HomeMy WebLinkAbout0360 REGENCY DRIVE - Health 360 Regency Drive
- — Marstons Mills
A= 064 - 056
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do.by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is
required by law.
DATE: Fill in please:
APPLICANT'S YOUR NAME/S. , SC:�1
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} !? ,.yLak is;�:'''.,r•� ' BUSINESS YO R HOME ADDRESS: — anc\- Q
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✓r'y :y;:.{ , IW �.s'u<:,;� _ Home Telephone Number - - - - --- -. - -
,,; , TELEPHONE # _
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NAME OF CORPORATION:
NAME OF-NEW BUSINESS nox ' �� �C,2-S TYPE OF BUSINESS Co
IS THIS A HOME OCCUPATION? . ES NO
ADDRESS OF BUSINESS.S C� MAP/PARCEL NUMBER _ (Assessing)
When starting a new business thePe are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth '
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in thi
MUST COMPLYsWITHtown HOME OCCUPATION
1. BUILDING COMMISSIONER' FFICE RULES AND REGULATIONS. FAILURE TO
This individual has been in r o any �ints that pertain to`this type of business. COMPLY MAY AESULfi IN FIN€G.
uth iz d Signatu e**
MEN S:
2. BOARD OF HEALTH
This individual has been infuri-ned of the per requirements that pertain to this type of business. MUSE COMPCY WITH ALA
,
HAZARDOUS MATERIALS REGULATIONS
Authorized Signature*
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This 'individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS: .
I
U '
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
360 Regency Drive /
� Y
Property Address
Sumner Kaufmany �
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/06/2008
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
Important: E --
When filling out A. General Information
forms on the
computer,use 1. Inspector: ,--'�!
only the tab key i
to move your Robert Paolini
cursor-do not Name of Inspector
use the return
key. Ca ewide Enter rises,LLC
Company Name r.11 r
r� P.O.Box 763 w
r•
Company Address
Centerville Ma. 02632
rerun City/Town State Zip Code
(508)428-4028 S14454
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Ev luation by the Local Approving Authority
3/06/2008
Inspe or'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.
****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.
360 Regency Dr.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
360 Regency Drive
Property Address
Sumner Kaufman
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/06/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 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 septic system is in proper working order at the present time.
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 of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced
❑ obstruction is removed
360 Regency Dr.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
360 Regency Drive
Property Address
Sumner Kaufman
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/06/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ 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:
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
360 Regency Dr.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w„ 360 Regency Drive
Property Address
Sumner Kaufman
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/06/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
" This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
❑ ® 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.
360 Regency Dr.•12/07 Tifle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ — Subsurface Sewage Disposal System Form =Not for Voluntary Assessments
360 Regency Drive
Property Address
Sumner Kaufman
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/06/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system-fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
360 Regency or,•12107 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
_ - Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
360 Regency Drive
Property Address
Sumner Kaufman
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/06/2008
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
❑ ® Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
360 Regency Dr.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM- 360 Regency Drive
Property Address
Sumner Kaufman
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/06/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information
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
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 2006:44,000
9 ( Y 9 (gpd)): 2007:27,000
Sump pump? ❑ Yes ® No
Last date of occupancy: 3/06/2008
Date
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
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):
360 Regency Dr.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
360 Regency Drive
Property Address
Sumner Kaufman
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/06/2008
every page. City/Town State Zip Code Date.of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
1988
Were sewage odors detected when arriving at the site? ❑ Yes ® No
360 Regency Dr.•12/07 Title 5 Official Inspection I°onm:Subsurface Sewage Disposal System•Page 8 of 15
l
Commonwealth of Massachusetts
N Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
360 Regency Drive
Property Address
Sumner Kaufman
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/06/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 14"feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well,or suction line: 20'+
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight.No evidence of Ieakage.System vented through the house vents.
Septic Tank(locate on site plan):
18"
Depth below grade: . feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
-------------------------------------------------------------------------------------------------------------------
Dimensions: 1000 gallon
4"
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
28
2"
Scum thickness
Distance from top of scum to top of outlet tee or baffle 6„
Distance from bottom of scum to bottom of outlet tee or baffle
14"
How were dimensions determined? Measured
360 Regency Dr.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
c,M 360 Regency Drive
Property Address
Sumner Kaufman
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/06/2008
.
every page. City/Town State Zip Code Date of Inspection
D. System Information, (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pump septic tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank
appears to be structurally sound.
