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0298 JOE THOMPSON ROAD - Health
298 JOE THOMPSON ROAD West Bamstable A= 174-001 -060 _ o I I I �I TOWN OF BARNSTABLE LOCATION ( d �J�j�� ,�s(,n `Z(f SEWAGE# '\'tLLAGE �TAr Qr�,r,,!bVz,0 tASSESSOR'S MAP&PARCEL /?V - 0()J—060 INSTALLER'S.NAME&PHONE NO. Sc C-, sue)' a?cy 0061 SEPTIC TANK CAPACITY e m-,4 /S-0 U 1) Q O)c LEACHING FACILITY:(ty� j� ��ak� -T� (size) �,� w }C ,/ X•�,� -.. Ila 0 :'"�'NO:.OF BEDROOMS �OWIER PERMIT DATE: (� 1 7 (0 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 ��rr on site or within 200 feet of leaching facility) /'1 feet ` Edge of Wetland and L• aching Facility(if any wetlands exist within 300 feet of leaching facility). feet *:t { FURNISHED BY . A L4 / S y\ ts � 1 0 ° '� T,1efi f Commonwealth of Massachusetts 00/_0&0 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 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 A. Inspector Information S filling out forms 4 IL1114f � on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane ICI Company Address Centerville Ma 02632 City/Town State Zip Code Ifew CI 774-248-4850 smjonestitle5@gmail.com, S14522 sean@smjonestltle5.com License Number B. Certification 1 certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1, ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Ap V'i—ng Authority 4. ❑ Fails 9/6/2019 . Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate I regional office of the DEP. The original form should be sent to the system owner and copies sent to I the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 298 Joe Thompson Rd West Barnstable is served by a Title V septic system consisting of a 1500 gallon septic tank, 2x distribution box and a row of 4 3050 Infiltrators. The system was found to be in proper working condition at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ d stribution 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): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 1.00 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 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. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. 0 ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 298 Joe Thompson Road v Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 gpd Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes 0 No If yes, discharges to: 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 years usage (gpd)): Detail Sump pump? ❑ Yes ® No current Last date of occupancy: Date l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 r Commonwealth of Massachusetts 27 Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No . Water treatment unit present? ❑ Yes ❑ No If yes, discharges to Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: system repaired 6/23/2010 per town records Were sewage odors detected when arriving at the site? ❑ Yes .® No 5. Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage, vented through roof. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form <� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: Tv Distance from top of sludge to bottom of outlet tee or baffle 3.5' 1„ Scum thickness Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. Water level was even with outlet, tank was not leaking and was structurally sound. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Vol u ntary.Assessments 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 298 Joe Thompso-i Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. City/Town State Zip Code Date of Inspection D. System Information(cont.) 8. Tight or Holding Tank(cont.) Alarm present ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required).Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 01. 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.): System has 2 distribution boxes inline. Both boxes were video inspected and found in good condition with no rot and no sign of past hydraulic overloading. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form v Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No*. Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 43050 Infiltrators. