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HomeMy WebLinkAbout0067 LITTLE POND ROAD - Health owl 67 Little'PorY`d.Road A= 065-022 Marstons.Mills a �¢C f: 6 ji i i ti Commonwealth of Massachusetts 0(OS^v�Lc*;_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Volunt Assessments L ITTle- Property Address C l _ L//e✓1-- - - d�'1 Ail n Owner Owner's Name information is rA r _0 N �'/ (,mod _ required for every page. City/Town State Zip Code Date of Aped, on Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end o`the form, 61=' t s I Important:When filling out forms A. Inspector I fo mation on the computer, ' / / Po .Suse only the tab key to move your Name of Inspector _ cursor-do not aE,41V( use the return Company Name /f key. Q U O� Company Address l / 45�a 0a I City/Town�5 State Zip Code resaav / _ Telephone Nu mbe License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and mainten a of on-site sewage disposal systems.After conducting this inspection I have determined that the s em: 1. Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Inspe is Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. tsinsp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts P Title 5 Official Inspection Form I. Subsurface Sewage Disposal System Form -Not for Voluntary Assess ents 67 41—I Mle, Property Address d�g h✓1 Owner Owner's Nam1VtQr5L-15 information isrequired for every page. City/Town State Zip Code Date of In pecti n C. Inspection Summary Inspection Su ary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) Syste asses: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass' section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l Property Address �qh _ Dvner Owners Name Its information is ll Q(s required for every I o l J page. City/Town State Zip Code Date of Vspecf on C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ 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. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t56isp.doc•rev.VM2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - of for Voluntar Assessments 67 Property Address p Owner Owner's Name information is G r f �0✓1 j / r'l/S IV14 j /01-� required for every page. City/Town State Zip Code Date of Ifispection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Tide 5 official Inspection Form:Subsurface sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form N t for Voluntary sessments u 6Zl; ee- off Property Address Owner Owner's Name information is required for every page. City/Town State Zip Code Date of I spec on C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ Static liquid level in the distribution box above outlet invert due to an overloaded / or clogged SAS or cesspool ❑ L+",1( Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Z/ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 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 C.4. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7/2&2018 Tide 5 Official Inspection Form;subsurface sewage Disposal System-Page 5 or 18 Commonwealth of Massachusetts ? Title 5 Official Inspection Form i. Subsurface Sewage Disposal System F rm -N t for Vol unta Assessments Property Address _ tMa h Owner OwnePs Name information is v required for every page, City/Town State Zip Code Date of Insp ction C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must Indic to"yes" or"no"for each of the following for a!!inspections: Yes .0 ❑ 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? ❑ as 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 NIA) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has / been determined based on: Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Tide 5 official Inspection Form:subsurface Sev age Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Volunta Assessments 7Tle, � Property Address Owner Owner's Name �t information is �i rsA/I& A4V01��required for every _ page. City/Town State Zip Code Date of In pect on D. System Information 1. Residential Flow Conditions: 3 J Number of bedrooms (design): Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: ,s 4S 14-AV", aa� a Y- 7-vi-,"io 1 4?.a6--vs — 4/,o Pow Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes No Seasonaluse? ❑ Yes LSO Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? Yes J"'No Last date of occupancy: AeA p y' Date t5insp.doc-rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form ;P Subsurface Sewage Disposal System o Not for Volunta Assessments O�(% Property Address Owner Owner's Name 1 �f information is Ct�.s7 �/� 6vL �'O 3 required for every T� /� I -�1 page. City/Town State Zip Code Date df Ins ection D. System Information (cont.) 2. Commerciallindustrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of infor mation: Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7126=18 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntar Assessments 6 Z-Ae. 4 ,4 Property Address Owner Pir(�w va Owner's Name / information is required for every /f 0n f page. City/Town State Zip Code Date o Ins ec ion D. System Information (cont.) 4. Ty:7W m: 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: Were sewage odors detected when arriving at the site? ❑ Yes FtJNo 5. Building Sewer(locate on site plan): Depth below grade: feet Material of constructi;e4---O ❑ cast iron PVC ❑ other(explain): Distance from private water supply well or suction line: _ ee feet Comments (on condition of joints, venting, evidence of leakage, etc.): tSinsp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for VolunX4d Assessments 67 �,f�l� lei Property Address (;P�o Q fn Owner Owner's Nam Ail-If /'�l�information is required for every e Ctrs OVIS VO� 3 J, page. City/Town State Zip Code Date of Inspec ion D. System Information (cant.) 6. Septic Tank (locate on site plan): 7 Depth below gr feet Z construction:te ❑ 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: S �l u Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 1 30 Scum tttickness ' 3 -7 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? fib Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): PLA Yh N GCO WI °vH� t5insp.doc•rev.M6=18 Title 5 Official Inspection Form:Subsurface sewage Disposal system•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �is Subsurface Sewage Disposal System Form -No for Voluntary Assessments C � L. Property Address 6/N'lavr inform Owner's Name information is � h e required for every �t rs nJ !I f _ y�� 3 P page. City/Town State Zip Code Date of I pec on D. System Information (cunt.