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HomeMy WebLinkAbout0052 SADDLER LANE - Health 1 52;Saddler:Lanz ' Marstons Mills A = 151 - 045 Cornmonwealth of Massachusetts s` = ( Title 5 Official Inspection p dorm 11 .: Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � d PrpCerty Address -- ----- O vner's Name -- -- .nformahon is rpqu >'-kred for every PS 7" R/,,. G p•3ge. CIty/IO'An State Lip Code Date of Inspe ion Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab key to move your 1 Inspector. cursor- et not use the return key. Name of Inspector �—V Company Name Company Address la -9e I I�>cJ 1�1 JI �Gt.S T �l c7 ✓`7 City/To A4 �M1 State Zip Code Telephone Num w / License Number LU [^+ ._J C' Certification I certify that I have personally inspected the sewage disposal system at this address an cx� n'formation reported below is true a d that the ection ,N!as performed based on my training and experience en e in the proper funce as of the tion and of the maintenancentenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of 5(310 R 15.000). The system: CD c, ; , Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority WfnSpectorl'lgture 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 -it that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. L106) �y „ I D, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address ✓!r /// S -- ----------- C.vner Chnei s Name required l reformation, � q/NreS T �required for every e �.J� page. City/T o Aon State zi Cie d 71 O p ate of rspe roe B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/ always complete all of Section D A) 7SystePasses: e not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: Cl One or more system components p s as described in the "Conditional 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 followin star determined," please explain. 9 ements. If"not 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): I Commonwealth of Massachusetts Pp Title 5 Official Inspection Form Subsurface Sewage olsposal System Form - Not for Voluntary Assessments Property Address z G9 vL� C•.vner "- A S --- G"mier's Name information1 d for every Page. Clty/To,�n State G Zip Code pate of Ins ction 9. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 ❑ NO(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO(Explain below): 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: If ❑ Cesspool or privy is wilhin 50 feet of a surface water F] (,-?sspool or pray is ,,v,fhin 50 fe@t of i borrjennq ,vegetated �.vetland or 3 salt marsh s H ....Inn , ..I.I•.H ...: , I.';{x UI'.,J•117Il.;d).,2 IJ �\ Comrnot1wealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System 9 p y m Form Not for Voluntary�. Assessments ci Prcperr/Address 01 / — ------ --- -- - Owner ,&ner's Name �,� (Nair ahfo Ie PS regwred for every ['�G✓ytS7�,,� � OaZ 6-9' page. C.ty/Town State ZipCode Date or nspe ion B. Certification (cunt.) 2. System will fall unless the Board of Health (and Public Water Supplier, if any) determines that the system Is functioning In a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: "•This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. 0) 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 Jue 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 (� Uquid depth in cesspool is less than 5" below invert or 3vailable volume is less thin '2 day flow ,0 ,.i i . :->f' .i•h.n F .� ..:..:. e . ;'+'. ..:d ;9 tom .,a J ,l V r Commonwealth o f Massachusetts Title 5 Official Inspection Form Subsurface Sewage olsposal System Form Not for Voluntary Assessments e sments z-a Prope Address ----- ---- -- m Owner 6Y—f l <?.vner's Name rnformation a / r-quued for every � �✓�s/- /HjJ�,3 P /�j Da 6, Page. Cityfrown "� State Lip Code Date of ins B. ctio Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ lid Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Cgi 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 well. ❑ Any portion of a cesspool or privy is within 50 feet of a Private wa ter ater supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater from a private water supply well with no acceptable water quality analysis. [This system passes It the well water analysis, performed at a DEP certified laboratory, for fecal colifonn 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.) El ^� The system is a cesspool serving Lid' P g a facilitywith a de 0 000 design flow of 2000 . 9Pd 9Pd . ❑ The system fla. I have determined that one o r more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. Thesystem 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 Hater supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— I WPA) 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 r shall upgrade the System in accordance with 310 CUR 15 304. The System owner should contact the a ngional office of the Cepartment PPropriate Commonwealth of lAassachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Z— Pr oPedY Address Owner information is C+mers Name regwred for every page. city/Town State Lip Code v o Date oo Insp ion 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 ❑ L� Were any of the system components pumped out in the previous two weeks? �❑ Has the system received normal flows in the previous two week perio d? d? ❑ 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? L� ❑ 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 Sall 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) able ep ) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Numb er of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): J J D C N,,I*d,A 17 Commonwealth of Massachusetts Title 5 Official Inspection Form m . 9 Subsurface Sewage Disposal System Form - �1ot for Voluntary Assessments g Property Address --.._..__.------_--- mform U vners Name -quit ahfo .s �� tc. A,41Sr�u�red for eve page. every cityrrown State z �d6 6,q p Date of nspe on D. System Infor ttion Description: hc.w, Number of current residents: Does residence have a garbage grinder? ❑ Yes �No Is laundry on a separate sewage system?[if yes separate inspection required) ❑ Yes [2""No Laundry system inspected? ❑ Yes No Seasonal use? Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: ate 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 ❑ Flo Industrial waste holding tank present ❑ '(-s ❑ No `ton-sanitary ',vaste discharged to the title 5 system? ❑ 'des ❑ i`lo /Vater meter readings, if available .. .A , .. .,.,,� .ni„H .. •fie i � .,� ,�..m ,!n! J . Commonwealth of Massachusetts =- ,.3 Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Nrnperty Address L// ---- Clvrerirformation is C.+mer's Name required for every page. City/Tonn State Zip Code Date of Inspe on ------------------------ D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General information Pumping Records: Source of information: _ L✓Pt � Was system pumped as part of the inspection? � � Cl Yes L�No If yes, volume um P ped: gallons How was quantity pumped determined? Reason for pumping: Type of Sy m: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ right tank. Attach a Copy of the DEP approval. ❑ Other (descnbe): r Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k Property Address �r /'f ---- -- -- --- Owner C1,vner's Name r,formahon r9 `/ r?quired for every T r✓+S /S page. Gityffown State Zip Code Date of Ir, pedi D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: .S� Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: feet Material of constructi;-4-0 ❑ cast iron PVC ❑other(explain): Distance from private water supply well or suction line- feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: ro feet Maten of construction: concrete ❑metal ❑ fiberglass ❑polyethylene ❑ other(explain) If tank is metal, list age. _ 7?ors Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ '(es ❑ (`lo Dimensions: - �X 8 �ludr)e depth S ) r C ommonwealth of Massachusetts VATV Title 5 Official Inspection Form I Subsurface Sewage Disposal'Syst1em/l Form - Not for Voluntary Assessments Property address — � l,llt s �� C•.vner l31Hner9 Name require hfo :e I /es1 �Ir p required for every (/�/ / // page. CiryrTown State Zip Code 03te of Inspe ion D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle / Scum thickness L�-e Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle g XX 12 How were dimensions determined? 