HomeMy WebLinkAbout0015 SADDLER LANE - Health 15 Saddler Lane
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c Commonwealth of Massachusetts
Title 5 Official Inspection Form
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e Subsurface Sewage Disposal System Form Not for Voluntary Assessments
15 Saddler Lane
Property Address '
John B. Hoffman
Owner Owner's Name
Information is required for every West Barnstable mAA MA 02668 4-19-19
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. Please see completeness checklist at the end of the form.
filling outt:When forms r. , c
g A. Inspector Information ��� �3 tea— .����.•'• '� ....•s9y,
on the computer, �q:. JAMES
use only the tab James D.Sears v ;
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Capewide Enterprises
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Company Name y-.W, - 1FTk•-o
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,Q Company Address
Mash pee MA 02649
City/Tawn State Zip Code
r 508-477-8877 S 1623
Telephone Number License Number
B. Certification
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
4-22-19
tors 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.712 612 01 8 Title 5 Official Inspection Form:Subsurface sewage oisposal System•Page 1 of 18
Apr 22 z019 21:48 HP Fax page 6
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
15 Saddler Lane
Property Address
John B. Hoffman
Owner Owner's Name
information is required for every West Barnstable MA 02668 4-19-19
page. City/Town 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 system is a 1000 Gal, Tank D Box and two chamber's.
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):
t5lnsp.doc-rev.7/2W018 Title 5 Official Inspeclion Form;Subsurface Sewage Disposal system•Page 2 of 18
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,Apr 22 ,2019 21:48 HP Fax page 7
Commonwealth of Massachusetts
P Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
15 Saddler Lane
Property Address
John B. Hoffman
Owner Owner's Name
information is required for every West Bamstable MA 02668 4-19-19
page, Cityl row n State Zip Code Date of Inspection
C. Inspection Summary (cons.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval it
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ NO(Explain below):
❑ distribution box is leveled or replaced. ❑ Y ❑ N ❑ NO(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:
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,Apr 22 ,2019 21:48 HP Fax page 8
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
15 Saddler Lane
Property Address
John B. Hoffman
Owner Owner's Name
information is required for every West Barnstable MA 02668 4-19-19
page. City/Town 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.
❑ 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 wafer 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 grtwnd or surface waters
due to an overloaded or clogged SAS or cesspool
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
� 15 Saddler Lane
Property Address
John B. Hoffman
Owner Owner's Name
information is
required for every West Barnstable MA 02668 4-19-19
page. City)Town State Zip Code Date of Inspection
C. Inspection Summary (cunt,)
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 is less than 6"below invert or available volume is less
than 1/day flow 7"'"'/"AIG
❑ ® 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 C.4.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ 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
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Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form • Not for Voluntary Assessments
15 Saddler Lane
Property Address
John B. Hoffman
Owner Owner's Name
information is required for every West Barnstable MA 02668 4-19.19
page. City/Town 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 C.4 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 aU 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)]
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c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
15 Saddler Lane
`r Property Address
John B. Hoffman
Owner Owner's Name
information is required for every West Barnstable MA 02668 4-19-19
page. City/Town 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
Description:
1000 Gal Tank D Box and Two Chambers.
Number of current residents:
1
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes,discharges to:
Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage 2017-142,000Gal
g ( y g (gPd))' 2018-130,000Ga1 s
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Present
Date
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,Apr 22 ,2019 21:49 HP Fax page 12
Commonwealth of Massachusetts
Title 5 official Inspection Form
Y Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
15 Saddler Lane
Property Address
John B. Hoffman
Owner Owner's Name
information is required for every West Barnstable MA 02668 4-19-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Comm arcialllndustrial 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: NA
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
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,Apr 22.2019 21:49 HP Fax page 13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�. 15 Saddler Lane
Property Address
John B. Hoffman
Owner Owner's Name
information is
required for every West Bamstable MA 02668 4-19-19
page. CifylTown State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system(yes or no)(if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
2012 Permt # 2012- 250.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 27"
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,):
Pipeing is 4" PVC SCH -40.
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,Apr 22 ,2019 21:49 HP Fax page 14
Commonwealth of Massachusetts
_ OF Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�. ,.' 15 Saddler Lane
Property Address
John B. Hoffman
Owner Owner's Name
information is required for every West Barnstable MA 02668 4-19-19
page. City/Town State Zip Code Dare of Inspection
D. System Information (cont.)
6. Septic Tank (locate on site plan):
Depth below grade: 17
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 Gal. Precast. H-10
Sludge depth:
3"
Distance from top of sludge to bottom of outlet tee or baffle
27"
Scum thickness
2"
Distance from top of scum to top of outlet tee or baffle 8
Distance from bottom of scum to bottom of outlet tee or baffle
16"
How were dimensions determined? Asbuilt-Tape
Sludge Judge
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 at working level. Tank at 17"below grade.Wlin and outlet cover at 4". In and outlet tees.
