HomeMy WebLinkAbout0679 WAKEBY ROAD - Health 679 WAKE BY ROAD
028-025-003 Marstons Mills
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Commonwealth of Massachusetts�0a5 -003
p Title 5 Official Inspection Form
', 7. I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
u 679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owners Name /
information is Marsrefuiredfor every tons Mills✓
MA 02648 02/21/18
page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Mathieu Rebello
key the return Name of Inspector
Y
Rebello Septic Inspections
"ICI Company Name
30 Norse Rd
Company Address
J South Dennis MA 02660
City/Town State Zip Code
774-722-0271 S114140
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
/18
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 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.
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
l�
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owner's Name
information isequiredore very Marstons Mills MA 02648 02/21/18
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 02/21/18
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owner's Name
information is Marstons Mills
required for every MA 02648 02/21/18
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 fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
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 'h day flow
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�``� � 679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 02/21/18
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ the system is located in a nitrogen sensitive area Interim Wellhead
❑ Area—IWPA) or a mapped Zone II of a public water supply well Protection
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.doc•rev.6/16
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
f
Commonwealth of Massachusetts
�n p Title 5 Official Inspection Form
�5 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
V 679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owner's Name
information is Marstons Mills
required for every MA 02648 02/21/18
page. Cltyrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) (310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
i
t5ins.doc•rev.6/16
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
I
I
I
AN
Commonwealth of Massachusetts
,�.p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/21/18
page. CitylTown 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? (Include laundry system inspection
information in this report.) ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage 2017-129 gpd-
9 ( Y 9 (gpd)) 2016-246 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
Lt&n..doc-rev.6/16Water meter readings, if available:
•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
cam, Commonwealth of Massachusetts
�n ,/-p Title 5 Official Inspection Form
< Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
679 Wakeby Rd
V
Property Address
Catrina Lopes
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/21/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: current
Date
Other(describe below):
General Information
Pumping Records:
Source of information: town records
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.cloc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
c Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
u—
679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/21/18
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
installed on 01/03/1991 per as built
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 24
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 12'+/-
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
joints tight, venting through dwelling adequate, no evidence of leakage
Septic Tank(locate on site plan):
Depth below grade: 2'feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
inlet lid has riser 6" below grade, outlet has no riser
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 9g I Tinl,
Sludge depth:
3"
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
,?) Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
c,v � 679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/21/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
32"
Scum thic<ness
2"
Distance from top of scum to top of outlet tee or baffle
6"
Distance f om bottom of scum to bottom of outlet tee or baffle
14"
How were dimensions determined? dipping stick and tape measure
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
maint. pumping at least once every 3 years, inlet pvc tee and outlet pvc tee solid and in working
condition. Septic tank seems structurally sound liquid level appropriate with no evidence of leakage
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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
I
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
+ VJ
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
V 679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/21/18
page. City/Town 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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
f
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/21/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
0"
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D-box D133 is in working condition with no solid carryover or evidence of leakage at time of inspection
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
c� Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
c u � 679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/21/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 2
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
2-500 gallon leach chambers 10'x30'x2'. Soil is sandy-No signs of hyrdaulic failure at time of
inspection-2"of standing water at bottom of chamber determined with a measuring stick-no signs of
high stain lines in chamber determined with mirror and flashlight-no signs of damp soil or unusual
vegetation around SAS
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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
«!% 679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/21/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/21/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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
M
133 �
I r
L
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
c V!% 679 Wakeby Rd
Property Address
Catrina Lopes
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/21/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 5+'
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:
previous plans state depth to high ground water
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
previous plans state depth to high ground water 5+feet
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
I`
c� Commonwealth of Massachusetts
�. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
c !% 679 Wakeby Rd
u—
Property Address
Catrina Lopes
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/21/18
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.doc•rev.6/16 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 17 of 17
TOWN OF BARNSTABLE
}y
t..' /�� SEWAGE # f = -�
LOCATION . y/��,�,o:h� os �o
�
VILLAGE 1r ASSESSOR'S MAP & LOT9�1 003
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACMITY: (type) fZ76 4Z J.,g 9/ (size)
NO. OF BEDROOMS 3
BUILDER 0 WNER
PERMITDATE: y r` COMPLIANCE DATE:
Separation Distance Between the: _
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S - Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) /57J Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by l�e-0A� Carr �n ibier,d,T
r
O
bl-�7
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No. `� S �°o O Fee/'4y
I
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -'TOWN OF BARNSTABLE., MASSACHUSETTS
application for Oioposml *potem Construction Permit
lo" Application for a Permit to Construct( )Repair( /)Upgrade( )Abandon( ) El Complete System 2 Individual Components
Location Address or Lot No.V 7,7�jy�-n / 4� Owner's Name,Address and Tel.No.
