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HomeMy WebLinkAbout0488 BAXTERS NECK ROAD - Health (2) '?viarstons Mills P' A = 075 038 { r: 1 • ,per �� `� �® COMMONWEALTH OF MASSACHUSETTS r EXECUTIVE OFFICE OF ENM1ONMENTAL AFFAIRS DEPARTMENT OF ENVIRO;NMENTAL PROTECTION RECEI O'6� DEC 0 8 2004 �Hf�CEI. �...! b C� Z r, �,,..,,�, --•W-�- TOWN OF BARNSTABLE � HEALTH UEPT. TITLE 5 OFFICIALINSPECTION FORM-NOT FOR VOUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 7CJtt�` Owner's Name: Owner's Address: ! Date of Inspection: Name of Inspe leas print)_ / Company Nam Mailing Address AMA Oib Telephone_Number:' I . CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at tNs address and that the information reported below is true, accurate and complete as of the time of the inspection. Tha inspection was performed based on my training and experience:in the proper function and maintenance of on sitesewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310,1CMR 15.000). The system: i V Passes Conditionally Passes Needs Further Evaluation by t1ie Local Approving Authority Fails Inspector's Si nature: i Date: The system inspector,shall submit a copy of this inspection report to the ikpproving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shaued 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 ofthe DEP.The original should be sent to the system owner and copies sent to.the buyer, if applicable,and the approving I authority. Notes and Comments ` D-&)C IlCG 110m�' ****This report only describes conditions at the time of inspection aid under the conditions of use at that i time. This inspection does not address how the system will perform iien the future under the same or different i conditions of use. i I Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTI& FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEV8`AGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Mdrew Owner . _ Date of Inspection: Inspection Summary: Check A,B,CD or E/ALWAYS complete all of Section D I 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 belori,.' Comments: i i B. System Conditionally Passes:. I 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.complyng septic tank as approved by the Board of Health: *A metal septic tank will pass inspection if iris structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: i -Observation of sewage backup qr 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 i obstruction is removed distf ibution box is leveled or replaced i ND explain: The system required pumping mere than'4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the-Loard of Health):. broken pipe(s)are replaced obstruction is removed i I ND explain: 2 Page 3 of I'l OFFICIAL!INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM? INSPECTION FORM PART A CERTLFICATION(continued) Property A ress:� � hits.A,-,z Owne i r Date of-inspection: k 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 i system is not functioning in a manner which will protect publiic Health,safety and the environment: _ Cesspool'or'privy is within 50 feet ofa surface water Cesspool or privy is within 50 feet ova bordering vegetated wetland or a salt marsh j 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. I _ 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 ito 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. i i j i 3. Other: I j I i I 3 Page 4 of I I OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM' PART A CERTIFhCATION(continued) Property. dress: C/ Owner �. i Date.of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes N Backup of sewage into facie=ty or system component due,to overloaded orclogged,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 t Static liquid level in the dis ribution.box above.outlet invert due to an overloaded or clogged SAS or cesspool i i� Liquid depth in cesspool isLEss 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 groundwater elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or�tributary to a surface water supply. V Any portion of a cesspool or privy is within a Zone i l'o,f 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 Iess.