HomeMy WebLinkAbout0074 SADDLER LANE - Health 74 Saddler Lar 'e
Marstons Mills
1 �
A = 151 - 048
6
TOWN OF BARNSTABLE
LC—ATION 7Y 54a6l Pr L n. SEWAGE#.
VTOLAGE I/U a/,h J-V d4 P ASSESSOR'S MAP&PARCEL �7/- a1-/f
INSTALLER'S NAME&PHONE NO. C, A-i Ito Gon 5`f-
SEPTIC TANK CAPACITY /3-00y
LEACHING FACILITY:(type) 4/-S-Vo' (size) yob X/off.8 X A
NO.OF BEDROOMS
OWNER r�
PERMIT DATE: -/-d y COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet
Private Water Supply Well and Leaching Facility(if any wells exist
on site or within 200 feet of leaching facility) feet.
Edge of Wetland and Leaching Facility(if any wetlands exist
within 300 feet of leaching facility). feet
FURNISHED BY
i
�y
t
Sc
No. ,. Fee
Y
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
pplicatiou for MigposMl *pgtem. Cougtruction Permit
Application for a Permit to Construct(Zepair( ) Upgrade( ) abandon( ) Complete System ❑Individual Components
Location Address or Lot No. -1A Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel j 5i STEPH]E`e J.IQ TE ANI):���OCUTR
Installer's rile,A dre�s and Tel.No. ` AST FAt�AlIOUTHA7iQ }liJ§ }�§� ���
C Designer's ame,Address TH.
% a o Goy s7.
Ar 3?9 tilav,g�a4 r /�Ll�/��d.ZG 0
Type of Tlding. jjPk 11'a � �5-
Dwelling No.of Bedrooms, Lot Size A sq.ft. Garbage Grinder ( )
r Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures /
Design Flow(min.required) b ® gpd Design flow provided S gpd
Plan Date %—j -7,\ , 0 q Number of sheets Revision Date
Title - r-r" ' O.-,-n.
Size of.Septic Tank Type of S.A.S.
Description of Soil �—;Zjz�—o -4 _,Jvi_
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by thi o rd of ealth.
Signed Date ,e vZ7"0y
Application Approved by - Date S
Application Disapproved by: U Date
for the following reasons
Permit No. acool IL-112 Date Issued -0
No. i ...�,�� 4M-c�k�"�� �;.. . j ,.,`,� 150
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNS TABLE, MASSACHUSETTS Yes
Application for Tigpont :�)pgtem ,Un0truction 3permit
Application for a Permit to Construct( Repair( ) Upgrade( ) fibandon O ®.Complete System ❑Individual Components
h
Location Address or Lot No. -1 A 5 ti &, Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel �j� .i 4r
STEPHEN J.O D017E VD�S5 0CLAT
SInstaller`s a(e,Address,and Tel.No. Designer's Name,Addr PST 1
, 0%/fo C ,57: RY LANE�V. Aw 379 AST FALMOUTH:MASSACHUSETTS 02536
508/640-2534
Type of Buitding:
(Dv,llingNo.of Bedrooms t Lot Size t y A 17i sq.ft. Garbage Grinderer Type of Building_ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 6/0 gpd Design flow provided gpd
Plan Date t-AA;,4 7a\ O Q Number of sheets Revision Date ,
F Title 5 +.,o , ! - 1 r�.. ►,,�e"1' 1-o I./c,'" 6,
1• Size of.Septic Tank p 1� � Type of S.A.S. G VkA,hk S't.''�.1't� '[tGl'tt�•t►4
Description of Soil Gft)k\-o Lto a y
i
e
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected. .
Agreement: r ,
The undersigned agrees to ensure the construction and maintenance of the afore described on--site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board oEHealth.
kSM�F i
f 1 Signed !�T%%' // '}Y Date
Application Approved by, ILLS r , d'- ;�, 7 Date z.a5_",��j``Q
Application Disapproved by: #' / l Date
r
for the following reasons
.j
Permit No. a *Oq Date Issued
-------------------------
THE COMMONWEALTH OFMASSACHUSETTS`---------------------------
-------
BARNSTABLE, MASSACHUSETTS
t
Certificate of Compliance ,
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ✓) Repaired ( ) Upgraded
r Abandoned( )by
at "� �> r�� �.' L n has been construct d in accordance q
with the provisions of Title 5 and the for Disposal System Construction Permit No. -.C61 dated
Installer 1) el, /'741/17 Designer 14 415fOt, _
#bedrooms Approved design flow � �J��� gpd
The issuance of this permit shall not be cdd�nstrued as a guarantee that the system w 11 fine to as designed.
Date / ��"/ Inspector_ .»
————
----
-- - ---- -- ___-
i ---------------------------------------------------1 + , ------------
No. d�q Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Digonl *p!tem Construction 3permit
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( )
System located at '"7`/r ,�,�`, /�/� $I
and as described to 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 thiss-pemt:
Date (jam-f b t Approved by i
t
f
� t_
'own of.Barnstab�e
Regulatory Services
Thomas F. Geiler, Director
eaxxsrABLF,
9 M�: Public Health Division
�A'F�Mp'tA Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644 Fax: 508-790-6304
l
Installer.& Designer Certification Form
Date: o(o oo� Sewage Permit# o?P0'Y-A19 Assessor's Map\Parcel 1 N 6
Designer: Installer:
STEPHF J.DOYLE AND ASSOCIATES
Address: 42 CANTERBURY LANE Address: f0,,�x 3 3 `!.
E-M 02636
608/540.2634 % 5-
On -/-0 �� / 1�,l.� was issued a permit to install a
(date) c (installer)
septic system at "T A�t� t k4rL2 based on a design drawn by
(address)
�.. L. t , dated 6� � .
( e gner
I c rtify that the septic system referenced above was installed-substantially according to
e design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout (if required) was inspected and the soils
were found satisfactory. „®®°' AAA,
'Itk OF
DAVID
B. G ° o`s STEPJ.
HEN
Installer's ignature) o �1ASON DOYLE �
v No.1066 �► � � ••�7�
9�G/STEP�� ssl\•c�,Q
SqN/TAR�P �y�'� su�v��®�a
esigner's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARINSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:\Septic\Designer Certification Form Rev 03-09-06.doc
r
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 12/30/2008
every page. City/Town State Zip Code Date of Inspection.
