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HomeMy WebLinkAbout0235 PRINCE AVENUE - Health 235 PRINCE. v R i1 -- - A= 076 0150 C_LS - - ►'S r . s COMMONWEALTH OF MASSACHUSETTS x EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS c DEPARTMENT OF ENVIRONMENTAL PROTECTION ti< 'W TITLE 5 OFFICIAL INSPECTION.FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION, . Property 4,ddrecc• Owner's Name. Owner's Address: AZA V / ---�-- Date of Inspection: RECEIVED Name of Inspector: (please print `�k LUU1 Company Name 1 ' �' �t�. NOV 2 0 i Mailing Address: C1gS�r TOWN OF BAkr+;i ABLE, HEALTH C) PT. Telephone Number: 70 CERTIFICATION STATEMENT 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 ectio►i 15.340 of Title 5(310 CMR 15.000). The system: t Passes Conditionally Passes Needs..P rther Evaluation by the Local Approving Authority Fail Inspector'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 the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at.the time of inspections and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of.use. Title 5 Inspection Form 6/15/20.00 page I Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: c2 C s+�.. Owner: L�1 Date of Inspectioftwlf / O Inspection Summary: Check AAC;D-or E LAL.WAYS complete.all of Section D A. ystem 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: B. System Conditionally Passes: One or more system components as described.in the"Conditional Pass"section need to be.replaced or repaired.The system,.upon completion of the replacement or repair;as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank.(whether metal or not)is structurally unsound;exhibits substantial;infiltration or exfiltration or.tank failure-is imminent:System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a-Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation:ofsewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with .approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced. , ND explain: The system required pumping more than'4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued), Property Address: '2 ' A"44 .Owner. Date of Inspecti : C. Further Evaluation is Required by the Board.of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless.Board of Health determines in accordance with 310 CMR 15:303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any).determines that the system is functioning in a manner that protects the public health,safety and.environntent: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 1.00 feet of 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 we1L _ 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 certi fit d.laboratory, for coliforin bacteria;and volatile organic compounds indicates that the well.is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen-is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forin. 3. Other: 3 Page 4 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: p2 Owner: Date of Inspectio D. System Failure Criteria applicable to all systems: You must indicate`.`yes"or"no"to each of the following for all inspections: Yes N Backup of sewage into 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 J clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ Li uid.de th in cesspool is than 6"below q p p o 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 ' J of times pumped V 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 f water supply. Any portion of cesspool or"privy is within a Zone 1 ofa:public well. Any portion of a cesspool or privy is within 50 feet of 6 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. f This system,passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate.nitrogen is equal to or less than 5.ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (� (Yes/No)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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) .yes no the system is within 400:feet of a surface drinking water supply _ the system is within.200 feet of a tributary to a surface drinking water supply the system is:located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well I;f you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VQLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 02,3,5— �GL� f4 Owner: Date of Inspectio .. /// /al r Check if the following have been done. You must indicate"yes"or'%io'..'as to each of the following: _ Yes No Pumping.information was provided by the owner,occupant,or Board of Health —AZIWere.,any of the system components pumped out in the previous two weeks? _ ilas 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? t//_ Was the site inspected for signs of break out T v _ 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? V _ 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 Sell Absorption System(SAS)on the site has been determined,based on: Yes no Existing information. For example,a plan.at the Board of Health. Determined in the field(if any of the failure criteria related to Pail is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 t Page 6 of l l OFFICIAL INSPECTION`FORM—1NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: _, I Date of Inspection. / a f. FLOW.CONDITIONS RESIDENTIAL ✓ Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CM 15.203(for example: 11.0 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no):,_, - Is laundry on a separate sewage system (yes or no):Atptp if yes separate inspection required] ~ Laundry system inspected(yes or no) .- Seasonal use: (yes or no): Water meter readings, if av ]able(last 2 years usage(gpd)): Sump pump(yes or no-): Last date of occupancy: COMMERCIALANDUSTRIAL,%#— Type of establishment: . Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system (yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe):. GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(ye or no : If yes, volume pumped: _gallons--How was quan it�y pumped determined? Reason for pumping: rn TY 'E OF SYSTEM V 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) _Tight tank _Attach.a copy'ofthe DEP approval _Other(describe): . p roximate a e of all components, date installed(if known)and source of information: Were:sewage odors detected when arriving at the site(yes or no):, 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM, .INSPECTION FORM PART C SYSTEM..INFORMATION(continued) R Property Address:o9 Owner: Y.*eL Date of Inspectio BUILDING,SEWER(locate on site plan) Depth below,grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance;from private water supply well or suction line: Comments(or condition of joints,venti ig,evidence o leakage,etc:): SEPTIC TANK: t�(locate on site plan) Depth below grade: _ Material of construction:_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:/©•� X�p°)(� Sludge depth: cPa -,�b—// f� Distance from top of sludge to bottom of outlet tee or baffle: 3✓. 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:. A/° .� �� Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels s related to outlet invert, evidence of leakage, a ): _ n Parj 1 GREASE TRAAP (locate on site plan)" Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum.thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.):. 7 Page 8`of 11 OFFICIAL INSPECTION FORM—NOT_I+OR"YOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTI+W INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: .5— �6u?' _ tP " Owner: Date of Inspecti 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/day Alarm present'(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping- Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:__LZ(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: buti L�C� Comments(note if box is level and distrion to outlets equal, any evidence of solids carryover,any evidence of age into or out of box, e c): 1' PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in.working order(yes-or.no):.,: Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): I 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: c:2,s iY- Owner: Date of Inspectio •: SOIL ABSORPTION SYSTEM (SAS): SF(tocate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leachinggalleries,number: leaching trenches, number, length: reaching fields,number,dimensions: Q X 9 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.)