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: l5insp.doc•rev.Z126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching facility was video inspected and found with a few inches of standing water and no signs of past overloading 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �^ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is West Barnstable Ma 02668 9/6/2019 required for every a e. City/Town State Zip Code Date of Inspection P9 p p D. System Information(cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 298 Joe Thompson Road lug,- _' — Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A =, 4a GA,> s� � Q}o p Box e� 0 t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 l Commonwealth of Massachusetts A Title 5 Official Inspection Form io Subsurface Sewage.Disposal System Form -Not for Voluntary.Assessments 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7!2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Tt Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 298 Joe Thompson Road Property Address Sharon Rood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/6/2019 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tigl t/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 l5insp.doc•rev.7,2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 L TOWN OF BARNSTABLE LOCATION SEWAGE #?,:57=Ff VILLAGE ASSESSOR'S MAP & LOT 6o/. , d INSTALLER'S NAME 6t PHONE NO. � D`oS�b�inii7%l�cb�%G�:� c. SEPTIC TANK CAPACITY LEACHING FAC I'�Y:(yp (size) 1 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER R OWNER p DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED• VARIANCE GRANTED: Yes .� ��� �����9 � , ,�� 0 9'*901lT&AV% 69ANSTABLE LOCATION C1T l,l- YO-1 `2,,4s, 46 SEWAGE # 9 V-Z VILLAGE. k.�jj( w 6-t& V ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY j chi LEACHING FACILITY<)-t' ) VIT. (size) �J-l3U w NO. OF BEDROOMS. - ` PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 0,A-- �n DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE. GRANTED: Yes No FCC iT AL � ` y 4 3 No.. ..y...... FRS.... p .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Bi-nVn!3ttl Wor1w Towitrnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:-, ...... -ol- Lor 'ou-ieddress or Lot No. --- ------------------------------------------- --------------------------- --------------------...............--------.....---- Owner Address Installer Address Type of Building Size Lot_.�3���.....Sq. feet .., Dwelling—No. of Bedrooms_________________________ -----_--._Expansi�j' Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons__-! ------------------- Showers (3) — Cafeteria ( ) A. O er fi res ..........-------------------------------------------------------------------------------------- W Design Flow.... ........... .....gallons per person per day. Total daily flow--- _ __.___..._ ........gallons. WSeptic Tank—Liquid capacity.1-SOO_galIons Length---S7...... Width_--T....... Diameter..-------- Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No._---.,_.-._.-. --. Diameter.................... Depth below inlet.................... Total leaching area---_..............sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..................... Lt, Test Pit No. 2................minutes per inch Depth of Test Pit--.-_---_.______-__- Depth to ground water........................ �+ -•--•------------- ----------------••----•......••-••-•-•-------•---•---------•-•-•---••--•..._........._..•--.............--•---......-•-------...----•---- ODescription of Soil...................................................................................... -----------------....---------------------------------............•-•-•---------- x U ....-•---•-------•------•-•••-----.._...-•---••---•--------•-------•--••---•-----------••••--•-----•••--------------•----•---•---•----•--------------•---••-----------------•----•-•-----•.....---...... w x -----•----------------------•---------•--•--------------•--•--------•-------------------------------------------------------------------------•--•--------•-•. -- -•---------•-----•-•••-•-•--•-•---- U Nature of Repairs or Alterations—Answer when applicable._ ,1.4_S._-�c..F_I... .. ................................... Agreement: The undersigned agrees to install the aforedescribed Individual'Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environ al Cod — undersigned further agrees not to place the system in operation until a Certificate of Comp Iance ha bee issued b the board h. l� Signed ..... �'.�.�.----- --- --���... .. . .. ------------------------------- Date Application Approved B PP PP y ---------- ... � - ..... /..6--"--� <' Dare Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------I....--............... ...... .. ......_..............................................._.. .... ....... ....... ............ ...... - ............................................ ......--------------------------------- Permit No. -. .....-..... .6.6. Issued ---------------- ...............................e...... Date No. FEB c .... THE COMMONWEALTH OF MASSACHUSETTS r t BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Modw Tonstrnr#inn rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Loc ion-[ddress or Lot No. --.... VL � ................................................. -----------•......•-----._.._...---- -------..-......---........---•-----..........--•--- J - Owner Address i —in --•--•----•--•----• � �� �'f �(n�i 1 Installer ( Address U Type of Building Size Lot. .....Sq. feet ►� Dwelling—No. of Bedrooms_________________________ ___--._.