1 �eIce, Comments Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N r/ C`r C T�'1 Y` t vt o ze 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 hate Of 1-1st p-irrping - II ..r 11 10 lie ;\ Commonwealth of Massachusetts -r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - iVot for Voluntary Assessments Property Address Q ------ �h, Cvrer owner's Name Information Is required for every W Ps T 4411"` page. Cityrrown State Li Code P Date of In pedi 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.): 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 Alarm present: Cl Yes ❑ No Alarm level: , Alarm in working order. ❑ Yes ❑ No Date of last pumping: oate Comments (condition of alarm and float switches, etc.): 'Altach copy of current pumping contract (required) Is copy attached ❑ Yes ❑ mo I Commonwealth of Massachusetts ,v Title 5 Official Inspection Form P. Subsurface Sewage Disposal System Form - \lot for Voluntary Assessments A t� �ProFarty address 11for-Mation is Owner C,,vne(s Name required for every yy ! LL j/J� 8 9 �s // page.• City/Town State Lip Code Date of inspectio'/ D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): A/a 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required). If SAS not located, explain why: Commonwealth of (Massachusetts T� = r Title 5 Official Inspection Form Subsurface Sewage Disposal System Fpl Pot or VoluntaryAssessment s Property Address --�------- ___ _ /�� Lamers Name .quire information s every ��G►i✓IST7. legwred for eve 4 Ile- page. GtyrTawn State Lip Code Date of In ion D. System Information (cons.) Type: ❑ leaching pits number. ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1-7 (� ,Si ✓I S O � 'N �G v /C� Zi 44• r 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 grrn,nrlwater inflow -- --- C r�s I� Coinnnonwealth of Massachusetts Title 5 Official Inspection Form . I Subsurface Sewage Disposal System Fo dot for Voluntary Assessments �.. d Property address PA //' r / / --- ------ -- i:%roner Owners Name ,rrormation i9 /PJ required for every w ,�s page. City/Tow,n State Zip Code Date of in pectio D. System Information (cont.) 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.): Commonwealth of Massachusetts Title .5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name information is I /eS� 1 / required for every lit/ t✓Is a� � (�a6� page. City/Town State Zip Code Date of Ins ion D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sews a disposal system,9 PIncluding ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate 7wher ublic water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately �3 r L C i, J R o-o' 1 �o"� belo✓ I • `i �) F-7 a t5in s i,I,O Title 5 Official Inspection Form.Subsurface Sewage Disposal System•page 15 of 17 r ;\ Commonwealth of Massachusetts k 'Title 5 Official Inspection Form t . j ,, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Prrperty address— - -- — — ---- ---- --.._.---------- -.. Cwner C.vner's Name I ^ / / — —----- - -- - ---- fnqion is r uireduued for every page. City/Town State Zip Ccde Date of Inspecti n D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water I 0 ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: Cl Obtained from system design plans on record If checked, date of design plan reviewed: Date ��Checked bserved site(abutting property/observation hole within 150 feet of SAS) with i al Board of Health -explain: le s ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high groundwater elevation: �6�< SO/' 3efore fillnq this inspection Report, p►ease See Report Completeness Checklist on next page. ,' II Commonwealth of Massachusetts Title 5 Official Inspection Form • J Subsurface Sewage Disposal System Form - Not for Voluntary Assessments s Property.iddress // ----- — --- Crvner C�vner's Name f� l equir anon 9 r l /' �/� Od66f A;A1 eryuired for every page. City/Town State Lip Code Date o Insp ion E. Report Completeness Checklist [9/11�nspection Summary: A, 8, C. D, or E checked inspection Summary D (System Failure Criteria Applicable to All Systems) completed 2--system Information — Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file imLl F�CE:Ca'IVED COMMONWEALTH OF MASSACHUSEM I DEC 0 8 2004 EXECUTIVE.OFFICE OF ENVIRONMENTAL A FAIR40WN OF BARNSTABLE DEPARTINENT OF ENVIRONMENTAL PROTECT@ HEALTH DEPT. '-IARCEL CAI TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM . PART A CERTIFICATION Property Address:52 Saddler Lane,= 02661— Owner's Name:Paul&Wendy Grove Owner's Address:•52 Saddler Lane,4 02668 . Date of Inspection:November 24,2004 S )\�LS Z��B Name of Inspector: REID C.ELLIS Company Name: ELLIS BROTHERS CONST.CO. Mailing Address: 23 ENTERPRISE ROAD, P.O BOX 59,YARMOUTH PORT,MA 02675 Telephone Number. 508362-6237 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper fimction and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to 15340 of Title 5(310 CMR 15.000 The system: Passes Conditionally Passes Needs Further Evaluation by the.Local Approving Authority Fails Inspector's Signature: �.L` �1 Date: 12 —P--'��f The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments zvel-C`,U' y ****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. r Page 2 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:52 Saddler Lane,West Barnbtable,MA 02668 Owner.Paul&Wendy Grove Date of Inspection:November 24,2004 Inspection Summary: Check A,B,C,D or E/AL_WAYS complete all of Section D A. System Passes: YIV /V b have not found any information which indicates that any of the failure criteria described in 310 CMR 15303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: & System Conditionally Passes: One or more system components as described in t te"Coaditional Pass"section need to be replaced or repaired.The system,upon completion of the replac em or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the I br the following statements.If`Snot determined"please explain. The septic tank is metal and over 20 years old*or a septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as roved by the Board of Health. *A metal septic tank will pass inspection if it is structural sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is availab . ND explain: Observation of sewage backup or break out or higi static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,sealed or uneven di button box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are rej laced obstruction is remov distribution box is le elect 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 rep cxd obstruction is removed ND explain: 2 Page 3 of I I " OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:52 Saddler Lane,West Barnstable,MA 02668 Owner.Paul&Wendy Grove Date of Inspection:November 24,2004 , C. Further Evaluation is Required by the Board of the Conditions exist which require further evaluation y the Board of Health in order to determine if the system is failing to protect public health,safety or the environm t. 1. System will pass unless Board of Health date es in accordance with 310 CMR 15303(l)(b)that the system is net functioning in a manner which protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surfm e water _ Cesspool or privy is within 50 feet of a borde ' g vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(an( Public Water Supplier,Many)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 absorpt on system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface wate supply. The system has a septic tank and SAS and th SAS is within a Zone I of a public water supply. _ The system has a septic tank and SAS and th 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 deter nine distance "This system passes if the well water analysis,ix rformed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrc gen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysi must be attached to this form. 3. Other. 3 Page 4 of 11 ` OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:52 Saddler Lane,West Barnstable,MA 02668 Owner:Paul&Wendy Grove Date of Inspection:November 24,2004 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes N Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool scharge 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 0Siqui"uired ool d depth in cesspool is less than 6"blow invert or available volume is Iess than Ys day flow pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ _/1�ry 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. y 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 fat 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis most be attached to this form.] �O(Yes/No)The system&.