WELL AS LEACHING CAPACITY (AREA X RATE) 496 GAL/PA Y SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. RESERVE LEACHING CAPACITY . 496 GAL/DAY 8) PARCEL IS IN FLOOD ZONE___ "C"__ . .29(40+40*4+4X. 74X2)+(4OX4X. 74) 9) LOT IS SHOWN ON ASSESSORS MAP 119_ AS PARCEL JOB NUMBER 50784 _ SH.' 2 OF 2