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HomeMy WebLinkAbout0051 FIELD STONE ROAD - Health (.LiaS) 51 FIELDSTONE RD. ,W.BARN. MAP-111 PAR— 051 s i } a rII No. 4210 1/3 BLU ESSELTE 10% Commonwealth of Massachusetts �(o% Title 5 Official Inspection Form z to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments CAS 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name / information is every West Barnstable y required for eve MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may.not be altered in any way. Please see completeness checklist at the end of the form. OI"OF fhfq 1019�/�i Important:out When A. Inspector Information '' fillin out forms on the computer, �4:' JAMES N use only the tab James D.Sears =z key to move your Name of Inspector ;r„ cursor-do not Jim The Inspector Man *�•. of �o. use the return key. Company Name P.O.Box 794 /f%�q�SF 1 S? Company Address West Yarmouth MA 02673 City/Town State Zip Code 508-364-4398 S 1623 Telephone Number License Number B. Certific ation I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 12-31-19 In ctor'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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /% 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name required for is every West Barnstable required MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal. Tank D Box and Field 2) 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts ,e Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name inormation is every West Barnstable requiredfcreve MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 Ieveled 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 r Commonwealth of Massachusetts �m Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name information is West Barnstable required for every MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name inormation is every West Barnstable requiredforeve MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in s less than 6" below invert or available volume is less than 1/day flow 4 tAOW IV ' ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 r Commonwealth of Massachusetts ,9 Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name information is required for every West Barnstable MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for a//inspections: 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 L Commonwealth of Massachusetts 19 Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name information is every West Barnstable required for eve MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: 1500 Gal. Tank D Box and Field. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Well Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �v- 51-Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name information is every West Barnstable required for eve MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name information is every West Barnstable required for eve MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: 1997 Permit #97 -434. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 28"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" PVC SCH -40. t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 ii Commonwealth of Massachusetts F Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name information is required for every West Barnstable MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ' ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10 Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Plan-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 18" below grade inlet cover at grade w/outlet cover at 6". In and outlet tee. No sign of leakage or over loading. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts ,.,A Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name information is required for every West Barnstable MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5msp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v� 51 Field Stone iRoad Property Address Victor Mankiewicz Owner Owner's Name information is required for every West Barnstable MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. 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 is 16"x16"-4' below grade. Box is clean and solid w/two line's out. No sign of over loading or solid carry over. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name requiratiforon e West Barnstable MA 02668 12-31-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type. ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: (2)2'x 4'x40' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts R Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name information equired fo is every West Barnstable required for eve MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two Trenches 2'x4'x40' camera out line's. No sign of over loading or solid carry over. No sign of holding water. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts ,F Title 5 Official Inspection Form -! Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name required for is every West Barnstable required for eve MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 r Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form XSubsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name information is required for every West Barnstable MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 0 0Jj j 3 _ ���,, Y R~3 - f, q f t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Fo rm:orm:Subsurface Sewage Disposal System•Page 16 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form o' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Field Stone Road Property Address Victor Mankiewicz Owner Owner's Name information is West Barnstable MA 02668 12-31-19 es required for every State Zip Code Date of Inspection page. City/Town D. System Information (cont.) 15. Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells �® 17' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 8-14-97 If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on Design plan 8-14-97 17' no G.W.. Bottom of trench around 4' below grade. Bottom of trench at 13' above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 Field Stone Road `J Property Address Victor Mankiewicz Owner Owner's Name information is required for every West Barnstable MA 02668 12-31-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included NG t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 LOT NO. : ADDRESS:� f OWNERS NAME: ,14G� 6,- SEWAGE PERMIT NO. : NEW: V'REPAIR: DATE ISSUED: 'DATE INSTALLED: LNSTALLERS NAME: fJC � �3r+LQ ,yrr >ZV'L��Ci_ INSTALLATION OF: ,�cG��s "oo��1 fniv� �.., ix ,4C WATER TABLE: ) FINAL INSPECTION BY: DRAWING OF INSTALLATION ON REVERSE SIDE : r. Y. .. � f/ i��ti �' � � !