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Home My WebLink About0350 SANDY NECK ROAD - Health West Barnstable A= 136- 014--,002 Commonwealth of Massachusetts /a&- 0/44- 0067, ,(.A Title 5 Official Inspection Form '- X Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ------------- 350 Sandy Neck Road ` Property Address Jean Russell Trust Owner Owner's Name information is required for every 02 west Barnstable MA 02668 2/3/20 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information SIa iyy filling out forms yl on the computer, use only the tab James Ford key to move your Name of Inspector cursor-do not Ford Septic Services, LLC use the return Company Name key. P.O. Box 49 r� Company Address Osterville MA 02655 Cityrrown State Zip Code ,ems, 508-862-9400 S 12482 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.34.0 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 luation by the Local Approving Authority 4. Fails i 6� 2/4/2020 Inspec Signature Date The s m inspec r shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) ithin 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 4 Commonwealth of Massachusetts Title 5 Official Inspection Form ' - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............� 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is required for every west Barnstable MA 02668 2/3/2020 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 c Commonwealth of Massachusetts �v Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is required for every West Barnstable MA 02668 2/3/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is 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 IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is required for every West Barnstable MA 02668 2/3/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: `* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/2 6120 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is required for every West Barnstable MA 02668 2/3/2020 page. Clty/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 %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. ❑ ® 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 1_ Commonwealth of Massachusetts Title 5 Official Inspection Form X Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............M 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is West Barnstable required for every MA 02668 2/3/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for a/f 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 Commonwealth of Massachusetts _ Title 5 Official Inspection Form ! Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is every West Barnstable required for eve MA 02668 2/3/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions:' Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection 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: unknown Sump pump? ❑ Yes ® No Last date of occupancy: currently Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is West Barnstable required for every MA 02668 2/3/2020 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: Unknown Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 II i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .� 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is West Barnstable MA 02668 2/3/2020 required for every page. Cityrrown 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: Date installed -9/20/2014 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 L Commonwealth of Massachusetts it Title 5 Official Inspection Form 7� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .............c 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is required for every West Barnstable MA 02668 2/3/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 3"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 H-10 Sludge depth: 2 Distance from top of sludge to bottom of outlet tee or baffle 24 Scum thickness 4 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tee's were present. There was no sign of leaka e.The tank was pumped after the inspection t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form }� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments yy 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is every West Barnstable required for eve MA 02668 2/3/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (Iccate on site plan): Depth below grade: feet Material of construction: ;❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/a 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 purnping 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 T❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/a 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 I� L Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is required for every West Barnstable MA 02668 2/3/2020 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.): N/a 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 Even 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.): The D-box was normal. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 12 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is required for every West Barnstable MA 02668 2/3/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in workings order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a * 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: 3-chambers 41'x12' per asbuilt ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is required for every West Barnstable MA 02668 2/3/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The chambers had 3"of water on the bottom. The sides were clean.There was no sign of failure. A camera was used to inspect. 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.): n/a t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 9 P Y 18 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M�v 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is required for every West Barnstable MA 02668 2/3/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: N/a Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts - p Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is West Barnstable required for every MA 02668 2/3/2020 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 El drawing attached separately A GAfA L ► ay o�7 �AL C �� 3r 31 � i o IV D I a y 0 C. l� a aG U 3 31 a8 Y 39 as' 5353X t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts 19 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is West Barnstable required for every MA 02668 2/3/2020 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: 25' +/- 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: Topo &Water contours maps ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 _�-, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .� 350 Sandy Neck Road Property Address Jean Russell Trust Owner Owner's Name information is West Barnstable required for every MA 02668 2/3/2020 page. CltylTown 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, 3i 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: 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 i TOWN OF BARNSTABLE Date: / / TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: BUSINESS LOCATION: 350 ,rn INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: J19 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: � Q S�Lo pc�_ INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals(Devel'oper) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers +/ Windshield wash ez d- z� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials t$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you. must do.by M.G.L.-it does not give you permission to operate.) You must first obtain the necessaiy signatures on this form.at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St.-, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. lt DATE: ,." , Fill.in please: rlr(� j 6�� , I P aCti4G ,JL gr J w�Z I' APPLICANT'S YOUR NAME/S: '\ r'i c , \/j C r e, IJnit�tt (BUSINESS YO.I JR HOME DDRE S: 3 SG S> ��"'� :.TELEPHONE # Home Telephone Number r, �:3r�r��. E IN.;'or; Email Address: NAME,OF CORPO.RATION:' NAME OF NEW'BUSINESS Si \ Le, -As'C.. 'ki TYPE OF BUSINESS IS THIS A HOME OCCUPATIQN?. ES NO ADDRESS OF BUSINESS 5� S 1U¢G MAP/PARCEL NUMBER ( 7 14L (Assessing). When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intehded to assist you in obtaining the information you may need. You MUST GO TO 200 Main St.