Assessor's Map/Parcel Gt tC L'/� s ear_ I!Qel�e �s
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size t11,37,749 sq.ft. Garbage Grinder( r�
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow Ila gallons per day. Calculated daily flow 3✓X gallons.
Plan Date Number of sheets l Revision Date
Title
Size of Septic Tank Ae 2�;f15Z2it Type of S.A.S.
i i o
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 Certifi-
cate of Compliance has been issued by th' B d He lth. r / / _
Sign d Date 1z31os
Application Approved by Date
Application Disapproved for the following reasons
Permit No. -5 —/0 Date Issued G
---------- --- - - - --------- ——————————
No. p 60 5 —lO;;L 2 '4 Fee / D�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION , IVN',OF BARNSTABLE, MASSACHUSETTS
y t /
_ 01pprication for Migaar 6pgtem Con!5truction Permit
�(q0 PPlication 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
- oc4�
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
7 _q
Type of Building: /z
Dwelling No.of Bedrooms 3 Lot Size i 7 J ;770 so.ft. Garbage Grinder(__f�/o
Other Type of Building 1�e�llCP No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow 3 3t15 gallons.
Plan Date / oJr Number of sheets l Revision Date
Title .5 Si le- /w 6 7Y� . 6 /' -
///5
Size of Septic Tank /D�9' rid'/��`/may Type of S.A.S. Z
Description of Soil
�y
I
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 Certifi-
cate of Compliance has been issued b this Board of Heath. /���5_
Sign d _ Date �
Application Approved by Date :3 'zLL/
Application Disapproved for the following reasons
4
Permit No. -� �/U Date Issued A -3 y G
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the O -site Sewage Disposal System Constructed ( ) Repaired (Upgraded ( )
Abandoned( )by � 7`r�/C�
at 12 7 Wa4jG9h y / �_5 has been construc ed 'n acr�or ance
With the provis ns of Title 5 and��l1e for Disposal System Construction Permit No. 5 dated ) L�/�
Installer 's a 1074 t Designer �� �-
The issuance of this permit shall1not e/construed as a guarantee that t e syst' �un tion as designed.
Date Inspector
No. G�'`.,�/ G24---------------'----------'—Fee /Dy 1--
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Mi!5pogat *pgtem on.5truction Permit.
Permission is hereby grand to Construct( )�Re}�ai Upgrade )iAbandon( )J��S
System located at y (j(/ r�/ p_f /`7
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the dal
e Cof s perrrtIt.
Date:_ T/yi Approved
TOWN OF BARNSTABLE
LOCATION 7'9 ��0 d,/� SEWAGE # fJor"-/4-�
VILLAGE //��� ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. yJ
SEPTIC TANK CAPACITY /,a0o GI L
LEACHING FACILITY: (type), C/,,,,;�,•g ��(size)
NO.OFBEDROOMS 3
BUILDER O WNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Feet
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
S �
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 �-- Feet
within 300 feet of leaching facility)
Furnished by D��r u' Calf C2.147
a
s
J
N ti
M
a t�
h's
O
Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director
`"` �
MAS& r Public Health Division
039.E0�" Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
0 ' Assessor's Ma \ParceldZ - D oO 3Date: Sewage Permit# a aS
Designer: \ UI wv & f of e,*,T Installer:
Address: N ! l Address: S 2-1`Y I/-
M 0 u 1qk X4W,.5 7rDi'5-g1115
On ,j Z OS� �Dl��0 [yfl�S�`. was issued a permit to install a
(date) (installer)
septic system at G 7 h W a4� based on a design drawn by
(ad ss)
^t D GPI dated
(design
volo<certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
ARNE \'
(Ins is Signature) CJAL.P Jm�
CIVIL
No 30792
FSS1 NG�
(Designer's Signatu ) (Affix OMpOTStamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
Q:Health/Septic/Designer Certification Form 3-26-04.doc
v pF aAn:
}� CERTIFICATE OF ANALYSIS Page
Barnstable County Health Laboratory
Report Prepared For: Report Dated: 10/16/2003
Order Number: G0323114
Christopher M.Arthur
P O Box 1039
Centerville, MA 02632
Laboratory ID#: 0323114-01 Description: Water-Drinking Water
Sample#: 23114 Sampling Location: 679 Wakeby Rd.,Marstons Mills Collected 10/7/2003
Collected by: C.Arthur 028-025 Received 10/7/2003
Routine
ITEM RESULT UNITS MCL Method# Tested
LAB:IC Lab
Nitrates 2.0 mg/L 10 . EPA 300.0 10/7/2003
LAB: Metals
Copper 0.2 mg/L 1.3 SM 3111B 10/10/2003
Iron <0.1 mg/L 0.3 SM 3111B 10/10/2003
Sodium 10 mg/L 20 SM 3111B 10/10/2003
LAB: Microbiology
Total Coliform Absent P/A Absent 309 10/7/2003
LAB: Physical Chemistry
Conductance 84 umohs/cm EPA 120.1 10/7/2003
pH 6.0 pH-units EPA 150.1 10/7/2003
Note: Water sample meets the recommended limits for drinking water of all above tested parameters.