• � av,e L9622C if AK CESSPOOL (cesspool must be pumped as part of ins pection)(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 or no): Comments(note condition of soil,signs ot'hydraulic failure; ievel_ofpondiiig,'coddition o1'-,vegctation,.etc.):.:. : PRIVY:d ate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTI.ON FORIVL;=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM`.INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:4�? 00,ewec Owner: Date of Inspectio SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. aoc 3 10 i Page I I of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:C�qc>� Owner: Date of Inspectio . SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water ,1 feet Please indicate(check).all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with locai Board of Health-explain: Checked with.loca .excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation 11 Permit Number: Date: Completed by: -_ HIGH GROUND-WATER LEVEL COMPUTATION ti Site Location: Lot No. t.:.r...: Owner: ( �' r/(ffftr�J Address: Contractor: � ���1 L2s Address Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date month/day/year STEP 2 Using `vVater-Level Rance Zone and Index Well Map locate site and determine: (4 Appropriate index well............... l? ' . ................. AiAl ............ © Water-level range zone C STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to ��/ water level for index well ........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current-depth to water level for index well (STEP 3-), and water-level zone (STEP 2B) � determine waterdevel adjustment ............................................................:............................. STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water r level at site STEP 1 �✓ Figure 11--Reproducible computation form. TOWN OF BARNSTA.BLE `i,C CR T C2 G � SEWAGE # 0 7& VILLAGE ASSESSO 'S MAP& LOT • /[� rK P6C*;f°S NAME&PHONE NO. SEPTIC TANK CAPACITY 6W SW /®/yi,E2 &ZJ, a;;r LEACHING FACILITY: (size) NO.OF BEDROOMS BUILDER O OWNERS PERMIIDATE: CO IANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �� Aw as `� Uri l h w {Ir'�' '�-� o . . /Cv CT /VC his TOWN 5ssR (n . 4LT r yp ASTABLE � BORTOLOTTI CONSTRUCTION, INC. �f 765 WAKEBY ROAD,MARSTONS MILLS, MA 02648 k. 508-771-9399 508428-8926 FAX: 509 428-9399 `• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: c3 AM JI Date of Inspection: Inspect s Name: Ovjne 's Name and Address: i CERTMCATION STATEMENT: I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in (ite proper function and maintenance of on-site sewage disposal systems. The System: Passes Conditionally Passe Needs Further E ation Local Aproving Authority Fails Inspector's Signature: Date: .3d The System Inspector shall submi/acopy of this inspection report to the Approving authority within thir- ty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. I INSPECTION SUMMARY! A)!7761 PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated i below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or•repair, passes inspection. Indicate yes,:nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If not determined",explain why not. The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water.level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - 1 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced _ Obstruction is removed:__: 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 the public health,safety and,the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh; 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH,(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ,..ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to:a,surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less. than 5 ppm. D)SYSTEM FATS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CM R 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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 clog- ged SAS or cesspool.g . ,. ,:. ,. - • ' . , �,• Liquid depth in cesspool is less than G"below invert or available volume is less than 1/2 day flow. Required pumping more.than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (cowhmcd) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen, E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant. threat to public health and safety and the environment because one or more of the following conditions exist: . 