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HomeMy WebLinkAbout0083 REGENCY DRIVE - Health 83 Regency �N�JL Marstons Mills i i f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information Sly#- mo/D on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane 1 6 Company Address Centerville Ma 02632 Citylrown State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 8/28/2020 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and a 1000 gallon precast leach pit. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f �. � 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass linspection 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ Tne system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/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: ❑ ® 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 CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply o ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Regency Drive V Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. Citylrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 0 Does res Bence 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 Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 1/2020 Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mil s Ma 02648 8/28/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool 9 P ❑ 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: original system installed 1994 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage, vented through roof. t5insp.doc-rev.7/26/2018 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M / 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet,'tank was not leaking and was structurally sound. Inlet cover is on a riser t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 l r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Regency Drive v Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/260018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 L_ r Commonwealth of Massachusetts Title 5 Official Inspection Form I. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - J/ 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of(liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ✓" Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1x1000 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.R26f2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form !P a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was dry at time of inspection with a stain line approx 3'from bottom. 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts +� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.MiSQ018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �r Z C-) 3 TL Z3 t(o A � 3(-, 1�\ Al- Z� �Z 3� yv r� �3 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. 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 f Commonwealth of Massachusetts �d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Regency Drive Property Address Jonathan Venezian Owner Owner's Name information is required for every Marstons Mills Ma 02648 8/28/2020 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist) completed ® D. System Information: For 8: Tight/Holding Tank-Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2&2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 6& - No... ' .-.1 F)1$..... gad.... THE COMMONWEALTH OF MASSACHUSETTS 1167 BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun fur Diupuuttl Wurku Tunutrnrtiun ramit Application is hereby made for a Permit to Construct (X or Repair ( ) an Individual Sewage Disposal System at: p � � Lo ti n- k dress r,Lot No O er Address W Installer Address Type of Building Size Lot...`T[ �.....Sq. feet �-t Dwelling—No. of Bedrooms.___ Y .______________________Expansion Attic (��d Garbage Grinder ( d,b aOther—Type of Building _-__- .............................. No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------- -.