Approved By:
(Lab Director)
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
ASSESSOR'S MAP NO. PARCEL
L0 AT ION SEWAGE PERMIT N0.
16
VILLAGE
�INST
A LLER'S NAME & ADDRESS
" -3 �fS,;co
t U 1 L D E R OR OWN ER
6 v, \-7 c e c
DATE PERMIT ISSUED /7�-&
DATE COMPLIANCE ISSUED
r
� '�� ����
��.
��� 7
t G'I` 1
Fss. a
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HE LT
- ...-... - A
Appliratiun for Dispuuttl Murky Tonutrurtiun rprmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sew ge Disposal
.....77
...a
.........7"._6c. ... ....46......... r4� ,a la.',...r.........
Location Addres or Loto.
Ce e�rOr'
.. rT�. •-Z_. ...� ------ ' ..�.._.... - ' 1 l�? ------- -----.....�---.............._.
W 1 1 "� :. r C _• Address '
Installer , Address
Type of Building 3 - vJ:L Size Lot_ _ ...... feet
,., Dwelling—No. of Bedrooms________________________....................Expansion Attic (/11p Garbage Grinder (Y(j
per, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
G" Other fixtures -----•--•--•--...--•-----------------•-----•--•--'
W Design Flow___________ ___S_:_..................gallons per person per day. Total daily flow........... _. . ?...............gallons.
WSeptic Tank—Liquid capacity4Q_0ogallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No---------_------_- Diameter.................... Depth below inlet.................... Total leaching area..
Z Other Distribution box ( ) Dosing t ),_/
''" Percolation Test Results Performed by. `�.G .-_: ;..._�'�.�__ /,�I__f Z te___l_
Test Pit No. 110-?.....minutes per inch Depth of Pit.___. ___ _.. DeptZgaround
ound water...___y�
Lt, Test Pit No. 2'' (2`minutes per inch Depth of Test Pit... .......... Dept water__
a ........... •----•-•-•-•---------•-•--...........................................................
:. .. ------------------•----------------------------------.....---'---•Descriprion of Soil. Q...' � &... XJ
VI .•----------------------�f__ .. -----------------••.._....__......_.......•--••--'-----"----_'''•-
W -
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 ITA IE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued by the 5bpayd Qf health.
Signed... - - ••- ..._--••'•-• --_•-•......................... 1
Da
Application Approved By..............
rowing
.--------'---__ • ..` ............................. -----------�.-
D ate
Application Disapproved for the f reasons-----------------------•-----------------------------------'---•------------------•-•..-.------a------•--------
....-'----"-'----'-----•----------------'•--•---'--'-----•-......_--------'-------•••--•----"-•---•-••-I--....._...._......--"--•••-•-•-••-•--•••------•---•-----'••--•--•••--'--•-•-••-••-'-....•'•--
Date
PermitNo......................................................... Issued........................................................
Date
7 0...............
7No....................... .........................
THE COMMONWEALTH OF MASSACHUSETTS
_T_VA
BOARD OF HE.�L I .
.1.fc; .........(................................
. .....**............OF....
Appliration for Disposal Works Tonstrurtion Prrutit
Application is hereby made for a Permit to Construct (414 Repair an Individual S)ew;ige Disposal
Syst t a
... .. ....74-UIr. .... .... ................. . .. ........ ..... ......................