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important: A. General Information
When filling out /
forms the / t 7,gvi
computer,
r,use 1. Inspector: 1J U
only the tab key
to move your Robert Paolini
cursor-do not Name of Inspector
use the return
key. Capewide Enterprises,LLC.
Company Name
r� P.O.Box 763
Company Address
Centerville Ma. 02632
City/Town State Zip Code
(508)428-4028 S14454
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
12/30/2008
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****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. I ,„ /
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 2
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 12/30/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The septic system is in proper working order at the present time.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the
Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 12/30/2008
every page. City/Town State Zip Code Date of Inspection
B. 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 ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 12/30/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than %day flow
l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4
f
. I
Commonwealth of Massachusetts
Title 5 Official Inspection Form,
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 12/30/2008
every page. City/Town 'State Zip Code Date of Inspection
B. 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:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
.'` Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is required for Marstons-Mills Ma. 02648 12/30/2008
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.208 (for example: 110 gpd x#of bedrooms): 330
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 12/30/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
The septic system consists of a 1000 gallon septic tank,distribution box.and 1000 gallon leaching pit.
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 ® No
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage 2007:43,000
g ( y g (gpd))' 2008:61,000
Detail:
2007:118 gpd. 2008:167 gpd.
Sump pump? ❑ Yes ® No
Last date of occupancy: 12/30/2008
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 12/30/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: Capewide Enterprises,LLC.
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1000
gallons
How was quantity pumped determined? Measured
Reason for pumping: Maintenance
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system(yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 12/30/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
20 years
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
3'
Depth below grade: feet
Material of construction:
❑ cast iron ❑ 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 10+
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight.No evidence of Ieakage.System vented through the house vents.
Septic Tank(locate on site plan):
3'
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene r ❑ other(explain)
t
If tank is metal, list age:
years.
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 gallon
Sludge depth: 0
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Paula Bruillard
Property Address
74 Saddler Lane .
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 12/30/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle NA
Scum thickness 0
Distance from top of scum to top of outlet tee or baffle NA
Distance from bottom of scum to bottom of outlet tee or baffle NA
How were dimensions determined? Tank pumped at time of
inspection.
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of solids
carryover.Tank appears to be structurally sound.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 12/30/2008
every page. CityfTown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
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: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 12/30/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert No
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage into or
out of box.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ 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:
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12
Commonwealth of Massachusetts
H r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 12/30/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1-1000 gl
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of.soil, signs of hydraulic failure, level of ponding, damp soil, condition.of
vegetation, etc.):
Sandy dry soil.No signs of hydraulic failure.Leaching pit water level was 56" below invert at time of
inspection.Stain line observed 50" below invert.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow El Yes ❑ No
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 12/30/2008
every page. City/Town State Zip Code Date of Inspection
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.):
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 14
Map Page 1 of 2
Town of Barnstable Geographic Information System
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http:Hwww.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=151048&ma... 12/30/2008
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
, Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 12/30/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: Bottom of LP 80'
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health - explain:
As-Built Card
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of
groundwater elevations.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
^M Paula Bruillard
Property Address
74 Saddler Lane
Owner Owner's Name
information is Marstons Mills Ma. 02648 12/30/2008
requirec for
every page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in.separate file
t5ins•09/OE Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
�y
-• ••• 1n uE N ASSACHUSETTS
y EXECUTIVE OFFICE OF ENVIRONMENTAL
DEPARTMENT OF ENVIRONMENTAL AFFAIRS
AL PROTECTION
OFFICIAL INSPECTION FORM-rNOT FOR VOLj
SUBSURFACE SEWAGE DISPOSAL SYSTEM STE FORM TARY ASSESSMENTS
PART A
CERTIFICATION
Property Address:
Owner's Name: ,��—_
Owner's Address: 17 C
Date of Inspection: 1n6
Name of Lupecto • I p
Company Name: ` p se,
� r
Mailing Address:
Telephone Number:
CERTIFICATION STATEMENTCD
I certify that I have personally inspected the sewage disposal system at this address and
below is true,accurate and complete as of the time of the inspection.The ' that the information reported
�g and experience m the Proper function and nspectton was performed based=on my.'.
approved system inspector pursuant o Section 15340 ofnitle on site 310 sews e g disposal a Sys y.I am a-DEP
CMR 15.000). The Sys m:
.� rrl
Passes
Conditionally passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signatur
Date: o�16
The system inspector shall su mit a copy oar this inspection report to the Approving
DEP)within 30 days of completing this $Authority
gpd or greater,the inspector and the system owns hall submit the repe system is a ort to the appropriatema esiign flow of 10,000
has
DEP.The original should be sent to the system owner and copies sent to the buye ' pJab& d office of the
authority.
the approving
Notes and Comments Q6 (2A co (
r\A . I Cj
C vs�ovti� v eS� , C)tC,�
6
****This report only describes conditions at the time of Inspection and under the conditions o
time.This Inspection does not address how the system will perform to the future under the same conditions of use. fuse at that
e or different
Title 5 Inspection Form 6/15/2000
page 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOB TS
PART A
CERTIFICATION(continued)
Property Address: Ce�' n
Owner: _'
Date of Inspection: (10
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Seedon D
A. System Passes:
.1/ I have not found any information which indicates that of the 15.303 or in 310 CMR 15.304 exist.Any failure criteria not valuatedd are indi tedbebelow cubed m 310 CMR
Co eats:
cb� IL
B. ystem Conditionally passes:
or more system components as des
r ten; upon completion of the cribed in the"Conditional Pass"section need to be replaced or
epaired,The
nPement or repair,as approved by the Board of Health,win pass.
