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Home My WebLink About0051 HOLWAY DRIVE - Health `51 Holway drive W. Barnstable 6 J 1 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information.s required for eveNV,w r BARNSTABLE MA. 02668 4/25/16 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out fo-ms A. General Information c on the computer, use only the tab 1. Inspector: key to move your p cursor-do not Michael O'Loughlin use the return Name of Inspector key. . � Company Name 714 MAIN ST. Company Address YARMOUTHPORT MA. 02675 City/Town State Zip Code 508-362-4942 577 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 4/26/16 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information is required for every BARNSTABLE MA. 02668 4/25/16 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information is required for every BARNSTABLE MA. 02668 4/25/16 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information is required for every BARNSTABLE MA. 02668 4/25/16 page. CitylTown 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 Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 F Commonwealth of Massachusetts - Title 5 Official Ins pection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 P Y Y 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information is required for every BARNSTABLE MA. 02668 4/25/16 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. El 0 The system fails. I have determined that one or more of the above failure criteria exist as described in 310 M C R 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information is required for every BARNSTABLE MA. 02668 4/25/16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information is required for every BARNSTABLE MA. 02668 4/25/16 page. City/Town State Zip Code Date of Inspection D. System Information Description: 1,000 GALS. H-10 SEPTIC TANK/3-HOLE H-10 D.B. / 1- H-10 6'x6' PIT WITH STONE . Number of current residents: UNKNOWN Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage PRIVATE WELL g ( y g (gpd))' NO METER. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: N/ADate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information is required for every BARNSTABLE MA. 02668 4/25/16 page. City/Town State Zip Code Date of Inspection D. System information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: UNKNOW. 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): I t5ins•3/13 Title 5 Officiat Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information BARNSTABLE MA. 02668 4/25/16 required for every .. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: SEPTIC TANK AND LEACHING PIT INSTALLED WHEN HOUSE WAS BUILT 1987 PER TOWN OF BARNSTABLE, D. BOX APPEARS TO HAVE BEEN REPLACED RESENTLY. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3'+- feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): UNKNOWN Septic Tank (locate on site plan): Depth below grade: 20"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1,000 GAL. PRECAST H-10 CONCRETE TANK. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5'x 4.5'x 5.6' Sludge depth: 1'- 6" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M ,•y 51 HOLWAY DR, Property Address SHEILA BRENNAN Owner Owner's Name information is required for every BARNSTABLE MA. 02668 4/25/16 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 15" Scum thickness 0" 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 15" How were dimensions determined? 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.): APPEARS TO BE IN GOOD WORDING ORDER , NEEDS TO BE PUMPED AT THIS TIME .RECOMMEND A 16" RISER INSTALLED ON COVERS. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information is required for every BARNSTABLE MA. 02668 4/25/16 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 an condition of alarm( d float a switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 1 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information is required for every BARNSTABLE MA. 02668 4/25/16 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.): APPEARS TO BE IN GOOD WORKING , THE COVER IS 28" BELOW GRADE. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information is required for every BARNSTABLE MA. 02668 4/25/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-6'x6' ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): APPEARS TO BE IN GOOD WORKING , NO SIGNS OF HYDRAULIC FAILURE . THE RISER COVERS IS 20" BELOW GRADE ON PIT.THERE WAS 18" OF EFFUENT IN PIT WITH A STAIN LINE 3'+- FROM BOTTOM OF PIT. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information is required for every BARNSTABLE MA. 02668 4/25/16 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.): 3. t' S 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-M3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 114 of 17 Commonwealth of Massachusetts =�,�~�Q�� °��N N��*�°�� 1�h� Title �� N80��mO Inspection Form Subsurface Sewage Disposal System Form ^ft�for Voluntary Assessments — pmvo,lyx*u/000 -----------------'-- ---------'-----------'----- SHE|LABRENNAN Qy4ner Owner's Name------------'-'------------------ --------------' -------- |nfonnuoun15 required for every BARNSTABLE K4 page. o/*nowm state Zip Code Date o/)nupnnUon D. System Information (cont.) Sketch Of Sewage Disposal 8ysbsnn� Provide a view nfthe sewage disposal -system, including Umm to ot]east two permanent reference landmarks or benchmarks. Locate all wells within 1OO feet. Locate where public water supply enters the building. Check one of the boxes below: . hand-sketch in the area below LJ drawing attached separately / � | � � | 15in 'on somm: rm*:m�svr1asoE-waona»wmowsw'pvs `omn | � / Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information is required for every BARNSTABLE MA. 02668 4/25/16 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: >20'feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 4/9/87Date ® 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: REFERENCE BARNSTABLE GIS BOTTOM PIT IS 12.5' BELOW GRADE AT ELEV. 42.0 AND 150, AWAY THE ELEVATION IS AT 10.0. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 51 HOLWAY DR. Property Address SHEILA BRENNAN Owner Owner's Name information is required for every BARNSTABLE MA. 02668 4/25/16 page. City/Town State Zip Code. Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I i I l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION 10t�3 ®��y �f�v v SEWAGE # 4 7 �2/ VILLAGE (� �gphS/r� y ASSESSOR'S MAP & LOT ISG—39 INSTALLER'S NAME & PHONE NO. Jo4m X rSEPTIC TANK CAPACITY o LEACHING FACILITY:(type) /000 (size) ZXla NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER � ¢ BUILDER OR OWNER /�/G sly�,y a Cow s7i DATE PERMIT ISSUED: 11"/�1- 97 DATE COMPLIANCE ISSUED: � - VARIANCE GRANTED: Yes No cs"" T Y � s� No... �=: :.� Fps.`.., , �.^_ 4 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH COIX-Y.-V -:......OF. :... . -. -`f...................................... 1 Appfir�afton for 11topooFaf Works Tonitrnr#ton amit Application is hereby made for a Permit to Construct ( V/) or Repair ( ) an Individual Sewage Disposal System at: s --— --------------------------- . _ . . . .�:----------•............................................ �n p mLocatioddress or Lot No. --- -Ya.G?...... _ Lhl.a14. ................................................ -•---------••------------:...---..............-------........._......._....------....-----------• ner A dress ... �s �al.�w ............ ✓,., �,e�a. s/. ............ Installer Address d Type of Building Size Lot�5�l_�_s'�_.._..Sq. feet Dwelling—No. of Bedrooms.____. __________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons____�!z................... Showers ( ) — Cafeteria ( ) Q' Other fixtures ____________________________ W Design Flow______._._.........................gallons per persona per day. Total daily flow____.__.: ........................gallons. WSeptic Tank—Liquid capacity`-P.Wgallons Length 8.__Lz"____ Width_4 Diameter________________ Depth<" _9__..-- x Disposal Trench—No_.................... Width.................... Total Length.__,______--_ii__ Total leaching area....................sq. ft. o Seepage Pit N _____________________ Diameter---�0__0.... Depth below inlet_ig__D....... Total leaching ar l._....sq. ft. Z Other Distribution box ( ✓ Dos•ng tarik ( ) p-(63 '-' Percolation Test Results Performed b .._. ____-- Q9. S)aA . (q�_._____ Date �t!_�RaLq� L! 7 - ) Test Pit Not____2______minutes per inch Depth of Test Pit.z�__ Depth to ground water_._._'�........--- Test Pit No. .__.7........minutes per inch Depth of Test Pit_25%..____.