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HomeMy WebLinkAbout0089 CHINE WAY - Health 89 CHINE WAY MARSTONS MILLS A= 098 - 061 / 1 U i i -� TOWN OF BATiNSTABLE LOCATION SEWAGE#OK/1J VILLAGE . 55 a S IJJ ASSESSOR'S MAP&PARCE 6 INSTALLER'S NAME&PHONE NO t i y LOJ SEPTIC TANK CAPACITY LEACHING FACILITY.(typ&f) 4&_ f4� ize)31/4 x r. NO.OF BEDROOMS 3 OWNER z�/ Y�6eC1!/ �u� e'dn PERMIT DATE:4ld COMPLIANCE DATE: o2g /3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ��' l�� t9' 33► �� s� o �a N , ,3 THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD* OF`•4H EALT 1Q4 — OF - a bg APPLICATION FOR ISP�Upgrad"( ..SYSTEM CONSTRUCTIO ERMIT } �. Application for a Permit to Construct111 Repair ( ) Abandon ( ) - ❑Complete SystemPqndividual Components oc io Own 's Name Ina /Parcel# Address ,/)n Lot rn� ' Tele V � 11V(Instal 's Name , , I sig V w D res w60�) cl s • % VT Te ephone elephone# Type of Building: ` Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage G in r ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min re red)_MO gpd Calculated design flow��gpd Design flow provided a�gpd Plan: Date O" Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evalua or ate of Evaluation DESCRIPTI OF REPAI S ALTERATIONS 1 The undersigned agrees to install the aboAoperati. al Sewage Disposal System in accordance with the provisions of TITLE S and fu r agrees not place sys Certificate of Compliance has een is ued by the Board of Health. Signed Date Z. Inspecti s FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 THE COMMONWEALTH OF MASSACHUSETTS. FEE! RGARD�.,0F REALT OF APPLICATION FOR)DISPOSAL'SYSTEM CONSTRUCTIONTERMIT t Application for a Permit to Construct ) Repair ( y)Upgrade '(' -) Andon ( ) - []Complete System P'I d idual Components IIV el 04L1:1 In 'A oc tic Owner's Name i —ram �. a /Parcel# `' ! Address l � �n I"`)' Lott �"') TWA Tele �� ot 2. Install s Name ( ? estg erls N m r:oki OY �/ reds 1 �Add i�s I/ s i Te lephone V nTelephone# Type of Building: �/ '('71 < of Size Sq.feet Dwelling—No.of Bedrooms Z Garbage Grind r ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(m0 re ,'red) gpd Calculated design flo�gpd Design flow provided 2��gPd Plan: Date Vi Number of sheets t Revision Date ✓ Title ) Description of Soil(s) �" - Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation ( 1. DESCRIPTI N OF REPAIRS S OR ALTER TIONS t A t�Clr�1 I� -v D ? 1 1 , The undersigned agrees to install the above described In )v)dual Sewage Disposal System in accordance with the provisions of TITLE 5 and forth r agrees not to place 1h�system in operoti n61 a Certificate of Compliance has been issued by the Board of Health. �$igned Date Z- 17221'7? IF specti as FORM 1 - APPLICATION FOR OSCP DEP, APPROVED-FORM•5/96 Fh:A—Oft.t.��sn11.l—sra_ua.m—.Y:ur w.-tom:ia tix fr-IC r—— rt'b- r-+qr'u.-W-�'..1+)M1ry bra t_Lr•r:v.-�r�.r p -�t No. f � T E COMMONWEALTH OF MASSACHUSETTS FEE'�Id0 BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: [0 Individual Component(s) ❑Complete System The undersi need hereby certify that the Sewage Disposal System;Constructed( ),Repaired(y) Upgraded(/bandoned at f. has been installed in accordance with the provi on 's of 310 CMR 1 .00 (Title 5) and the approved design plans/as-built plans relating to application Nob /3 61;ldated P' 3 Approved Design Flow (gpd) Installer CA4-01w*-, or Designer: Inspector ( Utz Date The issuance of this certificate shall not be construed as a guarantee that the s stem will function as designed, FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No,,-0 -3/ -6a THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTI/OrN PERMIT ,Permission is hereb on ed to Construct ( ) Repair ( Upgrade Abandon ( ) an individual sewage �� g disposal system at �F J I L) t.� 1 as/described in the application for Disposal System Construction Permit 1, . Q41 6 D ,dated Provided: Construction`shall be completed within three years of the date of this pertn'tsA�l'1'ocal conditions must be met. Date c l ) Board of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS B WARREN'm PUBLISHERS- BOSTON Town of Barnstable Barn Regulatory Services Department KAMPublic Health Division I Ep A�0. 