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HomeMy WebLinkAbout0266 JOE THOMPSON ROAD - Health 266 Joe Thompson Rd West Barnstable A= 174 —001 - 058 I I �I I TOWN OF BARNSTABLE 1!1--tATION '2(0(0 Joe SEWAGE# -2-0 -- 2-0 G VILLAGE W P ��SIe.L✓1t�t— ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. � � SEPTIC TANK CAPACITY ( S'Oo q o t fk t cy LEACHING FACILITY:(type) (size)` 7-9)' X V2 8' ` NO.OF BEDROOMS l® `3 OWNER �o�d PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ✓} Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching f, - (v /�' Feet FURNISHED BY - gx,SF Ar- L A '3VV 'YY3 ` 0 os� �� 'Z bo.S- _ 3 Sy' i w TOWN OF BARNSTABLE 1,.00:,ATbON" "� ✓c E-- SEWAGE # t/ V T J A 4/P/v ASSESSOR'S MAP & LOT r-2 - II4S: R'S NAME&PHONE NO SEPTIC TANK CAPACITY ��G /�5��E C 71.-A--' LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER C 4 ✓�•9y�`2 PERMITDATE: COMA CE DATE: Z- 13 " O Separation Distance Between the: Maximum Adjusted GI'oundwater Table to the 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 (Lf any wetlands exist within 300 feet of leaching facility) Feet Furnished by r Sa. 13 S� Commonwealth of Massachusetts Title 5 official Inspection Form aa Subsurface Sewage Disposal System Form :Not for Voluntary Assessments a G 6 �► s� Propel Address Owner Owners Name / i �ar✓� a /� D�6�� infoma5on s /v_V/ 6 �v a,0 required for every page. CityTovm Mate Zp Cc de Date of IrA pecti inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. important When A. inspector Info anon filling out forms on the computer, - use only the tab key to move your dame of irspecicr cursor-do not L— use the return Company Name /f key. io Company Address 0— Ciyrowr — State �O Zip Code tow - J8 Q 9 10 eiephone'Iv�`rnber ucense Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); i 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 syste 1. Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further E-vaivation by the Locei Approving,authority 4. ❑ Fails inspect s Signature Date The system inspector shall submit a copy of ti�s inspection repot to the Approving Authority(Board of Health cr 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 originai form should be sent to the system owner and copies sent to the buyer; if applicabie, 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. '.Jz 3 C Spa.trs_e^c•-•=a—.s.z—u ce Sewage Dspcsai Sysiem•pays of 18 5insp.Goc• ev.?�620;8 , Commonwealth of Massachusetts - I? Title 5 Official Inspection Form N Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C (D �..� (� Toe T 4d Owner Property Address fZip information is pwners Name required for everypage. City/Towr State Code Date of Inspe ion C. Inspection Summary Inspection Summary: Complete 1, 21 3, or 5 and all of and 6. 1) System P es: . 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: 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.00c•tev.7f2620+8 7,ve 5 oilaa nspecaon Form:suosurace sewage Disposa:system.?age 2 of 18 Commonwealth of Massachusetts is Title 5 Official Inspection Form '3 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a66 sow - o� Property Address W1, Owner Owner's Name information is ap required for every /L page. CitylTown State Zip Code Date of Insp,ectiort C. Inspection Summary (cost.) 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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (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): 17 broken pipe(s) are replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (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: ?age 3 of 18 t5insp.doc•rev.712612018 `0e 5 Of9cai Inspemon FO.—M suosurace Sewage Disposai System• Commonwealth of Massachusetts Title 5 official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Joe 1400,osoh R2 Property Address Owner Owners Name �/ /� information is ��es�- (3�/�'lS7�5l1 �T Od� 68 3 .lo do required for every page. City/Town State Zip Code Date o0nspektiun 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 `00 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 DCP 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 ';tle 5 sibsu-ace sewage Disposal systen•Page 4 of 18 t5insp.d=-rev.725/2018 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments lei Property Address Owner Owner's Nam K required for every information is �aei�T &/h S7�"`lf �✓� OPL64e S 0 a0 page. Cityri own State Zip Code Date l6f In ection C. Inspection Summary (cost.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No EllStatic liquid level in the distribution box above outlet invert due to an overloaded / or clogged SAS or cesspool ��✓/ Liquid depth in cesspool is less than 6" below invert or available volume is less than /z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: Any portion of the SAS, cesspool or privy is below high:ground water elevation. Any portion'of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. r, Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. I j 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 feetbut 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- ^ L 10,000 gpd. t— -{� The system fails. I have determined that one or more of the above failure L 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 0.4. 