No sign of leakage or over loading.
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Apr 22 .2019 21:49 HP Fax page 15
c Commonwealth of Massachusetts
VTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form • Not for Voluntary Assessments
15 Saddler Lane
Property Address
John B. Hoffman
Owner Owner's Name
information is required for every West Barnstable MA 02668 4-19-19
page. CityrTown State Zip Code Date of Inspection
D. System Information (cunt.)
7. Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
B. 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
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Apr 22. 2019 21:50 HP Fax page 16
N Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
15 Saddler Lane
Property Address
John B. Hoffman
Owner Owner's Name
information is required for every West Barnstable MA 02668 4-19-19
page. City/Town State Zip Code Date Df 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.):
D Box is 16"x16"-20" below grade w/cover at grade. Box is clean and solid w/two lines out. No sign
of over loading or solid carry over.
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stem ystem•Page 12 of 19
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Commonwealth of Massachusetts
U�. - Ti Sewage tle 5Officia Inspection Form
p System Form -Not for Voluntary Assessments
u 15 Saddler Lane
Property Address
John B. Hoffman
Owner Owner's Name
Information is required for every West Barnstable MA 02668 4-19-19
page. City(Town State Zlp 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:
® leaching chambers number: 2
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.V2612018 Title 5 Official Inspedion Forth:Subsurface Sewage Disposal System•Page 13 of 18
Apr 22. 2019 21:50 HP Fax page 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Pt
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
15 Saddler Lane
Property Address
John B. Hoffman
Owner Owners Name
information is West Barnstable MA 02668 4-19-19
required for every
page. City(Town 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.):
Leaching is two 500 Gal. dry well chambers. Chamber's are 37" below grade w/cover at 10".
Chamber's are wet on bottom w/clean like New Wall's.
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.):
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Commonwealth of Massachusetts
12
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
vi�w
15 Saddler Lane
Property Address
John B. Hoffman
Owner Owner's Name
information Is required for every West Barnstable MA 02668 4-19-19
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.):
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f
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
15 Saddler Lane
L Property Address
John B. Hoffman
Owner Owners Name
information is West Barnstable MA 02668 4-19-19
required for every
page. City/Town 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
19_2
134: J_A "
09-5: 6,3-3"
,v
a FR
i '
� a
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,Apr 22. 2019 21:50 HP Fax page 21
Commonwealth of Massachusetts
Title 5 Official Inspection Form
} Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
15 Saddler Lane
Property Address
John B. Hoffman
Owner Owner's Name
information is required for every West Barnstable MA 02668 4-19-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
�Estimated depth t hlgh 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:
Auger T,H.at 12' no G,W., Bottom of chamber's at 5'-8"below grade. Bottom of chamber's at 6"-4"
above T.H. Depth.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
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Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
15 Saddler Lane
Property Address
John B. Hoffman
Owner Owner's Name
information is required for every West Barnstable MA 02668 4-19-19
page, City/Town 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 4 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 atta
ched
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
7. Y
13o 0
N�
G W,
l5insp.doc-rev.7/26/2018 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal Syslem-Page 18 of 19
I
Town of Barnstable P#
Department of Regulatory Services
i Publi Z
A c Health Division Date
se;pc A�6' 200 Main Street,Hyannis MA 02601
M1a ? \
Date Scheduled J Time l ��6
Fee Pd.
,Soil Suitability Assessment for Se Disposal
Performed By: Witnessed Witnessed By:
LOCATION& GENERAL INFORMATION
Location Address S SR O
C0I¢. t" wner's Name
Address 1 S S4t�c� f�+ •W D Z S
Assessor's Map/Parcel: Engineer's Name AAe—/44L C-0-� /0 L
NEW CONSTRUCTION REPAIR x Telephone# S�Fl 7 37—9 7&
r ���-
Land Use s i f o. Slopes(%) `Z L Surface Stones��-I--c,-.