� , . `j) TOWN OF BARNSTABLE • LOCATION ` '"` SEWAGE # VILLAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 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 ASSESSORS MAP NO: ZI J T PARCEL NO: 61'V1 No. FEE THE CO MONWEALTH OF MASSACHUSETTS MASSACHUSETTS (�kyy trafiv c for Pisposal '�igstent C one-trurtion ]Jerntit Application is hereby made for a Permit to Construct(pC) or Repair( ) an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. L orS' rj rZ_PSTDAv E AFp VI c_roa /V ANk-IEu91Z -5-1 Ycla a cwq/w � �� _,SArU,4 /�J•/J. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. f2,�UsEF-1 Et_� 477-7-34 Q 7.� (CA ':SAP DWIGAl M� Type of Building: Dwelling No. of Bedrooms ¢ Garbage Grinder( ) Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 44 D A�gallons per day. Calculated daily flow - `�! gallons. Plan Date to ' -1 97 Nu}}n''ber of sheets Z Revision Date Title _P j!5j2&�jQLL y­ \jt�Aa r Ma•r! i c wl c Z p 3 GD �o 2 G� M Descri lion of Soil ��3`� Loa�''' • ��' A � �o�� � o,q'/I u AGA• Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed 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 ha een issued b his Board of H al Signed Date �" �- 17 Application Approved b Date Application Disapproved for the following reasons Permit No. � �� Date Issued �� No. _ � FEE THE CO MONWEALTH OF MASSACHUSETTS MASSACHUSETTS (}kyy irativn for Canstrurtio i jJerntit Application is hereby made for a Permit to Construct ()4) or Repair( ) an On-site Sewage Disposal System at: ` Location Address or Lot No. Owner's Name,Address and Tel.No. �. Lpr F'/CLDSTDNE ret.> yi c-r&e AAA Nk-/E ,0icz Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 4-7-7-z34 s n CAA 5� Dwrc�� MA Type of Building: _ r Dwelling No. of Bedrooms ¢ Garbage Grinder( ) Other Type of Building No. per Persons Showers ( ) Cafeteria( ) Other Fixtures rr Design Flow 440 gallons per.day. Calculated daily flow L/I gallons. Plan Date 6 -6 9 7 Nu]nber of sheets �-' Revision Date Title ��cvar sa-I QlAnL All�-I'ol y;; P ,, i> / ./ �. p� Description of Soil �S' -3 L60�' 3 l D 4,c Z6a/ylysCl�� GD Z a 4t /r�&_ W/ur►^ SAS• x t 'Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed 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 o ornp lance hasj eewnssued b his Board of H al r 1? 7 q;7 Signed Date Applicati n4Appioved"b Date Application Disapproved for the following reasons Permit No. �°'' Date Issued �� THE COMMONWEALTH OF MASSACHUSETTS Barpl-OG6It, , MASSACHUSETTS u ertifi a e ti (ITII><ttylinurr THIS IS TO CERTIFY that the On-site Sewage D• osal System installed or repaired/repla ed ( ) on by PA ,! G _� for //_-rrs-P' at �� has been constructed in accordance with the provisions of Title'5 and the for Disposal System Construction Permit No.921! i l,� dated Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This 4 _Certificate expires•you �p .N DATE 7 ' �/ ( 7 Inspector r� THE COMMONWEALTH OF MASSACHUSETTS No. .✓� -Burh -4k , MASSACHUSETTS FEE ' is usal stem 01.11,11ns#rur#ion ermt# Permission is hereby granted to to construct or repair( )an On-site Se,age System located at , i 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. All construction must be completed within three years of the date below. DATE �/ 7 Approved by FORM 1255 Rev.3/95 A.M.SULKIN CO.-BOSTON,MA LOT NO ADDRESS wd % Z���( c 1�i C _.... UtJNERS NAME: � ,G�>{,�^ � R SEWAGE PERMIT NO. : NEW: REPAIR DATE ISSUED:_ DATE INSTALLED: U- Zq 477 c l N r' c..