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0049 HANE ROAD - Health
497"Mane Road=- Marstons Mills P A = 151 . 008011 l r Commonwealth of Massachusetts 161 000 j Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 49 Hane Ord Property Address Susan A Wiper , Owner Owner's Name f information is Marstons Mills Ma 02648 10/16/20 required for every ' page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 14q$3 on the computer, use only the tab Michael DiBuono key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Ln Co � Company Address Cotuit Ma 02635 City/Town State Zip Code few 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10/19/20 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 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 iL r Commonwealth of Massachusetts Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/16/20 page. Cityfrown 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: System is functioning as designed with no sign of failure. 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 r Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/16/20 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): El 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/16/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) El Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑, The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts U,�` � Title 5 Official Inspection Form F� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Hane rd � Property Address Susan A Wiper Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/16/20 page. Cityrrown 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 If of a public water supply well 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 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/16/20 page. Cityrrown 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 c Commonwealth of Massachusetts p Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is Marstons Mills Ma 02648 10/16/20 required for every page. Cityrrown 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 Description: Number of current residents: 1 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 ears usage d 218 GPD 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Hane rd Property Address Susan A Wiper Owner Owners Name information is required for every Marstons Mills Ma 02648 10/16/20 page. Cityrrown 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: Not provided 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 I Commonwealth of Massachusetts Title 5 Official Inspection Form ]� Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/16/20 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: Compliance date of 9/22/00 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 2 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.): System is vented at the roof line 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 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/16/20 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1000 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure/Data On File Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tee's in place at time of inspection t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts �U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is Marstons Mills Ma 02648 10/16/20 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ 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 F Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/16/20 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 Level with no signs of failure 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/16/20 page. Cityfrown 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: 3 H2O Lc6 Chambers.. ❑ 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 lie Subsurface Sewage Disposal System Form-Not for Voluntary Assessments \V��W 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/16/20 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.): No sign of failure 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form J Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/16/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Assessing As-Built Cards hRO /iv►fiww.townofbarnstable.us/Departments/Assessing/Property_:.. . TOWN OF BARNSTABLE •LOCATION�/ /�.e.c.�� aI SEWAGE --r6,• _ vu LA^� / ?_,.� ' +=�M M ASSESsoR'S MAPdt[.oT ` NSTAUM SMB;NA &PHONE NO. J+g'� �3-n,R V,L ' SEPAL TANK CAPACrrY AQ=Ca 4. LEAcmNo PACII:ITY:(typo) F N0:OP BEDROOMS,,,, .____., t;. ev>z.oE�oR owNSR��4.1�lTo_�. PE MTfDATE: COIvIPUANCE`DATE: ,F� — Sepatatlon Distance Between too: Maximum Adjusted Otowidwaiet Table to the ottom of Leaching Fac[ltty Fast Pdvato Water Supply.Welland Leaddes ty (If any walls tutibt' on site or.wtt"?40 feet of adlity) Fees edge of Wedw aid Leaching Pam$If wny iwetlands oust within 300 feet of leaching fecltlty) Feet Furnished by r i.. �d� �. �'rx ,ice � ,°� y � .Pv ,�n, , rrv'� n�,� � � ri a � � yRi,-.•. d. , Y.rt�;. "�, � �''�'€ne„. '"'ys� �p .*"a ` �t "'s, r.z.,e;�sC�«r�'"a.: ��,r x� �s •�s� x �•,. pry - - - of 1 ` `�• ,. 10/16/202 -49.;AM.>l c Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/16/20 page. Cityfrown 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 t5insp.doc-rev.7126I2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/16/20 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: 10+ 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: 8/25/2000 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: Test Hole Data on plan 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 1 Commonwealth of Massachusetts p Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Hane rd Property Address Susan A Wiper Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/16/20 page. Cityfrown 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: 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 TOWN OF BARNSTABLE Y/ LOCATION 4 Y&I SEWAGE Orod 61 :5- VILLA % 0 M ASSESSOR'S MAP & LOT 109- 0"UI f INSTALLER'S NAME&PHONE NO. a : SEPTIC TANK CAPACITY/be3--e.) LEACHING FACILITY: (type) -7& 6 NO.OF BEDROOMS BUILDER OR OWNER C.A I k- PERMIIDATE: —P-S—G-c--41 COMPLIANCE DATE: , Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of.Leaching Facility Feet Private Water Supply Well and Leaching Tyacility (If any wells exist on site or within 200 feet of leaching.acility) Feet Edge of Wetland and Leaching Facility'(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ..k � G.rz r��� � � �� �� ��� b�, - � - � o � � , ` . .