— (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits.and licenses required to legally operate your business in this town. 1. BUILDING C MISSIO R'S OFFI�E This indivi ual h s,-e nfnf�r e f any�em'te ui eme is that pertain to this type of business.MUST COMPLY WITH SOME OOOC3PAT109� RULES AND REGULATIONS. FAILURE TO Auth d i natu * ';ONIPJ Y MAY RESULT IN FINES. \COMMENTC \n I ao 2. BOARD OF -ALTH This individual ha� bebn informed o x/�� t requirements that pertain to this type of business. . / fit -- AIUS CO APLY WITH ALA: A&rizedSignature** �"` HAZQiRDOUS MATERIALB'RECi AIS COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** e* COMMENTS: TOWN OF BARNSTABLE q LOCVTIEN �� ® � /`�O� rec ° SEWAGE#VIL �� Nl e ASSESSOR'S MAP&PARCEL _Tu� I� '-2 INSTALLER'S NAME&PHONE NO. Jam° s 9'"s-O OJ SEPTIC TANK CAPACITY /.,3'0 a LEACHING FACILITY:(type) fro,.e(size) >c NO.OF BEDROOMS OWNER J2&V �Plf v1✓� 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist w' 300 feet of leaching facility) Feet FURNISHED BY N-oo�G' 6 dam` S 3 = 0 � - 31 " No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppliLatlon for MispoSal *pstem ConstrUttlon permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No._?,<0 I/,�N �y NIec�O�� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel /3 6 /c/,Z /68 /r /"z(/f./ Installer's Name,Address,and Tel.No. >�o�-_s^v _�v v�- Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 5—/ -P-j / sq.ft. Garbage Grinder( ) Other Type of Building /1,G J No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Cj gpd Design flow provided S��, �� gpd Plan Date .r_ eo O Number of sheets l Revision Date Title Size of Septic Tank /J�0 0 Type of S.A.S. p p L-9AC ' z 44,..��f Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issubbs Board of Health. J'O�-,�'O /�' f (�Off' ed A Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued d. f r/• ;a t No. �„ _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: , PUBLIC HEALTH DIVISION'- TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for -Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Locatign Address or Lot No. f�0 I/JN /v✓c�6 Aj, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel /3 Installer's Name,Address,and Tel.No. o�-_}'v q-}'o v_y Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size )'/,p �_J 4!( sq.ft. Garbage Grinder( ) Other Type of Building ,C f No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 6) , gpd Design flow provided S��e Z gpd Plan Date 1 Te g, r/, P D r y Number of sheets t' Revision Date Title Size of Septic Tank /)-0 O Type of S.A.S. -3 A p t2 g24 L e,`w a Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place-the system in operation until a Certificate of Compliance has been issued by this Board of Health. J'v -_'O `1 s-U O j- &ied � Date //Application Approved by , /,/ /� Date /A r/4/ /v r Application Disapproved by / .A, Date for.the following reasons Permit No. Date Issued ---------------------------------- --------- - - ------------- ---W ---------------- /--�-------- ----------- -------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance �+ THIS IS TO C)T hat the On-site Sewage Disposal s stem Constructed( ) Repaired( V) Upgraded( ) Aband2 d( )by at _AND _ _ has been constructe acco e with the provisions of Title 5 and the for Disposal System Construction Permit No. �` da ed Installer Zf/Z'„I �- �z,i �,. Designer lc vv #bedrooms Lf Approved design flow 'f'� gpd The issuance of this perm 'll ft s a;1;1ot be construed as a guarantee that the system w �nc itit o as design.d. Date Inspector 1,/,%� ---- -------- --- / - - - - - -- - - - -No.-A -- No:`� � Fee ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS IDisposal 6pstem Construction Permit Permission is hereby granted to Construct Repair Repair(r � Upgrade( ) Aba�� System located at An 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. // A Provided:C strttction mu be completed within three years of the date of this permit. Date Approved by / down cape engineering, Inc. SIEVE SOILS ANALYSIS 350 SANDY NECK RD BARNSTABLE, MA DATE OF REPORT: 9/17/14 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 360 SANDY NECK ROAD BARNSTABLE, MA LOCATION: ECO TECH TEST HOLE SIEVE ANALYSIS Weight Sample(Grams); 177.9 SIZE RETAINED %RETAINED ; %PASSED --------__[WEIGHT ...........sum»�....»....».....»».....--------------------1.................................. lit 3141 ._ » ...»............. ..............» :0. --- --------_0_0%1 100.0% ._ _ .» .......�-------------.0 o 0.0 0.0/0 100.0% _ »0.0 0.0% »100.0% #10 ---_� »..........».................».4.3 -------- 2.40/o .. .... .. ... 97.6% #20 18.7 11.1% 88.9% -�_.. .. .. .........»..».............»»,-------------------. »............»..».......».. . #40 50.1 26.2% 71.8% .�-----------....»....................................»..»..... --------._------- .».......»......................... #50 _ _ 135.9 _ __ 76.4% 23.6% _»..... .....- �r 95.9%�......»»»...........4.1% ---.._.----- - ...............»..»».»» #100 174.2 _ _ 97.9% 2.1% #200 ---- »....».......... ....»» 