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HomeMy WebLinkAbout0018 SANDY VALLEY ROAD - Health 8 .Sandy Valley Road - - - - Marstons Mills q-^ `©C_07 - ;, P b V i I i I r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments lug 18 Sandy Valley Rd. Property Address Idna Cheban Owner owner's Name information is required for every Marstons Mills Ma 02648 6/29/2009 page. City/rown 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. fling Out aut orms Whe filling n A. General Information f ' on the computer, use only the tab 1. Inspector key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection �y Company Name 74 Beldan Ln. Company Address Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 SI 4522 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 6/29/2009 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. L j� U �V t5ins-09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Sandy Valley Rd. Property Address Irina Cheban Owner owner's Name information is required for every Marstons Mills Ma 02648 6/29/2009 page. Cityfrown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E I always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described. in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: 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"yet","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 of 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= Title 5 Of6del trspectim Form Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts IFTitle 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Sandy Valley Rd. Property Address Irina Cheban Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2009 page. Cityrrown 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-09M Tdle 5 Ot6dal Irsimbon Farm Subsurface Sewage Disposal System•Page 3 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Sandy Valley Rd. Property Address Irina Cheban Owner owner's Name information is Marstons Mills Ma 02648 6/29/2009 required for 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 t5ins•Og= Title 5 Ofidal Inspection Forth:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts lopTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Sandy Valley Rd. Property Address Irina Cheban Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2009 page. Cityrrown 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. ❑ An portion of a cesspool or privy is within a Zone 1 of a public well. Y P P p vY ❑ ® 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 S 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 1S,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 ❑ Cl 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•09/08 Title 6 official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Sandy Valley Rd. Property Address Irina Cheban Owner owner's Name information is required for every Marstons Mills Ma 02648 6/29/2009 page. Cityfrow n 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. ® a 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 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-09108 Tide 6 Official Inspection Form:Subswfoos Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Sandy Valley Rd. Property Address Irina Cheban Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2009 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump.pump? ❑ Yes ® No Last date of occupancy: current 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= Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Sandy Valley Rd. Property Address Irina Cheban Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2009 page. Cityrrown 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: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology..Attach a copy of the current operation and. maintenance contract(to be obtained from system owner)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-09108 Tole 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1.8 Sandy Valley Rd. Property Address Irina Cheban Owner Owner's Nar ne information is required for every Marstons Mills Ma 02648 6/29/2009 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: original system, 1983 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints,ok, no leakage, vented through roof Septic Tank(locate on site.plan): .9 Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 811 t5ins•09= Title 5 Official inspection Form:Subsutfaoe Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Sandy Valley Rd. Property Address Irina Cheban Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2009 page. Cityrrown 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 3.5' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 511 11 Distance from bottom of scum to bottom of outlet tee or baffle 10 How were dimensions determined? Opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Outlet baffle intact and in good condition. Water level was at bottom of outlet invert. Tank not leaking. Septic tank should be cleaned soon and again every 2 years as maintenance. Inlet cover is located under deck. 