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HomeMy WebLinkAbout0150 JONES ROAD - Health E nes Road Mills Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3> 150 JONES RD /C Property Address DACOSTA Owner �—' Owner's Naree � information is required for MARSTONS MILLS MA 02648 ,every page. City/Town State Zip Code Date of Inspection 49 IV 571 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information �'� When filling out `orms on the computer,use 1. Inspector: only tie tab key to move your DOUGLAS A BROWN curso--do not Name of Inspector use the return key. D.A.BR-OWN INC Company-Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Towr State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. 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 Evaluation by the Local Approving Authority -7-16 o s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to:he 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 LoV V6 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 150 JONES RD Property Address DACOSTA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM MET ALL PASSING REQUIREMENTS AT TIME OF INSPECTION. ALTHOUGH THE AS- BUILT CARD SHOWS AN INSPECTION PORT ON THE S.A.S WE WERE UNABLE TO LOCATE IT. 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 sepfic 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 150 JONES RD Property Address DACOSTA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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 FIND(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•3/13 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 7A- SVBy`0 150 JONES RD Property Address DACOSTA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS 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 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of W Commonwealth of Massachusetts Title 5 Official Inspection Form I' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 150 JONES RD Property Address DACOSTA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of.a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system 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. t5ins•3/13 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 °M 150 JONES RD Property Address DACOSTA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 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): 3 Number of bedrooms(actual): 3 per assessing DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 1 Assessing As-Built Cards Page 2 of 2 http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=047048&seq=2 7/8/2016 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 150 JONES RD Property Address DACOSTA Owner Owner's Name information is MARSTONS MILLS MA 02648 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT CARD SYSTEM CONSISTS OF AN ORIGINAL 1000 GALLON SEPTIC TANK D-BOX AND A 12.7X25 FT S.A.S CONSISTING OF STONLESS PLASTIC CHAMBERS Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d N.A at time of g ( y g (gp )) inspection Detail: SYSTEM NOT DESIGNED FOR GARBAGE DISPOSAL Sump Pump? ❑ Yes ❑ No Last date of occupancy: currentlyoccupied Commercial/Industrial Flow Conditions:. Type of Establishment: Design flew(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: t5ins•3/13 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 150 JONES RD Property Address DACOSTA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: currently occupied Date Other(describe below): General Information Pumping Records: Source of information: 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-3;13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form (r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 150 JONES RD Property Address DACOSTA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2010 per as-built card Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 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): 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: 1000 gallon Sludge depth: t5ins-31113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 150 JONES RD Property Address DACOSTA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 every page. City/Town 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 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank look fine at time of inspection. recommend pumping at time of transfer and every 2-3 yrs there after for maintenance. 