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 surace 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 e DisooszJ System•gage 5 0`t8 tsinsp.doc•rev.726201a ?;9a 5'offic'ai inspection=om:Subsunare Sewag I Commonwealth of Massachusetts lg Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name��-� � 1 ? 30 a� required for every information is CN�S l �h s 7�b�C_ (J page. CitylTown State Zip Code Date of nspe on 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 all inspections: Yes No P ping 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 NIA) i— 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)] `Je 5 c-.dal inspenon Porn:Suosurface sevrage Disposal System•Page 5 of 18 tSinsp.doc•rev.7/2612018 I Commonwealth of Massachuset ts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` a6� Toe oW soy �d Property Address etc� Owner Owners Name information is ��5'�" �(/�s��`vK � siC78 required for every State Zip Code Date of In echo page City/Town D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): dumber of bedrooms (actual). DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Opt Number of current residents: ❑ Yes No Does residence have a garbage grinder? Does residence have a water treatment unit? ❑ Yes I�No If yes, discharges to: �, ' Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes E i information in this report.) Yes No Laundry system inspected? ❑ Yes No Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: ❑ Yes No Sump pump? Last date of occupancy: Date "iae `Gai lospecon c �c,su`ace Sewage Dtspcsai System•Page 7 of td .6insp.doc•rev.7126i2018 Commonwealth of Massachusetts F Title 5 Official Inspection Form } Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner l�G Owners game �s information is 4- 1 &fN s,�� 6d-(o 6I required for every T 3"So Q page. CaylTown State Zip Code Date of spec on D. System Information (cont.) 2. Commerciallindustrial 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: O W � Source of information: Was system pumped as par of the inspection? ❑ Yes ' o If yes, volume pumped: - gallons How was quantity pumped determined? Reason for pumping: t5insp.00c•rev.726/2018 we 5 @flda irspeccon=orrn:Subsurface Sewage Disposal System•?age 8 of 18 1, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments (i .TOE / f?d v`r sowIlecl Property Address �l G�- Owner Owner's Name information is _ O'S �— required for every A page. City/Town State Zip Code Date of nsp lion D. System Information (cons.) 4. Ty;710 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: w� Op- �w S��4s Were sewage odors detected when arriving at the site? ❑ Yes No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of constructi;_40 ❑ cast iron PVC ❑ other(explain): �� ) Distance from private water supply well or suction line: feet Comments (on condition of joints; venting, evidence of leakage, etc.): •?age 9 of t8 -;;;e 5.?`dal�nspecucn For-.su=urface Sewage Disposai sys[em [5insp.doc•rev.712612018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .. C�) ! (/lOv7 Sol, Property Address Owner Owners Name/ information is required for every t/mil//�S-/1— 41;if / /�_ O p�/�page. City/Town State Zip Code Date of In n D. System Information (cons.) 6. Septic Tank (locate on site plan): Depth below grade: feet Material o onstruction: ncrete ❑ metal ❑ fiberglass ❑ polyethylene, ❑ other(explain) If tank is metal, list ace: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate ❑ Yes El No �o Dimensions: n Sludge depth: X Distance from 'top of sludge to bottom of outlet tee or baffle cJ�g / 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 — How were dimensions determined? - l Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): vvw �s rv1 t5insp.doc-rev.7r2612018 ide 5 o`oai Inspection.of m.suosuraoe sewage Disposai System-?age 10 of 18 J Commonwealth of Massachusetts Title 5 Official Inspection Form 5 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments )/6 Property Address Owner Owner's Name information isr1-JIr G�66B required for every page. City/Town State Zip Code Date of tspeclon D. System Information (cont.) 7. 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 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 J metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Sinsp.doc•rev.7/26i2058 %ie 5_—Maa:Inspecvon=om:Suosu=ace Sewage Disposal system•Page 1 t of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form �1 01 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Adcress Owner Owner's Nane /� n G �f/f� information is C//t// !� 6 / ' oo) 6g required for every �s ✓hs State Zip Code Date of I pecti page Cityrfown D. System Information (cont.) 8. Tight or Holding Tank (cant.) 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 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.): 004 / flb So S /f/0 _, _ n Forte.Ssos�rtaae Sewage Disposal system•?age t2 of 8 We 0 v Gai:nsoecuo t5insp.dOr rev.7252018 Commonwealth of Massachusetts P: Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c2�4 TO Property Address l/C-L Owner Owner's Name6 1 /�,( information is /ps� /✓1l � / 'r/T Uo� G 6� 'A �O required for every page. C!tyrrown State Zip Code Date oHns ction D. System Information (cons.