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 met rve a facility with a design flow of 10,000 glut to 15,000 gpd- You must indicate either"yes"or"no;"to each of thefollowing: (The following criteria apply to large systems in addi'on to the criteria above) yes no the system is within 400 feet of a surface inking water supply the system is within 200 feet of a tributary I o a surface drinking water supply the system is located in a nitrogen sensitive ea(Interim Wellhead Protection Area—IWPA)or a mapped Zone H of a public water supply well If you have answered"ye s7 to any question in Sectior E the system is considered a significant threat,or answered "yes"in Section D above the large system has fai4on' owner or operator of any large system considered a significant threat under Section E or failed under D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appregional office of the Department. 4 i Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:52 Saddler Lane,West Barnstable,MA 02668 Owner.Past&Wendy Grove Date of Inspection:November 24,2004 Check if the following have been done.You mast indicate W or"nor as to each of the following: Y No Pumping information was provided by the owner,occupant,or Board of Health ere any of the system components pumped out in the previous two weeks? tthe system received normal flows in the previous two week period? e large volumes of water been introduced to the system recently or as part of this inspection? V� 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,@Kcluding the SAS,located on site? _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of th tiles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of sawn? _ _ Was the facility owner(and occupants if different from owner)provided with information on the proper m aintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: rY no _ Existing information.For example,a plan at the Board of Health. _�_ Determined in the field if an of the failure criteria related to Part is issue ( y ed C at ss a approximation of distance is unacceptable)(310 CUR 15.302(3)(b)) 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:52 Saddler Lane,West Barnstable,MA 02668 Owner:Paul&Wendy Grove Date of Inspection:November 24,2004 FLOW CONDITIONS RESIDENTIAL 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): Number of current residents: i Does residence have a garbage grinder(yes or no),V Is laundry on a separate sewage system(yes or noj;4�if yes separate inspection required] Laundry system inspected(yes or now Seasonal use:(yes or no);,,� < Water meter readings,if available(last 2 years usage(gpd))p?22v? Sump pump(yes or no)✓—'P Last date of occupancy. /V COMMERCIALlINDUSTRiAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgtetc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Tide 5 system or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): y GENERAL INFORMATION Pumping Records / D 2— / S� Source of information: Was system pumped as part of the in 'on(y&or no): If yes,volume pumpexl;/U„ UV aallpns—How=Arr.—Aj .Pumped determined? L/ d�✓ � Reason for pumping. 6'��2.l1 .� 71E 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 tAlternative 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): Appr ate age of ll compon ts,date installed if known)and source of inf ation: fZ Were sewage odors detected when arriving at the site(yes or no): N G 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:52 Saddler Lane,West Barnstable,MA 02668 Owner:Paul&Wendy Grove Date of Inspection:November 24,2004 BUILDING SEWER(locate on site plan) Depth below grade: '/4'G/" // Materials of construction:: cast iron V 40 PVC other(explain): Distance from private water supply well or suction line: oZ_S- V Comments(on condition of joints,venting,evidence of leakage,etc.):•L .LI- iV ti V Y Lti1 ��b Cc SEPTIC TANK: 17�(locate on site plan) �N>� J&" rlvf'l `�w Depth below grade: _ / Material of construction: V concrete metal_fiberglass_polyethylene other(explain) J J4 If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or battle: 00 y Scum thickness: Z" _ Distance from top of scum to top of outlet tee or bate: y Distance from bottom of senm to bottom of outlet tee or e: rj JV, How were dimensions determined: Comments(on pumping recommen ons,inlet and oudl tee or bfiffle o6ndition,structural integrity,liquid levels as relate=to )utlet invert,evidence of til��v Lever._ o �+ a GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction: concrete metal—fi glass_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 oi baffle: Date of last pumping. Comments(on pumping recommendations,inlet and ou det tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 I Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:52 Saddler Lane,West Barnstable,MA 02668 Owner:Paul&Wendy Grove Date of Inspection:November 24,2004 TIGHT or HOLDING TANK: (tank must be pur iped at time of inspectionXIocate on site plan) Depth below grade: Material of construction: concrete metal berglass_polyethylene other(explain): Dimensions: Capacity Gallons Design Flow: aallons/day Alarm present(yes or no):: Alarm Ievel: Alarm in working order(yes or n ): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX,�(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): 6rVell, ,9 t/- iw s9 -..." PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,conditioi of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:52 Saddler Lane,West Barnstable,MA 02668 Owner.Paul&Wendy Grove Date of Inspection:November 24,2004 SOH,ABSORPTION SYSTEM(SAS): 11Qocate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: 'FA I L-7 A 0 Z W eV—,r 3/,5 1'sv, ,,j leaching galleries,number: e�✓ y r leaching trenches,numbs,length: leaching fields,number,dimensions: overflow cesspool,number: innovativetalternative system TypeVname of technology: Comments(note condition of soil,signs of hydraulic failure,Ievel of ponding,damp soil,condition of vegetation, !b�e l� r 7' y CESSPOOLS: (cesspool must be pumped as part f inspectionxlocate on site plan) ` Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scam layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic ure,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.): 9 I Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:52 Saddler Lane,West Barnstable,MA 02669 i Owner.Pad&Wendy Grove Date of Inspection:November 24,2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. 15go jj /�. �IV. c a 10 i Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:52 Saddler Lane,West Barnstable,MA 02668 Owner.Paul&Wendy Grove Date of Inspection:November 24,2004 SITE EXAM Slope �L2vP�G— Surface water �/1Jwu Check cellar �/� Shallow wells Estimated depth to ground water feet Please indicate(deck)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ecked with local Board of Health-explain: Checked with local excavators,installers- on), cs 41 Accessed USGS database-explain: You must describe how you established the high ground water elevation: J 1<t.,��_/. `7 &IT '.R.Jt..,ra + c�� /lib Gt114— �d 5/44 ik, -t5 i6bso C)C- Ze�yj 9 3 N 11 8 commonwealth of Massachusetts do m Executive Office of.Environmental Affairs �F C Department of roN .1 r Environmental Protection nor FPSjgB199? William F.Wald.. T F N Govemor Trudy Coxe, 4 Sretary,EOEA [� `ec David B. Struhs o Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: of Owner: L Date of Inspection: (r `t 7 ._ 11 (If different) y t"ils(J Name of Inspector: „c) Y)':5 Company Name, Address and 1 t-lephuno Numhi•r. {mil U C-t���<= �.Ll ��A�:\rr ��.c `1�.1 I f Yc,.��.%�('`✓ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-syi�/� gewage disposal sysic•Ins. The system: v Pd55e$ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signa ure. Date: �,'-3 t / The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 repot. to the appropriate regional office of the Department of Environmental Protection. The original should De son" it.- :nr system owner anti copies sew to the: buyei, if applicable and thi: ahp:ii',ing au"Ilioritt. INSPECTION SUMMARY: Check A, B, C, or D: A) S,YSTT PASSES: V 1 have not found an information which indicates that the system violates an of the failure criteria as defined in 310 CMR 15.303. Y Y Y Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determine(] (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not). The septic tank is metal, cracked, structurally unsound, shows substantial infiltration,or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a'conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Winter Street • Boston,Massachusetts 02108 0 FAX(617)556-1049 9 Telephone(617)292-5500 w i J Printed on.Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property AdJress: :,•„G)o i o .. L.,.-+• . -Z< w<.c:; 1 (�_ Owner: L,—1 Date of.Inspection: _3 - 7 B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: �J Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSIEM WII.I PASS UNLFSS BOARD OF IIFAITH DFTFRMINFS THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT 1HL PUBLIC HLALIH AND SAFL'IY AND 1HL LNVIRONMENI: _ 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. 1) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ 1hP 5v51en) hati a septic lanK anU SUIT dUSUfpUUll Sysienl and IS with li i1w ic6 i0 a iulia�c 'n8ici SuNN j G( Iflliuidi�' to a surface water supply. _ The system ha, a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The systen, liar a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 PPm D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified`below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system cornponerq du(, to an 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. (revised 8/15/95) 2 I , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION.(continued) Property Address: h.�� S ,�U<��.�.- 1.��u _ %Y,•<,, Owner: Date of Inspection: D] SYSTEM FAILS (continued): 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 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. /l Any portion of a cesspool or privy is within 50 feet of a private water supply well. 4d Any portion of a cesspool or privy is less than 100.feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. ,If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flo%+ of systern is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is %ithin 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 suppiy well' The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 31 aUU5t111lAtl SIVito I IIiA11IJh! /UI!!� 1 1;!'ll 1ifr'i ►IrVI/ r 4,K I tl CH iT Property Address: Owner: L-1 oljj Date of Inspection: Check if the following have been done: _VPumping information was requested of the owner, occupant, and Boaiz� of Health. in nrmal flow /None of the system components have been pumped not for at lest tw been introdu.ed intothe systemrely or as part of this i r spection• weekso and the system during that period. L'arge volumes of water a As built plans have been obtained and examined. Note if they are not available with N/A. (/The facility or dwelling was inspected for signs of sewage back-ul). .L/The system does not receive non-sanitary or industrial waste flow ✓TThe site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. _✓The se tic tank manholes were u tees, material of construction, dimensions, depth of liquid, deptncovered, opened, and the interiorh septic tank Inspected for condition of baffle P of sludge,, depth of scum — The size and location of the Soil Absorption System on the site has been determi ned based on existing information or approximated by nun-intrusive methods. J `, r,� „,-„ i;�,:f,-�.., with information on the proper maintenance of were provided Surface Disposal System. 4 (revised 8/15/9511 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: LYv,,—s Dale of Inspection: lv 3-`17 FLOW CONDITIONS RESIDENTIAL: Design flow: � ea)ons Number of bedrooms: Number of current residents: Garbage grinder (yes or no)' Laundry connected to system (yes or no)- Seasonal use (yes or no): . Water meter readings, if available: -- Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or.no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy. GENERAL INFORMATION PUMPING RECORDS and source of informati �✓vt.�.dJ�- tom:�-��n �-7`�� System pumped as pan of inspection: (yes or no)_ If yes, volume pomt,Pd gallons Reason for pumping: —TYPE OF YSTEM 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) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: /�/✓� Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: I—,-)- 's,"U'O", U%' Owner: i- ifotJ5 Date of Inspection: SEPTIC TANK: (locate on site plan).. ._ _._._....__ _._...._ t( Depth below grade: �q Material of construction: V concrete _metal _FRP —other(explain) Dimensions: Sludge depth: i` �i'31i Distance from top of sludge to bottom of outlet tee-or baffle: Scum thickness:_ ( tt Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) ,5 t.L —0 GREASE TRAP:L_/ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Ciictance from bottom ro cr,im to hnttnm of owiel tee o, batlle' Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural --integrity, evidence of leakage, etc.) (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S-,Q(A ca L hf Owner: Date of Inspection: TIGHT OR HOLDING TANK:�y (locate on site plan) Depth below grade: Material of construction: _concrete _,metal _FRP —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet (ee, condition of alarm and float switches, etc.) RTRIOU11ON BOX: (locate on site plan` _.,.. Depth of liquid level above outlet invert: Comments: mote ii ievei ano disuibui-�,,, +> t-yua:, e-u.'-l'ICC'ul su!iu' c.:Iju%ei, evidence of leakage into or out of be)., etc.) RUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of,pump chamber, condition of pumps and appurtenances, etc.) ®revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) OU- Property Address: b��- 1�1:�,� �1�I �-c.,c_..... Owner: L- y vl Date of Inspection:6'.',_..$)'7 SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type; leaching pits, number: 1 leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool;'nurrSber: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) d/Y�f CC7st-�c�'4(J vim.S CESSPOOLS: Wocite 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: Indicatiun of gruund�NaW:. inflow (cesspool must be pumped as part of inspection) Comments:,(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_� a (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.) (revised 8/15/95) ' B I. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C � SYSTEM INFORMATION (continued) � ff Property Address: Lc, Owner: 'L-y uf-'j , Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100'. �M 0 DEPTH TO GROUNDWATER Depth to groundwater: feet method of determination or approximation: C`` (sevised 8/15/95) 9 TOWN OF BARNSTABLE M T TON _�P-2 X-A D D.0 e d SEWAGE# D Cl—O/A ASSESSOR'S MAP &LOT —� INSTALLER'S,NAM E&PHONE NO. 6:U/P/1/6i D A LJ SEPTIC TANK CAPACITY /O tf—`� LEACHING FACILTI'Y: (typ es :rr.Q-C. .L- C. (size) / Y.,?o ' Oe oL s NO.OF BEDROOMS BUILDER OROWNER. PERMITDATE: 11210 o 0 0 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) s' i Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet o chin facility) Feet Furnished by • 9 y ,f' d, � • � / S9p r '-- TOWN OF BARNSTABLE LC50 ATION S� act CJ a `e J� �c�r�,� SEWAGE # VILLAGE • 'ASSESSOR'S MAP & LOT M KQ S 41�N l MILLS INSTALLER'S NAME & PHONE NO. o SEPTIC TANK CAPACITY �� �� �S ��49�--rT C-A-fu LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No it .d..hAfm itk, �Q AN9 Imo' vn,� FV` 6 i5 3 18' o to COMMONWEALTH OF MASSACHUSETTS RECEIVED 2,XECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS T 15 2002 D TMENT OF ENVIRONMENTAL PROT CT98L C� TOWN OF BARNSTABLE HEALTH CREPT. I Ot to 4q 1 R tio�ATrge`� TITLE 5 OFFICIAL INSPECTIO RM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERPFICATION Property Address: Owner's Name: " ►nt►� -} . c1,av,eu Owner's Address• —f — A rya p u MAP Date of Inspection: - ,2- 2� R E I D C. E L L I S PARCEL Name of Inspector:(please pl L L Ipnnt LOT Com an Name: S - P y Mailing Address: 23 ENTERPRI E ROAD, P.O. BOX 59 , YARMOUTH PORT, MA Telephone Number: 5 0 8_3 6 2_f,2 3 7 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper fun on and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signatur Date: 0 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent,to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of 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. Title 5 Inspection Form 6/15/2000 page I i Page 2 of 11. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ° PART A CERTIFICATION (continued) Property Address:Sa SA"Lr hc-- j.2LtrAgf� N& A OaV06 Owner.�,enQ m,r�a-1�ry�17e.