177.2 _� 99:g% --------- -004% PAN: _ 9 77.5 �100.0%0�- -�---� -0.0% -------- ---- ------------------ ----- ---- ----------- SAMPLE: 177.9 NOTE:TEST ON PASSING#4 ONLY, 3.2%RETAINED ON#4<45%O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-3(FINE SAND)(UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE: #4 1000/9 (TEST ONLY MATERIAL PASSING#4) OK #5010%400% OK #100 00/6-200/6 OK #200 00/6-50/6 OK fit"of M4s SAMPLE MEETS TITLE 5 FILL SPECIFICATION ��DANIELA.°ya >99%SAND OJALA CIVIL w RESULTS:PERMEABLE MATERIAL-CLASS 1<2 MINJIN.MATERIAL ° No.46502 NONCOMPACTED °5�'�FQIsTE�``��, SOIL DESCRIPTION: FINE SAND `�SS�oNa► E�'G Town of Barnstable IHEE Regulatory Services ( sax�vsTnsr.e, Richard V. Scali, Interim Director* MASS. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: �5ll Sewage Permit# , 0 Ill- 36-1 Assessor's Map\Parcel 13. Designer: DgP,1 �ov��gnD i �S Installer: ��,o,lZ, T,�-i�t� , Address: kY410' �;ttM Address: On ,i' was issued a permit to install a (datef in`st ler) n septic system at 5 S�<!�/ upc(,' P174 based on a design drawn by ��^^ (address) Q�v1 CJpv0yn'"Vri �S dated - '/ (designer) XI 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. Strip out (if required) was inspected and the soils were found satisfactory. 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..Strip otit (if requirPd);was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the I\A approval letters (if applicable) OF MgSS�C moo`' DAVID yG� D. (Installer's. * n tur COUGHANOWR N No. 1093 �FG15 T E�L�O (Designer's Signature) (Affix 0111 p 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 Rev 8-14-13.doc TOWN OF BL- R S 1t BLE i' I LOCATION rd /✓ec lC®e-o`' SEWAGE# •,,Z 0%` —l3 9 VILLAGE ,•�J ASSESSOR'S MAP&PARCEL �-- INSTALLER'S NAME&PHONE NO. ;�r c-/,) �o SEPTIC TANK CAPACITY %.3—0 a LEACHIlVG FACILITY.- (type) i /N f f 3 ' a(size) -/l x �f NO. OF BEDROOMS �J OWNER ,✓ CP i r vi✓� PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leachin Feet g Facility(If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and LeachingFacility Feet ty(If any wetlands exist 300 feet of leaching facility) Feet FURNISHED BY - t7 s - 3J` y ' i s i Town of Barnstable P# �ViE '. Department of Regulatory Services a DAMNrABIA MASS. Public Health Division Date 200 Main Street,Hyannis MA 02601� '� fUNtA'Ip Z/• -• / , �� t"� _ter. Date Schedulede� `� . Time �. Fee Pd. n , rl + 'S.oil Suitability Assessmentfor Sewage Disposal Performed B UGI V1 �o ` Witnessed ff t Y ha oo wir WitnessedBy: ` �64irolyS LOCATION& GENERAL INFORMATION Location Address - s o S 4l l l�� we:C k d Qt A Owner's Name 7eqh rel t k V.S S e l( +, l `_ y Address 35 6 !1 hd y UC'CEC.. Assessor's Map/Parcel: (3 6 ¢-Z Engineer's Name vQ 5 t- gq�lj S1t y�J�P� NEW CONSTRUCTION ++ REPAIR Telephone#- 1; 1& ® . Land Use % % et'i•��1 ta'�✓�) T^`1 Slopes M, �a 1. 1 Surface Stoned So e ` Distances from: Open Water Body toot ft Possible Wet Area'J 100,'+'ft 1 Drinking Water Well Drainage Way �® ft Property Line _ft Other ft SEETCII:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) rt pa N M � r: 2.57, t 6Q FR'3 Parent material(geologic) `0 tgcj1 O( W*S Depth to Bedrock D✓t.(? Depth to Groundwater. Standing Water in Hole: 1�!D�I� . Weeping from Pit Face 14 o n P Estimated Seasonal High Groundwater (tt P 4 Ply +44 n i f DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: >Frir40+Et~ ` Depth Observed standing in obs.hole: a� In, Depth to soil mottles: tti0 ® ��2In. Depth to weeping from side of bs.hole: In, Groundwater Adjustment ft.s l O r Index Well#__ Qt1I Reading Date: PIS __ index Well level Aci.factor Adj.Clroundwater Level__eJ PERCOLATION TEST bate Time Observation Hole# Time at 9" Depth of Perc Time at 67 Start Pre-soak Time @ I ime(9"-6") End Pre-soak <;i e 1l e Q K-q`ys I S of d►te- f_0 `2 M p; the` ' Su�e�y a ce v-K 5 a b� + oteo i`h Rate Min./Inch k . �'"r Mj �Jt ' Stte Suitability Assessment: Site Passed y Site Failed: y`r 1D Additional Testing Needed(Y/N) 0 Original: Public Health Division .. Observation Hole Data To Be Completed on Back"---------- I ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Consefvation Division at least one(1) week prior to beginning. Q ASEPTIC�PERCFORM.DOC i DEEP.OPSERVATION HOLE LOG Hole# � Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones,Boulders. orts�tency,%Gravel) r pre COQ"1D�(t2 �l `JDlte �r ryh • t 07- Cz DEEP OBSERVATION HOLE LOG Dole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) . 0-s Lpawi toy '71Z bite J - �6-`�D �i(•1� [®uw► lD��`�f4 �I ivw► 64 �4M _Z,�r7 V 6 " gym 441 vim :,Wkl !0 kiz �l4 J4 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con i to c Gravel) DEEP OBSERVATION BOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stot►es,Boulders, o s' ten Flood Insurance hate Mato: , Above 500 year flood boundary No— Yes . _ Within 500 year boundary No Yes .