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alanns 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: Soo 6;�-`lw, ❑ leaching pits number: ❑ . leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ !eaching fields number, dimensions: ❑ overflow cesspool number: Cl innovativelaitemative system Typeiname of technology: —'— -iae 5 QfSaa!!nspe�-Gon Fcnn:Suo-m`ce Sewage Oisposai System•Page 73 of 78 t5insp.doc•rev.7/26/2018 Commonwealth of Massachusetts Ti-tie 5 Official Inspection Form Ki Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c;,2 6 o#! o tj Property Address Owner Owner's Name/' information is Cam►!/ required for every page. City/Town State Zip Code Date of Ospecti96 D. System Information (cost.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc_): 40 44 L4 /wee . 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.): -,ae 5 of cai nspecbon Form.sucsurrace Sewage 01sposai System•?age 74 0£78 t5insp.doC•rev.726/2018 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owners NamLZ4,5� &-"U A;( Ol /�� lkld 0 � required for every page. ty Ci [Town - State Zip Code Date of Ins ction D. System Information (cons.) ` 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.): Tiue 5 v naaa nspecoon=orn.Su3surface sewage o�sposai system.?age t5 of t8 t5insp.aoc•rev.7126/2018 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments l; ,6 fG I ;_...�/ �6 / i�f O✓'� Soh C u Property Address Owner Owner's Name ,p information is L/V�s-� rNS�4 oda O IAv oZo required for every page. CitylTown State Zip Code Date of Insp 'on D. System Information (cons.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference II wells within 100 feet. Locate where public water supply enters lffbu' or benchmarks. Locate a p pp y g. Check one of the boxes below: sketch in the area below ❑ drawing attached separately i I FRm n T G/-/3 41 -/6 5 E--- �s°c�,coo„ Lf6 C O j 'i I I I nVt � ! rT4;S --------------- i Cover Title 5 C;fip2i mspr ,or,Fo-m:SuoSCrfaCe Sewage Disposal system•Page 16 of t8 t5insp.doe•rev.712612018 A - r Commonwealth of Massachusetts ell Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address pet C,L Owner Owners Name /� �S� n�,� information is /Vv/ S S�lf�► &6 required for every page. City/Town State Zip Code Date of In ectio D. System Information (cont.) 15. Site Exam: [] Check Slope Surface water ❑ Check cellar Shallow weals 7'�� "f 45* Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record If checked; date of design plan reviewed: Date Observed site (abutting propertyiobservation hole within 150 feet of SAS) Checked with Ioca oard of Health - explain: _ / a us f / Sf o!� u Checked with local excavators; installers- (attach documentation) Accessed USGS database- explain: Yoj must describ ho ou established the high ground water evation: r)/L-7 0 14 CA �r' e —-4�� "le . kiS4 ��.� C/ �Pr /4VI 16 • .� c — / Before filing this Inspection Report, please see Report Completeness Checklist on next page. 5insp.doc-rev.725,2018 Title 5 SScai lrspsacn Form:Suosurface Sewage Disposal System•Page 17 of 18 f Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address -- !G� Owner Owners Name information is / � !,` f // �,� D-)6 1 Ac required for every — (�/ JC/y1S7�J��[r / (� page. City/Town State Zip Code Date ilectionf io E. Report Completeness Checklist Complete ail applicable sections of this form inclusive of: Aspector Information: Complete all fields in this section. ER'te. In B. Certification: Signed & Dated and 1, 2; 3; or 4 checked li-' Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Fai e 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 t5insp.doc-rev.7/26/2018 T,[le 5 ar Bcai mspeczon Foy-.:suzsurace Sewage a5posai system•?age IS of 18 I_ Town of Barnstable P Department of Health,Safety,and Environmental Services moo`'THE Public Health Division Date 5 / .367 Main Street,Hyannis MA 02601 BARNSTABLE, v� MASS. 9. _ ATso nu,+" Date Scheduled 510 Time G Fee Pd. �� y Soil Suitability Assessment for Sewage Disposal Performed By: Jim/�-7h�C'�—) h-v4v4-- ,�•r'oost � Witnessed By: S LO RAIATI ON: ' Location Address Owner's Name >ii Ldo /.e3 . 8✓n-�wS y*-�3 L E Address Assessor's Map/'Parcel: 1141 00/ Engineer's Name NEW CONSTRUCTION REPAIR Telephone# L ra Q 3 Z Land Use l 7'bek.7-n✓,c o Slopes(/o) Cy Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line Other ft SKETCH: (Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) 1� 1 �i F Parent material(geologic) )"Or;*� A` %2>4tJ, p5%7'5 Depth to Bedrock Depth to Groundwater: Standing Water in Hole: X , Weeping from Pit Face A-)LA Estimaieu Seasonal High Groundwater A->/.4 `. DTI RMI:l TA'TI0 FORA ON L HICH VGA TiJ AM Method Used: :C' Deptiz Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well#___.... . Reading Date:_-_ Index Well level.._._! Adj.factor Adj.Groundwater Level PEI�CIDL,ATJ[�N TIaST <...:> '.?;Hatt �► Ttrue I Observation Hole# Time at 9" Depth of Perc 2 i� Time at 6" Start Pre-soak Time @ D rja Time(9"-6") End Pre-soak G Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back > Copy: Applicant I� EP Ok3.SEBVA` Q�1I LAG. :. Hobe=# . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. --Consistency ° G av I 3S /t,,f 5 /,O,?x 7-9 /�a�n- «- ey���-.•nos ee— ze, �r DEEP QB$L14"TIQN HQLE IaQG- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) I (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Co s' to ex.