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2843 2096 March 5, 2013 Mr. & Mrs. David W. Cudlipp 89 Chine Way Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system located at 89 Chine Way, Marstons Mills, MA was last • inspected on 1/29/2013, by Frank Nunes III, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails", under the guidelines of the 1995 TITLE 5 (310 CMR, 15.00) due to the following: • The effluent level in the pit is above the inlet pipe at this time. You are ordered to repair/replace the septic system with sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health • Q:\SEPT]C\Letters Septic Inspection Failures or Future Eval\89 Chine Way,MM Feb 2013.doc liarcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=5362 �PV a u »' # I Lo Logged In As: �.... Parcel Detail Tuesday,March 5 2013 Parcel Lookup Parcel Info Parcel ID 098-061 S Developer Loot LOT 38 Location 189 CHINE WAY ' Pri Frontage 1174 Sec Road Sec i I Frontage Village MARSTONS MILLS Fire District IC-O MM I Town sewer exists at this address NO �I Road Index 10300 Asbuilt Septic Scan: ey Interactive I, 098061_1 Map ( wit 2 I 098061_2 � Owner Info Owner ICUDLIPP, NANCY M& DAVID W Co-owner l%MCDONOUGH,THOMAS&JANICE Streets 128 PLEASANT STREET Street2 City ISHERBORN ( State EA j zip 101770 Country Land Info Acres 1.11 use Single Fam MDL-01 Zoning FRF Nghbd 0106 Topography Level Road Paved utilities!Public Water,Gas,Septic _ Location F Construction Info Building i of 1 Year ��— - � Roof Ext f Built 11989 1 Struct Gable/Hip wall Wood Shingle J Living Roof AC _ ,.. 2851 J Asph/F GIs/Cmp Central r, Area Cover Type Int style Cape Cod I Wall all Dry Rooms Drywall Bed 4 Bedrooms VIV Model Residential I"t!carpet Bath 4 Full+ 1 H Floor Rooms i , Grade Average Plus Neat Hot Air ( Total T9 Rooms ` .. Type Rooms stories 1 3/4 Stories _ Heat Gas J Found- Poured conc. Fuel ation ' Gross 7819 Area Permit History .............. http://issgl2/intranet/propdata/ParcelDetaii.aspx?ID=5362 3/5/2013 Town of Barnstable ` Barnstable j Regulatory Services Department er"a�1 I: nA S MASS039.. Public Health Division m rf0 MAC a, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2843 2027 February 14, 2013 Mr. & Mrs. David W. Cudlipp 89 Chine Way Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system located at 89 Chine Way, Marstons Mills, MA was last inspected on 1/29/2013, by Frank Nunes III, a certified septic inspector for the • State of Massachusetts. The inspection of the septic system showed that the system "Fails", under the guidelines of the 1995 TITLE 5 (310 CMR, 15.00) due to the following: • The effluent level in the pit is above the inlet pipe at this time. You are ordered to repair/replace the septic system with sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\89 Chine Way,mm Feb 2013.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=5362 Z p T H 602 AN le Logged In As: Parcel Detail Wednesday,February 13 2013 Parcel Lookup Parcellnfo Parcel ID 09 Developer8-061 Lot LOT 38 Location 89 CHINE WAY I Pri Frontage 174 I Sec Road( Sec `v— I Frontage Village IMARSTONS MILLS _I Fire District IG Town sewer exists at this address No ( Road Index 0300 Asbuilt Septic Scan: 098061 1 Interactive Map 0980612 s "` - Owner Info Owner CCUDLIPP, NANCY M& DAVID W , Co-Owner Streetl F89 CHINE WAY ( Street2 City OSTERVILLE I State! j 602 5 A Zip 5 Country I _� • Land Info Acres j1.11 Use ISingle Fam MDL-01 I Zoning I RF Nghbd 10106 Topography Level I Road Paved Utilities Public Water,Gas,Septic Location Construction Info Building 1 of 1 Year 1989 Roof Gable/Hip wall jWo d Sh le J Built Struct Living 2851 J Roof jAsph/F GIs/Cmp AC jCentral i Area Cover Type_ 6 Int Bed =1� (S' " I Style Cape Cod J Wall jDrywall Rooms 14 Bedrooms Int(— Bath r Model Residential Floor Carpet Rooms,4 Full + 1 H i M Total Grade Arag yee.Plus ) e i" Air Rooms, RoomS Type Heat .... Found-—._-________ Ad stories 1 3/4 Stones Fuel Gas ation Poured Conc. 4' ► Gross 7819 Area � Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=5362 2/13/2013 �y��� J � � �G � �� �� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M '( 89 Chine Way Property Address Cudlipp Owner's Name ,Y I d rSJOA S 0��I S MA 02655 1/29/13 Cityn'own 01b_ U0 I State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information J14 Ivy 1. Inspector: V Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Citylrown State Zip Code 508.272.6433 Telephone Number B. Certification -� I certify that I have personally inspected the sewage disposal system at this adcFrel and that:the information reported below is true, accurate and complete as of the time of the in"4 ection. The inspittion was performed based on my training and experience in the proper function and i aintenancemf on e sewage disposal systems. I am a DEP approved system inspector pursuantt�a ection 45:340 Title 5(310 CMR 15.000).The system: N ❑ Passes ❑ Conditionally Passes ® Fail -tea ❑ Needs Further Evaluation by the Local Approving Authority C rn al,111 AW 1129/13 InspectoW gig7natu6--�' 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. UW bi 1 A 13 89 Chine Way•03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 89 Chine Way Property Address Cudlipp Owner's Name Barnstable MA 02655 1/29/13 Citylrown 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: System"Fails"due to backup at the Leach Pit B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: n/a ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 89 Chine Way•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts ID Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,•'yt 89 Chine Way Property Address Cudlipp Owner's Name Barnstable MA 02655 1/29/13 City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cunt.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: n/a 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 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 89 Chine Way•03108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 89 Chine Way Property Address Cudlipp Owners Name Barnstable MA 02655 1/29/13 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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: n/a D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® 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. 89 Chine Way-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 89 Chine Way Property Address Cudlipp Owner's Name Barnstable MA 02655 1/29/13 Citylrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® 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 ❑ ❑ 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. 89 Chine Way•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 89 Chine Way Property Address Cudlipp Owners Name Barnstable MA 02655 1/29/13 City/Town 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)] 69 Chine Way•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 89 Chine Way Property Address Cudlipp Owner's Name Barnstable MA 02655 1/29/13 Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 1.5.203(for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes N No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: n/a 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 Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): n/a 89 Chine Way•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 89 Chine Way Property Address Cudlipp Owner's Name Barnstable MA 02655 1/29/13 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Pumped 2011 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: 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: 2/15/89 compliance on file. 3 bedroom permit also on file and engineering at 459 gpd Were sewage odors detected when arriving at the site? ❑ Yes ® No 89 Chine Way-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 a Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 89 Chine Way Property Address Cudlipp Owner's Name Barnstable MA 02655 1/29/13 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 12"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.): Septic Tank(locate on site plan): Depth below grade: 6-1feet 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: 1500g Sludge depth: 2° Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness 1/21' 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 89 Chine Way-03108 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< 89 Chine Way Property Address Cudlipp Owner's Name Barnstable MA 02655 1/29/13 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.