� � . ... _ F �,� , ` �� �. V ✓e..%,. ~. No. ` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYfcation for Mooml *potem Comoruction i3ermit Application for a Permit to Construct( )Repair( )0 Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 49 Hane Rd. , Barnstable Crighton / Wiper Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Craig R. Short PO Box 1089 Centerville PO Box 1044, S Dennis Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system to the plans of Craig R. Short #1 -870, dated 7-26-00. 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 Certifi- cate of Compliance has been issued by this oar of Health. Signe ® Date Application Approved by Z4 4 1 Date Application Disapproved f r the fo owing reasour GT Permit No. Date Issued l D THE COMMONWEALTH OF MASSACHUSETTS En4 04 50 tered in computer: .- Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSE17S t application for ;Migpogal *p! tem Construction Permit Application for a Permit to Construct( )Repair( )Q Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Lo on ddress or ot,No. Owner's Name,Address and Tel.No. Aane 1C , Barnstable Crighton / Wiper Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Craig R. Short PO Box 1089, Centerville PO Box 1044, S Dennis Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Na of 1� pairs or Alterations(Answer when applicable Title-5 leach system to tthe p ans of Craig R. Short 0, dated 7-26-00. 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;nvironment 1 Code and not to place the system in operation until a Certifi- cate of Compliance has been issued bye oar- of ealth. q d SigneAthe Date Application Approved by �✓ Date Application Disapproved lowing rears s 4 Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS Crighton BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the'On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded( ) Abandoned( )by Wm. E. Robinson Septic Service at 49 Hane Rd. , Barnstable 0 9 44s baft constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated 1 InstallerWm. E. Robinson Sr. Designer Crai, � R. Short The issuance of this permits all of bee o stru�e• as a guarantee that the systr)MA"I ill function as d- neld� y{l r Date V Inspector W� { , . t No ell,665 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVrSIO�N ARNS`TABLES MASSACHUSETTS Crighton 30iopogar 6potem Con5truction Permit Permission is hereby granted to Construct( )Repair(X)Upgrade( )Abandon( ) System located at 49 Hane Rd� Barnat-ahI a 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 mus tomple d wi '' three years of the date of t pe�t/.� a Date: DL/ Approved by . 6// �l � e��r s ��— ����� �__ r tlt" ,NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems.Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERNM OUT DESIGNED PLANS I, William E. Robinson,5Atereby certify that the application for disposal works construction permit signed by me dated � ��y� , concerning the property located at 49 Hane Rd. Barnstable meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or busirKss uses associated with the dwelling. Th soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system — Thel are no private wells within 150 feet ai the proposed septic system Then is no increase in flour and/or change in use proposed • There are no variances requested or needed. • The bonom of the proposed leaching facility will ap-e be located less than five feet above the mammum adjusted groundwater table elevation. f Adjust the groundwater table using the Frimptor method when applicable) • 1f the S.A-S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed caching facility will not be located less than fourteen 114)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +the MAX High G.W. Adjustment. DIFFERENCE BETWEEN A and B 4 SIGNED : l L t DATE: _ (Sketch proposed-`plan of system on back). y:health folder:cen ,, r. 1 —, C01L110\'titer-UTH OF MASSACHLSETTS _ EhECLTArE OFFICE OF E:��IRON,fENTAL AFFAIP.-S DEPARTMENT OF ENVIRONMENTAL PROTECTION OXE WMER STREE'.BOS T OA Mi 1 0210t t61:j 242-55(►t, TRUDY COX Secre:a-.v ARGEO PALL CELLLCCI DAVID B STp-•uc Governor Com.R►iss:oae- SUBSURFACE SEWAGE DISPOSAL SYSTEM OMPECTWN FORM PART A CERTIRCATION Property Address: 49 Hane Road Name of Owner Crighton / Wiper W Barnstable Address of Owner: Date of Inspection: its of inspector:(Please Print)Wm. Es Robinson Sr. MAR 1 am a DEP approved s em inspector to Section 15-W of Tide S(310 CMR 15.000) Company Name: Wm- E . Robinson Septic Service PARCEL ,I �+ MaIngAddress: PO Box 1.Qb9l. Centerville , M11 Telephone Number: 7?5- 7 7 LOT ; CERTIFICATION STATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate and complete as of the time of inspection. The inspection was performed based on my training and-experience in the proper function and maintenance of on-site,sewage disposal systems. The system: /Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Q Inspector's Signature: l�_�_ V - Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty (30)days of completing this inspection. If the system is a shared system or has a design flow of 10.000 gpd or greater.the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer. if applicable, and the approving authority. NOTES AND COMMENTS QD RE�E EQ t OCT 2 0 2000 N Taln�o!