---_ _-. W Design Flow...................15:5--____---.-•____gallons per person per day. Total daily lflow-...........................................g4lons. WSeptic Tank—Liquid capacity-1.OIIQgalIons Length__&-_-_ Width... Diameter..._N�A.... Depth.... x Disposal Trench—No. .................... Width ....... Total Length-------- I�...__ 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......���4. 1�.,��.....N.!�E................... Date....................._____.... a --minutes per inch Depth f Test Pit____________________ Depth to ground water_.__ . ---.__-.-. Test Pit No. 1___.�__._._ (Z4 Test Pit No. 2...............minutes per inch Depth of Test Pit.................... Depth to ground water... ..gKXCA).N.T a F -E --••---_...._...---••-------•--•-•-•--•••------•--•--•-•••••-••-•••----•---.---•••......----•-..--_ ••--•---••---- -•-••--•••-•• -...--•--------------! J 0 Description of Soil----.0.J2....... -'0----••---------LCAA..... x U w -------------------------------------------------------------------------------------------------------------------- ••---------............................................................... U Nature of Repairs or Alterations—Answer when applicable.----.-. R_" ......................................................................... ------....-•--------••••••••-----••-•--•-•--•-----•-•---•--•---•--••-------•-••-----------•-••••-•••--•••-•••••-----------------•••-------------- ...................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environ I Code—The undersigned further agrees not to place the system in operation until a Certificate of Compl ance has �S__i ssue y the board of health. Signed ._. ------ --- �e.�.-�------................................................................................. .................Date..........:..__.. Application Approved BY � .... 1--------------------------------- ----------------------------------- y ---------t'�-- -5----"--g Date Application Disapproved for the following reasons- ----------------------------------------------------------------------- ------._..........---------------------------- ---------------Date.................. PermitNo. ..........IY---`-----1-7-�--................ Issued ........................D azee...t.................................__.... _ No..7 IZ2- FEB ? ?.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApIptiratioit for Dhjipm Ml Norlai Tomitrnrtion Permit Application is hereby made for a Permit to Construct (><) or Repair ( ) an Individual Sewage Disposal System at: , � l�t-a ....t4� 1e !'�i� �{ --------•----- .r......--n-........--•---------•................... • -.A...._.. A ccr��aa\t;/f... p A.... ------- y �ti♦ + /`�T (_C T y J ' �! MAC ��� Lo V n Ks7 1F^�� G6r� !'ila�\I -.> .fit,N l�> 1 !�(�l kL4,r. O ncr ' Address � Installer Address �! UType of Building Size ......Sq. feet Dwelling—No. of Bedrooms____ ..__.__________________Expansion Attic (or) Garbage Grinder ( �)� aN Other—Type of Building _____f: ............... No. of persons-----------................. Showers ( ) — Cafeteria ( ) dOther fixtures -------------- ---------------------------------------.....----------------...---------- ---------------•••-•••••-•••••-•-•••......-••--••...-----•--- W Design Flow...................F5i"--y__-_-___-__-____gallons per person per day. Total daily flow_.-__._......_____....`f_..._._.___.........__gallons. tx Septic Tank—Liquid capacity_1_C�1^Cgallons Length_��... Width__ =l:.�--- Diameter___�!Q_.__ Depth...�-..�:..�.. Disposal Trench—No_ ____________________ Width___-__ii__-__------ Total Length.................... Total leaching area..................tsq. ft. Seepage Pit No--------A.;.._-------- Diameter-___�_''�__-__ Depth below inlet___16 ..... Total leaching area... �...sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by...... .................... Date........................................ a Test Pit No. I----a--------minutes per inch Depth of Test Pit____________________ Depth to ground water...5h,jtx r...... (i, Test Pit No. 2......