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): n/a Dimensicns: 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.): n/a 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): n/a 89 Chine Way•03108 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,..'` 89 Chine Way Property Address Cudlipp Owner's Name Barnstable MA 02655 1/29/13 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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.): n/a "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level w/the bottom of the pipe 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.): D-Box 2' below grade and in average condition for its age Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 89 Chine Way-03108 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a� 89 Chine Way Property Address Cudlipp Owner's Name Barnstable MA 02655 1/29/13 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ 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, etc.): Effluent level in the pit is above the inlet pipe at this time. System"Fails" 89 chine Way•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Chine Way Property Address Cudlipp Owner's Name Barnstable MA 02655 1/29/13 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): n/a 89 Chine Way•03/08 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 13 of 15 Assessing As-Built Cards Page 1 of 1 1' TOWN ON BARNSTABLE LOCATION �� 'g ani A.MT t-114 SEWAGE# VILLAGE + rjAf561 S #1,*1j4 ASSESSOR'S MAP 4 LOT 05,! Olof INSTALLER'S NAME 6 PHONE NO._J�I�tj t�EPTIC TANK CAPACITY j:Sj-3n J } �LEACIHNG RACiLITY:(type) 1rpt�-C�.g 5t (size) fi00 i C;,,NO.OF BEDROOMS_ PRIVATE WELL OIL U� WAT g E ,,BUILDER OR OWNER 14 S' le 1�0 ij 1d cift DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No_�� a E 19 http://www.town.bamstable.ma.us/assessing/HMdisplay.asp?mappar=098061&seq=1 1/29/2013 a Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 89 Chine Way Property Address Cudlipp Owner's Name Barnstable MA 02655 1/29/13 City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 11' 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: 1986 GW @ 11' Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: see above 89 Chine Way•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 ! Ldl 33 en d 10, 3 zv 17 2Y 37 �y 1 z� z7 'o I / r-- 3y -., �7 38 T�. / i i:J y A ruto P'TER; i4 n `"3ls 7 a;t NO 29733 7-1 /3 i . i• - /�5uc�✓.�f,✓-- !� Cn�«-✓CEO _ . � : .:: .: . Z7o FG - 3o.o� fG � 3�0 ��� ��� � ,�.. ,-.- / �-• � �.�1.-sae 3� 5 `-(l-lVEaSRO) / 0 •t SA.�i ': mod. Rl / Box /V G,4G., L-fro,✓ �• Z �. ZY.y ,SEpTyC Z9-/ G'.E,GT/F/E� ;b zy. g M }` C• 3 {'_ L�C,�T/asi /��,esrrv��5 A-lnL s 4 Z3b ZonlE•L LoT 3g �A/.d�g✓caa,/ ���54:� = Z., /oyi/y/i LG. z5575 / GE.erf,CY TN,4T'Th'�'.ccrw�,riry✓Sh�ow.v - .yE.G�E4.v 7;/4 TD1tiiY OF�A-Rr/�� .2E6isr�.ec�.C<tvo.S!/,2!/Eyo,P.� 11NI� /S ,S/ 2 ....,, _ .. �/ � ,.:!� � t1.�.G/.C.4,tij^-• j�4y S�O� /�j!//�.r�Yi,/� �p� �tvk ui raq, WIL- fi'E,2EdiV LIAM Si�4UGp C. s:, T�ESTG/S.yLor--�/,y TI�E:USEp . o NY E No. 19334 0 ! 1 1 i • 4 SUR Town of Barnstable tMWE�� Regulatory Services ti °s Thomas F. Geiler,Director �RM�A MASS.BLE. Public Health Division r �, �ArFo3.iA`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 QFax: 8-790-6304 Date: k8'1&9 Sewage Permit#v70/9—6'0'A Assessor's Map/Parcel -1 G Installer &Designer Certification Form Designer: 1 '�V�� Installer: —CVDW Address: Address: CV00T On 6tyu was issued a permit to install a (date v �(i�nssttaller) ll septic system at ��'��i based on a design drawn by (address) 400� dated 7i' (designer) 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. Stripout (if required) was inspected and the soils were found satisfactory. 