•sa�usn� `t: IiEALTH oar. '° � rev: se6 Pape lorn as C? -ten o^Recvtird Pane, SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM w _ PART A CERTIFICATION 1continued) Nap"Address: 49 H_ ane Rd. , W Barnstable Jwner: Wiper Dane of Inspection: .X Z_G-V (INSPECTION SUMMARY. Check OAH, C, o/ D: A. SYSyTE�II PASSES: (t,1/1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. STEM 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,wUl pass. Indicate"es no;or not determined(Y. N.or NO). Describe basis of determination in all instances. If"not determined',explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance lattached)indicating that the tank was installed within twenty 120)years prior to the date of the inspection: or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipels)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipels)• The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed _'ev1seC 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icort immd) Property Address: 49 Hane Rd. , W Barnstable Owner: Date of Ins�r T`21—4-v C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CMR 15.303 I1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Method used to determine distance (approximation not valid). 3) OTHER revise: ftge3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 49 Hane Rd. , W Barnstable Owner: Date of InsAi"Wry g—d.3—6_4 D. SY TEIM FAILS: You mus indicate either "Yes" or "No" to each of the following: have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this etermination is identified below. The Board of Health should be contacted to determine what will be necessary to correct.the faiiure. Yes Yo Backup of sewage into facility or system component due to an overloaded or cloggred SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LA qGE SYSTEM FAILS: You m st indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 If of a public water supply well) The ner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office f the Department for further information. reviseQ 9 2/5C Pagc4of11 f • SUBSURFAC E SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART B CHECKLIST Property Address:49 .Hane Rd. , W Barnstable Owner: Wiper Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No _ Pumping iinformation was provided by the owner,occupant, or Board of Health. ✓ _ None of the system components have been pumped for at least two weeks and the system has been.receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with NlA. _ The facility or dwelling was inspected for signs of sewage back-up. ✓ _ The system does not receive non sanitary or industrial waste flow. _ The site was inspected for signs of breakout. ✓ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. for example, Plan at B.O.N. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) _ The facility owner (and occupants,if different from owner) were provided with information on the propermaintenaac"I Subsurface Disposal Systems. reti-_sec 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION ►ropeny Address: 49 Hane Rd. , W Barnstable Owner: Wiper Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:r 56 g.p.d./bedroom. Number of bedrooms(design):_ 1 Number of bedrooms (actual): Total DESIGN flow C 19 6 Number of current residents: Garbage grinder(yes or no): Laundry Iseparate system) (yes or no):A,0; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no): A-D Water meter readings, if available (last two year's usage(gpd): l'9�tQ ( � OQQ Q Sump Pump )yes or no): Lest date of occupancy: CO ERCIALfINDUSTRIAL: Type o establishment: Design flow: gpd ( Based on 15.203) Basis o design flow Greas trap present: (yes or no)_ Indust ial Waste Holding Tank present: (yes or no)_ Non- nitary waste discharged to the Title 5 system: (yes or not_ Wet r meter readings, if available: Last to of occupancy: OTH Describe) Last of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 9-;w-0-0 System pumped as part of inspection: (yes or no)_A" If yes, volume pumped: gallons Reason for pumping: _ ,J A LIZ n r- TYPE OF YSTEINI Septic tank idistribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records;if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known) and source of information: e Sewage odors detected when arriving at the site: (yes or no) Al 6 rev seu Page 6(if 11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icontinoed) 'roperty Address: 49 -Hane Rd. , W Barnstable owner: Wiper Date of Inspection: BUI ING SEWER: (Coca a on site plan) Depth elow grade:_ Materi I of construction:_cast iron_40 PVC_other(explain) Distan a from private water supply well or suction line Diam er Com ents: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ _ (locate on site plan) Depth below grade:�l Material of construction: t/concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Is.age confirmed by Certificate of Compliance_ (Yes/No) Dimensions: t, Ad 't d Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: O 1, Distance from top of scum to top of outlet tee or baffle: r, Distance from bottom of scum to bottom f outlet tee or baffle: Now dimensions were determined: !%�-� -rh+--) ;omments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) { l�8/C�/C ✓L- b���(% GREA E TRAP: (locate on site platy Depth b low grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensi ns: Scum t ickness: Distant from top of scum to top of outlet tee or baffle: Distan a from bottom of scum to bottom of outlet tee or baffle: Date last pumping: Com ents (recom endation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, eviden a of leakage, etc.) El'�S�C c/2/90 Page 7or11 l r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ►rop"Address: 49 Hane Rd. , W Barnstable Owner: Date of Inspe r TIG OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate n site plan) Depth b ow grade:_ Material f construction:_concrete_metal_Fiberglass_Polyethylene other(explain) Dimensio s: Capacity: gallons Design fl w: gallonsiday Alarm pr sent Alarm le el: Alarm in working order: Yes_ No_ Date of revious pumping: Com nts: Icon i ion of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: Inote if level and distribution is equal, evidence of solidscarryover, evidence of leakage into or out of box, etc.) - PUMP CH MBER:_ (locate o site plant Pumps i working order: (Yes or No) Alarms i working order (Yes or No) Comme ts: (note ndition of pump chamber, condition of pumps and appurtenances, etc.) revises 9/2 /9c Page 8of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contiouid) 'roperty Address: 49 Hane Rd. , W. Barnstable Owner: Wiper Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers, number: leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, num6er: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failur , level of ponding. damp soil, condition of vegetation, tc.) 14'LD � ) •�. �� .C�Il^o.