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HomeMy WebLinkAbout0041 BILTMORE PLACE - Health ' 41 Biltmore Place .Marstons Mills 174 007M 2 t � •i ,� i rt Ili 1 1 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Biltmore Place Property Address Aubee Owner Owner s Name information is required for every Marstons Mills MA 02668 6/1/20 page. City/Town 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. A. Inspector Information C514or N51 f_ Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails s 6/1/20 inspedoKs 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts ,a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 41 Biltmore Place Property Address Aubee Owner Owner's Name information is required for every Marstons Mills MA 02668 6/1/20 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 f Commonwealth of Massachusetts r= ,ip Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form-Not for Voluntary Assessments L 41 Biltmore Place Property Address Aubee Owner Owner's Name information is required for every Marstons Mills MA 02668 6/1/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ C q Y Conditions exist which require further evaluation b the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 .% 41 Biltmore Place Property Address Aubee Owner Owner's Name information is required for every Marstons Mills MA 02668 6/1/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Biltmore Place Property Address Aubee Owner Owners Name information is required for every Marstons Mills MA 02668 6/1/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts ,F Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •u 41 Biltmore Place Property Address Aubee Owner Owner's Name information is required for every Marstons Mills MA 02668 6/1/20 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Biltmore Place Property Address Aubee Owner Owner's Name information is required for every Marstons Mills MA 02668 6/1/20 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Description: Engineering on file at BOH Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: OccupiedDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� 41 Biltmore Place Property Address Aubee Owner Owners Name information is required for every Marstons Mills MA 02668 6/1/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped 2013 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts �. ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .%� 41 Biltmore Place Property Address Aubee Owner Owner's Name information is required for every Marstons Mills MA 02668 6/1/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: System installed 2000, 1 leaching chamber added in 2005 to increase design to 5 bedrooms, records in file at BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments J 41 Biltmore Place Property Address Aubee Owner Owners Name information is required for every Marstons Mills MA 02668 6/1/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1811 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-10 septic tank appears to be structurally sound, outlet cover raised If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness 8" Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested and homeowner scheduled a pump out t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t, 41 Biltmore Place Property Address Aubee Owner Owner's Name information is required for every Marstons Mills MA 02668 6/1/20 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 41 Biltmore Place Property Address Aubee Owner Owner's Name information is required for every Marstons Mills MA 02668 6/1/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 0" Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-20 D-box is in the driveway paved over with no access, it was video inspected and appears to be structurally sound, effluent levels were