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 R- `--ions. Plan revision or certified as-built by designer to follow. Stripout (if r- cted and the soils w re found sfactory. ��N OF MqS o� DAVID e" B. (Insta e ' i e) MASON t If 9 No.1066 0 �; /ST P esigner's Signature) PLEASE RETURN TO BARNSTABLE PUBL._ ��fE OF COMPLIANCE WILL NOT BE ISSUED UN t ii, tsv i n i titb EURM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice fonns\designercertification fonn.doc Town of Barnstable P# � of� Department of Regulatory Services . BAMSPABM Public Health Division Date 200 Main Street,Hyannis MA 02601 M Date Scheduled //,3h,3 Time Fee Pd. Soil �S�uitaba ty Assessment for Se e Disposal Performed By: I/1`'r�l'o � Witnessed By: P's LOCATION&GENERAL INFORMATION Loca(ionAddress Je j 1A `� 0 & ID •,VPb' j� �7F V /�L Address Gv ("'r AssessorsMap/Pazcel: /iH� ✓/ Engineer's Name, MIjA NEW CONSTRUCTION REPAIR Y Telephone# Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 41 I ,�e V f 1 Parent material(geologic) Depth to Bedrock Depth to Groundwater:Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time Observation �,t} Hole# ✓' Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate MinAnch "IM .\!1, Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\.PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. '' JJ Consistent %Gravel 1 V 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graven DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graven DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graven Flood Insurance Rate Mao: Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurrin¢Pervious Material Does at least four feet of naturally occurring pervi u terial exist in 11 areas observed throughout the area proposed for the soil absorption system? If not,what is the dept t ofrtturally occurring perilous material? Certification I certify that on IS (date)I have passed the soil evaluator examination approved by the Department of Enviroi tal Protection and that the above analysis was orme by me consistent with the required training, ert' a an ex erience described in 310 CMR 15.01 . Signa<eDate Q:\SEPTIC\PERCFORM.DOC TOWN OF BARNSTABLE J t� LOCATION .�� T tyli SEWAGE # �' fj VILLAGE nAfSIY,tj_5 '1II/li'li5 ASSESSOR'S MAP & LOT INSTALLER'S.NAME PHONE NO. ,��� �p�i;5 (I not�; j, pSEPT C TANK CAPACITY_ LEACHING FACILITYi(type)`-i� 3 7 A (size) �C�O ;ENO, OF BEDROOMS, PRIVATE WELL O PUI3� L-1C. WATER UILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i L {1 .' k i ` �� � p �'/ �' � ,. .r �. '�' � i � q! ,� .�; ,, _ . r 10 F No.....3.1 11 Fss...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH /l l..............oF....�r�✓�.._.........-.----.-------------......._..--•--._..........---- ApplirFation for Disposal Works Tonstrnrtion Prrmit Application is hereby made f a Permit C nstr t (K) or Repair ( ) an Individual Sewage Disposal System at: JLocation Address or Lot No. / if------•-----....--••-•---- --•-•-----------------••--•------.... ....Xee..... B .....`�.. _........_._` 'L-�'... Owner .�.� Address -------------- .i -----------------------•--------- ............. .� .-•----------------............-•-...-•---- Installer Address !G G r S Q Type.pf Building Size Lot------�(If--•• •_/.—__ q, feet aU Dwelling—No. of Bedrooms___--. p ) g ( ) Expansion Attic Garbage Grinder NO p, Other—Type of Building __0 ?....9M.... No. of persons.......4................. Showers (I ) — Cafeteria ( ) a' Other fixtures_............................................................................ W Design Flow....... --- ..........gallons per person per day. Total daily flow...........3.�_<..... ............gallons. 1:4 Septic Tank—Liquid capacity.A5t gallons Length----!_r?....... Width...... Diameter................ Depth....T._.'...-_. Disposal Trench—No. Width.................... Total Length.................... Total leaching area___j- _____sq. ft. Seepage Pit No--------------------- Diameter____.Q_........ Depth below inlet......_............. Total leaching area.....Ll:4_..sq. ft. Z Other Distribution box V) Dosing tank ( ) Percolation Test Results Performed by....... ...... e............................ Date---- / ............. W a Test Pit No. 1...A!