Location-Addres _or Lot
Z.................. . ..... .............................. -----------------......
Address
.......... ...................................... . .......................................... .....................................................
Installer Address
Type of Building ...Sq. feet
Size Lot_ 4i..............0
Dwelling—No. of Bedrooms......:z�................................Expansion Attic (- )4p Garbage Grinder
aOther—Type of Building ............................ No. of persons.....................--.--.. Showers Cafeteria
Otherfixtures ..................................................................................................
<c ...
W Design Flow............ .....................gallons per person per day. Total daily flow............ _._.........._.gallons.
P4 Septic Tank—Liquid capacity': i�.Qgallons Length................ Width................ Diameter.........._..._. Depth................
Disposal Trench—No. .................... Width............._...... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.._................. Depth below inlet.-_................. Total leaching area... ._.___....... ft.
,.
Z Other Distribution box Dosing 1—
Performed�b .......Percolation Test Results Mound
te .......... ... ..... .....- water1.4 Test Pit No. I ';�....minutes per inch Depth of Pit..... . .... Depth ... 151le
04
44 Test Pit No. 2-fr&A.49.-minutes per inch Depth of Test Pit....42............ DepthIS ground water.
-:
........... = fi ...11------------------------------------------------------------------------------------
0
Description of Soil.....0..
'6---q..../-- --------*--------------- ------------------
..... ----------- _'fo. ...... .alv.. ..... --------------------------------------------------------------------
----------*-------------*------
................................................................................................................................................................11......................................
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 T I T I.E 5 of the State Sanitary Code—.The undersigned further agrees not to place, the yste in
operation until a Certificate of Compliance has bee .issued by the b of health.
Signed. ................. ........................ ....3..... ....
Dat..
Application Approved By..............Ar%�.. ............... . ................................................ ----------
Application Disapproved for the , I rowingo_'r__e__a_sonS:...........................................................................................Date. ........
......................................................................................................q...................................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...... ..............OF.... ...........
9rdifirate of Toutplialta
TEHUI,� IS TO CEo�,RFY,, That the, Individual Sewage Disposal System constructed t��®r Repaired
by...... .4............. .............................................
✓
at..... .7 �}_. .... ......... ------......... 1...... .. ... ...............................................
has been installed in accordance with e provisions of TITIE
.5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No....... .......� dated.......... ..............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNQTIOf4 SATISFACTORY.
/...T..........................DATE.................... ......... ...... I Inspector......._7 ............................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL
No.... ........... '
) 7 r
FEE.........................
Permission is hereby granted-------. .......................................................................
t Construct or R Individ *e Disp o I Rep W1 Sew. I
atNo.....? I LZ ....................................................................
Street S
as shown on the application forDisposal Works Construction Permit No...:.?.....G......1_6_1_ Dated.........3...)...... ............
----------....................j.. C&VA01 .1..................
d of Health
DATE.......... .........................................
e,
FORM 1255 A. M. SULKIN', INC., BOSTON
�r +
,, Z D R, r-
1 FH'iLi� 'i
i lSo /-RoNT46,c-
r� WELiBERG �l -
o No.366 _ .�o//S/dS:;FN At TC. r Tc
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y
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L��►ts..: N CkPrn+si o
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99 y 9 I 9g 3
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99". 5'a
32 N
• ���r2 .98'�
e�px,TEC�\ l°'m•o <i\ � lam; ` r P2o�ps,a,
•EASC I V i "6
• Q PiLeIOS l .�O,.JT
.h WELL
S,1
6 8m ?9✓�s �
i
0•2 O �
y, 7 y-
15� 99•S � tG69 �P
/1'�Aitac 99 '
I _ �— lC,�•r•T, Y
LEGEND I GnY
EXISTING SPOT ELEVATION OxO I6i� CERTIFIED PLOT PLAN
EXISTING CONTOUR --- p o �- 7 ��
FINISHED SPOT ELEVATION �Q. p �Zo�q
FINISHED CONTOUR 0 t
IN
APPROVED BOARD OF HEALTH -9 Ali S1 -` ,L 11,A A%SS+
DATE AGENT SCALE s "= o " DATE $ 27 /9(
LDREDGE ENGINEERING CO. INC) CLIENT
I CERTIFY THAT THE PROPOSED
EGISTERE REGISTERED JOB NO. 65 0 BUILDING SHOWN ON THIS PLAN
CIVIL LAND DR. CONFORMS TO THE. ZONING LAWS
ENGINEER URVEY OF BARNSTABL , MASS.