� Within L00 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? e S If not,what is the depth of naturally occurring pervious material? Certification `t tqI5 I certify that on N� l 6 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and,that3the above analysis was performed by me consistent w' the requir training,expe ti a and experience described in 10 61v jH 15.017. OF4q Signature �S� 1 " I Date �PPf % ��o DAVID o D. -4 o COUGHANOWR N 'CE N SE10 0 Q:\ EMCWERCPORM.DOC EVA0A Assessing As-Built Cards Page 1 of 2 JVf71111'/�.sa O}/40/Y'J'/i fY/. sa/ Kri.sy� .��ryL�JJ677 iJv +.JN 111,10/r TOWN,/OF"B�ARNSTABLE r �/�/g/��' LOCATION 3 W NQdc+( peSEWAGE# VILLAGE W, AIf ASSESSOR'S MAP 6z LOT 136 M INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY An 8a �� 30 ,exCay. LEACHING FACILITY:(type) (size) NO.OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER nLiLDER OR OWNER R.W. Is��il DATE PERMIT ISSUED: 1.26 DATE COMPLIANCE ISSUED, VAR7AN �GIrXN :/ s `�'"No� �, W O sue, a JACe tZD. —�toeaa a �e We11 -k I�ovr 35 fo Cep., /No q' http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=136014002&seq=1 9/22/2014 TOWN OF BARNSTABLE • LOCAPPN SEWAGE # ? WWI ViLLAGE 13QrWi562AkP— ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ��'� G.�► LEACHING FACIL TY: (type) `�•^�L'�— (size) NO.OF BEDROOMS j BUILDER OR OWNER PERMITDATE: 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by moo, O 'S3 35" T COMMONWEALTH OF MASSACHUSETTS fD EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ff r 9,Y �• /y ! TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 350 Sandy Neck Road West Barnstable Owner's Name: Jean Russell Owner's Address: Date of Inspection: 8/4%2005 Name of Inspector: (please print) Patrick T. Sullivan ; Company Name: Ready Rooter ' n Mailing Address: P.O.Box 371 Sandwich,MA 02563 "} Telephone Number: (508)888-6055i c CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the in rmatiogreporteii 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 D`EP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The Syst m: Passes Conditionally Passes Needs Further Evaluation by the Local Authority Fails I Inspector's Signature: T ,._ Date: S z� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****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. I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 350 Sandy Neck Road West Barnstable Owner: Jean Russell Date of Inspection: 8/4/2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D C. System Passes: _ZI have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass",Action need to be replaced or repaired.The system,upon completion of the replacement or repair,as appro ed by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for the follo mg statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the sepf tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank ilure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as appr ved by the Board of Health. *A metal septic tank will pass inspection if it is structurally ound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is availab . ND explain: Observation of sewage backup or break o�or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled oro neven distribution box. System will pass inspection if(with approval of Board of Health): , token pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pump' g more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approva of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 350 Sandy Neck Road West Barnstable Owner: Jean Russell Date of Inspection: 8/4/2005 C. Further Evaluation is Required by the Board of HealtZd Conditions exist which require further ev/nn of Health in order to determine if the s stem 9 Y is failing to protect public health,safety or the e1. System will pass unless Board of Heals in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner rotect public health,safety and the environment: _Cesspool or privy is within 50 fee of a surface water Cesspool or privy is within 50 et of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Sup er,if any)determines that the system is functioning in a manner that protects the public health,safet and environment: _The system has a septic tank and soil absorpti;system(SA and the SAS is within 100 feet of a surface water supply or tributary to a surface waterThe system has a septic tank and SAS and thethin a Zone 1 of a public water supply. The