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 Tide 6 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Sandy Valley Rd. Property Address Irina Cheban Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2009 page. Cityrrown 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:Subsurfaos Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 18 Sandy Valley Rd. Property Address Irina Cheban Owner owner's Name information is required for every, Marstons Mills Ma 02648 6/29/2009 page. Cityfrown State Zip Code Date of Inspection D. System. Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0rl Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box is functioning as intended. 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 17 Commonwealth of Massachusetts lugTitle 5 Official. Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Sandy Valley Rd. Property Address Irina Cheban Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2009 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number. 1 ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit had 1'of available leaching at time of inspection and no visible signs of past hydraulic overloading. Soil was dry and no lush vegetation. Cover is down 2.5'. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09= Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 130 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °e 18 Sandy Valley Rd. Property Address Irina Cheban Owner owners Name information is required for every Marstons Mills Ma 02648 6/29/2009 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official ansp ectoon Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Sandy Valley Rd. Property Address Irina Cheban Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2009 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 4 Aa3 �`�'' act-i A i T 8- y= 3y"b �" t5ins•09= Title 5 Official Inspection Form:Subsurface Somalia Disposal System•Pap 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Sandy Valley Rd. Property Address Irina Cheban Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2009 page, City/rown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09= Title 5 Official hspec ion Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 18 Sandy Valley Rd. Property Address Irina Cheban Owner Owner's Name information is required for every Marstons Mills Ma 02648 6/29/2009 page. Cityrrown 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS 711 VRONENT EXECUTIVE OFFICE-OF ENVIM FAIRSz))L,�.- DEPARTMENT OF ENVIRONMENTAFr 9TIgCTIO . D��'I�dON TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: (�Z Owner's Name: Owner's Address: Date of Inspection: / �p Name of Inspecto please print) rCJ/D9l���i�-c Company Nam , Mailing Address: Telephone Numbe . 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 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 Needs Further Evaluation by the Local Approving Authority ils 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. i 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 1 Page 2 of 11 ' f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.A CERTIFICATION (continued) Property Address: Owner. ' Date of Inspection: / Inspection Summary: Check A,B,C,D or E./ALWAYS complete all of Section D A. System Passes: n/ V I have not found any information which indicates that any of the failure criteria described in-3 IO CMR, — 15.303 or in 3101 CMR 15.304 exist.Any failure criteria.not evaluated are indicated below. Comments: . B., System Conditionally Passes: One or more system components as described.in the"Conditional Pass sectionneedto be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer:yes,no or not determined(Y,N,ND)in the;for the following statements. If"not,determined"please explain. The septic tank is metal and over 20.years old*or the septic tank(whether metal.or not)is structurally unsound,exhibits substantial.infiltration or.exfiltration or.tank failure is imminent.System will pass inspection if the existing;tank is replaced with.a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of.sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed' I distribution box is.leveled or replaced . j ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health).: broken pipe(s)are replaced F obstruction is removed � 1 ND explain: } j .2 Page 3 of 11 i OFFICIAL INSPECTION.FORM --NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE'.