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 a9 PP �equal to or less than 5' m provided that'no other failure criteria. ,b are triggered. A copy of the analysis must be attached to this form.] y -v (YesfNo).The system fails. I have determined that.one;or more of the above failure criteria exist as described in 310 CMR 15.363),.therefore the system fails..The system owner should contact:the Board of Health to determine what .ill be necessary to correct the failure. E. Large Systems: To be considered a.large system the.s,Fsteni must serve a facility with a'design flow of 10,000 gpd to.15,000 gpd• You must indicate either"yes"or"no"n 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 r 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM'—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM;INSPECTION FORM I PART B• ,- CHECKLIST �Q_ Property Address:` I Owner: Date of nspection: L Check if the following shave been done. You must indicate"yes" or"no"as to each of the following: t , Yes To i _ ;>. • . .. Pumping.information was provided by the owner, occupant,or-Board of Health _ZWere.any o'f the system components pumped out in the previous two weeks? V Has the system received normal flows in the previous two wee.lk period? V Have lar e.wolumes of water beeh introduced to the system rec�ntl or as art of this inspection? g Y Y P P Were as built-plans of the system obtained and examined?(If tiey were not available note as N/A) I . Was the facility.or dwelling inspected for-signs of sewage bactl up _ Was the site inspected for signs of breakout? Were all system components,excluding the SAS, located on site? I 4 _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition 0�tle 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 i maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)onithe site has been determined based on: Yes no; Existing information. For example,a plan.at the Board of Heai<th. I Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 NR 15.302(3)(b)] S ' Page 6 of 1 I OFFICIAL I.NSPECTION,FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART;C SYSTEM INFORMATION Property Address: �C� ( Owner: Date of Inspection: A (/ FLOW CONDITIONS RESIDENTIAL(� Number of bedro (. esign):, .I Number of bedrooms.(actual): DESIGN flow based on 310 C R 15�203 I(for xample: 11:0 gpd x#of bedrooms): 07ID6 Number of current residents: Does residence,have.a garbage grind er.(yes or no /40 Is laundry on a separate sewage systen ( es or nol .[if yes separate inspection required] Laundry system inspected/(�qes or n I: Seasonal use: (yes or no) ,� / . Water meter readings; if a ailable(]as-2 years usage(gpd)): Sump pump(yes or no)- Last date of occupanc L � I . COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR.15.2'03): 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 q'itle 5 system (yes or no):_ Water meter readings, if available: I Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped asVtofhe ins ction(yes or n If yes, volume pumped: gallons--How was a.u. ntity pumped determined? Reason for pumping: TYP&OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy —Shared system(yes or no)(if yes,lattach 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 ofthe DEP,approval —Other(describe): Approximat age of all components,date installed(if known)and source of information i Were sewage odors detected when arriving at the site(yes or no . 6 Page 7 of i 1 OFFICIAL INSPECTIO FORM'—NOT FOR VOLUNTARY ASSESSMENTS SUB N SURFACE SEWAGE DISPOSAL SYSTEM:INSPECTION FORM PART C SYSTEM INFO ION. (con ued) Property A dress: Owner. Date of Inspection: 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) r� Depth below grade: Material of construction: concrete_meta]_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: rJ Sludge depth: /I ��II Distance from top of sludge to bottom of outlet tee'or baffle: Scum thickness: -�6 - Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottoT of outlet tee or baffle: How were dimensions.d'etermined:. Comments(on pumping recomme ations nlet acid outlet tee or baffle condition, structural integrity,liquid levels related to outlet inverl,evi ce of leakage, etc GREASE TRAP/.J�:(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(cons' ued) Property A dress: Owne Ulf Date of Inspection: TIGHT or HOLDING TAN hank must be pumped at time of inspect on)(locate;on site plan) i Depth below grade: Material of construction: concrete; metal fiberglass_polyethylene other(explain): Dimensions- Capacity: gallons Design Flow: gallops/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.): DISTRIBUTION BOX:Z(if present must be opened)(locate on site plan) 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 akage into or out of box, c.): an- PUMP CHAMBER/.