>/ Cik, i L`✓L e CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: )epth of scum layer: U Dimensions of cesspool: (� L Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) tof s: divon of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) site plan) of construction:olids: Dimensions: s:ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PaRc 9 of I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Nap"Address: 49 -Hane Rd. , W. Barnstable lwner: Wiper Jate of Inspecoon: 2,_ o--) SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) yL L o 1 1 �0 V reviset -'0 000- Sad" Page]0 0!11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(COnd wed) ropwty AcJkk"s: 49 Hane Rd. , W Barnstable Owner: Wiper Date of htapec6dn: r'y NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Deep Groundwater depth: Shallow Moderate SITE EXAM Slope Surface water Check Cellar Shallow wells 1 Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record t/Observed Site (Abutting property, observation hole. basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators. installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) revised- 9//2/ 9E Page 11of11 Town of-Barnstable P# Department of Health,Safety,and Environmental Services �t ME Public.Health Division Date Q, 367 Main Street,Hyannis MA 02601 BARN6 AB ahm MA89. 'Arm 0 Date Scheduled A000 Time Fee Pd. (/ I • , Soil Suitability Assessment for Sewage Disposal Performed By: C r �+e y �^ Witnessed By:jol V A f I o�►I� l . P� ............................ ...... LOCATION& CEP�T1r L INF0.10 :ATION Location Address Owner's Name /Yj q r3�i q 'Or—*(� /� .. A,lm I fT��� � � 49 Zd ,a I3 3f/ Address 34 Assessor's Map/Parcel: 70ROgg-0/ Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use 1 �a�•..l Slopes(%) Surface Stones 'y o Distances from: Open Water Body N/A- ft Possible Wet Area 7_< Drinking Water Well ^-fill? It Drainage Way 4 G It Property Line 2 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximiq to holes) oPE►--► 5 f ALA. 299.78' S t* 2q O p9 206 c 0 / 1% N �� a Parent material(geologic) Car V- Depth to Bedrock Depth to Groundwater: Standing Water in Hole: C Weeping from Pit Face��S Estimated Seasonal High Groundwater ::>::>::>::>;»::>::>::>:;;>:;...:.:...............:.:...::.:.....:...:::::.....::.::..:::....:::.:.:..:::......;:«:. ...: .:>::;...:;..:.....;......:..:.... :;.;.;......:....>;.....:;...;...,....;...::.;:.; D " 'EI�TA'1Ol�i 'U SEAS{)NA C 'VVA't'Et'1'At3L :.'.> .. .::............ :...........:,,...................:......... ............................. Method Used: Depth Observed standing in obs.hole: / V in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well#__:._.._. Reading Date:.__.___._ Index Well level . Adj.factor Adj.Groundwater Level ,...::.>.:.:; P.... 2:..:Cl� , TIt��1,TE.��T.................z>.ate:.......... T�m tt,..:.::.:::::.::::::::: .................................................................................................................................... Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time® Time(9"-6") End Pre-soak Rate Min./inch Site Suitability.Assessment: Site Passed Site Failed: x Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant i nEET �1$s 12v m>I 1 t O E Hnl�#......... Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.°° rave 2 4•^3`u <<+a o y 3 / '}S �J4� C L' /� Z•� 3 c �� wa tee'We— DEEP` DBSER�ATION HOt L�I. Hole# �. ... 11.1 .. Depth from Soil Horizon Soil Texture Soil Color Soil ; Other. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistencv.° Gravel) A/o fop i ,�� n,o. /8 -.3a. � L o•4.�••� 3// c q a e -/matt & L bEEI' E1►135E1t �l IOt;E t,OC l olae# . . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel) :::<:> DEEP. ER--V t1.. LE.LC::G; Hvlc.#.....::>::<::.. .:..::.... .. .. .. _ . Depth from Soil Horizon Soil Texture Soil Color. Soil _.... Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,° Gravel) Flood itisul•afice Rate P.A Above 500 year flood boundary No_ Yes Within 500 year boundary No_ 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? Na If not,what is the depth of naturally occurring pervious material? Certification I certify that on A/ey �'9 (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 training,expertise and experience described in 310 CMR 15.017. Signature (/C Date Z=t-�� TOWN OF B ARNSTABLE LOCATION SEWAGE # d-t:Pd SG VILLAGE ASSESSOR'S MAP & LOT ��I INSTALLER'S NAME&PHONE-NO. j SEPTIC TANK CAPACITY/64:5� - LEACHING FACU-n Y: (type) ,---//.mod 4. C. (size),A.2-7:5:Z ' NO.OF BEDROOMS ` BUILDER OR OWNER�� PERMITDATE: s Grp COMPLIANCE DATE: —D� Separation Distance Between the: Maximum Adjusted Groundwater Table to the$Doom of.Leachmg Facility Feet Private Water Supply Well and Leaching acility (If any wells exist I on site or within 200 feet of leaching faacility) Feet Edge of Wetland and Leaching Facility(If any vetlands exist within 300 feet of leaching facility) Feet bf Furnished by' V. l 7�, ` k L y � L `SOWN OF BARNSTABLE LOCATION ok \\ e @ SEWAGE # G �3 VILLAGE - ASSESSOR'S MAP St LOT_IS) $' INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY \ 0CD C)' I LEACHING FACILITY:(type) -11;� size) —,-2> NO. OF BEDROOMS PRIVATE WELL OR UBLIC WA BUILDER OR OWNER ©N\ ® S DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 0 Ike- CL Ic 1 i to ° i 1�5,6% J► 0 0 6 FRic...... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... _.....OF..... .................. ............. ........ Appliration for Bhipasal Works Tonstrurtion araft Application is hereby made for a Permit to Construct ( Pror Repair an Individual Sewage Disposal System at: ------------ Location-Address or"Lot,No. --------------- -------------...... 5? .77...............A/..