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. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: 1/Pumping information was.requested of the owner,occupant,and Board of Health. None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _jZAs-built plans have been obtained and examined. Note if they are not available with N/A. fhe facility or dwelling was inspected for signs of sewage back-up. _A'I'he system does not receive non-sanitary-or industrial waste flow. __,,�ffhe site was inspected for signs of breakout. _LIZAII system components,excluding the Soil Absorption System,have been located on site. _, The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of baffles or tees,material of construction,dimensions,depth of liquid, pth of sludge,depth of scum. _klne size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- F tt JI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) -fie facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -- PART C _. .. SYSTEM INFORMATION FLOW CONDITIONS r I Number f Bedrooms: 9/ Nun per of Current Resider : E Flow: al orsoe Grinder: Laundry Connected To System: Seasonal Use: Water Meter Readings, ' table: Last Date'of Occupancy: A�!]P ,,1) Type of Establishment: Design Flow: aallonstday Grease Trap Present: (yes or no) IridustrialVaste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: - Last Date of Occupancy: OTHER: Describe) Last Date;of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 1 System Pumped as part of inspection:AO If yes,volume pumped: Qallons ' Reason for pumping: TYPTOF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) __.._ Other(explain): AP ROXIMATE AqA of all components,date_ipstalled(if known)and source of tinformation Sewa "odors detected when arriving at the site: yA -4- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade: // Material of Constniclion: k____concrete metal FRP_Other (explain) Dimisions:/b.5,)(&'J►!,e�-'_Sludge Depth: rV'/ Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: .3 d/,, Distance from bottom of scum to bottom of outlet tee or baffle: /torte. Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation outlet invert, structural itlte rit ,evidence f leak e, etc.) IAZ6 i , GREASE TRAP: Depth Below Grade: Material of Constntction: concrete metal FRP Other (explain) — — — — Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or batlles„depth of liquid level in relation to outlet invert,structural integrity,-evidence of leakage, etc.) TIGHT OR HOLDING TANK: Depth Below Grade: Material of Constrtiction:__concrete_metal FRP—Other(explain) Dimensions: Capacity: gallons Design Floc gallons/day Alarm Level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) i DISTRIBUTION BOXs_,Z Depth of liquid level above outlet invert: �. Comments: (note if lqvel and distribution is equal evid ce of solids carryover, evidence of leakage into or out of box,etc.)_ PUMP CHAMBER..AA . Pttm`p is in w 6order:oikin }.. Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan,if possible;excavation not required;but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: Leaching Pits number: Leaching ch ambers,number; Leaching all ri es num er• Leaching trenches,number,length: 16P Leaching fields,number,dimensions: Overflow cesspool,number Comments:(note condition of soil,signs of hydraulic failure level of ponding,condition of vegetation, etc.)__r. p CLIP 74-61.0- CESSPOOLS. Number and configuration: Depth-topof liquid to inlet invert 9 th of solids layer:� y Depth of scum layer: Dimensions of Cesspool: Material f s o construction: Indication of groundwater:, ' Inflow(cesspool must be pumped as part of inspection) " Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) .rw,... ...• '._.. .•. _: .. .. ... ... is r ..... T. .... .....". .......