-...__._minutes per inch Depth of Test Pit.................... Depth to ground water... 1'.'f ?..N- � 1*Y l 0+ ----••-•••-•----------------••-•••••- --•-••------••---•-•-•••-•-•--------•••••••--•........-----.--....................................V- .. D Description of Soil....n ... - '' --------------- --`....Via: ---I?-1 -a---�---- rTalU111 8,�7 p. W V ....-•••-••-•-•--------•••••-------•--•-••-••-••----•-•••-••••••......••-•--••••••-----•-......--••-••••------------•----•-••---••-••---•.............................................................. W -------------------------- ----------------------------------------------------------------------------------------- ---------------............................................................... /�. U Nature of Repairs or Alterations—Answer when applicable--------- A_"1........................................................................ .....................................................................................................................................................................................................•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State EnvironMe= l Code—The undersigned further agrees not to place the system in operation until a Certificate of Compl=ance has,\ e n issued�by the board of health. Signed - .................................:...._ t a - `�...� ............................_ Date Application Approved By ---------- ��.,c,.�, .� cry, Date Application Disapproved for the following reafons: ....--...................---......----------------------------------------------------------------------------------------------_,� ................................................................................................................................................................................................................ ................. Date..._..------ Permit No. .........T,. ..--------- 71--. Issued D ate F ..---- —..._--.. —:.__-- -—.—_. —.—.----- ————— --'--- —:--- ----_.----_._.--_.�-„�.-----.-------..-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Qxr#ifi atr of CITomplian e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( �) or Repaired ( ) by ----------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------.............---------------------------- �it Insrauer at has been installed in accordance h e provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. _. �._-----I---7..P....... dated -------------_---------------------.__----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.. �j'�f DATE...... � `......G- ..-`'. �..-��_75--------------- Inspector,._ =' �-..'.Z ----- -------------=-------------------------------------- - ------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ' No..'��..�............... FEE.--:I..i'11�........ Difivosttl Nork.5 Tomitrurtion permit Permissionis hereby granted.............................................................................................................................................. to Construct or Repair ) an Individual Sewage Disposal System atNo.................... .- - -•----•.....�' h � ..�.e•, �---------,-A..... Street Q _ as shown on the application for Disposal Wor -s Construction Permit ...---•-----.......•----••.....--•-•-. ._...-•-------•••......