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: - Capacity: gallons Design Flow: -- gallons per day i t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - of for Volunta Assessments Property Address Owner Owner's Name ' V VO�W4 3 information is required for every page. City/Town State Zip Code Date o Ins cti n D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert &Vro 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.): -�-�/ ` X t5insp doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts �- Title 5 Official Inspection Form �= Subsurface Sewage Disposal System Fo mA t for voluntary Assessments 70 L/ o, Property Address Owner Owner s Name iUectin infonnaaion is required for every Date of In page. City/Town State Zip Code D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: — Title 5 Official Inspection Form:Subsurface sewage Disposal System•Page 13 of 18 tsinsp.doc•rev.7/26/2018 Commonwealth of Massachusetts e Title 5 Official Inspection Form I. Subsurface Sewage Disposal System Form -Not for Voluntary A essments Property Address Owner — P'l evvr Owner's Name information is required for every r'i l' `i�Ns �• A (faes— page. City/Town State Zip Code Date Ins ction D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 7- �� n' `� o��G w �c �►r G�rG 1 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool - Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.726/2018 Title 5 OFfirial Inspection Forth:Subsurface Sawage Oisposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary A essments /7774e,-, Al Property Address _r1rf c11�' Owner Owner's Name information is � I � (3 a, required for every 4 page. City/Town State Zip Code Date of I spec ion D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: - Dimensions Depth of solids Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): LSinsp.doc•rev.7f26l2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts z Title 5 Official Inspection Form Subsurface Sewage Disposal System Fo -N t f r Voluntary Assessments r Property Address � �I Owner :Ownerr's Name information is required for every G rs S / C�c� 6 page. City/Town State Zip Code Date of spe ion D. System Information (cont.) 14. Sketch Of Sewage 'sposal System: Provide a view a sewage disposal system, including ties to at least two permanent reference landmarks o enchmarks. Locate all wells within 100 feet. Locate where public water supply enters the build' Check one of the boxes below: and-sketch in the area below drawing attached separately /— ..►ram CT t5insp.doc-rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 , TOWN OF 13ARNSTARLE WCA7MOPt si t4ACrE# � LLAGE ,A rtr�3 . ASSESSOR':S MAP:&PARGEI: 0. INSTALLEIVS NAME 4:PHONE NCl: +t � f SEPTIC UN CAPACITY: �.� :w LEACIIIN FACII ii f'(type Chi i F iJ b:(size)s p x t t,, r� NCJ OF BEDROOMS. OWNER r, , PERMIT'DATE: T hA COMPLUNGE:DATE; . / Separatio{mistance Between the`. Macimym Adjusted.Groundwatcr'fable to the Boiivra af' hi,ig Facility x .Private Water'Supply Wet[ond'Leaching Fadity(If any exist,01) ssteor,,in Q0=feet'vfJeaChtngfacit2y) Feet. Edge(If'Wttlaodr and Learhing Facility(If aMy:iveflands eXi t u fhira: 3..00 feet of leaching.-€aoiiity) Feet ,FURNISHED U7LrI4 B ('� � � t5't�►'ti t. t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage nisposal System Form - of for Vol un ry Assessments L- � +�P/ A✓1� i� Property Address aw Owner Owner's:Name information is required for every I Ir o f 1/_(!_ 0PLW 3 a a page. City/Town State Zip Code Date Insp ction D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date — ❑ Observed site (abutting'property/observation hole within 150 feet of SAS) Checked with lo9pl Board of Health-explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how yo estished the hig ground`_ water eleyan:�44,3- 6. 1 6e lo 4n,de e-�-� 7 f �44 s s _14K Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title.5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form III Subsurface Sewage Disposal System For -Not or Voluntary Assess ents Property Address Wl aylti Owner Owner's Name information is �- required for every page. City/Town State Zip Code Date of Ins ctio E. Report Completeness Checklist Com;�A. te a applicable sections of this form inclusive of: I pector Information: Complete all fields in this section. B. rt�cation: Signed& Dated and 1, 2, 3, or 4 checked C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 ilure Criteria)and 6 (Checklist)completed D. System Information: For E:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 1.5: Explanation of estimated depth to high groundwater included t5in3p.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE CATION t L.`1�� �c�y�� r��� SEWAGE# VILLAGE ,p r.