712 MAIN STREET CH. BY &ug
HYANNIS, MASS. SNEET—ZOF Z' D TE REG. LAND SURVEYOR
_ 20 FT.. M/N. „ A'O'E : /F E/TNER TslE S�PT/C TANK OR
• ��EACr•///vG PIT ARE MORE TN9:•V /2"BELOW
/D FT. M/N• ' �,RAOE� A 24�.D/AM ETER C"aNCRET� COVER
SHALL BE ,9A'0!lG.NT To 4RA 'EXT/e g .
i ) CONCRETE M/N. P/TCN i h+E.4VY CA ST /,?O/Y CO{/EI? Sf/.4 L L a-= USES
W COVERS _ �B /N OR/V_ WA y
co VER
CL EAN .SANG
I: .g.•DIA.`
�a' I SCNEautb40 t - -
I•.,.:; ��� 2LAYFR
DIST, o o 4 �yASHFO STbNE
SEPTIC TANK a • � + rh • • • + + • o '
BOX o. � a + � � 8 • • • • • + .•• e N
1 •EFFECT/✓E + ♦ • 314'.- �2
Y: +.v. • a r + • DEPT.H • • • ♦ o 0 1V.45NED STONE
/.o 113 b v..a r •', • • • • • • • p ••a PRECAST SEEf34GE
/ 13
x s o r + • • o • . + + ' e 0/7OR EQU/V.
I NVZKT EL EVAT/ON S ySa rra<.o/p" . L. p a &Z 90,3
INVERT AT BlJILD/NG 97s FT. !°�T:Gs1y°If�a'ry.
/NLET SEPTIC' TANK 7.Z FT t�.• Jz. FT O/�4/►9.. of C(SEETABUL..4T10N>
0ll74(-E7' SEPTIC TA V<- : 7. ID Fr. r. t
i INLET DISTJ4'IBUj/ON BOX 6•° FT. GROUND W,4 reR TA9LE
I SECT/pN 4!�' •
D!lTLETD/STR/.9lIT/UN�OX 9S 8 � _ -
/NLEr cEACNI>ra ;oi.T 5y 3 Fr SEWAGE APISODSA L SYSTEM
' . LEACH//VG PIT . TABULATION
SCALE %4 /'-o" D/MENSIOAl A 3•�- FT.
DES/GN C'R/TERIR „ D/M,FNS/oA, a 4 FT_
NVA ER OF 8ELZROOMS 3 DiMENS/ON C 4—F7,.
GARBAGE 07SPOSAL 4/,Y/T Nej--e_ SO/L LOG S
TOTAL EST/MATED FLO.v_33v_G.4L.jDAY SOIL TEST /6t/ SO/L 74FS7#2 SOIL TEST
NUMBER aF 404CHI Va f>jT.�_. ( f-E�F� 98.3 �-�-EL4FJ . ,OATE OF SOIL TEST / G
SIDE L_-ACH/NG PER P/T 1_SD•7 s� FT. RESULTS WITNESSED BY
3UTTOM LEACHING f'ER P/TJ1 .—,Sq. FT. D - y Tod' PERCOLAT/ON RRTE#I LESS M.,Ivl NCH
TOTAL LEACH/NG AREsi �`! SQ. FT. t S v0 t°rL PERCOlA:T/ON RATE/l2 M/N.1/NCH
QE3ERliE LE.4C's•/t/YG AREf+ Zloy_SQ. FT. " - Zo
G E 7
♦(H OF 'i
SAND fR/?uFc L o T 7 v✓/�/cE�/ �I�
s,
PPfILIP •r'®/�S All
t3
i� WEINBER �
` EL OR.E'DGE ENCrI EERING CO. INC.
86.3 7/2 A 1 N T.,
L M S /!),,A N N t 9, MA S.
a NOG/Tocw ;,t"ArER E/VCOCJ,NTEi?cp
G.40UNO Y✓ATFR A7' ELEV.V. ✓OB /VD. 510 9SHEET`OF Z
PROFILE s'
TOP FNDN. AT EL. 98.5'
ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NW TO SCALES s ASSUMED
ACCESS COVER (WATERTIGHT) TO 1. DATUM IS
WITHIN 6" OF FIN. GRADE M NOT AVAILABLE ►AKMY RW
96.9 MINIMUM .75 OF COVER OVER PRECAST 2. MUNICIPAL WATER IS L
2% SLOPE REQUIRED OVER SYSTEM 95.0'
$ EL. 94.8' RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. wars
EXIsnNG '.1000 FOR FIRST z' 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H
J
GALLON SEPT3C 9 .4't* H-`
TANK (H- 10 ) GAS 91.08' — 5. PIPE JOINTS TO BE MADE WATERTIGHT.