-••-•••---•- B and of Health DATE--- ." � V•................................. f FORM 36508 HOBBS&WARREN.INC..PUBLISHERS ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 • Sandwich, MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446. CLIENT: John Britton LOCATION: Lot 29 ADDRESS: P.O. Box 492 83 Regency Drive Barnstable, MA Marston Mills, MA SAMPLE DATE: 3-30-94 COLLECTED BY: D.A.Scannell DATE RECEIVED: 3-30-94 TIME: 11:00 AM SAMPLE I.D. : G-7 JOB #: Marstons Mills, MA WELL DEPTH: 74, RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100ml (MF Method) 0 0 pH pH units 6.0-8.5 5.36 Conductance umhos/cm 500 104 Sodium mg/L 28.0 9.83 Nitrate=N mg/L 10.0 4.70 Iron mg/L 0.3 IT 0.05 Volatile Organics EPA Method 601/602 ug/L N.D. COMMENTS: Low pH indicates high corrosive characteristics. * See report attached. Yes No WATER IS SUITABLE FOR DRINKING PURPOSES OR PARAMETERS TESTED. XX Date Rona d J. aari Laborator Director IT = Less Than U'1'ECH SOS 759 GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCO) Field ID: C-7 Lab ID: 7317-01 Project: Britton/tot 29 #83 Batch ID: VG2-0354-W Client: EnviroTech. Sampled: 03-30-94 Cont/Prsv: 40mL VOA Vial/HaHSO4 Cool Received: 03-31-94 Matrix: Aqueous Analyzed: 04-04-94 PARAMETER CONCENTRATION REPORTING LIMIT (u9/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 5 BRL 5 Vinyl Chloride BRL 5 Bromomethane Chloroethane BRL Trichlorofluoromethane BRL 1 1 BRL 1 1,1-Dichloroethene Methylene Chloride BRL 1 BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform BRL 1 1,1,1-Trichloroethane BRL I Carbon Tetrachloride. BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene 1,2-Dichloropro ane BRL 1 Bromodichloromethane BRL 1 2-Chloroethyl Vinyl Ether BRL 5 cis-1,3-Dichloropropene BRL I Toluene BRL I trans-1 ,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL I Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene BRL 1 meta-and Para-Xylene * BRL 1 ortho-Xylene * BRL 1 Bromoform BRL 1 1,1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS a,a,a-Trifluorotoluene 30 31 103 % 87 - 113 % 1,2-Dichloroethane-d4 30 28 92 % 83 - 117 % .�2 BOARD OF HEALTH TOWN OF BARNSTABLE ApplitationArVell Congtruction Permit Application is hereby made for a permit to Construct Alter ( ), or Re it ( an individual Well at: Location — Address Assessors Ma d p and Par ce (,) --Owner( Address— SlJ___�lS.��_�ni4 ( ( _ l^ie!_1___9C 11�" L3�• 16GKJ4001 1-rd ;U&S 1A Installer — Driller Address Type of Building Lj Dwelling S Other - Type of Building----- ------ No. of Persons------ T e of Well_Y��__� c-----____-- YP ---------_--_-----_-_-_-_-- Capacity--------------------_____-_-- Purpose of Well c ----wa le-f------------- — Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certifin�catt of Co pliance has been issued by the Board of Health. Sig ned dG�Lu g — — — date Application Approved B —— En! date Application Disapproved for the following reasons:-----___—_______—_---________-__ date Permit No. -- r- —-------- Issued-------- — date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliante THIS IS TO CERTIFY, That the Individual Well Constructed (�, Altered ( ), or Repaired ( ) DA - f Installer a 9 �p �ewC D` aiS �awS M r at---------6 a$-_--- �_— It has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit Na. Dated ,��—" ��. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- ----- -- --- — ---— - -__— Inspector -- No.-------'---!� Fee- __l BOARD OF HEALTH K TOWN OF BARNSTABLE Zipplitation-*rVel[ Con.5truct ion Permit Application is,hereby made for a permit to Construct ( �), Alter ( ), or Repair ( )an individual Well at: Y' Location — Address Assessors Map and Parcel Owner Address / n y!lr r rJ c,_. e- / ( 0i_, l_/r- 3/_l,�Qo!'1 11 /11 b,— Installer — Driller — f Address i / Type of Building Dwelling --------------------------------------------------- Other - Type of Building No. of Persons--------------------------------- Type of Well—`I -�� -------- -- - —- --- - -------- YP - -- - Capacity-------------------------------------- Purpose of Well--)c M c��a 1`� - -- - Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed-A"""4_ --------------------------------- --- %`,%�j date Application Approved - --------------- date Application Disapproved for the following reasons:----------------________________________________________-____________---__—_—____ -------------_-- ----- ------------------------ /� / date Permit No.