�,i�y� tlK� ASSESSOR'S MAP&PARCELOGS INSTALLER'S NAME&PHONE NOV-4--.4Q SEPTIC TANK CAPACITY 1� �� ��w `��`�✓ LEACHING_FACILITY: (type (size) �37.6' x k L§"�x ;cv NO.OF BEDROOMS OWNER l�t,p,r, ��• ^� PERMIT DATE: COMPLIANCE DATE: ' Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility > Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) I "I Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHEDBY�kdQC-D'4 A 1 �� �34 0 l 3 � _ G t�- \Vf Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �/ PUBLIC HEALTH DIVISION - TOWN OFiBARNSTABLE, MASSACHUSETTS Yes applitation for Mispo8a1 ,6pitem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade(�bandon( ) [:]Complete System VIndividual Components Location Address or Lot No. o 3~�� �� � Owner's Name,Address,and Tel.No. =�j� �O S� Assessor's Map/Parcel -- � O a 2 Jsk`M Yr Installer's Name Address,and Tel.No.ij=5$1$kn(.6055 Designer's Name,Address,a d Tel.No.Sb t ^ chi ( Type of Building: Dwelling No.of Bedrooms Lot Size ? sq.ft. Garbage Grinder( ) Other Type of Building ? No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided gpd p Plan Date p(n ®(s Number of sheets o� Revision Date Title Size of Septic Tank t r Type of S.A.S. � ..T— Description of Soil ��•P� ✓� Nature of Repairs or Alterations(Answer when applicable) � x,e,Js,�g -f' -W r -G, _"_2 � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. b Signed Date p l �} r/ Application Approved by _V 112C Date Application Disapproved by Date for the following reasons i Permit No. Y0 l r Date Issued s x Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISIO.X�; TOWN OFfBARNSTABLE, MASSACHUSETTS 'S application for Disposal- p 4rm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(Abandon( ) ❑Complete System 21ndividual Components Location Address or Lot No.6 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel<:!D- S // S Installer's Name Address,and Tel.No. Designer's Name,Address,and Tel.NWs 36Z�-33�f = 4�'�� -cam v_-- '' C7( �'�>✓�(�,r ti Sc�v� Sjsi� Type of Building: k Dwelling" No.of Bedrooms Lot Size > sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow(min.required) gpd Design flow provided S �" gpd Plan Date O m Number of sheets Revision Date ti Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) . \ �( f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore.described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. e Signeda2� enDate / Application Approved by �_. -._. Date '-t -1 Application Disapproved by Date for the following reasons Permit No. Date Issued 1 ------------------------------------ ---^-------,-------------------- ---------------------------------------------------- ----- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded VI) Abandoned( )by at (, �� has been constructed in accg�dance rov with the isions of Title 5 and the for Disposal System Construction Permit No.0' //01 S-""'dated N . Designer 4V\g—_u #bedrooms r Approved design flow / gpd The issuance of this permit shall not be con trued as a guarantee that the system wt1`hf it a{f�n ass designed. Date Inspector_ Inspector No. 6 1 > ^L-2-0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade Abandon( ) System located at (T� k r and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title.5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. I Date b r� ; Approved by Town of Barnstable .�t"E'Or+ti Regulatory Services o� Richard V. Scali,Interim Director BARNSrns[,e. 9�A MASS. ��� Public Health Division TFan9'�° Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 24 l Sewage Permit# 4 cS—Q 12;3 Assessor's Map\Parcel p( bZZ Designer: NeAA-10_.,(_ Installer: Address: 0 I;�0, �Y 1 Address: _ �•� yr lU,a,✓�`� �� r��,�(�.y���� Ong ,iS' . ,3 as issued a permit to install a (date) (installer)/� septic system at G� 079- Po-�id P based on a design drawn by (address) dated (designer)D ^ n 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. Strip out (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 Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constru E liance with the terms of the 1\A approval letters (if applicable) a�A OF �� to RRE VSSignature) 0 114 esign is Signature) (Affix tamp Here) PLEASE RETURN TO B STABLE PUBLIC HEALTH DIVISION. 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. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Town of-Barnstable °FTME r � Regulatory Services Richard V. Scali, Interim Director B MASS. Public Health Division v Mass. � t639. c 3�e,`� Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 ` Office: 508-862-4644 Fax: 508-790-6304 Homeowner Certification Form for Alternative Svstems Property Address: (07 L411I 9 62 NJ i M' / 41 L0 Assessor's Map\Parcel: eA0 2,2- Property Owners Name: 9j60 1,L,CT In accordance with Massachusetts DEP alternative system approval letters, the following certification information is required by the Owner of record. The Owner of record must place an "x" in the applicable box next to each line certifying the information. Yes N\A ❑ I have been provided a copy of the Title 5 I/A technology Approval letters. (15 page Standard Conditions letter and the specific technology letter) I have been provided with the Owner's Manual ❑ 56 have been provided with the Operation and Maintenance Manual ❑ I[ For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(l0) nd the Approval For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15287(5) ❑ If the design does not provide for the use of garbage grinders, the restriction is understood and accepted LJ ❑ Whether or not covered by a warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303 I , 57A1- 71&OIL 5-F agree to comply with all terms and conditions above. Pr perry Ow e s print name Property w s Si nature Date Note: This form must be submitted along with the septic system disposal works permit application for all I\A systems including new construction, rep airs\upgrades, with and without aggregate (stone) and with conventional design criteria or credited design criteria. Q:\Septic\IA homeowner certitication.doc .t Ni TRANS. NO.: CITY/TOWN: APPLICANT: Q,r ADDRESS: 1 e DESIGN FLOW: 33- gpd REVIEWED BY: DATE: N/A OK NO GENERAL' Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan[310 CMR 15.220(4)(u) Locus Provided 310 CMR 15.2204(t) Plan proper scale?