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.):
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):
i
360 Regency Dr.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15
I
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
^M 360 Regency Drive
Property Address
Sumner Kaufman
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/06/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank (cont.)
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert No
Comments (note if box is level and distribution to outlets equal any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage into or
out of box.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes El No
Alarms in working order: ❑ Yes ❑ No
360 Regency Dr.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15
I�
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
^M 360 Regency Drive j
Property Address
Sumner Kaufman i
Owner Owner's Name
information is Marstons Mills Ma. 02648 3/06/2008
required for
every page. City/Town State Zip Code I Date of Inspection
D. System Information (cont.) j
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type.
® leaching pits number: 1-1000 gallon
❑ leaching chambers number:
leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Sandy dry soil.No signs of hydraulic failure.Leaching pit was dry at time of inspection.NOTE:Stain line
is 10" below invert pipe.
i
360 Regency Dr.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
360 Regency Drive
Property Address
Sumner Kaufman
Owner Owner's Name j
information is required for Marstons Mills Ma. 02648 3/06/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
360 Regency Dr.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
r -
Map Page 1 of 2
Town of Barnstable Geographic Information System
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http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=06405 6&mapp... 3/6/2008
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
360 Regency Drive
M
Property Address
Sumner Kaufman
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/06/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: Bottom of LP 60'
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:
As-Built Card
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database- explain:
You must describe how you established the high ground water elevation:
USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of
groundwater elevations.
360 Regency Dr.•12/07 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 15 of 15
Town of Barnstable
�F THE r,
Regulatory Services
BARNSTABM ; Thomas F. Geiler, Director
9�'pTE�A,�� Public Health .Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
This septic system inspection report was completed by a private inspector who is certified
by the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original/copy of this
report; this Division does not warranty the functionality of the septic system in the future
not does this Division agree with any technical observation s and interpretations
contained within this report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual
number of bedrooms approved at a particular property would-be listed on the"Disposal
Work Construction Permit".
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
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PLOT PLAN OF LAND
"TO THE BEST OF MY KNOWLEDGE, THE FOUNDA TION L OCA TED IN
SHOWN ON THIS PLAN IS AS IT ACTUALLY EXISTS ON THE GROUND. BA F�IVS TA BL E - MASS.
"
DA rE.• OCT. 14, 1988 ���� F \ Y PREPARED FOR
DAVID SPEC BOIL DEPS
CHAALES
SAfJiCKI �„I� DA TE.' OCT. 14, 1988 SCALE-1 =50 FT.
28085 1
FLOOD ZONE C (NON-HAZARD) CA PS' 6 ISL A NDS SUP VE YING
D-30 �FssoGISTERS
FALMOUTH — MASS.
f� j 6 TOW OF BARNSTABLE
LU�;e rNi �y �i!G1 �� SEWAGE # gZ- S74
..
VILLAGE/''/G!/','S�D/ZS ASSESSOR'S MAP & LOT _
INSTALLER'S NAME & � •6ii yZ -'�OJ
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER ,fC
DATE PERMIT ISSUED:
DATE COUPLIANCE ISSUED:
VARIANCE GRANTED: Yes No •�
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N7 ..........�...:S .. .... . ............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.--...OF...-.--..--...... ..................
Appliration for Dispuml IV 117
rk " Tonstrudiun rantit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
Sys�ezn at:
A.4.1�>L.................................. ..................................................................................................
Locatio-Add
ress or Lot No.
.... ....... ..........
Address...........................................
Owvzer
....... ....
Installer Address
Type of Building Size LotA._,(_),0C.k-e
U ...........L3........................Expansion Attic ( ) Garbage Grinder (Dwelling—No. of Bedrooms---
04 Other—Type of Building ............................ No. of persons.........G9.............. Showers Cafeteria (
Other fixtures .
---------------------------I-------- --------------------------------*------------------------------------- ----------------------------
Design Flow________________5.�;______________._gallons per person Rer day. Total daily flow.- ..........................gallons.
1:4 Septic Tank—Liquid capac�it.,,,.J..,D-Z).(�'gallons Length Width.A.'_10�biameter................ Depth.-�._D'(
W I - "Disposal Trench—No_.................... Width___._...__.___._._.. Total Length._____._.__.__.____ Total leaching area....................sq. ft.