system has a septic tank and SAS and thethin 50 feet of a private water supply well. _The system has a septic tank and SAS and t e SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to etermine distance "This system passes if the well water an sis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds in ates 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 oft,analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 350 Sandy Neck Road West Barnstable Owner: Jean Russell Date of Inspection: 8/4/2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _✓ Static liquid level in the distribution box above outlet invert due to and 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. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is 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 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.] ,ti�Z--)(Yes/No)The system fails. I have determined that one or more of the above criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a fa ' ity with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the folio ing: (The following criteria apply to large systems in additio to the criteria above) yes no the system is within 400 feet of a surface rinking water supply the system is within 200 feet of a tri tary to a surface drinking water supply _the system is located in a nitroge sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water suppl well If you have answered"yes"to any q stion in Section E the system is considered a significant threat,or answered yes in Section D above the large ystem has failed.The owner or operator of any large system considered a significant threat under Section or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner sho d contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 350 Sandy Neck Road West Barnstable Owner: Jean Russell Date of Inspection: 8/4/2005 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 -ZWere 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? _/4JA 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 than 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: Yes No _ Z 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(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FO RM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION Property Address: 350 Sandy Neck Road West Barnstable Owner: Jean Russell Date of Inspection: 8/4/2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 �. A Number of current residents: Q_ Does residence have a garbage grinder(yes or no):1--xt, Is laundry on a separate sewage system(yes or no):�[if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): tip Water meter readings, if available(last 2 years usage(gpd)): r Sump Pump(yes or no): `(xr5_ — r✓�,.,_ �. o .. Last date of occupancy: �.g COM M ERCIALA NDUSTRIAL Type of establishment: Design flow(based on 3 gpd Basis of design flow(sea Grease trap present(yes Industrial waste holding ): Non-sanitary waste dischtem(yes or no): Water meter readings, if/ Last date of occupancy/u OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): Yr— If yes,volume pumped: (camgallons--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 a copy of the DEP approval _Other(describe): Approximate a e of all components,date installed(if known)and source of information: 4D, Were sewage odors detected when arriving at the site(yes or no):�d i Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 350 Sandy Neck Road West Barnstable Owner: Jean Russell Date of Inspection: 8/4/2005 BUILDING SEWER(locate on site plan) Depth below grade: -0 1 Materials of construction: mast iron_40 PVC_other(explain): Distance from private water supply well or suction line: 1 1rJ` Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: locate on site plan) Depth below grade: A a Material of construction:_zconcrete_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) 1 Dimensions: Sludge depth: ar " Distance from the top of sludge to bottom of outlet tee or baffle: a? Scum thickness: r. °' 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: �.p �„(p� + \tt%P' - V'-' Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): �1 l v�,�� .r.