�` R_minutes per inch Depth of Test Pit.................... Depth to ground water.....ff-Ap-_____. GT., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 --•-•-•--•-•---------------------------•------•---• -----•---•.....----- -----........-•--•---•-••...---- -----•-•-----------••-••-•............-----•---- 0 Description of Soil....A-Z.._.."t_4.t"4...;vQAI��r �� � �` ��1au`� �' - « ��"l..s�s,� x �._.. p U ----•--••••••-•-•••---•-•-••••-----•-•------------------------••--••-•-•--•-------••-----------•-•-----•••-•--••----------------------- W ------------------------- ...........................................................................-•---------------•--------••••------------•--••-......------•••-----•------------------------•--. ' U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Sys in ab ordance wi rov the isions of'TT _ : p of the State Sanitary Code—The undersigned furt e agrees n t pl e he syste in operation until a Certificate of Compliance has been issued by the board of health ' Signed.-•-.... __�,r .. --- -•-------------- --•--• --p�...... Application Approved By •-••-• - :_._... ' at , .._.... ........ .. ..... ........ .. ---- ----•-••-- - ate Application Disapproved for the following reaso •............................................................................................................... - .................................•-----------•----•-•••----------••---•.....------------....--•---•...--•-----•------------------------------•-•-------------------------------•------•--•----...._.... Date Permit No.------ • //A?------------------•--. Issued Date 4 No..... . ..._.�l FEB....� ../........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -OF....t.. 4 ."G.-41................................................................ ApplirFation for Disposal Works Cnnnstrnrtiun ramit Application is hereby made for a Permit to Construct ") or Repair ( ) an Individual Sewage Disposal System at ....€ .: .... ! =.. ' ---------------- ------------------------..-. .----•------ -------------------------------•------•------- Location-Address or Lot No. ,wG �. y Owner Address Installer Address d Type of Building Size Lot_.... ,_ . `�-------Sq. feet U ' Dwelling—No. of Bedrooms..........1..............................Expansion Attic ?) Garbage Grinder (PQ p�I Other—Type of Building ..f!_ _: r :.... No. of persons......'/................. Showers ( ) — Cafeteria P I Other fixtures W Design Flow.......:_ R :�-. ` .............gallons per person per day. Total daily flow........... ......-....--......gallons. 1:4 Septic Tank—Liquid capacity. `5:K. .gallons Length._..`0..._.. Width........... Diameter................ Depth....`:........ W Disposal Trench—No. ++� f�:.-__- Width____________________ Total Length.................... Total leaching area.__�"_____sq. ft. Seepage Pit No--_---------------- Diameter.__. _.. ...... Depth below inlet.................... Total leaching area.... ...sq. ft. z Other Distribution box ( ') Dosing tank Percolation Test Results Performed by...... r .; -..._ .. ............................ Date.... sa i ............. as Test Pit No. 1...—.'_ .:.minutes per inch Depth of Test Pit.................... Depth to ground water_____01 GT.I Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ D Description of Soil....0.. 1 0141, 5A ..:..... J r."a _ Rt te_< :..` . ,.,- "............. ---------- ------•... -------------------- W ••---------•-------------- ----------------••-----•-----------.....---••----........----•-----......----•------------•------------•-•-•--------•---•-----•-•------•-------••----•---•---------.._....--- UNature of Repairs or Alterations—Answer when applicable............................................................................................... ...-------•------------------------------------------------------------------------•--............-----------•-----------------------------------------------------------------------------._......