----- � Y'''—` ---- - ------------- Issued---------- �— �Y '47 � - -ate ---- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( �, Altered ( ), or Repaired ( ) y / Installer at �+ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No g�-� --Dated-= —�-=-e,1711 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---------—-------------— -- -- ------ ---- Inspector- -- ---- ------------------- -- BOARD OF HEALTH TOWN OF BARNSTABLE Yell CongtructionPermit 1 No. - �—---- �f Fee- -'------------ Permission is hereby granted--�. -'=!��--'j= �/--------------- to Construct�), Alter ( ), or Repair ( ) an Individual,Well at: - - ------- --------------------------------- Street as shownon the application for a Well Construction Permit No.-- C r" 0_04/__11-/ -- - - - Dated -_- =' _ Board of Health DATE -- —=' 'tom--_��� Q�,�_ i - ------------------- 47 EXISTING 100' radius LOT 30 / 0 / LAND. r i 1000GAL / PT FA TER-LINE '�o o �,�► `\ TANK PT -PROPOSED- '��',�,� -\ HOUSE- \ JOHN ,+ RESERVE ��\` 1 ' \ �sl r - - / \ �v LANDECVILAULEY � • �,30 AREA D.B0X �(� - - 0 i/ \ No.35101 A ----- ----— 10 150 ' radius N_ �\ �/ 1 PROJECT LOCATION �\ ► �' `� RAILROAD SPIKE LOT 29 REGENCY DRIVE SET IN 12" PINE MARSTONS MILLS ASS. ELEV = 50. 0 APPLICANT LOT 29 .. MARYANN VENEZIAN .. 44,329 s.f 920 MAIN ST.; OSTER VILLE, MA LOT 28 \ VACANT LOT YANKEE SURVEY CONSULTANTS \\ o Q \\ • 1'S0'+ UNIT 5, 40B INDUSTRY.ROAD a P..0. BOX 265 MARSTONS MILLS, MA. 02648 TEL. 428-0055, FAX 420-5553 FsCALE.- 1'=30' JFDATE: 03-22-94 REV REV 4- ` JOB NO, 50440A SHEET 1 OF 2. EL, =_5_0.5 PROPOSED TOP OF FOUNDATION 20' MIN. CONCRETE CO VERS 2"LAYER OF 2, 49.8 PROPOSED GROUND EL.=_48.5f CONCRETE COVERS WASHED STONE A5T' IR611� / T 7 I 4 / i i 4 7.8E LEVEL 7.5E OR SCHEDULE40 Box Ef , P. V.C. PIPE 12 S=0.02, D=15' 4"" SCHEDULE 40 P.. V.C.DIS PIPE — MIN. M N. —FLOW LINE S=0. 02, D—15' S=0.01, D=21' PRECAST 10'" INVERT MIN. 19 B %g oo LEACHING 0 0. C EL.= 46.80 — INVERT CRUSHED 88 W EQUIVALENT STONE o o°o S a 8%S o S BINVERT o INVERT EL.= 46_25 `� c EL. — 46 50 EL.=_45. 78 c oc o� 5' � oC INVER INVER o �, 3/4" TO 1-1/2" _1000 ___GALLONS EL = 45.95 EL.= 45_57 0 cc WASHED STONE SEPTIC TANK p W c EL.=40.6 LEACH PIT 13, 3' � s' PROFILE OF 12'DIAM.--� SEWAGE DISPOSAL SYSTEM - - - - - - - - - - - - - - NOT TO SCALE BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE EL=_36.3_ ALL ELEVATIONS ARE ASSIGNED PETER SULLIVAN, PE WITNESSED BY: EDWARD BARRY HEALTH OFFICER I" OF TOWN OF __BARNSTABLE o �� -- e JOHN y� SOIL LOG LANDERS-GALLEY GENERAL NO TES PERCOLATION RATE _2_ MINI INCH CIVIL P NO. 8187 No. 35101 1. THIS PLAN IS FOR INSTALLATION OF NEW SEWERAGE DISPOSAL SYSTEM. �P,, DATE _ 03=0_7_—_94___ �o,� �',,o�r 2. LAND COURT PLAN REFERENCE 16427D SHEET I OF 3. 3. THIS PLAN IS FOR INSTALLATION/ REPAIR OF SEPTIC SYSTEM` AND NOT TO BE USED FOR SURVEYING OR ZONING PURPOSES. TEST HOLE 2 TEST HOLE 1 DESIGN DA TA:4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. EL — 48.3 EL. =48.6 TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS THREE FOR THE SUBSURFACE DISPOSAL OF SEWAGE. LOAM and NUMBER OF BEDROOMS 5. ALL COVER TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN SUBSOIL LOAM and 12" OF FINISHED GRADE. 3' 45.3 3' SUBSOIL GARBAGE DISPOSAL NONE 6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME, UNLESS NOTED BY FINAL CONTOURS. TOTAL ESTIMATED FLOW 330 GPD 7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE ( -110 _GAL./BR.IDA Y x _ 3 _ BR.) OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER MEDIUM MEDIUM OR WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING SAND SAND SEPTIC TANK CAPACITY --10-0-0-- SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING. UNLESS NOTED. LEACHING AREA REQUIREMENTS 8. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL 36.3 BE MORTARED IN PLACE. 12' 12' SIDEWALL AREA 1 B_8.5 GAL.IS.F. 188.5x2.5=4 71 9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH BOTTOM AREA 113 _ GAL./S/F 113x1. 