�1, GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglas _polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet te/and Distance from bottom of scum to bottom of ffle: Date of last pumping: Comments(on pumping recommendations, i tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakag i Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 350 Sandy Neck Road West Barnstable Owner: Jean Russell Date of Inspection: 8/4/2005 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 olyethylene_other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order es or no): Date of last pumping: Comments(condition of alarm and float sw' hes,etc.): DISTRIBUTION BOX:_AZ(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Q'* Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chambe/ondition of pumps and appurtenances,etc.): Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 350 Sandy Neck Road West Barnstable Owner: Jean Russell Date of Inspection: 8/4/2005 SOIL ABSORPTION SYSTEM(SAS):_AZ(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: _leaching trenches,number, length: t4 -� p leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): (� n NO CESSPOOLS: (cesspool must be pint►ped as art 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 or no): Comments(note condition of s il,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,si s of hydraulic failure, level of ponding,condition of vegetation,etc.): Page 1.0 of 11 OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 350 Sandy Neck Road West Barnstable Owner: Jean Russell Date of Inspection: 8/4/2005 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. I y e c D � O 4 , 3 III Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 350 Sandy Neck Road West Barnstable Owner: Jean Russell Date of Inspection: 8/4/2005 SITE EXAM Slopes/ Surface water Check cellar Shallow wells✓ Estimated depth to ground water 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: Observed site(abutting property/observation hole within 150 feet of SAS) _Checked with the local Board of Health-explain:—7<n,_,__-)v-, Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: SS, r d �. TOWN OF BARNSTABLE ` 1��/� LOCATION ,3- o S�M7,Y /UQG�G _SEWAGE # VILLAGE ItZ A/(' I . ASSESSOR'S MAP Cz LOT INSTALLER'S NAME S& PHONE NO. SEPTIC TANK CAPACITY /000 cri 30 �xcay. LEACHING FACILITY:(type) (sue) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER (L, BDILDER OR OWNER R. �• �SS�� DATE PERMIT ISSUED: 1963 DATE [�/COMPLIANCE lIS�vfsr SUED- VARfARW(��'XNTE ) o W ' JwwoaV a � well 35 - o cerv, woo gal ' + �J ` EAST SANDWICH. MA • s, THIS IS A 2 VARIANCE REQUESTED QOPo 'S;4 MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR. 32 'COLOR ELF VQT§OoNS r r. 310 CMR 15.221(7) - COMPONENT PLAN A. ELEVATIONS SPECIFIED ARE INVERT ELEVATIONS DEPTH TO FINISH GRADE. 36 in USE COLOR PLAN ONLY (BOTTOM OF PIPE! EXPRESSED IN DECIMAL FEET(B RESS AL MAX REQUIRED - VARIANCE TO N FOR INSTALLATION SEWER LINE OUT EXISTING 34.25 60 in OF COVER REQUESTED. DETAIL IS FULL/ / ` BEST SEWER LINE OUT GARAGE 33.00 lop �. VIEWED IN / NOT SEPT C TANK. IN 3L75 v . 1 ..FULL COLOR. . 31-- SEPTIC'I TANK OUT. .31.50 90UT� cq SCALE . D-BOX IN 29.33aq gNBF9A - .D BOX OUT_ 29 161- / LEACHING SYSTEM IN 29.00 N sl h!lGy�q y BOTTOM OF LEACHING 27.00 WEST BARNSTABLE. MA dop �3 a ryo�o : 1 MM u�. 9 LOOT 2 E N AREA J.119 ac.f ro 33 89 48,744 sf F O C BETE PLAN BOOK 392 PAGE 48 33 ONC ASSR MAP 136 Pa 14-2: z 34 CONTOUR "C O 0�-- �Ty 35 PROPOSED SOIL • PJ ABSORPTION S I S T EM PROVIDE VENT PIPE A L - . SEE DETAIL AR ON.BACK VE LA RAL 11ZF ET 33 . Av / WELL GARB � Q 34 G R !/I I/l w V OT p \ P OWED J1� �35 ` Jul. / . s ��H OF Lltiq �jH OF .SS SS � Q 9r 9r °9q,,� : .DAVID DAVID yoJ� aD. �0�� ` COUGHANOWR COUGHANOWR N ?ti 37' No. 1093 No. 461 F NO TES \. 37 / D,�Q�\Q� \;� 0,9j`F� O + SOIL REMOVAL AREA - REMOVE ALL FILL O / AND UNSUITABLE SOILS DOWN TO THE � V I SC'c JC�/� 24; C2 STRATUM AND REPLACE WITH CLEAN O 38 3B — MEDIUM SAND PER TITLE 5 �c� PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM (310 CMR 15.255('3)). \ DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING. �' - � THIS . .�F- J LEGEND EXISTING 1000 GALLON SEPTIC TANK O Q 39 PLACEMENT OF ADDITIONS..SHEDS, FENCES OR SWIMMING POOLS. OWNER ' • - �L / EXISTING SHOULD < SETTS REGISTERED LAND DISPOSAL S WAGE SHOU CONSULT WITH A MASSACHU IS TO BE PUMPED. COLLAPSED AND 'Y\ E o ABANDONED IN PLACE OR REMOVED: SCALE: l In 30 ft \� 39 1000 GAL E SYSTEM PLAN K SEPTIC TAN. 0 30 60: ABANDON EXISTING LEACHING 150o GAL - --SERVE EXISTING DWELLING SYSTEM IN PLACE. SEPTIC TANK .� ER�EAN rKEIR -TO'S 0 10 20 30 1 o. p L OWNER SHALL OVERSEE FINAL GRADING DISTRIBUTION BOX 0 • • OWNER OF RECORD L l SCHEME. DO NOT ALLOW RAINWATER PRINT ON Il x 17 in PAPER \ RUNOFF. TO POND OVER SYSTEM..' FOR PROPER SCALE' .. PIT 350 . SANDY' NECK ROAD NO OTHER WELLS WITHIN I50 ft OFP.O. BOX 1265 PR INSTALLER TO INSTALL VENT PIPE THE PROPOSED LEACHING GALLERY WE THAM; MA P. EST BARNSTABLE MA PER CODE. WEST RS20. 