Answer yes,no or not de ' ed(Y,N,ND)in the for or the following statements.If"not deter ned"please
The septic tank is metal or 20 years old*or the septic tank(whether metal not is strut
unsound,exhibits substantial infiltrate or exfiltration or tank failure is imminent,S m ) hn y
existing tank is replaced with a Complyin septic tank as approved by the Board o ealth, will pass inspection if the
•A metal septic tank will pass inspection if ' strut
turally
indicating that the tank is less than 20 years of ' available.sound,not leakin if a Certificate of compliance
ND explain:
Observation of sewage backup or break out or hi
obstructed pipes)or due to a broken, � tic water'level in the distribution box due to broken or
approval of Board of Health): _'settled or uneven stub 'on box. System will pass inspection if(with
broken pip are replaced
obstructi a is removed
distri ution box is leveled or replaced
ND explain:
The system require limping more than 4 times a year due to broken or obstruct
pass inspection if(with proval of the Board of Health): pipe(s). The system will
broken pipes)are replaced
obstruction is removed
ND explain:
T7tln Q ine"nntin" 17—r"411 crnnnn 2
: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1A S J U�t 9-- [_V\ _
Owner:
Date of Inspection; I ? fo
C. her Evaluation is Required by the Board of Health:
C 'lions exist which require further evaluation by the Board of Health in order to determine if th s to
is failing to otect public health,safety or the environmentys m
1. System w pass unless Board of Health determines in accordance with 310
IX
system is no unctioning Ina manner which will protect public heal 15 3(1)(b)that the
health,safety
and a environment:
— Cesspool or is within 50 feet of a surface water
— Cesspool or pri is within 50 feet of a bordering vegetated wetland or a marsh
2. System will fail unless the Board Health(and public at Supplier,If any)determines that the
system Is functioning in a manner that p tects the public heaat safety and environment:
— The system has a septic tank and soil a t rption s in
surface water supply or tributary t a surface (SAS)and the SAS is within 100 feet of a
ter supply,
— The system has a septic tank and SAS and
A3 is within a Zone 1 of a public water supply,
— The system has a septic tank and SAS end the S is within SO feet of a private P water supply well.
The m has a
Private waterrssupply well**.septic M tkho used t determine and 1 feet but 50 feet or more from a
"This system passes if thew water analysis,Performed at a D certified laboratory,for coliform
bacteria and volatile organic ompounds indicates that the well is
the presence of ammonia trogen and nitrate nitrogen is equal to or from Pollution from that facility and
failure criteria are trigg ed A copy of the anal than 5 pP�Provided that no other
Ysis must be attached to s form.
3. Other:
Title i lnannrlinn Fn.�r.����i�nnn 3
• OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
CERTIFICATION(continued)
Property Address: . c ad of Lh-
Owner: Y`(`
Date of Ins don: 1
D. System Failure Criteria applicable to an systems:
You mu indicate`Yes"or'bo"to each of the following for Iniaspectio :
Yes N
Backup of sewage into facility or system component due to overloaded or clogged SAS or
Discharge or ponding of effluent to the s cesspool
clogged SAS or cesspool urface of the ground or surface waters due to an overloaded or Static liquid level in the distribution box above due to an overload
cesspool
aool outlet invert d Overloaded or clogged SAS or
L
depth in cesspool is less than 6"below invert or a
Pump g more than 4 times in the last year vailable volume
ie less
than
'r4 day now
RequiredII of times pumped_ lN�due to clogged or obstructed
— s[. Any portion of the SAS,c Pipe(s).Number
.� Any portion of cesspool
cesspool°!Pnvy:s below high ground wad elevation.
water supply. spool or privy is within 100 feet of a surface water supply or tributaryto
— � Any portion of a ces a��e
spool or privy ie with a Zone 1 of a public well.
— � �Y portion of a cesspool or privy is within SO feet of a
-bL Any Portion of a cesspool or isprivate supply well.
Pn�'Y less than 100 feet but greater than SO feet from a private water
supply well with no acceptable water quality analysis. [This
Performed at a DEP certified laboratory,for coltform bacteria and volatile organic compounds
Indicates that the well is free from Pollution from that facility passes u the weU water analysis,
nitrogen and nitrate Ntrogen is equal to or less than S 1Uty and thePresence
PPm,Provided tht no other failure criteria
are triggered.A copy of the analysis must be attached to this form.l
(Ye moo)The system tail�a.I have determined that one or
cubed m 310 more of the above failure criteria exist as
CMR 15.303, therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000
gpd. gpd to 15,000
You must in either"yes"or"no"to each of the following:
(The following trite ' ly to large systems in addition to the criteria above)
yes no.
— — the system is within 400 feet o urface
Ong water supply
the system is within 200 feet of a tributary t ace drinking water su
— the system is located in a nitrogen sensitive area(Int ri
Zone H of a public water supply well ead Protection Area_MPA)or a mapped
If you have answered"yes"to any que in Section E the system iru-s considered a si
"Yes"in Section D above the 1 system has failed. The owner or operator of any laz e se threat,or answered
significant threat under S on E or failed under Section D shall u
15.304. The syste er should contact the appropriate re onal office of the D g t. Considered a
upgrade the system in accordant 'th 310 G'MR
regional
Department.
Titla 'c lnanartin.. rr—A/1 vmnnn
4
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: addle o—
n
Owner:
Date of Inspection: C3
Check if the MoiOrg have been done.You must indicate"yes-or"no"as to each of the following:
Yep No
Pumping information was provided by the owner,occupant,or Board of Health
c/ Were any of the system components pumped out in the previous two weeks?
Has the system received normal flows is the previous two week period?
_ .Z 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)
LL _ Was the facility or dwelling inspected for signs of sewage back up?
— Was the site inspected for signs of break out?
_ Were all system components,excluding the SAS,located on site?
_ Were the septic tank manholes uncover
of the baffles or tees,material of construction, en mo d'and moor of tank inspected for the condition
dimensions,depth of liquid,depth of sludge and depth of scum?
_/ ,_ Was the facility owner(and occupants
maintenance of subsurface sewage disposal e s different from owner)provided with information on the proper
S posal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
I _ 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 is
is unacceptable)[310 CMR 15.302(3)(b)] sue approximation of distance
Title i incnortinn Fnr.,,All a,)nnn 5
p' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address; L4 sca U(er----Lkx\-
Owner:
Date of inspection: �/"%
RESIDENTIAL, FLOW CONDITIONS
Number of bedrooms(design): 3 Number of bedrooms(actual):
DESIGN flow based on 310 C1* 15.203(for example: 110 gpd x#of bedrooms Number of current residents: U ). 3 3 0
Does residence have a garbage grinder(yes or no): R 0
Is laundry on a separate sewage system(yes or no):P1 0 [if yes separate inspection required)
Laundry system inspected(yes or no):j�('
Seasonal use:(yes or no):JaLD
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(Yes or no):i(�0
Last date of occupancy: V1 C W V) G \j G cc"\+ for- C"-Fe.w
CObE1MCIALJINDUSTRIAL
establishment:
Design flow(b d on 310 CUR 15.203): 2m—
Basis of design flow tsfpersons/sgt%etc.):
Grease trep present(yes or n
Industrial waste holding tank presen or no):
Non-sanitary waste discharged to the Title
Water meter readings,if available: m(Yes or no):—
Last date ofoccupancyAq •__
OTRE ).