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•3/13 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 150 JONES RD Property Address DACOSTA Owner Owners Name information is required for MARSTONS MILLS MA 02648 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 t5ins•3/1:3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments sa`'¢ 150 JONES RD Property Address DACOSTA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): box level no leakage or solid carry over 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: although the as-built shows a observation port we could not locate it. t5irs•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 150 JONES RD Property Address DACOSTA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 16 hi cap infiltrators ❑ 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.): 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 t5ins-3/13 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 150 JONES RD Property Address DACOSTA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 every page. City/Town 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 150 JONES RD Property Address DACOSTA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 every page. City/Town State Zip Code Date of Inspection 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM , 150 JONES RD Property Address DACOSTA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 every page. 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: greater than 5 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: 7-2016 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: design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 150 JONES RD Property Address DACOSTA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 every page. City/Town 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Assessing As-Built Cards Lseea Page 1 of 2 _ TOWN OFBARNSTABLE LOCATION 1,56 -JC rW SEWAGE#d01d-"/ VILLAGE. ASSESSOR'S MAP&PARCEL 04 INSTALLERS NAME&PHONE NO. PAL C SEPTIC TANK CAPACITY rZ x <ST i le,cl G � LEACHING FACILITY:(type) A size NO.OF BEDROOMS 3 +1 t c n c- N a.r, pp.n1GlL-,e A tl OWNER ?C i C lc \� PERMIT DATE: 1(LS-t C COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Or- Feet FURNISHED BY A¢C!� fjia,: JCTk;�J Qeur of HS VOLt` lid !� Our b vrtg� i,000 "D3 ! itoo K L1 n ['CI 5r i hq://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=047048&seq=2 7/8/201,6 Town of Barnstable P#_j )q 3 Department of Regulatory Services > MAS&t� : Public Health Division Date o 039• �e� 200 Main Street,Hyannis MA 02601 Date Scheduled / ho Time Fee Pd. ZUv, Soi Suitability Assessment for Sewage Disposal,i , r � ` Performed By: Witnessed By: �.r\ �- _ h . a LOCATION & GENERAL INFORMATION /� Location Address 't) © � Owner's Name ko�is Address Assessor's Map/Parcel: C54-1V Engineer's Name G` ' 'CS`(Y�.� NEW CONSTRUCTION REPAIR Telephone# S b!'�^-,�j(� Land Use ` :\' t C11 _ Slopes(%) Surface Stones_N j a- _ Distances from: Open Water Body N or ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line_410 _ft Other ft yly. SKETCH:,(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 411 h r � � ��1 ( S E P 1 4 REC'0 _ _ i _ _ •► aid 1 - a ..'.--.�� � - �. cfS( B =1 Parent material(geologic) 0 07 tx3 t% Depth to Bedrock Depth to Groundwater. Standing Water in Hole: 1)L O I> t> Weeping from Pit Puce rLz 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:o weeping froN side of obs hole in Groundwater AdjustmenW ft. A-w —.`. -� � i�"C_V'�r�(...�.-�-•--�..--,- R�du. (�'t . T,.s"'�,,^ ,. � C��CF �-.K — ui'f.�� ti.,wm-c•--.•Fi j"r`Jf a ,6 ...-. .az - ... .-..... "r �. inaPx V { .