Seepage Pit No.......... .........;,�iameter.tOLQ Depth below inletL-..D....... Total leachinTarea2l"!D......sq. ft.
z Other Distribution box D tank
0;tCl -7 ......Percolation Test Results Performed b ao... ..S:ktkV D a t e.
Test Pit No. I......Z:_......minutes per inch
Dept of Test Pit.).... ........... D pth to ground water______________________--
P-4 W:� Iter------16��----------
44 Test Pit No. 2......7......minutes per inch Depth of Test Pit- ......... Depth to ground w
--------------------------------------------------------------------*----------------------------------*-------*-----------------------------------
0 Description of SoiV2,... .........................Dpoi K!i�,IG
.......... __F_RajN.E.ER..MUST..S.U'
......... ........... ....
�7 ....... .......... T..............lt,'��.ALLAT OP; AND CERTIFY IN
.. .................
c S INST L
........................ .... :Tp. YSTEIVI WAS
--- __
-------------------------------
U Nature of Repairs or Alterations—Answer when applicable-----------q,00r-0A�K16ff't0'15LAT I
...................................................................................
.......................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITA 12 5 of the State Sanitary Code—The undersig further agrees not to place the system in
operation until a Certificate of Compliance has en issued b the b r o (>
-----S- •. .... ............... ........... n?—a C
. ...... ..........................
Date
Application Approved By............................. .........................................................
--------------
Date
Application Disapproved for the following reasons:................................................................................................................
...................................................................................................................................................................................... ..............
-� -`E;1-7&
PermitNo.................................................
CAPE & ISLANDS SURVEYING CO., INC.
131 Spring Bars Road
Falmouth, Massachusetts 02540
508-548-5486
November 7, 1988
Barnstable Board of Health
367 Main Street
Hyannis, MA 02601
RE: Lot 40 Regency Drive, Barnstable, MA
Gentlemen:This is to certify that the proposed well was installed in accordance
with the plan dated September 7, 1988 and that the leaching pit is more
than 150 feet from the well.
Sincerely,
David Sanicki ,
DS/cma
f r • ,
N ....... FE$........1_�—'...._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
, ppliratiun for Dhip sal Vorks Tonutrttrttutt Frrutit
Application is hereby made for a Permit to Construct ( ✓) or Repair ( ) an Individual Sewage Disposal
�System at
. cry... .0 :l s-� .................................. ..................................................................................................
Locati ' Address or Lot No.
----- -----juai;�-... .... .. ._... --- -.... --._....__....
W Owner Address
a •-•---......---•••--•-------••-•---•------••----•------•.....................r.................. --•....---•-•---•-•--•--._...----•---••----•-••-•-•---•........_.......•-•----•----••.._.......---
Installer Address j—
Type of Building Size Lot_ ._
�-, Dwelling—No. of Bedrooms..............J........................Expansion,Attic ( ) Garbage Grinder ( )
a Other—Type of Building ............................ No. of persons..........,i9.............. Showers ( ) — Cafeteria ( )
Other fixtures
WDesign Flow.............:.. .................gallons per person per day. Total daily flow.- �..............._.__..... 1pn�
WSeptic Tank—Liquid'capacity...!Lf`(gallons Length.�_._�n__.. Width.-•--.._.`-�Y Diameter................ Depth.. .-__.1._.
xDisposal Trench—No. .................... Width.................... Total Length.._...;_.....__..... Total leaching area....................sq. ft.
Seepage Pit No.........I........... DiameterYb.i.. �_..... Depth below inlet.................... Total leaching area���
p g !•.............sq. ft.
z Other Distribution box ( ✓) Dosjxig tank ( ) 1�- �1 Z 1
'-' Percolation Test Results Performed V_0421L._ �l1'r1 t k .���%1 �'F iv+� -:- Daten u J- X �C>>�('......."
4 Test Pit No. 1................minutes per inch Depth of Test Pit.._.._....__...__._. Depth to ground w ter------------------------
44 Test Pit No. 2._._..7.......minutes per inch Depth of Test Pit.K�-!:.......... Depth to ground wler------.�J.. ...........
I. •--------------------------------------------------------------.....-------......-----------•................................................................
D Description of Soil 6'_____.__L
-------------------------•-•-----------------------------•------------••-----.................................
U -•--•••-•-••-----••-•-•---••-•--.41....--_.:-.. - -•------------------•-•-------.....---------------......---------•••---..__....--
U Nature of Repairs or Alterations—Answer when applicable...................................................•......................_._......__..........