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner Date of Insption: 4 94OCo t 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 thelenvironmeIIt: _ Cesspool or privy is within 50 feet of a surface water . Cesspool or privy is withim50 feet of a bordering vegetated wetland or a salt marsh i i 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 within1.00 feet ofa 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 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. 3. Other: i i 3 Page 4 of 11 OFFICIAL INSPECTION.FORM-—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) en Property Address: - Owner: A Date of Inspection: _ �.4a " /&p2 t!p 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 _ Discharge or ponding of effluent to the.surfac.e of the ground or surface waters due to an overloaded or clogged SAS or cesspool 1/ 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 ''/Z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number / of times pumped y 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: r _ V Any portion of a cesspool or.privy is within a Zone:-1 of a:public well. Any;portion of a cesspool orprivy 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'waterqualityanalysis.f 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 arei triggered.A copy of the analysis.must be attached to this form.] (Yes/N6)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. i 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• You must indicate either"yes"or"no"to each of the following (The following criteria apply to large systems in addition to the criteria above) yes no 4 _ = the system is within 400 feet of a surface drinking water supply i 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 f If you have answered"yes"to any question in Section E the system is considered a'significant threat,or answered "yes"in Sectiod 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 15.304.1 The system owner should contact the appropriate regional office of the Department. ,4_ Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE`SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B ,l CHECKLIST Property Address: Owner: 44 Date of In pection: Check if the following have been done.You in 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 i 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) v Was the facility or dwelling inspected for signs of sewage back up 1/ _ 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: i 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 issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] i . i r 5 I - Page 6ofll OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.AS = SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C SYSTEM:INFORMA-TLO�N . Property Add!ressc G Owner: 0 ---1*—,a ;o�7 Pf ;4' 1-��' Date of Inspection: . LO W CONDITIO NS RESIDENTIAL Number of bedrooms(design): Number of bedrooms actual :_3 DESIGN flow based'on 310 CMR 15.203 (for example: 11.0 gpd x#of bedrooms): CJ Number of current residents: fit Does residence have a garbage grinder(yes or no): - Is laundry on a;separate sewage system(y s or no)/O)[if yes separate inspection required] Laundry system inspected( e or no)j0 Seasonal use:(yes or no): L Water meter readings, if aya' able last 2 ears usage d ©y� g �D Sump pump(yes or no): v Last date of occupancy: . COMMERCIAL/INDUSTRIAL,A% Type of establishment: Design flow(based on 310 CMR 15.203): gpd 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 or no): Water'meter readings, if available: Last date of occupancy/use: E OTHER.(desciibe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the i spection{yes or no):Wo If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE SYSTEM eptic 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): Ap proximate age ofall c mponents,date install (if known)and source of information-. Were sewage odorsrdetected when arriving at the site(yes or no 6 Page 7 of 11 t OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address:Af Owner: { Date of In pection: Qff (P BUILDING SEWER(locate on site plan)/V v Depth below grade: Materials of construction:_cast iron 40 PVC other(explain): " Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:Z(Iocate site lanon r tP�f) Depth below grade: Material of construction:�crete metal'_fiberglass_polyethylene _other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) >> � Dimensions: Is— X cy )GS Sludge depth:j Distance from top of sludge to bottom of outlet tee or baffle: 17 Scum thickness: .Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bolt f outlet tee.or baffle: / How were dimensions determined: Comments(on pumping recommeations,4nlet and outlet tee or baffle condition,structural integrity,liquid levels related to outlet invert evid a of le age,etc.): f. of gUtw�' Of GREASE TRAP. (locate on site plan) i Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 4 i i 7 Page 8 of I I ;OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �o Ilk ✓ Owner: Date of Inspection: + J411,J TIGHT or HOLDING TANK:AQ(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/day Alarm present(yes or no): Alarm.level: Alarm in working order(yes or no): Date of last pumping:. Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: Ll (if resent must be opened)(locate on site plan) p .. Depth of liquid[level above outlet invert: Comm fents(note if box is level and.distribution to outlets equal,any evidence of solids carryover,any evidence of age into or out f box,etc. r PUMP CHAMBER: (locate on site plan). is Pumps in working order(yes or.no): Alarms in working order(yes or no): -- - - - - Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): i . 1 r i. 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:. J Owne . � /_ _ Date of Inspection � t� SOIL ABSORPTIO SYSTEM(SAS): t/ (locate on site plan,excavation not required) If SAS not located explain why: Ty!D leaching pits,number:/— leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative systenr. Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,.damp s il,condition of vegetation, a4 CY CESSPOOLS (cesspool must be pum,/ ped as part of inspection)(locate on site plan) Number and configuration: Depth--top of liquid to inlet invert: Depth of solids laver: 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 failure,level of ponding,condition of vegetation,etc.): j PRIVY/4 V (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 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Pro erry Address: P ld Owner. / Date of Inspeetio (� 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. LI 1 low �( c cn . Pf 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: LyG�I�' 4 Owner: 0 hrlu Date of Inspection: SITE EXAM Slope Surface water Check cellar - =a .. .. - :-f -`a ._- :- •-. — 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 Board of Health-explain: Checked with.local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: ""0616fWa r C� j E 11 Permit Number: Date: N.`--.:. c`>� Completed by:- HIGH GROUND-WATER LEVEL COMPUTATION j �� ���� Site Location: � Lot No. Owner: �2L 0 Address: Contractor: P/_&/1�/ df,5 Address: fLy'. Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. ............................................................ ....... .Date l Cam/ month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.........:.......... . ... � � OB Water-level range zone ..................................................... G STEP 3 Using monthly report"Current Water Resources Conditions." determine current depth to water level for index well ................. month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth :to water level for index well (STEP 3), and water-level zone(STEP 26) determine water-level adjustment .............. / _....................................... STEP 5 Estimate depth to high water by subtracting the water level adjustment (STEP 4) from measured depth to water / level at site (STEP 1) ....................................... i Figure 13.—Reproducible computation form. 15 2liv �.. �_ FEE '�/_ '-` THE COMMONWEALTH OF MASSACHUSETTS OG I BOARD OF HEALTH Town Barnstable ..................... ....................OF..........................................---------.........------....................... .2 ppliration for Dispiliml Works Tomitrurtion ramit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: �1I(� Lot 2 Sandy Valley Road Narstons Mills, ....9 Sad ass. .........• .........•. ._....... ... ... ............ -Loc i •Ad ess or No Capricorn Realty rust 765 Falmouth Roadt, Hyannis .--.. ........................................................... w Steve L e b el Owner Address Installer Address UType of Building Size Lot.................... Sq. feet ., Dwelling—No. of Bedrooms-3.......................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building MI•I1.Qh.............. No. of persons.....................--.--.. Showers (2 ) — Cafeteria ( ) Q' Other fixtures ............................ W Design Flow........55................................gallons per person per day. Total daily flow........33.Q...........................gallons. R 0 ; Septic Tank—Liquid capacity 00_gallons Lengtl1Q_'6......... Widtlk.10.-... Diameter................ Depthj...$.-...... ; Disposal Trench—No. .................... Width.................... Total Length................... Total leaching area....................sq. ft. Seepage Pit Nol------------------- Diameter....6._.--.--..... Depth below inlet....6............. Total leaching area._266-......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) r,ldred e En ineerin 11-2 81 Percolation Test Results Performed by.....................g...........ta........._...._..... -.