BAFFLE 91.25' ® ® ® ® ® ® L� ®
Z. 91.0. ® ® 1 ® ® p p ® ® _ 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH
6" CRUSHED STONE OR MECHANICAL ® ED ED ® Q ® I� a
COMPACTION. (15.221 [21) 2' ® ® !� ® ® ® ® ® o MASS. ENVIRONMENTAL CODE TITLE V.
DEPTH OF FLOW 4 (� SLOPE) (�% SLOPE) 89•0'
7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO
TEE SIZES: 3/4- TO 1 1/2" DOUBLE WASHED STOf`:E BE USED FOR LOT LINE STAKING.
INLET DEPTH a 1� � .. /► �r
LOCUSMAP
OUTLET DEPTH = 14„ z��n fit` � �'/ -J�, 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
—ke!21.111 f NOT TO SCALE
FOUNDATION EXIST. SEPTIC TANK 100' D' BOX 10, LEACHING 6' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED
FACILITY WITHOUT INSPECTION BY BOARD OF HEALTH AND ASSESSORS MAP 28 PARCEL 25-3
PERMISSION OBTAINED FROM BOARD OF HEALTH.
LEGEND 10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING
10fl.0� PROPOSED SPOT ELEVATION THE LOCATION OF ALL UNDERGROUND & OVERHEAD� BOTTOM TH EL. 83.0' UTILITIES PRIOR TO COMMENCEMENT OF WORK.
100x0 EXISTING SPOT ELEVATION \
100 PROPOSED CONTOUR
— — 100 — — EXISTING CONTOUR
SEPTIC DESIGN:
WELLt PER OWNER SEPTIC DESIGN: (GARBAGE DISPOSER IS NOI ALLOWED )
DESIGN FLOW: 3 BEDROOMS ( 110 GPD) = 330 GPD
USE A 330 GPD DESIGN FLOW
SEPTIC TANK: 330 GPD ( 2 ) = 660
RO USE A 1500 GALLON SEPTIC TANK
_�
LEACHING:
Y —r .cr..)
I DIRT %' 1 ,94VT SIDES:
—/--�- Dy 150' �_ BOTTOM: 30 x 9.83 (.74) = 218
" 7 DRIVEWAY 454 336
GAS AREA -1 TOTAL: S.F. GPD
I < ./METM (SNOW)�� USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR
®p ; ,/ / EQUAL) WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5'
WE
BENCHMRKl/ BETEN UNITS
COR CONC. BLKHD \ /�1
TEST HOLE LOGSELEV = 97.5' \ L
DECK
ENGINEER: ELDREDGE ( ',✓ VST;
MA `
T. McKEAN \ V SHM �T /� APPROVED DATE BOARD OF HEALTH
WITNESS..
DATE: 1/14/860
--
i9�
PERC. RATE _ < 2 MIN/INCH N ��
/ 1 I T 'r
CLASS SOILS P# 5681 � � � . ,
E 5 T EE P L A N
ELEV. OF
pA 1 95.0' \ WELLt PER OWNER
TOP & MARSTONS
��` MILLS
SUBSOIL r® f` �`�' ,bd
48" 91.0' I-`SCR TH PREPARED FOR
BORTOLOTTI CONSTRUCTION/PERKINS41
ho MARCH 15, 2005
4
MED. SAND
off 5W-362-4541
& GRAVEL f®x 508-362-9: 0
LOT 7 \
` 43,770 sft
down cape en gin e eying, in c.
H OF 1,f,S c i 1�4 0' \ � ACNE ARNE H 9�G� CIVIL ENGINEERS
v ®JAALA OJALA _ LAND SURVEYORS
Nm.2 " l Mtn N
144" 83 a►'.0' Scale:1"_� � oQa 307¢2
939 main st. yarmouthport, ma 02675
DATE ✓ ARNE H. OJALA, t
y 05-041 NO GROUNDWATER ENCOUNTERED o 20 40 so so 100 FEET P•I-•S•, ..
B0RT0L0T n_PERKINS_SP.DWG f