(1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] X System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways, parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] �( Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(0] daily flow septic tank capacity(re uired andprovided) soil absorption system(required andprovided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g) Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h) Names of soil evaluator and BOH representative [310 CMR x 15.220(4)(h) and(i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? 310 CMR 15.242 Certification statement by Soil Evaluator[310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n) Address lY ttm E Sheet 1 of 7 M N/A OK NO Location of every water supply, public and private, [310 CMR 15.220(4)(k) within 400 feet of the proposed system location in the case x of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR X 15.220(4)(m)] if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer 310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220 3 X Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] 'l Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? X [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not> 36" deep (unless Local Upgrade Approvalor LUA requested) 310 CMR 15.405(1(b) Address (,(� '' "�-' u Sheet 2 of 7 fir, /i,1Lt,s �/1/ - �y ,1 N/A OK NO SEPTIC TANK Size OK? 310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] x Outlet tee with gas baffle or approved filter[310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] D( Separation between inlet and outlet tees (no less than liquid x depth) 310 CMR 15.227(2) Inlet/Outlet elevations at least 12" above high groundwater (.-xcept as described 310 CMR 15.227(5)) or permitted for X upgrades under LUA[310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 x CMR 15.232(3)(f) Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<I 000gpd, two for systems >1000 gpd 310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR X 15.228(2)] > 10 ft from building foundation[310 CMR 15.211(1) Buoyancy calculation Required/Done 310 CMR 15.221(8)] X H-20 Where appropriate? [310 CMR 15.226(3)] �C Setbacks from resources 310 CMR 15.211] mot, Y Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and (3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CNIR 15.224(4)] Address /A Ale- 1964 Nam(. Sheet 3 of 7 M- ,�ls ' e f N/A OK NO BUILDING SEWER AND OTHER PIPING Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line (when water and X sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided ? [310 CMR 15.222(8) Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] �( Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) 310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/(leachfield below pump chamber) Endca s or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h) Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) X DISTRIBUTION BOX: Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] X Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] X Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] �( Minimum sum 6" [310 CMR15.232(3)(e) Watertight cover if<2000gpd); waterproof manhole if>2000gpd X [310 CMR 15.232(3)(d)] PUMP CHAMBERS x; Capacity (emergency storage above workinb design flow)? [310 CMR 231(2) Proper setbacks 310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and (8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed? Provided? 310 CMR 15.221(8) Address W ( LI (1 ��'��` K Sheet 4 of 7 �- /fit� � 1� � • . N/A OK NO SOIL ABSORPTION SYSTEMS (SAS) GENERAL _. Calculations correct? 4 feet f naturally o to all Y occu rnnb materia l demonstrated. [31 OCMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed 310 CMR 15.247(2) System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] inspection ports specified and within 3"final grade? [310 CMR 15.240(13) Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] GALLERIESXITS-XHAIVIBERS:310'CMR 15 253 . . 4- Chambers and Gal, in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate 1' minimum- 4' maximum. [310 CMR 15.253(1)(b)] 2'sidewall credit maximum[310 CMR 15.253(1)(a) X In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)] TRENCHES 310CMR'15 - � Width T minimum 3' maximum [310 CMR 15.251(1)(b)] 100 feet- maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours 310 CMR 15.251(2) Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] BED;SAS (Maximum size of bred or:;feld 5000 gpd) ' "` { `4L minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' 310 CM R15.252(2)(d) Maximum separation between lines and outside of bed 4' [310 CAZR 15.252(2)(e)] �� r Aggregate depth below discharge pipes 6" minimum, 12" maximum. 310 CMR 15.252(2)(g) .Separation between beds 10' minimum. 310 CMR 15.252(2)(0 t_ Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address �� � Pe l_ Sheet 5 of 7 9"1 A1 � l� F • 1 N/A OK NO DID THE PLAN.INVOLVE Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r) Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval[310 CNIR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system- make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems< 2000 gpd) or quarterly (>2000b d) good to note on plan[310 CMR 15.254(2)(d)] " �( Construction in fill - Did the plan specify that the fill shall meet �( the specification of 310 CNIR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer 310 CMR 15.255(2)(b) Retaining wall must be designed by Registered Professional Engineer [310 CUR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CUR 15.252(2) and Guidance Document] u At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Gravelless System;[I/A Approval Letters) j 3 Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge X to scour soil 'interface Alternative'Septic Syste n[RA Approval Letters) , ' y� ,._£*£ Was DEP Approval Letter provided and/or have you. reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? i Is there a note on the plan regarding the requirement for U, perpetual maintenance agreement?' Any alarms involved on se agate circuits Did the applicant submit an`operation and maintenance manual? .. Has applicant submitted a copy of a maintenance Variances Are the variances listed on the plan ? [310 CMR 15.220 (4)( )] RLS Stamp necessary on plan if a component is within five feet of property line [310 CNIR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414 Address �j`7 �, 1� Sheet 6 of 7 N/A OK NO Nitrogen Sensitive-Areas Is the system in a Designated Nitrogen Sensitive Area (Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? 