�aha:�L Date of Inspection: Q•a 3-D z- Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: .o I have not found y 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: System Conditional B. Syst 1y Passes: One or more system components as described in th "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 f r the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or I ae septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or, failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as a proved by the Board of Health- *A metal septic tank will pass inspection if it is structural)e sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is availab . ND explain: Observation of sewage backup or break out or hie t static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven di mbution box.System will pass inspection if(with- approval of Board of Health): broken pipe(s)are r laced obstruction is removed distribution box is le eled 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 rep aced obstruction is remov ND explain: rage�vi i i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ° PART A CERTIFICATION(continued) Property Address: Sa es LAh-9— w'1�' nsTfth .mA oaldo Owner: &Y m mtra t lCt m 1--% 1- -'. Date of Inspection: T-Z3-0 a I C. Further Evaluation is Required by the Board of Health: Conditions exist which require fiuther evaluation by the Bo d 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 ac ordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect ublic 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 veget Lted wetland or a salt marsh 2. System will fail unless the Board of Health(and Public V later Supplier,if any)determines that the system is functioning in a manner that protects the public he dth,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 v ithin a Zone I of a public water supply. The system has a septic tank and SAS and the SAS is v'thin 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is 14 ss than 100 feet but 50 feet or more from a private water supply well**.Method used to determine distg nce "This system passes if the well water analysis,performed E t a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the m ell is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is eqi ial 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: OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: S.�pr . W anT e,�TC a44b Owner. Kr Dd.�r�eN Date of Inspedion: C) .z3-o D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes N _ kup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ — S c liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or V4quired spool uid depth in cesspool is less than 6"below invert or available volume is less than'/day flow pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number times pumped portion of the SAS,cesspool or privy is below high ground water elevation. 7Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface er supply. portion of a cesspool or privy is within a Zone I of a public well. 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] " - (Yes o)The system fa ls.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 necess to correct the failure. E. Large Systems: To be considered a large system the system must se e a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either`fires"or"no"to each of the fb Ilowing: (The following criteria apply to large systems in additic n to the criteria above) yes no — _ the system is within 400 feet of a surface ' ing water supply _ — the system is within 200 feet of a tributary to surface drinking water supply - the system is located in a nitrogen sensitive at ra(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. a owner or operator of any large system considered a significant threat under Section E or failed under Secti " D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropria regional office of the Department. 4 Page 5 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: `4y%.e tom.RPrASAI I-e YEA as A Owner:tev�)Am\n+1Zart'1DIAV,e,4 Date of In p tion: 23 -0'a- Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Ye No umping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks as the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as 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,aKciuding the SAS,located on site ? y0baffles Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition 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: Ye no — 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 CM 15.302(3)(b)) 5 I i Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ° SYSTEM INFORMATION Property Address: Lt ��V �nS"fiR• Y,� t�1,4� . Owner: Date of Inspec ion: q-2.3-02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): I/ 1 DESIGN flow based on 310 C1vIIt 5.203(for example: 110 gpd x#of bedrnoms): __ T L Number of current residents:_ Does residence have a garbage grinder(yes or no)- Is laundry on a separate sewage system(y r no Rif yes separate inspection required) Laundry system inspected(yes or no)�-� .r' ,yam 154J� 0� Seasonal use:(yes or no):�D / C;� Water meter readings,if available(last 2 years usage(gpd))oZ 0 /lyj�00 C;L— Sump pump(yes or no): &0 Last date of occupancy: t05 !L/1.��/� COMMERCIAL/INDUSTRIAL Type of establishment: . Design flow(based on 310 CMR 15203): amd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):— Industrial waste holding tank present(yes or no):_ Non-sanitary-waste discharged to the Title 5 system(yes r no):— Water meter readings,if available: Last date of occupancy/use: OTHER(describe): Pumping Records GENERAL INFORMATION Source of information: U (v % V4 a� a*AO Was system pumped as of the pection(yes or no): If yes,volume pum Igns--How was q jp7pecLdetetmined? Reaso for pumping: . Y 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): ea,1 1� g Jrs t S� w kxjw r xx m44 g 4- o all cdnponents,date ' le if known)and s urce of' tion: Ah ti Were sewage odors det7gted when arrivingat the site(yes-or y / (yes or no)1149 .6 i Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1fivvp- W�.1�x�rnsTi��lzThn�A c��tcd AYA Date e of In tio2� n: 9-2� Pe a BUILDING SEWER(locate on site plan) /' Depth below grade: , / Materials of construction: cast iron 40 PVC V other�expla`m): Distance from private water supply well or suction line: J % I- Comments(on condition of joints,venting,evide ,of leakage, ): SEPTIC TANK:Wocate on site plan) Ir. n/1./s 'L" j �j 4A- of �-�' (5►�t Depth below grade- Material jb ` Material of construction:Vconmtc metal_fiberglass polyethylene other(explain) �f tank is metal list age:T Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: �L H Sludge depth: oall t Distance from top o sltSdge to bottom of outlet tee or baffle: t Scum thickness: _ Distance from top of scum to top of outlet tee or baffle: u y Distance from bottom of scum to bottom o outlet ee or baffle: How were dimensions determined: Comments(on pumping recommdhdaflons,inlet and ou t tee orloaffle c dition,structural integrity,liquid levels aI r�elqt� o outlet invirden a of 1 ,etc : i 0 u law GREASE TRAP:_(locate on site plan) Depth below grade:` Material of construction:_concrete metal_fi ___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 017t affle: Date of last pumping: Comments(on pumping recommendations,inlet and outl t tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ex -e W I tdc"Q Owner:Z"R'Mnty►--i i gm a i��el�� Date of Inspection: -1�3-o 6(4 TIGHT or HOLDING TANK: (tank must ed 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: gallonstday Alarm present(yes or no): Alarm level: I Alarm in working order(yes r no): Date of last pumping: Comments(condition of alarm and float switches, DISTRIBUTION BOX:fif present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leaks a into or out ipf box,etc.): dxt�6 . i Us V4 L At%ow i<I A +A Al A" PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,conditi n of pumps and appurtenances,etc.): 8 I Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 0 ++ ,,,, SYSTEM INFORMATION(continued) Property Address: 60,JAAI"�Me. W. rn_T )VYtfJ a�lc(e 6 Owner: typn'l Date of Inspection: 9 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type .J rw� 3 O 41 Sl JAP oZ�s drao 1 ✓N leaching pits,number.leaching chambers,numb_er: 5 d P l R I V AI JV M, 101,44 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 CjI�G N —L'2JCp ILA SQL'`' tJl°-16 2-7 CESSPOOLS: (cesspool must be pumped as pal t 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 or no): Comments (note condition of soil,signs of hydraulic 1~ lure,level of ponding,condition of vegetation,etc.): l� PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic fa lure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ql Property Address: Si�c�ear kyxy e b� I Y li Owner: r�MMA K4�P►_1 ell Date of Ianspection: 9 23 03- I DISPOSAL SYSTEM SKETCH OF SEWAGE D S Provide a sketch of the sewage disposal system including des to at least two permanent reference landmarks or benchmarks.Loca a all wells within 100 feet.Locate where public water supply enters the building. r s #4 r g tv Ll v 10 i I Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: .Sa 544-0-r �p2� ,61 Owner:bu\ftm-t Date of Inspection: c-a3-ol- SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water V y feet Pleas e (check)all methods used to determine the high ground water elevation: from system design plans on record-If checked,date of design plan reviewed: bserved site(abutting property/observation hole within 150 feet of SAS) hecked with local Board of Health-explain: )Accessed hecked with local excavators,installer attach doc to ) USGS database-explain: = 0,6/0 V l YOU Mtst describe h_ow�ovu�establis�a hi h groundwater ei ation: _ L 7 _ _ {-�`• Z 4 ASSESSORS MAP NO*, �{ 1 ' No. �' (� A1� _ PARCEL Na f� � ' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZfppYication for Migozar *p.5tem Construction Permit e Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's�ap/Parcel t Installer's Name,Address,and Tel.No. Z — Designer's Name,Address and Tel.No. Dew 9 40• 6 &,Oy 7 ,?-/ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r Design Flow /a gallons per day. Calculated daily flow "U6 gallons. Plan Date jt Number of sheets / Revision Date Title T� Size of Septic Tank �Gll/J"�/yG / bow Type of S.A.S. ,Pe4 Description of Soil, Z e> Pi/1 tQ G O'v 3_105 Nature of Repairs or Alterations(Answer when applicable) -- Date last inspected: DESIGNING ENGINEER MUST SC.1F: RV" INSTALLATION AND CERTIFY 1.4 V.% Agreement: THE SYSTEM WAS INSTALLED IN T The undersigned agrees to ensure the construction and maintenancetdf QQ@ a Ti�eF fte 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 Certifi- cate of Compliance has been issued 2by this Board of Health. Signed Date / a a Application Approved by Date '� Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE MASSACF�U� ENGINEER MUST '�' ,2, S T Sr1^� i - ON AND CERTIFY IN Certificate of ComprwM SYSTEM WAS INSTALLED ,N �TR!CT THIS IS TO CERTIFY, that the On-site sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandone )by / at --g has been constructed in a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. D� l31�ated Installer Designer 11,0 O The issuan f s p sh not be construed as a guarantee that the sy e t 1 fu cti as esig Date Inspector ---------------------- No. .. � Fee {, Entered computer: THE nmf�IWEALTH OF MASSACHUSE SFes _. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS r r S 01pplication for Ziopoml *p!5tem Con.5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components r Location Addressor Lot yN^o. Owner's Name,Address and Tel.No. Assessor's I�ApAtel `'� •)� 'Z. 4� /� .� .� �� Installer's Name,Address,and Tel.40 — Designer's Name,Address and Tel.No. Type of Building- Dwelling No.of Bedrooms_ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( Other Fixtures Design Flow—7 � gallons per day. Calculated daily flow ? gallons. Plan Date Number of sheets�� Revision Date f Title Size of Septic Tank- T e of S.A.S. --a' n /-- � YP r Description of Soil Nature of Repairs or�All terations(Answer when applicable) 4c s}i , 1 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 Certifi- cate of Compliance has been issued by this Board of Health. Signed Date 47 Application Approved by hdC4 ea— - Date Application Disapprove for the following reasons Permit No. Da te Issued /— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS _ Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by w at �, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. / —dated Installer Designer r , The issuance of this p rmit shall not be construed as a guarantee that the sym 1 function as designe t3f� Date I 41 ? fop—Ins'ecttird +7, No. V 1 Fee Z22P THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Ziopozal *poten� Conotruction Permit Permission is hereby granted to Construct(`Repair( )Upgrade( )Abandon( ) System located at -4 4 t and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of-the'date of this p t. 1 Date: Approved by_ Cam---' _ - —•• ��� Ipo \ tll.!k IV I vv.r t I � � O� __. -- � VY�K v wuo ji"i Icy - rillI �I I zXl' i i ff _ I ,li IRWIN olmd i J + - M"i U rt 41 m►4t ,�Mper<<a•i-j�uun, (v�v wiry►aw►br-) Imo. so3�o Iww,oN ¢o• tJ�>'b'<��+'�*� I (zlAW31 (A) w. 99 �� At,liO>,�,ca p�ue( (z}off•)k+�S'd'� - �c prr�on►' tP a1. Wlbrie Oliver , .. Nantucket 006Z1r11!Wa)l SVSV-£VZ(009)L paniasOU s1461&jfv 4:%-- 'Oui SUMOM pue SLWOJ 08610 £Zld sd£L- + II _ — t 11 i i s I I -14 i - 1 .-- _' _J._ 4. j r-_ _� ._t fi � { i — i { , it If i. i _�. t _�,.. _+-•t•- _t_t_'�_.J_!_' - --�-1 --FF-- -{ '-i --�---f-+'-.�--i Z--j ', I i - - - ��71 LS I•� I "�I I --s----- . i 1 (�i � t 1 _t } , i I ;t�- t i I � t t { 1____a-L`_-•--; 1 -----+-�-- -- - t �.�...�.1��.._r i_G7 ' ? 11�g y� ,��•iih---T-- { 1 � '1� -i_.:�." Y�...t_•-'--'t._•--. ._L J - -�'--t I ��.�{��' I }f ,_._LL_' � J._J__� ' , � 1{f v�l� I ,�._ `-i I ' I.��_�'•- t�:�{r1 �' �� t � ' ' + -;- :_.-, , r-- 'Z- ��_' -41 -i- t-t- 1` 1 fi�' tl S,A Pp Plows � f TOWN OF BARNSTABLE -, _LOCATION S"e1 c r-4 DD.0 L,y SEWAGE # 4 0- �. "'VELLAGE_� . /�,��,�,� rT,� ,�a ASSESSOR'S MAP & LOTbrl�005 ( INSTALLER'S NAME&PHONE NO.ram-U/P %,� of�f O �j► o y SEPTIC TANK CAPACITY _ /a 4-,- LEACHING FACILITY: (typF, 1 �.,�L ,�, (size*)11U_y,-?o NO.OF BEDROOMS__ BUILDER OR.OWNER O PERMTTDATE: /AZZ o a o COMPLIANCE DATE. Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet o chin facility) Feet Furnished by y i r CoTown cal Barnstable ril Co�y Depar-Imcnl of I lc;11l11,Safely,:Ind Elivil-ollnlenit(I Services � 1 o�nuro, . I'filllic Ileallll Division vale_ -- SI 167 t,'Inin Sllect,I 1pannis NIA(11G01 t • 1 r1A NrafAI11E, _ � '• - -- _ �L�A,u^6' � lk l e IA93 -Dale:seliediile lice t'd. ✓� Soil Suitability Assessi»ew fur Seivage Dispostrrl � 1'crfnrmcd fly: �CWQ 1Vilocsted Ily: LOCATION & GENENW., INFORIYIA`I`I'W Local Address S,46bl d'— ()tvncr'sNninc 6lO� y C' sir bDtc2 (/+U ti �• � Y� nddress . nsscssor's t`iap/l'arccla /�� ( latginccr's Naalc ; — w' NEW CONS fROCtION REPAIR (/ 'telephone N �'O' R 1(32—6'-Tca Land Use slopes °o o 1I /' I (• ) d ' � Slit Sloncs Dishoccs from: Opco\Vita hilly Z-Lqq II Possible Wel Alea n Drinking Walcr\Nell �ft Dmina"e Way .._ 6 Y l� It I'mpclly I.inc _ �� � 11 Olhcr Il SKI,I'C 1 1: (Street Valle,dimensions of lot,cxacl localions of lest holes&flat Isis,I(calc wcllalyds in praxirpily to holes) Od 3 �D�ooM t I'menl malclial(geologic) �/r�E `�A (�' Dcplh to Ilcdrock �dG Depth to Groundwater: Standing IValcr in I lose:. No - Weeping fiool Pill Fite_1610 lisliolllcd Scasolnl I ligh Gloundwalcr —�S` , 8 _ — — DETERMINATION YOR SLASONW, HIGH AVATERTABLEF Method l)sed: G R—aL►N !> tAJ h-W. NB / 45-1(-COU J �e Depth Observed slandiog in obs.hole: _ ill. Depth to soil mottles: Depth 10 weeping Ifolo Side of obs.hole: _ Ill. Oloololwalcr Adjuslmew Index Wcll ll .- ItnndbrR Date: _ _ Index Well level _ Adj.faclor— Adj.(iroundwala Level • I'I�ItC'OI�/\'l'rUN '1'LS'I' tide i�►ltle,� ' Obsemlioll I line!1 Thnc at 9" U11'10�• �II I Ucplh of Pat Z/ 'flnle nl 6" I r 1 SInr1 Prc-soak'I imc (i "time(9"-6") a l t r 31p , '( I lied Vic-sonk /�Ir/ •/_ _ Rale Min./Inch Site Soilabilily Assessnlcol: Site Pnssed Site Failed: Additional Tcslilg Nccdcd(1'RJ) i Original: I'ublic ilenlih Division Observalloll Ilole Dala To lie Completed nn Ifack Copy: Applicant O13SIhItVAT N fl uti-I.,OG. , Yule If ` Uepih liooa Still ilorizun Still Temote Soil Color Soil Other Stnlncc(in) (IISIM) (Mollsell) hlollling (Shocloic,Storms,Ilooldcics. : -32 , rr it 3a yG 8o--13z_- Ls_ /6 - -------------- I I. I)I!EP OPSERVATION HOLE LOG II(IIc fl j 1leplh liool Soil I lot lzoll Sttil'1'c04c Soil Color Soil Other Sur race(in.) ((.ISIM) (blonsell) Mollliog (Shoclute,Slopes,Ilotil(leres. -- Consistency-%Gll(ycO i DEEP 0118NAVA'I•ION HOLE, LOG' ll(ilc /I Uepih From Soil I lorizon Soil•texture Soil Color Soil Olhct 5orlit6c(in.) (IISDA) (Moosell) Mollliog (Slntclore,Stoncs,Iloolducs. -- — S.S�Ii1�1411SY..1��1(IyCI) DER111. OUS UtVATION IIULIV LOG Itole If epih lionr Soil I lotizort Soil Texime Soil Color Soil Olhct Surlitcq(in,) (IISUA) (Alnnscl4 Mullling (Slnichirc,Slopes,Iloolticics. . .' — l,SlllilSlkll�l4.SIIIlY.41) ', °l 1 gin,• � (,. •� I � Above 500 car nand bnomint• Kit) t wilhin Soo year bogndtoy No �'' Yes ` --- I Wllhlu I(lU year Ilnnd buundnry No_ .;Yes. i . Ucp) I of orally Occur� 'c • 'l Is 111:IIci•i;il ! I)ocs at least four, feel of iialurally occurrillg perv'oi s ni; real exist ill all areas obsci vc(1 Ihronghout Ille area proposed I01-the soil absorption syslem'1:,__...::,: .