•...w ».. .......a r+ ...: I -G SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks Locate all wells within 100 Feet. l U1' b� G G G�q 3a � DEPTH TO GROUNDWATER: , Depth to groundwater: /I Feet Method of De rmination or Approximation:Ary .E'%�'1� � l`!"O Gf.S, 6,✓, S 4' -7- TOWN OF BARNSTABLE LOCATION r�, � Pit�- g AIM-- SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. .�'�� R ® SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �'�,�'� (size) NO. OF BEDROOMS Ll PRIVATE WELL OR PUBLIC WA ER 1/ BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes ✓ No i s - - FES.......SCT..__C....... y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _OF................ ............................. Appliration for Uiipniitt1 Works Tonotrurtion Prruti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....: Za l : ----------------------------•--...... / �cs �'s---... - , ' .. f. ......... L c tion-Address or Lot No. ._......�..Y..... .... ..... ..... -----........._...._...__................ ----.........-------•---••--•--•---••-•----•_.._......._........_......_... n / c t ------••-----------------------Address a _......... .... tI.O!�.�fir........ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures -------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GTq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... R+ ----------------------------- ----............................ ------------------- •--------------- .--- -------- ----------------------------------- ----------- ••-- 0 Description of Soil.........................-.............................................................................................................................................. x U Nature of Repairs or Alterations—Answer when appli cab le..____.___� .. ............................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI1 5 of the State Sanitary Code—.The undersigned urther agrees not to place the system in operation until a Certificate of Compliance has been issu d y the r ' health. Signed........ . ............ ...........•-•------.........------.--_.. ................................ Application Approved BY.............................................................--•-•----------------•--•-•---•------ ........................................ Date Application Disapproved for the following reasons-.............................................................................................................. - ......................................................................................................................................................................................................... Date PermitNo.... ..: �-. ..... --------------------- Issued_.....................-................................. Date y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................�T.� �!.!OF................ ��-- .1 ............................. Appliration for Disposal Works Tontrurtion rermit � Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: f� ........./`f - ... L .... lion-Address--------------------------------- ......................or Lot.N�.......................................... �.. .Q�'. •-• - % w / i Address f Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms.......................:....................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) G4 Other fixtures --------------•-•--------------•---.............-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.-_---------------- Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box e( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water._....................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-•--------------------------•-••••----••-•...•--.........................---••-.......-•••-..................•••.............-----•......................... 0 Description of Soil.........................................••----•------......--------•--•---...........-------•---•---...---....--•---.._.............--•---.......................------ W U -------------------------- ------------- ----------------------- .......