__� Depth to ground water........................ x �-�3---- g� ` �.................... ------- -- - -- ` �] s.hs4�4 ---------------------- --- Description of Soi _-______ c W 4_ �7 "�tutt x _..._..•---------••-•----- �.`.q�.._�ll.¢ r.."Sa �L' . .... - � M ��LL ��1"--` -------- U i t l v i U Nature of Repairs or Alterations—Answer when applicable_______________ ...... ...t.c_.___._.___.. ...... -------------------------------------------------------•---•---•_...._._..----••-••••------•--------••--••--••----------•-•---------••-•---•-•-•-•-•-•-•-•••--•-•--••-•-------••----_._................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT 2 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has n i ued by the board of h lth. Signed.... ......................................... •............................. Date Application Approved By..... �-�t ^,-}..__ " '�'` C Date Application Disapproved for the following reasons:.................................................................................................................. -•------•-•-•---------•--•••-•-------•--••-•---•------•-•••._...-•--•--•---••-••-•--•....................._ Date PermitNo...... .. ------------------------- Issued....................................................... Date �.Lirr THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,t .:.vt'.'&4).Lr....................................... Appliration for Disposal Iforks Tonstrurtion Vrrmit Application is hereby made for a Permit to Construct (./) or Repair ( ) an Individual Sewage Disposal System at: l: a ..: ........-•--•-------------•- 1>�- �, c�: ......................................................... Location-Address -•••••-•••••.._•---•---_--•----.-----or Lot No. ;• ............................................... ...-•----------.............. I........._..... w! � r caner Address Jc t�!/..?%..................................... ------- 4(-�!_`?. ./� LC/, /.,,7r��h ...„h...........-•---- Installer Address d Type of Building Size Lot �+.. _ .._.Sq. feet Dwelling— ,.....................................Expansion Attic ( ) Garbage Grinder ( ) `'4 Other—T e of Building No. of ersons-•. QI YP g ----•----------------•------ P Lo.................... Showers ( ) Cafeteria ( ) C4Other fixtures -•------------------------------------------------•---'------•------------•--....------------•--•--.•.........---------......_..........--------.--•-- W Design Flow..........' .........................gallons per person Iper day. Total daily flow....... .......................gallons. WSeptic Tank—Liquid capacity PaC?v.gallons Length�.__1,�_ ___. Width_ .__ 0'_ Diameter---------------- Depth,. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.................... DiameterAD.'.__. Depth below inlet.( D........ Total leaching area&PJ......sq. ft. Z Other Distribution box (✓) Do ping tank Percolation Test Results Performed t... ........... Dat .(.V_ _ yr_.'_�Cj?Ck;cS, I I Test Pit N <1....Z.......minutes per inch Depth of Test PitZA\..._......... Depth to ground water...._'"........... rs, Test Pit N42....Z.._ _minutes per inch Depth of Test Pit2-t5 .... Depth to ground water---_..-_.__._..... •• •• t.#Q1- ----..0 �.. ;. Descr><ption of So _.:-�}---- __ �{t4� Icy, V ..........................2 eu..�!_b.rk,._SCE.4ILL- 4_cl e f.................................� e_ ._4 ._... _��__.. l.tA l�1��n W ......................... ••••---••.........•... T_ - cl.... ----------------------------------------•---..... 1- , `--(41v{ll,a�C.�fi� < hr�..........-•----. VNature of Repairs or Alterations—Answer when applicable.............. -------4. ...... -------------•••••••••••••---••------••••••-•-••-------•--•-•----•••-••---••----••-•.....••••.......••-••....---•-•••••-•••-••--•••••••-•-•.......••-•-••-•••••••••-•••••••••-••-••---•-----•--••••-•••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIZ- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance;hasen ' sued by the board of h lth. Sign LI - .........................•••• Date Application Approved By.... "`-c} -- ---"'~"`:}--••---------------------------•-•------ Date Application Disapproved for the following reasons________________________________________________________________________________________________________________ ----------------------------------------------------•----•-----------•--------..................