-. I If not, Mint is llic(pep o, ofiiahil':ally(►ccuri'iiip;`jicrvuius liialciril? -------- S�L-lific;ililJ . cerlify Illm on 11 b (dale) I have passed (lie soil evallinlor extiminalion approycd by Ihc: I)cparUncnl of linvir nmcnlal Not ccli()it ;uul Ihnt Ihc above analysis was perfortuc(l by the consislenl willi { (he required Iraining, expertise andd expericilmdescribed in 310 CMIt 15.017. G Signature---- -- ---------- -- Date /� 1 " � � ✓ �� 'ate_ No...q .:... `� FEs..... .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ----....�T-. ..`..............OF.............3A7_....12.........-•---.............. A liration for Dis' uiittl Works Tutu tradinrt Prrmit Application is hereby made'.'fb,r,a Permit to Construct (� or Repair ( ) an Individual Sewag7 Disposal . System at: .14 M Locit�—Address or Lot No. Owner .Qw. ----•----•-�s .�/�.� .............. .................•--....------. Installer Address Type of Building I Size ....Sq. feet Dwelling—No. of Bedrooms... I...�Z--�4t—= .__-. Expansion Attic ( ) Garbage Grinder ( � `4 Other—Type of Building No. of persons............................ Showers Cafeteria' Q+ Other fixtures .----•---------------------------•-•----------•-•.............._ W Design Flow........_rv..'S.........................gallons per person per day. Total dail flow...............3.�....... ............gallons. WSeptic Tank—Liquid ca acit t!�----balions Len th.g.:�• . Widthh: '... Diameter................ De th ,6=.F�A' x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area................"..sq. ft. 3 Seepage Pit No...0`-J�' Diameter..�'.�..Z--Ff Depth below inlet G.. :Total leaching area.Z�.`.' !..sq. ft. L Z Other Distribution box (>Q Dosing tank ) _ '��•� `�G� . . Percolation Test Results Performed b ..........................................................-�.�..' Date_ ,�G'. �_yy_.... _._ _ Test Pit No. 1....L.z-.minutes per inch Depth of Test Pit..... -5........ Depth to ground water...!'-'!".-!.tee 44 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to,ground water........................ x .. .................:................................... . . ............................................................................. 0 'Description of Soil........� cv©-3Cam. j«`ev-4 -.6wjsu# %•-6. -iSo--...e:lax^._.3N�s v . ..............................................................•..........----.................I .................................................----•---.X-!o....�-�.....---........ W .....•-----------•------•--•----•••...-•-•-•---------------------•-••---------•---•------------------•--•---•-•-•-••-•-----......-------------------•------•---....................••........-------.... VNature of Repairs or Alterations—Answer when applicable................................................................................................. ..........................................................--...................................-•------.......--------.....------------......--------------------••-•-•---•-----------............---•- Agreement: . The undersigned agrees to install the aforedescribed Indivi ual Sewage Disposal System in accordance with the provisions of.LITLZ 5 of the State Sanitary C e— The ut ers'gned further agrees not to place the system in operation until a Certificate of Compliance has be d t b of health. ,�'.. ... Signed.. ........... .....:....••---.._...............---...... .... D a,7 Application-Approved By............ ..---....... ...... ..... Da Application Disapproved for the lowing reasons:................................................................................................................. ...-•--•-----.....-•...................................•----•---------•-..................................------...............--•-------•---•--.......................----••.........................._ Date PermitNo.......................................................... Issued........................................................ Date ........14.No..... C-) is .....FR ...... ................ ...... /THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------- ..................OF......................................................................................... o\4 iration for Disposal Works Tonstrurtion "virmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: E VU'//� L L --4f Localtipp,Address, *3or Lot.No. ot;000 .. . ..... 25�_.j............................................... ........ Owner jA d er ........... ........... ........................................... Installer Addreis-. Type of Building Size Lot..........I................Sq. feet Dwelling—No. of Bedrooms.,_._ Z= L ° - _____:___Expansion Attic Garbage Grinder Other—Type of Building..........;.................. No of persons............................. Showers Cafeteria 04 Other fixtures ......................................................................................... ............................................................. Design Flow.......... .......................gallons per person per day. Total daily flow.............................................gallons. Septic Tank—Liquid Length.!��... Width A.,-.`-_- .. Diameter............... Depth�:L_17e'__ Disposal Tretich—No. .................... Width.................... Total Length...................... Total leaching area....................sq. ft., Diameter.��'�� Seepagb4PILf No.__. ............. Depth below in1et.<-'..a Total leaching ft. Z Other 'Distribution box ('X-) Dosing tank Percolation Test Results Performed by._. .................................................... ............. Date.L.An/**�*�*�.�7................. Test Pit No. 1__4._Z--_.minutes per inch Depth of Test Pit..... ........ Depth to ground water..................�r fi Test Pit No. 2...............minutes per inch Depth of Test Pit_._____...__________ Depth to ground water.._____..______.._...._. ................................................... ....................................................................................................... 0 'Description of Soil.........V-I........GCJ Cam...... W U ....................................................................................................................................... ...................... .................................. ............................................................................................................................................................. -------------------------------------- U Nature of Repairs"or Alterations-Answer when applicable--------------- ................................................................................ ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Indivi ual Sewa&:;f)Disposal System in accordance with the provisions of T I A'LZ 5 of the State Sanitaiy C" The �c rs.gned further agrees not to place the system in, rice as e Z operation until a Certificate of Complia 1h b Led-b �t jyof health. Signed.. .... . ........... .......................................... Date Application Approved By.. .............. ...... .... .... ................................ ....... ' t Dat Application Disapproved for the oollowing reasons:.................. ............................................................................................ ........................................................................................................................................... ........................................................... wf Date PermitNo.................. I . ...... lssted.._"......................... ........................ Date .......... ...... ....... ............. THE COMMONWEALTH OF MASSACHUSETTS _ i BOARD' F HEALTH ............ OF. 1 4................ .J/ ..................... (9rdifiratr of Toutpliatta T TJ1 _IaAt the Individual Sew constructed (L1<_01r T is Y, T ge Disposal S, stem construc Repaired............ by �7-74------v �4 ......................................................................... iller r Ins F r 'r .................W. .......... ..................... ............ ... ........at............... has been installed in accordance with. the provisions of TITLE 5of The State Sanitary Code as described in the application for Disposal Works Construction Permit No"_____ ............ _dated_ ......._....._....__._.__.____. . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �7 Inspector............ ............... ...... DATE.............I v .....J.... -................ ....................... ....... .. THE COMMONWEALTH OF MASSACHUSETTS BOARD,,9F HEALTH ............ ..........................OF..... 9.... .... ........................ 717 FEE........................ No.....................t. 11is#osal',Works (gon trudion Permit 7- 7� hereby granted...... ................................... Permission is her k y........ ------- ... .......... to Construcl (---IrDr Rer I)air w Individual Spwage Disposal System '7 ................ ......................... at No....-.../La ... ....... ..... .. .. ....... NN ..... J Street` n Permit a� shown on the il�r n for Disposal Works Constructio ..... L ..........................7 . ..........�....................... Board of Health DATE..................I ...... - --------------------------- ........... 4. SECTION — SEWAGE a SEPTIC TANK- "D"BOX - �1 -LEACH PIT TOP OF FON (MSL)* —"2 OF VeTO lb" WAS ED;STONE fti'17n I �a V�r IN• OUT• v� �^ A IN- AA- OUT• IN. _mac ifY I'T� ' �pG L�L1= 14 .18 sEPTIc ,{ TANK S• 53 I4rj.Z 4 Y�O ct. ELEV. ELEV. ELEV. ELEV. 141*71,41 ELEV. ELEV. Coy 1� . � �...��y yYl,W 1• IS I� I I�� OF'Vi"•bah" O g.z WASHED STONE / �. cc+ o le of ---76� TEST HOLE LOG �� �t�V' 3:�' o R, Four�a�rl J �rl10 n TEST BY ++ C F3.O. rG+1 Spa WITNESS 3 �� ZZ ro rani.- ' I�r TEST DATE BEDROOM HOUSE --� -� ti.> DESIGN m T.H: - 1 T.H. 2 O !e' r j� c;l_ ELEV. I sc:,' ELEV. �(� !et_l (() 1d/1 ' � L.C7 � � 0 1 T.� PERC RATE MIN/IN. DISPOSER DISPOSER � � bso�3Co FLOW RATE 330 (GAL./DAY) _5 , SEPTIC TANK (1.!;)_ s t�q REO'D•SEPTIC TANK SIZE dog 1��"---• _�_ �' 3� (S� o.r1 ` �.� --•-�4-� � tom. LEACH FACILITY e SIDE WALL c3Tc'..�o = tom.9 (2,5 Z a 3 �.. G/D. \ �� ri- r I BOTTOM (�/z��-Tc,= So. ,Ct,o ? c> G/D,. TOTAL USE: vlr. LEACHING -- K �� `� s✓rF. �lB�r^ k Cn' I� �Q WATER ENCOUNTERED / o NOTES: (UNLESS OTHERWISE NOTED) 3.DATUM(MSL)=TAKEN FROM `�'4��w ��QUADRANGLE MAP 2.MUNICIPAL WATER \.L;2 _.___-AVAILABLE &c - 3.PIPE PITCH:141'PER FOOT 4.DESIGN LOADING FOR ALL PRECAST UNITS:AASHO- .44 �H OF 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(2)FT. 6.PIPE JOINTS SHALL BE MADE WATER'TIGHT'- 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. AIR NE N. y D G Tee c �p�/Ong cT�c>�.) STATE ENVIRONMENTAL CODE TITLE 5 qLA "' T SITE PLAN 8. Ty�-� pLA�-I FQ�- � �� �7:- Gc�!V e hIT i oNi A-i. S V LT C>I V t S t O kl 11 woL� o�,`�c o.rat� �• �'p W. N! C*v I M rC:fa!"(" LOCUS: V-0:�_4-? G Li C7 l �2 l_1�.1J 11pT VbE UbHD Pam_ .�CLo.�'•Z„f �..1G -�rd.�n. ►V p a �1M OF MA 11 Ut` TF-IP RE GINEER . ��P fJq AL t �o�' ARNE Sys REF: Idown cape eaginet g o N PREPAaEn FnQ; t y I 4 (� l_cat��C CIVIL ENGINEERS ' LAND SURVEYORS - -- 0 BOARD OF HEALTH OR _ CONTOURS (EXISTING)----- -----• (PROPOSED)-�0-•O•0-0-- APPROVED DATE — MA . �G�(� LK�� SCALE ' 2 _ DATE �j� - Mm3. N . _ COVER TO BE WITHIN Rao 6" OF FINISHED GRADE INSTALL INLET TEE OR SPLASH PLATE EXTENDING 9" MIN. COVER TYP. COVER TO BE WITHIN TO 1" ABOVE OUTLET INVERT I 6" OF FINISHED GRADE , WATER TESTED FOR LEVELNESS � 6' TOF== 153.00' 2' LEVEL 3' MAX. COVER FINISHED GRADE = 152,00 4 PVC PIPE 4" SCHED. 40 1' MIN. COVER I ilmon f�L, SCHEDULE 40 PVC PIPE 2* PEASTONE 3 (TYP} S-.02 FT/FT S-.02 FT/FT 149.35' s=.o2 FT/FT for 14• 12.00+/- Lf. ! _ J f I 16.50+/- Lf, C O O G C3 ® - Locu / } 4' ctis BWTLE 149.55' 149. 149.05' C3 10 0 0 CM � 12 DISTCEBOX SEPTIC TANK 6" OF 148.85' 3 i 24 Imo- 3_--" 46.85' lli MECHANICALLY COMPACTED ( I - 3/4" TO 1 1/2" LOCUS MAP i EXISTING STONE 3_FLOWDIFFUSORS H- 10 I I BUILDING -- DOUBLE WASHED STONE NOT TO SCALE EXISTING 1000 GALLON DISTRIBUTION o 'X 30 ' _5 'MIN SEPTIC TANK BOX ' H-10 H-10 BOTTOM OF TEST HOLE OR USGS ADJUSTED p 1 ?35.0t7` , GROUNDWATER ELEVATION SEPTIC SYSTEM PROFILE NOTES: NOT TO SCALE 1 . SEPTIC SYSTEM SHALL BE INSTALLED ACCORDING TO 310 CMR r- �_ 15.00 (TITLE 5)AND THE TOWN OF BARNSTABLE BOARD OF HEALTH A• N E 11ON S A D D L__ R L L 1 ,A�� S REGULATIONS. I APPROXINATE, TEST HOLE # 2. ALL. PIPES SHALL BE 4" SCHEDULE 40 PVC CQNIRATOR 3. THE DIS I RIBUTION BOX SHALL BE WATER TESTED TO INSURE w SHHRA L DAM 12/-/99 WrTWSS: DONNA MIORAND' LEVELNESS AND EQUAL FLOW. I car 146 Tm HOIF , 146.00` tu►roR TODD LABARGE 4. THE INSTALLER IS TO VERIFY THE LOCATION OF UTILITIES AND SEWER a DO" S" SOIL, SOLTEXTURE SM COLOR SOL WMUW. o� LINE ELEVATIONS PRIOR TO INSTALLATION. 142 SUI HORMIN I. C`"'F_ 5. SOIL ABOVE C LAYER (SHOWN ON SOIL LOGS) SHALL BE REMOVED ! - 148 �tSQ�I (uUNSEu) AND REPLACED WITH CLEAN SAND ACCORDING TO MASS. LOCAL 0-32 FILL j SPECIFICATIONS IN THE S.A.S. AREA. 6. EXCAVATION FOR AREA WHERE 'ILL IS REQUIRED SHALL EXTEND 5' va �i/O) ; 32-40 A OAAMY 1OYR4/2 - I LATERALLY BEYOND S.A.S. ' t I - 7. VERTICAL DATUM - TOP OF FOUNDATION. Iv� UU ZS , , 40-80 BW SANDY 7.5YR5/8 i 8. SYSTEM IS NOT DESIGNED FOR GARBAGE GRINDER. I I I LOAM I 9. ALL PRE CAST UNITS ARE TO BE PLACED ON 6" MIN. CRUSHED 80 -132 C LOAMY 10YR5/8 STONE, MECHANICALLY COMPACTEC. ! SAND 3 ( I 10, MIN. PIPE SLOPE •1/8 'IN/FT. 11 . ALL CONSTRUCTION DETAILS ARE TO CONFORM TO STATE OF MASS. i ! N0 132" PERC AT 80" ENVIRONMENTAL CODE TITLE 5 AND LOCAL REGULATIONS. GROUND WAIfR ENCOUNTEREDAT -LIEN. 1 35.00 <2 WIN. PERC 25 COLS ( }151.5�7 ! ' 12. ALL MANHOLE COVERS ARE TO BE WITHIN 6» OF FINISHED GRADE. 13. SEPTIC TANK TEES SHALL CONFORM TO MASS & LOCAL � EXIS TI NG u REGULATIONS- EXISTING SPOT ELEV ATIONS-----,II CL) -- ! BEDROOM 1%.0 , 1 0. 5 DwELLiNG 14. ALL STONE IS TO BE DOUBLE WASHED ACCORDING TO MASS. & LIVING LOCAL REGULATIONS. i I 152 15. GROUND COVER OVER SYSTEM COMPONENTS SHALL NOT EXCEED 3'. I KITCHEN/DINING 1, 152 151. 1 25J GARAGE 16. EXISTING LEACHING PIT SHALL BE REMOVED ACCORDING TO LOCAL � 144 _ i' REGULATIONS- EXISTING1000 GAL TANK 17. CONTRACTOR SHALL GIVE HOMEOWNER OPTION OF INSTALLING ZABEL r^ i i� SHALL BE RELOCATED i 00 OR EQUAL) EFFLUENT FILTER. I 1 A 8 ( ) 151, 15 •79 5 --; BED , 2 O6 sEE NOTE 18 18. CONTRACTOR SHALL VERIFY STRUCTURAL INTEGRITY AND WATER ��°cfi LEU 1 I ` #� 1 3. TIGHTNESS OF EXISTING 1000 GAL TANK. IF TANK OR SITE CONDITION -T - - 15 62152.81153. 4 4 i WILL NOT ALLOW RELOCATION A NEW 1500 GAL TANK SHALL BE USED. OVERCIG 152. 5 To C LAYER .. 154 CONTRACTOR SHALL PROVIDE PRICE TO OW RE ANY WORK IS �Rco �P!R CISD , �' STARTED .AS AN OPTION IN CASE IT IS TION XISTIy4 STONE WALL DESIGN CALCULATIONS: C c lUlt, �46 115 1 .69 APP�OX. LOCATION 7� i % / I NUMBER OF BEDROOMS: _3 �r 1 -GARBAGE DISPOSAL UNIT: - 12 '` INE I 1 o i NONE 5 3 1 52.9 1 _ " 1 BATH EEC 2 , TOTAL ESTIMATED FLOW APPRLIVAL MP I 1� OAK PR�bBE0.WALL O ( 110 GAL./BEDROOM/DAY X 3 BEDROOMS i I � �' I COORDINATE w±rH owlat I 6___�: 4 t `- REQUIRED SEPTIC TANK CAPACITY= (330 GPD X 2.0' = 132�D GA!__ 150 09 ; I ACTUAL TANK SIZE: 1500 E I I S Ti N G BED _ GAL. Date DESCRIPTION Drawn Checked I �!3 I E,E 1NC 56 LEACHING AREA REQUIRED. R E V I S I O N S 152 /A?w OX. LOCATION L- SOIL CLASS - ? 154 __�_ ,X PERC RATE - Ste_ MIN/IN. SEPTIC SYSTEM DESIGN -____----- 12" OAK JAR - Q..Z4_ GPD/FT PROPOSED 2ND FLOOR 330 _ GPD / 0_74 . GPD/S.F. _ _ 445_95 _SF USE _ 446 SF AT ----`"�- 52 SADDLER LANE LEACHING CAPACITY: IN 156 _ 158 3 FLOW DIFFUSERS WITH 3' OF STONE ALL AROUND WEST BARNSTABLE -- SIDES= [A_Q_' x 2 x 2 _ ', _ SF BOTTOM= [ 0 x --IaQ-- SF SCALE: 1" = 20' DATE: DECEMBER 9, 1999 I 158 -�' TOTAL CAPACITY = __A6L0__ SF LA BARGE NOTE• EXISTING OVER DIG MAY GO AROUND EXISTING TREES IF POSSIBLE ENGIIVFFRING & CONTRACTING P.O. pox 7$4 THIS PLAN IS FOR SEPTIC SYSTEM DESIGN ONLY AND SHOULD NOT BE USED FOR PROPERTY LINE LAYOUT DENI\tISPORT, ABTA 02639 (508) 432-6360 SITE P LAN PLAN REFERENCE: SITE AND SEWAGE PLAN FOR LOT 47 SADDLER LANE, "HUNTER DRAWN 8Y: SGM 9 9 _ 1 2 0 -7 HILL" WEST BARSTABL.E, DOWN CAPE ENGINEERING 1985. CHECKED BY: TAL SHEET 1 OF 1