-_Expansio Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons--_ --__________-_--_-. Showers (ZS — Cafeteria ( ) dOther�� res ------------------------•---------------------------- -------:�-•--•- W Design Flow..__.:_.._______ ______________^___-_gallons per person per day. Total daily flow-.-�3..............................gallons. WSeptic Tank—Liquid capacity,.S�DgalIons Length -------- Width__.____... Diameter-._-._--_-Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------- ............. Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by....... ------------------•--------------..•••-•---.._.._......•-•••-••... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ C4 ---•----•----•--------------------------••--------••----••-••••••-----•••••••--••••.........._------........................................................ ODescription of Soil....................................................................................................................................................................... W .............................................. ............... ••-•••-•--•-•--•-••••----------------------------••--•--•--•-••-••--------••••-•-•••---•--•----•••••-••----.............................. W -_ '_ x -•••--•------------------------•-•......--------•••-----------....--------------------•••••.------------------------------.....----••---------------•••••••. -- Nature of Repairs or Alterations—Answer when applicable.- 4:S_.__ -._r-.__,� _. V U P PP - v V ------------•--------•-•------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environ al Code=Tl� undersigned further agrees not to place the system in operation until a Certificate of Comp lance ha bee issued b the board ofrh-e ih. Signed ........ ....... ..4 . ..-.r. � � ........ ^..y..... f... Date r' �. . .....APPlication Approved By ---------- - . t ; e ----... Application ....G Disapproved for the following,reasons: ............... . ........................... ...........................tt----------------------------------------------------- - r Date 7 PermitNo. ..... y............15 . ------------- ----'/ ���-�'' i - t.„ Issued .................:.....Dare............................................ " ------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Vir TOWN OF BARNSTABLE \:LErtifirate of Carali inurrr, THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) yI Ct>� -------------------------------.........-------------------------------------------------............-------------------------- at ...... Q - . i ytau X. ............ ............. has been installed in accordance ith the provisions of TITLE 5 of�The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....................................._....... dated ......_...._---------------------------_.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------! ....... ._..f -- - Inspect r= ... - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Disposal Vorkp Tnns#rudion "rrmit Permissionis hereby granted.---------------V---J- .----------------------------------------------•----•-------.......•--..._......__. to Construct (X) or Repair ( an Individual Sewage Disposal System at No.---•-•. �- t' v� -----.. ? � �� ._... -------- ;r'fir / r'? cl l ° ....................... Street p �• e} as shown on the application for Disposal Whorls Construction Permit No.7 f.�S_- , _ Dated______...0_`.. _..7.___..'_........ ................................. ....................................................... L � DATE................. J 7•- ` ................................ Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS Town of Barnstable P# Department of Regulatory Services a,MaTABLX : Public Health Division Date .� t6A 200 Main Street,Hyannis MA 02601 Date Scheduled IL7 Time- j Fee Pd. (OD Soil Suitability Assessment for Sewage isposal Y Performed By: / Witnessed By: ,yr loll, ,� _ (' Location Address LOCATION& GENERAL INFORMATION n ✓ Owner's Name Ac'� �o O Address Assessor's Map/Parcel: D t/ Engineer's Name '6 nWt✓- �ku.C�1 NEW CONSTRUCTION REPAIR Telephone—� 1 lephone# �. Land Use Slopes(%) to Surface Stones N t� Distances from: .Open Water Body ft Possible Wet Area ft Drinking Water Well — ft Drainage Way ft Property Line /�f ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) S Pva, 0 - to Parent material(geologic) How / Depth to Bedrock 2U 0 r Depth to Groundwater. Standing Water in Hole: PIAWeeping from Pit Facern Estimated Seasonal High Groundwater N J DETERNIINATION FOR SEASONAL HIGH WATER TABLE Method Used: AXJtiC Depth Observed standing in obs.hole: in, Depth to soil mottles: !rin. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level „ Ac ,}hetor Adj.droundwnter Level,, , f Observation PERCOLATION TEST Date Hole# Time at9" Zlr";Alu Depth of Pero Time at 6" 3 0 Start Pre-soak Time @ O' - '11mie(9"•6") 30 End Pre-soak Rate MinJInch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)T_ Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior'to beginning. Q:\SEPTICU'ERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# A Depth from Soil Horizon Soil Texture .Soil Color, Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) F " A L 5 p k ' Z Y � S,4WD Y Loxes► �o Y� '�6 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi t n Flood Insurance Rate Map. Above 500 year flood boundary No_ Yes -Within 500 year boundary No--!:f Yes, Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas,observed throughout the area proposed for the soil absorption system? j:-5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on �� `� (date)I have passed the soil evaluator examination approved by the . Department of Environmental Protection and that the above analysis was performed by me consistent with the required trai ' g expertise and experience described in 310 CMR 15.017. Signatur Date Z f Q-.\ EPTJCIPERCFORM.DOC No. 510 " '' `" Fee l J_ � , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplitatiou for Mioozal *paem Cou5tructiou permit Application for a Permit to Construct( ) Repair(1/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (`� ��� Own 's N me,Address, d Tel.N �. � r VQ6 Assessor's Map/Parcel U Instaal 011e`r's1�m�,Address,and Tel No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size �d sq. ft. Garbage Grinder (J� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 41 7T gpd Plan Date q Number of sheets Revision Date 11 Title Size of Septic Tank ® S__rjQ) Type of S. Description of Soil JGe_d" V-C>[A Nature of Repairs or Alterations(Answer when applicable) cep(6k r t Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed - Date Application Approved by Date ��'� Application Disapproved by: Date �T for the following reasons Permit No. l ��' Date Issued - ----- - - - - - - -- - No. a t/'j} '� tY � �;a; r. _ Fee l �- ` THE COMMONWEALTH OF MASSACHUSETTt" Entered ncornpu Y es tFr:� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYicatiou for Tfgpogar 44pgtem Congtruction Vertu Application for a Permit to Construct( ) Repair(d Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. � Ow� 'srNa_me,Address, d Tel.NJ. Assessor's Map/Parcel UU i ,,, O 6 Installer's N me Address and Tel.No. Designer's Name,Address and Tel.No. t�3 �,J �4 n � G f `Z� 36 d�f aC Type of Building: /C,{ Dwelling No.of Bedrooms Lot Size /d 0 sq. ft. Garbage Grinder (1W Other Type of Building No.of Persons Showers( ) Cafeteria ti Other Fixtures Design Flow(min.required) 3 O gpd Design flow provided 7Jr. gpd Plan Date Number of sheets Revision Date' Title on Size of Septic Tank Type of S. CG• -b--k_ ' Description of Soil *25C.rCw LnCA,, A- Cr re a=r� Nature of Repairs or Alterations(Answer when applicable) (e ptG C--f C Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed i Date �,///7 ((} PP PP Y � Application Approved b Date Application Disapproved by: Date for the following reasons I Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ✓) Upgraded Abandoned( )by 7NC-p1A 1;�t-- _V,, at I)COC ,Y!je A- o K /� (�J (4. 0 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. O 17 b dated o Installer `< IL 11�7 c-_t� Designer (�� }t� ,n� \je #bedrooms _Z Approved design flq gpd The issuance of thi permit shall not be construed as a guarantee that the system will fu "'Un as desi ed. Date i/j /t p Inspector •vv. Y'� No.C- .-o (/ " ( Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS Tigpogal *pgtem o gtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. �n Date (/1" l f Approved by i ► + I , ' G�L��'t�-� -� t 1�'`� Town of Barnstable el.HE Tp� / Regulatory Services s�xnisTABt,E, MASS. F.,Geiler, Director 039. Public Health Division rFDMA,�A Thomas McKean, Director 200.Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# U\ _)� Assessor's Ma \Parcel _ Designer: �� -}�—►J Jl, �- 5 pE Installer: 1jCcT r - ► . Address: 92,3 Zt ,Z e,A Address: i15 L5L—b YA2j-(6-tri-+ R7b, G' � �/b►-� was issued a permit to install a (date) (installer) septic system at R(:AId oe" ed on a design drawn by (address) S-17E PH A A. 14.gq�, PE- dated (desigffer) 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 changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. ,.J,.,,,,PA,l 'was::•'�.;:..,,.!y (Installer's Signature) CIVIL� �AL (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. QASepticWesigner Certification Form Revised.doc CI TRANS. NO.: CITY/TOWN: APPLICANT: � �>> ADDRESS: 0913 DESIGN FLOW: 3,30 gpd REVIEWED BY: DATE: S� v N/A OK NO ""a Legal Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot,tax parcel number and lot number noted on plan [310 / CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] z/ Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) / [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] ' System Calculations [310 CMR 15.220(4)(0] daily flow septic tank capacity(required and provided) soil absorption system(required andprovided) a/ whether system designed for garbage gruzder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CNM 15.220(4)(h) and (i)] Location and date of percolation tests (perfonned at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address ����� G�� Sheet 1 of 7 N/A OK NO Location of every water supply, public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in.310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR / 15.000] System components not >36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] Address Sheet 2 of 7 r N/A OK NO SizeOK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5"per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees(no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1 000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks fiom resources [310 CMR 15.211] Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and (3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address 1-7 Sheet 3 of 7 N/A OK NO Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line(when water and / sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable / [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/(leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 / CMR 15.323(3)(a)] V Riser if deeper than 9" [310 CMR 15.232(3)(0] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] PLT1VIPCIA�MBE�2Ss n. x« � 3h« Capacity(emergency storage above working—design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and(8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)] Address / `7 /UG y�� Sheet 4 of 7 N/A OK NO OIL SO TI'OIS� 'SESS ) E9EL d �y� yy Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] ✓ Required separation to groundwater? [310 CMR 15.212)] V1, Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or / >36"deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)'l Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet / every 20 ft. [310 CMR 15.253(6)] i/ Each structure with one inspection manhole(if>2000 gpd must ✓ be to grade) [310 CMR 15.253(2)] Aggregate 1' minimum- 4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40.sq. ft. [310 CMR 15.253(6)] RENCHLS�31OC1I . 55 � ' _ �s dM.,,.. ,.,�' aka.H „z� x - �« yxa "�'s @�, ,a��: �`;° :�;,".r $.%`Yz Width T minimum T maximum [310 CMR.15.251(1)(b)] 100 feet-maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches)..[310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] BEDrkSAS�{I1%Ia_x�m_ owl,If SOOT d) . _ IN � �� �� h , � a minimum 2 distribution lines [310 CMR 15.252(2)(a)] ' Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.25242)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] . Separation between beds 10'minimum. [310 CMR 15.252(2)(0] Bottom area used in calculations only[310 CMR 15.252(2)(1)] E Address 17 Sheet 5 of 7 N/A OK NO rDID ,HE 'L" 1�1 <OE"S I � :�� � E � ,1 � ,�,.�r�,s,<.', r.�aA' , ,. i e G:`�, .v,.L ,.�s :z'm�e „ Pressure Dosed System ? Provided pump and piping V calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill - Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer[310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Gra e Zess Syste�m jllA PeOL, e"..b, Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Ar7ter�aattveSetcstem AAPProvuletteas] MIM :; � �� . Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance 1 WE�ll7lQflCe ,.z z- x z � 1, u, ,apt: Are the variances listed on the plan ? [310 CMR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 / CMR 15.414] Address /7 7 ��Gi Sheet 6 of 7 . N/A OK NO � rv,.�n,,,,,lt1 ogCIZ;.S'elZsztly_eArL'aS4 '� � � �f � w�c€y�� � sa7 k,,.v's� Is the system in a Designated Nitrogen Sensitive Area(Zone 11 for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is they system proposed on the same lot as served by private well ? 1310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] � e .0,`'`�✓�a, �xt �g-r' z � ��.4."h ^"n.� wRw sa co '�.�'�zz��3 s, s�.,'�`tx ^+ � y ,�� ,xS�� ?F"3s x�x «raz� a� �.r±'� Miscellazzeous Pumping to septic tank? '[ 310 CMR 15.229] Shared System [310 CMR 15.290] i i Address 7��G-o - �'�C' Sheet 7 of 7 �q ©p/ No.....i � -- .. Fps....`3............. ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Dijon ial Wnr w Toufarurtiou f rruti# Application is hereby made for a Permit to Construct ( ) or Repair (C4-an Individual Sewage Disposal System at ocation-Address or Lot No. �v�?-.-_. DA B . 9rmOso................................................. ------ ---� t- Owner a �yJ y�� ���,fit � / �� j ,/�� ,,c,�C:� /��Q/�^/Ad ress�w//� OTT........ �p� �� ('� N .......