% ve /o LS a��.. � 3 3 2- 4 If I)E QBSRVA.� QYO ,E LQG IA1B#.. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel 1)EE 4BSER`V ATI4N IIC} ,E L.O.G Hole## Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) ._ (USDA) 4 (Munsell) Mottling (Structure,Stones,Boulderes. Consistency ° Gravel) Flood Insurance Rate Maa Above 500 year flood boundary No_ Yes Within 500year boundary No Yes Within 100 year flood boundary No Yes Depth i of Naturally-Occurring Pervious Material • x Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,What is the depth of naturally occurring pervious material? Certification I certifythat on /r r 4 (date)I have passed the soil evaluator examipti;on approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required train i , e pertise and experienco.described in 310 CMR 15.017. Signature _- Date No. �/- — Fee6 W' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH IJIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftphtation for Mfsposal *pstrm Const union permit Application for a Permit to Construct( ) Repair(V--Ulpgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (o G -3 erQ�j,•��� M )7Z.1. Owner's Name,Address,and Tel.No._,5-W�- fa - 51549 Assessor's Map/Parcel ` `7 c{ 21 .17 a/.. O j d Instere,Addres ,and Tel. o Designer's Name,Address,and Tel.No.0 Type of Building: Dwelling No.of Bedrooms Lot Size (, S�S sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 o gpd Design flow provided 3 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /,OUZO Type of S.A.S. _ Description of Soil -2, Nature of Repairs or Alterations(Answer when applicable) cT+A-< S I-S-3 ko (30X Z-Sao M e -C Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore describ on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and of to pla Sys ni in feration until a Certificate of Compliance has been issued>thisard of al Date /l Application Approved by Date Application Disapproved Date for the following reasons Permit No. ®I I - ;FO<O Date Issued f 2011 _ i`_ W •�;;.-�+..-n-s.�..r..+..a;...a,..�,,-�.+,.:w�.'Ss�ai7;�: x-.,�i..�`�.-�b..�++-..:.:-h*:.��:.+....-�...v.�.»as;r*'y...-•---.-•a. -- f�l h.r. �.._� �w.,+.+++.--^�.y. , No.. Fee /w' THE?,CQ_NMONWEALTH OF MASSACHUSETTS Entered iri computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABL�E,� -,,ASSACHUSETTS Yes s Rppliratlon for Disposal 6pstem Construction Permit Application for a Permit to Construct( )' Repa i( Upgrade( ) Abandon( ) ❑ ❑Complete System; Individual Components Location Address or Lot No. (v L 5oe rk aiV5,v, Rd, Owner's Name,Address,and Tel.No.Sl>� � �• Sr/ W 9 Assessor's Map/Parcel / 7 t( !f . p� 0S i Installeri''s1s Na/(me,A/ddres ,and TJell.6N_ / Designer's Name,Address,and Tel.No. SOj• 16,1- F1T 441 Type of Building: Dwelling No.of Bedrooms Lot Size -/.S sq.8. Garbage Grinder( ) Other ,` Type of Building No.of Persons Showers( ) Cafeteria( ) Other.Fixtures -fir 4 Design Flow(min.required) �3 0 gpd Design flow provided ��� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /S Type of S.A.S. . ( au a Y/rtii Description of Soil 2,,, Nature of Repairs or Alterations(Answer when applicable) ,i(.t u." y Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described'on-site sewage disposal system in se m accordance with the provisions of Title 5 of the Environmental Code and riot to place the system in operation until a Certificate of v Compliance has been issued by this Board o Heal h Signe , / � Date ApplicationAp rovedby Date Application Disa°. roved b PP pp Date - for the following reasons Permit No, Zo ��� Date Issued 6 2-0 f 1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance s y THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(b� Upgraded( ) Abandoned( )by at R. G g,-e r h o� sau (�G. / A has been constructed in accordance /Z4/ri with the proms sio�ns of Title 5 d the o�rspo Sy t®mom' nstruction Permit No.�11'BOG dated Installer r ,,� Designer #bedrooms 3 Approved design flow A 3 3 a gpd The issuance of this e T' it shall not be construed as a guarantee that the system wil func 'on�a. designe Date � I (J a o l l Inspector r i fFee'�/Do, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstrm Construction Permit Permission is hereby granted to Construct( ) Repair(P/) Upgrade( ) Abandon( ) System located at n A-U 4 r and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio must be completed within three years of the date of this permit. Date 61 2-9 ���I Approved by _� Town of Barnstable �pTHE T Regulatory Services Thomas F. Geiler, Director * BARNSTABLE, MASS. g Public Health Division ArFDMA�A Thomas McKean,Director 200.Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Zot Sewage Permit#a011 - a 0 G Assessor's Map\Parcel 174 Designer: Installer: «—: Address: Address: P-y, 5'k /S 3 S On was issued a permit to install a (date) (installer) septic system at Z G-6, based on a design drawn by (address) dated e, i 3 �l / (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with ( major changesi.e. greater than 10' teral relocation of the SAS or any vertical relocation of any component o e septic s stem) but accordance with State & Local Regulations. Plan revision or ertified as- ui"lt by de 'gner to follow. o , WIX- A. � I'{i`1lM7 CIVIL t nsta er gnature N°•35461 (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Revised.doc r COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVI1<ONMENTAL AFFAIRS 4 Y d )DEPARTMENT OF ENVIRONM'I:NTAL PROTECTION C� p ,e �qM cvey A 350 MAIN STREET WEST YARMO[JTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A t a ~4 6 CERTIFICATION MAP 174—PARC 00.1 -_ Property Address: 266 JOE THOMPSON ROAD �' w Owner's Name: C`EL[,A,DAVID S Owner's Address: 266 JOE THOMPSON ROAD o -T) �h Date of Inspection JUNK.8,2005 Name of Inspector:(please prin,) JAWS D.SEARS k.0 M Company Name: A&h Canco Mailing Address: 350 A/tain Street Wesi:Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes .11eeds Further Evaluation by the Local.Approving Authority Fails Inspector's Signature: Date: The system inspector shall sPiuit opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of complet'-rig this inspection. If the system is a shared sys4 m or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the app op.-iate regional office of the DEP. The original should be sent to tlee system owner and copies sent tot he buyer,if ap>iicable,and the approving authority. Notes and Continents ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 266 JOE THOMPSON ROAD WEST BAP.NSTABLE,MA 02668 Owner: CELLA,DAVID Date of Inspection: JUNE 8,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes:.( I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CUR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 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 obstruction is removed ND explain: 4: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 266 JOE THOMPSON ROAD _ WEST BARNSTABLE,MA 02668 Owner: CELLA,DAVID Date of Inspection: RUNE 8,2005 C. Further Evaluation is Required by the Board of Health:N/A k 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 salt marsh 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 public water supply. A The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: k Title 5 Inspection Form 6/15/2000 3 r Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 266 JOE THOMPSON ROAD WEST BARNSTABLE,MA 02668 Owner: CELLA,DAVID Date of Inspection: JUNE 8,2005 D. System Failure Criteria applicable to all systems: N/A 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 boa above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in leaching is less than 6"below invert or available volume is less than%day flow �- 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 N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"_yes" or"`no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No 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 11 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 is 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. Title 5 Inspection Form 6/15/2000 4 f Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 266 JOE THOMPSON ROAD WEST BARNSTABLE,MA 02668 Owner: CELLA.DAVID _ Date of Inspection: JUNE 8,2005 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 hvo 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,including 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)has been determined based on: Yes No ✓ 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(3Xb)] r, Title 5 Inspection Form 6/15/2000 5 T Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 266 JOE THOMPSON ROAD WEST BARNSTABLE,MA 02668 Owner: CELLA,DAVID Date of Inspection: DUNE 8,2005 FLOW CONDITIONS RESIDENTIAL✓ 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 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): N/A Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): 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) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1997 PERMIT#97-48 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 266 JOE THOMPSON ROAD WEST BARNSTABLE,MA 02668 Owner: CELLA,DAVID Date of Inspection: JUNE 8,2005 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 16" Materials of construction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 26" Material of construction: concrete metal fiberglass polyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 15007GALLON PRE CAST Sludge depth: 3" Distance from top of sludge to the bottom of outlet tee or baffle: 27" Scum thickness: V 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&TAPE 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,INLET TEE—OUTLET TEE. NOTE:MIDDLE.COVER AT 5". NO SIGN OF OVERLOADING OR LEAKAGE. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _ polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 266 JOE THOMPSON ROAD WEST BARNSTABLE,MA 02668 Owner: CELLA,DAVID Date of Inspection: DUNE 8,2005 TIGHT or HOLDING TANK: N/A (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 Flew: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Continents(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"X 16"—5'—10"BELOW GRADE,BOX IS CLEAN&SOLID. NO SIGN OF O'vTR LOSDING OR SOLID CARRY OVER. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Continents(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 - . r Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 266 JOE THOMPSON ROAD WEST BARNSTABLE,MA 02668 _ Owner: CELLA,DAVID Date of Inspection: JUNI:8,2005 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: �— leaching chambers,number: 4 leaching galleries,number leaching trenches,number,length leaching fields,number, dimensions: _ overflow cesspool,,number: innovativelalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS FOUR INFTTRATORS,LEACHING IS 5'BELOW GRADE INSPECTED WITH CAMERA. WET—NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionX 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 cons?ruction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) Title 5 Inspection Form 6/15/2000 9 L" Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 266 JOE THOMPSON ROAD WEST BARNSTABLE,MA 02668 Owner: CELLA,DAVID Date of Inspection: JUNE 8,2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 8 R FAR A o 1- 3 �7 ' .A - y �g Title 5 Inspection Form 6/15/2000 10 r Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 266 JOE THOMPSON ROAD WEST BARNSTABLE,MA 02668 Owner: CELLA,DAVID Date of Inspection: NNE 8,2G05 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 12 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-if checked,date of design plan reviewed: Observation 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 estatlished the high ground water elevation: TEST HOLE 12'NO WATER. TEST HOLE 5' BELOW BOTTOM OF LEACHING. BOTTOM OF LEACHING AT T BELOW GRADE. 10,43 £' 7 ' aC 1*4 cNIAeh s, Title 5 Inspection Form 6/15/2000 11 TOWN OF BARNS ABLE !7y,. jr °vt L7CAI0 /1I ��_ SEWAGE # 9 7 VILLAGE ASSESSOR'S MAP & O INSTALLER'S NAME&PHONE NO. CAN SEPTIC TANK CAPACITY+_ /rC90 so l/ LEACHING FACILITY: (type) ZiJ�� �4f�reS (size) . �C y NO.OF BEDROOMS 3 LTYI.DER O WNER� V of u J �6�J`IzeS� PERMIT DATE: COMPLIANCE BATE: 4' 1 i/ 9T Separation Distance Betwoen the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by a A a - l ' - r No. Fee tHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Migool 6potem (Coneaructiou Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. /S o L J Owner's Name,Address and Tel.No. 4-`��- t 6-a~J JOE T7,1o)%7P aN �� ?'. rP�1 i J�h.S./ �v7-i r�oS%r Assessor's Map/Parcel ?4./� W, )O'2 5 v 4 42'yc0?aa 'e,4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 5 A Z_L 1 _ R —�c J� �i" 1t- 19�A/���0 2 7Z� /� .Q.✓✓.rt�i ,4 Type of Building: Dwelling No.of Bedrooms Garbage Grinder(a o) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 lcv gallons per day. Calculated daily flow -1 Z gallons. Plan Date I - ZX !V.7 Number of sheets / Revision Date Title Description of Soil S riN.F- - 44eAi yAA ZY�Lh, 5.4 4;16 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by VBVdealth. Signed Date *tox Application Approved by \ Date Application Disapproved for the following reasons it Permit No. 9 2"4100 Date Issued — �7 --------------.----------�---_---------- rLTOWN OF BARNSTABLE LOC ATIO t ��� _ SEWAGE # VU1LAGE P.'� v.%�(� ASSESSOR'S MAP& O LJ v INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY fe0 Tc LEACHING FACILITY: (type) --(size) NO.OF BEDROOMS 3 "} UII.DER O .0 -WNER: Ll PERMTTDATE:--.Q.= Lt 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 Feet within 300 feet of leaching facility) Furnished by cry 1r � d Fee i�i�COMMONWEALTH OF MASSACHU,SETTS PUBLIC HEALTH DIVISION'-TOWN OF BARNSTABLE., MASSACHUSETTS 4. 01ppYication for �Digpogal bpgtem Congtruction Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: 7,11 Location Address or Lot No. /i v d & Owner's Name,Ad ress and Tel.No. 4-1tS;• G 4.O� v�r-E7706 PSoN A_% C��-�J7, �/JFM S 4-v.- >4>5,t Assessor's Map/Parcel 1 Z 4- //_S p �T R a7 J,F4�'' �a1 / J� LAAA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 5 ,•Qr L.L C�✓� ,may'rj�2 II IS (p a 2S "�ru.Q�k �.. -�r 4-9 /��-��3 v rZ zZ /-� �.✓.y.s .4 Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(a a) I Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 1,0 gallons per day. Calculated daily flow 3 2 Z gallons. Plan Date 1• -zX 9!;0, Number of sheets I i Revision Date Title Description of Soil SS h-itvs - 41tb., c,,oA jNature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of Envir nmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this B d o ealth: P Y ,� 4� Signed , 11 Date J)b Application Approved by Date 51-Z2 Application Disapproved for the following reasonst t }3 f4k Permit No. Date Issued .f ,-< S7 17 ------------- ------ -- ,, -- --------- THE COMMONWEALTH OF MASSACHUSETTS - BARNSTABLE, MASSACHUSETTS ,. w Certificate of Compliance /THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( )on by Installer ` at 7,' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No`1 ;;t dated Date Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. ———————n ————————————————!-. ————--—————— No. y' 7 ' I d Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS f 'igpogal *pgtem Congtruction Permit Permission is hereby granted to to construct( lqrepair( )an On-site Sewage System located at No.# S-o,--*-' Vatna2LZ2 Street and as described in the above Application for Disposal System Construction Permit. 17 -Vi _ No. Date 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: Approved by Board of Health .......... Test pit # P-6735 ___•� Z Made 10-5-87 i5S wit. J. Dunning . 40 s4 No water encountered1 I / Perc. less 2 min per Map 174 pcl 1-58 !' Lot 15P' T. & S I147.