----------- Date..__...-------.1. .-------.._.-------- aTest Pit No. I2A.0.......minutes per inch Depth of Test Pit..I?............ Depth to ground watef.I.one...engounter- fi Test Pit No. V,A.........minutes per inch Depth of Test Pii�4/A............ Depth to ground water-N/A.............. e a ------ •---------------•--••-•-----------....... ...---••-----...--•-•----•-.---•-------...._....•-----•••................---•--•--•--.---- O Description of Soil......... ....-..2.----•-...IQ 111...&..!QlaQ'il......................................................................................... x 2' - 10' D1edium yellow_ sand ................ 10' - 12' med. white sand�tr s o f r av aceel o water at 12 ' W -------------------------------------------------------------------- -------•--------•--•-------•----•--•--•-- ---•-----------•--------.... -------------1n------.....----------•---------•-- U Nature of Repairs or Alterations—Answer when applicable.....................................................:............:..............:............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue b alth re sSigned P . 118 .. Date ApplicationApproved By..................................................................... • ........................................ Date Application Disapproved for the following reasons:---•----------------•-•----..........-----------------.......--------------•-•-•--------•--...................... ----------•---•------------••----•--------•-••--•---•------•••----•--•--....•--------•----•---------•••---------•------•------------------------•---------------•------• •--------------.......... Date PermitNo......................................................... Issued_....................................................... Date No.---•---��-.... / FRs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable _......... _ ...... .............OF...................................... Appliration for Kliipoii al Workii Tonotrurt"tun ramit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: L ot # 29 Sandy Valley Road X1AMWPXXX Marstons Mills, Mass. ..............................•---------.............---•--•-----------------------•-••-••••--•... .....-•-------......----...•---------------••----•---------....-•-----•-••-•--•--...........------ Capricorn Ri°ffio'�?'t:Pust 765 Falmouth Road;°'Hyanrilis •--......--•...............••---•-----........................-•----•---.............__....--..... ..........-----......--•.......-••-.....------•-•-............••-•----.....---............._...._. W Steve L ebel owner Address ........................................ ................................................. ....-------•---------------------•----•._.._.................--•---.............•---.............. Installer Address UType of Building Size Lot............................ q. feet U Dwelling—No. of Bedrooms---3......................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ranch............. No. of persons............................ Showers (2 ) — Cafeteria ( ) 04 Other fixtures -----------------------------------•--------------.....------......--------•------------ ............................................................. Design Flow...........5e:._.........................gallons per person p r day. Total jail flow......... 811 W Septic Tank—Liquid capacity1000 gallons Length$�.... ..... Width_.......1�__ Diameter................ Depthlr.._ x Disposal Trench—No. ..................:. Widt _�....-............ Total Length..__..__.�-....... Total leaching area....................sq. ft. I Seepage Pit Nol.................. Diameter.._.. ._.......... Depth below inlet.................... Total leaching area...266......sq. ft. Z Other Distribution box ( ) Dosin a k ) ar&dge Engineering 11-25-81 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1.2 9 0...__.minutes per inch Depth of Test Pit...12�..__..__. Depth to ground water?Zone encounter (1 Test Pit No. 2Nl.A._......minutes per inch Depth of Test Pitt��A..___.._-._ Depth to ground water..N� .............. e PG O Description of Soil..........0.'-----_..?' loam & topsoil-.._._ x 2' - ib` Nieciium Mellow sand 1�r---_--12-,-----med.---wYiite sand trac ---- W J -----c e s of gravel jno water at 12 UNature of Repairs or Alterations—Answer when applicable........................................................:....................................... ------------------------------------------------•--------...------------•--•-----------------........---.....-----------------------•-------------------------------•--•--•......-------•-------•••----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of Health. Signed...................................................................... Pres. 9/13/83 .....