Distances from: Open Water Body /YM ft Possible Wet Area 2 L321--ft Drinking Water Well
Drainage Way ft Property Line --3�ft Other` ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands A proximity to holes) '
0 w—Z
2
t�
Parent material(geologic) r`� Depth to Bedrock 'Af/A
Depth to Groundwater. Standing Water in Hole: �/� Weeping from Pit Nee /jAd _
Estimated Seasonal High Groundwater uP t4
DETERMINATION FOR SEASONAL HIGH WATER TABLE s;
Method Used:
Depth Observed standing in obs.hole: In, Depth to soil mottles:
Depth to weeping from side of obs.hole in• (3rn!�nel�fMtpr
index Well# Reading Date: Index Well levels Adj.factor Adj•Groundwater Level,,,e
PERCOLATION TEST Date � Time..�.�
Observation
Hole# Time at 9" 1 Z 3
/i
Depth of Pere � /!�� Time at 6" (Z:Z-]
Start Pre-soak Time® 1 l ; 3 3 'Mme(9"-6") 2 d 1
End Pre-soak
Rate MinJlnch
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:XSEPTICWERCFORM.DOC
1
DEEP.OBSERVATION HOLE LOG Hole#. 6
Depth from Soil Horizon Soil Texture. Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling '(Structure,Stones;Boulders.
Consistenci.
•
A 0` )eV-L
lF. 36 T3 � , toY)c
36, -74F C, 5 L to Y✓L J7 a Lh" is
C-t. M—-5 Z.5
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture . Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. Orav l)
eZ1,7 �i NC)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil , Other
Surface 00" (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Con istency,%Gravel)
. 1 _
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,:Stones,Boulders.
Flood Insurance Rate Man: (_x/
f1hDVe�in"i jc5r fl..:.-?b ::.^.ds*v NO-
-Within Yes u✓.�
1
500 year boundary No Yes
Within 100 year flood boundary No Yes
Death of Naturally Occurring Pervious Material
Does at least four feet.of naturally occurring pervto s material exist in all areas observed throughout the
area proposed for the soil absorption system? e S _—
If not,what is the depth of naturally occurring pervious matorial?
Certification �-
I certify.that on (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the.above analysis was performed by me consistent with
the requited training,expertise and experience described to1(1CNLtt 15.017.
Signature
Date
Q:\,SEpTlC�PBRCPORM.DOC
TOWN OF BARNSTABLE
LOCATION /,57 Sa cJc P r 1,n) SEWAGE# 2-01 2
'r LAGE lua(S�t4, L5__ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY (2X ISM'( t-j)
LEACHING FACILITY:(type) SQ-) o► J(o%A c'bgMn S (size)
NO.OF BEDROOMS 3
OWNER L�ti► (�
PERMIT DATE: 2 COMPLIANCE DATE:
Separation Distance Between the: Ak)*Ac
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ��Pt-« Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility°)' Feet
FURNISHED BY
,4i10 '14-T
box A
G
- I.T3
OUT-2 '2
Lj
2 r.G3,3
f -
7
' b
�o _ 25 �(oo oZ)
No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftpYitatiou for his saY 6pstem (Construction Permit
Application for a Permit to Construct( ) Repair(' Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No./3*s��Jl�r LN Owner's Name,Address,and Tel.No.
L e,,v&
Assessor's Map/Parcel S�
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
ej
Type of Building:
Dwelling No.of Bedrooms ,'} Lot Size sq.ft. Garbage Grinder( )
Other Type of Building 1✓4 e No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 7'>U gpd Design flow provided 3 3/ gpd
Plan Date ��<L�/2 Number of sheets 12 - Revision Date
Title
Size of Septic Tank iE5L19 A „ Type of S.A.S. TCo
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 1 ev4 fo// A-,,Pr
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Si ed Date*eh�—
Application Approved by Date
Application Disapproved Date
for the following reasons
Permit No. Z-O C Z Z 50 Date Issued 8 o 7 l
s '� D0 ov
No. �.y' Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN,aF-BARNSTABLE, MASSACHUSETTS
pfication for Mis -6pstPut construction hermit
r
Application foi a Pe-imtt'to Construct( )/ Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
4 Location Address or Lot No. /3 S4J�/lrr Gn/ Owner's Name,Address,and Tel.No.
L r.v le-
Assessor's Map/Parcel
Installer's Name,,[Address,and Tel.No. Designer's Name,Address,and Tel.No.
qco
Type of Building: /
Dwelling No.of Bedrooms Lot Size /�i�2 �L sq.ft. Garbage Grinder( )
Other Type of Building Aav 4 Y No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) -y y gpd Design flow provided 3 3/ gpd
Plan Date 702 C Number of sheets 2-- Revision Date
Title
Size of Septic Tank t(i5 f V S Type of S.A.S. SCap ;gel
Description of Soil ,.