---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal IS in a ordance wi the provisions of'T'Ij 5 of the State Sanitary Code— The undersigned furt e agrees n t pi ,e he syste in operation until a Certificate of Compliance has been issued by the board of health Signed.......f' .. °..:..: ; .. I a - Application Approved B ..... .. ate Application Disapproved for the following reaso .-•-•--••-•-•-•-----•••----•-•-•••-••-------------••-••---•-----•--•----•----------•---•----------------•-•-- ---------•-•--•---------•--•-----•----------•------•••---•--•...-•--•-•--------•--•-----•--•---•-•-----•-••--------•-••---•-----•--•---•------------•-•--------------------------------------_------- S�qDate No...... -.. ---------//Z-------------•---.._.. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `CZ OF. ` Tnrtifirair of Tnniplitanre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X) or Repaired ( } e - Installer at-----_-----------------�?. � �. L I d' _._. ,_ ........... -- ------------•-•----------------------••-.._..•--•--•-•--•---•--•---•----•--•------•----------...... has been installed in accordance with the f6visions of TiT'r. of T ff to SanitaryCode as described in the application for Disposal Works Construction Permit No------- 2.�__'..�i.. .. dated _____________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT.YHE SYSTEM WILL FUNCTION SATISFACTORY. Inspector _- - —. DATE................... ,...�.. ----•------=---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ............................. No.......... FEE....... Disposal Work.6 Talnstrn.riion amit Permission is hereby granted.. .: ...... , 1'. .!.HdY------------------------------------------------------------------------------------------- to Construct (,Y.) or Repair ( ) an Individual Sewage Disposal System atNo.................... ._.__._5.__ '_e+V' �......s '(t-� I,...__..._......._........_...__.______._... ._. ._.._. Street i Q as shown on the application for Disposal Works Construction Permit No. --_-/- __ Dated---- .E,� .................. .......................... =----------------------....................................... Board of Health DATE_-----_------- ------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ASSESSORS MAP ! ��� rvc�rr;s: �.}- - - ---- 'I-LST I-10LL: LOGS c_­> PARCEL : \_ rLvoU zU1fE: SU I L EVALUA-1 Ull : �1UJ G 1) '1 lie installation shall comply witl►'l ille V and 'fawn of e)*Y/!�(, Boaid ol' kl� �IC,�� : 1leallh Regulations. ,i WI1IJESS : ✓ IIEI=EItEIJCE: t � 2) 'l Ile installer shall verily the location of ulililies, sewer iuvetts and septic ��� Lam. I � 3 � DA1 E: }. - _--- = collipolents plior to installation and setting Katie elevations. rEHCULA 1 UIJ HA I I : kA1Q) � �� '.�JQ`'I �, �� �J 3) All gravity septic piping to be 4 loch Sch <I1► PVC at I/8"per foul. 'I he Iilsl �b� (/ -� ' two feet out of the d-box to the leaching shall he level. 11-I 2 4) 1 his luau is not to be utilized For Inoperly line delettuinatiuit Iwr ally other purpose other than the proposed system inslallalion. 1L(✓ i 1%1� 5) All septic components must meet Title V specilicalious. Tasking shall not be constructed over I I I U septic components. 7) 'l he properly is bounded by properly corners and properly lines. _ (� --- �� Z ✓---� — 8) '1 lie property owner shall review design considetalious to approve of total LOCA 1 I UIJ MAP , — F\ 4 — — �Jto � � design flowmid number ofbedrooms to be considered for design. Receipt �S3 _ -_ .._ ofpaytueid Im the plan and installation based ou the plan shall be deemed �,� Jarapproval of the design Ilow by the owner. 9 1 he existin leachinJ orcess ►cols shall be primredand filled wills material ) g 6 I Iper'l ille V abai►dotw►ettl procedures. 'I Bose wilhiu the proposed 5115 shall J be removed along with contaminated soil and replaced with clean sand per " Title V specs. 1 lU)System components to be IU feet lions water line. Sewer lines crossing the water line shall be sleeved with 4 inch SC11 �IU PVC with ends grouted if applicable. 