310 CMR 15.214(2) Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Miscellaneous .. Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address Sheet 7 of 7 'own of Barnstable P# I/YT-1 Department of Regulatory Services MAX"N % r Public Health Division Date MA83. �AP i439.A1� 200 Main Street,Hyarrais MA 02601 Elr MA'1 6 I. Date Scheduled / Time' 1. Fee Pd. Hwy "Soil Sicitabiiity A.ssessrnent for° Sew e = isposal Performed By: ��� �'�`+ ��✓ Witnessed By: ��` W• SGt/��D„ �/ I LOCATION&.GENERAL INFORMATION Location Address (o ~( L � � Owner's Name Address Or Assessor's Map/Parcel: 0 S�Oa Engineer's Name p4-', �t-1.1-- � V -2 NEW CONSTRUCTION REPAIR �� Telephone# S-o 3 6O- 3 Land Use K�'s 1 e� AT.k, Slopes(`Yo)_1_9 Surface Stones Distances from: Open Water Body> ft Possible Wet Areal ZOO > _ft Drinking Water Well ft Drainage Way 7!6 Q ft Property Line _>16 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) �y S ie +� Parent material(geologic) jCC " 11/� Depth to Bedrock t" Depth to Groundwater. Standing Water in Hole: Weeping from Pit FAce C� Estimated Seasonal High Groundwater DEN VIINATION FOR SEASONAL HIGH WATER TABLE i 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 bevel i PERCOLATION TEST' bate Thne Observation Hole# Time at 9" Depth of Pere Time at 6" Start Pre-soak Time @ I lime(9"-6") End Pre-soak lg Rate MinJlnch �~ Site Suitability Assessment: Site Passed X Site Failed: Additional Testing Needed(Y/N) i 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 _V S DEEP.OBSERVATION'HOLE LOG Hole# Depth from Soil Horizon Soil Texture; Soil.Color. Soil Other Surface(in.) (USDA)' (Munsell) Mottling (Stnucture,Stones;Boulders. onsistency.%Gravel) lh i 4 DEEP OBSERVATION HOLE LOG dole#. i Depth from Soil Horizon Soil Texture Soil Color Soil Other r Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisten %Gravel) . " vs, i i DEEP OBSERVATION HOLE LOG Hole# tk I Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. nsistency.%Gravel) j M ' i 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. i i • i 3 ' Flood Insurance Rate Map: i f Above 500 year flood boundary No Yes ._ / ._____ Within 500 year boundary No y Yes Within 100 year flood boundary No, Yes Depth of Naturally-occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? d f' aural occurring— -� a-t-eer-ial? If not,what is the depth naturally t ly urnng pervious m Certification I certify that on fo IC (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the requir training,-expertise and experience described in.310 CMR 15.017. o IK Signature 1 ' Date ! Q:\SEPTIC\PERCFORM.DOC j TOWN OF BARNSTABLE 22 ?oAJ61)ed, SEWAGE # r �7�� VILLAGE111A,'6% Aj, IS ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 00 �1_ A LEACHING FACILITY:(type) 1066 14/.LOB size) NO. OF BEDROOMS- PRIVATE WELL OR UBLIC WAT BUILDER OR OWNER, k DATE PERMIT ISSUED: 1 .DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No, - .� ��� �� �� � J.. po ^c; V�0 °�' ��, '�G.c �,1 4 S�DL x b � No.11-3_�>D_ --k:;1Z FEx 7/ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -PP.W.114...................OF......B.AF Ns-rASLE_.......................... Iiration for Ilia nia1 nr ��� � k T n trnrtuan ramit Application is hereby made for a Permit to Construct (><.) or Repair ( ) an Individual Sewage Disposal System at: L-c_I S. IL Tb�. > E-=rrA -es ... ....................................... ......_.. -- Location-Address or Lot No. AQRd. .1 f►LT 7 ------------------ L arLE...Rom o�►v- ... Owner Address ■.......................................... a ----- - ..................... ARNS']74$LE..�N(ARSTt?NS ...... .LS Installer Address Q Type of Building Size Lot 4"..... .t.Sq. feet U g— .............Expansion Attic (go) Garbage Grinder (No) Dwelling No. of Bedrooms............. ................ aa Other—T e of Building No. of persons............................ Showers YP g --------•------•------------ P ( ) •— Cafeteria ( ) QOther fixtures --------•---•-----------------------•--•---------------•---••-••••-•-•••----------------------------------....----- ...... W Design Flow.........55...............•.__•..._..gallons per person per day. Total daily flow-------330........................gallons. WSeptic Tank—Liquid capacityli.O.00gallons Length$..4..... Width'_ 10.. Diameter________________ Depth_5__6 x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Q.Seepage Pit No......1............. Diameter-----I -__-____ Depth below inlet-5k.7.... Total leaching area..Z.57...sq. ft. z Other Distribution box (X ) Dosing tank ( ) a Percolation Test Results Performed byCgR9:.COD 5tM-VE CCA(3"4M�ITS Date_...4 7 Test Pit No. 1---- .........minutes per inch Depth of Test Pit__ 44....... Depth to ground w f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground .. � P a eta _.. STE�HCV r:S'e?:, • Description of Soil TP* LOT'�5 O"— 30"ToP Solo- a`5uB50/G. a AL`Yv x ff 30. 2 l•... • - '44 T�e.AT .. F SA�1P 4z t_�IED••---- ----------- WCv.,RA1/F1..,--------------------- . •o ff° °�, `' U Nature of Repairs or Alterations—Answer when applicable................._____________•_____.......____.___..........._. ouf •�d�---- Agreement: a e✓f The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT1_2 5 of the State>anitary Code—The undersigned further agrees not to place the system in o on until a Certificate of Compl' ce en issued by the board health. Sign '!.. -----------••• •. / _Iq PPIi i n Approved�By.... --- . .......... .............................................. ............4�-- ---- .Q �, Date Application Disapproved for the f ollowin easons:-------•••----••---•••-••--•-••--••-•---••-•-----•-----•---•---................................................. ..