�'b' l 4y i NSTALLERS NAME :���G� 5'��� � ,� � �_ `-' t ,� l 2. v+�NG�L�S' i INSTALLATION OF:�f=pT r /��NfC 2�C 4X 4 WATER TABLE: 1 FINAL INSPECTION BY: DRAWING OF INSTALLATION ON REVERSE SIDE : i y q• 4 No.- -- ='-13 Fee---� V----r'- BOARD OF HEALTH TOWN OF BARNSTABLE Appiicat ion-for 1961 Con0ruct ion Permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Location — Address / Assessors Ma and Parcel Owner Address eye ''`'P-�1 (.J �g0 SL �k------- ----- -- 4c----------------------------------- Installer — Driller .Address Type of Building Dwelling `� Other - Type of Building ------------- No. of Persons------------------------------------------------------ Type of Well—1_ -- ----- - ---- ------------ Capacity Purpose of Well------b0,,sA-fk------------------------------------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Cer ificate .of Compliance has been issued by the Board of Health. Signed `�✓ f�----------- date Application Approved By �let��..sa -------------_-- �7-- 77 date Application Disapproved for the following reasons:-----------------------------------------------------------------------------------------------_ ------------------------- -- ----------------- - - ------------------------------------------------ ,A , date PermitNo. Issued--------------------------------- --- --------------------------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f CompUnte THIS IS O CERTIFY f/That th Individual Well Constructed ( ), Altered ( ), or Repaired ( ) f / by- -- - -- -- --`_:l�v--!—Ir-------------------------------------------- ----------------------------------------------------------------- -------- --/-- —-- Installer Zo� S rfe �c� ST� /Zj at- --- —--------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.V17-31-f,2- -----Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A'S A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- ------— - — --- -- Inspector-------------------------------------------- ----------- tea': is•g,t. .s� f F e---�� c''.� - BOA OF HEALTH ^; T O,rW N ed- .O F,.�/B A R,N S TABLE Zip' icationAr-Vett Congtructionpermit Application is hereby made for a permit to Construct( ), Alter ( ), or Repair ( )an individual Well at: ��r -S ---------------------------- ---- - - - - -- ---- -- - - - -- -- —— - - - Location - Address Assessors Map and Parcel 'L L�I LTo/- MG— - ���4 ��2 ---- Owner Address -, S«.�,� - � - w, 1 -� 1 �� X - �o- --�---5 -------------------------- Installer - Driller ? Address Type"of Building :>".� 4 } .� 'Rwellin k 4 t 1 r w Other - Type of Building--------------------------------- No. of Persons----------;=----------------------------------------- v Typedof Well ------------ - -` ------------------- Capacity------------------------------------------------------------- --- -- Purpose of Well----�OL--fl-n- ='' : ==------------------ ti y °� Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a� erC ificate .of Compliance has been issued by the,Board of Health. M�C1� G JT,I - --Signed - -- - ------------------------------------ -- - • date Application Approved By—' - ----------------- -- t �-7- Application Disapproved for the following reasons:------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- date PermitNo. - Issued-------------------------------------------------------------------------- date vmarAMAge%eelam-+mm eoaa 9000 BOARD OF HEALTH .TOWN OF BARNSTABLE �ertificatr ®f �Comptiancr•y.; THIS IS O CERTIFY//That th Individual Well Constructed ( ), Altered ( ), or Repaired ( ) nCvn,w - . <// / Installer O / has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --/- -= ----Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. Y DATE- - - - -- —-------------- -- Inspector --------------=-------- -----------------------_---_----- BOARD•OF HEALTH 1 TOWN OF BARNSTABLE 1prtt Con5tructionj)rrmit No. -�__/___L_2� � Fee-- - ----- Permission is hereby granted-� -`���0 -= -------- =-- !