Nature of Repairs or Alterations(Answer when applicable) ,vy FG IJ iVrW
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
'r
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate-of
Compliance has been issued by this Board of Health.
S' ed f Date L /�—
Application Approved by Date_4G p 2
Application Disapproved y Date
for the following reasons
Permit No. !.tom(-L j Date Issued 8 G Zo 1 Z t
-----------------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
.g`
Abandoned( )by `L/� i�y %}raw.✓ r `�i�C
C
at l S S has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.o)Z'?,5C dated R
Installer�����3 .� �j✓erw� �n/G Designer kiffind
#bedrooms �� Approv�d esign gpd
The issuance of this permit s Il not ,e/corns�trued as a guarantee that the system will fu ed.
Date j V Insp ctor
T
No. ZO/2.- 250 Fee t 6 mot/,W
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal *pstrm Construction 'ermit
Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon
System located at/S �a e,�/ Y� l--V /j,-�e, rS fort A4"113
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Co struc ion must be completed within three years of the date of this permit
Date ( ?,0/Z Approved by
' 08/08/2012 07:32 5084775313 ENGINEERING WORKS PAGE 01
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
Um
AL 48 Public Health Division
ass
1 Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office. 509-862-4644 Fax. 508-790.6304
Date: Sewage Permit# Ameseor's Map/Parcel
Installer&_Pesigner Certification EQrrm,
Designer: ,g:n j,..,,. Wares+ 1 nc . Installer: Sca u vt is n c
Address: fz W. C rb.x 4 l& i;d. . Address: r'V' 5 C*
On '� l .� was issued a permit to install a
(date) (installer
septic system at 1 .5- SKdd!e_-L�i 1 /114 based on a design drawn by
(address)
L. /t't� �► 5- dated -7('Z61 i 2�
(designer) - -
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (Le,
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State&Local Regulations. plan revision or
certified as-built by designer to follow. Stripout (if required) ted and the soils
were found satisfactory. "orb
PETER T.
ENTstaller's ��gnature) Mc ClvIt EE
No.35102 0
--� rsTS
(Designer's Signature) _(Af Fix Design eV
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS.
BUILT CARD ARE RECEIVED BY THE B,AMSIAABLF PUBLICMALTH DIVISION
qAo fice fbrmMesigercer0cation famdoa
44
ASSESSOR'S MAP N0.95-9,,N5 PARCEL Lk
N ' � .LO.CATIO � SEWAGE PERMIT NO. �
E Lkscx��,ec \ti ��- $6 \
,INSTALLER'S NAME i ADDRESS
k _ \A
B U I L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
/k
r
. . 1 w FEB. .No...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD- O.F� HEALTH
o. ...........oF. f � .1 / V ................
.� lirttti�ait fur l n tti urk . Cron.utrur#iun rrmi#
.
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at: 1 �T# .
............. .................... ........
.............
Location-
.. K-L.�r� lr Address o. Lot•No.
.........................................
' Owner
W ........... ..�� ,1.....�'CLl_�S%/1,_.--------------....------•--....:.. ._..........-- ./%
Installer Address
Type of Building Size Lot._—tte-Q.....Sq. feet}
UGarbage -
..a Dwelling No. of Bedrooms _3._.. ._____Ex anion Attic Grinder g— F P ( ) ( )
p, Other—Type of Building.__._a_______________________ No. of persons............................. Showers ( ) — Cafeteria ( )
Q' Other fixtures = -----------------------------•--........______-----------•••-......................... �—
Design Flow-------1.1Q...........................gallons pe preen �r day. Total daily flow.._......___�,�'_ � gal „
I
Septic,'Tank—Liquid capacitylODO_gallons Length�-�Width—,-_(�'Diameter:..............: Depth�_�. .
W' Disposal Trench—No..................... Width..................... Total Length.................... Total leaching area....................sq. ft. `
x
3 Seepage Pit No.� 40Diameter-.__,__&._._._. Depth below inlet.....t! ?..._...Total,leaching area_Z61_/_...sq. ft.
z Other Distribution box Dosing tank
Percolation Test Results Performed by._. D�NLt- 11.1E1�:r•�IhDU... Date.....cap �t �.....__.. .
Test.Pit No. 1.."2•_._minutes per inch Depth of Test Pit... ___..:__ Depth to ground water....kloljf%'_
(% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth�to ground water.........................
.. _
Description of Soil... ..-.CC?.._
-C1t
_ .. .----•-- -_--i.� �D��.�. �J.....[ __.._ f,..