--------------------------•-------------------------•----------------...----------•-•--•-•------------•--------------------------------------•--------------------------................•.........••--
Agreement
The undersigned agrees to install the aforedescribed individual Sewage Disposal System in accordance with
the provisions of iITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
ignrd= ---------•------••--------•--•-------••----------------
Date
Application Approved B - 1�................................................... �2�-��►
Date
Application Disapproved for the following reasons:-------•------•---------------------•---------...---.•----••--•--•-............................................
............................................•---•-••---------•---•---------••----•-•-------•--•--•-------•----------•....••••••--•-•-•---...-----•-••••••---•--•-...•••-••..................--.......--
Date
.n Permit No......................................................._ Issued........... � 2 --- �--
• D to
THE COMMONWEALTH OF MASSACHUSETTS
BOARD _OF.__ HEALTH
wnrtif iratr of (joutplittnrr
THIS IS CERTIFY-, t the Individual Sewage Disposal System constructed ( ) or Repaired ( )
^�?...._••---•---- -------------------•-----•-----------------------.-----------------------•----•------------
� - L{ l C� Install
at_..... ---------------------------t.....----•----....._ s � � 1 1 _l.(.
.----- L ................................•.
has been installed in accordance with the provisions oI of The State Sanitary Code as descr'bed in the
application for Disposal Works Construction Permit NO...[���.....•�I.Co dated_...___�-�'Z�_j_�: .
TIME ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
y - t Inspector. -.
DATE..... ��'` ............. l_.J...... -- w
It
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r �
�;-� �•� N..........OF............ .S ��.. L- .......
7
FEE........................
Diu ru.. t�.T urku ' nrtiott antic
Permission is hereby granted.... �_.: .!� �(-----•--- .�^�.! .5�.............................................................. }
to Construc ( ) r Repair ( ) anJndividu Sewage VisKsal System
Street e
as shown on the application for Disposal Works Construction Perini
Board of Health
DATE
FOR,%1 1255 HOBBS & WARREN. INC.. PUBLISHERS
' Department of Environmental Management/Division of Water Resources
WATER WELL COMPLETION REPORT
WELL LOCATION
Address a.1 t- /
City/Town I - ;f r t l
G.S.Quadrangle Map
Grid Location
Owner 's t'L r
Address
WELL USE CONSOLIDATED WELL
Domestic❑ Public ❑ Industrial ❑
Type of Water-bearing Rock
Other
Water-bearing Zones
Method Drilled
\tlt,�T 1) From To
2) From To
Date Drilled "�1 j/�`' 3) From To
-- 41 From To
r CASING �r Depth to Bedrock
Length 7� Diameter <<
Type UNCONSOLIDATED WELL
STATIC WATER LEVEL Water-bearing Materials `
Feet below land surface 0J Sand: fine❑ medium❑ coarse Q
Date measured 1' Gravel: fine❑ medium❑ coarse❑
GRAVEL PACK WELL Screen:Yes [] No 0 )S !
Slot# 20 length from to
Split Screen (or 2nd screen)
WATER QUALITY TESTS MADE Slot# lenqth from to
Chemical ❑ Biological 2 Depth To Bedrock
PUMP TEST
L,.
Drawdown feet after pumping days hours at GPM.
How measured Recovery feet after hours.
LOG of FORMATIONS COMMENTS: (On well or water)
Materials From To
0
r'. I o M
2v, DRILLER
Firm L.W.Sawyer %ell Uri.li.i yl
Address Y.U. b0,L 1JU4
City t lyf:,00,url, .d J; :iOJ
Registration No.
r �
� operator's ignature
Please print rrm y
BOARD OF HEALTH COPY 15M-2 84-176471
;gig OFFICE LABORATORY
1498 HIGH STREET 176 PLYMOUTH STREET
j BRIDGEWATER, MA 02324 BRIDGEWATER, MA 02324
OLIVEIRA ENVIRONMENTAL LABORATORIES, INC.
FOOD- DAIRY PRODUCTS -WATER-WASTEWATER
CHEMICAL Et BACTERIOLOGICAL ANALYSES
(508)697-2650
September 16, 1988
L.W. Sawyer Well Drilling
P.O. Box 1504
Plymouth, Mass. 02360
Source: Well Water - Bored Well with well point - 79 feet deep - producing 30+ gal/min.