- r------------------------- - ----------------------------------------- to Construct ( ), Alter ( ), or 4epair ( ) an Individual Well at: No. ----------�t�C 1- --------------------------------------------------------------------------------------------- street as shown on the application for a Well Construction Permit No. - - ---- - ---- ---- — - = Dated- -tea - - - --------------------------------------- _..._ Board of Health DATE--------- -- -- --- — - ' ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte.130 Sandwich, MA 02563 (508) 888-6460 1800-339-6460 FAX(508) 888-6446 CLIENT: Bart'Hall LOCATION: Lot 5, Field Stone Dr. ADDRESS: W. Barnstable, MA COLLECTED BY: L. Wile SAMPLE DATE: 7-14-97 SAMPLE TIME: 12:OOPM WATER SAMPLE_ TYPE: New Well DATE RECEIVED: 7-14-97 LAB I.D.#: 977-249 WELL SPECS.: I W1. 6' PVC/20 GPM RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Limits Coliform bacteria /100ml 0 0 9222 B pH pH units 6.5-8.5 7.19 4500 H+ Conductance umhos/cm 500 116 120.1 Sodium mg/L 28.0 9.1 200.7 Nitrate-N/Nitrite-N mg/L 10.0 0.11 4500-NO3 E Iron mg/L 0.3 0.26 200.7 Manganese mg/L 0.05 0.021 200.7 Hardness (as CaCO3) y mg/L 500 17.9 200.7 Sulfate mg/L 250 17.5 375.4 Potassium mg/L 20.0 0.8 200.7 Alkalinity mg/L 200 46.8 2320 B Chloride mg/L 250 18.4 4500-CI L Turbidity NTU 5.0 9.2 2130 B Color APC units 15.0 < 5.0 2120 B Magnesium mg/L WA 2.0 200.7 Calcium mg/L N/A 3.9 200.7 Volatile Organics ug/L See Report ND EPA 502.2 ND= None Detected YES WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. i Date4 36 R nald J. ri Laboratory Director <=less than >=greater than TNTC=too numerous to count Page 2 TOXIKON CORP. REPORT York Order # 97-07-287 y Received: 07/16/97 Results by Sample i SAMPLE ID 977249 FRACTION QU TEST CODE 02 2 NAME yOC IN H2O BY PURGE i TRAP Date 8 Time Collected 07/14/97 Category PATER Dichlorodifluoromethane ND 0.50 1,1,1,2-Tetrachloroethane ND 0.50 Chloromethene ND 0.50 1,1-Dichloropropene ND 0.50 Vinyl Chloride ND 0.50 Bromoform ND 0.50 Bromomethane ND 0.50 1,1,2,2-Tetrachloroethane ND 0.50 Chloroethane ND 0.50 1,2,3-Trichloropropene ND 0.50 Trichtorofluoromethane ND 0.50 Bromobenzene ND 0.50 1,1-Dichloroethene ND 0.50 2-Chlorotoluene ND 0.50 Methylene Chloride ND 0.50 4-Chlorotoluene ND 0.50 trans-1,2-Dichloroethene ND 0.50 1,3-Dichlorobenzene ND 0.50 1,1-Dichloroethane ND 0.50 1,4-Dichlorobenzene NO 0.50 cis-1,2-Dichloroethene ND 0.50 1,2-Dichlorobenzene ND 0.50 2,2-Dichloropropane ND 0.50 1,2-Dibromo-3-Chloropropane ND 0.50 Chloroform ND 0.50 1,2,4-Trichlorobenzene ND 0.50 Bromochloromethane ND 0.50 Nexachlorobutadiene ND 0.50 1,1,1-Trichloroethane ND 0.50 1,2,3-Trichlorobenzene ND 0.50 1,1-Dichloropropene _IUD 0.50 Benzene ND 0,50 Carbon Tetrachloride _D 0.50 Toluene ND 0.50 1,2-Dichloroethane ND 0.50 Ethylbenzene ND 0.50 Trichloroethene ND 0.50 m-Xylene ND 0.50 1,2-Dichloropropane ND 0.50 p-Xylene ND 0,50 Bromodichloromethane ND 0.50 o-Xylene ND 0.50 Dibromomethane