%3....1 ........0 C-1 Owner Address ..................t- ,a_ ............. ................ . . ........................... .............. ........, Installer Address Type of Building Size Lot-140.40 7?'..Sq. feet Dwelling—No. of Bedrooms..............3.........................Expansion Attic Garbage Grinder Other—Type of Building ... ffVNo. of persons......... .............. Showers k-+— Cafeteriart—) Otherfixtures ........................................................................................ ............................................................ Design Flow.................... -_----.__-_gallons per person p;r djy. Total daily flow.........43.4-0.....................gallons. Septic Tank—Liquid capacity.1120gallons Length.Q....1 ... Width-f!1. Diameter________________ Depth..%-A......:-F. Disposal Trench—No. _1.............. Width..11- Total Length----CA.*...... Total leaching area---- ...sq. f t. Seepage Pit No--------------------- Diameter._.................. Depth below inlet........._...._..... Total leaching area..................sq. f t. Z Other Distribution box (I Dosing tank�-� Percolation Test Results Performed by.....H1.0-T!".0-.3.4f...PO Date................................P-Seo 3 7 ----------------- Test Pit No. 1.....A...Vminutes per inch Depth of Test Pitl................ Depth to ground water......I---f.f------- 44 Test Pit No. 2----I..Zminutes per inch Depth of Test Pit-_- Depth to ground water-_____- no- ................. 04 ........ ................................................ 0 Description of Soil---------------fn.v......... ......ryi.a_K, 5 e, I Ct n- U ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------------- -------------**------------------*-------*------------"-----------**Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'LIHZj 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has berg issued by e board of health. Signed ) ................... ... ...... . ..................................... e .. ........ ....................... ........g ..I ed By................................ . ...Application ..4---------------G-------- -------------------------- Date Application Disapproved for the following reasons:............................................................................................................. ......................................................................................................................................................................................................... Permit No. 4e� Date - -�5�3 ........................................... Issued....................................................... Date --------------- i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -- ......OF......'................................................•-."E- .... ..................._......-- Appliration for Disposal Works Tontrnrtion ranfit Application is hereby made for a Permit to Construct ( 1')'or Repair ( } an Individual Sewage Disposal System at: - 0 i f t f=, e tI 7 A lZ o ci r� VV, ; o �•- . ......_..... - ... Location oca ..... ....._.......... ............. ....._..--. ------------••--------.-..--.-----.--.--.--...---...--.........•-----------------------•-•....... S / <Z :?t`Ownerddress J—�.......................I f 1--——!--)='�-�^----`---- i �i Address ` S ..............................7 (P v 1 a _..------•------------- .......... ............_.............................. ........................._.......................... Installer Address Type of Building Size Lot!..` ,_��.� ...Sq. feet U Dwelling—No. of Bedrooms...............3.............._. .._..Expansion Attic ( ) Garbage Grinder ( )►-I aOther—Type of Building ..E...�_`_'.^2:.1,'! No. of persons........ ................ Showers (- ) — Cafeteria-( ) 04 Other fixtures Design Flow..................................._......_.gallons per person per day. Total daily flow.........3:3.0.....................gallons. WSeptic Tank—Liquid capacityl ?.2.gallons Length!9_..�..... Width_'.!_°.... Diameter................ Depth.,:-6.. .� x Disposal Trench—No._A............... Width.1.1:........... Total Length...�L�i........... Total leaching area__!!::� _�4 ....sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (I ) Dosing tank-(~')' , '-' Percolation Test Results Performed by....LLP..'.. ...... .........' ....... Date...... ? ........................... a 1 Test Pit No. 1......'!n...?-._minutes per inch Depth of Test Pita " Depth to ground water.....t__ fi, Test Pit No. 2..........&'____minutes per inch Depth of Test Pit2_.:3.Z....•. Depth to ground water______! R+' ------------------••-•------•••--••-•.....--•--------.......--•-----•...•••.............--••-•-••------•••...........----•---••-•••••....---...... It Description of Soil '� --- '--.....:.: ............:-'.: ................................................................................. x w ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---•••.... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -••----•-•-•-------••-••----•••••---•------•-----••------•----•-•--•-••••--------------------------------••--•-•------.....................-............................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. \ C� Signed....... - / Co Date Application Approved BY ... .i........ ---------------------------------------- Application Disapproved for the following reasons-------------------------------------•-------•-------------------•------•----•-••/.......................... .........................................................••••--•--------•-•--•--•----•--...••-•----••••••-----------•••-•-•••••-•-----------------•-•----------------•---------•......----•--••••--•--- Date PermitNo.._. ....................................................... Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............7�.....0....!'././\/.....OF..... .: n<!S r=7.1. ..E.:`-........... ........................... Tnrfif ira r of TompliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (VI-or Repaired ( ) .............•------.....-•----•----•.......----•••._......-•---•.... -••-•-----••-•----...••••-•--------•---...._............•----•--................