� •-u� t �,t.c%tiYuc i 7 ,vr:i ` PERCOLATION TEST Date 10 Time &' r Observation ¢ Hole# ; v Time at 9" , Depth of Perc Time at 6" a.. StartPre-soakTime @ Time(9"-6") . End Pre-soaks Rate Min./Inch IL +� � r Site Suitability Assessment: Site Passed, Site Failed: Additional Testing Needed(Y/N) i 7 t 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:\S3PTIC\PERCFORM.DOC F i a a f. DEEP.OBSERVATION HOLE LOG Hole# , Depth from Soil Horizon Soil Texture .Soil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. on istenc % ravel o oNj DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) DEEP OBSERVATION HOLE LOG Hole#T Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,'°Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten Flood Insurance Rate Man: / Above 500 year flood boundary .No— Yes ✓.__ Within 500 year boundary No Yes _ Within 100 year flood boundary No, ' Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervt uP�maatterial exist in all areas observed throughout the " area proposed for the soil absorption system? yes . I ' If not,what is the depth of naturally occurring pervious material? Certification ' I certify that on (d )I a e ,assed the soil evaluator examination approved by the Department of En ironme tal Prote tion n th t the above analysis was performed by me consistent with the required trai ng,expe,'se and e e ie a escribed in 310 CMR 15.017. Date Signature r Q:\SEPTIC\PERCFORM-DOC TOWN OF BARNSTABLE 'I LOCATION (� al��f�Q SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL Q -4- �} INSTALLERS NAME&PHONE NO. P9L Cni Cc, - c`�i rPtO SEPTIC TANK CAPACITY `Lx t-S i i LEACHING FACILITY:(type) (size) NO.OF BEDROOMS 3 ac, OWNER PERMIT DATE: COMPLIANCE DATE: Lao I 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 lid t Sri key,K �aSP No. D Fee ' P100 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS IZIPPlication for Mkg oga[ * item Cou5truction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑ Complete System Alridividual Components Location Address or.Lot No. 1 5 6 S RC-\ Owner's Name,Address,and Tel.No. ' M. M; n5 �C��•U. Cep"-\ Assessor's Map/Parcel 6" o/-i-� - SQZaQ Installer's Name,Address,and Tel.No. '`'Q-C r_0NVr1g C,l® Designer's Name,Address and Tel.No. c Type of Buildings Dwelling No.of Bedrooms 3 Lot Size J �_ sq. ft. Garbage Grinder (1J/ Other Type of Building NOT--.Q No.of Persons 3 Showers( ) Cafeteria( ) Other Fixtures L_C3,JC,, OM I 0he;N tt"517- c1s. Design Flow(min.required) gpd Design flow provided gpd Plan Date -`p Number of sheets C Revision Date Title ` �zc� 5o�s�c�;w:R SQ-,Y,- Sf>o�jC �Sl lye Size of Septic Tank �,C t �_ rv1p CQ\ Type of S.A.S. e`aZ �(, S wimp\, \A Description of Soil 1 - n��i.W0\7_f1S Am a\c2r, Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the re on-site sewage disposal system in accordance with the previsions of Title 5 of the Environ ode no a th m in operation until a Certificate of Compliance has been issued by this Board of Health 71 Signed` ate Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. .�. Date Issued No. rt►,,t:r--�r�' Fee D ! THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s j PUBLIC-HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye 2ppricotion for Xigpogaf pgtem- Congtruction permit Application for a Permit to Construct( ) Repai Upgrade( ) Abandon( ) El Complete System,Individual Components 3 Location Address or Lot No. (5 .hh,,3U(ki S "� Owner's Na1,e,'Address,and Tel.No. Assessor's'Map/Parcel 0" C) Installer's Name,Address,and Tel.No. (-)QLC_ - C DN-N5rg eroDkesigner's Name,Address and Tel.No. Ca(Z4--,C('3 S*SAY 5-C,3-5 39--+q l� Type of Building: Dwelling No.of Bedrooms Lot Size ��f �,`� s . ft. Garbage Grinder Ti 3 q g ( Other Type of Building N_1�pr)_g No.of Persons Showers( ) Cafeteria( ) Other Fixtures LCaW ,, ,,,,.,,Design Flow(min.required) 3 3 rj gpd Design flow provided Li9, gpd Plan Date 10 $ — 1 p Number of sheets �+ c Revision Date 4 Titlei^nz�CRC� `^J�}�SJC �C. GP 34.�JG' .Se2 ��S�SC.