appropiate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments l 41 Biltmore Place Property Address Aubee Owner Owner's Name information is required for every Marstons Mills MA 02668 6/1/20 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * if pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp,doc•rev.1/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 41 Biltmore Place Property Address Aubee Owner Owner's Name information is required for every Marstons Mills MA 02668 6/1/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): H-20 chamber installed in 2005 per BOH record has steel cover to grade in the driveway, there is 3" of effluent in chamber at this time, no indication of past back up, the 3 original chambers are presumed to be H-20 per 2000 compliance and 2005 compliance on file at BOH 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): f t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 t i Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 41 Biltmore Place Property Address Aubee Owner Owner's Name information is required for every Marstons Mills MA 02668 6/1/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title .5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t; 41 Biltmore Place Property Address Aubee Owner Owner's Name information is required for every Marstons Mills MA 02668 6/1/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 3�o's Lt t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 41 Biltmore Place Property Address Aubee Owner Owner's Name information is required for every Marstons Mills MA 02668 6/1/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells >132" Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2000 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: 4'seperation per compliance on file ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 I Commonwealth of Massachusetts re Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Biltmore Place Property Address Aubee Owner Owner's Name information is required for every Marstons Mills MA 02668 6/1/20 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Biltmore Place Property Address 'J Jason Aubee Owner Owner's Name information is ea"Q l� MA 02668 August 16, 2012 required for "VVesi arnrst9b4e— 9 every page. City/I own 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:When filling out �A. General Information �, ,,{{ ( � forms on the � .• - _ � I computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name r� 189 Cammett Road Company Address c Marstons Mills MA 02648 'BlPO Citylrown State Zip Code 508-428-1779 S112855 t Telephone Number License Number L _ -B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further aluation by the Local Approving Authority August 16, 2012 Job# 12-127 ctor's ig ature 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 O Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is required for west Barnstable MA 02668 August 16, 2012 every page. Cityrrown 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: Tank was not in need of pumping at time of inspection, leaching chambers had 1-2"of standing water with no sidewall stains. B) System Conditionally Passes: ❑ one or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is West Barnstable MA 02668 August 16, 2012 required for every page. Cityrrown State Zip Code Date of Inspection 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(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11l10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is West Barnstable MA 02668 August 16 2012 required for State Zip Code Date of Inspection every page. Cityrrown 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 i of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an over El ® or clogged SAS or cesspool ` ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 4 of 17 