(static water level 65 feet)
Located on the property at Lot 40 Regency Drive - Barnstable, Mass.
Coliform Count
/100 ml @ 35 C 0
Membrane Filter
S.P.C./ml
@35C L 1
Color (APC units) 0.00
Sediment none
Turbidity (NTU) 0.32
Odor none
Taste satisfactory
pH 5.70
Specific Conductance
micromhos/cm 260.
mg /liter
Total Alkalinity (CaCO,) 4.00
Free CO, 15.6
Total Hardness (CACO,) 38.0
Calcium (Cal 6.40
Magnesium (Mg) 5.37
Sodium (Na) 29.0
Potassium N 3.25
Total Iron (Fe) 0.02
Manganese (Mn) L 0.01
Silica (SiO,) 9.00
Sulfate (SO,) 4.00
Chloride (CI) 73.0
Nitrogen - Ammonia 0.09
Nitrogen - Nitrite 0.001
Nitrogen - Nitrate 2.10
Copper (Cu)
L = less than
On site collection made by T. Harris of L.W. Sawyer Well Drilling - 9/13/88 at 4:00 P.M.
Sample delivered to laboratory by T. Harris - 9/14/88 at 10:30 A.M.
Bacteriologically, this well water is of a satisfactory sanitary standard and is suitable
for drinking and domestic purposes.
Chemically, this well water is acidic (will be corrosive) . All other chemicals tested
meet the standards.
Director
The Standard Plate Count indicated the general bacterial population of the well at the time of collection.
Coliform Group Bacteria:
Significance
The coliform group bacteria includes organisms found in the intestinal tracts of warm blooded animals, birds,decaying organic matter(hay,
leaves, wood, etc.), the top 2 to 3 feet of the soil, lakes, ponds, brooks, rivers, drainage and types of vegetation.
Because the organisms can cause some illness; because the presence of coliform organisms in the water suggests that other more harmful
organisms may be present, water containing one or more coliform group bacteria per 100 ml of sample should not be used for drinking or
cooking purposes unless boiled 5 minutes or disinfected by other means.
This bacteria is of animal origin (intestinal tract)and may be considered as closely associated with disease causing organisms.On this factor,
none should be present.
Color — APC Units- Ground water ought to be practically free from color. For attractive water - color should not exceed 15 units.
Turbidity — NT Units - Recommended limit not to exceed 5 units.
Odor&Taste — For water to be of high quality, the water should be odor free and taste good.
PH — The pH value defines the concentration of free hydrogen ions in solution. Expressed on a scale extending from 0 or very acid to 14 or
�- very alkaline with 7.0 being neutral.
Specific Conductance — Conductivity is a good criterion for measuring the degree of mineralization and assessing the affect of diverse ions
on chemical equilibria.
Total Alkalinity — The alkalinity of this water represents its content of carbonates and bicarbonates.
Free Carbon Dioxide — Well water having a low pH and a Free CO, level in excess of 50. mg/I will be corrosive to iron, bronze, brass and
copper tubing and fittings.
Total Hardness — Standard not to exceed 50. mg/I. Waters having a hardness level of 50 to 100 are in the medium hardness range, over
100 very hard.
Calcium -- Calcium contributes to the total hardness of water.Appreciable amounts of calcium salts break down on heating and form scale
in boilers, pipes and cooking utensils.
Magnesium — Magnesium is a common constituent of natural water. Magnesium and calcium ions are principal contributors to water hard-
ness. Concentrations in excess of 125 mg/I can exert a cathartic and diuretic action.
Sodium — Recommended limit not to exceed 20 mg/I.
Potassium — Potassium concentrations in drinking water seldom exceed 20. mg/I.
Total Iron — Standard not to exceed 0.3 mg/I.
Manganese — Standard not to exceed 0.05 mg/I.The principal reason for limiting the concentration of manganese is to reduce esthetic and
economic problems.
Silica — Silica content of natural water is most commonly in the 1 to 30 mg/I. Silica in water is undesirable because it forms difficult to
remove silica scales.
Sulfates — Standard not to exceed 250 mg/I.
Chloride — Standard not to exceed 250 mg/I.
Nitrogen — Ammonia is present in variable concentrations in many surface and ground waters. Its occurrence in ground water is generally a
result of natural reduction processes.
Nitrogen - Nitrite — Nitrite in water poses a health hazard, but fortunately seldom occurs in high concentrations. Waters with a nitrogen -
nitrite concentration over 1 mg/I should not be used for infant feeding.