Rat--- �- -1-.._t2Abh1t-'->---------•--------------------------------------------•----•------•-------- '
w
VNature of Repairs or Alterations,—Answer when applicable............................................................................................... l
......................... =.......
•..........
...._...............
........
_••••.......................................................................................
Agreement
The, undersigne grees to .install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of AITILE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee �iassuued by he and of health.
Signed•---��.....• - ---•-•............................... C� " �......._
{_
Date
Application Approved By....... '--•------•-- ----...-•---_=------•-----•-•------- .. ........................
Date
Application Disapproved for the following reasons_...............................................................................................................
'............................... .... __..._..._......' ...._...._
Date
PermitNo.................................... �........ . Issued-.. - ..............................................
r i Date
-'�
4;:
s THE COMMONWEALTH OF MASSACHUSETTS
/BOARD OF HEALTH
._........oF. ►,�I.. "C"l . h.f ................J-1 JV ,..r
` Y
A(ppltratton for M-n .4, 41 Blorks Tomitrudion ramit
'Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at: #
:.'...�?.D om....................................
- = 1•-........
Location�A�ddres o.
JLot No.
al/ /................. 1.�! ; .. Q6�Si/I�...----------- .........:.-------- •-------.....---------------.......-- -----... U/G«......-----• ------
Installer Address '� ���
Type of Building a Size Lot._._...j:..................Sq. feet
r Dwelling—No. of Bedrooms( ._...........Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building................,.............
No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures .. - -�a..��:t -----...-----------------------------------.................-- --.-----------.----.-.
Q Y f% tV"1:
W Design Flow....... . ............................gallons per person per day. Total daily flow............�,�2 .,-------..-gallons.
WSeptic Tank—Liquid capacityl. Q.O.gallons Length _`r Width:4'-.110- Diameter................ Depth 2'.
x Disposal Trench—No. .................... Width...... ............ Total Length.................... Total leaching area....................sq. f t.
3 Seepage Pit No. U 0Dfameter.......CS_..... Depth below inlet.... .......Total leaching area-�./...sq. ft.
Z Other Distribution box VI) Dosing tank ( )
aPercolation 'Test Results Performed by...211..4.0 Date.... .:��.� .._._. .........
Test Pit No. L:!E....minutes per inch Depth of Test Pit...14-1........ Depth to ground water....kin,KO-1
Gr. Test Pit No. 2................minutes per _inch Depth of Test Pit..!;................. Depth to ground water........................
..............•-----•-•----.._........................................._....� -........--••--.......---••-•---•......-••---•.............-•-•--•--•- .........
Description of Soil.
O M_... � �C"�.. � '� -... ��'....��,�`..�..`.- �1.1<*.,;._�.,�-�._'�:?:_...):..�..�.�__„...°.,�.�-�P. �.
v ( _,tea ,,t !!'. -,-- _�L f c' :�,_ .�i 1 1.... h-j t:)..............------------------------•----... ..--•--..........----....
w -••--•---•-•--••-•.................•- ......._....•----•-•-•-----•-•............--•--•.........._...----•-------------•---•---_••-......------------.........-----..........•--•..............--•--.....
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
......................... ...-•----.. ........------...--•-------....................--••--•-•----•-----•------------------•--.•--••---�-----•---- ------------.........................----
Agreement:.
The undersl a..rees to install the aforedescribed Individual Sewage Disposal Sy stem in accordance with
the provisions of TITL: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee y'issuued by he and of health. ti
Signed �jC=..V• . --•--...--•........................... yl. 2•�'.. .
Date
�� �'c ,....................••......
Application Approved By.....L•--•- ------g... .... :.....�..: 0 ate D
Date
Application Disapproved for the following reasons:_..----•-....:..•...--•-•.........................................•-------...--••--------.......................
•--•-••-•..................•-•-------•--...-..---....------. --------•-••--------------------•--..............-------•-----------------•----------------•----------------------•--........---•-••----
Date
Permit No. - ._._ Issued_.......................................................
Date
1 —7j rw`
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......71 ................OF.. ...................................................
G�
a Tntif iratr of Tomplinurr
C'"'THIS IS TO CERTIFY, Tyat the Individ 1 Sewage Disposal System constructed (_<or Repaired
............ .........