^.!:—..c� 1!N!��._/�/N 7'V .....�/.f�i� ..._... C ''d._ ....�_.____t_..._.. Cam) F-1 ... ........ .. ... .............. f_ _ .......... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms-------------- _ _______.Expansion Attic ( ) Garbage Grinder ( ) aOther—T'ype of Building ____________________________ No. of persons__--____________--..____-_.- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------- - - W Design Flow.............. .....................gallons per person per day. Total daily flow.............. :X9.0.....gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter---------------- Depth................ x Disposal Trench—No_ __________________ Width.................... Total Length-------------_---- Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... Test Pit No. I................mmutes per inch Depth of Test Pit_.___________---__ Depth to ground water...._..___.............. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �4 ------------- ---------------------------------------------•------------------------........._---_............--•---........._..--------------......---.•---- ODescription of Soil........................................................................................................................................................................ x U ----.. W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature 9f Repairs or Alterations—Answer when applicable....----/ ...... .------ �Z� ... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h ee is ued t board of health. Signed .............. �................. ` �� ----......-.. Dace p, Application Approved BY C .. - ,-n..�........................... Dal..-..-/-��� te Application Disapproved for the following reasons: --------- ------------------------------------------------------------------------------------------------------------------ . ...--. .. .......................................... . ....................... ......................_ q �. Permit No. ....... .............................. Issued ..... -- - Due i Tel ©O/ . E>6(0 No.._..1..CC���R.. Fss....''�7. ... �.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE . Ap.pliratiou for Dijapoittl Work.5 Towitrnrtion f umit Application is hereby made for a Permit to Construct ( ) or Repair ( _ an Individual Sewage Disposal System at: .................................. ....J^7J� � vn�.SG�► a 0 (,J i`/�n1.�;��L� Location•Address L.,ot No ...................... � _> _IS �o. e ! ................................. owner C—e)\}J I�:L-' ( V;6' W,/���i1� ./ Y4S�CJf-„-J ddress� -.....----•----•....................•----••-•-----------•----'-•-'-'-----••----------.... .......------------........................._....................................................(/Y 1 a Installer Address PQ vType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms-------------- _------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.-_-____-_-_--______--_--- Showers ( ) — Cafeteria ( ) dOther fixtures .----•--------------•----------------------------------------•-•----------------------- ---------------•-----------------------•--------....----- .. W Design Flow.............. ..............__..gallons per person per day. Total daily flow...__...._.. ___-��_-� .....gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) W Percolation Test Results Performed by.......-.................................................................. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water.-.-_.-.-_.__-__-.-----_ r;L, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -------•---•----------------------------------------------------------•-------------.._..........---...................................... .---- •-'----•----- ODescription of Soil....................................................................................................................................................................... x U ------------------------•-'----•---------------•----•----------•--...------------------•-'-•------------------••--•---•--------------------•-------------------•---------------...."-------'-'----•--•. W U Nature of Repairs or Alterations—Answer when applicable.------. _..:/..............:....... !_*...�........�_�............_. ,,2 ^ C� r ...._�!a....--=.�5.. ��. .c ....__ .A'0'k4 ........(.�)._': :a.....�t � 0 G ?�c� o-C_ -S E191!c..�A�)4:L, ...._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has/been issued /b tbe,board of health. / Signed ------------- j.� ( ,// Date Application Approved By ......................�� JJ ..... -------7, Date Application Disapproved for the following reasons- ------- -------------------------------------------------- ------------------------------------------------------------------------ . ........................................ ............................................................. ...................... :........... Date PermitNo. ....'" '.?--------------------------- Issued ............. . ............. .. .................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ('Iez#ifirate of Q-Tootplianre THIS IS TO CERTIFY,, 1h.a{ the Individual Sewage Disposal System constructed ( ) or Repaired ( � ) by ... .... � .'.CJ. �� G .,-----------------C:P.0 i.s�72tet,C�----- -----. installer _ at ... .. . z . - /S `') �..�.........`,.7�J�....--���lVv1��SlhJ =�d�?Q... � ' ......../ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. PP P 277. - dated ........... ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.. DATE........... -" �.../........ Inspect _!- ..� - -).. -- - --------- ' ' - ------ -�------ ----------,---------------,------------------------- ---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 2 TOWN OF BARNSTABLE ................... FEE........................ Dispoal Vorkn Tanotrudion ramit Permission is hereby �granted................... <.d... Gi�l-)-7 ._ �^j '- n `' �G^I = ---------------------------'--............... to Construct ( ) or Repair O an Individual Sewage Disposal System atNo................... ....... Street / ���.. � ....as shown on the application for Disposal Works Construction Permit No--- _....,_ __ Dated........... ....:. � �.� .................•---------------...----- -�77 ~ d of Health---•-------------------------•---------•--•- DATE............... - - Y.\.�-7'—"- ...----.....--•------------ Boa t FORM 3870E HOBBS&WARREN,INC..PUBLISHERS l_ I 152 � �� / FLOOR 150 �� �� REINFORCED CONCRETE DISTRIBUTION BOX b THREE OUTLETS FOUNDATION 148 _� ' _ DRAIN 146 •��- W W EL V 137.25 1T' MIN _ 2P 4 SCHEDU 12" MIN •- s- o.os S- .03s 144 — �� 9' INV ELEV 136.25 142 INV ELEV 135.75 6. FOOTING PLAN VIEW INV ELEV 135.58 SCALE: 1° = 40' �� INV ELEV 135.00 INV ELEV 136.00 - ELEV 130.50 8 1500 GALLON — — — — EXISTING 140 �m '�,yp � PRECAST CONC � FROST WALL SEPTIC TANK mQ1� ' 0 ` WITH TWO PROPOSED 144 SCH 40 PVC 1500 v°� a41oN C TAW �,� QP� � 12' MIN f' TO 8' WASHED STONE TEES PROFILE L+� 146 s6' NOT TO SCALE 138 20' LEACHING PIT ELEV 127.0 T P C EST) 146 144 LEACHING PIT ) 1 42 ESERVE AR 1 3 6--- RE LEACHING PIT NOTES: SEPTIC TANKS SHALL BE WATER TIGHT AND CONSTRUCTED OF SOUND AND DURABLE MATERIALS NOT SUBJECT TO EXCESSIVE CORROSION, DECAY OR FROST DAMAGE OR TO CRACKING OR BUCKLING DUE TO SETTLEMENT OR BACKFILLING. TANKS AND COVERS SHALL BE DESIGNED AND CONSTRUCTED TO WITHSTAND 1 q ANTICIPATED LOADINGS. - ® INLET AND OUTLET TEES SHALL BE OF SCHEDULE 40 PVC AND A® SHALL EXTEND A MINIMUM OF SIX (6) INCHES ABOVE THE FLOW DESIGN CALCULATIONS ODE — OF THE SEPTIC TANK AND ON THE CENTER LINE OF THE SEPTIC SEPTIC TANK LOCATED DIRECTLY UNDER THE CLEANOUT MANHOLES. FLOW: THERE 138 BETWEENHTHE STOPS OFTE AN AIR HE TEES A D TSPACE OF AT HE AST INSIDE EOFNTHE TANK 3 BEDROOMS ® 110 GALLONS �— COVER AND THE TOPS OF THE TEES SHALL BE LEFT OPEN. 330 GALLONS PER DAY \ / THE INLET TEE SHALL EXTEND 13 INCHES BELOW THE FLOW LINE AND 111E OUTLET SHALL EXTEND NINETEEN (19) INCHES DELOW SEPTIC TANK: 1500 GALLONS 134 ---- 136 THE FLOW LINE. LEACHING PIT REQUIREMENTS,: INVERT ELEVATION OF SEPTIC TANK SHALL BE AT LEAST TWO BARNSTABLE CODE: 6' X 8' 132 CB 134 INCHES ABOVE THE INLET ELEVATION OF THE OUTLET. 1000 GALLON CAPACITY CB LEACHING PITS SHALL BE CONSTRUCTED OF BRICK, PERFORATED PERCOLATION RATE: 3 MIN/INCH 132 CONCRETE OR INTERLOCKING CONCRETE BLOCKS LAID DRY WITH OPEN JOINTS. AT LEAST 12 INCHES BUT NOT MORE THAN 48 OR LESS (CAPITAL ANALYSIS — INCHES OF 3/4" TO 1 1/2' STONE SHALL BE PLACED AROUND THE GREG SHORT ENGINEER, 10-21-87) LINER. THE COVER SHALL BE CONSTRUCTED OF REINFORCED CONCRETE. THIS SYSTEM IS NOT DESIGNED TO ' ACCOMODATE A GARBAGE GRINDER ALL CONSTRUCTION SHALL CONFORM TO THE REQUIREMENTS OF TITLE V of 310 CMR 15 AND THE TOWN OF �^ 1500 GALLON SEPTIC TANK L,,`5�.°, tK OF BARNSTABLE INV AT FDN 137.50 LOAM & ELEV 139.0 'y THE DESIGN ENGINEER SHALL BE 0 SUBSOIL 2 0 NOTIFIED 48 HOURS PRIOR TO REQUIRED INSPECTIONS. INV OUT 136.35 VERY FINE /vNO 1 INV IN 136.60 SAND Q FINE SAND A4014 '4 AND 'STONE SYSTEM DETAIL s RESERVE AREA INV IN 136.10 FUTURE LEACHING PIT TRACES OF NOT TO SCALE INV OUT 135.93 „ ems'":"'s SILT NOTE: BOTTOM SEPTIC TANK D — F:7 REVISIONS: BOX '1 �.� POCKET OF ELEV 130.5 DESIGNED BY: JGV DRAWN BY: JGV CHECKED BY: JAV INV IN 134.66 /��:< + , »`� VERY TIGHT 16' MIN ` -y-' AND �"ND°STONE SEWAGE DISPOSAL DESIGN i ON STREET —BOTTOM LEACHING PIT SIDE OF ELEV 127.0 LOT 152 JOE THOMPSON ROAD 1r MIN WASHED STONE HOLE ONLY BARNSTABLE, MASS I 6' X 8' LEACHING PIT 0 6 8' NO WATER ELEV 124.0 SCALE: AS SHOWN JULY 18, 1994 VOZZ A DESIGN GROUP 3841 WASNINGTON STREET BOSTO N. MA—263-8282 02131 eiT-ae�-e2es i I I 7 71 7A T�-' 7 _ d : i , r ' • , e _ r I _ ACCESS COVERS MUST BE W!THIN SPE T ON , IN C ! 