� SIsS�P/hl 1 Size of Septic Tank Type of S.A.S. `oZ ,� t( a S �Oc•p\ ��� Description of Soil Nature of Repairs-or Alterations(Answer when applicable) A7) '-i- 1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore dese ''b.ed on-site sewage disposal system in accordance with the provisions of Title 5 of the Env iron e ode •nd not o pla e- ystem in operation until a Certificate of Compliance has been issued by this Board of Health. / = � Signed ate t, r 5 \b U Application Approved by � ,�Date Application Disapproved by: v /� Date for the following reasons f , Permit No. ..+ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS }€ Certificate of Compliance THIS IS TO CERTIFY,that the J.On-site Sewage Disposal System Constructed ( )te�n+ Repaired ( Upgraded ( ) Abandoned( )by C.N U►.1 J at � r� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer #bedrooms Approved design flo614 gpd The issuance of his ermi shall of be construed as a guarantee that the system' will u'ctto as a gned. Rio ---.. Date Inspector _ V i II- —�No: 4 / �t..f�,; —.----.--.--.— . .--_— ------_----- . . -Fee —,,--- 1... THE COMMONWEALTH OF MASSACHUSETTS 77 r PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS &gpo5al *pgtem Congtruction Permit Permission is hereby gra ted to Construct ( ) Repai ) U grade ( Q) 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. rr�� Provided: Constru�tion rq4st be completed within three years of the date of this e ' i 1. �I'/ Date l� , � Approved by / , / Town of Barnstable THE Tows Regulatory Services HAP. o� Thomas F. Geiler, Director BARNSTABLE, Public Health Division Y MASS. `bA 1639. ,`0 Thomas McKean, Director rED MAt 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Dater p� �Q Sewage Permit# - Assessor's Map/Parcel 0.4� a y8 Installer & Designer Certification Form Designer: �'hQ.; r� c AM Installer: ') QX A" Address: Address: D , oa6y9 �- On -) was issued a permit to install a (date) (installer) septic system at i 5U �,10c�S ,",tom\ �`, based on a design drawn by (address) �— Qm dated D (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. 1 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. Stripout (if required) was inspected and the soils were found satisfactory. ? (I Her's b at e) 3Fi, Des1 s Signature) (A \ esfgnetr" Stanp ere) f � �s PLEASE RETURN TO BAR STABLE PUBLIC HEAL ON. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH"THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. ciAoffice forms\designercertification form.doc. LOCATION � '� SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME i ADDRESS Jol� T/ BUILDER OR OWNER DATE PERMIT ISSUED ;20 r DATE COMPLIANCE ISSUED r � �� ��. �� �-'`'� �.�1. � i ____,_.. �� ..i' i. f r- _ -- Y � 3 Fins......'Z g.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN.....OF.............BARNSTABLE .......... .............................--.............................................. Appliratiun for Eliipuual Works Toustrnrtiun amit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: ones Road ...... ......... -........... ................Lot_�..... 2.3..5... � .. .....�J ...... J......---................ :._. Location.Address or Lot No. Owner Address W .'..�° w.... ............... -r" . ........................................•-- �"� Installer Address Pq d Type of Building 3 Size Lot..__........._.9_.__.....Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder Vi�) .-U Other—T e of Buildin APa 4 iAs/ ,6.QA No. of persons............................ Showers — Cafeteria aOther fixtures ..................................................................................................................................................... W Design Flow............55..........................gallons per personr day. Total daily flow-___-_.-.-.330......._........_......Pal �o�ns. WSeptic Tank—Liquid capacity.1,000gallons Length.__ 6 ... Width...4..1Q.. Diameter................ Depth..'`�j____''__....._. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..._....._1_____.... Diameter......1Q Depth below inlet__...._6....._... Total leaching area.....267....sq. ft. Z Other Distribution box (X ) Dosing tank ( ) Percolation Test Results Performed by....PAPR... Survey od...Surve _. ms1tritS Date..... 1.4 Test Pit No. 1...... ........minutes per inch Depth of Test Pit------1.2._...... Depth to ground water.