'T r ,f Installer
at.......................`-� ..................................� ltJ..I �/FI�I�S7GJ/y..F........ . -•...........................
has been installed in accordance with the provisions of TI;.LZ a ogFee(State'Sanitary Cod s d r'�' in the
application for Disposal Works Construction Permit No..___.`.E.....-- --------------_-_..__._. dated_...-_ __...-�-
THE ISSUANCE OF THIS CERTIFICATE SHALL`, 07 BE CONSTRUE® AS A GUARANTEE THAT TfbF
�. SYSTEM WILL FUNCTION SATISFACTORY. ,
DATE-....�E l C ................................................... )nspector................................................................ ..._. ........
Y j a �.l, _..-a-Yam.--•— __ __ 1 i.
.............. a..w.,».a ...>a a .,y�. u !i�;,, .a;�.�.-..-�. ..P '.ems•-.r"r^-�w-r���
THE COMMONWEALTH OF MASSACHUSETTS
BOARD _O:, -JEALTH
�./ 2 t% .
�-- Fitz—-.....................
N 3.....---.--•---
Disposal Sprks (gun rw1w �rruti�
t/ic��Z L C: S
Permission is hereby granted------------------------------- '
" to Construct (i�or 2epair ( ) an Individual Sewage Disposal Sy t
iiat NO...................------..-- :.. _............................................................
Street C,� _ > -
Dated...--
as shown on.the application for Disposal Works Construction Permit,No ............. ••----•-•-••--•-••
. -
; -
Board of fiealth
DATE........ 15...............
r
SECTION - SEWAGE '
1�.
j 1 -SEPTIC TANK- Z I -"D"BOX - 2 I+ - LEACH
TOP N OFF f /
M ��
WASHED STONE
TF
3 • I ^
IN• OUT•
IN• OUT• IN•
-G 1,
LD�O
I�I 1 . ,— r U ,�
�Lf TANK � f
ELEV. ELEV. ELEV. ELEV.
(
ELEV. ELEV. r
yy �, 4' E i j
i WASHED STONEo
n. Cl i �•
HOLE LOG \
TEST
TEST BY f�,FaI I2 r3a�l K 61,c all L orb
S / \
/r' WITNESS
TEST DATE BED'ROOIl4 HOUSE
r •
DESIGN ��.o� y F \ - \d�'A
T.N;. 1 T.H. # 2 n . s � , / J P,.\� J
ELEV:IJI.q' ELEV. k e* .K p _y� \ �/ i ` �436 1
/'M ����� PER_E RATE'-`�2" MIN/IN. DISPOSER DISPOSER
5 P.5 IL FLOW RATE �j (GAL./DAY)
IZP� SEPTIC TANK (1,Ci)T 1
f4p REO'DSEPTIC TANK SIZE
iiL'o le! LEACH FACILITY
SIDE WALL TC '= �
- BOTTOM z, G/D. ���� � � \•
I�4n i i9 ,4 TOTAL < i , ljj
1
I
L USE: fi?t\iE. '!LEACHING
II
,
WATER ENCOUNTERED. 12�G �(�I� In
f
NOTES: (UNLESS OTHERWISE N TED) -
4E7
1.DATUM(MSL)+ TAKEN FROM �•'' ;�.1 ! f QUADRANGLE MAP S _
2.'MUNICIPALWATERM-Ire ___:___AVAILABLE *•.
3.PIPE PITCH:W"PER FOOT =r
4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- -44
5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT.
' Yr
HALL BE MADE WATERTIGHT
i
' JOINTS S
6.PIPE JO _
7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. • — .-, '' ' t ! SITE - PLAN
STATE ENVIRONMENTAL CODE TITLE S I.t 0&_y_O ��x I r�ti1 !,4; ; ~ I '' ^^ A �^y
/�j 'eta2.�,a,g LOCUS: W T-4
)-JOT �� USED :-ate- '.�.T�?c::-Z.�`f l_„1C; �Td�.�+JG+ , l-rvC✓-'�� t ./- ".� � � F .9.' ��
Ctr< k�%17)`�_+`rt�1�` ,d.P--G7Vt•:.f.� .r�C:(-f,FP �.r t.. ". r,... �C-L- tF � i -AREG.PROFESON -G-IN-E-ER-
�i �Z�I
REF: 3
down cape engineeiin t 1 PREPARED FOR:
LE��L SoLt..�1.�15
CIVIL ENGINEERS
ND R - R r
LA SURVEYORS -
' �o��GT�� 110 5 it�/EYt� (I _ ( +
•- CONTOURS (EXISTING)............. r- �10 MtiA�.• �:���,: SCALE ", _ I(> 7'8 J --
(PROPOSED)-O-O-O-O- APPRO\/ED DATE MA Y Y�. � 21
to DATE
d _
LEGEND
98 - EXISTING CONTOUR 5
134 PROPOSED CONTOUR
x 100.98 EXISTING SPOT GRADE SFRI,F
U UNDERGROUND WIRES rRo R
� G
EXISTING GAS SERVICE
BENCHMARK w EXISTING WATER SERVICE '�' r R.