15ins•11/10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is required for West Barnstable MA 02668 August 16, 2012 every page. Citylrown 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: ❑ 119 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 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 El ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is West Barnstable MA 02668 August 16, 2012 required for every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts : Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is required for West Barnstable MA 02668 August 16, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 5 Number of current residents: 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 Seasonaluse? ❑ Yes ® No ` Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑'Yes ® No Currently Last date of occupancy: Occupied. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No r Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No k Water meter readings, if available: t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts 9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is required for West Barnstable MA 02668 August 16, 2012 every page. CitylTown 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: Pumped early 2012 ICI Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts. Title 5 ,Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is West Barnstable MA 02668 August 16, 2012 required for every page. City/Town State Zip Code Date of Inspection ` D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: SAS expanded in 2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): 16" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5' long x 5.8'wide- 1500 gal. 1" Sludge depth: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is West Barnstable MA 02668 August 16, 2012 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness Trace Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was at bottom of outlet invert and tees were intact. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle - Date of last pumping: Date t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is required for West Barnstable MA 02668 August 16, 2012 every page. City/town 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 ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is West Barnstable MA 02668 August 16, 2012 required for 9 every page. Cityrrown 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.): No solids or high stains present. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is West Barnstable MA 02668 August 16, 2012 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Four 500 galdrywells ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: t ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching chambers had 1-2"of standing water with no high stains Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction i Indication of groundwater inflow ❑ Yes ❑ No t5ins-11110 Title 5 Official Inspection Form Subsurface sewage Disposal system-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Biltmore Place - Property Address Jason Aubee 'Owner Owner's Name information is West Barnstable MA 02668 August 16 2012 required for 9 every page. Citylrown 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 soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Tale 5 Offic ial Inspection ection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is West Barnstable MA 02668 August 16, 2012 required for ---- - - ------ State Zip Code Date of Inspection every page. City/Town 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 13 3 Cover@ grade 4 I,': t, 26 I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is required for West Barnstable MA 02668 August 16, 2012 every page. Cityfrown State Zip Code Date of Inspection Q. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 30+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: - r Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 •Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Biltmore Place Property Address Jason Aubee Owner Owner's Name information is required for West Barnstable MA 02668 August 16, 2012 every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Tins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 wc, 10101 _ No. ,W06 � To dV �fg2— Fee THE COMMONWEALTH OF MASSATS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Z(ppYication for Miopaal *pgtem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade(.✓)Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ylOwner's Name,Address and Tel,No. ql 6 1 � c i�ldc� Assessor's Map/Parcel In��staller''s Name,Address,and Tel.No.` Designer's Name,Address and Tel.No. b0-17CWIA Cr.) .�01"ov\ ((ii q7Z)j,,3�nCOICC. �.+HS;nee..� T'`L•v3� � 4�9' ��114 _ IJ 1 V�\1ie� COA. yGl•KtcvT�l W��O/� Type of Building: Dwelling No.of Bedrooms Lot Size V 7 sq.ft. Garbage Grinder( ) Other 'lope of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow �� gallons per day. Calculated daily flow -5 60 -gallons. Plan Date to Z2 00S�_ Number of sheets J Revision Date 0200 Title Size of Septic Tank Type of S.A.S. Description of Soil Nature 1-of Repairs or Alter tionis_(Answer when applicab e) ��0;�,�>., r9T 1 ��✓�3�, ✓'�g[..� � �Vie. � �.�1✓�ra n�.i `J'S Y S ✓Vl Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance witlj the provi�issjy_: yeph)ji f the Environmental Cod and not to place the system in operation until a Certifi- cate of Compliance has beenardAof �th_ Signed —Date 7C/ Application Approved by Date Application Disapproved for a following reaso sit Permit No: ^ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER ,that th On-site ewa Disposal System Constructed( ' )Repaired ( )Upgraded(�) Abandoned( by C®vt 3 at / h s b n constructed in a or dance with the provisions of Title 5 and a fo Dis al System Construction Permit No dated q/�6� Installer r-�N5 1d 1. Designe The issuance of this _e t shall not be construed as a guarantee that he sy - fun tion as designed. Date 3 Inspector bl' No. ~� . ;-�=---=a;-=;, � Fee -- � THE OM ONWEALTH OF MASSACHUSETTS Entered in computer: L. Yes PUBLIC HEALTH DIVISION -,TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for Mfs;pool *patent Cottgtruction Permit Application for a Permit to Construct( . )Repair( )Upgrade(V)A&ndon( ) ❑Complete System ❑Individual Components Location Address or Lot No. L/jy; a �(Q Owner's Name,Address and Tel.No. Assessor's Map/Parcel � �l $ �A-v v"C_ G I{n�staller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Jo��a,1el CoH141,a1��n CaP� �HS:�.�.:. , T"c Type of Budding: 5-v 8- 3 Gd- E/.,y/ i Dwelling No.of Bedrooms S °'°'Lot Size •y 7 sq.ft. Garbage Grinder( ) •Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow � _n gallons per day.\Calculated daily flow -5-60 gallons. Plan Date y �A��vo S- Number of sheets 1 Revision Date oo Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alter tions(Answer when applicable) AA_A;'1 1`0.^ cT1d wa,,h �y 4L ed-obi 6v5l_ew1 Date last inspected: Agreement: ` The undersigned agrees to-ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with,the.provision o Tits 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss e y//th` oard of I� •th, S Signed n _ Date 7 U Application Approved by 1A Date Application Disapproved.