-•---•------------•-----•--------------•---•-----------•-•-------------.....-------------•------...-------•-•-•••---•••--•-•--•---------•------••-•--•••-----•-------••-•-•••-----••••-•-•---.•-•-•--- f� 21 Date Permit No. -!'- �`�l�®...................... Issued ..... Date No................_....... Fxa....... l..........��..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L�. . ...................OF...-.. fl'�+ ��..e►" 1a .... Aplrliration for Dispag al Workii Tonitruriion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _'Fbm i> S-5;r�tT_'�__._S ......-- -_- Location-Address -••- -••••- C:.A ?R.i ai?.�1_ (es`_: .. A...:TT"i.e _i ..tp•"P°p ao.. -- Owner i. :. AJa'�7�1(Cfit4E. MART ?AU It�I_{4L5 ,a - .� Installer Address U Type of Building Size Lot45,00tSol. feet .-, Dwelling—No. of Bedrooms.............3................_..........Expansion Attic Wo) Garbage Grinder (No) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ..................................................................................................................................................... Design Flow.........,.t~'.6..........................gallons per person per day. Total daily flow.......�� 0.......................,0Ions. �' W Septic Tank—Liquid capacityl��l�_gallons Length>�_._�_____. Width�___l�1 Diameter________________ Depth___._... _.-. x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area--------------------sq. ft. 3 Seepage Pit No------I.............. Diameter....10....-_.._. Depth below inlet..,V"_,.(Q7_.___. Total leaching area_9.57...sq. ft. Z Other Distribution box (SC ) Dosing tank ( ) Percolation Test Results Performed bya�lp_!;�0©__S VE COAISuG�''}A1fSDate__._4_~"7-_8(' Test Pit No. 1...?.........minutes per inch Depth of Test Pit___.. `°__. ... Depth to ground w V T, __ g 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground ...........4SPI si, 1:4 __..._...•-•-----------------------•----.......-•--•---••--•-•.....•-•-----•-•••------••--••--••--••-....... U fb `' • � SIE? �1.._ Description of ..®___ ,��..."`T"� S tC.. �r O/L ALLYN_______ c`' v 34?" N ___ �, -- I� ________ .--"--- �...__�1_t..�rs� ���15?__ ._�Z_ _-�.�.'�"�t.-•---.ITT't-F�-��•-•-------------------••---------- `'- ...__�^rit_sor� No.302i6 P' ---------------------- - x a hST V Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________ ___ ri ...---•-••-•----•-•-••---...-•------------------•----------••-....-••-----------._. ._ .. h�AL��9-d- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'I'LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in o ion until a Certificate of Compliance has been issued by the board of health. Signed........ ._..----••.............•---------.....------....------------------- -•-------------..._....-----••- r D to pp"ic ti n Approved ----------- By . ---- ---- `�--. u = Date Application Disapproved for the followin easons:-•----------•---------•--•-•----•-•-----------•----•••-••---•---------------•-------•--••----•------•--••--•••-- -------------------------------------•-•--------.....---------------------...--------...•------•---------I.......................................................-....................................... u ? Date Permit No......................................................... Date Permit Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ............................OF..................................v..:_............_.......---........_..._._. Trrtif irtttr of ToutpliFanrr THIS ISM-O_CERTIFY, Th t the Individual Sewage Disposal System constructed (�) or Repaired ( ) -t cC'( C_ by.................... ;--------------------- -----�-•-••....------------I----11-----------...---------------..._......__f.._._...........---------------........----------------- has been installed"in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No- -)__'_3 10__________________ dated_.....C_--_�-_____S... ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE.....................1.C2___-j:.. .......................... Inspector...................... .....l,.l--•----••---•--••----...---•----•-•-•--•---- THE COMMONWEALTH OF MASSACHUSETTS �. BOARD OFF HEALTH ijB r! 36� ............................................. FEE. �r No..... ............... .......... Disposal Workii Tongotration rautit Permission is hereby granted------ ---------------------•----..._...•-•----....------....-----....----..._......---...... to ConstructV ) or R�ir ( ) an Individual�Sewa e Disposal y tem i at No.1.u7C"-----------------l.S......... ,( -���= ---------�`-- J .....�U•-----... Street as shown on the application for Disposal Works Construction P r it No.5?_-_7-'6 ___ Dated___.__. .- _____ ............. :.. - ^� - ------------------------------ - t/� Board of Health DATE......................-••-------•-----•---...1­6"') .............4_g� FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS LOCATION go-cQ I..cl►�c I Fcermee� �I� y2� N0._P -5 I— -_ VILLAGE �s�r.►15 11 i�lS _ DATE - 94 APPLICANT vor�crn2n �cQ I i Toyst FEE ADDRESS_2(, gco f4m TELEPHONE' NO. 77/_/3/e (Non-refundable) ENGINEER �,� S'�rvt� _TELEPHONE NO. _ DATE SCHEDULED f-- (Applicant' s signature) • • • • • U O . p . • • • O • • O • • O • • • • • • • • . . • • • • • • . • • • . • • • • • • • • . . . . . • • • • O • • • O • • • . • • • • • •ASSESSOR'S 6IAY • • & LOT No : �iwp �1-3 is ;3 a SCUT. LOG SUB—DIVISION NAME_ G i/f� ®dr►� Ft�� � DATE_ 4 - 17- Ire. TIME (Ol4rv1 EXPANSION AREA: YES NO ENGINEER 'DOWN WATER K PRIVATE WEE, - Tom•, "Cl—trail BOARD OF HEALTH EXCAVATOR SKETCH: (Street name, el:c. ,dimensions of lot, exact location of L•esL holes and percolation Lc� :ts, locale wetland.