OUTSIDE COR./BOTT. STEP 135,62 �`�� �` a a� °tee DR.
EL.=136.81 (Assumed) x `� TEST PIT
BENCHMARK o ° S PERCHERON
0
QO� EXISTING SEPTIC TANK 34 Aai�O, �\ ' �\ (LOCUSPPA
o
(TO REMAIN) �6�j. \ ay Q WAYLOOSA
0 \ o
h INV.(OU T)=132.5f(VERIFY) ` 3
^�h \\ . . . . . . . . . . . . . .
x. .136,69
HOLDER LA`� t E RQ PREAKNE S JOE OLDER
EXISTING LEACH PIT �-13f-- 136,38 N
TO BE PUMPED, FILLED W/ .. 135.73 36.05 �'� LOCUS MAP
SAND AND ABANDONED DECK ��
� NOT TO SCALE
x 136.57, GENERAL NOTES:
Z 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
137,29 BOARD OF HEALTH AND THE DESIGN ENGINEER.
iEXISTING T F 99�136,71'.II - ONo 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
y3}2 HOUSE(#15) 13 3 x 'I .p I OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
134,91' O �^ ' T.O.F.=137.37f x 37�76 rn LOCAL RULES AND REGULATIONS.
i 55 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
3 i I x yr TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER.
c� �3 x �1 j6 1 SHRUBS 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
.. \ 136.6 x 14L5 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
I 0 SHRUBS ENGINEER BEFORE CONSTRUCTION CONTINUES.
,ry y3 I �� 13 .96 X" + 1 6.43 -�(� 139,80 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
GARAGE
10 O \�� 136. 1 I 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
'-,LOT 4 f�• I ® �� I THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
O• 1 34.23 I
MBLU �1.51 -055 N tN LAGP❑LE 136,71 I HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
\ 4�TP.-2 :'1 �'� x i 14�,�1. 9 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
15,522± .F. 137. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
.136,7.2<.
�`y I D :':'j �`\ ' ' ' ' • o + C 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
a 135,82 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
PAVED> .`:'� �`� ��A�O DIRECTED BY THE APPROVING AUTHORITIES.
1. 6?48
DRI t/EWA Y 38.74 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
L=109 91 , \h 132.36 SHRUBS.\ THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
x
` CONSTRUCTION.
R=:069 08, L=61:;95";' ` G 1 1. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
x R=55992 13 2 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
131.52 ` � 1 3.59 x REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
-136 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
133.06 � •� 4.�4 INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL.
130,14 �\ x 134,93 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
OF R4S edge of pavement IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
1 .00
9 31
•1. ,4 132 6 4 33 0
F � PK SET
o� PETER T.
McENTEE PROPOSED SEPTIC SYSTEM UPGRADE PLAN
o CIVIL N SA DDL ER LANE 15 SADDLER LANE, MARSTONS MILLS, MA
No. 35109
IS510 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
F 1 FNG�� OWNER OF RECORD Engineering by: SCALE DRAWN JOB, NO.
LENK, EDWARD C Engineering Works, Inc. 1„=20' P.T.M_ 210-12
15 SADDLER LANE 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
L WEST BARNSTABLE, MA 02668 (508) 477-5313 7/26/12 P.T.M. 1 0f 2
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL: 130.5 DECK
FOR A DISTANCE OF 15' AROUND THE
SEPTIC TANK PROPOSED D-BOX .
PERIMETER OF THE S.A.S.
INSTALL RISERS & COVERS OVER INLET INSTALL WATERTIGHT RISER & PROPOSED S.A.S. I
AND SET TO 6" OF FINISH GRADE. COVER SET TO 6" OF GRADE PROVIDE TWO ACCESS MANHOLES TO WITHIN 3"
PROVIDE ACCESS TO GRADE OVER OUTLET COVER OF FINISH GRADEIFOR INSPECTION PURPOSES
T.O.F.