Pumping Records gg GENERAL FORMATION
Source of information:
Was system pumped as part of the inspection yes or no): �7--
If Yes,volume pumped:i= gallons—How was quanh
Reason for pumping: v e pumped determined? v
T�TE OF SYSTEM
Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
Privy
Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology,Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components dat installe (iif known)and ur of o Lion:
[LO .
Were sewage odors detected when arriving at the site(yes or no):ao
TiNa f Tnenn�hinn l;^,,,4i1 4qnnnn 6
. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
i
PART C
SYSTEM INFORMATION(continued)
Property Address:7L4 �dU(ems
Owner:
� f S
Date of Inspec�oi
BUILDING SEWER(locate on site plan)
Depth below grade: Z 6� �It
Materials of construction:_cast iron 140 PVC_other
Distance from private water supply well or suction line: -gyp( pram):
Comments(o co tion of joints,ven ' g, Bence of leaka etc.):
(�0
SEPTIC TANK:_(locate on site plan)
Depth below grade: tr
Material of construction: concrete_metal_�rglass—polyethylene—other(explain)
If tank is er age: base confirmed by
certificate) a Certificate of Compliance(yea or no):—(attach a copy of
Dimensions: �� f
Sludge depth:
Distance from to of slud a to tt
Scum thickness: ottom�pf outlet tee or baffle:
!� I�e J
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of nude tee or baffle: C�--i U tf r� I le v`d S
How were dimensions determined. t�(�1�eI
Comments(on pumping recommenihons,inlet and outlet tee or baffle condition,structural inte d to ou�Gt mee � e� akage�etc.): ( r grity,liquid levels
as refs
0(J SVC7'VI'
GREASIE TRAP:_(locate on site plan)
Depth below gra
Material of construction: crete_metal_fiberglass
(explain): —' _polyethylene_other
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee orr
Distance from bottom of scum to botto oe>uilet tee or baffle:
Date of last pumping:
Comments(on p econunendadons,inlet and outlet tee or baffle condition,s rote
as related to ou et invert,evidence of leakage, etc.): grity,liquid levels
Title C Tnonni.tinn Rnrrn F/1 C/7Ml1 7
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT'S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: ec�
Owner: D ,(I,Date otIn spec tion.
TIGHT or HOLDING TANK: (tank must be
pumped at time of inspection)(locate on site plan)
Depth b:ofconstruction:
w grade:
Material c metal
fiberglass_p°lye n
Dimensions: explain):
Capacity. gllons
Design Flow:_ allo y
Alarm present(yes or no):
Alarm level:__ in workingorder
Date of last p (yes or no):
Comments ndition of alarm and float switches,etc.):
i DISTRIBUTION BOX: (ifpresent must be opened)(locate on site plan)
Depth of liquid level above outlet invert.QUf
equal,
Comments(note if box is level and distribution to outlets any evidence of solids carryover,any evidence of
leakage into rout of bo etc.):
� S S dr ear �1 ��� c C�►^ c/e�^
P CHAMBER: (locate on site plan)
Pumps in working order ye ni.
Alarms in working order(yes or no): ---
Comments(note condition of pump c er;condition;u;n'P /
enances,etc.):
Title i fncnuntinn Fnr.,�!�/1 i/�l1/1/� 8
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F S S
PART C ORM RM
SYSTEM INFORMATION(continued)
Property Address: L4 Sc�/c�ler�
r
Owner: a('
Date of Inspection: Ob
SOIL ABSORPTION SYSTEM(SAS):
(locate on site plan,excavation not required)
If SAS not located explain why:
---------------------
leaching pits,number 1
leaching chambers,number
leaching galleries,number. —
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number;
innovative/alternative system—
Comments(note condition of so' sips 1���of teehaology;
� �of hydraulic failuro level ofpondin
S damp soil,condition of vegetation,
J2 fp v bvcCkr 1c O LLd
CESSPOOLS: (cesspool must be
Pumped as part of inspection)(locate on site plan)
Numb d configuration:
Depth—top o , 'd to inlet invert:
Depth of solids lay
Depth of scum layer..
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or
Comments(note condition of soil,signs of by c failure,level of
Po ondition of vegetation,eta);
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note c Won of soil,signs of hydraulic failure, level of ponding,condition of ve
getation, etc.):
Title i incnartinn T'+nnrti
9
' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: L4 ScA J t CC Lr\ .
I
Owner. R=4
Date of Inspection• ()
SXETCH 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.
P
(CIA
� b
e Al _ Is'
13f _
pa-sily, Pit` L12llol'
in
f
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: �{ S A L-2r Lr\
57. � t:
Owner: @•
Date of Inspection:
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Hoard of Health-explain:
Checked with local excavators,installers-(atta h documentation)
Accessed USG$database-explain: _ZO r\'e—
Yo must des be how you established fhe 61 ground w er elevad _
l `r o tnP t �-k n 0
a r
Tola G inenartinn l:nrm 411 vinnn l l
ias��
aF
Town of Barnstable P#
y, Department of Regulatory Services
i : ttua<rtaru3tE : Public Health Division Date 7 L't✓ -U-
>M
�p saJ4 ,e� 200 Main Street,Hyannis MA 02601 -
ran
Date Scheduled �G Time_( LA
M Fee Pd. �(}D
I
I
I
i Soil Suitability Assessment for Sewage Disposal
;
Performed By: Witnessed By: t 2�
LOCATION&GENERAL INFORMATION
Location Address 7 4GJr�. Owner's Name �1
'PAL-\�� �
Address 1 a S'�'bT✓V~Z J�TJ `-"�
iNi, �r !S ``,/ '3a+t;�1 t�i�c-,1.