Nitrogen - Nitrate — Standard not to exceed 10. mg/l. Nitrate, in high concentrations can and do cause methemoglobinemia or so-called
nitrate poisoning in infants. Water with 10 or more mg/I of nitrate is unsatisfactory and is not considered safe for drinking or cook-
ing. It is especially dangerous to children and should never be used in infant formulas.
Copper — Standard not to exceed 1.0 mg/I.
i
s y% TE.K Fin"F LE
AOT 3 Sr".'ALE
TOP FDN. FINISH GRADE i o o ,t� FINISH G17ADE OVER
EL .poi so P-0;
'- FINISH GTRADE OVERDIST. BOX 99.3FINISH GRADE OVER
SEPTIC TANK 9 9..5 cmv/ � LEACHING PIT 9 9,� ,
NN
112 MA X.
p.�p a �o.•e:t ° e. O o o•:o.a.s .:d.eb a.p�• a .�:e!e.�pA
•. .. 6 a 3" OF 1/8'' — 1/2" 12" MAX PRECAST CONC. OR
ASHED `FEa'STONE :, Q: :a..e•:.:a.._.
-� OUTLET PIPE LEVEL BRICK 6 MORTAR
,
t.: TO 12 BELOW GRADE
a FOR 2 FT MIN e °::D:°°• ;;;:a:ao:oe':• e
e o.
0.
d
97G'8 � n L6"
o ;� 'i '0 6• e ' o.'.d 'a p o o• oo,
:°o ? C. I. OR PVC TEES a l—<"
' B9MT. FLR. '�o•p•o •.:. � .� OOO
GALLON I
o•.::o�. •:;� t, ��'STR.IBt/TION BOX
EL P o o .r
t
PRECAST CONCRETE o INSTALL ON LEVEL BASE 3/4" TO 1-1/2" 6 ,
o: PRECAST p
• e oa
WASHED •
:u
01 H I0 R�:INFO,�CED s CRUSHED
CONCRETE
a.� STONE
e:o?a:e•aq':e'..o o .;o-:o ° :_ .:°'.•o•Q.a::•::.j•:•6. 'o.• e o•:o: I .y
•......,....--^--. ..->. .a;'o,.o.b•.o.o�:oaP•o,p•e . • c, c .•o.co..o.o. :o: o• o•b:o. _ '� "! -,�:.I
�o SEPTIC TANK �° �:. . o �o �
ve C<rr: / � �. c _ _ INSTALL ON LEVEL BASE
' N"�f E.• A'C:r=t VA TE TO ELEV g2.2 OR
o'a
I
L d >< 8 --
», ? LOI'E�l TO t WOVE ALL IMPERVIOUS 010 2 ._0„
MA TERIAL"' .�,�,. + T,yl THE LEACHING AREA `_
REPLACE EXt_,
__ A �',� TED MA TERIAL WITH ,
c,
_ . CL EAN, CL A Y- F&TE7 ;SAND 10 -0
EFFECTIVE DIAMETER
PRECAST CONCRETE
LEACHING PIT
LEACHING PIT
,.- r "' • -GENERAL NOTES y• f ,, 6a tee..,,
C° RP G 1. ALL EL EVA.TIOl4'.S SHOWN ARE BASED ON
ASSUMED INSTALL ON LEVEL BASE
2. ALL PIPES IN' THE .S YSTEM MUST BE CAS T IRON --- -- ----- -
- \ • s ., . . OBSEP lA TION P T - t
Q4 SCHEDULE 1U- PVC T
3. THE BOARD OF",'HEAL TH MUST BE NOTIFIED P-5921
WHEN CONSTRUc'TION IS COMPLETE PRIOR
5000 GALLON' �1 �.
PRECAST CONCRETE �` o �_ _�� TO BA CKFIL L It IG PERCQ� TION/ I/v•�'E.-
-- - SEPTIC TANK 4. ANY CHANGES ;At THIS PLAN MUST BE APPROVED
BY THE BOARD OF HEALTH AND CAPE 6 ISLANDS WITNESSED BY*
`� / �' ►+8`�' 2� 4n/ SURVEYING CO., INC. T. MCKEAN • .