----• ............................. Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:--- -•--------••---...-•--...•--•-----------•-----•--------------------------------•--------•-•------....--•--- ...---•-•---------------------•------•---••----------•------....••-------••-----•-...._..--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........Town..................OF.......Barnstable. .................................. .......................... Trrtif iratr of Tomplianrr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed (X ) or Repaired ( ) t e ve L.e bel --------------------- Lot X 29 Sandy Valley Rd, Mar is Mill at................•--------•-------------•----......--•----•--•---•----------•--•---•----------------------------••-------.--V •----•! 1-------------•---=------•-•................................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSU NCE OF THIS CERTIFICATE SHALL P,SS.BE, ISTRU AS A GUARANTEE THAT THE SYSTEId FU TION SATISFACTORY. ��//���. DATE % t�................................................ Inspector.... ..... ......------------•------•.......-•-•................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town........................O F...Barnstable FEE........................ / Rspoottl Workii Tonotrurtion "permit Steve Lebel Permission is hereby granted -- --------- •-••---••--. to Construct ) air ndivi 1 Sewage e Disposal at No.....T...........................................................of �?� �9 pand�r �la lfey ' M �% Marstons Mills, Ma. ' , :, P .•-•-----..........•--- ........................................................... Street as shown on the a 7c'an for Disposal Works Construction Permit No..................... Dated.._........____..__.__................._.. ...............•........-•-..__ ._�:'1rx.._•---......_------•-•-•� r_ ------- Board of ealth DATE................................................................................ ti,. FORM 1255 A. M. SULKIN, INC., BOSTON L w 3 r F Qdl� C r SFr�i� Akra CN4ne 2F i Gr p (�o b ( ! o s ze � I \ Ig Zh � ( � . t i � �► 16 PerLl � •9 10 �O� 23"1, P L Z I ERG b . 366 40 G� TES Fss�OAL •� CLOT Z i3� So is —reF 7 do 2 3 G'I LEGEND EXISTING SPOT ELEVATION Ox0 CERTIFIED PLOT PLAN EXISTING CONTOUR --- 0 -- -- '` FINISHED SPOT ELEVATION � r{OBEr T ��:;,.��� 16'T" 27 pl,qTJ 33�/, '�'G . FINISHED CONTOUR 0i BkUCE V'4z to [LDRE'D I N APPROVED , BOARD OF HEALTH sT/��� � SAI��°j �,A� ��� ASS+ �y0 DATE AGENT Ho such SCALEI ��= 3o DATE , L13Lp-3 �'�LOhZEOGE ENGINEERING CO. IN CLIENT_ I CERTIFY THAT THE PROPOSED EGISTERE REGIST9-RED JOB NO. 9 ZSC. BUILDING SHOWN ON THIS PLAN CIVIL LAND DR. CONFORMS TO THE ZONING LAWS c ENGINEER SURVEYOR OF BARNSTABLE , MASS. 712 MAIN STREET CH. BYE"E' Q'& g NYANIV I S, MASS. OF DATE REG. LAND SURVEYOZ � - SHEET-L R 240 FT. M/N• NOTE /F E/7-NER THE SEP7 TANK OR �. _.EffGN/wG P/T .ARE MORP T/a�9:/ /2' BELOIc/`' /D FT. M/N. JRA OE, A 24'O/A M E TER C'OiyCR E TE CO vER �<'" �LcV. S/,IALL eE BROCJGNT TO 6RAOE.6-;,V.. EXTRA �o� 1 CONCRtTE 4 PVC OJPE HEAVY CAST /RO/Y CoVA--R S/�ALL 3E USED V COVERS M/N. PJTCN /F/N OR/VEyt/A y 2CO/VCRETE A _0. / G AGE Cd 1!ER CLEAN ..SAND a- &A C.Je :�. UQ[//O LEVEL - '� ._ • . . .-. �/ 4 . 4..CAST 'LAYER 1 • -' /ROJV P/P� �GL7 0 a o �Y►Q� Glf ��8 -3�6 '¢ /N/N.P/TUlI —L GAL. • I • • • • • • • > •4o t %'PON fT. SEPT/C TA/VEC e � � • • • • • • • • s • • • e AL WASHED STDNE ♦ • ► •EFFECT/VC • ` . - I �2 �` , • • • • DEPTH • • • • .• 0 WASNED STONE' �30 S V Z.5= //7/ • • • • • • • • • • o PRECAS T SEEPAGE' fNIiPRT I�LEYAT/OiYs 7�.5 v /, u - 78 i aj•• • • • • • • • • ••`a P/7 OR E-QUJV. s ♦ Ar 5Y7 CP D FT D/AM. fi INVERT AT ffWJ.D/NG S-s' FT. /NLET SEPTIC T.4/VK q9,3_FT L FT. AP/A W. I C(SEE iBul.4T/Ow, O/JTLET SEPTIC TANK g .l FT. r j /NLET D/STR/6!?/DN 80X ITT. SECT/ON OIe GROUND MITER TAOLE 00TLETD/37'-R/0lI'T/0N BOXY FT. SEJ%VAGE /�lSPOrSA t SY.S'TEM /NLET LgACN/NG PIT 97. l Fr. T, 49VI-A ION LEACHING /o/T DESISN CRITERIA SCALE : %s" _ /=o' o/MFNs/ON A Z.S T. Nl/MBER OFBEDROOJys 3 D/HENS/ON C FT. �,ARQAGED/SPOSAL UNIT SO/L LOG SOIL TEST TOTAL EST/J►'L�TEG FLOW 33� GAL.�DAY SO/L TEST Af/ SOIL 7FST2. NUMBER QF 1f.4CN/N4 PITS l_ f`E[EK I/ I-.-LEY PATE OF SO/,L TEST 8 ZS .83 S/OE LEACHING PER P/T 1$�s 51g PT.. — RESULTS AV/TNESS'ED dY BoTTOM LFACN//VG J01&R P/T _2-1,5' Sq. Ay- o•, O-2'LoA�+ '� PERCOLAT/OJV /tATE.�/ -6 Z-� MJN�I/NCN gu�sc�e, TOTAL LEACH/NG A qRA �7 SO FT, — AENCOLAT'/ON RATE/k2 M/N.�IJVCH RE5ERVELE4C/I1/v6AREA 247 SO. FT. OF nq\ `I-I2 �. o= LoT Z9 pc.4iv 3/c. 33Y, / Ru8_ 1 ; T �': B RG 4Cal s _ 6 R u C E 1 ' —�i ! ElJ;.'r CG • .c 9 No. 366 TO a.� ��i` EL DREDGE ENGINEERING CO9/NC•. ►� 7/2 "A//Y Sr. , HYQ"Al/S, M,c,►SS, �� SU.Eiy�J� [-P1 ND GROUNt7 yY�4TCR ENCOCJNTEREo CL/E/VT: co DATE 'F i3 83 \�- R GRO UND h/A TER A7- ELE1/ _ . JOB No.• Q3 2s� SHEET' ZOF Z