(or the following reasons/ rr _. . �i-� No. l --;�< " / U Date Issued Permit �. V r- � � ! - -j-------------- -- -- ' THE COMMON?JVEALTH OF'MASSACHUSETTS � BARNSTABLE, MASSACHUSETTS t Certificate of Compliance THIS IS TO CERTI FY, that thy On-site Sewa a Disposal System Constructed ( 4 )Repaired( )Upgraded (✓) Abandoned( by S at U l X�/^447 has been constructed in accordance with the provisions of Title 5 and the for Di spoaal System Construction Permit No, r � dated y 'tea/ e, Installer - I Designe ti The issuance of this e 't sh 1 not be construed as a guarantee tha the sy t fu tion as designed. ` Date S Inspecto No.I ' Fee THE-COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Zigpool *pgtent Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(v)Abandon( ) System located at 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. Provided:Construction must be completed within three years of the dare oof th s it Date: O Approved4, 5 JUN-09-2005 02 :01 PM DOWN CAPE ENGINEERING 508 362 9880 P. 01 Town of Barnstable Regulatory Services _ a Thomas F. Geiler, Director ABLE, tes¢ . Public Health Division o Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: lalq 05 Sewage Permit# ZEDS�✓� Assessor's Map\Parcel Designer: 1,Anee,n Installer:'� /°�( �..• '�� Address: P/q Hal1,1 JNf—' Address: q --��1��,57`"r �'"lX• On_ Z!©+� �06�Vl©lll-i cl©lsr was issued a permit to install a (date) (installer) septic system at ��t�M 0✓C r14CA based on a design drawn by (address) f 14, dated 64 (de ' ner) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. N OF ARNE H cyc (Ins er's Signature) JACIV v No. 30782 2-4 / 1 gNAL ��G\ (Designer's Signature) � (Affix DesiJ1ffT&tamp Here) Pla&ASY, RETURN TO BAR ABLE PUBLIC HEALTH Dl«SION, CERTIFB�CATE OF C,OMELIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND A BUILT QARD ARE BECEIVED BY THE BARNSTABLE PUBLIC HEALTH DI ISION. THMK XQU. Q:Health/Scpd✓Designer Cutificadon Form 3-26-04.doc J 0 G �Pf . m N N ti y' 3. Lu 0 ce TOWN OF BARNSTABLE LOCATION/ �fi'r --- 1 l�'�r�7 r I�L+-t.C--SEWAGE # y �Y�G� //�J � VILLAGE /� ;,-tea a'�i�aaii_�L ASSESSOR'S MAP & LOT � t7" INSTALLER'S NAME&PHONE SEPTIC TANK CAPACITY Lam? t,,tL._ LEACHING FACILITY: (type) 1 14- L.;•{-,{ v,31704-4size). .3 JJ-95 k- NO: OF BEDROOMS � OR OWNER tglti4C -� PERMrrDATE: COMPLIANCE DATE: I o 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 b17 rrj' 1 TOWN OF BARNSTABLE L' LOCATION k—SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Z� SEPTIC TANK CAPACPfY IS20 AAL— LEACHING FACILITY: (type)�ia[e-P-i- L;.4A-,,;&7tv�(size) JJ ,4:1 JJJJ —i— NO. OF BEDROOMS DOR OWNE eqMAZ, r PERMITDATE: COMPLIANCE DATE: ©© i, I I I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well 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 to No.��­ `TJf� THE COMMONWEALtH OF'MASSACHUSETTS FEE 0. ' BOARD�j OF HEALTH A� OF L` AYl.c/ Ld✓ P� V*APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Per m't to Construct ( Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components Location Owner's Name /'Zvi®a 7-e A l Z GO 150- Map/Par Address - d�t�,'' 1 � Lot# ` Tele hone# Installer's Name Designer's Name Address Address Telephone# Telephone# Type of Building: f/ Lot Size 174 Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( )fA© Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min. equi•ed) T ( 0 gpd Calculated design flow gpd Design flow provided gpd Plan: Date 7. ✓V Number f heets Revision Date Title Jr Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator_ dZZ& Date of Evaluation ?� DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 cfluLfyrther agrees not to place the s stem in operation until a Certificate of Compliance has been issued by the Board of Health. Signed'4 Date " FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 IT No. '7.5� THE COMMONW Alm- 0F`.MASSACHUSETTS FEE Oy� BOARD .-OF HEALTH — OF Ad Al �P � APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT. Application for a Perm�to Construct 91Q Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components ,Lo 1 7'� /�i�i7r�/t! Parr-�x e�. �WIEe� �@•�'S Ttt�.. �`r'YL�.Sr1' . A Location Ow.,,,NName eo 7, 1 Z t Map/Part # Address Lol# Telephone# 't S TIt111_^�I.o� (�✓✓ �� Z—�i 1C tA4F- "1Cf Install,r's Nam, Designer's Name Address � Address Telephone# Telephone# `7.L Type of Building: ///,hiz;�� / Lot Size u Sq.feet Dwelling—No.of Bedrooms , . Garbage Grinder ( )t4O Other—Type of Building No.of persons . Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min equi ed) �/ gpd Calculated design flow T o gpd Design flow provided KJ/gpd _:. Plan:._Date 7 N Number f heets Revision Date Title S Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator jD Date of Evaluation _M or 110" DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE2rrther agrees not to lace the s stem in operation until a Certificate of Compliance has been issued by the Board of Health. Sign Date &-I .40 � z FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. 7-O&W 41S_5� THE COMMONWEALTH OF MASSACHUSETTS FEE 149, BOARD OF HEALTH CERTIFICATE OF C07LIA CE Description of Work: ❑ Individual Component(s) complete stem The undMined herebycertify that the Sewagee Disposal System; onstructed ,Repaired( ) Upgraded( ) Abandonedby /`/ Ll✓ at Go has been installed in accordance with the provisions of 310 CM 15.00 Title 5) and the approved design plans/as-bLuilt plans relating to application No.Zgr/-yS �dated Z Ap roved Design Flow (gpd) Installer e Designer: Inspector �ZG�- Datelot The issuance of this certificate shall not be construed as a guarantee that h system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No7 -y` THE COMMONWEALTH OF MASSACHUSETTS FEE lt%Ot��_ 7y W7, X/,Z— 9A.* h)&/ BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereb granted to Construct epair ( ) �Jpgrade ) Abandon ) an individual sewage disposal system at 1� Z i �// i / a ,,_ -� as described in the application for Disposal System Construction Permit No. 7iO'?'V-4/.J dated Provided: Construction shall be completed within three years of the date of this p 'mit.All �to ditions ustmet. Date !� Z�zv� Board of Healt c ` FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM •1255 (REV 5/96) H&W HOBBSB WARRENrM PUBLISHERS- BOSTON 12•� Iq'-o' q c I �r-u` � - I - i00 �j a2 Vq'-r-d M.a►JG�5f�PX�•ri orb/-�%G� �.A . D r , 5Z6a�� Y K / Ti , I i i rG C N I I T , .i K ® I — .Z o' t2 .61 I� b m F7 ' G'r �'-C' G'•G' �'-q' G=G' q'-d H=3 1'�+ 3••0• I G'-o' '1'-`�' ��.now� orGaF�Goc� IL --yyl�✓s-f-m C (+MO TOWN OF BARNSTABLE OCATION " f rP- SUWX9F#=0 11 VILLAGE W. C-�6L4 ASSESSOR'S MAP&PARCEL L 00-7 xlZ IN3TVff±tWS NAME&PHONE NW�'rf-,`Lle— 06OIII'A- SEPTIC TANK CAPACITY 60 LEACHING FACILITY:(type) (size) QC1 NO.OF BEDROOMS OWNER PERMIT 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 13 I 3 , - " Oki \ \ \ \d\d\f\!\!\F\f\f\r Cover@ grade v \ % f\!°,\f\f\,\,%\!%\, % u r%r t ! r%r A `t \ \ ! \ \ ♦ \ \ 1 f f f f 26 TOWN OF BARNSTABLE T.00ATION y/ r�.l�,r„a� 4�� SEWAGE #1?0G3''/3-0 'VIT LAGS ASSESSOR'S MAP & LOTI =�%� INSTALLER'S NAME&PHONE NO. Ua•�/e/� 5 f r..e,�i�s:� S�,zS-�$2 L SEPTIC TANK CAPACITY rsad G�L LEACHING FACILITY: (type) Qkk1 ad e4^y4 - (size) 13 x r1.r X.2 NO. OF BEDROOMS- BUILDER OR WNER PERMITDATE: f''.z'as' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S f 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 6d4z s 4 / C/- iv- S'fr, O O 03e �ey� r/fo.v /� C� W E— Qco ��-nzruw»nd�w+p �x.iyah�i __— I I k.. IV - - .... Id vi LL- _._ ._ .. � ---- -- — -- — - �X.j. - E.-, 5 • i i' I I F. co ... 01 ---_ i.1r10 CO 15�' —f _ co ( � _ z f • i - -. ._ .� _ - -- - - -- ...tee ,i ,� � o 1 _ in dxv�44v at�1J� ,1 i _ _ .. .... —v 12c�lWdown tw tA71HcGG1�dr __��Voi cGtilVevS�oN � i. � 1 \ prop addt-h ct7 --�,�t-�po�ed� t-�i�t��� ►MaW. wlodr�Ga`�-i�h now-> Vc -rn �.GauAo� t-� 4 e�jr�'� . =vDIrlrt�+��f'� - w� _t�ew �riz<4t��. �jrded.l� �►�lit� �iC���r��t��. 2: � J 2 `-► p �Q d x 24 ._ :- t. 'ard,M Wa o - — -. - - Fl �• _ __ - =- +d � { I I .�. H Ham. { 04 E-0 Ic Val U) eX t ���'ar�'�ow�► hail._._ _ - VACTZARM lo 10 �m u r A� s :.� r�P I - f l)I I I 6-- ..-__. _ �.6c•�CG J �', 1 I j I �I II at r- �1 1 I«I I �1 I o•r ' . is ; _ r 1 � - • -- ---- _. -.