HomeMy WebLinkAbout0363 SANTUIT-NEWTOWN ROAD - Health 363 Santuit-Newtown Road
Marstons Mills
N A._.030 129- J
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` TOWN OF BARNSTABLE q
LOCATION 3 [3-�..J �c1 Y) t&-)* '^a3EWAGE #
V`A,LAGE I�� r' S ��. Nam! 111 ASSESSOR'S MAP & LOT 03O'
INSTALLER'S NAME&PHONE NO. Z&oa<
SEPTIC TANK CAPACITY /-0-a
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: -ihj COMPLIANCE DATE: 2 v 1
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
-�! � Feet
on site or within 200 feet of leaching facility) �—
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) !✓ 1 Feet
Furnished by Zf
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(� Cie CG Feea' � r 1N . Pr
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0
THE tOMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ftpIication for Misposal *pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
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 this Board of Health.
Signed Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
No. � � Fee
THE LMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zipplicatlon for 0sposal 6pstem Construction 3dermit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
E
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
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 this Board of Health.
Signed Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Vr11*`,Upgraded( )
Abandoned( )by �,' j H
at 2 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. U Cj-11J dated -7 (1 C7
Installer Ra A rle „VA�j� Designer
#bedrooms Approved design flow 330 gpd
The issuance of this ermit shall not be construed as a guarantee that the system wil tio as designed
Date .2 Inspector WSJ
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Disposal Epstein Coneitruction J)ermit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date Approved by
Xq-4qg
No. t.. ' ,1 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pprication for Thow6al 6pgtem Cougtructiou permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System El individual Components
Location Address or Lot No. .3�3 541,tvilr Owner's Name,Address,and Tel.No. 36-3 �/ i��j_ p�
Assessor's Map/Parcel 3a r � 'V ieW t it Rol
Installer's Name,Address,and Tel.No.5,e �7 / '�J r Designer's Name,Address and Tel.No.
t"G °
Type of Building: �y
Dwelling No.of Bedrooms ISP 51 G,iT Lot Size / sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3�0 gpd Design flow provided '19 gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
u�
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 Envi nmental Code d not to place the system in operation until a Certificate of
Compliance has been issued by this Bo f H .
Signe 9 Date e OF
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No. 6�,Wlw -J-- Date Issued
No. .\\��..////// .���"�7:' � Fee
THE:COM ONWEALTH OF _MASSACHUSETTS Entered in computer:
�^ PUBLIC HEALTH DIVISION - TOWN OFaBARNSTABLE, MASSACHUSETTS Yes
01pprication for Migpogar *pgtem 06ngtruction Permit
Application for a Permit to Construct( ) Repair.( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. �- S4N tl�l l vl�U/Tdwh\`Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel O
i
/ /?7 /
Installer's Name,Address,and Tel.No.`� f�?� Designer's Name,Address and Tel.No. �/ ��
G q G7ball lC
Type of Building:
Dwelling No.of Bedrooms pesl,G eNT Lot Size of a /L/ sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures +
F
Design Flow(min.required) jd gpd Design flow provided �p gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
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 Envir nmental Code d not to place the system in operation until a Certificate of
Compliance has been issued by this Bo f Hea
Signed Dated ei �;,2 57 — C-
�� Application Approved by /�j/ �j Date -",
Application Disapproved by: Date
for the following reasons a
zn
Permit,No.' Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( )
Abandoned( )by ow -Q v��j Kv/
at SG Ci/T �rr��`d!,y ha been c nstructed in a ordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 dated
Installer���' �/(' a&5_T� C Designer
#bedrooms Approved design flow gpd
The issuance of this pe 1m't shall not be construed as a guarantee that the system will ll fu cti n as desig ed.
Date s.A Inspector����
_ _ .
_--No.-� - -- —r _------__----.----�-,------------------Fee -�—��--^"""
THE COMMONWEALTH OF MASSACHUSETTS
I
PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS
Iigpool *pgtem Congtruction Permit
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon
System located at 7�1i!9` W cP
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Cons t ct;on t be completed within three years of the date of this
Date Approved by
APPLICANT:
ADDRESS:
DESIGN FLOW: ��'S 1� 7 gpd
REVIEWED BY: DATE:
N/A OK N0 .