--•-••......•-- Installer . -•----------••-•• ---• --•---•---•--------•-------•••••••-••---•-.----•.............•-•---......---- has been installed in accordance with the provisions of TITLE �of The State Sanitary Cod as described in the application for Disposal Works Construction Permit No. r?_.__ _. ........ dated._ _ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................••--•-------.......--•---•--.............-•--••......-•----• Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `�.✓✓N..........OF...----13r ,Z i✓ S T--7:20 L .}= cS0 3 •-•..................••••............._........_......_............ �/ No. .�.... .... FE ---••••......•.••----•• Disposal Works TwOustrurtion0vantit Permission is hereby granted...____..___:._.. ...................•.. to Construct ('') or,Repair ( ) an Individual Sewage Disposal Stem Street r as shown on the application for Disposal Works Construction , mit N��� 3 /` . •---=-------- --- Dated-----�-- --�•----<------(-------•-- ............................................................................. oard o Health FORM 1255 A. M. SULKIN, INC., BOSTON a .1 V II11 Ill .1 113Lil1)1U ? - ('/► Deprn-lnlctit of IlealIli,Snfc(y, trod I!itV11'altoIeitIiI Services 1'uI)lie Health Divisi(lll a •i. 367 f,•laln SUcel,I lymmis MA 026011 i uArorerem a �/)/) - AIAd9. pµ(" " 4 lime St:hethiled �10 'I'intc lice I'll.���_ Sail Suitab lit)l Assessment for Sew I ige Dish ' rl 1'cifmnncd fly: r 0./ S . ��Jp/' %VfincsSed fly: �(gic' !fi�p1V & G��NI;I ALINlrOftM • oI.ocnlloo Address /I/ // / Owncr's Nnnle NA (�1G Tod s ��'64I �MJ Lgzc Address Assessor's hlap/I'nrcel: f 009-0/1 Engineer's Nnole C r"QI,� Z • Stiart NOV CONSTRUCTION 1(fl'Ail( felephoile it SO 8 398 ®3/ I.nlld Use I >C�}v►7�e- Slopes(°o) I y0 - Sur Nee Slones AJ O DISIatices I}mile Open Willer Ilody. A II NISSlblc Wei Arcn xsO (1 DtInkhlg%Ville,Wcll ft r Drnlnnge Wny Z O Il I'lopclly Lfne Z<93 II 011ler fl S IC I;'I•CI I: (Slice(mane,dimensions of ini,exncl Inenllmns mf test hales A title tests,locnle welimlds fit proximity it)holes) .299.78' '02a O/C- 12' ti 2 09' ot. 1* � ra c � W < . a_ 4 N O.T S 1 IItt.I n r 1 m tuinl( colu Ic C�tr 6 g, l - tf @r Depth W licdrock Deplh to(houndwnlm Slnndbig Willer ht Itole: Weeping Flom I'll fnee FS1111lnlral Scnsonnl I ligh(lruiiodwnlc► I)L`I POINONA'1'Il7N YQl .Sl ASONAi. I11C;I1.1'V `I'I�It.'�' IjLI� beplh b rvcd slnnding In nhs.hale: in. Depih to soil ntoilles: in. Depth to weephlg from side of obs.hole: In. Otnundwnlcr Adjuslowil 11. Index %Veil ll _ ., IirndlnR Dille: _ _ Index Weil level __ _ Atll.factor._ Ad.l.Oroumdwatcr Level . . � I'I�LtC(j[.,rC't'10N '['LS'I' `. '~�.Ii�ile� '� 9 oo•i�lrne Observntfoll I tole It / J/ 00 Time al 9" �Q � A 11 Depth of I'crc Go 72 Time ill 6" SlnlI Pic-souk Tinlc n /O :/ c O Giul Pre-sonk /d :33'• y , 11.111c tviin./Inch Z 1J3 M Slit Sullnbllily Assessnlcnl: Site Pnsscd Site I'nlled: Addilloofil Tesliog Ncelle(I()'M) Origbinl: Public Ilcnlllt Division Observn(loll Hole Pith To Ile Completed oil linen j Copy: Appllcnni t�rs>�,I� Ut3si;i(��,t i rUiv i>UtJ ;JUr hole It i I)e1,Ihliut+t Soill fill bzun . Sall'Icalurc SollCulor Soil (')Iher Sutlitce(in.) (USUn) (t luitscll) ►.lallllog (Sltochne,Sluncs,Ilooltictcs. - _(.Sa15111S11CY.1�nS1tAYS�) " San ..------- -- - -- —- —- - .f_o n 3l, . 9 0" G► � .G o a..,,/ a S - .dab�c:(. G �b DIFTW UISSE RVATION ItUI.,I Loc., Hole It I)cltih linnl Soil Ihitlzou Sail•fexhnc Sail('alor Snil ()liter Sill lace(ht:) (II.SDA) (Milliscil) t`lollling (Sltitchirc,Slrnics,Iluuldcres. 1)1;FT 011S1P;1(VATIUN 1101.,1; 1,U(11 Hole ll hcl+ih lionl Still I lilt b.on Soil'f vdilt c Sol)(:'ular Soil Ulhcr Snrl'nce(ill.)•) (I1.SOA) (hlnnscll) hlnulln C (Shucluic,Stones,llnnidcres. --- — S.i!IIII11Sl�)'..sr�!lY411 D 11" J oU81JivAItov [I 1,1�1 IJUG )1l �) hc(+Ihhuht Still Ilorlabh Still"Icxlwc Soil Color( Still OIhcr Surface(In.) (USDA) (khutscll) hIvIIIMg (Shuelurc,Sit lilt:s,Iloitlllctcs. 1 _—.-- ---•---•-----• it Above SOU pent Mind botiiltlnry fJn_ -- Ycs_x Whhlrl i0o ycni luntiultliy Nu_- Yes -- Wllhbl Iila yenr.Ilnod huondnry No Yes + I�sIIlI!tlLL{ll.ltJilll ( lillt!(:-jjuyj QL5 LtilsliJ Does ill icasl lilur feel of f171urahy accuhlog pervious lilalcrirll exist ill nil nrcas ohscived 1111oiightilll (lie nrca proposed fui. the soil nbsui-plloil system? If out, tvbai is (Ile deplll or ilnlarnlly occurring pervions malcria17 S:�Lt�lsil.11911 cellify lhni oil Nov' 94 (dnlc) 1 Ililve passed the soil evnhiniilr cx1m ililinlinll nj)provc(l by the 1)cpnliolcnt or l;nvironnlcninl hrolcclunl aril 111111 file nbovc nunlysis evils perforincd by rut• cunsisicnl With the rc(plired Irllinilig, expertise slid exl)ciicllce desel bed in J 10 CMII 15.017. 6 [);lie 7�21o1G�p BENCH MARK : F>o L.A=- - 9 a ELEV. / 33, y2 /v:C",v� TEST HOLE RESULTS . P�637 ('5-0 v v,,� Y, T'O P c M I�"�/ G L DATE : G; - /� E3 WLTNE SSE D BY � _T/�awl� s mc/rER1V S . ©. H. n'7•fin/T a ,c- 6O s c.9Ler PGA Pre-a p o s�i �� a Y "<o L- 9 M C(7,; TH_'2'NC. I3R i AN D U L)L Aff_Y }-logy.» E s §'M `G"rH SYST�-.✓t /Z v L'7,9 TF•.D V 3 O/8 S 20 �1 © '7 AJ, G,S O 7-H. 2 t=G / / G .o y� / /= E'N C0 V/V T•=Ie ED �, T'� P 4' _ row f, VOP-w7lZ 7- / 2 s V a sai4... Off. //.�..5•" ► � 8 7-0 8 Z TZ N1 0 Vj ,D / C7' ,Q L .,'S Z 5 A N Ef-�P2 10 V 0 G_ C h/. T/2, "IVC H R �ToE 1=1 n!E' E Ia L C vV ! T H C 1. ,E-,9�! M EDJ CJM TO r � ,, Z /oo�o �Es E-�t✓.E Il8 � L E'.•�C// � 2E.9 • l0 /io" ( 8' x -f O') v- M�� - 144 t L /o4.S 132" e=L J0.S:o 0 7- / 2 � EL //ASS ►' 1 0 12,x2 g'x 1.S' L�,gC,y -yc H MANHOLES AND COVER TO BE BUILT TO ! Z ELEV. TOP OF � FOUNDATION WITHIN 12 OF FINISHED GRADE I !' CL / E�fC Vn/TEl�E� 2.45 FINISHED GRADE MIN. 2% SLOPE rF Av s v 4 C0 T- / O �/ �. 4" DIA. - . ---- 4�� DIA. PIPE FIRS 2"MI �� A T ,8 0 T TO n� 0 F- C E L [..9/2 f-J C7�G "�: -' I P E - ' MIN.PITCH T. 2�LEVE M N. 2LAYER OF � �'. T'H En/ / r' /s To t3 E R EMt7 vF i • '..I MIN. PITCH i.►•,v,,w, l/2 47 8 �2 PEASTONE q• / Q Dc T �'' �G�9C,5"I3 -50 7-HAT FOOT- I/3.0o �4%FT. /OQQ INVERT !I/.00 6 Q � � �,0 • X INVERT �. GALLON R a s~ INVERT I^�Gi /S 1?LAGFD6M,�r. OF r• //2.7S ///./ DIST, :'® �t`Q 4 m�� �4'' 1Y2• DIA. SEPTIC TANK :.