(locate on si.e 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 VO1UNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFO TION (continued) Y ress:Property A d ' P �y ✓� Owner. pt: <C - Date of Inspection: P c� SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) -If SAS not located explain why: ' Type . YP leaching pits,number: leaching chambers,number: leaching galleries,!number: leaching trenches;!:number, length: 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, C4 CESSPOOL . '(cesspool must be°pumped as part of inspection)(1c6te 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. (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): i i I I � i i 9 n Page 10 of I 1 i OFFICIAL INSPECTION FORM—NOTI FOR1 VOLUNTARY;.ASSESSMENTS SUBSURFACE SkWAGE DISPOSAL SYSTEM INSPECTION;FORM PART C I SYSTEM INFORMATION(continued) s ! Property Address: i Owner Date of Inspection: ! SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent.:reference landmarks or i benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the.building. I I 1, oI^1 NAj ,E1 i , 10 Page l l of l I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEI't INSPECTION FORM I PART C SYSTEM INFORMATION(con'tinyi6d) Property Address: Owne Date of Inspection:. c SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth toground water 7— feet Please indicate(check)all methods used to determine the high ground wailer elevation: Obtained from system design plans on record-If checked,date of dAign plan reviewed: Observed site ;abutting property/observation hole within 150 feet of.SAS) Checked with ilocal Board of Health-explain: Checked with local excavators, installers-(attach documentation) ✓Accessed USGS database-explain: You must describe how you established the high ground water elevation: i . I s I i I 11 Permit Dumber: Date: Compleb-d by: HIGH GRDUND-WATER LEVEL COMPUTA-:'ION. Site Location: l � � � /IJI. Lot No. Owner: :9PA j,06t:i'�y/I,-r111�/ Address: Contractor: /� Address: � � �' i Not es: STEP 1 Measure depth to water table tonearest 1/10 ft. .......... ............................... ......................':......... .Date month/day/Year I. i STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.............................................. OB Water-level range zone ..................................................... i STEP 3 Using.monthly report "Current Wate.r Resources Conditions" determine current depth to water level for index wel ........................... month/year STEP 4 Using Table-of Water-level Adjustments for index.well (STEP 2A)., current depth to water level for index well (STEP 3), and water-level zone (STEP 213) 7s determine water-level ad:ustment .......................................... .............................................. STEP 5 Estimate depth to high viater by subtracting the water- level adjustment (STEP 14) from measured depth to water levelat site (STEP 1) ............................................................. .............................................. Figure 13.--Reproducible computation ford. i 15 I ........... .� ,.....,....o....,+,�,r-_•...-- ...._v....._.,,.:...._-�.,...� ..W. «..,-- ....�..,.»e.,..., .-j. .� I�.edE4 w.a-...... . J ._ __ .--___ ______.---- --� ���C�,-1-/ err - -• - _---- - ---- --�- _- _ _. _- - - � --- -_f��o���-_ _ . . ._.. _ ___ -----_ _ COMMONWEALTH OF lvll�SSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ic RECEIVED DEC 0 8 2004 I LOT :r I TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A VA CERTIFICATION Property Address P Y j Owner's Name: Owner's Address o � Date of Inspection: g ' Ely Name of Inspect (please print)y ' Company Na Mailing Address f Telephone Number: —7"7/- c CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information rtported below is true; accurate and complete as of the time of the inspection. The inspection was performed based on my training and experienee: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 Needs Further Evaluation'by the Local Approving Authority 1 Fails I Inspector's Signature: Date: The system inspectorshall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days bf 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 mportto the appropriate regional office of the DEP.The original sh6uld 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 is e Page 2 of 11, OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS 1 SUBSURFACE SEVl,---AGE DISPOSAL!SYSTEM INSPECTION FORM PART A CERTIFICATION continued L i