:�r�• -;�;� -sue -�.��r-�::.. ���,.� - �.,��
Legal boundaries denoted [310 CMR 15.220(4)(a)]
Street, Lot, tax parcel number and lot number noted on plan [310
CMR 15.220(4)(u)]
Locus Provided 310 CMR 15.2204(t)
Plan proper scale?(1"=40' for plot plans, 1"=20'or fewer for
components) [310 CMR 15.220(4)
Easements shown (310 CMR 15.220(4)(b)]
System located totally on lot served [310 CMR 15.405(1)(a) for
upgrades)- if not, a variance is required 310 CMR 15.412(4)]
Location of impervious surfaces (driveways, parking areas etc.)
310 CMR 15.220(4)(d)]
Location all buildings existing and proposed 310 CMR
15.220(4)(c)] V
Location and dimensions of system components and reserve areas
[310 CMR 15.220(4)(e)]
S stem Calculations [310 CMR 15.220(4)(f)]
daily flow
septic tank capacity (required andprovided)
soil abso tion system (required andprovided)
whether system designed for garbage grinder
North arrow [310 ClViR 15.220(4)( )] /Va
Existing and ro osed contours [310 CMR 15.220(4)( )]
Location and log of deep observation holes (existing grade el. on
each test) 310 CMR 15.220(4)(h)
Names of soil evaluator and BOH representative [310 CMR /
15.220(4)(h) and (i)]
Location and date of percolation tests (performed at proper
elevation?) [310 CMR 15.220(4)(i)]
Percolation test results match loading rate? [310 CMR 15.242]
Certification statement by Soil Evaluator 310 CMR 15.220(4) ')]
Observed and Adjusted groundwater(method for adjustment
given or indicated) [310 CMR 15.103(3)and 310 CMR ✓ .
15.220(4)(n)]
Location of every water supply,public and private, [310 CMR
15.220(4)(k)]
Address ?j(o�j �jvQc.� - �> -0-MU3 LZD Sheet 1 of 7
I
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T
within 400 feet of the proposed system location in the case
of surface water supplies and grayel packed public water supply
within 250 feet of the pmposed system location in the case
within 150 feet of the proposed system location in the case
of private water Supply wells
Location of all surface waters and wetlands located up to 100 ft.
beyond setbacks listed in 310 CMR 15.211 and any catch basins
located within 50 ft. [310 CMR 15.220(4)(1)]
Water lines'and c`itheF subsurface ufilities located [310 CMR /
15.220(4)(m) (if water line cross see 310 CMR 15.211(1)[1 ) !/
Profile of system showing invert elevations of all system
.components and the bottom of the SAS [310 CMR15.220(4)(o)]
Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)
Stamp of Registered Land Surveyor(required if construction
activities within 5.ft. of lot line) [310 CMR 15.220(3)]
Test Holes adequate (two in each of the primary and reserve
unless trenches as permitted in 310 CMR 15.102(2)or as
approved for an upgrade under LUA at 310 CMR 15.405(1)((k)]
Test hole adequate to demonstrate four feet of suitable material?
310 CMR 15.103(4)
Test Holes adequate to confirm adequate groundwater separation?