-...... •-•--------..-------•-••------------------------ •----------1---.---••-----•- ------ ------------------------------------------------••----------..................--•-•-•--.....---•-•----•........----- .............../ i f'7 ..... •• Nature of Repairs or Alterations—Answer when applicable � .... "y' .... .................................. U P PP .................. -•-------------------------------------•--------•---.............................---...........-•---•--•-•-•-•-------------------------•--•----....----•-----.........--•------------•--................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.1 5 of the State Sanitary Code—.The undersigned furtheragrees not to place the system in operation until a Certificate of Compliance has been issued by ' the obar of'`health. Signed. ................. .......... Date........_.... y i ApplicationApproved BY ..........................................................- ........................................ Date Application Disapproved for the following reasons:..........................................................................................................--- ....................................................................................................................................................................................................... Daw Permit No... ...............------ Issued...---...--•-- ----•.....-••-•................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT/H� ............... (....::.1......OF.............Lr r .�:!-:Y Cf°................................... (Iprfif irate of Tomphitnre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by........••----.... ...N.��....... c.< � .................................................................................... . ...........•-•-•-.. ._...._ Installer at.................... ... _..:.... .......... .......................... ..---.................................................................... has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......_... .......... dated.............................:.................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................. .. ............... - Inspector................. ............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �y� No.....�''j .:1.6 ............ .......... `'. Fas... .�.......... 19toposal Works Ton#rudion Permit Permission is hereby granted. ...%{..., �;::,c.� ..--.•......--- to Construct ( ) or Repair ( an I1 vi ual Sewage Disposal System atNo................................................................................................----- -•--••..........-••••-•----..._........ .....................••................. Street / as shown on the application for Disposal Works Construction Permit No.. 1�li'� - Dated.:........................................ ----•------•-----•-------•-••------•. .............•---•--...------•-•••-............._ rroard of Health DATE........................ ...nl......�.. ........................---..... FORM 1255 A. M. SULKIN, INC., BOSTON i 3. ,4 NO. O F OUTLETS: ETS. 3 < � Revi sions:siO nS MANHOLE COVER TOF FINISH GRADE TEST DATA 15V2DESCRIPTIONDATE NOTES. 'i II 1 1 1 I. DISTRIBUTION W ,12 M N. UTIO BOX TO WITHSTAND H 10 0 tT ST D TRENCH f _ RESERVE-ACTIVE I 6 D 0 I / /87 !N !GATES I OBSERVED INDICATES _ ADJUSTMENT _ COVER 1 LOAD ING UNLESS UNDE R PAVEMENT, DRIVE S DESIGNATIONSCHANGED EDPEtC OR TRAVELED LOADING TBST SEASONAL GROUND TER � SHALL APPLY r r AD U TMENT 4 INLET I 15 v21 .• .•� I r _1. PROVIDE INLET SHOWN WHERE 1 'L TEE L TEE AS O H RE i 1 r LOPE F D S O INLET PIPE EXCEEDS 1 1 C S OA8 FT FT • EMOTE P No _ , � !1 TP No T I , , .. `OR IN A PUMPED SYSTEM, w 6 1 12:9' L. 1 _ 3 R D.E L .. i RD.E Ef_G T STE 4 F"R EGA! 3. FIRST TWO FEET OF PIPE DUT OF THE 6 '1 1 1/ . 1 L� I V 5 D STRIBUTI N BOX E D.� O O TO B LA/ LEVEL 8 REINFORCED 2 1 V ,RE N W OBSERVED PLA N VIEW E 2 L. .9 .E GW r W L. � .. G .E , N T 1 1_ E n 5 M ET Ot!'fL f_ _N � _FIT TANK 4 i 4 O MIN. RE OMMENDE MANUFACTURER f C D UFA CTU i _ T c 0 TEE 0 4 9 <. TEE ... R T ND R APPROVED A , t i tJiD DEPTH O O O O RO ED EQUAL L. f TOP SUBSOIL 0 & i 1 1 � N N -REMOVABLE COVER 1 4., ., 13/ 1 .9 4 0112S J .