—none-----__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........... P� -OF MAC' x •-•-••-- -•------------•-•-••......•--••-........---•------------------ ....... _ .. O Description of Soil..... .._•5__wood.•loa�lt�......0.,e5....-_..'4a�}...SLibao. ............................................ ---•RGBER1' ycGn `� ......... 'd.......7 0._COarse...s nd...wlg.onie...gx'�.Yei....................•-•-----........----- ............F. V W 012.4 coarse sand-And l p vVoR --- -------------------------------------------•-- . .---•--•-_. .. y 7411 ,0 Nature of Repairs or Alterations—Answer when a licable...._.____________________________________________________________ ,o �p No.Y. •---•--•------------------------------•--•--------------•-•--------•-...........----•-••-•-------------.......----•-------------......-----------•---•------•-•........... g Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance wi sly( the provisions of TIT?.;,;. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. / Sign ........ ........................................................ ••....... ._. Date Application Approved By........ ------ te e� r7 a Application Disapproved for the following reasons:........... ......--•••...............••-•-•-••------•--••-•-•----••--------•-•-•...---........................-••••---•-••---•-•-•-•--•-----•----•-••-••---•----------•----•--•---••••----------------••--.......•. Date PermitNo......................................................._ Issued-`.j.... -•14..- .....--•- ................... Date -1 i, __7 � a � 7� ? T r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN BARNSTABLE ........................ . .............OF..........................---...........-----------------------------•..............-•-- ApplirFafiOn for Biovoottl Works Tonoiratriion Vrrmit Application is hereby made for a Permit to Construct (y ) or Repair ( ) an Individual Sewage Disposal System 32 Jones Road ......... »». -s ................ -• -•---•-•------------------------------------------•---•--•-••----------------•----•---.--..------- 1 J {f 1cocation-Address J(1f or Lot No. 6......•....... `� ......_k' » .. --•--------------•..................---_.... .......... �. .. ..lt<. ..._......... -•--------•-------......................-••-•- 40,4 t4 Owner j 1k Address W .................................................... hL 6__.................................................................._. Installer Address 31D3nn 73 Type of Building t Size Lot----------------------------Sq. feet U Dwelling—No. of Bedroom .....................4....................Expansion Attic ( ) Garbage Grinder/ (e ) Other—T e of Building�. " �''��3�. .. No. .of persons............................ Showers — Cafeteria Otherfixtures . •----•--•-•-••----..-•-••-••-•--•--•-•. •-•.......------•-••••-• --•-------------•-• -•••••........................ ....-•-- W Design Flow..__.___.__-?............_ fl----:-gallons per person per day. Total daily flow........... Q_._______..__......._. oRs WSeptic Tank—Liquid'capacity •._ gallons Length__:._-t_.•.... Width...4_,3,O.. Diameter................ Depth._.............. x Disposal Trench—N1. .................... Width. ................ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter__._..::_.__.__..._. Depth below inlet......... .t....... Total leaching area.....'G�3�_.sq. ft. Z Other.Distribution box O Dosing tank ( ) aPercolation Test Res Performed by, ct E?..................St#'tj y 00 $ . Date..... .1( 1978.. a Testi Pit No. 1................minutes per inch Depth of Test Pit... 2.-....._. Depth to ground water....]On Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...................... V166 tYi + y ---------------••-•----------............•-• P'f�-0F M ovnt3 sub , -------------------•••-----•-•---••-•••-•••-• qs Description of Soils ._--, �yc, x �► '"" ._.RDBERT tiG G'ti3'► t> 1tr/sgla .Z ---•.........................•---•---••_... .� U .. w, �,9 e 0 CCfST'3 ..._��.3.{3 5...... .gra . . . ...... F• � U Nature of Repairs or Alterations—Answer when applicable......._ DAYLOR r„ .o ,p o.23741 O --------------------•---•-•-••--•---........