---------'--••----•--------------------------------------------------------------------------...•-•--.•-- Date PermitNo..... .......................... Issue(L..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........;..�.........OF.......... . .. :............... ................................ Trrtifiratr of Tuntplittnrr THIS IS TC CER IFY, That the Imlividual Sewage Disposal System constructed ( ) or Repaired ( ) by -----•--- -....... - Instal \, at•-------•...............•..La.T -•----•---• -f✓C --------•------•------------_------------------•------------------------------ has been installed in accordance with the provision of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit ............ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F CTI TISFACTORY. DATE........-- ._... ..._-•••••.............•-•-... Inspector-------•••••--••-•..._--_7_- — '- P ••�•--••-........._...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q _OF....... ..... S ........................................ ................... FEE...Il...---......... Disposal Works Tnntrnrtinn rrrm' Permission is hereby granted................ ....... • ..............................�•-----••• .............. .........•....... to Construct ( ) or Repair ( ) an Individual ewa a Dispos ystem atNo........ ......L_X • � .................... ' . • 3----.---•--------------•--------------------------------.-.--------.------- St eet as shown on the application for Disposal Works Constructi Permit N ,l 1...• Dated._-V.. ....... ' ................ �^' -` ----.-------------.----------•- �i� DATE........... "--�-Y........&.2................................ Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS f AsBuilt Page 1 of 1 TOWN OF BARNSTABLE O LOCATION �Ofi,�l3 yO�wQy ��t�� SEWAGE # 0 7' �21 VILLAGE ASSESSOR'S MAP & LOT 136 ---39; . INSTALLER'S NAME & PHONE NO. jo4," `SEPTIC TANK CAPACITY IWO f ^ �LEAC14ING FACILITY:(type) /ywa (size) ZX/o NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 4116 e G,tysf DATE PERMIT ISSUED: 11'/11- F7 DATE COZIPLIANCE ISSUED: VARIANCE GRANTED: Yes No �--~- http://issgl2/intranet/propdata/prebuilt.aspx?mappar=136038&seq=1 9/17/2013 rt •�i ` COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PR �FON ONE WINTER STREET,BOSTON MA 02108 (617)29 k9i g�\ WILLIAM F.WELD B,j Y CORE Govemor J Secretary ARGEO PAUL CELLUCCI �BggNs 99TDA STRUHS Lt. Govemor y�FPTAeCF ommissioner °r 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM — PART A CERTIFICATION Property Address: �� 1�� W•� �� Address of Owner: ��eco1c1 ��To� Date of Inspection: t,�.io��["] O'�tO�'� (If different) Name of Inspector: C �.e�� Company Name, Address and Telephone Nu ber- CERTIFICATION STATEMENT SQL_ L - \A2Z 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.inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority F ils Inspector's Signature: Date: 1 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of.the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) i� Printed on Recycled Paper �( v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: ' Date of Inspection: B1 SYSTEM CONDITIONALLY PASSES (continued) Sewage'liackup or breakout or high static water level observed in th distribution box is due to broken or obstructed pipes) or due to,agi Token, settled or uneven distribution box. The ystem will pass inspection if(with approval of the Board of Health):` i broken pipe(s) are replaced —" obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year ue to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF H LTH: Conditions exist which require further evaluation by the oard of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH ETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH A D SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet o a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD F HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A NNER THAT PROTECTS THE PUBLIC HEALTH:AND SAFETY AND THE ENVIRONMENT: The system has a septic tan and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic nk and soil absorption system and is within a Zone I of a public water supply well. The system has a septi tank and soil absorption system and is within 50 feet of a private water supply well. The system has a sep'c tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution rom that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D] SYSTEM!FAILS: I have determined that the system violates one or more of the following failur criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be co tacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an verloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the groun or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet i ert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below inve or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last ear NOT due to clogged or obstructed pipe(s). Number of times pumped_. — Any portion of the Soil Absorption System, sspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is with' 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is w' hin a Zone I of a public well. Any portion of a cesspool or privy is ithin 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 If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile orga c compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to lar systems in addition to the criteria above: The system serves a facility wit a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and t environment because one or more of the following conditions exist: the system is withi 400 feet of a surface drinking water supply the system is w ill' in 200 feet of a tributary to a surface drinking water supply the s stem is in a nitro en sensi Yg five area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public wate supply well) The owner or operator of a such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR .00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 r; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal. stem. P Y (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property AcAress: Sl 1k-c.>N ts-xx- Owner: Z�stTiN ` Date of Inspection: 'FLOW CONDITIONS RESIDENTIAL: Design flow:'330 gallons Number of bedrooms:�� Number of current residents: d2. Garbage grinder (yes or no): f Laundry connected to system (yes or no):—!��5 Seasonal use(yes or no): NCB Water meter readings, if available: Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ r Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)__j,3p If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overlow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: _ 1$ Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 5 r� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �j f �� Owner:� �aN Date of Inspection: ac� SEPTIC TANK: lA, (locate on site plan) of Depth below grade:�tz Material of construction: _concrete _metal _FRP—other(explain) Dimensions: VY)Q - Pt\ Sludge depth: �'I tl Distance from top of sludge to bottom of outlet tee or baffle: Ia Scum thickness: " \t Distance from top of scum to top of outlet tee or baffle: \TJ it Distance from bottom of scum to bottom of outlet tee or baffler Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet inve structur I in grity, eKidence of I akage, etc.) Jwm u: J2t(L o.. GREASE TRAP:_%M (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: i-bIwa,Ui Owner: /J Date of Inspection: TIGHT OR HOLDING TANK: ND (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: Ue{ (locate on site plan) Depth of liquid level above outlet invert: Wt Comments: ote if level nd distribution is equal, evidence ofsolids carryover evidence of leakage into r out f box, etc.) —�13 .AA 1 PUMP CHAMBER:1�0 (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/0.3/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Cj (T�%f♦ �; c,( Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_� (locate on site plan, if possible; excavaEion not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:4 0(6 leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: ( ote condition of soil, signs of�Jhydraulic failure, level of pondin condi ' o egetation,etc.) �, CESSPOOLS: (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, ievel 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.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properl ddress: Owner: Date of Inspection: ' 1 c SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Qy DEPTH TO GROUNDWATER Depth to groundwater:'X feet �— method of determination or approximation: (revised 11/03/95) 9 YS TEPIPg �FL E NOT ;'SCALE TOP FON. }fro e T yam,s FINISH GRADE V EL . . '�6• o FINISH GRADE OVER e..a ',' FINISH GRAT;E OVER Fe ..e: •: DIST. BOX FINISH GRADE OVER SEPTIC TA moo. cs - LEACHING PI T v,co,o R.; � r•C VARIES `� ; 77n ,'TfiCQ1i: -- •ip...o,0 i',� o O.'