• 6 MIN. T TONE . N 6 D4A.OU.t? T S LC f . . LOCUS 2 - 2 - MED COARSE 11 �_ 2 /o MII� GRADE- BOTTOM BASE S N Et_ STABLE . . TOM 0 LEVEL , . 6 PROVID o _ E -Q A O s ND o � .: S o. � 0 4 0 e . ., 2.. I e MfATERTIG H 3 4 AMA L COVER c T - 2 DI MANHOLE C , NT r N JOI S LTYP. a MIN. 4 INLET n ,r n a oa�' References:i i o- 1 I < F T T o � 2 MIN. 0 I/8 TO'. 1/2"- 4 TT7T' 4 OU L E 4 . a VIE W 16 T _ C BOSS SEC K)N 2 Q N VIEW A,_PLAN E HED STONE w s G CONDITIONS:EXISTING CON ONS c ' P v J TY. 2 _ 1 o a 7 / C o v c, NOTES. /2 , 1 5 lA. II 2 A 5 `tom W CAPEENGINEERING 1 D 4 DO N ; r _.� 4 11 V A ED STONE F INLET 1 3 TO 12 rV SH S 0 e- INLET AND OUTLET TEES TO BE CAST IRON . . 2 3. 2 I LOADING . C TAN K TO WITHSTAN D H 0 LO .• . 1. SEPTIC �0 PVC OR CAST-IN-PLACE CONCRETE. 80TTfl M ON 6 2 87 "SCHEDULE V D A ELE ME DRIVES OR TRAVELED n . . UNDER PAVEMENT, 410 8 UNLESS U 6 U TYP .�t v � . .TYP LE YEL STABLE � ) BE ENTERED UNDER MANHOLE COVER. 2 _ LOADING SH ALL APPLY. TEES TO C 4� E YH2OLO G •WHERE B WAYS, H A S aJ' BASE r I 7 R ND R CONCRETE CON - I RECOMMENDED MANUFACTURE ROTO O O AND O C 7 E CONNECTIONS C 5 PIPE CO 8 ALL P 2. 6 t, M N. TO T VIEW 3/4 ION v CROSS SEC CROSS SECTION DE A O S 1 _ APPROVED EQUAL N BE WATERTIGHT. Q RUCTIO TO ST h 2 S i TONE V , 8 8 LEACHING N DETAIL G TRENCH I TAIL HIN L MAP 500 X DE LOCUS DISTRIBUTION Ba GALLONS: DI T U NO. O OF S DETAIL NK I - SEPTIC TA4 9 9 - SCALE:: �_ NOT. TO SCALE _ tV 1 I2083 T T SCALE ; NOT O SC NOT C ALE .. O MO S t BOTTOM OF 0 2.9 10 HOL E PROFILE DESIGN N ANALYSIS y ,1 SYSTEM 0 A NOT TO - SC LE 12DESIGN FLOW.• 12 A A R - f HOL AND COVE P6 69 MANHOLE E 7 "I _ D BDRM--440 GPD GRADE _ 4 BDRM X IO GP / FINISHED H INISH � nArE. BROUGHT TO DA TE-* 10 27 87 F 0 I / / F EL. FINISH GRADE TO HAVE :MIN. 2 0 N G / _ GRADE - FI I_ FINISH 15.20 FACILITY.. EST BY. .SLOPE OVER -LEACHING Tt � E BY. Pro ect Tt le w TEST N AN f , M.J.DO OV iw 1 , WITNESSED Sr: SS WITH � eY. WITNESSED WASHED E WtT E STONE 2 F 18 TO 1 2 W SH ,MIN. 0 / REQUIREMENTS:/ SEPTIC TANK RE UI F S C Q 1 E, 1 FIRST TWO FEET TO B . _ 11 0 F DUNNING 1/8 T i G ERRY UNN 8 / FT LAI D ID LEVEL END T P PLUG N Y A A A E 1500 GAL TANK 60 L USE PD 150 6 G 4 0 G X /o E.ER RAT P C PE RC.RAT E: _ - (2 (3 -. f � 11 1.66 11 4 . o 11.64 . 7 - 0 4 PERFORATED D PV.C. S 0.005 R R TE\ P 0 N H`' 1 . E , NCH AfIN. ! C 15 2 arrx t 0 GAL. 0 •IS 0 � c 0 o v BOTTOM i � o LEVEL C NC. PRINCE ,AVE REINFORCED o _ 235 .9 \ l Y DISTRIBUTION i 1 , A TP o.: TP No. SEPTIC TANK N BOX ON `MILLS 23.5 M ARST S L.' D.EL.D.E R GR G . MA BARN STABLE, BAR ST A AB E BASE . A E ST L T BE INSTALLED ON L VEL L. L. " 0 N GW.E GW.E .. LEACHING FACILITY REQUIREMENTS. LE C G 0 0 - TRENCHES 1 D 1.5 DEEP 2 WI E X 1 = q F A A 3.0 2.5 7.5 G L/L SIDE RE t I 2 2 I = A LF B . TOM AREA 2.0(1.0 2.0 G L/2 - BOTTOM 3 A F ' 3 9.5 G L/L 4 4 P F- 46.3 44 0 G D/9.5 GAL''/ L 5 5 6 6 - LEACHING FA ILITY PROVIDED: C O 7 t 7 _ / ' 1 - 1TRENCHES-_23.5 LONG 2 2 WIDE X .5 DEEP 1 .. r A 446 GPD I, PROVIDED C PACITY r^ 9 9 1 �. R R .f) CAPACITY 10 10 v , t -. 4 _h 5 : Y r 3 -' 11 1 1 , 1 f 6 NOT ES S I� 12 12 0 9 8 O / 3.1 i 12 11 5.7 3 8 I � � D ALL CONSTRUC UNLESS OTHERWISE NOT ED.DAT E..- DA TE. I U L,E I E r / , C , N ALL ON D AND MATERIALS SHALL C 3 FENCE TtON METHODS E yy /1 D �- C K A 0 I T 2 _ S , NVI R N V HE:STAT E D TITLE F T M : >TI L O FORM TO Y i Q l O TEST BY. '- EST B 13.5 , T BLE :L AL ._ PPLICA LOCAL m DE AND ANY A MENTAL O 1 3 E C R AN D REGULATIONS. I , E RULES FE NCE C , E F , O . D / a A / ,K D C N Y � ! A r WITNESSED B 0 L D B ESS 6 � T WITNESSED WR7V 7 W S E 2 � - W � � F 1 8 G E 0 l ' WI DE E D i L S ,- 0 L A . � r K C ._ B L 0 . WHERE�` S E _ss ALL POINT c 8 USED AT R TO 1 N 2 GOUT B b 8 c � 12. � WAY : - ER R LEAV E ALL CONCRETE 1 v PIPES ENT O _ i e,0 K A w `WATER PROVIDE A STRUCTURES SIN ORDER TO P O .» ATE. c �, S RUCTU E ATE. R R N. PE RC. R P PERC. CO NC, - 3_ i r 4 t / I 4 - w _ _ TIGHT SEAL i G Q 4 l H INCH NC !N. o J.!KIN ! bf 3 T. WALL L I S TE E RE � R. 0 R. N C T C O TANK HALL JOINTS I N