-, in proximity Lo t.esL- holes ) NOTES : 1091 7` t 93 W r d � • y 1 PERCOLA'P1,JrJ 'PEST 11OLE NO: I LI'VATION : 'ZEST HOLE 1\10: ELEVATION: 2 5�fogo a A 2 scmd _-- ....__.. 5 5 __---- 6 - -- —ew " E, - - U _ �5aota® f` gr�ar Inc/ U ----- 9 / 9 lU _ lU 11 11 i 4q" 12 We �-� 12 _- 13 v v, c�� 1 3 14 14 16 16 SUITABLE FOR SUB-SURFACE SEWAGE : LEACHRIG FIELD LEACHING PITS LEACHING "TRENCHES -- UNSUITA1tLE FOR SU13-S[MF.7\CE SEWAGE.. REASONS : NOTE: E,NGIMEE;RING PLAIDS MUST SHOW MJMB1 [2 ASS)IGNED ON PE'RC TI;;ST APPLICATION ORIMHAT,; C011fT,rTr.T) Trl• 1?Wr'TRI;TY PY 1) . P. nT11) P!TtTP.rlr•ln -TO n�)?\Pn-n[:, T1r11T,T[1 COPY: RETAINEU 13Y APPLICANT - — a MARSTONS MILLS LEGEND . 3 LOCUS 67 LITTLE POND RD. PROPOSED CONTOUR 9® PROPOSED SPOT GRADE p -- 98 -- EXISTING CONTOUR oY l O + 96.52 EXISTING SPOT GRADE v W— EXISTING WATER SERVICE 0 RACE LANE ® TEST PIT ' CONVENTIONAL 13X25 BENCH MARK p 9g 3 BEDROOM FOOTPRINT TOP OF FOUNDATION Q 96 93.22 I� 94 BARNSTABLE GIS DATUNI 213.03, 92 p �l O s 90 gg 86 LOCUS MAP 84 gz PAVED DRIVEWAY ' LOCUS INFORMATION r TITLE REF: BK 6300 PG 204 PARCEL ID: MAP 065 PAR. 022 _{_•_• _ O 1• 1 - / I i � I i 'I 'V I r SEPTIC SYSTEM REPAIR PLAN yd' LOCATED AT: ,I o ;fir J;;� I I � l �" 67 LITTLE POND ROAD L_O T 15 :-'20 ft AREA = 45000 sf+— (,�% c)c, z % ;�AREA . MILLS, MA fill PLAN BOCK 239 Pf c ,,E 83 //% r �,�/ - 'O-" PREPARED FOR col / Gf6 ASSR +,I.GP 65 PCI_ 22 / � -'�Fp RIGOLET/READY ROOTER i 0 AUGUST 17, 2015 ma's 80 Or MAss9 �AEYR{ t N 78 .4 SANITWLLJ P� MEYER & SONS, INC. 9492 , P.O. BOX 981 76 PL AN goF k EAST SANDWICH, MA. 02537 SCALE: 1 in = 30 ft EX15T. 1 ,000 GAL S8 „86 84 %/ PH: (508)360-3311 0 30 60 82 FAX: (774)413-9468 LEACH PIT . 0 10 20 3o EXI5T. I ,000 GAL ga 78 . 76 meyerandsonstitie5�gmail.com www.meyerandsons.com. SEPTf6 TANK . �� . � , SHEET 1 OF 2 J#17.44. ' n I � NOTE:MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: TO PREVENT BREAKOUT, THE PROPOSED ' FINISH GRADE SHALL NOT BE < EL:85.69 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. T.O.F. EL.=93.22f SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6 OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. VENT GENERAL NOTES: • F.G. EL.=92.6f F.G. .G. EL.=92.40t F.G. EL: 91.Ot F.G. EL: 91.0(MAX.) 1.'ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 9" MIN COVER/ OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 36" MAX COVER L = 25' P L = 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: ® S=1% (MIN.) EL. 90.57 ® S=1% (MI0 S=1% (MIN.) - 310 CMR 15.405 (1) (8): 4"SCH40 PVC - 4"SCH40 PV4"SCH40 PVC 1) A 2.31 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING TO BE 5.31 FT (MAX) BELOW GRADE VS REO'D 3 Fr. (H20/VENT PROVIDED) LLj1O- 11.3" TO \INV.=89.521 14" INVERT 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 4B"UWD INV.=89.27INV.=85.30 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE �L,EL DESIGN ENGINEER. GAs BAFFLE) 4 ROWS OF 6 UNITS AT 6.25'/UNIT = 37.5'/ROW 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING INV.-86.8FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. INV.=87.0 SOIL ABSORPTION SYSTEM (PROFILE) 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. EXISTING 1.000 GALLON SEPTIC TANK 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF EXIST. SEWER OUTLET RESTORE VEGETATIVE COVER THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. BACKFILL WITH CLEAN PERC SAND 7. DWELLING IS SERVICED BY MUNICIPAL WATER. TO TOP OF CHAMBERS 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. NOTES: 1 CONTRACTOR SHALL VERIFY ALL EXISTING 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE BREAKOUT=TOP ELEV.=85.69 LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK. PIPE INVERTS PRIOR TO CONSTRUCTION INV. ELEV.= 85.30 2) D-BOX SHALL BE SET LEVEL AND TRUE TO OF 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. BOTTOM ELEV.= 85.36 �� '�Af 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION GRADE ON A MECHANICALLY COMPACTED SIX EXISTING SUITABLE Q� J'� INCH CRUSHED STONE BASE, AS SPECIFIED IN 2.83' MATERIAL y�`� :9 12. THIS PLAN IS TO 8E USED FOR SEPTIC SYSTEM PURPOSES ONLY Z G AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 310 CMR 15.221(2) 5' MIN. ABOVE BOTTOM OF �E R M 13. NO KNOWN PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 4 z 2.83' = 11.32 o WITH 1500 GALLON SEPTIC TANK IF FAILED, (7.06 PROVIDED) USE 4 ROWS OF 6-HIGH CAPACITY 15. ALL PIPING TO BE 4"SYSSCHTEM 40 O 1/NOT (UNLESS SPEC. ) DAMAGED, OR UNDERSIZED. BOTTOM OF TESTHOLE: EL:78.30 = INFILTRATOR (H20) UNITS W/ ENDCAP-NO STONE y 1 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW C/ E � FOR THE USE OF A GARBAGE GRINDER. 4) INSTALL INLET & OUTLET TEES W/ 16. NO WETLANDS WITHIN 150 FT. OF PROPOSED LEACHING GAS BAFFLE AS REQUIRED SEPTIC SYSTEM PROFILE NITA0, 5) PLACE "T" IN D-Box. TYPICAL SECTION N.T.S. mts. , 75" DESIGN CRITERIA SOIL LOGS P#• 14787 NUMBER OF BEDROOMS: 3 BEDROOM DESIGN DESIGN FLOW: RESIDENTIAL: 3 BEDROOMS ® 110 GPD/BR = 330 GPD DATE: AUGUST 12, 2015 DESIGN PERCOLATION RATE: <2 MIN/IN SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) SOIL EVALUATOR: DARREN M. MEYER, RS, CSE 1614 GARBAGE GRINDER: NO (not designed for garbage grinder) WITNESS: DAVID STANTON, BARNSTABLE HEALTH DISTRIBUTION BOX: USE DB-5 (1-120) Elev. TP- 1 Depth Elev. TP-2 Depth • SEPTIC TANK: 330 gpd x 200% = 660 gpd USE EXISTING 1,000G SEPTIC TANK 89.80 0° 90.80 0" L A LOAMY SAND A LOAMY SAND 'LLEACHING AREA REQUIRED: (330)/.74 445.94 S.F. 89 13 1OYR 3/1 8r, 90,13 1OYR 3/1 8" PRIMARY S.A.S. LOAMY SAND LOAMY SAND 10YR 6/8 10YR 6/8 USE 4 ROWS OF 6 - HI-CAP INFILTRATOR H-20 UNITS-NO STONE 87.47 28° 88.30 30" • B LOAMY 6SAND B LOAMY BSA D SEC-0 N !NV>RT BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF CHAMBER) 84.30 C 66" 85•38 C 65" HEIGHT END CAP (CHAMBER) 24 UNITS x 6.25 LF x 4.73 SF/LF = 709.50 SF MEDIUM MEDIUM INFILTRATOR - HI CAPACITY (H2O)CHAMBER PERC TEST SAND SAND ® 83.1 2.5Y 6/4 2.SY 6/4 TOTAL AREA = 709.50 SF PROPOSED SEPTIC SYSTEM UPGRADE PLAN DESIGN FLOW PROVIDED: 0.74GPD/SF(709.5SF) = 525 GPD > 330 GPD req'd 78.30 138" 79.30 138"11 67 LITTLE POND ROAD, M. MILLS, MA PERC RATE <2 MIN/IN. ("Ci" HORIZON) NO GROUNDWATER OBSERVED Prepared for: RI olet/Ready Rooter Exc. ', System Design and Site Plan by: SCALE DRAWN DATE **11.32 X 37.5 = 424.5 SQ FT. > 400 SQ FT. REQUIRED MEYER&SONS,INC. N.T.S. DMM 08/17/15 • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX961 to conduct soil evaluations and that the above analysis has been performed by me consistent with the EAST SANDWICH,MA 02537 CHECKED SHEET NO. requirements of 310 CMR 15:017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. 