Asseisor's Map/Parcel: y ` z `L Engineer's Name
NEW CONSTRUCTION >" REPAIR _j/ Telephone#
-�
Land Use IL/_\.� t
.���1�� Slopes(96)_ Z -!tp _ ,Surface Stones L=,
Distances from: Open Water Body G o ft possible Wet Area l S p ft Drinking Water Well }1 S j ft
Drainage Way `ft Property Line \c ft Other 4 ft
i
SKETCH:(street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
a ,14
' r
__ Nsr/
l°
�f
Parent material(geologic) Q b Y% Depth to Bedrock +� 1<0 t` 1
Dep6to Groundwater. Standing Water in Hole:A W/ Weeping from Pit Pace
Estimated Seasonal High Groundwater lV.A
DETPRMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: In, Depth to soil mottles; In.
Depth to weeping from side of obs.hole: In, Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level : Adj.faetor,,,,._,T.Adj,Groundwater Level e
PERCOLATION TEST Date —Z 0 Time tk r t`*
Observation
Hole#1 Time at 9" tt', z-,
Depth of Pere �n C f`tl Tlme at 6"
Start Pre-soak Time @ 1t'.t30 I t-.O Time(9"-V) e, -0,
V
End Pre-soak '.l�L _iLLI_ti/ '� 11'u4t3tl �D
Sp-,ns I'tArl't-��
RateMinJInch
Site Suitability Assessment: Site Passed 1 Site Failed: Additional Testing Needed(YIN)
i
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100'of wetland,you must first notify the.
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:SEPTIC\PERCF012M.DOC
I
I
' i !
i
j
i
DEEP.OBSERVATION HOLE LOG Hole# ►
Depth,from Soil Horizon Soil Texture Shcl Color Soil Other
Surface(in.) (USDA) (Munsell Mottling (Structure,Stones,Boulders.
"te
ock
yj
D-\L� t� 7-
DEEP OBSERVATION HOLE LOG Hole# 't. -
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) ----- Mottling, •(Structure,Stones,Boulders. j
Consistency.
it
N\ti
-Lo
D—t C, t-Nr$t!, 5 f`(.�I. \ L000cc' N \k v,
0
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Co L O t_g o tG ti
1 o ► ,C>n\u� x•l (o -t, �\ 1 S\ Sh lid
�,Ao o
DEEP OBSERVATION HOLE LOG Hole#_
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Comiswlg
. 6�(v � Sl._. \OAK `3 'fi 1�r0�\ l_oOSc�•� ?� -
i
O
WAtj
Flood Insurance Rate Mao: /
Above 500 year flood boundary No_ Yes
Within 500 year boundary No-,/_ Yes
Within 100 year flood boundary No 2 Yes
Death of Naturally Occurring Pervious Material
- - -. "Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? _
If not,what is the depth of naturally occurring pervious material?
I
Certification
I certify that on 3-Q►�— (date)I have passed the soil evaluator examination approved by the
i
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required training,exper6 a and experience described in 310 CMR 15.017.
Signature I l Datb b�'-Z0 0
QASEPTIC03RCPORM.DOC
wl- CA T ION SEWAGE PERMIT NO.
`VILLAGE r5e -t '7
I N S T A LLER'S NAME A ADDRESS
I�
B U I L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED 2/ �
Cl
s
�c�c'0.c
r
it
. � g S -q5
No... ..__...�.... FEs............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1:o..w.. ........oF..` sZ"A.... . ------------------
Appliratiun for Diupuuttl Works Tonutrnrtiun trrutit
Application is hereby.made for a Permit to Construct ( o; Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or iLo No.
................_.._ .` ..-- - �...... �._... ....------ --..........._...._. ;/ t",t�► +-/..._ .............---•--........-••••-•.......
w � �r y` 1-VZ�.� .. ...... ..........�.,�. ..� c.-�; ; ...........................................
Installer Address
Type of Building = Size Lot.. -.• .+� -Sq. feet
Dwelling—No. of Bedrooms............................................ p ( ) g •---- - /�'0
aEx Expansion Attic Garba e Grinder �'w
WOther—Type of Building..........:.................. No. of persons............_............... Showers ( ) Cafeteria ( )
Other fixtures --- ----•--•••--••••=• ' -..... .............••...
Design Flow.:............110......._ _.._....gallons per (er tday. Total i,ty, flow.:_ . .......... .. to
WSeptic Tank—Liquid capacity( ..gallons.. Length: _.J...._,Width:_56..,_�1}_... Diameter................ Depth_.....jQ....
x Disposal Trench—No. ---_--..-•---.-.--- Width.................... Total Length.....................Total leaching area..........__._..._.sq. ft. '
3 Seepage Pit No...__......t........ Diameter...... .)....... Depth below inlet......C........ Total leaching area-��.�._Esq. ft.
Z Other Distribution box V) Dosing tank (
Percolation Test Results Performed: Date.:. _.t. ... ........
,.a Test Pit No. 1................minutes per inch Depth of Test Pit... ��.:_. Depth to ground ate .. Q �d....
fs Test Pit No. 2...... .z..minutes per inch Depth of Test Pit---V!k!... Depth to ground water.�Q� .._..
a0Description
d........................................................lt... :_ .........................�...
Desc ' tion ofttSoil .1
•L.GJ �J. _;. .4 ::.: -.i t i -- ...............................................
w ....-•-•••••.......-•--...-•-----•.....--••-•......-••••-•-•-•........................••••-....••••:..........•-•....-••-•••-•-=•-•...........••-•---•---•-••...•••.................-••:......._......... '
VNature of Repairs or Alterations—Answer when applicable...............................................................................................
-•-•.......:.......•-•---.....-•---.................------..........---•-•------•---.............-----............-----------------------•=------------•----••---........................----...........
Agreement:
The undersigned agrees to'install the woredescrividual Sewage Disposal System in accordance with
the provisions of:I':L:; 5 of the State SaAAs
The
ers' ned further agrees not toVlace system
operation until a Certificate of Compliance hd of health.Sign ...........•--•..... .....••---- ..�Application Approved By-•-••••-•-• . ...........-••-•-•.... . .��
ate
Application Disapproved for the Lowing reasons:.................. ...............................................................
..........................•-•-••---.............----........---..........---•--•-•-•----..............._....---......---^•--•-----•--........................•.................. • . ..
Date
Permit No: = _ Issued-.......................................................
Dau
No. 5
ES........... ...........
THE COMMONWEALTH OF MASSACHUSETTS
— vBOARD OF HEALTH
—T:
Appiutttion for Diipniial World Tomitrudinn ramit
Application is hereby.made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal
System at:
...........1: -'."C.._ ....`-.. ....,�......-�.t2._.�.....t_�.. C,. . �..0 ��2. -���-�=�.:...................