[310 CMR 15.103(3)]
Benchmark within 50-75' of system [310 CMR 15.220(4)( )]
Materials specifications noted? [various sections of 310 CMR
15.000]
System components not,> 36" deep(unless Local Upgrade /
Approval or LUA.requested){310 CMR 15.405(l(b)
Address �,7.�� � [ t"l 1" J17�-�,I ��� Sheet 2 of 7
_ 9
Size OK? -[310 CN1R 15.223(1)]
Inlet tee located ten inches below flow line 310 CMR 15.227(6)]
Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR
15.227(6)]
Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)]
Note regarding instal.lation on stable compacted base [310 CMR
15.228(1)]
Separation between inlet and outlet tees (no less than liquid
depth) 310 CMR 1.5.227(2)
Inlet/Outlet elevations at least 12" above high groundwater
(except as described 310 CMR 15.227(5)) or permitted for ✓'
upgrades under LUA [310 CMR 15.405(1)(k)]
Minimum cover 9"(Tanks buried more than 9" must have risers
on all openings and on the d-box) [310 CMR 15.2228(1) and 310
CMR 15.232(3)(f)]
Three access covers (inlet and outlet must be 20" or greater) -
middle access at least 8" (b 7/07) [310 CMR 15.228(2)]
Access to within 6 " of grade - one port for systems< 000gpd, ✓,
two fors stems>1000 gpd 310 CMR 15.228(2)
All at-grade covers secured to unauthorized access? [310 CMR
15.228(2)]
> 10 ft from building foundation [310 CMR 15.211(1)]
Buoyancy calculation Required/Done 310 CMR 15.221(8)]
H-20 Where appropriate? 310 CMR 15.226(3)
ySetbacks
�eyt!rb�'acks��from�resources [310 CMR 15.211]
'L�.L YK.f �.illiy�
Required when other than single-family dwelling or flow>1000
d [310 CMR 15.223(l)(b)]
First compartment 200%daily flow; Second compartment 100%
daily flow 310 CMR 15.224(2) and (3)]
"U"pipe through or over baffle, outlet of each compartment with
as baffle or approved filter[310 CMR 15.224(4)]
Address )"r(1[�� ' b Sheet 3 of 7
r Y
Located at least ten feet from any water line? [310 CMR
15.222(2)
Disposal piping at least 18" below water line (when water and
server cross, see 310 CMR 15.21 ](1) 1])
Cleanouts re uired/ rovided ? [310 CMR 15.222(8)]
Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)]
Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable
L
CMR 15.222(6)]
er pitch on all runs? (.005 within gravity-distributed trenches
eds) 310 CMR 15.25](9) and 310 CMR 15.252(2)(c)]
on roblem/(leachfield ip chamber)
Endca s or vent manifoldspecified?
Size and orientation of discharge holes specified? (not smaller
than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310
CMR 15.252(2)(h)]
Materials specified (310 CMR 15.251(5) specifies various pipe
types allowed)
ORDER
Stable compacted base [310 CMR. 15.22](2) and 31 0 CMR
15.232(2)(a)]
Splash plate or baffle tee required on inlet/provided? (when
7
pressure sewer to d-box or steep pitch of gravity sewer) [310
CMR 15.323(3)(a)]
Riser if deeper than 9" [310 CMR 15.232(3)(f)]
Inside minimum dimension 12" [310 CMR 15.232(2)(b)]
Minimum sum 6" [310 CMR15.232(3)(e)]
Watertight cover if<2000gpd); waterproof manhole if>2000gpd
[310 CMR 15.232(3)(d)]
Capacity (emergency storage above working=design flow)? [310
CMR 231(2)]
Proper setbacks [310 CMR 15.211 (same as septic tanks)]
Watertight 20-in minium access manhole at least 20"MUST BE
TO GRADE [310 CMR 15.231(5)] (�
Service components accessible (not too deep,with piping,
disconnects accessible)
Alarm floats - alarm on circuit separate from Pumps specified?
Exceeds two units must have two pumps operating in lead-lag
mode. [310 CMR 15.231(6) and (8)]
Stable Compacted Base [310 CMR 15.221(2)]
Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)]
Address ��-�� ,�� �1'J
Sheet 4 of 7
r Y
3
Calculations correct?
4 feet of naturally occurring material demonstrated? [310 CMR
15.240(1)] 1/
Required separation to groundwater? 310 CMR 15.212).]