-....... - ---. -- ._ .. _ ------ ---— — ---- _-- - i �,, t• �. y� f ll G - SCALE:/�r-i'_V-r APPPOVEO BY: DRAWN 9Y-��C' •. O-E:j _� -. GL�I'�V /Y REVISED DPAW LNG NUMBER i I r i Iti �L\ CI J .. 0-1 -Ir I , I , ------ i - I i i - : \ I i Y At `/) APPROV ED BY: DRAWN I REVISED DALE: 7,7<-.(':. v .. DRAWING NUMBfW i SYSTEM PROFILE TEST HOLE LOGS TOP FNDN EL. 87.5' " (NOT TO SCALE)_ t ACCESS COVER (WATERTIGHT) To ENGINEER: D.A. OJALA, SE WITHIN s" of FIN. GRADE JERRY DUNNING 2% SLOPE REQUIRED OVER SYSTEM E,,5.0' WITNESS: I RTE 6 5 26 98 EL. 84.8' 2 DOUBLE WASHED PEASTONE DATE: / / ( SERhCE RD. EXISTING 1500 PERC. RATE < 2 MIN/INCH .. /LOCUS * I MINTON N PTI N E c 159 y GALLON s 9 83.4 I CLASS SOILS P a H-20 83.0 t # o TANK (H- 10 Fir) alaao O 000a 0 82.17'* I3 C l = � � � 0 4' AROUND m 0 ELEV. ELEV. 0 2' a0ED0 CDED00 � 0 80.17'* QQ oP��• DEPTH OF FLOW = . 4— Q 8615 Ott $3.5 TEE SIZES: » 3/4" TO 1 1/2" DOUBLE WASHED STONE 0 » p INLET DEPTH 10 2» 2 OUTLET DEPTH = 14" E LOCATION MAP NO SCALE LS 40 0 2.5YL6/2 4 2.5Y 6/2 LEACHING ASSESSORS MAP 174 PARCEL CO FOUNDATION '' 17' SEPTIC TANK 80' D' BOX 1 3' FACILITY 9'f B B ZON' �' DISTRICT: RF S; *NOTE: THESE ELEVATIONS ARE APPROXIMATE ONLY AS SYSTEM -WAS NOT LS LS YARD SETBACKS: ACCESSIBLE. INSTALL PROPOSED 500 GAL. CHAMBER AT SAME ELEVATION AS EXISTING CHAMBERS. 2.5Y 6/6 ., 2.5Y 6/6 FRONT = 30' 36 83.5 36 80.5 Si)E _ 10'* REAR 15' TH 2 71.0' C C PLAN REF. — FLOOD ZONE: C �..�. ., M/F SAND M/F SAND * WAIVER GRANTED BY Y, 2.5Y 7/4 PLANNING BOARD _ I 2.5Y 7/4 -_93 94 �� AP DISTRICT •84 ALL WATER TO BE DIRECTED AWAY FROM FOUNDATION D D �� \w 132" 75.5' 150" 71.0' _ - - Wd. �A 11 N OTES `91_ - -___ _-►�•oft-,,.nt a NO WATER ENCOUNTERED L'6�'s a �EPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) 1. DATUM IS ASSUMED 20,3 550 AVAILABLE OP II CESIGN FLOW: -5 BEDROOMS ( 110 GPD) - GPD 2. MUNICIPAL WATER 1S _ AD TIO _ __ l SE A 55U GPD DESIGN FLOW 3- MINIMUM PIPE,`PITCH TO BE 1/8" PER FOOT. II PROP. DECK EXTENSION i� i� SEPTIC TANK: 550 GPD (?) = 1100 4• DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H— 20 e$ n 5. PIPE JOINTS TO BE MADE -WATERTIGHT. II I SE A 1500 GALLON SEPTIC TANK (RE—USE EXIST.) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. o , _ — �� LEACHING: ENVIRONMENTAL CODE TITLE V: � N $1 II SIDES: 2(42 + 12.83) 2 (.74) 162 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE USED FOR LOT LINE STAKING. } \II f 42 x 12.83 (.74) = 398 I _� EOTTOM: 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. DEa<' 9 !I TOTAL: 757 S.F. 560 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED 2' '1 EXIST. °\►11 O ADD (1) 500 GAL. LEACHING CHAMBER (H-20) WITH 4 STONE - ----- DWELLING Y� FROM BOARD OF HEALTH. A`+ END AND SIDES TO EXISTING (3) 500 GAL I = 87 5• e9 11 _ 10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE CHAMBER/STONE SYSTEM LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR R EXIST,;1500,GAL. SEPTIC 11 TO COMMENCEMENT OF WORK.: TANK (RE—USE) N GARAGE 8� 1\1 _ SLAB LEGEND I. SITE PLAN 1 m ` 1 TH2 s� �\1 1 G0.0 PROPOSED SPOT ELEVATION OF 41 .$ILTMOI E' PLACE I; 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: o- 10G PROPOSED CONTOUR _ 86--� BARNSTABLE ADQ (1) 500;GALLON CHAMBER e -- 100 EXISTING CONTOUR PREPARED FOR: (H-20) .WITH 4 STONE i �\� M/M JASON AUBEE AROUND .TO EXISTING CHAMBER/STONE SYSTEM, 8� 116.43 $5�\\ f PROVIDE WATERTIGHT C.I. 30 0 30 60 90 ACCESS COVER TO GRADE. OPEN QQ SPACE BOARD OF HEALTH �I u PROP. VENT WITH CHARCOAL FILTER MA SCALE: �.. = 30' DATE: APRIL 6, 2005 AND BUGSCREEN (FINAL PLACEMENT BY APPROVED DATE CONTRACTOR WITH HOMEOWNER CONSULTATION) NOTE: BENCHMARK: CATCH BASIN off 508-362-4541 $A$ LOCATION FROM AT ELEVATION 84.4' fox 508 362-9880 INSTALLERS CARD ���yzKOFhfS. \J' AOF4t9SS9 down cape engineering, Inc. �o ARNE �o� ARNE H. �yc H. o JALA OJALA , CIVIL ENGINEERS Noo,,26348„ CI31C 2 N LAND SURVEYORS Fe s�a�`� ° 939 main st. yarmouth, ma 02675 sUR\1 T 05-046, AR OJALA, 1 _ < f .