Location-Address J or.Lo,No.
Owner y...............Address .....
W �.1�:: `� r ! .. a t.V G-I•I•/� / —I.. ...........f!.. ..f �'�..1 �f= ` t ....................................
M Installer Address
Type of Building Size Lot.. ...5...14 7..Sq. feet
U Dwelling—. No. of Bedrooms...............` ..:. ...Expansion Attic ( ) Garbage Grinder 010
'4 Other—Type of Building No. of persons:............•.............. Showers Cafeteria
Other fixtures --- .......................... c�r ...... .....
Design Flow.............. 10.............._ gallons per•persutn per day. Total
. dily flow............. D...e..._t.h.... ln .
Septic Tank—Li uid ca acit ..ga]lons Len �h. . .0__ Width:5 Diameter................ P c
x Disposal Trench—No..................... Width.................... Total Length.............-i..... Total leaching area......................sq. ft.
3 Seepage Pit No...........t.._..... Diameter............. Depth below inlet...... am.......Total leaching area10L.J..sq. ft.
Z Other Distribution box VQ) Dosing ( )
Percolation Test Results - Performed by.�!/...�. � _� *t!�� I�,� � Date... ? t�.� '��
rt ...�
Test Pit No. L.�� 2t...minutes per inch Depth of Test Pit-.... ii:_. Depth to ground water..�114k _
64 Test Pit No. 2..:_�•.Z..minutes per inch Depth of Test Pit... _.. Depth to ground water.:tA� !f: ..._
Rai f ......
o �,
Desc tion of.Soil..). ._... 41 � ...�-....!�1 ,...............•..............
75
t✓ ...............................................
------------------------------------------------------------------------------------•--•------------------...------------......----...._.....--------....... .......----------------........_••-•••---
V Nature of Repairs or Alterations-Answer when applicable................................_...............................................................
................•----.........-----...............-..------------....:----------•---.............------......------------------------------........------•-----------------------.......----............
Agreement
The. undersigned agrees to install the aforedescribed Indiidual Sewage Disposal System in accordance with
the provisions-of TITLZ 5 of the State Sanitary--C de— TeiMiders'gned further agrees not to place the systemoperation until a Certificate of Compliance has bee�s�ed bd of health.
Signed /14
T),
Application Approved BY = It �._.. . .. . ----------------•----•. �4.. . �ate
..
Application Disapproved for the ollowing reasons:..............•-----.....----------------------....------------------------.....----------......._....--•••-•..
Date
PermitNo......................................................... Issued_.......................................................
Date
...r..w...i-..i.+Mwa:-.3.i.y-w.-W-✓...-r✓...✓.. ..✓.w..+w...n..a...w w...w.a.....r.-..Er.:r,i-8_M.».4.4 a.3.N st d-.:M 4.a..:-.y'o..y w.✓w.w.r.r w r..r.s .................a
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........OF. .... .,.
`-� (grrtifiratp of Tuutplianre
THIS IS TO CERTIFY, Thai the?I.nd v dual Sewage Disposal System constructed (--I or Repaired ( )
by........... 1-:�� .._ ' �.1. 1l ......_.....
. - +
�.� / Iq'Iler l` pCe at.......-t'`�?- ----..1...........- JJ...... ►... ._..f €!._.1. ..-
._ r _ .._.
has been instilled in accordance with the provisions of T TIL- 5 of The State Sanitary Code as described in the
PP 1 �.... ��:. t dated_....._l. •,_�--a ..........
application for Disposal Works Construction Permit No....:.................. ...... ,
:THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL-FUNCTION SATISFACTORY.
..'. . ............. Inspector-----_. ...DATE...................•.•.�+. .........-----•---........- f Y ...............
a.��. x.......}...... ... ...a.. Yea.✓
t
t• THE COMMONWEALTH OF MASSACHUSETTS
BOARD/OF HEALTH
ry
No.�5
.. _ ._..` FEE...... .......-:
_ Disposal arks Tunstrurtiun Vrrutit
w Permission is hereby granted.......... -------------•--......---------..............--------.....----••---•-----
to Construct ( t-) Repair ( ) an�.Indiyidual Sewage Disposal System
at No. o � �� �.! ... - �/�a r �.............................................
Street
as shown on the application for Disposal Works Construction Permit No.... ._ t;fgDated.__.._.._..f -9 —
�� f�
._.. ` f / (` _
�oard
of Health
DATE........ g_ j._� �� .✓ /
t ........................................ . _
r
- ---- .- --- - T—. _ .. .,..,..r .,.... .. -. .• • - p - v :y.. •ram -.L
F f
.t
:.F�EOGE . . ,. :. ,..:. .:, ,. • rt ,._ -
M� •1 ...y
_ X.
ate::
12 . SEPTIC TANK - D . BOX- LEACH
Ae
WAS EO STONE n,. ..
,
t:
IN•
2 ,�^' \
OUT• _ `/ .:
E'TA-
PTIC plp.32
/
OY� 179..8 Q
ELEV.
TANK
ELEV. - ELEV..
o
9.�
99
r \.
1. 5 l 7ELEV ,.Z
2
ELEV.
-.. yet,
a OF ii .•11h, ,
.W HED STONE' a', �'•
AS .,.
t.
P� col , .
TEST HOLE LOG � •'- ,: ��� I7 f r�s � .- • , . ; `�, _ / � �
p e.4i / ( _
TEST By
WITNESS ' 1
86 .� 6
T
TESTDA E DESIGN BEDROOM HOUSE
T.H,.� 1 I T.H. +� 2 �y� r, ��� ' / � � �, "AL, ' 6
ELEV.'.IJrO ELEV.ILJ/.�/ NO / 1 M1.. .�
- 1 1
II LO M N h NI PERC RATE. G 2 MIN/IN., DISPOSER olsPosER
5u FLOW RATE 33G7GAL.IDAY I 33.0
sNIL-
� I f�q•.O t . SEPTIC`TANKell, P -
r
REWDSEPTIC TANK'SIZE1 V
LEACH EAGI LITY' �-- -
D M
rz 04
a 1
=125, - �(o ,
SIDE WAIL lt�7T4'. �ZSy . . 3�4 O G/D.
h t� ' -4
b � \
1, l
� . . BOTTOM. ICJ, 2 - far S . j,p } _ � G/D. /� / / \ � I I .