'I he proposed SAS is being installed below the water service a� line. The lithe is to be sleeved as aforementioned and maintained its place. �� S L- 1' �I- I C S Y S I CIv1 D E S I C71J ( I O If a garbage grinder exists it is to be retuoved and is (lie responsibility of the 110 / owner to ensure such. FLOW ESTIMATE � 12)'1 lie installer is to lake caution in excavation aiouud the gas line il'such exists. gEU11UUIdS A f GAL/GAi'/HEDhUUId �GAL/DAY 13)'1lie installer shall,verify the localimi, (luantily and elevation oh lie sewer �\ �� lines exiting the dwelling jnior to the installation. SE0 f I C iAIJI� 14)'I his plan is tcpteseulative Duly that a system can lit on a properly tueeliug / 'title V reduitcnten(s. GA,LY DAY x 2 DAYS - 'AL IDS �I� ti/ USE 6 b GALLON S Er,r I C I Alrlc SOIL APSc RPT I VII 'SYS 1011 11 �j } 4 t 1 \, V�-4itZ �ifl�tI Y�U� ✓�l/� �J / —=A 12 DAVID AS jq — --- J f aE13-I, I C. SYS7 L- Iv1 . SECT 10IJ ------------- L_ 7 ► � — ��l ►I>t� A LL&A ?t� � L11 �''V J; iL y3Ljr/Y ID -sue -- GAL , V/ � E(�X��.�� l. ©i L rV�l Nt SEI' f I C 1 AIJIC �. -� � x ,(o� --- S 1 .I-L A1�11� S LVJAGL I' LAID -�- _ LOCAT 1 UIJ : _ PIiLI'AIZLu roll : (� � I P - P r-1 I 1 SCALE : DAY I U 11 . IJASOI l,p UAIE : I � / I)BC AS ILSANUWII C 11� 1 h q ULS I c:�IJS V Z r„ f� DALE , IIL-AL11I AGE11f ( 508 ) 633- 2 1 771 *� ASSESSORS MAP : NO FES: PARCEL : (,p -- --- -I-LST I-10LL LOGS _ I I '1 he iustalladoll shall comply wills 'I ide V •utd 1 overt of \ ° \ l=LUUI) ZUIIE: SU I L EVALUA I UIt. 1/1 G ) 1 Y ►{��! l�uatd of k t �— I Ica I I Regulations. I1tJESS . � ,L�' 1111FERE110E t / I � (JATE: 1 2) 'l lie installer shall verily (lie location of utilities, sewer inverts and septic �G j� /J ( � I ��p cotulrunettls (Hint to installation and sellint! base elevations. UJ/ 1 v"I ,�( "�-,►�'� -- rERcoLA 1 Utr HA 1 E: — J 3) All gravity septic piping to bed inch Sch ,Itl PW al 1/ll" per lout. 'l lie lust bD �t l- ' two feel out of the d-box to (lie leaching shall be level. 111- 1 1 FI-2 4) '1 his plait is not to be utilized lbr pruperly line deleuuinaliuu florally other 6t/L t%tl,L purpuse outer thwi the pruposed system ins(allation. _ S) All septic components utust ineelTille V spccilieatiuns. �✓ I� ��� h SK> (i) 1'tukiug shall not be constructed over I I 10 septic cutupuueuls. 7) 'l he property is bounded by propetly command properly lilies. LUCA I I U11 1,JAP — _ `J 9 L w 8) 'l lie properly owner shall review design considewtiou f t s to approve ootal b �j t design lluw and number of bedtuon►s to be considered Ibr design. Receipt a'( GJ r -� p� — of payment litr the plan and installation based lit► the plan shall be deemed ttl'Ittuval of the design Ilow by the owner. 9) 1 he existing leaching or,cesspools shall be pumped and Iilled with utalerial per'l itle V abaudouuteul procedures. 1 huse within the proposed SAS shall J be renwved along with cuutatuutated soil and re placed with cleats sand per 'I itle V specs. 1 O)Sysleur co►upunents to be 10 leer Guth water line. Sewer lilies crussing tite g;�7Z water line shall be sleeved with 4 inch SC;I 1 dU PVC-' with ends grouted if a! applicable. 'I he proposed SAS is being installed below the water service \ DES L I' I G IJ�I- I S Y S�I�L Iv1 line. Ilie line is to be sleeved as albrementioned and maintained in)place. �� .S t I 1 l) If a garbage grinder exists it is to be removed and is the respuusibilily of(lie owner to ensure such. � FLUYY ESTIMATE t 12)'1 lie installer is to take caution ill excavation around the gas line if suet► 2 exists. B119110OMS A-r 110 GAL/GAYIPEDAUUM `-7�GAL/UAY 13)'lhe installer shall.verily the location, quantity and elevation of he sewer Xlines exiling the dwelling ,mior to site installation. ` r �p S P"T 1(' lAlll( 14)'I his plan is tcpteseutalive ot►ly that a systemeau lit on a propetly uteeting J 1 1 ille V Miuitenteuls. m0,Ai UAY x 2 DAYS -1. 3AL USE I � GALLON SEPJ I C TANK 'r /�� l 01 L A3SCtItP I U1J SYS 1 1 .lu _ cAVID �a M,asoly 1 ^ 1066 ST r , 1, 1 C SYSTLIVI SECT 10N � ,,; �f 7 / L� Dr; TO M GAL J .� SEPTIC 1A1Jlc 3{,l� x a",E�,a o I I Bpi �1t S I �I-L 11W SEWAGE PLAN D ICI U,` PRLPARLU FOR _ (1 , � � �►fit, ��;��?� c��l C -7 SCALE : z \.� �1,Ck, ZIO DAV I D 11 . MA S O H)K5 DA I E : I 0 � DBC LIJV 11WHIAE11 I AL UL- J 101,15 a I: AS I SAVIUW I CI I . MA UA I E HEAL111 AGE1J 1' ( 5 r 08 ) tsJ3 2 1 7T , -----------------