� INVERT - INVERT 80X //0- `. 1• V 3 ©.•.• WASHED STONE C^ C©.�►7 r�iq C T.E.D ©/Z V/ R G, I N) SAN,D . a. PLACE w 0 N INVERT �'� D A L�. AROUND f c• O^� THEN Q '¢ D,A) FEE/2F'v1'c'A TED • �-- - ' L3 O TTO /�'� • � � /2 � FIRM BASE �- 7� �72 /8 a-o • . ' R�S �`o A "' • BOTTOM AT ELEV. /08,5�DR'A/n/ P/P,E"' W / Th+ 3/4 -�Jyi D/A• n I0 MIN. - - OGARBAGE ( 2O' MIN.) _-- ----•J l �,��"i` . SS'TC OO n/ �r�$ ` `C`T`Z Xi.TO GRINDER N 5/ 7�5 Fi ON E,Vo S I7 larNrN n/ /� 7`�D To AO 0 GAA L T E!E V. a ¢.S Dir y w,E'L-L p L A C�=-?D /N S?9/V-I> P R O F I• L E OF GROUND WATER TABLE X 3ArZ o v✓ Q !" s �--��'T-� • S A N I TA.R Y DISPOSAL S Y S T-E M G3. 82 -. ! ( NOT TO SCALE ) DESIGN DATA tikY �' 0 CONSTRUCTION OF SANITARY DISPOSAL BEDROOMS Q I 5 �I SYSTEM ' SHALL CONFORM TO THE MASS. } ENVI RON M E N TA'L CODE TITLE SC DESIGN FLOW 3 3 Q GAL. DAY ' (REVISED - T- I-?7) AND T-HE TOWN OF LEACH RATE 2 MIN. INCH 5 2 , QoP�S�D -� ,C3AlZ/VST�I3LE' HEALTH REGULATIONS. REQUIRED LEACHINGCAPACITY 3= P i AM ,LY � �¢04 M . �/. A J2�'•9� �`,,,•�� Gi • SEPTIC TANK, DISTRIBUTION BOX AND LEACH- GAa. D PROPOSED , o;' ," l03�o GAL DAY. N_ ING UNIT TO BE OF REINFORCED CONCRETE . 2•S .sx a )�- /• v i2x 26 -- �-- MIN. CONCRETE STRENGTH ■ 3000PS.1. C4s� s� 24, G72+S MIN. STEEL STRENGTH • 20,000 P. S. I. SEPTIC TANK : /000 Gfa� . - MIN. DESIGN LOADING : H_/_-. 0 DRIVEWAYS . NOT TO BE LOCATED OVER SYSTEM PROPOSED SEPTIC TANK: UNLESS H2O DESIGN LOADING IS USED • ALL PIPES AND - FITTINGS TO BE WATERTIGHT 20/. 54 AND TO BE OF CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL- DATE SITE PLAN . SHOWING PROPOSED CONSTRUCTION ZONING DATA L E G E N D LO C A T I O N /V?A4 IZ s 7 mo 95 5. Z O N E OPEn/ .S,v,�C i ,•,/ T2�• FOR : L E,�3 "'L - 5'©t. G Q w v D�' �/. C o rz A. DATE .: _ — _ — _ TEST HOLE LOCATION • REQUIRED AREA _ �•9',3,_ Ga) /v,�yo� EXISTING SPOT ELEVATION IT-6 REFERENCE *- /-• 07 ' / / � -s syvwN REVISIONS • i � zs 8 REQUIRED FRONTAGE S4� 3�.s EXISTING CONTOUR -- Ig—. H o�GN'rl, - 3 ��2N. J2 ©� p,��,a . ► %o CR 4 2 G P G, L G•�G $ REQUIRED FRONT SETBACK : _C�3©� 30 PROPOSED CONTOUR SHORT =;1 cl S ALE • = 3Q REQUIRED SIDE SETBACK : / /s•i PROPOSED WATER SERVICE ---W— O. 7 - ' 7 STER REQUIRED - REAR SETBACK : �� �� � PROPOSED GAS SERVICE NALE�` PROPOSED ELEC. a TELE E a T— CRAIG R . SHORT , P. E. PROFESSIONAL CIVIL EN G I N E E R BUILDING INSPECTOR APPROVAL DATE 1131 OLD ROUTE 132 HYANN IS , 'MJL 02601 FILENO. /- -76 SHEET -OF 1 BENCH MARK : 11v Po L E xt7/ / 9 ��. 10 TEST HOLE RESULTS P S V, G37 (v'�p w� Y, Ta o G•,rt,9 N y �-_/7 v.,� ,�`f / .g �. E - ► DATE : WITNESSED BY ?"H o ivl 4-7 s 6 4 S C,q L Er P L.4r✓ Prz a p O S&7D �� y N Q L YE'S /✓l 'r C"- T ,,c)77 _ 2_111C. Z3 R l AN D U D L E Y I•-I o�,v, E s '/y1 �G R.9 rN 1712�i N�GsF_ SYsT���/ Z vS- i 120 I 7'`4 FG 6.,5 0 77 H, / �= E'/1/ C O V/V 7—4r)Z E,D 7-40 f' f' 7-0 10 / Z'' 5 V 8 soil. 8'A. E L (O vv P ✓tY/Z 7 ��I ,� •�� I �\8 Tv rC3 E /Z �M o VJ 1D / C9' � L.. L' 24° EL / /4.0 ) AZ 0 V n/O L-E'A C ti. T/Z ENC H FI Ai e TO C &r D VV / 7-H C L M1,49--V MEnt UM ra Co C O A ft S AS S R n/ M /vJ Eat tr1M IV r+ 2 `' /oo�0 1Z�s�R✓E gyp, l io• � 8 x `f�•� _ u 144' t /o4,S 132 e=G l0.s,o U ' 1` 0 /i /� ► �� p �2'x2 gx I•S c•FAch� T2�NC f-/ MANHOLES AND COVER TO BE BUILT TO • 1 't� ELEV. TOP OFis o FOUNDATION WITHIN 12 OF FINISHED GRADE e FINISHED GRADE MIN. 2 /o SLOPE s'. © T" / p /� ,l � 1 2'F CLAY /5 E,�/CC7VNTEltED 2• • �l .� 4'� DIA. _ -••• 4DIA. PIPE FIRS A T ,8 o T T o r✓� a F' C E L LAi2 /-1 O E, E '• ,v�. " M N. 2 LAYER O F _ ;.�:5v. : MIN.PITCH FT. LEVE pEASTONE /�s /2 7'"H Fn/ / T is T o air )Z EM lv�/F' Q O MIN. P 1 TC H 14 !/2. �•7 ' q• � Q C3o T Fi� TZ�F'GAC �.D So THAT FOOT- INVERT y. V4/FT• INVERT s awrw INVERT 7,65 ~ �••• - 0. .� X On/ ) 9 M,.f. o, GALLON ./ //2.75 / q + I .I �� / IV SA/✓D . E TIC _TANK D I S T, ,, ® S a m �/4 /2 D 1 A (^ CO/►-� P� CTE"D ©iZ �! �ZG, / 1 %! INVERT •1 INVERT BpX /lO,o `•� 1. W a 03.0 . WASHED STONE l PLACE ON INVERT �, m; ALL AROUND l THEN /� ¢ D�� • PEi2F"ORATED ai /2' /A' . Q1� a 61� 00 .1 7-o � , --►{ FIRM BASE. �--- 74 --� — . • 3 �� 0 MIN• � S2R<5• •�o.. : ' �` BOTTOM AT ELEV__S /P.E" w / 77,A) /4 �JYz Di.9• S TO N� J To ;3F rn/ 3T.gLL,E.D o tvoGARBAGE ( � 0� MIN. ! Zx Z8 x�. f GRINDER , �^ g' C On/NE TE,D To A G oO GaAL . 2' oN �N� S LEACH R.�nKNI J •'i"s'r j Q D/z yw,�t,L PLAGsZ� /N sAn/1� PROF I• '.. E OF GROUND WATER TABLE O ,GoW Q !"-' � � S �"��T� • , SANITA.RY DISPOSAL SYSTEM G3. 8Z �. ` __ — � ( NOT ;TO SCALE ) DESIGN DATA tiky � • CONSTRUCTION OF SANITARY DISPOSAL 3 BEDROOMS } Q I 5 EYTEM , SHALL CONFORM TO THE MASS. DESIGN FLOW 330 GAL. DAY NV IRONMENTAL CODE TITLE 3= i (REVISED . 7- 1-77) AND T-HE TOWN OF LEACH RATE - Z MIN. INCH 2/' pQoP�sD �C3A/?-IV STx7L31. E HEALTH REGULATIONS. REQUIRED LEACHING SAPACITY : 3= GAR• D��`,,,•�� Gi • SEPTIC TANK, DISTRIBUTION BOX AND LEACH- PROPOSED , ," l0310 GAL DAY. INGM MINT TO BE OF. CONCRETE STRENGTH = E 3000pSRETE : 2.s i.sxao .0 C• 's 12x oo G� 1 - (�fSG s� . iflE`K _ - 24, G72 +S MIN. STEEL STRENGTH = 209000 P. S. I. REQUIRED SEPTIC TANK • / L - - MIN. DESIGN LOADING : N /o /000 G,r9G. PROPOSED SEPTIC TANK: • DRIVEWAYS . NOT TO BE LOCATED OVER SYSTEM UNLESS H2O DESIGN LOADING IS USED 20/. 54 i �° • ALL PIPES AND FITTINGS TO BE WATERTIGHT AND TO BE OF CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL- DATE SITE PLAN SHOWING PROPOSED CONSTRU CTION UCTION ZONING DATA L E G E N D L.0 C A T I ON �A i2 N S Ti�3�3�.. ' ( /Vi,a rt.s�•-o.�/s fYl/ L 5) /Y�i9s 5. ZON E � — ��'E^i -S��c�" � 'V 7z.�' TEST HOLE LOCATION FOR : LE,t3 .EL - SOL [. Ows ,DES/. co,an. DATE .: REQUIRED AREA ' — ��9'.3`SGa) /v, qo=I EXISTING SPOT ELEVATION 17.6 OFF REFERENCE . _/- o �• / � 9 -5 s � owT/ QR REVISIONS : Iozs e REQUIRED FRONTAGE :._ ...�/Sa:� 3 7.5 CRAG sq, [� �!2/�/• � '��; • ©� y'��ifl �► REQUIRED v, � , , EXISTING CONTOUR — 16 ' �� sH tpGf}^/ ,t3/c ,q�ZG f'6i 4G44 e Q RED FRONT SETBACK : _(� � 3 PROPOSED CONTOUR 16 . 