I TOTAL
\ .
I°IZ 17I,s
USE: OI�I-E,. LEACHING051=1
hI T ► \ \ /
\ /
lWATER ENCOUNTERED
:' (UNLESS'.OTHERWISE NOTED)
NOTES
I.DATUM(MSU*TAKEN FROM ` D�'G+ QUAORANGLE MAP.:
2.MUNICIPAL WATER -AVAILABLE _.__M
7 p�� \ l 7g
3.PIPE PITCH:R"PER FOOT 1
4.DESIGN LOADING FOR ALL PRECAST UNITS:AASNO• -44 tY ��1'.•_
��
S.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT. V�/ •• �,
6.PIPE_JOINTS SHALL BE MADE WATER-TIGHT
A,RNE H
7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. c O jA!A +': ! / /
STATE ENVIRONMENTAL CODE TITLE S_ �" C:V:1. wf C jJ S \ /�d >� >�,� l Em M��
S. TytS pL�, F=4L. - p�l7�c.'� r��dClC ow�a_� 4_L0 S�CaJ�p f 1
�o-r dE urn Pam 7s+.o�'.vf �.vc— d.�Y..•v � /- '�C�C ___ LOCUS.
13h•k'.E��T&gR tx',
REG.PRO SlQNA1aNGINEER o`' ARNE yG�
_ H. \ REF:
down cope ei7gineeting A I PREPARED FOR: Lw�� LL�W
_ CIVIL ENGINEERS
LAND SURVEYORS �
BOARD OF 1HEALTH �OR I) I
CONTOURS (EXISTING) ROVED N 1/ MA t p SCALE 'v
(PROPOSED)-0-0-0-0- APPROVED DATE Y �r. D�
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BUIL[ING DEPT. D rE
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.. _ ,.. FIRE DEPARTS TENT DATE
. BOTH SIGNATURES ARE REQUIRED FOR PERM17-TIHG
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TOP OF EXIST. FOUNDATION EL. 191.1' Q II
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FINISHED GRADE EL. 190.5't
Li.l "
„ 1/8" TO 1/2" DOUBLE WASHED STONE @ 3" THICK OR GEOTEXTILE FABRIC m LLJJ
6 6 (2) I/PORTS(MATHIN 3" OF FINAL GRADE)REQUIRED SEE PLAN VIEW a- Z
s" ' FINISHED GRADE EL. 184.5'f Q <C Q �
,Zp 2p' FINISHED GRADE EL. 184.5 f
INV EL Dia. MIN. Dia. lllll I lllllll""�"""'l"�"��"�'I""'3„ I'll�1"'f// "'I"'I'� 11( F ¢ a V/
187.6± 6
II 15' HORIZONTAL
(GAR. 190.7f) RISER F-1I-�-- 8.5 --I EL. 181.9' jar NO BREAKOUT " �
10' MIN, 14" MIN. INV EL m eee o eee a '�'' EL. 179.07'
INV EL ---\ ,/--- INV EL INV EL ' 's" r-4s" 12.83' --�i o z 0 m o
Min. 6 Q Q N
187.03 IN
EL 181.07 3/4 - 1 1/2
187.28' BELOW FLOW LINE GAS ' Sum ' '�' " '••�'"' �
LIQUID LEVEL 48" BAFFLE 181.70 181.50' DOUBLE WASHED STONE 34" �.:''~ 24" (n (�
6" Stone 42' * 48• ,,_4 48" U �I' z N
PROPOSED DISTRIBUTION BOX
PROPOSED CHAMBER TRENCH k6 58 m
m Q
PROPOSED 1500 GALLON TANK NUMBER OF TRENCHES = ONE Ld Q
NUMBER OF UNITS = FOUR (n
PRECAST REINFORCED CONCRETE DISTRIBUTION BOX BOTTOM OF TEST HOLE (#3) EL. 174.0' PROPOSED LEACH TRENCH-END VIEW z,o C' 7C_r MAC=' C) W w
PRECAST REINFORCED CONCRETE 1500 GALLON SEPTIC TANK Minimum wall thickness = 2" NO GROUND WATER OR
Z
REDOXIMORPHIC FEATURES OBSERVED INSTALL FOUR 500 GALLON UNITS Q Q
Tees shall be constructed of Schedule 40 PVC and shall extend a Minimum inside dimension = 12" WITH FOUR FEET OF DOUBLE WASHED STONE
tank and be on A watertight cover is required. AT ENDS AND AT SIDES O
minimum of 6 above the flow line of the septicASSESSORS MAP 151 PARCEL 48 Iw-
the centerline of the septic tank located directly under the Outlet inverts shall be equal to each other and at
clean-out manhole. 2 minimum below inlet invert. � I
The inlet pipe elevation shall be no less than 2'° nor more than 3" The distribution lines from the distribution box shall all have f ZONING DISTRICT: RF
above the invert elevation of the outlet pipe. equal inverts as determined by flooding the distribution box to
the height of the distribution line invert after all lines have OVERLAY DISTRICTS: AP
Septic tank shall have a minimum cover of 9. been sealed in place.
Two 20" manholes with readily removable impermeable covers Invert adjustments shall be made by filling with durable and
of durable material shall be provided with access ports nondeformable material permanently fastened to the line or
The outlet tee shall be equipped with gas baffle. reconstructing the lines until all inverts are of equal elevation. LOCUS ADDRESS:
74 SADDLER LANE, WEST BARNSTABLE
BUILDING SETBACKS:
FRONT-30'
SIDE & REAR-15' {
LP
FEMA DATA.
PP ZONE "C"
PANEL: 250001 0015 C
MAP REVISED: AUG. 19, 1985
DESIGN FLOW:
N5o FIVE BEDROOMS = 5 x 110 GPD == 550 GPD REQUIRED FLOW
;',.`,.,!','•4� ogy' ",: NO GARBAGE DISPOSAL ALLOWED -
EXISTING DWELLING - THREE BEDS z
LIVING SPACE ABOVE GARAGE - ONE BED PROPOSEDcD O
FUTURE DWELLING EXPANSION - ONE BED
USE: CHAMBER TRENCH 42'L x 12.83'W x 2' EFFECTIVE DEPTH
P �. .;..