� Open Space ' �515isf fine to i i 1n �N p� pOrf Lot 151 I . medium sand Medium j �i• N sand i 4 { 14 r 4 a / Q /0. F � j• O i I ZS• i , I Septic d14, esi No bedrooms Disposal no { r-,osen i/ Req. leaching 339 '1Pd Reg. tank 150p aal . FoVNrs Ist••o 4U' - ' Provided leaching �. -/ 15x24=360x. 74= 266 . 4 \ - 78x2=156x. 74= 1_15.4 I ►45.� ' �� / I 382 .0 pd j / 1 I /4 C.'3 �- 1 Z.7.Oo a i F ' 1 ® i Joe Thompson Road z Ca-C.N Rn 5 inrS 14s.s 50 ' wide l4o•s Use 8 high capacity Infiltrato 4 each row with 3 ' stone on sides and middle as shown. I S¢a Profiles No Scale f End. M4,l.�c• �au,i�` • �va•G rJ d... VV'�•UJC�G'Ga .� c.y wt7u tauA r/r Y 1�60PC*� p jC)c:4 ✓:i.'._au:i aui ' _ '� ail.t',.y:/ZA�{.�• �!f L.1� �..J y,Y J 3/4, f ( �2•I 4 :, {t• .1;. .. r'o+u 'L.�'� t,.. y .:fit•.- 1 � �. 1�;1 i a . . _ -- -. I - i Plan of Land in Centerville, MA For James Antiposti Being lot 150 as shown on a plan of Hunter Hills = sh 4 dated 6-16-87 fj Elevations are on N G V D 1 _ Date: Agent Barnstable board of health Scale 1"=30 ' Date 1-28-97 All Cape Engineering I 49: Harbor Road Hyannis, MA 02601 j E XI '3477 0 9 0.2249U �1STf'i SSICNAt.E�"' �t Wit'L�3 �__ � : _ - _ • Tom,.,---.�----• 4' VENT OR ACCESS COVERS MUST BE WITHIN 9' MINIMUM. CHARCOAL INVERT EL EVA T I DNS DES I GN CR I TER I A GENERAL - NOTES . 6' OF FINISH GRADE 6' MAXIMUM COVER FILTER DESIGN FLOW: FIRST 2' TO INVERT OUT SEPTIC TANK: 111.7 BE LEVEL MIN 2'- OF PEASTONE I 3 BEDROOMS AT 1/0 G.P.D. PER - I. THIS PLAN IS FOR THE,DESIGN AND CONSTRUCTION OR FILTER FABRIC l8*MIN INVERT IN DIST. `BOX: 10.67 OF THE SEWAGE DISPOSAL SYSTEM ONLY. INVERT OUT DIST. BOX: 1I0.5 BEDROOM EQUALS 330 G.P.D. DlAM PIPE INVERT IN LEACH CHAMBER: 110.4 NO .GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS !l1.7 1/0 5 2' H-20 �� 10 4 3/4' - 1 1/2' D1A. BOTTOM OF LEACH CHAMBER: 108.4 SET. SEE SITE PLAN. GAS IBAFFLE 110.67 110•4 DOUBLE WASHED STONE ADJUSTED GROUND WATER: N/A SEPTIC TANK REQUIRED: 3 OUTLET 2-500 GAL LEACHING CHAMBERS OBSERVED GROUND WATER: N/A 330 G.P.D. X 200K - 660 GAL. 3. ALL CONSTRUCTION METHODS AND MATERIALS AND EXISTING D-BOX W/4' STONE AROUND, 12.8'r x 25'1 x 2'd E SEPTIC TANK PROVIDED: 1500 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL 1500 GAL BOTTOM OF TEST HOLE #2: l03.4 H-20 CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL SEPTIC TANK 6' CRUSHED STONE OR SOIL -ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS. COMPACTED BASE DES 1 GN PERC RATE ! 5 M1 N/I NCH SOIL TEXTURAL CLASS - 7 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER PRODr L E : NOT TO SCALE EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 330 GPD / 0.74 GPD/SF 446 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH- STANDING H-20 WHEEL LOADS. f v PROVIDED: 2-500 GAL LEACHING CHAMBERS W/4' STONE AROUND. A-471 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR 471 S.F. x 0.74 - 348 G.P.D. APPROVED EQUAL. 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED SOIL TES T P I T DA TA & PRECAST CONCRETE OR APPROVED POLYETHYLENE. INDICATES _� INDICATES BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER PERCOLATION = OBSERVED TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE TES T GROUNDWATER OUTLET. N 85' 14'24'E CATCHo&4SIIV .9� TP l Ps/3285 Tp2 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE". LOT LINE BP 159.99 P �l5.3�_ ' I 0. HORIZON TEXTURE COLOR ll7 5 0' HORIZON TEXTURE COLOR 115.4 1-888-DIG-SAFE AND THE LOCAL WATER DEPT. LOT CDR B j o i - FOR LOCATION OF UNDERGROUND UTILITIES. EXISTINGAS VENT - 2-5do GALLON ,\ `` A SAND 3/3 LOAMY IOYR - A SAND 3 HE LOAMY IOYR fAPPROX! ATE) _----Z�CHING CHAMBERS �. �, '�' �- ., �^` I 3/ 1 ! TPs2 1 W/4' STONE AROUND 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY DESIGN ENGINEER TWO DAYS PRIOR TOCONSTRUCTION TP+1...�....• m r.t.7 `r LOAMY IOYR LOAMY IOYR ! B SAND q/6 D SAND 4/6 OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE .# pi CONSTRUCTION INSPECTIONS 22' 1 15. T 22' l I3.6 t i oR 0 BE PUMPED DRY REMOVED 25 14.5 MED I UM IOYR MEDIUM IOYR O �\ s,-.••'`D-BOX v y Pa C SAND 6/8 C SA 6/8 9. EXISTING LEACHING T O ND co \ 8 /14.3 3 / 7 THE NEW SAS AND ----ti 3 •• 2' 12 UNDER AND WITHIN TH 1 N 5 FEET OF P 1c 4, ' _- -- .4 BMON'GARAGE C2 SILT IOYR C2 SILT IOYR BACKFILLED WITH CLEAN SAND. SLAB. EL-115.25 LOAM 5/6 LOAM 5/6 LOT ISO 16. 515+ S. F. $ MED!UM IOYR YR MED 1 UM 'I O YR N o SAND 6/4 , Cl SAND 6/4 CI ti 0 72 e+ 'L V OFI ail NO WATER NO WATER S�PTIC TANK 1F��FF 120' 107.5 !44' 103.4 ,r ` � O DATE: MAY 20. 2011 • TEST BY: STEPHEN HAAS ! B �, ''•� ,`�\\,\`' `t,�iti� `• �F� - WITNESSED BY: DONALD DESMARAI S bPERC RATE: C 2 MIN/INCH � t �9orl___ -� O VARIANCES REQUIRED : j TITLE 5. MAXIMUM FEASIBLE COMPLIANCE SECTION I5.221: (7) GENERAL CONSTRUCTION REQUIREMENTS THE TOP OF ALL SYSTEM COMPONENTS SHALL BE NO MORE THAN 36' DEEP. 5 FOOT OF COVER IS PROPOSED AT THE DEEP END OF THE SAS, A 2' VARIANCE IS REQUESTED..; S E- P T ! C S YS TE-M DE- 5 G/\/ 266 JOE THOMPSO/V RD . MAP 174 , PARCEL 00 / - 058 W,E"S T S A R /V S TA S I E "A . PREP,4 RED FOR' , f\ . LEGEND ■ CB j CONCRETE BOUND v 40\ _ lr -}�� �•._�1 p HYDRANT l NE S CA L E- I - .20 .J U/V E / 3 . .201 / i SADDLER/ LOCUS l ` - a�,� f GAS LINE EAGI_ E SUFRVEY I NG I NC OHW- OVER HEAD WIRES JOE # LIGHT POST 923 Route 6A Yarmouth ort MA . 