Property Address: i Owner. �. Date of Inspection: Inspection.Summary: Check A,B,C.D or E/ALWAYS complete all of Section D A. System Passes: 10 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 exisi.Any failure criteria not evaluated are indicated below.; I Comments: i 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. I. I 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 over20 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. j ND explain: I Observation"of`sewage l ackupor break out or high static water level m 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 r;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 i ND explain: I l 2 I i j Page 3 of 1'1 OFFICIAL!INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property M,dress: ! Owne ►C . Date of Inspection: i ... I C. Further Evaluation is Required by the Board of Health: I I i 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: i Cesspool or privy is within 50 feet ofla surface water Cesspool or privy is within 50 feet ofla bordering vegetated wetland or a salt marsh i i i 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 aseptic 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. is _ The system has a septicc 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 I 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 it less than 5 ppm,provided that no other failure criteria ar'e triggered. A•copy of the!analysis must be attached to this form. i ' I ' � 1 � i 3. Other: I. j I 3 r Page 4 of 1 l I OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner. Date of Inspection: ` 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 facil_ty or system component due to overloaded or.clogged SAS or.cess'pool' Discharge or po.nding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool a✓ Static liquid level in the dis_ribution.box above outlet invert due to an overloaded or clogged SAS.or / cesspool V) 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 V Any portion of the SAS, cesspool or privy is below high groundwater elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface / water supply. _ V Any portion of a cesspool or privy is within a Zone:] of a public well. _ Any portion of a cesspool or privy is within 50 feetjof a private water supply well. Any portion of a cesspool or privy is less than'l_00 feet but greater than.50 feet from aprivate water supply well-with no acceptaible water quality analysis. [This system passes if the well water analysis, performed at a.DEP certified laboratory,for col.iform 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.i&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.] !�U (Yes/No)The.system fails: I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.3A,therefore the system fails.The system owner should contact.the Board of Health to determine what will be necessary to correct the failure. i i j E. Large Systems: To be considered a large.system:the system.must serve a facility with a design flow of 10,000igpd to.15,000 gpd• You must indicate either"yes"or"no"tD each of the following; (The following criteria apply to large systems in addition to thecriteria above) I yes no j _ 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 quest-on 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. 4. Page 5 of 11 OFFICIAL.INSPECTION FORM;-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL;S. YSTEM INSPECTION FORM =i PART CHECKLIST ! Property Address:` oo Owne �- i Date of Inspection: � i Check if the following have been done. You must indicate"yes"or"no"as to each of the following: I . Yes No £ . Pumping.inform afion.was provided by the owner,occupant,or Board of Health tl Were.any ofthe system components pumped out in the previous two weeks ? Has the system received normal flows in the previous two weel:period? _ v 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) I , Was the facility.or dwelling inspected for signs of sewage back up / Was the site inspected for signs of breakout? v — / i Were all system components,excluding the SAS, located on site i _ 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)] ! i i I ' 5 I Page 6 of 11 OFFICIAL INSPECTION,FORM NOTFOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART; C - SYSTEM INIORMATION K Property Address: p Owner: Date of Inspection: 4JIVA117 ZA 6X TLOW CONDITIONS RESIDENTIAL � Number of bedrooms(design):- Number of bedrooms(actual):�~ DESIGN flow based on 310.CIv1R 115'.20�3 (for example- 1 I:0 