Aggregatespecified as double washed [310 CMR 15.247(2)]
System Venting required/provided? (system under driveway or /
>36" deep) [310 CMR 15.241] ✓
Inspection ports specified and within 3"final grade? [310 CMR /
15.240(13)] r/
Breakout requirements met?(No violation of breakout elevation
within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and
Guidance Document]
'f
Chambers and Gal. in trench configuration supplied with inlet
every 20 ft. [310 CMR 15.253(6)]
Each structure with one inspection manhole (if>2000 gpd must v
be to grade) 310 CMR 15.253(2)]
Aggregate I' minimum-4'maximum. 310 CMR 15.253(1)(b)
2'sidewall credit maximum [310 CMR 15.253(1)(a)]
In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)j
Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)]
100 feet-maximum length 310 CMR 15.251(1)(a)
Minimum separation 2x effective depth or width whichever 1�
eater(3x if reserve between trenches) [310 CMR 251 1)(d)]
Situated along contours [310 CMR 15.251(2)]
Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document]
Wo
minimum 2 distribution lines 310 CMR 15.252(2)(a)]
Maxinium separation between lines 6' 310 CM R15.252(2)(d)
Maximum separation between lines and outside of bed 4' [310
CMR 15.252(2)(e)]
Aggregate depth below discharge pipes 6" minimum, 12"
maximum. [310 CMR 15.252(2)(g)]
Separation between--beds 10' minimum. [310 CMR 15.252(2)(f)]
Bottom area used in calculations only 310 CMR 15.252(2)(i)]
Address Sheet 5 of 7
� n
Pressure Dosed Svstern ?. Provided pump and piping
calculations as re uired.[310 CMR 15.220(4)(r)] ✓
Pressure dosing required on all systems >2000gpd or alternative
systems undf:raemedial approval [310 CMR 15.254(2) and I/A
Remedial Use Approvals]
If used in gravelless system - make sure jet is directed as not to
scour soil interface [Guidance Document]
Inspections once per year (systems<2000 gpd) or quarterly /
kthe
000 d) good to note r - lan [310 CIv1R 15.254(2)(d)] 1/
nstruction in fill - Did the plan specify that the fill shall meet
s eciflcation of 310 CMR 15.255(3)? ]/
ervious barrier and/or retaining wall ? Guidance Document]
Impervious barrier installation must be supervised by
designer [310 CMR 15.255(2)(b)]
Retaining wall must be designed by Registered Professional /
Engineer [310 CMR 15.255(2)(a)] 1/
Side slope not exceed 3:1 ? 310 CMR 15.255(2)]
Breakout requirements met? [310 CMR 15.252(2) and
Guidance Document
At least 5 ft. from impervious barrier to edge of SAS (10 ft.
recommended) (310 CMR 15.255 (2)(e)]
Check DEP A roval letters for credits and desi n conditions
If used with pressure dosing do not allow pressure discharge
to scour soil interface
Was DEP Approval Letter provided and/or have you
reviewed the letter for conditions?
Is the technology being properly applied and does it meet all /
DEP-A roval Conditions? 1�
Is there a note on the plan regarding the requirement for /
perpetual maintenance agreement? )/
Any alarms involved on separate circuits
Did the applicant submit an operation and maintenance
manual?
Hasa plicant submitted a coy of a maintenance
Are the variances listed on the plan ? [310 CMR 15.220
RLS Stamp necessary on plan if a component is within five
feet of property line [310 CMR 15.412(4)] I/
New construction or increased flow proposed - [Refer to 310
CMR 15.414]
Address -b&o7 `�' i -
Sheet 6 of 7
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„ "^�, ..c t. �- •`+ia -'"''`Ystc�, w
Is the system in a Designated Nitrogen Sensitive Area (Zone II for
a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and /
310 CMR 15.216 - also refer to Policy regarding upgrades of such
existing systems]
Is the system proposed on the same lot as served by private well ? /
[310 CMR 15.214(2)] t/
Are the nitrogen loads proposed in compliance? [310 CMR
15.216(1)]
Y
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Pumping to septic tank? [ 310 CMR 15.229
Shared System [310 CMR 15.290
Address ?j[D� �✓��I� �9�t t�}"'y 02 Sheet 7 of 7
•
-Jul `08 09 08: 20a pTown ofBarustable
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"o Regulatoi-y Services
- Thomas V. Geiler,Director
NAMa Public Health Division
Thomas McKean,Director
200 Main Street,Flyanuis,MA 0260I
Office: 508-862-4644 Fax: 508.790.63w
)installer&Designer CerOlfica�tion farm
Date:
1
r
Designer:�
VI j Installer:
5�
Address: . "jcx'r Address: Ol
On was issued a permit to install a
(date) (i:nstallec)�y����
septic system at71( 6 .1 �" _'� based on a design drawri by
--� (address)
dated
(de_5igner) '
1 certify that the septic system referenced above was installed substantially according to
the desip6 which may include minor approved-changes such as lateral relocation of the
d$stribution box and/or septic tank.