---•----•-•-••-•-•----•-•-•-----------•---....................................................................................... 4i Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accor a c the provisions of TITTIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in S operation until a Certificate of Compliance has been issued by the board of health. Sigd... ........j .....------•.................................•---•-•-•--_••-- dDate Application Approved By....... ......... ..... .. . Datei/ �• . Application Disapproved for the following reasons:....................... --•--•-•-•-•------------•------------•------•-----------------------------------------------•-------•--•-•-----•-----••.....------•-----•-•-•---•-•-••-•----••••-•••---••••-----••--•••••••••---•------ .. Date Permit No......................................................... Issued.........................................:............ » Date THE COMMONWEALTH OF MASSACHUSETTS BOARD (?J5 HEALTH � ...OF........ . . .� I/1!j................................................. Tn#if irtt#r of TontpliFanrr THIS IS TO _CERTIFY, That tie�Individual Sewage Disposal System constructed-( ) or Repaired'( ) by/.......... ................................ ----------------------------------------------------•----------•--------------------------------------------------------......•.........------------- lx f lns Ilr at...................•---•.........•••••...-------•----•-•••--•............••••...-•-•--•••-•---..................................................................................................•..... has been installed in accordance with the provisions of T 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N . -..___ ..__ ._.___._ dated__ «... 1 ... '� '.._____._. THE ISSUANCE OF THIS CERTIFICATE SHAL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH . . .........OF......... FEE Disposal Vorkii Tono#rur#ion rrnti# Permissionis hereby granted _..--•--.........................••-•-•-----------------•------••------•----••.................•--.-•--- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No......`==r I ..:.. ' .....• i.. . <. l ` J....P. 1 Street as shown on the application for Disposal Works Construction it No... ... :A.a,d Dated._ n_/_�`. ZC.......... .......................... H DATE............................................................................... R FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS x. c " i • BOIL LOO / �,n i u( ►fit S �����'�'� .:tiA�,n rvx 4h:r• .,F,e :y}..�.,�WnV 1:I,T!Ic � �l �.J.aIL_ / — - ���. ._� L1 • ' 2.,of�S tONf LOAM e-Fiti2 ro. n � 4 C.I. D I S T ,� BOX 1 , • - J WIN iQQQ et, .{N IOOO GAL. !/ GAL. L`� ! '',; ".� PRECAST OR •� �° So�1�. 8f21A�i�tst ` ( SEPTIC 6 1 ,f BLOCK 13Z.✓ TANK .� SEEPAGE PIT 1 M 20' MINIMUM • v c1 FOUNDATION I %: WASHED STONE ' 6Z?•S 1 I SCALE I 5 EUVATION SKeTCH 10. -{ PQGlC.ypATQ � L SS_.T-" .7�1�a Mi/tilclT�_P SCALE i"- 4' TEST BY : GAP--. t �S• TOWN INSPECTOR BACKHOE OPERATO � �TQb/ _ TEST MADE ON _ R44 / �(a !9_ .� --- JONES - t Tttlw'. 5T'•'faL4TL. ItP,9 -c4#cWN wp-r2.t< t.,OcsA•Ta�o �► v F�O A O I3Y AN of Tc rW>A L- rs 4 u-p swKy ` as aN MAY 1-9 1 1'78 ,&,NP PAY-I.AW:a or- TH m Ta w N Dt= V. AAAE79, J 1,f ix , . , • � �i.�u,r.p.-�1oN � � riG,StWN �t,.C�Wm t'TY � 510f✓WDtt�t•- t Sr_X 1.'XalSi�o= A'?14*1 I� to exI MrINU ff5 13 93 a.F sE�rlG .►lNx' ` �3 - �9 � - za 8oX •� 1� .t . !2 yt. or 1 � \ vtIA 1 . P., y ti 1Rje�?AWjf 'Age fi to In t t 36 M � ELEVATION SCHEDULE r PROPOSED SITE P1QIn1 I INV AT FOUNDATION � 1,�!�L� fit' OF, w q � qAE BtaYBT ®�818q C 11414� 2.' INV INTO SEPTIC TANK �/ � ROBERT yG �c9 IN F. ROBERY 3 i NV. QUT OF SEPTIC TANK = 13Z•5� C3 No AYLOR �t of 23741. ( � DAYLOR O c '("DY�/N 1 A+V Ir.�''f•L��'1►� No, NfOff Ci 4, INV INTO' DISTRIBUTION BOX = t3�'`�"`f � .� w��� CALE : I"-Wl 19 ,a�r C�ST�� 137.21 C-e"407 5 1 N V OUT OF DISTRIBUTION BOX 6. INV INTO SEEPAGE PIT 134'•Z� CAPE COD SURVEY CONSULTANTS ROUTE' 132 7. BOTTOM OF PIT _ 130• HYANNtS, MASS. A DIVISION toiTON rU*Y[Y CONOULTANTJ, INC. - 8. BOTTOM OF STONE LAYER r 2-1b" DIAM. ACCESS MANHOLES x n 4" PVC (CAPPED)INSPECTION PORT TO BE INSTALLED AND TO BE WITHIN 6.OF GRADE VENT PIPE ((@ Least 24 Inches tall) :,� C;` JI ,d *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. Schedule 441 PVC w/Char000l Odor Filter ESTABLISHED VEGETATIVE COVER .