SEPTIC TA S 3 ALL SNIPLAP JO S A OC. ING - ` \ A. M. WIL`SON SS s IE 5 - T 2. CASKETS O R �14.5) NEOPRENE:2 WITH 1 � BE SEALED 0 n 1 : s s v- O I. 4 D V WATERTIGHT m T PROVIDE A'15 L CEMENT O O ASPHALT C II MAIN STREET i A 9 L L N G _. G DWELLING E I 0 N O S I / SEAL. 1 S T �.. G A1- E X( 3 s O J fl , MA _ 0 TERV LL E 2 _ 15 z _ S f \ V. A - E L E F F / INVER TELEVATIONS w F r _ IB s R a N I R U, CONCRETE SEPTIC TANK, AST `XI TING CESSPOOL � PRECAST-CO C , , � 5 428 1450 T �K_ . C _ \ DECK WITH REMOVED LEACHING FACILITY r r.E EMo D B AND LEAC G C z D l T/ON BOX, A WOOD _ _ � VE UNLESS UNDER PA H DING U SS 12.13 0 STAND 10 LOADING 2 AT BUILDING WAY WHEREIN T RAVELLED S t � INVERT ---- MENT DRIVES OR T a 12 i , I HALL APPLY. 8 3 H 20 LOADING S \ 3 2 . PREPARED` F AT S EPTIC TANK !n 9 - OR . � INVERT )INV ( 4.0 1 �I 4. � / W _ M HALL BE SCXED HE SYSTEM S z ALL PIPES IN T ST o _ S (out) 1.6 6 13. A NK o , SEPTIC T ._.r 4 ERT AT S ) E �0 ORE UAL.INV ( UL Q .. 1R �_ _ E � • G � A AR H Y UNG G MIC AEL 0 ISM ING I EX , 11.64 I : n 1 ' I . BOX � % E SHALL BE FREE OF AT D ST WASHED RUSHED STONE S L 4 .INVERT. � 6 S C 12.I 5 W 2. 1 I 1 , ti / ' ALL DIRT. DUST AND FINES. ; R T, ' I. 7 _ l l k Q I T BOX (o ut) 4 R AT D S I 4 INVERT 1 ) ` 3 I i I l 2 t WATER ` INTERSECTION OF ATE t , 7 AT . POINTS ©F 1 3 I� I I .5 E ALL '. 13 1 I LINES AND SEWER .LINES :BOTH PIPES SHALL_I � , 1 FACILITY. I o '� PRESSURE INVERTS AT LEACHING BE CONSTRUCTED OF CLASS 1 SO SSU I I :" J I � 4 I I 6 I 6 t ' , PRESSURE 'TESTED TO PI NAND ARE TO BE PRE S I I f PE S BEGINNING OF E I f WATERTIGHTNESS. T B G R WATERTIG S.INVERT A ' ASSURE t Title:� INV Drawing / Dr - .5 13 2 I I _ ns 4 FACILITY - 1.42 ;' � LEACHING I l I ET J ! SEPTIC TANK DISTRIBUTION BOX C. < I 8 w I F \ E BY>' D R TEND D SHALL BE MANUFACTURED ROTUN O O INVERT A S� INVE B \ I : I I 0 3 _� I - I IL TY '- 2 7 VMANUFACTURER.HING FAC AN E UI ALENT LE ACHING I I _ Q i 3.6 z 3 w 2. . 5 4_ _-- SUBSURFACE CE IO 1 1 N _ I FE 6 F 1 + N TT M O L 1 V : UNSUITABLE MATERIAL I AT BO O ._..--- 9 _,EXCAVATE ATE ALL U SU r A C ELEVATIONi R "" 4- , 9 8 7 i 11 4 - - 9.8 5 _ FACILITY 3 _- _ AREA _AND BA KFILL WITH LEAN A IL LEACHING A A C C F C 1 LEACHING - P T o ` j _ 6 I BA NK A A \ TO E B `GRAVEL OR COARSE SAND. `: BANK i B A E WA�. S E 4 G WATER 1 HEAVY E UIPMENT SHALL 7VOT ,BE ALLOWED V GROUND0 OBSER VED ED 2.9 �'�' Q I' N ' T OPERATE ' OVER THE LIMITS OF THE ELEVATION O OE LE A E , 12 - DISPOSAL SYSTEMS THE 12 .6 SEWAGE D S S S S DISPOSAL DESIGN E' FCONSTRUCTION F THE SYSTEMS. I COURSE O O A AL GROUNDWATER X E SON MA S T HE SEWAGE 1 N IELD MODIFICATIONS O T 5 1 O F _ a ELEV ION .8 4 5 _:. -�__=- .-,:...� _ _ - , _ .--. SYSTEM SHALL BE MADE WITHOUT < _ DISPOSAL YSE S L L A N0 _ S S S T - E _. ,- SCALE I I �.,. w � S L 0 , E D G E 0 F _ - ENGINEER PRIOR WRITTEN APPROVAL OF THEE G ER O -.. _ AND THE LOCAL BOARD F HEALTH. U 7 J S � 2 ' THIS SHALL BE INSPECTED A E 1 S Y EM SHAS R 0(,xt R' __. SST CONTOUR U: ING Ofti 0 6 _XIST , ... IRED B N 2 1 TITLE V.� ..- U Y SECTION 0 O .r _ . f Q _ _4 `�..5 9 E PRG POSED co�vroUR OF COMPLIANCE S RE 1 CERTIFICATE C A r A 12.0 3 A ING ELEVATION EXIST T 1 E E N" F TITLE M R DBYS 10 2.80 UST BE Q U CT w t , I _ 2 O _ �.ELEVATION I _P SE D RO 0 P ) B�. �-OBTAINED BY THE CONTRACTOR UPON M_.�.. CD CTD U O CO a i •. x LEZI N B V WORK. O OF -THE A O E IF; AN i - r . O AS a BUILT" PLAN I REQUIRED E A�-. S U ED DU TO ONTR _ , Q C C 1_ A D , . A .. , .. Sca e S NOTE APPROXIMATE TE , , .. F UNDERGROUND UTILITIES 'S PPROXI , LOCATION U .. L C TIO 0 TOR DEVIATING E O IA ING FROM:_TH SE PLANS , WO RK cz -, i ^ :,t.. t r FOR SUCH A B ILT' PLAN HA CONSTRUCTION!ON . t C S U S SHALL BE BEFORE C LAST U T ,`D BE R 0 VERIFIED E FIELD 0 ,B VERI E IN THE L ,_ SHOULD E AND S N • PEN. . C M ATED Y E-COMPENSATED B THE CONTRACTOR. CT O FEET \ EE 14 THIS SYSTEM I DESIGNED 6 S ST M S NOT D S GNED FOR A P N GARBAGE DIS DISPOSAL UNIT. _ Date: _D IVo � . 4 D u /8 7 H+9 V N G.V D Design. • M.J D ALL ELEVATIONS N ARE BASED O N. s I S O S S De � 9 _ r P. V. . DATUM. _ : k. _ .rChet Drawn:P D n M.J.D. JOb No 2 0 55.0 . Sheet Of I 2 r I , 4 w , _ c x ¢