_ I certify that the septic system referenced above was ingalled with''major changes (i,e.
greater then 10' lateral relocation of the SAS or any vertical relocation of any component
of the sep$Cpystem)but in accordance with State &Local Regtflations. Plan revision or;
certified as-&A-1 by designer to follow.
OF
aAVID
er's Siziature) B.
WSON
Np.1066
- SqN/TAR�p�
(D er s Signature) (Affix Stamp Isere)
PLEA, E RE 1 o $ARNC7('AB ,E SUBLIC REAL D ION. C . TIlh7CATF
Off' C CF. 1VOE SS D• BO '.TS fF4RM AS-
BUl .T CA.12D A R1V RECRIWD B '.Tii<E.BARN sTAuI Pun- -U INK A, I DX'YIST=i
THA YOU.
Q:HcaltioScptic/t:csigner Ccttifica►tion PorrL
SANT��T TOWN OF BA.RNSTABLE y�
LOCATION 3 3�NW+O W 1'1 R� ' SEWAGE #
VILLAGE MOs vn� M,I�J S_ ASSESSOR'S MAP &LOT62 Q
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY I OW A QVgL— IV Wow rt-,6 C.
LEACHING FACILITY: (type) 1000 1 t t ' bh2 (size) 2 d if
NV ��}�X CDV�r bc,c'1SQr
NO.OF BEDROOMS Z lva �bw^
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet.
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
a�
S
I
23' CC 16"
f dui''
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTALAFFAIRS
DEPARTMENT OF ENVIRONMENTAL to 6ftCTION
RECEIVED
NOV 1 9 2002
TITLE 5 TOWN OF BARNSTABLE
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
1-k-T4 ru 7— PART A
CERTIFICATION
Property Address: 363 Newtown Rd.
—Marstons Mills,MA 02648
Owner's Name: Hauke and Susan Rask
Owner's Address: 363 Newtown Rd.
Marstons Mills MA 02648
Date of Inspection; 11/14/02
Name of Inspector: (please print)_Donna McCaffcry_ MAP
Company Name: PARCEL
Mailing Address:—PO Box 41
—South-Wellfleet,MA 02663 LOT
Telephone Number: 508-349-8214
CERTIFICATION STATEMENT
-1 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
Fails
Inspector's Signature: C Date: 0()O-\
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
DER The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
*.***This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
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Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:,_363 Newtown Rd.
_Marston Mills MA
Owner• Rask
Date of Inspection:_11114102
Inspection Summary: Check A,B,C,D or E/ALWAYS complete.all of Section D
A. System Passes:
X I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CNM 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.
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 stiuclurally
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
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 tames a year due to broken or obstructed pipes,).'The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 363 Newtown Rd.
Marston Nfflh MA
Owner: Rask
Date of Inspection:_11114/02
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(i)(b)that the
system is not functioning in a manner which will protect public health,.safety and the environment:
Cesspool or privy is within 50 feet of a surface water
— Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will-ail unless the Board of Health(and Public Water'Suppl er,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 conform
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:
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 363 Newtown Rd. —
_Marston 11Tlls MA_.
Owner:_Bask —
Date of Inspection._11/14102
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
X_ Backup of:sewage:into faulty or system component due to overloaded or clogged SAS or cesspool
_X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_ N/A Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool. inspector Note:no D-box present
X Liquid depth in cesspool is less than 6"below invert or available volume is less than'h day Dow
—_X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped .
X_ Any portion of the SAS,cesspool or privy is below high ground water elevation
—X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_ X Any portion of a cesspool or privy is -thin a Zone 1 of a public well.
_ }7_ Any portion of a cesspool or privy is within 50 feet of a ovate water supply well.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
su4ly well with no acceptable water quality analysis.(This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)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: flow of 10,000 d to 15,000
To be considered a large system the system must serve a facility with a design gP
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
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 Sulky
— — the system is located in a nitrogen sensitive area(Interim Wellhead Ptotection,Area-IWPA)or a mapped
Zone n 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-
i
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CRECKLJST
Property Address: 363 Newtown Rd.
_Marston Mills MA
Owner:_Rask
Date of Inspection:_IV14102
Check if the following have been done You must indicate`)(es"or"no"as to each of the following
Yes No. or Board of Health
X- — Pumping information was provided by the owner,occupant,
X Were any of the system components pumped out in the previous two weeks?
X _ 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?
N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X Was the facility or dwelling inspected for signs of sewage back up?
X Was the site inspected for signs of break out?
X _ Were all system components,excluding the SAS,located on site?
X Were the septic tank manholes uncovered,opened, for the
n and the:interior of the tank inspected
- - — condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of Mudge and
depth of scums Inspector Mote: could not access inlet opening of septic tank,it a located below a
brick patio
X _ 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 bas been determined based on:
Yes no
Existing information.For example,a plan at the Board of Health.
_X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of
distance is unacceptable)13 10 CMR 15.302(3)(b)]
i
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 363 Newtown Rd.
_Marston Mills MA
Owner: Rask
Date of Inspection:_11/14102
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual):—2
—
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):6 ft pit with 2 ft.stone
surrounding pit Capable of 4
bedroom design now under
1978 code
Number of current residents:ga 4_
Does residence have a rbage grinder(yes or no):No_
Is laundry on a separate sewage system(yes or no): No
'[if yes separate inspection required]
Laundry system inspected(Yes or no):
Seasonal use:(yes or no): No_
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(Yes or no): No_
Last date of ocaapancy: purrent
COMIVIERCIAIJINDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gnd
Basis of design-low(seats/per$ons/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:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:_owner
Was system pumped as part of the inspection(yes or no): no,but was pumped 1,4id-October, 4 wks prior to
inspection
If es,volume 1000 gallons—How was quantity 1 I�determined?
y �:—
Reason for pumping:_routine maintenance
TYPE OF SYSTEM
X Septic tank,distribution box,soil absorption system. Inspector Mote: No D-bog present
—Single cesspool
_Overflow cesspool
Privy
Shared system: or no)(if yes,attach previous inspection records,if any)
_InnovativelAlternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
—Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
pre-1991,per owner who bought house in 1991
I
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: *3 Newtown Rd.
_Marston Mills MA
Owner:_Rask
Date of Inspection:_11/14/02
BUILDING SEWER(locate on site plan)
Depth below grade:_18 inches
Materials of construction:—cast iron 40 PVC X other(explain):
Distance from private water supply well or suction line.
Comments(on condition of joints,venting,evidence of leakage,etc.): in sound condition,no evidence of leakage
SEPTIC TANK:_(locate on site plan)
Depth below grade:_12 1 eth lene
Material of construction:_X concrete metal_fiberglasso y y
other(explain) �,
If tank is metal list age:— is age confirmed by a Certificate of Compliance es or no): attach a—( copy of
certificate)
Dimensions: 1000 gallon tank
Sludge depth 0 inches
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:_1 in
Distance from top of scum to top of outlet tee or baffle:_5 in
Distance from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined: liquid levels
Comments(on pumping recommendations,inlet and outlet tee or bye condition,structural integrity,
as related to outlet invert,evidence of leakage,etc.):has Bement baffles in sound condition. Tank full at time of
inspection--no signs of leakage;tank in sound condition. Liquid level at outlet invert.
GREASE TRAP:_(locate on site plan)
Depth blow 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. liquid levels
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, qw
as related to outlet invert,evidence of leakage,etc.):
Page 8 of 11 _
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_363 Newtown Rd.