S '•"' [42 + 42 + 12.83 + 12.83] X2.•0 = 219S.F. cii
42 x 12.83 = 538 S.F. 18s PROPOSED CONTOUR O
757 x 0.74 = 560 GPD TOTAL DESIGN FLOW C
Ff SEPTIC TANK SIZE: - 180 - - w o
- USE 00 GALLON
^ EXISTING CONTOUR
550 ® 200% S 15 G a
-`W- WATER LINE Z
<
GENERAL CONSTRUCTION NOTES `� '': : -� o
L All the workmanship and materials shall conform to R E.P Title 5 °os:,f.'.-. -' - -G- GAS LINE z
and the Town of Barnstable rules and regulations for the subsurface
disposal of sewage. ..., �, _
t � EXISTING LEACH-.-PIT
2. Access ports over tank tees shall be accessible ,..,... TO BE ABANDONED
within 6" of finish grade.
3. All components of the sanitary, system shall be capable of
unless the are under or within 10 ft
withstanding H-
of drives or parking. H-20 loading shall b- used under or within
10 ft of drives or parking unless noted Plastic equals may be "" `� 174 -- - - - J>. ..;.
used in lieu of all precast units. f.;4;: / ' i 176
4. The excavator/contractor shall call dig safe and -verify the location S55.08'28"E 172 / �---
of all site utilities prior to any excavation, and shall be responsible 178
<� 'r
for all matters relating to electric easements. 291.s4 �--- - PROPOSED S.A.S.
5. Sewer pipes shall be 4" Schedule 40 PVC laid at a min. 0.02 slope. goo:. / / / ` �\ CHAMBER TRENCH
6. Any masonry units used to bring covers to grade shall be
r .
mortared in place. 80
._.1. ----
7 Finish grade shall have a minimum slope of 0.02 ft per foot. 6 / a
LOT 49 � �
8. Existing system components -if any- shall be abandoned ----M_ _ ---�sa 7ns
per Title 5 requirements. "' : 85,492± S.F. 172
9. The exca va for/con tractor shall be responsible to contact .' '�'`; 1 .96 ACRES / / -/r �`°P���P ~ �'`- I, I 176
Doyle Associates 24 hours prior to any required inspectionsLLJ
184; , ~
00
10. All components shall be marked with magnetic tape or A.'...
g P Tps I o.2 �' Q 00
compara blemeans in order to locate them once buried. a0i;�' '" 6 I )+ ' G. m o
11. 36" max cover over system components.V `� *"
_ , t p 174 tP L J
z < a
12 Where water service connection is located closer than ten feet from
'`�:_ k 1 6 �-
sewage components, service line shall be set in PVC and pressure tested. `s':: / .t
f 1 f �� O pzww
13. Septic tanks, grease traps, pump chambers and distribution
172 Z m
P g s.37 �: :apRtVE � ,.`
WAY"• / 1 ss F-
boxes shall be installed level and true to grade on a level, ',: :i" r /
t... /e
7. Z
/ O W
/
f the component ;''� l ,7
stable base that has been mechanically compacted. I hl ;.
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BM: TOP FOUNDATION O Q
/
/ G_
proper compaction is required to ensure stability and to l
is laced in fill y O
P , P P P 4 �'' ..�\ �. / ,' / / .•+. / LP / ELEV. 191.1' / / � Q z Q m
Native round with a 6" aggregate base is otherwise adequate. \ f DATUM: GIS± / o
prevent se t tlin g \
q k` 1 , / O OONln
14. When sewer lines cross water lines, both pipes shall be constructed ofw
174 \ t; s¢r�soo wL {� LLj a- r
class 150 pipe pressure tested to assure water tightness1s0
NOTEi4
WHITE PINE
} ABOVE
O , / , GROUND \
POOL t72
`17 � 0
SOIL DATA: / _ \ ~_ O
0
176 �
TEST DATE: 05-20-09 \ q �} ` �- - - 178 N OF U >,
SOIL EVALUATOR: S. DOYLEP�� M4S�
(APPROVED: 03-95) 4214 S4'E \ \� \� \ arc Hr \ \ \ Ng0� ��� DAVID '��y � � >
WITNESSED BY: DAVE STANTON R.S. \\� \� \\ \ �i \ - -180 B (n z W
FIRE MASON y Q Q (n -0
J \ 182 \ \ PIT / v 9 No.1066 �'� J
TEST PIT 1 TEST PIT 2 TEST PIT 3 TEST PIT 4 �\\ I'll F � _
PERC 2 M/INCH PERC 2 M/INCH PERC <2 M/INCH PERC <2 M/INCH �1 Z<C U
EL. 186.9' +, EL. 186.9' ,+ EL. 185.0' ,+ L. 185.0' ,+ 176 17s 1eo � sa isfi,`" --. .,,,. _\�., _ _ ,.- 8 ,,. ' O00 , L'>' <C �
� M
0 0
8s 18a ` '- -� �c9 5g0 W O_ Q N
SIA" SL 1OYR 3/2 "A" SL 10YR 3/2 °'AS' SL OYR 3/2 S'A" SL 0YR 3/2 9� 0
-6 6„ '-� //"' LLB -
SIB" LS O'YR 5/6 SIBS' LS 1OYR 5/6 "B" LS 1OYR 5/6 "B" LS 10YR 5/6 ,
W 60"(EL. 181.9') W 60"(EL. 181.9') W 60"(EL. 180.0') W 60"(EL. 180.0) 182 180 �p�* Ali,334® Z = .�
PERC ® 65" PERC ® 65" v c�w��G OF EgFo cti®®® O 00
SIC" MED. +> » MED. „ „ MED ,> „ MED.
s PSTEPHEN �� O
J SAND 2.5Y 6/3 C SAND 2.5Y 6/3 C SAND 2.5Y 6/3 SAND 2.5Y 6/3 _ In
w DOYLE z
� #s� 0 ► `�
EL. 176.4' „ EL. 176.4' " EL. 174.0' " EL. 174.0' „
126 126 132 132 � � °�_ �`O o�' ® = z
NO G/WATER OR NO G/WATER OR NO G/WATER OR NO G/WATER OR ®� `4✓ y�®®da® CL Q 0
REDOXIMORPHIC FEATURES REDOXIMORPHIC FEATURES REDOXIMORPHIC FEATURES REDOXIMORPHIC FEATURES
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