ND 0.50 Styrene ND 0.50 cis-1,3-Dichloropropene ND 0.50 Isopropylbenzene ND 0.50 trans-1,3-Dichloropropene ND 0.50 n-Propylbenzene ND 0.50 1,,1,2-Trichloroethane ND 0.50 1,3,5-Trimethylbenzene ND 0.50 1,3-Dichloropropane NO 0.50 tert-Butylbenzene ND 0.50 Tetrachloroethene ND 0.50 1,2,4-Trimethylbenzene ND 0.50 Dibromochloromethane ND 0.50 sec-Butylbenzene ND 0.50 1,,2-Dibromoethane ND 0.50 p-Isopropyltoluene ND 0.50 Chlorobenzene ND 0.50 n-Butylbenzene NO 0.50 Napthalene ND 0.50 Notes and Definitions for this Report: DATE RUN 07 2 9 ANALYST CMD INSTRUMENT _G UNITS W DILUTION N ND = NOT DETECTED AT DETECTION LIMITS R ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte.130 Sandwich, MA 02563 (508) 888-6460 1800-339-6460 FAX(508) 888-6446 CLIENT: Barry Hall LOCATION: Lot 5, Field Stone Dr. ADDRESS: W. Barnstable, MA COLLECTED BY: L. Wile SAMPLE DATE: 7-14-97 SAMPLE TIME: 12:OOPM WATER SAMPLE TYPE: New Well DATE RECEIVED: 7-14-97 LAB I.D.#: 977-249 WELL SPECS.: 1007 6' PVC/20 GPM RESULTS OF ANALYSIS: Parpmeters Units Recommended Results Method Limits Coliform bacteria /100ml 0 0 9222 B pH pH units 6.5-8.5 7.19 4500 H+ Conductance umhos/cm 500- :' `. . 116__. Sodium mg/L 28.0`;,: ., .. F n :; 9.1 200.7.".""" Nitrate-N/Nitrite-N mg/L 10.0 0.11 4500-NO3 E Iron mg/L 0.3 0.26 200.7 Manganese mg/L 0.05 0.021 200.7 Hardness(as CaCO3) mg/L 500 17.9 200.7 Sulfate mg/L 250 17.5 375.4 Potassium mg/L 20.0 0.8 200.7 Alkalinity mg/L 200 46.8 2320 B Chloride mg/L 250 18.4 4500-Cl L Turbidity NTU 5.0 9.2 2130 B Color APC units 15.0 < 5.0 2120 B Magnesium mg/L N/A 2.0 200.7 Calcium mg/L N/A 3.9 200.7 Volatile Organics ug/L See Report ND EPA 502.2 ND= None Detected YES WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. Date �U — ;, R nald J. ri Laboratory Director <=less than >=greater than TNTC=too numerous to count Page 2 TOXIKON CORP. REPORT Work Order # 97-07-287 Received: 07/16/97 Results by Sample SAMPLE ID 977249 FRACTION 01A TEST CODE 502 2 NAME VOC IN H2O BY PURGE & TRAP Date & Time Collected 07/14/97 Category WATER Dichlorodifluoromethane ND 0.50 1,1,1,2-Tetrachloroethane ND 0.50 Chloromethane ND 0.50 1,1-Dichloropropene ND 0.50 Vinyl Chloride ND 0.50 Bromoform ND 0.50 Bromomethane ND 0.50 1,1,2,2-Tetrachloroethane ND 0.50 Chloroethane ND 0.50 1,2,3-Trichloropropane ND 0.50 Trichlorofluoromethane ND 0.50 Bromobenzene ND 0.50 1,1-Dichloroethene _ ND - 0.50 2-Chlaroteluene ND 0.50 Methylene Chloride ND 0.50 4-Chlorotoluene ND 0.50 trans-1,2-Dichloroethene ND 0.50 1,3-Dichlorobenzene ND 0.50 1,1-Dichloroethane ND 0.50 1,4-Dichlorobenzene ND 0.50 cis-1,2-Dichloroetheme ND 0.50 1,2-Dichlorobenzene ND 0.50 2,2-Dichloropropane ND 0.50 1,2-Dibromo-3-Chloropropane ND 0.50 Chloroform ND 0.50 1,2,4-Trichlorobenzene ND 0.50 Bromochloromethane ND 0.50 Hexachlorobutadiene ND 0.50 1,1,1-Trichloroethane ND 0.50 1,2,3-Trichlorobenzene ND 0.50 1,1-Dichloropropene ND 0.50 Benzene ND 0.50 Carbon Tetrachloride ND 0.50 Toluene ND 0.50 1,2-Dichloroethane ND 0.50 Ethylbenzene ND 0.50 Trichloroethene ND 0.50 m-Xylene ND 0.50 1,2-Dichloropropane ND 0.50 p-Xylene ND 0.50 Bromodichtoromethane ND 0.50 o-Xylene ND 0.50 Dibromomethane ND 0.50 Styrene ND 0.50 cis-1,3-Dichloropropene ND 0.50 Isopropylbenzene ND 0.50 trans-1,3-Dichloropropene ND 0.50 n-Propylbenzene ND 0.50 1,1,2-Trichloroethane ND 0.50 1,3,5-Trimethylbenzene ND 0.50 1,3-Dichloropropane ND 0.50 tert-Butylbenzene ND 0.50 