NbrstonsAdis AVIA
Owner._Rask
Date of Inspection:_11114/02
TIGHT or HOLDING TANK (tank must be pumped at time of inspection)(iocate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallonsiday
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:_N/A (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
D bog not present
PUMP CHAWER: (locate on site plan)
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.):
Page 9 of I l
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 363 Newtown Rd
_Marstons Mills MA
Owner: Rask
Date of inspection: 11l14102
SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
X leaching pits,number._I—
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovativelalternative system Typelname of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):Pit area was excavated,pit was uncovered and opened. 6 ft leach pit surrounded by 2 ft.of stone.
1 foot of water in pit at present. Pit bas been as much as % full,evidenced by waterline. Pit is located in
driveway and is H-20 with cement riser and steel manhole cover 18 in.below grade
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 or no):
Comments(note condition of soil,signs of hydraulic failure,level of pondmg,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.):
Page 10 of l l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_363 Newtown Rd.
_Marston Mills MA
Owner:_Rask
Date of Inspection:_11114102
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 w r su 1y enters the building
dU
lug
10' ti�
23► b��w f�c-hG
c �
F
P
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_363 Newtown Rd
_Marstons Mills MA
Owner.• Rask
Date of inspection.:_11114/02
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 20_feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design Plans on record-1f checked,date of design plan reviewed:
X 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)
X Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
House is at approximate 70 ft.elevation contour tine per USES quad map. Groundwater fed wedand
immediately:across Newtown Rd.is at approx.elevation 50 per USGS quad map and represents groundwater
elevation.
700
- U6�6 �vGll 5bw2�3
��ro�dwr�Pr �IGtr��
12;
l
Town of.Barnstable P#
Department of Regulatory Services
Public Health Division Date
tbIM
200 Main Street,Hyannis MA 02601
a
Date Scheduled � Ito I Time Fee Pd.
Soil Suitability Assessment for.Sewage Disposal
Performed By: r/ Iy Witnessed By V `��
LOCATION & GENERAL INFORMATION
Location Address 2 � � er's Name
ddress
Assessor's Map/Parcel: /vZ Engineer's Name
NEW CONSTRUCTION REPAIR ✓ Telephone#
Land Useu��1"`^r�7� Slopes(4'0) Surface Stones
Distances from: Open Water Body 'ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line ft Other ft
- - SKETCH:(Street name;dimensions of lot;exa locations of test holes&perc tests,locate wetlands in proximity to holes)
ww _3
_
C
Q
� � "r•4
\L k
S
y
Parent material(geologic) �^' `-'— - Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: _In, Depth to Soil mottler in,
Depth to weeping from side of obs.hole: in. Groundwater Ad,Juetinent $.
Index Well# Reading Date: Index Well level Acts.factor— Adj.Groundwater Level
PERCOLATION TEST Bate . Time
Observation I I
Hole# Time at 4"
17
Depth of Pere t/ Time at 6"
Start Pre-soak Time @ 'Cime(9"-6")
End Pre-soak ,
Rate MinAnch
of
e
Site Suitability Assessment: Site Passed' Site Failed: Additional TestingNeeded(Y/N)
Original: Public Health Division t ; 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:SEPTICIPERCFORMMOC
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency, oGravel)
rQ
4'
1 � ,
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture, 'r , ; Soil Color Soil Other
Surface(in.) (USDA) (Munsell) ' Mottling (Structure,Stones,Boulders.
Consistency,%Gravel
I
DEEP OBSERVATION HOLE'LOG Hole#
Depth from - Soil Horizon Soil Texture Soil Color .. �; Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent Gravel
{ DEEP OBSERVATION HOLE LOG Hole#
Depth.from Soil Horizon Soil Texture Soil Color ' - Soil Other
Surface(in.) (USDA) ',(Munsell) 'Mottling (Structure,Stones,Boulders.