.A: :'O.p;°.'•e'•'e: o '.�;o�'.e,,. ":s:e•.r.•• ;e.•_1..o_..r: •,o.o,:� / /Q _, �M 4y.,�.t . . ,t 0....0.. ♦. •O. •O.'.'.•a:•,...o':.•p,'[}.0. 4 a •v9 1/ �+ �/2" ,�` MAX D•e .p d,.. . _ 3" OF " PRECAST CONC. OR ' ASHED PEAST'ONE :. .?.;; :e,:e o •'•`' ,o: a: OUTLET PIPE LEVEL BRICK"6 MORTAR s TO 12 BELOW GRADE e - ••" a FOR 2 FT. MIN. o • p. •o•. s•..o o•o�:Orb:?o; °:ens o;ao.•••• .•o� . Q: a e C . d• 6~ e 37 �� o••a o0 0 6: 0 °•e o C. I. OR PVC TEES _.__ bn e e 0. ,d. �° o p 24.0 4 • 1 BSMT. FL R n` /,•/ //•/ GALLON D' D•• .dl EL . °aEP"; S TIIBL�TION BOX . I _ INSTALL ON LEVEL BASE 3/4,• 7-D-1_1/2" 4: 6 a PRECAST CONCRE - a a PR- T p NOSHED p. ,y-0 0 REilvFO cE o f I a =no a, CRUSHED CONCRETE .o;o: o-a•.e-.. ,b:::a:o ,,... o.Q. . ..d.. . .•�:.::.' o o. STONE ;y �o,,o,.o.b.•o.00.o.o,o•,o,•oo.,•0•.4.•opo••Q;aQo••c•o•.• o• o•b:o• .d �ef •o c H-4?0 RE'. "'NF. SEPTIC .Q i INSTALL ON LEVEL £SASE °•.o a o ';N. ° :e' a °•'o: I T r 6a NO E.• EXCA VA . E TO E EV •n'•L LOWER TO REMOVE ALL IMPERVIOUSe e i_ °:�,::.' �,� MATERIAL BENEATH THE LEACHING AREA , .. w F Lo icy REPLACE EXCA A TED MATERIAL WITH -_._. CLEAN, CLA Y FREE SAND v , F V E FECTI E DIAMETER 3 o / - `�_.,. LEACHING PIT r 'OTE S /C?�3, t7�' rc� `, moo`.. T , P INSTALL ON LEVEL BASE ir <' s :ro.�,• .vp,/ _ �,, , . A L�. EL E 6/A /T.0�° �' SHt�i�lN ARE BASED ON ,4.5 S U M E T> _ N� 2, ALL PIPES IN THE SYSTEM MUST BE CAST IRON ,r•.a -•.-... ,/ --`"'-` i s l �C�"a LI�C.It..�. •"!C. ' :�>1'C. '* i s ... — . .. �. BSER1/A TION I T .. All _ f �4 /t! :! �. , b ..Tt� .aa,Tlt�ff�t S Ct7MPL .TEE PRIOR - r PEt=iCOLA TION Roel i1c": / ,rg n� �'f .• 7••, J .yam g .� � �, 2/ !! �\ /� /G•�L T l'1#" ..._ Te�'aY1 � , ,;� � � TO, �94E.a�a/-"a's l..i,�d� ,�-i -sf. . a 4. ANY CHANGE a N 7H.:S PLAN MUST BE APPROVED MIN./IN., BY THE BOARD' OF HEAL TH °AND CAPE 6 ISLANDS WITNESSED BY. .. '� SURVEYING CO INC. /Vcs ti e y �i sl y c r " \ 0 5. RAI TERIALS AN!� INSTALLATION SHALL BE IN LOT _ 2,3 �+� �, 2 ° .r, COMPLIANCE, iY i ;H THE STATE SANITARY BRO. OF 'HEAL TH DESIGN DA TA --\- Ct�DE — TI Tip E V ` DA TE: f \ •- AND LOCAL APPLICABLE 8 - 'h 4 . ti h, o � s �, �,� ,, F'UL ES A/✓D =E6Uf.A TIONS -. C. NORTH ARROW J S FROM RECORD T.W x 4 N o l�l� Y * NUMBER OF BEDROOMS � � PLANS AND d .3 _., o ,-rya+ �o�G H .' S NOT TO BE USED FOR SOLAR PURPOSES a ~O• "y�- GARBAGE DISPOSAL � N N ►t �P° �' fr 71ti ] �. FLOOD HAZAR!�tZONE C -T !' e�1 ToP,ai� s„b s i . b.� i . DAILY FLOW .3.3 o GAL . ��'� \ �'.,!' �� ,_.�._ �, S. IAA TER SUPPL Y: �.-i�.vr�c l�tie // w� c i•,�, w Clay GAL . n /.Z Y / OOC.� ,� --,,..,. � SEPTIC TANK ,4EQ D. _ , M.sgna i ci., , M.sa�� w SEPTIC TANK PROVIDED • /, ao o GAL . po -f000 GALLON 9' w a z I Y s8•a. v PFW"_sr- NeR �,�c A --~- --- - M,d, ,, , << LEA CHING REQUIRED .�GPD. to y � � � 5`e?FPTIC TANK29.6 ,� ``� w/olar paiehts �' .� i 1/1 d - �-3 s q M d SIDEWAL L AREA /off S. F. 40 F. y7/ GPO f n h d /�E9t 'S.F.X 2'..� G/S. _ /. BOTTOM AREA L EGENe ,�-- -__,Lc,c-_ z z Zy- N• WA4-cr ' ?'9 S.F.X �- Q EIS.F. �y�GPO -- 9:� LEACHING PROVIDED sso GPD �yOPOSED ELEVA TION .V Y .MISTING CONTOUR 38 / R� I L A sN -� 00 --- ° ,gSFR v a rlonr Pl r .: SINGLE FA MIL Y RESIDENCE d; �,r,! ❑ LF TRIBUTION BOX LAAAAA of Mgssq� RPCHARD ��, PRC��OSEGi 5Eh/A GE DISPOSAL 5 YS TEM � L- �1F�ERVIOUS 0," UNSUITABLE MATERIAL Q 'CACHING PIT BERTRAND .34 WITHIN 10 FT. OF, THE LEACHING No. 29894o Q PREPARED FOR FACILITY IS TO -,. B AE OV R M EO or GISTS, .,./J�r �" ,,•-" y 2, ( PLACED WI TN CLEAN SAND ,� o EPTIC :TANK FSS/ONAL ENG\r ROB 8 - ER T FEL ONEY • BREAKOUT CALCULATIONS.• o� •" " INVERT 9 i_EACH. PITS-26.0 (JQP1 � � o SLOPE ELEV. 26.0-0.16 , SERVE "'' LOT3 HOL WAY DPI VE MIN. PROTECTIVE DIST. RES'D.-,r4 x a, PIES T BARNS TABL E -- MA SS 8 �` PRO VE DIST. PROVIDED-26.0 ' 9' S7,' 5'O PE IN EL TION DAVIT) n� , 4,T �,. I --� DA TE. AP,.,-1 9, 19e7 2CA0115 �._ CAPE 6 ISL.ANDS SURVEYING, INC. RA PLOT PLAN -, SCALE AS NOTED G. // � SCALE., 1 = 3� P`. J.. V G.7 .::•V i1 p. r'.;..�Y:;' 3 7,=�90 7c a �< , G STF� � P. O. BOX 334 , .' SEC P�'L LOT HSE PLAN NO. say &8T TEA TICKET MASS.