Tetrachloroethene ND 0.50 1,2,4-Trimethylbenzene ND 0.50 Dibromochloromethane ND 0.50 sec-Butylbenzene ND 0.50 1,2-Dibromoethane ND 0.50 p-Isopropyltoluene ND 0.50 Chlorobenzene ND 0.50 n-Butylbenzene ND 0.50 Napthalene ND 0.50 Notes and Definitions for this Report: DATE RUN 07/22/97 ANALYST CMD INSTRUMENT G UNITS ug/L DILUTION 1 ND = NOT DETECTED AT DETECTION LIMITS .Department of Environmental Management/Division of Water Resources �w WELL COMPLETION REPORT WELL L(PCATIO GEOGRAPHIC DESCRIPTION Addres - ��—��++ P ori/�/� /y1 C 111,) Q S E W o f W'��`M /7 .s�I�/g ..G %�S! (leer) (circle) �f City/Town ��' �'� 5fd y{ f" Well owner (road)(road). Address cow ©- 4 N SO W of (ml.in tenths! (circle) Board of Health permit obtained: yes•n no El intersect. w/�� (road) WELL USE WELL DATA Domestic Wpublic❑ Industrial ❑ Total well.depth it. Monitoring❑ Other Depth to bedrock-.1.� ft. 11�7e�� Water bearing roc4C�tnco solid,aled material: Method drill�eydy(�C Y /^ Date drilled7/ Description (9, ""Q y Water bearing zones: CASIN vG 1) From To Typo 2) From To Length(O 0 ft. Di.(.,LD/.) In. 3) From To Length into bedrock ft. Gravel pack well: dia. Protective well seal: 040 Screen: dia.. Grout_❑ Other Slot length-from- STATIC WATER LEVEL(all wells) Q� Slat fc water level below land surface ft. Date 4/8 WELL TEST(production wells) 'DrawdownQn ft. aftor pumping hr. min.at.?4 gpm HowmeasureA:"Pt Recovery �g ft. .after f hr. min. 0 LOG of FORMATIONS COMMENTS Materials Fronr To � �h p io A /0 �6 Driller � � 51�" 5;00 3a // Firm ' (� f'�i.Ej 7j C: 1 56 ,Address ail 50 6 City/TownIf f lJ ( �l.� ' �4d4,4_ avv OD Supervising Driller RegX f`" -C Signature of stipervising re istered well driller . �flease print firmly .. ,BOARq OF ME�ALTH CtOPY i•p ...., ,...t�... ,v 1...�.. . .. • .... .,...... Ar .#`.4 1,,. .i,F.d Y s. .., .ntr�+•..:k .:'L�d • y6y it i a �8:, 41 �o . i��u/Ec` �.sue«• . �r - ,� N 1n 4B�p ooy IN MA OF SS -\NOF4f .0 �„ 1 !lo u� � 3 2' , 1 \�.1, \ , ��$• s9c �_ WILLIAM Gam, WMORA.NILLIAM F ym g F. CIVIL -I /Z' p a ry i ; $ MORAN v� v No.138990 p�3.4557 0 mac/ TEP` suRi .00 L- io2 R' i 1 e� ;I �� 1 13AR-t4g1'A5LE - �= DISPOSAL PLAN ICToR MAAw (CLEW ICZ FZ oA© - aP S�.Zo, 4 9� UA 4 W.P. OLDHA�y��''"��• A5� 1 �M ASSOC.INC. SANDWICH, MA. I SCALE 1"4-6 6 8 1 99 7 I r f _ k o . `T 96. S Fus•G�DL .. D F.•f• V&JT 6 2"Pryt� r- 88•0i.t. CIR.AaE -Zxst_oPr. 82.0 ,y � Q ,s, P.• rd.. Frr.t :1EE f;7, F"- 1 1 OODlorn DrST•4'DMw• flrr� ps/.t. P.p�r 9e�c $E�nc _ � �� Z•4A81.7 79 5 et 9 ' TYPICAL INSTALLATION PROFILE OF DISPOSAL SYSTEM END VIEW N.T.S. LEACHING• `RENCH Place a sanitary tee on the inlet pipe at the distribution box. -re-,T ?i r,4/ t� _ -fc5 T �, r 2 WSAXJ . Spit $oiL soic. 304 L t+¢c G oGo2 1?EPI/1 9007, TE),-,-uI !,of tA z, _ i ;r.oGeneral N es: 7-6XR � LOAM 17•5yezDisposal system designed in accordance oB$ � �0•7 with the provisions of Title 5 of the t4 Los'm y Massachusetts Environmental Code and , o l'r� 3/i A Sa.vp IOY/Zlocal Board of Health Regulations. 9y 5 88 3 t I• 77 All pipe and fittings to be Schedule 40 y /OyuANO .or better. 32y �4 Jo41 -7.During installation distribution box is too ioYz ; C,be .water tested to insure that it is level. s.+Na Six inches of crushed stone is to be placed j 4E.�,IuAj I 'RM5- g ,-_7 beneath the septic tank and distribution box. Z✓ i G �SAJ�o Sys/3 TEST cA,J ;'�.�' I The first two feet of pipe out of the distribution -�c box are to b# level., EzT Z, t c-YAs bawl 1-c b car/eT a r Zo �9 20¢ • I! ! 