508?62-2922 DMM 2 Of 2 - 1A 1i SOL TEST PIT DATA: SEPTIC TANK DETAIL: 1 � 000 G4AL . DISTRIBUTION BOX DETAIL: LEACHINU HI I U� IL: REVISIONS- tN INDICATES INDICATES NOT 10 SCALE PERC. V OBSERVED NOT TO SCALE NOT TO SCALE NO, DATE P_554�) TEST GROUNDWATEW LOAM 8 SEED MANHOLE C( VER NOTES: 1. SEPTIC TANK SHALL BE STEEL 4. INLET AND OUTLET TEES TO BIE CAST IRON, L- NO. OF OUTLETS: BROUGHT TJ FINISH GRADEi OR PAVEMENT TP Lo-T- 15 TP TP TP REINFORCED CONCRETE. SCHED. 40 PVC OR CAST-IN-PLACE: CONCRETE.TEES It GIRD. EL. 68.7 GIRD. EL. GRD. EL. GRD. EL. 2. SEPTIC TANK TO WITHSTAND H-10 LOADING TO BE CENTER-ED UNDER MANHOILE COVER. NOTES! -7 2"MIN OF' 8 G W. E L. m o yxTE P_ GW. EL. GW. EL. GW. EL. UNLESS UNDER PAVEMENT, DRIVES OR 1. DIST BOX TO WITHSTAND H-10 LOADING TO 1/20 FILL WASHE _j TRAVELED WAYS WHEREIN H-20 LOADING TRAVELED WAYS,WHEREIN H-20 LOADING I UNLESS UNDER. PAVEMENT, DRIVES OR D 12"MIN. PRECAST I-__ STONE , SHALL'APPLY. SHALL APPLY. A DIST. I r_-� f�- , - f -I , 3. ALL PIPE CONNECTIONS AND CONCRETE MANHOLE COVER GRAD4 z BOX 2. PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF BROUG14T TO FINISH a = C= :C= I= C= C= C= C3 CONSTRUCTION TO BE WATERTIGHT. VC INLET PIPE IS U e So i L_ INLET PIPE EXCEEDS 0.08 FT/FT OR IN t cr PUMPED SYSTEM. -.4=:j­r= cm cm C2 a % NOTE: GENERAL NOTES: _ 6il� 2-, L___T- 3. FIRST TWO FEET OF PIPE OUT OF DIST CIO LEACHING PIT TO - COVER e IL-rLA SA"�� WITHSTAND H-10 LOADING 1. - THIS PLAN IS FOR DESIGN AND BOX TO BE LAID LEVEL. L 17,71 . '61 m . CL C3 cl cm c= C-D C= C= 0 — UNLESS UNDER CONSTRUCTION OF THE SEWAGE PLAN VIEW Tj I.' REMOVEABLE-\ PRECAST PAVEMENT,DRIVE OR DISPOSAL FACILITY ONLY. v,x,l PERC 7NORMAL WATER LEVEL 3/4"TO 1-t/Z" a cm C0 C= C= = (M C3 0 TRAVELED wAY WHEREIN COVER > - ' LE H-20LOADING SHALL 2. ALL CONSTRUCTION METHODS AND 10 6, 7 DOJ3 LEACHING PIT MATERIALS SHALL CONFORM TO MASS. WAS E APPLY.' _D a = m r= C= C= c=1 a D.E.Q.E. TITLE 5 AND LOCAL BOARD r HI 114" PROVIDE STONE TEE OF HEALTH REGULATIONS.- INLET WATERTIGHT (no fines, JDINTS( yP) 0 C3 C3 r:3 C=) cm C3 a 3. ALL PIPES LOCATED UNDER PAVEMENT -1 SEE ,t- NOTE 2 C4" INLET L,4 'j) OR TRAVELED SHALL BE SCHEDULE TANK 4 - .. 0 0 m m 0 13 40 OR EQUAL. PRECAS T 4'.0" MIN. OUTLIET I SEPTIC LIGUIO DEPTH —P TEE J0 cm c=1 4 OUTLETA r SAt,lv �' (�PA\/F_L J ---------- L _j z DIA ---BOTTOM ON BOTTOM LEVEL STABLE ON LEVEL STABLE BASE 0. CROSS-SECTION 7171��/ - BASE DIA. PLAN VIEW CROSS-SECTION VIEW CROSS 4 4_1 17,1,7 — CONSTRUCTION NOTES- DATE-.' DATE: DATE: DATE: INVERT ELEVATIONS: -4Su&A8LE,SOI'L:' NCOUNTER"Et,'ALL U 4-7- �WITXIN -A wttt sk4Lt,8E ,REM0VED TEST BY: TEST BY: TEST BY: TEST BY: 87. 56 LEACH'INS FA,61_11TY; f 4w INVERT AT BUILDING 26NS AROUND ,TH Ep C 4N '-Z,-r VF_ VJILSOQ LOT 16 6 AND- SHALL SE R LA St ITH"tLS 4N INVERT AT SEPTIC TANK(in) 'jN-ACCORDANCE WITH ND 'A WITNESSED BY: WITNESSED BY: WITNESSED BY: WITNESSED BY: �ND GRAVtL P Ke A"_i NIF -7, 11 TITLE 7. 1. 4 INVERT AT SEPTIC TANK(Out) 8 41 CAPRICORN REALTY TRUST / I PERC. RATE: PERC. RATE: PERC. RATE: PERC. RATE: 40 INVERT AT DIST. BOX(in) 67 , 03 MIN./INCH MIN./INCH MIN./INCH MIN./INCH' 8(, 4v INVERT AT DIST. BOX(out) S78. 5.3#4E, I I INVERTS AT LEACHING FACILITY: DATUM: ASSUMED VERTICAL DATUM: 8G, S7 17. \CP 4- NIF Lr) I , I — BENCH MARK USED: SEE PLAN CHRISTOPHER F. KAPP cl- 1,0j OBSERVED GROUNDWATER Q_ ELEVATION —7 LC-1 6,4 brc_ T X C.B./D.H. FND. j ZONE:RF _7 V 1.Jut SETBACKS; IkIv, 57 j FRONT 30' DESIGN CRITERIA. DESIGN FLOW: 7`7 - 15 SIDE j 1 /h REAR 15** �4 BEDROOMS AT I/G G.P.B./D 33 0 G.P.D. LOT 4 I ,Z It x 1 97, Ajo GAP�EA6E (:i7P_L1VjpEA_1_11 Z / 7z, 0 NIF ED CAPRICORN REALTY TR 71�/ UST A The BSC Group fl REQUIRED SEPTIC TANK: 2c 3 30 x 495 GAL. NOTES: I SEPTIC TANK PROVIDED: 14000 GAL. / 6- 1 P/1_F /LA.) Cape Cod Survey Consultants PROPERTY LINES SHOWN HEREON WERE COMPILED I\N SIZ_E OF LEACHING FACILITY REQUIRED: FROM A PLAN RECORDED AT THE BARNSTABLE 1V z DESIGN PERC. RATE: MINJINCH REGISTRY OF DEEDS IN PLAN BOOK 429 PAGE 58 / /6 Yt 3261 Main Street CK) AND DOES NOT REPRESENT AN ACTUAL SURVEY ON C7.,p to Route 6A Barnstable Village MA THE GROUND. �Ilj 02630 _j V11, 617 362 8133 THIS TOPOGRAPHIC SURVEY WAS MADE ON THE GROUND BY TRANSIT AND STADJA .METHOD t�j 4s,:L PROJECT TITLE: ON MAY, 1970 SIZE OF LEACHING FACILITY PROVIDED: A, Cli SEWAGE DISPOSAL '/ I., . / 1 - (01 PIT w _ST6�4 --q t�7 SYSTEM DESIGN F 53, W _5/D.C W A 1- /76 5,r, X L. 7,> -4 j I E 0 T7'0 f-1 -79 Y, 1 , 0 FOR :5,F: (?P LOT 15 )k .0011, 100, LITTLE POND SCALE: 1"=2083-'+ ESTATES � 7 LOCUS PLAN IN LOT /0 100, Y 8W.EL-/OO.00 C.8,1D.H. AT N.W. ARNSTABLE, MA LOT 14 V loo, COR.OF LOT 7. J/, (MARSTONS MILLS) NIF -RUST V CAPRICORN REALTY PREPARED FOR: DATE PRI!IFESSIONAL ENGINEER- - CIVIL LOCUS CAPRICORN REALTY TRUST.' 1001, LfTTLE POND, RACE LOT LANE N C, FRANK DATE: FEBRUARY 27)967 WHITING It No� ?PP45q mys-r1c LAKE COMP/DESIGN: CHECK. SAW DRAWN: R-UH TAW. IL. H.'G, 1--f7- 6­ S 7 'PL N VIEW OR E FIELD� W.B. DATE PROFESSIONAL LAND SURVEt SCA 1" 20' B.M.EL.-63.81' - C.BID.H. AT N.W. COR. OF PLISKIN LOT. FILE NO� 3138606SS.2D DVVG. NO. 1247-13 SHEET 0 ;7HT 40 GO FEET yp) JOB NO 3J386D6 I OF I