2014 CHA OPERTY ADDRESS 02669 . : [DATE. SEPTEMBE 508 364- joeo ETE-3863 08.94 ►�U2 � Oo IL TEST LL�OO l m5mmQou DD [E S@QQN]N C f� L�CC U�U LQQT � OO S 1�OOe GALLON SEPTIC TANK DISTRIBUTION BOX •', DIMENSIONS & DETAIL SOIL. EVALUATOR: DAVID D. COUGHANOWR. ASE #461 DESIGN FLOW: 4 BEDROOMS X 110 GPD-'= 44.0 GPD , . • • ,• 'WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. • No GROUNDWATER ENCOUNTERED SEPTIC TANK: 44.0 GPD X .2 DAYS 8-80 GALLONS TEST PIT l - 2 MIN/INCH IN C2 SOILS INSTALL NEW 1500 GALLON SEPTIC TANK. -- ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER ^ DISTRIBUTION BOX: USE SHOREY DB=$ H-20 i. In NOT 12 in INCHES HORIZON TEXTURE (MUNSELL) MOTTLES. TAPER TO C MIN 33.70 - SOIL ABSORBTION SYSTEM: 0-5 Ap LOAM.. 10 YR 4/2 NONE FIRM I� SCALE �. FROM THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE 5-27 B SILT LOAM 10 YR 4/3 NONE FIRM f N TANK L- L TO SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES o - say 27-104 C1 SILT CLAY2.5 Y 6/3 NONE FIRM PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. 0 O. LOAM THE 41.5. ft x 12.83 ft x 2 ft LEACHING' GALLERY. o' 8 nt LO 25.03 -._.:. .r b .In STONE.-BASE 104-19 . C2 MEDIUM SAND 10 YR 5/6. NONE LOOSE DEPICTED BELOW CAN LEACH: -- �� ry- 17.70 2l in CROSS .SECTION VIEW NO GROUNDWATER ENCOUNTERED BOTTOM AREA (41:5 x 12.83) 532.44 sq. ft. TEST _PIT 2 SIDEWALL AREA (2x(41.5+12.83)] .x2 =.217.32 s4. .ft. s �. ��. 2 MIN/INCH IN, SOILS ELEVATION DEPTH. SOIL USDA.SOIL SOIL COLOR SOIL OTHER TOTAL AREA = 749..76 .sq. ft. INCHES HORIZON :TEXTURE (MUNSELL). MOTTLES _ 1O 33:85 FLOW CAPACITY .- 0.7.4 x 749J6. _. 8b4.:82 gal/do ft-6 �n 5 - 0-8 Ap LOAM 10 YR 4/2 NONE FIRM. INSTALL.A. .41:5 ft .x 12.83 ft.x 2 .ft .GALLERY AS CONFIGURED 8=30 B SILT LOAM 10 .YR 4/4 : NONE :FIRM BELOW. FLOW CAPACITY = 554.82 gal/day WHICH EXCEEDS SOIL .A S S O R P T 1 O N INLET CENTER OUTLET 30-108 Cl' SILT CLAY 2.5 Y:6/3 NONE. FIRM THE 44.0 gal/day REQUIRED. CONSTRUCTION DETAIL R R LOAM _ S I COVER -- -- VET 24:85USE- CO YWELL 108-19 C2. 'MEDIUM SAND 10 YR 5/4 NONE' J.LOOSEJ O . 3 IN DROP COVER ER CO S Y T E M 18.02 M FLOW •. PRECASTEY �• • ►• LINE -► DUNWELL PERCOLATION RATE to in = 14 TO . 1 O t F BU DETERMINED TO BE LESS.THAN 2 MINUTES PER INCH FROM - ING ^ 7D .8 X BY SIEVE ANALYSIS OF: 911712014 (99% SAND). . . . -- 8 in � ® ��x :` �Y m FLOOR PLAN �n cq IrL� OOUIT II�L�/r--dUV LIQUID AS •,� 4 LEVELILN . .MAIN N �.�. HOUSE earth ' j STONE . -INSTALLER TO.OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. R 6 . in STONE BASE BED I N OOM ft 8.5 ft 4 .fz 8,5. ft 4 fi 8.5 ft a rf -ALL COMPONENTS .INSTALLED: SHALL MEET THE MINIMUM. Roots SEPARATION BETWEEN INLET & OUTLET REQUIREMENTS OF MAS.SACHUSETTS TITLES SEPTIC 0 . CODE- (310:.CMR 15) - .UPPER FLooR 500. GALLON DR.YINELL TEES NO LESS THAN LIQUID .DEPTH INSTALLER .T0 VERIFY .;LOCATIONS OF .ALL UNDERGROUND . CROSS. SECTION:.. VIEW.. DIMENSIONS &:DETAIL INSTALL ONE.INSPECTION . UTILITIES. BEFORE-EXCAVATING FOR SYSTEM. RISER TO WITHIN THREE GARAGE. BREEZE -ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION KIT INs�HNDIc°arElLocA ZONE OF. .LOW FLOW FIXTURES & APPLIANCES -AND PERIODIC war CHEN BED ON AS-BUILT PUMPING OF THE SEPTIC TANK. BA ROOM LIVING TH ROOM BED rr -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR :LOADING.: Ro.oM oD�? 36 DO NOT PARK OR .DRIVE VEHICLES OVER SEPTICSYSTEM. � � DD�D in usE MAIN FLOOR 102 TOP OF FOUNDATION ALL PIPE TO BE SCH.. 40, PVC RAISE COVERS TO WITHIN VENT AND TO PITCH AT 1/8 in/ft MIN EL 37.41 + 6 in OF FINAL GRADE PIPE CROSS SECTION : VIEW INSTALL AN APPROVED.GEOTEXTILE 34.00 35.00 FABRIC OVER STONE I. =IiRnn USE MAX RATED 28 I 3/4 in TO H-2024 In 3/4 in TO USE H-20 • N - EQ 1-1/2.In GRAVEL UNITS in DEPTH IV 7/2 In GRAVEL � OIIVSTIr--�1L�L� 30.00 OBSERVED GW ONE AT 17.70 . p� p� �p WELL S - �oJ�� L�L�O011V INDEX DW 252 34.25+ o °adaa, oo. 48 in 58 in 48 in $° �oo6a�oo PRECAST 00,...,oQoao ZONE A oo° EXISTING o 31.50 °oop o�oo° °�� READING DATE AUGUST: 2014 �o oaoamoo°a DRYWELL a°o `� o o,. 154 in �CpOC� `��1� A ND 29.16 00 0000�0°QOo READING 47,40 ' 6 in O O o O +. ADJUSTMENT 1.5 FREE O STONE TO DUST AND FINES IN BE DOUBLE WA DPLA.CE 31.75 SEE DETAIL ON BACK STONE. SOT ABSOGRPTUO�IADJUSTED GW BELOW 29.33 29.00 9.20 BASE SYSTEM SEE DETAIL 6) .25 ft 6 in. STONE BASE 61 ft - o) 4,5 .ft PAGE 2 _ b) 54 ft 27.00 ADJ USTED SEASONAL. BELOW. b) 16 ft . . .HIGH. GROUNDWATER. . 19.20. SEWAGE DISPOSAL SYSTEM PLAN 350: SANDY NECK ROAD WEST BARNSTABLE. MA ISEPTEMBER 20. 2014 ETE-3763 PG 2/2