gpd x#of bedrooms): Number of current resident Does residence.have a garbage grindv(yes or no)✓ Is laundry on a separate sewage system (yes or no):d�obf yes separate inspection required] Laundry system inspected( ees/or no):/' Seasonal use:(yes or no !1�/ :.. Water meter readings if available last 2 years usage ZVI-00 ai Sump pump(yes or no)IZV " Last date of occupancy: C/. ejozj. COMMERCIAL/INDUSTRIA Type of establishment: Design flow(based on 310 CMR.15.103): gpd Basis of design flow(seats/persons/sg rt,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): i GENERAL INFORMATION Pumping Records Source of information: Was system pumped asVPpart the in p-ection�(yes or o) If yes, volume pumped:- gallons--How was quantity piunped-determined? Reason Tor.pumping! TYPYiOF SYSTEM _✓'Septic tank, distribution box, soil absorption system _Single cesspool j _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 ofthe DER approval —Other(describe): A . roximate age of all com onents,date installed(if known)and source of in ation: ' �1111?IL �,� ,1 Were sewage odors detected when arri, g.at the site(yes or noy. �(� 6 Page 7 of I I I ' i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Vf j S A � Owne j Date of Inspection: (,�/Lc�. � �( ! 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;liner Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: Iocat on site plan) I Depth below grade: Ll YJ_J Material of construction'; oncrete_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) / + lc\' Dimensions: ��"3 ` X. 6_ ' Sludge depth: fa Distance from top of sludge to bottom of outlet tee or baffle: 7- Scum thickness: Distance from top of scum to top of outlet tee or baffle: e �� Distance from bottom of scum to botto of outlet Itee or baffle' How were dimensionsdetermined Comments(on pumping recomm ndation , inlet and outlet tee or baffle condition, structural integrity, liquid levels dated to outlet invert, elvidence of leakage,etc!): ' �% x �� GREASE TRAPU locate on site plan) Depth below grade: Material of construction:_concrete_metal fiberglass_polyethrylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottomfof scum to bottom of outletitee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels i as related to outlet invert, evidence of leakage,etc`.): I ; ! i 1 ! ; 7 r-- Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM-INFORMATION(continued) . Property Owne d. r1Wi 7 - Al, Date of Inspection: , �C TIGHT or HOLDING TAN (tank must be pumped atItime of inspection)(locate.on site plan) Depth below grader Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallon3/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.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments (note.if box is level and distributio�outlets ual,jany evidence of solids carryover, any evidence of kage into or opt of bo C. e �� 640 PUMP CHA MBER�(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.).", I , I : j ii 1 I I i Page 9 of 11 OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEMINSPECTION FORM PART C SYSTEM INFORMATION (c-ntinued)� Property Address: " OwnerYnspection_:;�2 Date ofcod 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: a hing trenches;number, length: leaching fields,number, dimensions: / d overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of pording, damp soil; condition of vegetation, CESSPOOLS: W(cesspool must be pumped as part of inspection)(Iccate on site plan) Number and configuration: Depth—top of liquidto 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(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): . 9 i Page 10 of l 1 OFFICIAL INSPECTION FORM-NOT'FOR VOLUNTARY ASSESSMENTS SUBDISPOSAL ; I SURFACE SEWAGE SYSTEM INSPECTION ' f PART:C SYSTEM INFORMATION(continued) Property Address: Owner: oC S`'l Date of Ins p ection: SKETCH OF SEWAGE DISPOSA7.SYSTEM Provide a sketch of the sewage disposal system including ties;to at least two permanent reference landmarks o. benchmarks. Locate all wells within 100 feet. Locate where public water supply enters th;e building. I ,mo b JA tt Yj I 10 i Page 11 of l 1 OFFICIAL;INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 41 Property Address: C "" ' jC �� Owner. Date of Inspection: SITE EXAM I Slope Surface water Check cellar Shallow wells Estimated depth to ground water ZZ feet Please indicate(check)all methods used to determine the high ground water elevation: i 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, Checked with local excavators, installers-(attach documentation) Accessed USGS;database=explain: You must describe how you established the high ground water elevation'' i I1 Permit 'Dumber: Date: ComplEted by: � HIGH GROUND-WATER LEVEL COMPUTATION Site Location: i� f �� Lot No. Owner: $ ��j�J� Address: Contractor: pr ��� 1 C�,��T` Address: #, Notes: �/c>�®fZS /��5 STEP 1 Measure depth to water table tonearest T/10 ft. ............................. ................................................. .Date month/day/year STEP 2 Using Water-Level Range Zone and Index;Well Map locate site and determine: /y OA Approp'riate index well........................ I OWater-level range zone .................':................................... STEP 3 Using.monthly report"Current Water Resources Conditions" determine current depth to l water level:for index well ............................ month/year STEP 4 Using Table of Water-level Adjustments for index:well (STEP 2A), current depth to water level for index well (STEP 3), 22 Z determine 7e✓ ' water-level adjustment ..... .............................................. evel zone (STEP 2B) and water-I !................................... !. STEP 5 Estimate depth to high water ...r by subtracting the water- level adjustment (STEP 4) from measured depth to water 1��7 levelat site:(STEP 1) ............................................................. ............................................... Figure 13.-Reproducible computation form. 15 r real 1S �C�``D/� e TO/WN OF BARNSTABLEQinv�s� ✓ SEWAGE # N' LLAGE KJt1 S Fri I ASSESSOR'S MAP&LOT(0'7S- 03'b j11�j( S NAME&PHONE NO 4 b -C �'�r W-7705;2�gel SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �CU (size) NO.OF BEDROOMS BUILDER O OWNE PERMUDATE: 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 i f, Uo� 1 Z-6pec�-<n CaTri- TOWN OF BARNSTABLE LOCATi01�'W,> of?"G& 6 6r SEWAGE # `VMLAGE jot 0b Wit; ASSESSOR'S MAP& LOT (375 03� SQd 5 NAME&PHONE NOS,"t�—ItoIf?tl �'� • . g`7-2/ SEPTIC TANK CAPACITY I O() 00 ►c--,�c(�4 . 1 ACK LEACHING FACILITY: (type) �C C D �, (size) NO.OF BEDROOMS BUILDER O OWNE �' J3112`/ O 0fretA 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 i J 7 19 - �� 10 ' S' ."JFCT TO APPROVU OF r d No... C7.1 'i2 ".,,FPS AFL€ ®�JSERVA7I®�9 Fss... ............... THE CO ;OdI�I�1V'&U ,1$ OP MASSACHUSETTS BOAR OF HE TH ..U. v.`................OF....P .. ------------------..........._.................... App iration for Ditipooa1 Workii Tomitrurtion ranfit Application is hereby made for a Permit to Construct ( or Repair ( } an Individual Sewage Disposal System at:6 ................... ........................................................................... ...............�................................................................................. Location-A res's l or,I of No: ------------------------------- -------------------------------------- ---------------------------------.---•- J� w er 44t�� Address W .......l. ---------------------------------------- ------------------------------ •------- ..... -•--------- Instal r Address QType of Building Size Lot___ . � Sq. feet U Dwelling—No. of Bedrooms...................._------_-_...--•___-___Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building ............... No. of persons......_..........___.___.__. Showers — Cafeteria Q, Other fi to ----------------- ------ - W Design Flow............................................gallons per person per day. Total daily flow__._�..Z.�..._____...____......._._gallons. WSeptic Tank—Liquid capaci)0.7 gallons Length------ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length----_.............. Total leaching area......._............sq. ft. Seepage Pit No........l......... Diameter....... Depth below inlet........ ._.... Total leaching area.. ......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `" Percolation Test Results Performed by............................. .....................................•----- Date........................................ Test Pit No. 1...............minutes per inch Depth of Test Pit-------------------- Depth to ground water___________________.._-. ( Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil----•_ �•T.-- LL ......................... •-----•--••...---•................................................ x ii { , .................. rh. w f �d' -. 40 ----------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable- ----------------------------•-------•----------------------•---------------•--------•-......