0 = 113 DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO LEACHING CAPACITY (BOTTOM & SIDEWALL) 584 GAL. OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. NO WATER ENCOUNTERED 10. THE EXCA VA TOR�CONTRACTOR SHALL VERIFY THE LOCATION OF ALL 584 UNDERGROUND UTILITIES PRIOR TO ANY EXCA VATION. RESERVE LEACHING CAPACITY -- — GAL. 11. THE PERCOLATION TEST LOCATIONS WERE TAKEN FROM SHEET 2 OF JOB NO.:50440A INFORMATION PROVIDED BY BAXTER and NYE E.USTING 100' radius LL \� .v iv ��\ • ��i� of ����y. PAW MERITHEW LOT 30 Ile OF JOHN LANDERS-CAULEY ,a 16, Q ' •-p ,l CIVIL ; I p.�C' �� 0.$ �p cS� No.35;fl1 CIO 1000GAL 60 // / / o, 16' / �p �' on (SEPTIC i TANK 48 RARER VE 592 i 1 \21 .-\D.EOX 0 ----- ----- � I � O ra Tdz'uis PROJECT LOCATION RAILROAD SPIKE, LOT 29 REGENCY DRIVE' SET M 12 PINE MARSTONS MILLS \ �� �� ��, ,,�' 23.3 ASS. ELEV = 50. 0 LOT 29 APPLICANT MARYANN VENEZIAN 44,329 s.f. 920 MAIN ST., OSTERVILLE, MA LOT 28 VACANT LOT YANKEE SURVEY CONSULTANTS p UNIT 5, 40B INDUSTRY ROAD 63•g15 P. 0. BOX 265 MARSTONS MILLS, MA. 02648 TEL. 428—0055, FAX 420—5553 1'=30' FDA 03-22-94 \` REV REV' : 04-04-94 \ _ JOB NO. 50440A SHEET 1 OF 2. EL:= 50.5 PROPOSED TOP OF FOUNDATION _ w 20' MIN. CONCRETE COVERS 2"LAYER OF 49.8 PROPOSED GROUND EL.=-4B.5f WASHED STONE i �n 4 7.8f LEVEL CONCRETE COVERS 4 CA5'1T IR6NI / / i / / / / 4 75f OR SCHEDULE 40 6'f P. V.C. PIPE 4" SCHEDULE 40 P. V.C. 12" S=0.02, D=15' DIS M N. PIPE — MIN. BOX FLOW LINE S=0.02, , S=0.01, D=21 PRECAST INVERT iMN Ig,< B" 08 os � `C LEACHING EL.= 46_80 _ INVERT CRUSHED 08 g , �y IT OR STUNS 0 o 8 0 8 08"" B INVERT W p EQUIVALENT INVERT EL.— 46.25 EL.= 46.50 EL.=_45. 78 0 5 0c INVER INVER p G ( 3WASHED STO14" TO NE _1000 ___GALLONS EL = 45.95 EL.= 45.57 0 pC SEPTIC TANK o W EL=40.6 LEACH PIT 13, 3' f— 6' PROFILE OF 12'DIAM. - { SEWAGE DISPOSAL SYSTEM - - - - - - '! NOT TO SCALE BOTTOM OF TEST HOLE OR OSGS PROBABLE WATER TABLE EL=_36.3_ ALL ELEVATIONS ARE ASSIGNED PETER SULLIVAN, PE ! WITNESSED BY- HEAL WARD BARRY HEAL TH OFFICER Q� BARNSTABLE TOWN OF ------------ l0E-IN SOIL LOG LANDS s-CPU EY GENERAL NOTES P NO. 8187 PERCOLATION RATE _2_ MIN./ INCH � � ciVeL o.351L1 P 1. THIS PLAN IS FOR INSTALLATION OF NEW SEWERAGE DISPOSAL SYSTEM. DATE _ 03-07-94 2. LAND COURT PLAN REFERENCE 16427D SHEET I OF 3 — 3. THIS PLAN IS FOR INSTALLATION/ REPAIR OF SEPTIC SYSTEM TEST HOLE 2 TEST HOLE 1 AND NOT TO BE USED FOR SURVEYING OR ZONING PURPOSES ! EL.= 48.3 EL= 48.6 DESIGN DATA. 4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO DER -- TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS THREE FOR THE SUBSURFACE DISPOSAL OF SEWAGE. LOAM and NUMBER OF BEDROOMS 5. ALL COVER- TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN SUBSOIL LOAM and 12" OF FINISHED GRADE. ,g' 45.3 ,3' SUBSOIL GARBAGE DISPOSAL NONE 6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE TOTAL ESTIMATED FLOW 330 GPD SAME, UNLESS NOTED BY FINAL CONTOURS. j 7ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE ( _110 _GAL./BR./DAY x _`3_ BR.) OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER MEDIUM MEDIUM OR WITHIN 10' OF DRIVES OR PARKING AREAS H-20 LOADING SAND SAND SEPTIC TANK CAPACITY _—10-0-0-- SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING. UNLESS NOTED. LEACHING AREA REQUIREMENTS 8. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. 12' 36.3 12 SIDEWALL AREA 188.5 GAL/S.F. 188.5x2.5=4 71 BOTTOM AREA 113 _ GAL./S/F 113xl.O = 113 9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH - DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO LEACHING CAPACITY (BOTTOM & SIDEWALL) 584 GAL. OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. NO WA TER ENCOUN TERED 10. THE EXCA VA TOR�CONTRACTOR SHALL VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES PRIOR ,TO ANY EXCA YATION. RESERVE LEACHING CAPACITY 584 _ GAL. 11. THE PERCOLATION TEST LOCATIONS WERE TAKEN FROM SHEET 2 OF 2. JOB NO.:50440A INFORMATION PROVIDED BY BAXTER and NYE. ` ` .