� r ,...,. ,,. _ - - SEPTIC PROFILE TEST HOLE LOGS T.O.F. AT EL. 87.0' ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) ACCESS COVER (WATERTIGHT) TO ENGINEER: D.A. OJALA, SE 86.0' MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE JERRY DUNNING 2% SLOPE REQUIRED OVER SYSTEM 83 5' WITNESS: -- RTE 6 RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE: 5/26/98 S CE RD, 84.0' FOR FIRST 2' PROPOSED 1500 3' MAX. PERC. RATE _ < 2 MIN/INCH LOCUS GALLON SEPTIC 83.33' TEE O I I p 9159 MINTON >/ 83.58 TANK (H- 10 } GAS I H 20 80.5 CLASS SO LS # a o� BAFFLE 80.17' oo«� 80.0 Cl 0 Cl 0 MIN o 79.67' orn MMC] (� Cl (� [] L� � 4' AROUND o ( 2 % SLOPE) 6 CRUSHED STONE OR MECHANICAL � " o r� OaCl a OOCI � ELEV. ELEV. COMPACTION. (15.221 (21) oc 91 Q [� [� C] [� (� 0 a 77.67 1 2 pE DEPTH OF FLOW = _4 ( 4 7 SLOPE) �� 0 EP 86.5' 0 0 4 83.5' TEE SIZES: 3 4 TO 1 1 2 DOUBLE WASHED `STONE w. INLET DEPTH = . 10 / / 2" 0 2„ 0 OUTLET DEPTH = 14" E E LOCATION MAP NO SCALE 5Y 4�. 2. L6/2 4�� 2.5YL6/2 FOUNDATION---- 17' SEPTIC TANK 80' D' BOX 13, LEACHING ASSESSORS MAP 174 PARCEL FACILITY B 6.67' B ZONING DISTRICT: RF LS LS YARD SETBACKS: 2.5Y 6/6 2.5Y 6/6 FRONT = 30' 36"' 83.5' 36" 80.5' SIDE = 10'* REAR = 15' PLAN REF. - TH 2 71.0' C C FLOOD ZONE: C MINTON LANE M/F SAND M/F SAND * WAIVER GRANTED BY PLANNING BOARD 2.5Y 7/4 _._. 2.5 Y 7/4 ELEC. TRANS PAD -' AP DISTRICT UTILITY CLUSTER . 97 81.84' \ ELEC,TEL,CATV �•... g , 71.0' 9 9g � 132'• 75.5 150"20' Wide draina NOTES: ge ea NO WATER ENCOUNTERED SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED } 1 . DATUM IS ASSUMED LOT 2 DESIGN FLOW: 4 BEDROOMS ( 11 000 GPD) = 440 GPD 2. MUNICIPAL WATER IS AVAILABLE 20,336 sf+ USE A 440 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. w SEPTIC TANK: 440 GPD ( 2 ) = 880 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H-1 O 0 �� 1500 5. PIPE JOINTS TO BE MADE WATERTIGHT..� USE- A --_- GALLON SEPTIC TANK n? I 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. LEACHING: ENVIRONMENTAL CODE TITLE V. 11 SIDES: 2(33.5 + 12.83) 2 (.74) = 137 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE USED FOR LOT LINE STAKING. 91 �� BOTTOM: 33.5 x 12.83 (.74) = 318 8. PIPE FOR SEPTIC SYSTEM TO SCH, 40-4" PVC. DECK � p TOT,AL: . 615 S.F. 455 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT 26 PROP 4 BR 9p ;0 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED DWELLING USE (3) 500 GAL. ACME OR EQUAL LEACHING 1 �-- fn FROM BOARD OF HEALTH, ,a TF - 87.0' -0 CHAMBERS WITH 4' STONE ALL AROUND 10, CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR GAR, SLAB ��� TO COMMENCEMENT OF WORK. 0 EL. 86.5' � r LEGEND TITLE 5 SITE PLAN PROPOSED SPOT ELEVATION OF LOT 2 BILTMORE PLACE ���� 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: n - - 6 �� - 100 PROPOSED CONTOUR � CIO /L� Q. BARNSTABLE � 100 EXISTING CONTOUR PREPARED FOR: 4 8S - MAINE POST AND BEAM 116.4-3� D O 30 0 30 60 90 OPEN ° SPACE ° BOARD OF HEALTH UTILITY CLUSTER ELEC,TEL,CATV APPROVED DATE MA SCALE: 1" = 30' DATE: DULY 31, 2000 NOTE: LEACHING FACILITY IS NOT BENCHMARK. CATCH BASIN off 5oe-362-4541 DESIGNED FOR VEHICLE LOADING AT ELEVATION 84.4' fox 508 362-9880 (USE H-20 COMPONENTS IF Of VEHICLE LOADING EXPECTED) � �1H OfMA9oy ARNEdOWn cape en eerin , InC. ARNE H. ASJq�yJ GJ, � H. �. g OJALA OJALA CIVIL ENGINEERS CIVIL N q 26348 4 _. ._. LAND SURVEYORS �o� 9FC/STER�� e s'�Na o`'°Q, Fssiok __ Az 99-.246-2 939 main st. yarmouth, ma 02675 N H. OJALA, P.E., P.Q.S. DATE _ eat ' i ' Q I 40 op - t s1,12 _ 1 oe I ti 4-4 - ? 4 , %,-Z- F, Fi I A co z.. , w f : i 1 1 : } r .. .... t< .,�..:;,.� ....>.- ,_....-. _..... .. ,. ., .� :.. -..,�....._... :.....,_. _:... Lam(/. � 1 . r r t ► U K _ x._ :.. � � haw cat� I , r: It E i -- - - 1 n F ivl 41 -- , F t OL j Ste!` i i M new I