-. " h Existing Foundation �house,to Isepticrrtank S.tic tank covers must be D-BOX cover must be '. ... .. .! OUTT 5 TOP OF FOUNDATION ELEV, 100.00 pp f had de within b In. of finished grads y t within 6 in. o finis grade Grads over Septic Tank- sab.00 Grade over D-Box-9b.00 Vrade over SAS -08.00 �' ` ♦ i. ' +, •. ,, + +;,v , ,+j+ ''mot l \i .• +` •••+ %° o R ,'•.•' '^",t r;••:;+, .,r;', !r ! r.+•,+. „+ ., 'rr:'' r ' DISTRIBUTION BOX LEACHING COMPONENT u ;•t t n r ,, BACKFILL WITH CLEAN SAND " r: r ,. (.r•:''..,'Y�a• t ,.v u,.�.,, +., a a •.+.f,•r•"r ,, '+, r „4r t' ,.r•r:.A+:�. • r•Yr h + Y , tr ,r• .• +• 1 + Mfg �'•:. .A r •r •,, ':, a 1, •1 • ,. •f4„+! r ,• �' wm_ v v �• " s} +� y+ c ! t (NATIVE OR PERC SAND) t, } . . „ SET DEEPER THAN b INCHES BELOW FI�lISHED r, .rr r!�.y v' +7 !. '+1,7,. M �,'. -" +++ :tr.++rr•,.ri4 7 dv ui. y ,y, _. RAISED IN 0 OF r >r, +1Y, tt+ `r' `r •,s+ `rr."' ':,• GRADE SHALL BE TO MATH i' ,:; „ FINISHED GRADE. �r �'' T REINFORCED ORC D PRECAST CONCRETE E I S 2 - ^. ++, "` ''", A w i' STEEL E NF E EC C0 C ET 0 4 b HOLE H-10 � "0'• t � I TOP OF UNIT ELEVATION 95.00 IT rs , ., ,. ,+,r 9,4 '4, . ... "rr.r,+•,!. r+�..r'!+ t4 ti,,+ r •. i+•„ { ,S A. S O,O " : 'v+r Lr ', ' t •r :, v M'.r i',,i n INSTALL 1UF-TiTE GAS BAFFLES OR EQUALS f.. - 1 or Greater IST. BOX S Maximum Covsr 4" PVC CAPPED INSPECTION PORT TO BE+r 15 EXIST. (CAPPED) .r� + r t , tr ,•t .,s.v ,.+ +v,., ri H ,4 r � t ,! tr.:, µ INSTALLED AND TO BE WITHIN 6" OF GRADE i T P In 1000 GAL. S•" A Y 0.01" INV. ELEVATION - 94.50 1''' C7 ' M ,,,++ r.. 1'!+' +i 4'r'rr+ , t ,•ir .t++ •,i4 r+Y.• •irb' N p fa ELAN VIEW FROM EXIST, FOUNDATION Gi SEPTIC TANJK �p of j.�, t,n ;,r /•' 3-24" REMOV LE COVERS <O H-10S1n to . ,1 + 1 y''N+ - . , . . . . . . . it O- O, li N r t OONCRETE FU li it u•i 9 BOTTOM ELEVATION -' 93.50 ' :t. ;.r 4" sr .;, _ ''Y ���''' GENERAL NOTES G 3 min. clearance %� r 13' INLET'T" y b in.of 3/4"-T 1/2" Tv" 1 ta' 6' ,EXISTING SUITABLE MATERIAL b" min. 2"min. inlet to outlet _ . ,� w > compacted stone rn 4 ROWS OF 4 UNITS AT e.25'/UNIT+ 2 END CAPS• 25.OD' t"'"" °"'"�'' OUTLET 1, Contractor is res onsible for Digsafe notification, Verification of Utilities °' S' MIN ABOVE BOTTOM OF 6� ; Liqul7Tiret"" yr p u 4 4 - o rnm. ,4• �'� and protection of all underground utilities and pipes. > TEST PIT OR GROUND WATER ti " SYSTEM P OFILE > _ 5' -7" - 5' -7" c - EFF, WIDTH f2,�0 2. The septic a distri ution box shall be set Not to $cola - "� Bottom of Test Hole 1 Elev.= 88.00 GROUNDWATER NOT OBSERVED a 4'-0" min• „' level on 6 of 3�4 -1 1p2 stone. b in.of 3/4 1 1/2" " i• s« '" Liquid depth 3, Bockfill should be clean sand or grovel with no compacted stone ';-: GROUNDWATER NOT OBSERVED 0 120 a "' NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 8" BELOW GRADE BOTTOM OF TP-1.: - 88.00 " SUIL ABSORPTIOU SYSTEM CSECTI❑N) I stones over 3" in size. ESHWT NO GROUNDWATER OBSERVED 0 120 1 4. This system is subject to inspection during installation HIGH CAPACITY INFILTATROR (H-20 LOADING)/ GEORGE O'BRIEN "'''•+ .� t'• ,'-'"'+A•" ,r *~ w •' ' by Carmen E. Shay - Environmental Services, Inc. ®"_o• 4 -10" 5. The contractor shall Install this system in accordance (OR EQUIVALENT) CROSS SECTION AND SECTION with Title V of the Massachusetts state code, the approved plan NOTE: EFFECTIVE DEPTH OF INFILTRATOR 1$ 11" and Local Regulations. NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" 6. If, during Installation the contractor encounters any TYPICAL 1000 GALLON SEEIIC TANK soil conditions or site conditions that are different NOT TO SCALE from those shown on the soil log or in our design instoliction must halt & immediate notification be made to Carmen E. Shay - Environmental Services, inc. 7, No vehicle or heavy machinery shall drive over the PERCOLATION TEST septic system unless noted as H-20 septic components. Date of Percolation Test: 10/04/10 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. Test Performed By: CARMEN E. SHAY, R.S., C.S.E. 