-----------•------------------------------------•----------------------...-----------------..............--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I- L p 5 of the State Sanitary Code—The ndersigned further agrees not to place the system in operation until a Certificate of Compliance has be ' bed by b d of health. Sign -----•-••--•-•----------4& A_�4 ........................... ...3/�-— Application Approved By........................... ••• •..... --•------- --•---- l z o�B Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ......•--•••--••--------•--..•--••------•-------•---•--------------•--•---------•---------•--•••----.•••... --------------------------------------------------- -- -- Date PermitNo......................................................... Issued....................................................... Date 4 THE COMMONWEALTH OF MASSACHUSETTS BOARD90F H {A)LTH ' ...............O F.....PA A._4CC .'""=_-----•-------......................... for Digpnaal Workii Tomitrnrtinn Vamit Application is hereby made for a Permit to Construct ( r Repair ( ) an Individual Sewage Disposal System at ocation- d ess t or jIpt No. .......................... . . .. .........................•----- -------- ----------------........................... a e ess -.. ..................... -•-•--••-••-•--•-----•...•-••--•-•--•-•-..........---------- ... Install Address ��"' JZ d Type of Building : Size Lot___ .....................Sq. feet Dwelling—No. of Bedrooms.............Z ..............._.........E�p sion Attic ( ;. ); Garbage Grinder ( ' ) Other—Type of Building No. of persons............................ Showers — Cafeteria p' Other fi d Design Flow.............. ---_--------_--_gallons per person per day. Total daily flow.......................�1 __ gallons. W ,+ -------•--- WSeptic Tank—Liquid capacit�6-1 gallons Length...... '._. Width................ Diameter------------_--- Depth................ x Disposal-Trench—No. .................... Width.................... Total Length------.__._.. ..--- Total leaching area__-_-_-_--_----_--sq. ft. Seepage Pit No........./-------- Diameter........7-------- Depth below inlet......... ...... Total leaching area..42: ..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. 1--------_-------minutes per inch Depth of Test Pit-________---_-.-_-•- Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ t� ° O Description of Soil-•----- M- �.. �,�........-�`-.---------------------•------•----•----•-----•-•-----•-•-•--•----...-•-- x :o-:----�-------w-- ... -- .. ............. -- ---------------------------------------------------........•...---- n,„ jp W v .x �CJ ----------•-------------• '� ------ UNature of Repairs or Alterations—Answer when applicable...................................................:.......................................... -------------------------•---------------------------•---------------------------................---•----•-------........................................=...........=..............•----•-----•----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i p 5 of the State Sanitary Code— The dersi ned further agrees not to place the system in operation until a Certificate of Compliance-'has be i ed by b d of health. Sign --•-f........----••......•--•• ;•-- '1 d {. ' Application Approved BY Date Application Disapproved for the following reasons-------------•----•...................................................................... ................... -•------=------------------•------•----------------------------------------------...........----------------•-•---------------------------------------------------------------------------------------- Date' PermitNo......................................................... Issued....................................................... Date i 4� ; THE COMMONWEALTH OF MASSACHUSETTS 9 BOARD ,OF HEAL H OF..................................................................................... I Tntif iratr of Tontphaurr . THIS IS TO CE IFY, That th� ndi-vi al Sewage Disposal System constructed ( o! Repaired by ...._.... .... `d.....�-------- +:�-� f �° C ller �f�/� � t i Gib/ L at. .................................... --------- --•----•-------•----•--••-•-•••-• -••--•-- ----••-••-----------•- has been installed in accordance with the provisions of T � application for Disposal Works Construction' Permit No .......121.............. dated-.