Consistency. Gravel)
,
Flood Insurance Rate May:
Above 500 year flood boundary No Yes
Within 500 year boundary NojZ Yes `
Within 100 year flood boundary No✓ Yes
Depth of Naturally of Naturally occurring Pervious Material Material
Does at least four feet of naturally occurring perv'o material exist.in all areas observed throughout the
area proposed for the soil absorption system?
is the depth o ha urall occurring ery us material?
If not,what P Y g p
f Certification
I certify that on tO (date)'I have-passed the soil"evaluator examination approved by the
'Department of Environ ent Protecti n and,that the above analysis was perfo ed by me consistent with
the required training,expe i a x eri nce described in 3:10 CMR 15.017.
Signature Date C
Q:\SEPTIC\PERCFORM.DOC
ASSESSORS MAP : �j TEST HOLE LOGS NOTES:
PARCEL: � f Z�
--� FLOOD ZONE: /10_7 '����-'�G�$L� S01 L EVALUATOR: FYI • �� L5� 1 The installation shall compl with Ttl V and Tf Bbl Bd f
WITNESS : I k Il A loa ) Y ie own o arnsta e oar o
R' REFERENCE: Z7I , / g
\ � 3� ` 2c�{`�' _ DATE. Health Regulations.
2 The installer shall verifythe location of utilities, sewer inverts and septic_Z�7_Z '"' ,�, PERCOLATION RATE:.G 2 Ml*I, 1 ) components prior to installation and setting base elevations. p
3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first
TH- I TH-2 two feet out of the d-box to the leaching shall be level.
6-4w Lo►� ,� S�`��� t,o�gw( 4) This plan is not to be utilized for property line determination nor any other
c
purpose other than the proposed system installation.
5) All septic components must meet Title V specifications.
�7)kyyxj L9v.&� -.Awoy Lo"
�- ,9 /Z �D _ ;� 1OItfu, - 1 2b �jl 6) Parking shall not be constructed over H10 septic components.
�s,O h �` � ' �' (�` 7) The property is bounded by property corners and property lines.
LOCATION . D D D 8) The property owner shall review design considerations to approve of total
GP E 44kV design flow and number of bedrooms to be considered for design. Receipt
U' YL1 'S��1� of payment for the plan and installation based on the plan shall be deemed.
j approval of the design flow by the owner.
4TIDr``� �— <-N o 9) The existing leaching or cesspools shall be pumped and filled with material
\0 ow ! ,�•�1 � � 9 �Z Op '� per Title V abandonment procedures. Those within the proposed SAS shall
L\a• � be removed along with contaminated soil and replaced with clean sand per
_._ Title V specs.
-Z 7� 10)System components to be 10 feet from water line. Sewer lines crossing the
water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if
applicable. The proposed SAS is being installed below the water service
SEPTIC SYSTEM DESIGN line. The line is to be sleeved as aforementioned and maintain
ed in place.
y ° 11) If a garbage grinder exists it is to be removed and is the responsibility of the
FLOW ESTIMATE
s � � owner to ensure such.
1\ 12)The installer is to take caution in excavation around the gas line.
BEDROOMS AT I ID GAL/DAY/BEDROOM -Z'ZUGAL/DAY 13)The installer shall verify the location, quantity and elevation of the sewer
Ines exiting the dwelling prior to the installation.
N ( IQ-% �Zi SEPT i�: TANK____-''
. !. f
n Z2fl GAL/DAY x 2 DAYS - `7 10 GAL
USE I DAD GALLON SEPTIC TANK Al
SOIL ABSORPTION SYSTEM
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95' O yA.`' BOTTOM AREA: IZ, 01"1 :� � �OC3
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f -� �5 T IC SYSTEM SECT ION
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SEPTIC TAN !L._ °l� t.W /// 4 1 N�b All 10
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° /� ✓ Y-' SITE AND SEWAGE PLAN
4
\ LOCAT I ON :
PREPARED FOR :
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SCAL
If
---''� [DAV I D B . MASON DATE: It) 'o Z
Z DBC ENVIRONMENTAL DESIGNS
EAST SANDWICH . MA
3 DATE HEALTH AGENT
W ( 508 ) 833- 2177
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