9 MINIMUM. ` I V N E T R EL E VA T 1 ONS DESIGN CRITER IA . . ' 6 OF FINISH GRADE GENERAL NOTES : PORT ` 3 MAXIMUM COVER - DESIGN F ' , : FIRST,2 TO LOW . lNYE 0 704.0 - _ Rt UT SEPTIC .TANK ., MIN OF P A T N 2 E S O E 3 BEDROOMS AT 1 !. THIS PLAN IS S F0 :I. BE LEVEL 10 G.P.D. PER R THE DESIGN AND CONSTRUCTION . INVERT lN`DIST. BOX. 102. 1T 0 I B R FILTER FABRIC- " BEDROOM'EQUALS OF THE SEWAGE DISPOSAL 1 INVERT OUT D l 102.0 E U LS 330 G.P.D. `` E D!S 0 AL :SYSTEM ONLY. 4 D A�u PI U ST. BOX 3/4 -' 1 _I/2 DIA. ' 98,5 INVERT (N'LEACH:CHAMBER. ' . NO GARBAGE 2. VERTICA o B GE GRINDER L DATUM /S ASSUMED. FOR BENCH .MARKS DOUB E W 104.0 102 0 e L ASKED STONE . 2 H 20 % 96.5 BOTTOM OF LEACH CHAMBER , GAS SET, SEE SITE TE PLAN. $ 96 5 BAFFLE 102.J7 98.5 _. !ADJU5 TED GROUND WATER._. N/A _ � SEPTIC TANK REQUIRED. 4 I NF t TRA TOR 050 'S 3 UT I 3 OUTLET N/A _ EXISTING , OBSERVED GROUNDWATER. 330 G.P.D. `X-200x 660 GAL. J. ALL CONSTRUCTION METHODS AND MATERIALS AND D 80X TONE AROUND. 12 r x 6 / 'x 2 d SEPTIC T � MA I NT N F. <-; < � BOTTOM OF TEST HOLE 92.5 - E T!C TANK PROVIDED. I500 GAL. .EX/STING ENA CE 0 THE SEPTIC SYSTEM.-SHALL 1500 GAL i � CONFORM TO 'MASS = ` SEPTIC l C TANK D.E.P. TITLE 5 AND LOCAL ' 6 CRUSHED STONE R E E 0 . SOILBSO BOARD OF E COMPACTED BASE - A RPTION TEM REQUIRED. HEALTH REGULATIONS. DESIGN PERC RA - � T � O MlN/INCH. _ 4 SOIL TEXTURAL ALL SEPTIC SYSTEM OM XT RAC ,CL S,, I l C PONENTS,LOCATED UNDER PROF I L_E NOT TO SCALE � , EFFLUENT LOADING RATE AREAS SUBJECT0.60-GPD/SF TO ..VEHICULAR TRAFFIC OR GREATER - ' SQUIRED 3.30 GPD /_0.60 GPD/SF 550 S.F. R THAN 3 IN DEPTH SHALL BE CAPABLE OF WITH STANDING H-20 WHEEL LOADS. PROVIDED: 4 INFILTRATOR ' . - \ !L TRA OR 3050 S W/4 f STONE AROUND. A_624 S.F.,< 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR Q V 624 S.F. x: 0,60 - 375 G.P.D. APPROVED ED EQUAL. _ 'N 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED ,: r r ' ;I SOIL TES T T oA TA I PRECAST CONCRETE OR APPROVED POLYETHYLENE. .; BOTH SHALL BE`WATERTIGHT. D BOX SHALL`BE WATER , INDICATES INDICATES ,:. PERCOLATION OBSERVED _ TESTED FOR_LEVEL WHEN THERE IS MORE THAN :ONE ; a :TEST GROUNDWATER , \ OUTLET. s CATCH BAs/ �- TN P * P#12883 LOT 152 .; / TP #2 > Q 7. BEFORE CONSTRUCTION CALL DIG-SAFE . 18:689+ S.F. � _ _ 1 888 IG-S � .: HORIZON TEXTURE. COLOR D AFE AND THE LOCAL WATER DEPT. : . � HORIZON TEXTURE COLOR .� ti 0 - l03.0 0 103.0 R L CATION:OF UNDERGROUND UTILITIES. _ ,- LOAMY IOYR LOAMY IOYR � ` SAND 3/2 SAND 3/2 � 8. SEPTIC S S M"_ - 1 Y TE .INSTALLER .SHALL:.NOTIFY THE. D SIGN'' 6� � E EN INFER TWO DAYS .PRIOR ;TO CONSTRUCTION- .,.....-.., � , SANDY IOYR SANDY. IOYR B B OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE_ . � LOAM 5/6 f LOAM 5/6 _.. i .....: ....: COS.. ... .:'.... ..:.....:. ... ......::,..:.................. CONSTRUCTION INSPECTIONS. � 28 d 00.7 24 ............ l 0 l.0 SILT IOYR SILT IOYR _ C� i LOAM 6/6 9.;, EXISTING CESSPOOL TO BE PUMPED DRY AND -, _' ., •� � ' �. � LOAM 6/6 f�t.rA _ 54 .. 98.5 54 ..... :.................c.....,.......•••• BACKFILL SANDY IOYR ._ F. eM HYD TAG rs9� SANDY IOYR _ EL r 03.5 r; ,,_ _•� � � ,_ LOAM AND 4/6 LOAM AND 4/6 /0. ALL UNSUITABLE`MATERIAL AHORIZONS) '( d B �GRAVEL V - ,. GRA EL ENCOUNTERED.-BELOW r E BE W THE INVERT OF THE LEACHING b• � ti Q N, .3 FAC!L I TY TO BE`REMOVEDFOR " = A DISTANCE OF 5 ^ AROUND AND :REPLACE • , _ D WITH SAND IN ACCORDANCE ., .. a ,� ,�• / _ -. - WITH TITLE 5 TP.r vEn - NO WAT NO WATER r/Nc TNREE � � ' '; -:� ' 120 ER .93.0 I26 92.3 F , 8EDR . ,. ODAI D DATE: y 4 INFILTRATOR A3v,s- TEST B Y ESTEPHN HAAS •. ., N'/4 STONE AROUND 1 WITNESSED BY: DAV! `STANTON _- D EXISTIIm}G � ` ' RATE AIT . . J' / lEXISTING A. , SEPTIC TANK. YCIVIL :�S . � � ST w 5 VAR / ANCES REQUIRED : Pool TITLE 5. MAXIMUM FEASIBLE COMPLIANCE 5 zze 2 SECTION 15.221. (7) GENERAL CONSTRUCTION REQUIREMENTS 5 THE TOP OF ALL SYSTEM COMPONENTS SHALL BE .NO MORE THAN 36 DEEP. r 5.5 FOOT OF COVER IS PROPOSED A THE DEEP END OF THE SAS• A 2.5' VARIANCE IS REQUESTED. SEPT S Y' S TE/VI OAS / G/V • 298 /OE THOMP50/V RCS . "AP 174 . PARCEL OO / - OCO S T &A ,R` IVS TA RZ E . "A . o. o ..q 9 PREP.4 REO FOR �. L EGEND ' � I i s AR TH m I m CB CONCRETE RETE r� oq• W i -}- `. _ WATER LINE x SCALE . / - 20 M,4 Y 2.5 GO .2010 SADDLE � R, , LOCUS 1��. , HYDRANT ' -.r o! I --,._-„ ' •'. G . ` GAS LINE ' I a OHW- OVER HEAD WIRES RES GL E SUFREY I NO 1 N ' _ E /� \/ � t 1�' TIGHT POST . �_ 923 - Route '6A / 1 �_ ` --E- UNDERGROUND ELECTRIC L 1NE � r Ya r mo u t h p o r t MA . 02675 M -T- / T UNDERGROUND TELEPHONE LINE ��` r I � 5 O 8 3 6 2 8 1 3 2 CTV UNDERGROUND CABLEVISION LINE 508 432 5333 40.4 SPOT EVAT ON 40 , ' EXISTING CONTOUR PROPOSED 40 44 R POSED CONTOUR O 10 20 L-oC M P . JOB O N 10 037 F 1 EL D CFW/RBWLCALC: SAH/CFW CHECK: CFW DRN. SAH S U A , : I