---------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................`..........:Z:"....9....----••••-----•--•••-•-•-. Inspector.......... '1 -------------•--------------------------•--------------------- THE COMMONWEALTH OF MASSACHUSETTS ..........BQARDG�it/3 TZ1T4✓ ...OF..... .............................................................. N >_�„ %°' FEE.............•.......... Ii ern �tl��rk tr uan rrMit Permission is h eby granted. ----•.... ..................•----.-----••---- •---•--••----------------••----•••---•--• ....,... to Construct ( e Repair ( ) at}_ dividu ew spos atNo.- ............................ -- ---------------------------- . -- -----------------------.... Street as shown on the application for Disposal Works Construction F-crmit NNoo.__•................. Daatelq.......................................... DATE......�1.7.� 4U................................................ so Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS i '75 o3 6� APPLICATION .FOR PERCOLATION TEST AND OBSERVATION PITS LOP-.-A-TION L}-�j c ` J At �iZ_ 1G {�i (� NO✓"%- � � VILLAGE Y,v S l >S —w t S DATE APPLICANT // -D" `��� J FEE_/ J �� k,ADDRESS �7(� �j,4jC i-L=�- LC�� I N� TELEPHONE NO. (Non-refundable ENGINEER � e` �T , _TELEPHONE NO. �-­7Z-9---L_j (3 DATE SCHEDULED_ 7 Jb (Applicant's signature ASSHSSOR'S 2�iAP �.O T NU: S�� . o_. . . . . . . . . . . . . . . . . . . . . i. . . . . . . . . . . . . . . : . : . . . . SOIL LOG n �� SUB-DIVISION NA14E DATE TIME CJ.CO�I EXPANSION AREA: YES L--'NO _ l�1�'Z�L � 4-� ENGIN_EER:'?� TOWN WATER PRIVATE WELL BOARD QF HEAL7 EXCAVATOR SKETCH: (Street name, etc. ,dimensions of lot, exact location. of test holes and percolation tests, locate wetlands in proximity to test holes) OTES: C 4 7w: ev c ) PERCOLATION RATE:_ LL25,2- TAA f-4 M rt-r�� +v TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: • 2 0, Z,,Y ,ar•�{4�n�okp . 1 2 4 2i'_ 4' P> 5 ,t,..c aF 5 6 6 8 8 ©-rE• 2 C; 9 e5A L 1*-► 5 10 10 Pvt ►-►�Y -� 12 12 13 to 7r 2 13 14 L i2' 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: . LEACHING FIELD_ LEACHING PITS ✓ LEACHING TREN:CHE§ UNSUITABLE -FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER- ASSIGNED .ON PERC TEST APPLICATION • ORIGINAL: COMPLETED IN ENTIRETX COPY: RETAINED BY APPLICANT BY P F ANn rr RFmRNED TO BOARD OF HEALTH .!Wm SECTION - SEWAGE �, -, . "---�=�,� ' • 1,� NORTH -SEPTIC TANK - - "D"BOX - - LEACH__ T' 1 TOP OF FON ' / 1 , (MSL)* �! / - -- OF 'B TO 42" NOTE: WA4%sHED STONE REMOVE ANY UNSUITABLE MATERIAL FOR A DISTANCE OF 10 FT.AROUND ENTIRE LEACH AND REPLACE WITH CLEAN COARSE SAND. OUT+ IN- OUT• I-O~ COUP!^ • r• _� //// {1 IN. l ! v � Q !! OUT- IOOOG -I-tN• / fr .r --^ � ,i _/Zr IOSEPTIC ELEV. TANK ELEV. ELEV. ELEV. O ° 144711, ,,\_ ELEV. ELEV. r NOTE: ` ✓ } ' 1 e .d BRING ALL COVERS TO WITHIN OF TO- 0� s --�^ - zo 1 FT.OF FINISH GRADE. WANED STONE JJII �Y ` iI TEST HOLE LOGFor TEST BY ,p TEST DATE WITNESS 1 11 `' ` '0 C�IkJ DESIGN _- BEDROOM HOUSE ,t 1 fn!A T.H. T.H. # 2 ;� �t�'S�2i•� ELEV. � _ ELEV./S• 0 � -T N Q t Y7 FERC RATE G MIN/IN. DISPOSER � \ T I � + LOW RATE/! ( AL./DAY) .J r ¢ r '' O�G �,Q 4 A I SEPTIC TANK / /0 U.S) J-o a REO'D SEPTIC TANK SIZE �,! ( f _• �8,Q LEACH FACILITY %^ `� C� k.-I SIDE WALL . , _.-. BOTTOM � Cif " r L +�e,� - G/D. 3�(e Q USE: o�✓ _ _LEACHING A ER ENCOUNTERED if { t NOTES: (UNLESS OTHERVYISE NOTED) �} 1. DATUM.(MSL)+TAKEN FROM_-�bQ �CYrY�,�f_-__- �p. OF A� 0. 2. MUNICIPAL WATER------- .•----AVAILABLE 2�� �f.G�° JAM ES 3. PIPE PITCH: rk MP"PER FOOT - j/J JA n } I ,, �+ 4. DESIGN LOADING FOR ALL PRE-CAST UNITS: AA$HO- �� qq 1 ` n y r {� k7 G �. 5. MIN. GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. �I's B- 1MAN •/ F i F' 76 � • 6. PIPE JOINTS SHALL BE MADE WATER TIGHT {\G3 - 4 •„i 92=8 � ( 1i`0----DISTANCE AS CERTIFIED � � 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. \C jt Q Q- / /�Q� STATE ENVIRONMENTAL CODE TITLE 5 \Y �"*/$(�� �O '� ��lS"ff1 4 Qom' 1 HEREBY CERTIFY THAT THE BUILDING SITE PLAN SsldNA'L 6� aHOWN ON THIS PLAN IS LOCATED ON THE (GROUND AS SHOWN HEREON&THAT IT LOCUS: 4-o'06 a� 464X7 S Akre r TO TO THE ZONING BY LAWS OF THE ' TOWNWN OF OF REG.PROFESSIONAL ENGINEER 4HEN CONSTRUCTED. DATE I R.EF: /g77 ,f- 4A-j dOG✓d C tip @ @d�'//!@@l'//!�' PREPARED FOR: l�f ,G. LrA+4�LJ/V l�iYlQ, CIVIL ENGINEERS CONTOURS ((EXISTING) ------------- BOARD OF HEALTH I LAND SURVEYOR$ ------------ I REG. LAND SURVEYOR (PROPOSED) -0-°0-•0-0- APPROVED DATE MA Yarmouth&Orleans,MA SCALE I DATE '78-OSS