02675 :) -E UNDERGROUND ELECTRIC L I NE P r --r" -T- f UNDERGROUND TELEPHONE LINE �i%�i j`I/1;t� ) 3 6 5 3 3 2 -CTV- =UNDERGROUND CABLEVI ( 5 0 6 2- .SION LINE �/ ! +40.4 SPOT ELEVATION �--40 EXISTING CONTOUR + 40 PROPOSED CONTOUR L OCUS MAP o Io 20 40 - � JOB N0: 1 .l-048 LF�IELD;CANAL- CALC: SAH/CFW CHECK: CFW DRN: SAH I i C 'MUST BE WITHIN - VENT R 'i . ACCESS. COVERS E 9 MINIMUM. CHARCOAL 'i INVERT ELEVATIONS . DES CRIT IA : = 6' OF FINISH GRADE CH ER GENERAL NOTES . ES 6. MAXIMUM COVER .FILTER . DES I GN FLOW: Y FIRST 2' TO ;, -• INVERT OUT SEPTIC TANK. l l.7 - _ MIN 2 OF PEA STONE ° 3 BEDROOMS AT IIO O.P.D. PER 1. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION BE.LEVEL INVERT- 1N DIST. BOX. ° I10`.6T _ _ OR FILTER FABRIC l8'MING.P.D. OF THE SEWAGE DISPOSAL - S BEDROOM EQUAt S 330 E GE D I S AL SYSTEM ONLY. INVERT OUT DIST. 'BOX 1/0:5 - 4 DIAAf 01PE a INVERT IN LEACH CHAMBER: 1/0.4 NO GARBAGE GR I NDER 2 VER T I CAL DATUM I S ASSUMED, FOR BENCH MARKS J 11.7 10 5 $� H 20 0 3/4 1 I/2 D I A. 2 BOTTOM OF LEACH CHAMBER. 108.4 SET. SEE SITE PLAN. GAS � 4 i 110.67 .o DOUBLE WASHED STONE F BAFftE _ l 0 4 ADJUSTED GROUND WATER. N/A SEPTIC TANK REQUIRED: ; 2 500 GAL LEACHING CHAMBERS 3. ALL CONSTRUCTION METHODS N A ` 3 OUTLET _ OBSERVED GROUND WATER. N/A 330 G.P.O. 'X 200x 660 GAL. LA D M TERIALS AND EXISTING .. D-BOX W/4 STONE AROUND. 12.8 r x 25 l x 2 d S N MAINTENANCE OF THE SEPTIC SYSTEM SHALL 1500 GAL i .BOTTOM OF TEST HOLE *2. 103.4 EPTIC TA K PROVIDED I500 .GAL. EXISTING H 20 CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL, SEPTIC TANK 6' 'CRUSHED STONE OR SOIL -ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS. COMPACTED BASE DESIGN PERC RATE C 5 MIN/I NCH SOIL TEXTURAL CLASS l 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER :AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER • EFFLUENT LOADING.RATE- 0.74 GPD/SF PROF I L E • NOT TO SCALE 330 GP0 0:74 .GPD/SF 446 S.F. REQUIRED THAN 3. IN DEPTH SHALL:BE CAPABLE OF WITH- / } STANDING H-2 WHEEL LOA 0 EE DS. 4 PROVIDED: 2-500 "GAL LEACHING CHAMBERS W/4' STONE AROUND. :A-471 S.F. 5. ALL SEWER PIPE SHALL" BE SCHEDULE 40 PVC OR 471 S.F. x 0.74 348 G.P.D. APPROVED EQUAL 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED SOIL TES T PIT DA l 7-A PRECAST CONCRETE OR APPROVED POLYETHYLENE. INDICATES INDICATES BOTH SHALL BE'WATERTIGHT, D-BOX SHALL BE WATER PERCOLATION OBSERVED TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE TEST ? GROUNDWATER OUTLET. , t ' . CATCH BASIN # N 85e 14:2� RIM-10 TP #! P 13285 TP #2 ,- e•44 7. BEFORE. CONSTRUCTION CALL 'DIG-SAFE'. 99 LOT LINE eP t59. I t 1-888-DIG-SAFE AND THE LOCAL WATER DEPT. LOT COR eP t fs.a� HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR ( o / 0' 117.5 0' 115.4 FOR LOCATION OF UNDERGROUND UTILITIES. EXISTING SAS VENT - - LOAMY IOYR LOAMY IOYR + / 2 SdO GALLON \ ` �i /1 ! A OX \ Fi f-1 ! t f PPR I�TEI -""LfACHING CHAMBERS r, SAND 3/3 SAND 3/3 + f ° � 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE ' } TP-2 ( W14 STONE AROUND \ ................................. ... ... ... ....... _` �.: N �.: LOAMY IOYR LDAMY DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION r :E,- ! :� r IOYR ., B B OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE SAND 4/6 SAND 4/6 y a _ CONSTRUCTION INSPECTIONS. <_ ........ tVE� 22 115.7 22 113.6 ...... .. .... .::..... 3 .. :�r�.s _,, ` MEDIUM D-Box i Qp C / IOYR C / MEDIUM IOYR , SAND 6/8 SAND_ 6/8 9. EXISTING LEACHING TO BE PUMPED DRY, ` REMOVED r4,r \ - , ��.. ................................ 38 l l 4.3 32 I !2.7 UNDER AND WITHIN 5 FEET OF THE NEW SAS AND RM ON GARAGE C2 SILT IOYR C SILT IOYR BACKFILLED WITH CLEAN SAND. ti +o \ y SLAB. EL-I I s.2s LOAM 5/6 LOAM 5/6 LOT 150 Q� 54' .............:........:...:.....::....... 113.0 60' .... .... ..... ....... 110.4 16. 515+ S. F. MEDI UM IOYR MED I UM IOYR + C,� C \ \ + N o SAND 6/4 SAND 6/4 LISTING �„ NO WATER NO WATER t ,.. ' ---.� .+• '�G � ;i., o,�,,y�F 120 107.5 /44 _ I034 ,. SPTIC TANK F!` F \j . NIL ••. ``� ,, �, ` •, � '`o- ,.,..t�<; may 9lt4�s��i� , DATE: MAY 20 2011 L. TEST BY:' STEPHEN HAAS •� 1 o ' W T S "F 1 LAVES ED BY: DONAt D DESMARA l S • `, `. �. \ V PERK RATE: l 2 MIN/I NCH Zo zt f ° VARIANCES REQUIRED : TITLE 5, MAXIMUM FEASIBLE COMPLIANCE y` SECTION 15221 r7 GENERAL f 1 CONSTRUCTION REQUIREMENTS THE TOP OF ALL SYSTEM COMPONENTS SHALL BE NO MORE THAN 36' DEEP: i 5 FOOT OF COVER IS PROPOSED AT THE DEEP END OF THE SAS. A 2' VARIANCE IS REQUESTED. - 1 S P 7`T % ,C S Y S 7 EM OE S / G/�/ 2e50 JOE THOMPSO/V R© . IVAP / 74 . PAROE t •mow WEST SARMS TABLE . M,�1 0 LEGEND 1 .1 It �- ■ CB CONCRETE BOUND •lo xI qo���` _1V WATER LINE > S (::-AL E : ' / 2 0 .J(JIVE- ! 3 2 0 / / aDOLERI o~L 000S .. O HYDRANT �7 -G GAS L I NE EAGI- E SUFRVEY I NG 1 NC JOE rxoMeS.'.._.w_ ------ , ` OHW.-- OVER..HEAD WIRES - J cJ23 Rou t e 6A # LIGHT POST .� �` , y }! E UNDERGROUND ELECTRIC L`I NE ' `-.� Y a r rt io u t h p o c t MA . 02675 -T °UNDERGROUND TELEPHONE LINE /�/i%�T\ / 1 508 3 6 2-8 1 32 //I /�+ CTV- ' UNDERGROUND CABLEVISION LINE 508 432-5333 +40.4 SPOT ELEVATION 40 EXISTING CONTOUR + 40 PROPOSED CONTOUR L ocvs MAP 0 10 20 40 JOB 0: 1 1°-048 F 1 :CAN , C LC: SA /CFW CH CK: CFW DRN: SAH ` BN ELD AL A H E r . k ,