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. Results Witnessed By: DAVID STANTON - BARNSTABLE BOH 10. All solid piping, tees & fittings shall be 4" diameter EXCAVATOR: Shay Environmental 'Services, inc. Schedule 40 NSF PVC pipes with water tight joints, Percolation Rate: <2 MPI 0 6,0" 11. MUNICIPAL WATER IS AVAILABLE TO THE SITE and Surrounding Test Hole Test Hole Properties. No. 1 No. 2 / DEPTH SOILS ELEV. DEPTH SOILS ELEV. J 0 98.00 0 98.00 ROM Sandy Sandy THE PROPERTY LINES ARE APPROXIMATE AND / Loam Loam COMPILED FROM THE PLAN BY CAPE COD SURVEY CONSULTANTS J 10 YR 3/2 10 YR 3/2 ENTITLED "PLAN OF #150 JONES ROAD, Ar 97.50 0'-6" At, 97.501 MARSTONS MILLS, MA J PLOT PLAN sand scndy DATED MAY 24, 1978 / AT SHOULD ND IS TBET USED DFOR NO PURPO TO BE A SE OTHER THAN J 6"_24" 10 YR 5/6 6"-24" 10 YR 5/0 THE SEPTIC SYSTEM INSTALLATION, J Be 96.00 96.00 J SILT LOAM SILT LOAM J I3 Y 2.5 Y NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE J 24"- 40" 94.67 24"- 40" 04.67 FROM THE EXISTING LEACH PIT TO BE DISPOSED / C, C, OF AS PER BOARD OF HEALTH SPECIFICATIONS, / Mad/Coarse Mad/Coarse 9 2.aSand Sand2.s Y%4 EXISTING LEACH PIT TO BE PUMPED DRY & / ,"96 40"- 120 1313,00 0"- 120 88.00 FILLED IN -PLACE /^,Ply _ LOT #324 + ^ V P // 100 / oo """•s.-•..+err Ar r.rr^•".-' � ASSESSORS MAP -- 47 PARCEL 048 " `S' ',5` Perc #1 ' ZONING -: ,RESIDENTIAL Depth to Perc: 40" to 58" Perc Rate- <2 MPI PROJECT BENCH MARK 10 Groundwater Not Observed NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY TOP OF FOUNDATION No Observed ESHWT / ELEV. = 100.00 (Assumed) ADJUSTED H2O Elev. None .� ar LOT' #323 ALL OUTLET PIPES FROM THE EXISTING �� DISTRIBUTION BOX SHALL BE " - -e'"'�'' i� 3 Bh'.DROOM SET LEVEL FOR AT LEAST 2 FT. _.- �fh � 12 CONCRETE COVER aovS ' � k' s s" OUTLET f. 2" LEGEND • '+,, ,+ r „• f, -" ;' KNOCKOUTS GRAVEL , #f84 •�'f --- 15,5" *: -� 12" INLET 88X0 DENOTES PROPOSED ,A. DRIVEWAY ^- FAILED _ OUTLET ) EXISTING01000 gal. Leach Pit ��' ~�---._ s B• SPOT GRADE Septic Tank i' ;' " "' `''' 2 X 104.46 DENOTES EXISTING ''------ ..--�` � / a � Jr� 15.5 1.75 D-Box .f` PL/AN--SECTION CROSS SECTION P� - PROPERTY LINE i 5 HOLE DISTRIBUTION BOX - H 10 Effj-- PROPOSED CONTOUR / TEST HOLt`#:,, � NOT TO SCALE - ELEV.- 98.00 -,._ai 97-- - ,.- -. -97 EXISTING CONTOUR Design Calculations O Number of Bedrooms: 3 Equivalent to 330 Gal./pay DEEP TEST HOLE & Garbage Grinder: No PERCOLATION TEST LOCATION j 2.7 TEST HOLE #2 Leaching Capacity Proposed: 330 Gal./Day Minimum ; ELEV,= 98.00 Septic Tank - 2? x 330 Gal./Dcy -660 USE EXIST, 1,000 GAL. TANK , FENCE 1 SOiL ABSORPTION AREA: Using percolation rate of <2 min./inch �>4" PVC � - Bottom Area: 0.74 gal/sq. ft. x 473 sq. ft. 350.02 gallons 46 0' 'VENT Sidewall Area: NOT USED PRIVATE DRINKING WATER WELL 06.601, Providing: 350,02 gallons Uses 4 ROWS OF 4- HIGH CAPACITY CHAMBER UNITS REVISIONS STONE FOR AN SAS HAVING 1HE DIMENSIONS# 12,70' x 25.0' NO. DATE: DEFINITION LOT #322 Bottom Area: (General Use Approval for 4.73 SF/LF of INFITRATOR 4 UNIITS + 2 END CAPS per ROW - 25.0 FT1 10-5-10 CaICUIptiOhS 1 4 ROWS x 25.0 x 4.73 SFJLF - 473.00 11 LOT #325 DESIGN FLOW PROVIDED: 0.74(473 S.F.) 350.02 GPD 31,893 Square Feet +j- VARIANCE REQUESTED: 1. REQUEST A VARIANCE TO INSTALL A SAS MORE THAN 3 FEET BELOW GRADE . A 4" PVC VENT AND H-20 CHAMBERS HAVE BEEN PROVIDED. rO�r *` CID PROPOSED LOT #326 %-61? PREPARED FOR : �I 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM 10 OF 00 PATRICIA COVELL # 150 JONES ROAD Bedroom Dining MARSTONS MILLS, MA 0 ; 1 50 JONES ROAD Bedroom r Kitchen MARSTONS MILLS , MA 02648 PREPARED BY: t ,,z:� � � 2nd FLOOR 1st FLOOR ..� `� . "RHEY E. SHAY 3 BE 10usE I=I_aaR cNF � C I_ •EAWRONMENTAL SERVICES, INC. (Description Provided By Owner) ~ 111 THORNBERRY CIRCLE MASHPEE, MA 02649 GiSTE LOT #321 S'41VI-FA111?� "`;.. TEL/FAX : 508-539-7966 r 1 "-20' DRAWN BY: CES DATE: OCTOBER 5, 2010 T#SD-1193 iLENAME: SD1193PP.DWG SHEET 1 OF 1 III : i I