\ --
°� 5. MA TERIAL S ANL� INSTALLATION SHALL BE IN BARNS. �F L TH DESIGN DA TA
W COMPLIANCE W:,,TH THE STATE SANITARY ,�Q7• B, / ;���
-•o ��- ,� CODE - TITLE" V - AND LOCAL APPLICABLE DA TE.-
r - - - - -
z - ¢ -- _ .r�'. ter.f Z,, ? '" z
-- __ RULES AND RE(�ULA TIONS NUMBER OF BEDROOMS 3
Q iao.5' O Teo,2
c -s- 6. NORTH ARROW IS FROM RECORD PLANS AND -r o s e t I T o P
—74--- P GARBAGE DISPOSAL
- _ tot IS NOT TO BE USED FOR SOLAR PURPOSES s„ b , o , so b s e
DA IL Y FLOW �8-GAL .
L a -r �/-O_ �--�� _- I° "°. 7. FL OOD HAZARD ZONE C zy• p� GAL .
B. WA TER SUPPL Y -VA WELL SEPTIC TANK REO D. —�6®e.
I. O acres }_. SEPTIC TANK PROVIDED CAL
—,�3R
LEACHING REOUIRED CPD.
'• � tray C. In•a
.� Div
�B h' S4t�FWALL ARfA5= S. F71
h nM �..� N l a d t .. S. F.X G/� F. = GPD
BO��OM AREA 1 =�_S. F. 79
LEGEND s " " d S a, s.F.X G/s. F. _ 590GPD
LEACHING PROVIDED GPO
11ROPOSED EL E VA TION AV#
t�
-- 99 —— c�xrsTING CONTOUR 4�INGL E FAMILY RESIDENCE
® OBSERVA TION PIT
} ❑ 17ISTRIBUTION BOX of n =Ca
PROPOSED SEWAGE DISP_OSA L.,,,.S YS TEM
o. J11ecLS l.�4�+F: LAi 0—%J AND CC-: iF`t tt9 V
QQ LEACHING PIT U . BERT �:na SYSTEM WAS INSTALLED IN 6"p;
Ha. z�s^a I PFIEPAREO F F,,ORDANCi_To PLA •CT
SPEC BULL DERS N•
0 o "EPTIC TANK `csS�oNAL "��%l
LOT 40 REGENCE Y DRIVE
jRP l ?ESERVE �� ��H of 4114-- MARS TON MILLS BARNS. MASS .
OAVIp Gs
LE
P7 Z8 ,WIPE INVERT ELEVATION ti CHA CKI
SANICKI
DA TE: `S'�o 7, /9e s
AFC$7 EFt4 f CAPE 6 ISLANDS SURVEYING, -INC.- -
PLOT PLAN �� �� �o �ss,�N�l L �,, � SCALE AS NOTED P. 0. BOX 334
SCAL,E_J_ • o-
PLAN NO.
_ MAP SEC PCL !_O T H,SE ��r....�; "
<�� TEA TICKET, MASS
S YS TEM PROFILE
NOT TO SCALE
TOP FDN. FINISH GRADE L v o •v FINISH GRADE OVER
EL ./a/ s'o :o:.:oo FINISH GRADE O VER
DIST. BOX 99• ? FINISH GRADE OVER
SEPTIC TANK 9 9..f
LEACHING PIT 9 9,z.
_a:.?•'012" MAX.' /
o:
0: p.. il,e•O'i.0:.,0, e:O.,•.O. d. •e .'t A ; . . ..e' S" OF 1/8" 1/2" 12 MAX
:� 0^b. I j.,: n. a„ ,r •tr.':e:•.• .e: .e:. e •d•'O.•e:e• D
AS,'yE0 PEA 1 STONE PRECAST CONC. OR
••. o. e:•e••e to•.e:
BRICK 6 MORTAR
9" OUTLET PIPE LEVEL ;. TO 12" BELOW GRADE fi
' _• 4•. •O • •t•.
c
FOR 2 FT MIN.
.o.•o �`�"x"-�,., � e:� n ' n �,:: ••°•oe•..e:on�'o:o:p:aq •o•a:a:oo,•oo.;••a.,e o
f T, �// .
'•p': ;6. 1'/� 5.. 0 •°: ••e:::l.:°•' ..'o••.e• :1 O p A •..' 0...0: d •.Q••D,e.•• p.,4.�•�
o•.::o:° a: 4_ a 97. �'3 96LO o,o' ►y•0 ° ° ;p 'Dnb o, o
C. I. Of? PVC TEES
o:
BSMT. FLR. :° 10G 0 GALLON
:'o b DI,,'—; TRIBUTION BOX � o
EL . 9
PRECAST CONCRETE A INSTALL ON :LEVEL BASE 314,, TO 1-1/2"
•e
o.