F.G. EL.=132.5]to 133.8 �
� /EXISTING
F.G. EL.=135.0tF.G. EL.=134.Ot ��
EXISTING F HOUSE(, 15)
f MAINTAIN 2XIGRADE (MIN.) \ OVER S.A.S. O� T.O.F.=137.37f
L26' L = 17'
®'SCH40ri
(PVC) ®"SCH40(PVC) �34.0
,a", Ba O as
U-i14" 8" :MEFFEC
3 BB
EXISTING 48" LIQUID GARAGE
LEVEL App 5.2' 4'(SIDES)1 INV.=132.17 PROPOSED INV.=132.00 GAS BAFFLE E WIDTH = 13.2' 0 1 �'
INV.=132.50t �� Iv I Ln � ^�
(FIELD VERIFY) INV.=130.00 j co ' o
EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS N '
SURROUNDED WITH STONE AS SHOWN ' S6,g'
H=10 RATED to
TOP CONC. ELEV.=130.8t ' 69.7,
Al
BREAKOUT ELEV.=130.5
NOTES: INV. ELEV.=130.00 as®B a aaa
aaaaa aaaaa 0 S.A.S. LAYOUT
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE ease eases aa0a
BOTTOM ELEV.=128.00 4' ENOS 8.5 .
INVERTS, PRIOR TO INSTALLATION. ' 4'
2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' OF NATURALLY OCCURING EFFECTIVE LENGTH = 29.0'
ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL AND 4'
STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). ABOVE GROUNDWATER LEACHING SYSTEM SECTION ®®®® O ®®
3) INSTALL INLET & OUTLET TEES AS REQUIRED. NO GROUNDWATER, EL.=122.6 - ®®®®®® ® ®®®® 33"
4) CONTRACTOR SHALL INSPECT EFFLUENT FILTER ON 1 3/4" TO 1-1/27DOUBLEI_j w ®®®®®® ® ®®®
OUTLET TEE AND REPLACE IF NECESSARY. WASHED STONE cV Z ®Ly-m
SEPTIC SYSTEM PROFILE 3" LAYER OF 1/8" TO 1/2"
DOUBLE WASHED STONE
N.T.S. (OR APPROVED FILTER FABRIC) 102"
SOIL LOG 4" KNOCKOUT
DESIGN CRITERIA DATE: JULY 18, 2012 (REF P#13,698) 20 DIA. COVER
SOIL EVALUATOR: PETER McENTEE PE (SE#1542)
NUMBER OF BEDROOMS: 3 BEDROOMS WITNESS: DONALD DESMARAIS R.S. HEALTH AGENT 4" KNOCKOUT 4" KNOCKOUT 62"
SOIL TEXTURAL CLASS: CLASS II ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH
DESIGN PERCOLATION RATE: 8 MIN/IN 134.0 0" 133.1 0"
DAILY FLOW: 330 GPD FILL A FILL 4" KNOCKOUT
DESIGN FLOW: 330 GPD 133.0 A 12" 132.4 A 8"
i
GARBAGE GRINDER: NO-AND NOT PERMITTED WITH THIS DESIGN SANDY LOAM , SANDY LOAM 5OO GALLON CAPACITY, H-10 LOADING
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 132.5 10YR 4/2 18„ 132.1 10YR 4 2 12„
LEACHING AREA REQUIRED: (330 GPD) = 550.0 SF B SANDY LOAM B SANDY LOAM CHAMBERS
10YR 5/8 10YR 5/8 N.T.S.
131.0 36" 130.1 36"
.60 GPD/SF C1 SANDY LOAM C1 SANDY LOAM
USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 10YR 5/4 10YR 5/4 3PERC PROPOSED SEPTIC SYSTEM UPGRADE PLAN
SURROUNDED BY DOUBLE WASHED STONE-ALL SIDES COBBLES & COBBLES &
BOULDERS BOULDERS 127.5 78" 127.1 72" � �15 SADDLER LANE MARSTONS MILLS MA
SIDEWALL AREA: 2 13.2' + 29.0' X 2 = 168.8 SF C2 MED. SAND C2 MED. SAND
( ) 2.5Y 6/4 2.5Y 6/4 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
BOTTOM AREA: 13.2 x 29.0 = 382.8 SF
COBBLES & COBBLES & Engineering by: SCALE DRAWN JOB. NO.
TOTAL AREA:..............................................................551 .6 SF 123.5 BOULDERS BOULDERS Engineering Works, Inc.126" t22.s t2s" N.T.S. P.T.M. 210-12
DESIGN FLOW PROVIDED: 0.60 GPD/SF(551 .6 SF) = 331 .0 GPD PERC RATE 8 MIN/IN. ("C1 " HORIZON) 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
NO GROUNDWATER ENCOUNTERED (508) 477-5313 7/26/12 P.T.M. 2 Of 2