74• o No Ground Water EncountRrea oiL ; 4- moo« �7seZ-q-ox4 'x2 ' Leachin Trenches VEpp c pR"Z. (�KTUQC GpLoQ P��r�{; TCKru Pt� scow rc Percolation Test Date Zo Witness 88•0 l97 C. o �„�rG �c� _- ! o LoAi✓ ? i Percolation Test Rated _S min/inch drop 3 o t-GALTyi 7 „ o l�,f,/✓t �,�y�z:s Soil Type Class T Factor o.7 ��4- I LOAMY 51 3 LoJaM- 3' BC�'S A SANI> loy� /� S4/1/ ••4.0 ioY2 4 $���ooM x tlo 4+'D = 4 C, DD Qcavr¢� 1 ; a<► , . I I 8�1 __. .co�<»a% _L aa��-. S��TiG T.Q� � 3J" g s�N.r. Iflyk� �.�•~ 3 SAAj`o _ !PAM.L' 84.Z 1��OL�A�r�4bE 4•Q�NOc¢ To •LE /dJsTALrc� C, SJgNr� loy L83 CI spti1D lOVP, /3 DESIGN CALCULATIONS : 70 MsDIUM 81 2 Bottom: 4-0 x4x0 .74= t Ig G.P.D. ,, CZ SANr.;, ?,SY'e% CZ EAUG s , ��=D Sides: [ (¢bx2 )2+(4x2 )2 ]0 _74 ---13o G_P.D 14, 1997 7/ Zo Al) MG14 , 9 wiCzO D. Z+8 G.P.D.1 1997 X2 Sot CUA LvATo /Z �(�-r /��..D STo►.�t= �D T>, �'-^T. 4-g+� G.P.D. P*ot'ided --oL)r-,-,4SHEET Z o� �C . 1 � 9c Jh �P I- s I �r6g, LOCUS PLAN 11 _ p�, �S•o ``a I` 14, IZ Pc4eN if's 1Z, Da�w i >o !n R-�ED oay v OF L(tA OF,f I k f�ou & 3 L E \ \. \ �P�(N -- MAssq ��P qc WILLIAM F. ti MORFN WILLIAM 0 CIVIL r g F. -'t No.13899 y MORAN c�i� 9 O � � ► ` �"� ` ti 3 U .p 14557 s O IS !�(:�/s-Tr F su DISPOSAL PLAN 9�, � �cc.r��rp�; \l ICTOR NAAN rctEW 'CZ RCAF 58 � ''`� t�l t45l�c�A , �.► � W.P. OLDHAM ASSOC.INC. SANDWICH, MA. SCALE 1 ` 40' 6-8199 7 { A • I !, F��f- GEI►DE - VEuT �$c0 F..1• G 2• Pr....�e,He 83.0 CyP-a pe -Z%st_oi*s BZ,o F I O O -/ ~M Z FILL 12�hN�J• 1 � Ir M'�' t 'r��"p�aN�' P�" � •" �d �=wtsA.d s bo g rack /5 ��.L D�sr• 12� '-j/4� 4'D1wn.�• Rr►{ RV-4- sex ! 1=,N w„"'heY! Z I-o T'Aht 3�¢�0 1�2r vJ�Vs�+ea sc 8 1.7 ✓?'1 75 8 5.Z 5 40'--on at•9 TYPICAL INSTALLATION PROFILE OF DISPOSAL .SYSTEM END VIEW N.T.S. LEACHING- TRENCH ^e to Sp t4 I TA+ V. TcE Ohl Ti�E- I NIL=- ' )NJSU?ZE. T p.F ��! _rr.3 = M �TZ• 0-P0��b TEST SO•L 5611� I 501 L yu'T7� �!Z 7'rxT+2E COL0,2. S r�l J�DQIz rE�T:1K� COL02 General Notes: C �cA� 7SYQ2 ly 89 o _ A,c� 7�YZz/� 9! o Disposal system designed in accordance 3 88 �' LpAM y go. 7 with the provisions of Title 5 of the LoAmt4 Massachusetts Environmental Code and 1� A SA,D °r� 3�3 5AA 3� local Board of Health Regulations. q �oAMy 89 3 tAA 96. 1 All pipe and fittings to be Schedule 40 S /°Y25�4 B SANvy tOyQs¢ • or .better. 32 �, L-oAA4 y S� , g� 3 41 C9A/Lt y' g7. L During installation distribution box is to 5ANa !oye u ; 7 N _ C, NAO 1 dy,2-5�3 be _water tested to insure that it is level. 6 - a ' 92 Six inches of crushed stone is to be placed !tile�i�N % 2c gZ,Z i ]�1 =�1✓M r r I beneath the septic tank and distribution box, gZ GZ ��No 2 SYQ/3 CZ SAN' The first two feet of pipe out of the distribution box are .tot be level. 12c 79•0 !`� G-„taco ba 44lt �o b ,n�s-.� i��i .^ ? oar/=r r P- 7S-o o s ��-�� 'aR� , No Ground Water Encountered -UseZ-4-o x4 'x2' LeachingTrenches SOIL STRATA Percolation Test Date 5,1zolc17 Witness C, -- _ Percolation Test Rated -S min/inch drop 304-P-D o=- _- Soil Type Class T Factor 0•74- 'SOIL. EVA.L VAro2 I _ 4• g•::•�1Zr�Ql--� !C t j;. �a J .�--;'J :ti +�A .:�•'9,'J tEe:.> • i S//•�ti'1'D �vC 1-i p41.1 o W EE ;�•.�-,� L�A,L�b C �'4?!�)D�R_ TIC ,�'� I�)ST�L�c� DESIGN CALCULATIONS : Bottom: +6 x4x0 .74= 118 G.P.D. Sides: ( (4.ox2 )2+ (4x2 )2 ] 0 .74 = ;? G.P.D - ------��a G.P.D. M Al V }�1�1 C- z . X2 l _6T f-r�LD �-'�a G.P.D. Provided SHEET 2 of 2