' " a° s PRECAST p p
:.o..°.. .°•. o•,.° . ;e WASHED I
0 REINFORCED � CRUSHED CONCRETE t
e•jp' •e'oq a:a:: o-:o;e,o.e•o Q o:op'•e: :.y::6. 'o.: b o oC S TONE
s
_, at.�: 0.,3:•c c°.o:o C .o.o o•. n;4.4 d ;o;a o:o o::e..p:. o b o. I Q .
- H- 10 REINF. n o a:�
A, -- ,SEPTIC TANK o:. .. .)
_ °
.INSTALL ON LEVEL BASE
� . VA TE TO ELEV. 82.2 OR - •n
Gd � � NO EXCA _ _ ,;.. � —
LOWER TO REMOVE ALL IMPERVIOUS ,_
2 .;•O
7.• MA TERIAL BENEATH THE ,�EA CHIi'�G .AREA 6 '-0 "
REPL A CE EXCA VA TE"D MA T,�RIA L WI TH
CLEA °°T, CLAY FREE SAND 10 '-0 "
TM
9 ,
EFFECTIVE DIAMETER
/ PRECAST CONCRETE
/ LEACHING PIT
ir°r,' °� GENERAL NOTES LEACHING PIT
,a SSUMED INSTALL ON LEVEL BASE
G RP I �t 1. AL L EL EVA TIONS SHOWN ARE BASED ON �—
\
9 2. A °le u,PIPES IN '7'HE SYSTEM MUST BE CAST IPON
OR Si� ' DULE .PVC. Al T _ _. • __ :.
OBSERVA TTO
3. Tf:'F 6a,� OF HEAL TH 'MUST BE NOTIFIED P-5921
WHEN CONSTRUCTION IS COMPLETE PRIOR
1000 GALLON s� i PERC01A TION RA T:E,
PRECAST CONCRETE o TO BA CKFIL L ING
'----_ SEPTIC TANK �� �— �� ` 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED MIN./IN.'
BY Tf ,BOARD OF HEALTH AND CAPE & ISLANDS
WI TNESSED B Y'
SURVE}INJ' CO. -INC. T. McKEAN
5. " MATERIALS AND INSTALLATION SH.4�',L BE IN
a gg
COMPLIANCE}WI 'H THE STA TE SAIVI TAR Y BARNSB,`- �I,g7d L TH DESIGN DA TA
CODE - TITLE V - AND LOCAL APPLICABLE DA TE. • . 6
RULES AND REGUL A TIONS n, t 3
o ,00.s off—.
'°c'Z NUMBER OF BEDROOMS
Q 6. NORTH ARROW IS FROM RECORD PLANS ND -r o s a , I r -5 ,
� GARBAGE DISPOSAL
IS NOT TO BE USED FOR SOLAR PURPOSES s„ b . o ,
L o -r `f O __ ,° ` ' 7. FL000 HAZARD 'ONE C zy• ! �� DAILY FLOW —�36-GAL .
-- B. WA TER SUPPLY SEPTIC TANK REO 'D. GAL .
I. O acres "a0 • ? so, ncl
SEPTIC TANK PRO VIDED
LEACHING REG�UIRED GPD.
4 e• la�r clay
188
�'� S �FWALL AR2fA5•= S. F71
\ rJ - S. F.X G/� F. = GPD
p� \ G /o' �• ,� n A;a K BO�T�OM AREA S.F. 79
c, LEGEND S.F.X G/S.F. _ �GGPD
L EA CHING PRO VIDED GPD
1.' ; •
0
we /� ..�"` 0
PROPOSED EL EVA TION "'y` was y� _-_ d8•z
- -- 99 -- EXISTING CONTOUR S'INGL E FAMILY RESIDENCE &
I OBSEVA TION PIT
❑ DISTRIBUTION BOX °F
PROPCISED SEh A GE DISPOSAL S YS TEM
o j 1AI:rlS DESIGNING ENGINEER FAU T
0 LEACHING PIT `� H 2�s�a INSTALLATION AND CERTIFY
1 PE•PA,Z?ED FOR
�� a
SPEC BC�'IL DEf�S J -' r
o o SEPTIC TAl4'K Fs, r
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