2,4 REQUIRED SIDE SETBACK : �!;'� �S� PROPOSED WATER SERVICE —W— '`FSSF��STER��`��� CALE • / = 3O REQUIRED . REAR SETBACK : Q /s � PROPOSED GAS SERVICE —"G---- PROPOSED ELEC. 8t TELE E aT— CRAIG R . SHORT , P. E. PROFESSIONAL, CIVIL ENGINEER BUILDING . FILE NO. /- INSPECTOR APPROVAL DATE 131 OLD' ROUTE 132 HYANN IS . -MA, 02601 s74 SHEET 1 OF 1 BENCHMARK SCiL .TEST ' C .TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR -DATE OF SOIL TEST oa.00 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE ELEV. ! CLEAN SAND SL1tl. TEST DONE BY' C�"�- WITNESSED BY :?eri-Y •t��r�a.-tin y (ASSUMED) CONCRETE covERs LOAM AND SEED o A PA%/ -D OBISERVA11ON H ELEV.- `. 4 SCHEDULE 40 PVC PIPE ` PERCOLATION RATE 2 MIN. NCH AT o-7 2 NCFiES MIN. PITCH 1/8" PER FT. /1 2 LAYER OF 04 9 9 Z:r 1/r TO 1/2- LEGEND: DEPTH HORIZ TEXTURE COLOR MOTT. OTHER • lIrL 99,3,,3 MRX WASHED STONE VENT EXISTING SPOT ELEVATION 00x0 •r �} ,Sty ri*A y o�' No vusv�r 4' CAST IRON PIPE - "' REQUIRED EXiS,11NG CONTOUR ----00---- Z,. goo.;t (OR EQUAL) MiNiMUMYX FINAL SPOT ELEVATION d y t PiTCN 1/4' PER F1: ? 1 CU. FT. OF FINAL CONTOUR —LO ,3 G CONCRETE ! - ANCHOR SOIL TEST LOCA11ON 2,4 FLOW.LINE E L 9 G.3 3 a UT1LllTY POLE �- t C, L .t' , 10■ TOWN WATER W W ,9d.7; ELEV. MIN. ��, . . . . ° CATCH BASIN ADD •• �i7. 4p Nil ° 10� ° 9S,v GAS LiNE c f C �S a nCL !1 ELEV. = 98.+� GAS ELEV. _ ?Z./0 6" SU _ 91r17 3 ° ELEV. CLEAN OUT C.4. !2 G D i S TR i B U Ti ON CESSPOOL C.P. 0 Sal u•�rvis` a ELEV* ' 4-KX� HIGH CAPACITY INFILTRATORS WiTH C3 C/a /Q s M R T 4, LIQUID OUTLET _ — B 0 X 7S'8 3 STO E IN AN y 6. 47-DEPTH TEE *t! 4 FEET 14 INCHES TO BE WATER TESTED 1I�c.37 X Ica" TRENCH FORMATION � 5 FEET 19 INCHES iF MORE THAN ON£ 'OUTLET 5 FEET 24 INCHES 1000 GALLON WELL ,LJ "0 WATER ENCOUNTERED AT 1'� ELEV. a ` 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) SOIL ABSORPT10N 8 FEET 34 INCHES SEPTIC TANKZONE 3/4- TO 1 1/2' ,�'? INDEX SYSTEM (SAS) WASHED STONE � ADJUST ,Y a30r 01= s,4-V.Z� L-4Lry 77 DESIGN CALCULATIONS ` USGS PROBABLE WATER TABLE ELEV. NUMBER OF BEDROOMS SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE 7/tea) ILEv. - GARBAGE r DISPOSAL UNIT 70 NOT TO SCALE BOTTOM OF TEST HOLE ELEV. R TOTAL ESTiMATM FLOW 110 GAL/BR./DAY X 3 Bk.)'CAL/bAY �/ REQUIRED SEPTIC TANK CAPACITY .; `. �,�?' ic3ca GAL - ACTUAL SiZE OF-SEPTIC TANK S GAL SOIL CL..ASSiFICATiON DESIGN PERCOLATION RATE . EFFLUENT LOADING RATE GAL/DAY/S1' r LEACHING AREA. 1/ 37` + 94 n SO."FT .,.,, LEACHING CAPACITY AR��EgA X RA TEE GAL./bAY row" LEACHING CAPACITY (t 2X 8 x .7r) 7'' t se uc►r `• NOTES: G ___ __ 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO 'D.E.P., xiz L- G�2 .5 p ,1� q(� 99 N TITLE 3 AND THE TOWN OF ZAgy-TraV447' RULES AND-" REGUL.A11ONS FOR-THE SUBSURFACE,DISPOSAL.OF SEWAGE. A,- 2- ALL COVERS TO SANITARY UNITS SHAH BE BROUGHT TO SEA' OV40 r1/ WiTMN .6";OF "FNiSHm GRADE f - 3. ALL COMPONENTS OF .THE SANITARY SYSTEM SHALL BE CAPABLE OF "• "" " 'fa'S' WITHSTANDING H-1 Og LOADING`UNLESS THEY ARE UNDER OR .WITHIN �, • ;cy hry f j� N� 10 'FT. OF DRIVES OR PARKING AREAS. •H-20 LOADING SHALL BE USED UNDER OR WITHIN 10,FT. OF.DRIVES OR PARKING AREAS. . � 4. AI.'Y MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL 8 9`l I, BE MORTARED N`PLACE. \ t -. ___ .. __ y 5.NO DETERMINATION HAS BEEN MADE AS.TO:CO1rtPLiANCE WiTH �. �` DF.MFD OR ZONING REGULkTiONS. O*JER. APPLICANT S T9 =_ �. CA -C h' .7 3,q.��� OBTAIN SUCH DETERMINATION FROM APPROP ATE>AUTHORITY. _�_._ __ . a S -- = - — - _ - _ �. 1 Ey/ 7 6.UTILITIES SHOWN ARE APPROXIMATE ONLY: EXCAVATION CONTRACTOR E'` cm �p`NK } -. �- `- ` iS TO CALL 'DIG-SAFE" AT.1-888-3�44-7233 AT LEAST :72 HOURS ;a " _'-- PRIOR TO COMMENCING WORK ON SITE. 7. CONTRACTOR IS TO VERIFY GRAD 'AND akv*TIONS AS'WELL AS T `�' ' � SITE CONDITIONS PRIOR TO COMMENCING WORK ON;SITE. ANY;YARIATiON g, (zj ,� � � ���' �� �� \ iS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER _._ . IMMEDIATELY. 8. PARCEL IS iN FLOOD ZONE ...:..�.,•` 9. LOT IS SHOWN .ON ASSESSORS:MAP �" � AS PARCEL 'c1 I' + cy �G, 09 ' `- "� � 10. t7QST1NG SFPTICS ARE TO BE PUMPED.AND BACKFlt1fD. ` 0 C NEW D t ST, DQX 11, ALL-UNSWTABL.E 1MATMAL SHALL"SE MOVM'FRW UNDER /AND �'0R t A MINIMUM OF,W AROUND LEAcHINO.F'ACIM AND # REPLACED Wt1H L �' 'w/'✓A T" �C.1.mac MATERIAL AS SPECWn IN 310 CZAR 15.255t(3).,.I F Enrc v .rr `� 5 TH urn 4.r r�g� G. pia. ro to .e APPROVED: BOAR OF_ E 1. < AGENT 7`�"sThica t�-s DATE ��- tT 431 PROPOSED SEPTIC I�ESI N ' FOR PROJECT LOCATi N 9 'e -1A F r ry 'CRAIG � SHORT . ,C? u>L,DI�/G 1 oc.�7"iox✓ ;PE2 CC1zr a pl-c1r P� ti S Y Z owoV C. Aol=V' *AJ 0. AarE12/rvG, PROFESSIONAL ENGINEER , ::. "c D 6 re p 41 Z 7/8 ls s r.9 m� D .0 Y L>q BOB—, P.O. BOX 1044 c �,w L-,- 12 4 s SOUTH DENNIS MASS ( • 398-8311 02650 �! 0f }DOVE 2D DATE -'t/�'24 ®t� CALF I*► _ �Q ' �a CRAiC �y k3 SHORTT j� REVISED JOB NO.: .. ' CIVIL No.27 LOCATION • MAP o REVISED, SHEET OF oni C1 998 'CRAiG, SHORT,:P.E. ^, a l SOIL .:TEST . `0 .. —BENCHMARK .r` SE 20 F"f. MINIMUM FROM CELLAR DATE OF SOIL TEST ` TOP OF FOUNDATION 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE SOIL TEST DONE BY /�.?e.r a . r ELEV 1cm.00 10 FT. MINIMUM , CLEAN SAND WITNESSED BY (ASSUMED) CONCRETE LOAM AND SEED OBSERVATION H04 1 aFv.= COVERS e SCHEDULE 40 PVC PIPE PERCOLATION 'RATE -Z IAN./iNCH AT L `' "INCHES MIN. PITCH 1/8 PER FT. 20 LAYER OF ,/s• TO 1/20 LEGEND: DEPTH HORIZ TEXTURE -COLOR MOTT. OTHER • ,�9 1+aA WASHED STONE VENTEXISTING SPOT`ELEVATION 00x0 2 4 ea G-%' 4• CAST IRON PIPE `� 3 REQUIRED EXISTING CONTOUR ----00---- „ ao (OR EQUAL) MINIMUM FINAL SPOT ELEVATION l yr PITCH 1/4• PER FT. 2 1 CU. FT. OF FINAL CONTOUR 3G Lit .SQ r, r CONCRETE SOIL ?EST LOCATION !Z E = g t �j G.3 3 a, ANCHOR UTILITY POLE FLOW LINE _ • TOWN WATER ®W•�•�•�W�®• ELEV. a' MIN. , . • • e CATCH BASIN `?7. t 00 ° �iS.o GAS LINE G , z a d. f?1713 7�" 0 ° " ELEV CLEAN OUT C• /2G • .. �S.9 3 .: ELEV. •• 48.as BAFFLE GASELEV. .. p c. 0 6 SU CESSPOOL C.P. (� S� DISTRIBUTION _ c r� hs ELEV. 4 HJ0 HIGH CAPACITY INFILTRATORS MATH ^ � Ala ?r Ner1b 4f U UID OUTLET BOX STONE IN AN Z 1 ` ` it A- ✓0 v�t?41 4 FEET 14 INCHES TO 8E WATER TESTED 1!x 37 TEE X/ca„ TRENCH FORMATION 5 FEET 19 INCHES IF MORE THAN ONE OUTLET nvo WATER ENCOUNTERED A7 144 ELEV. ' 6 FEET 24 INCHES 1000 GALLON - WELL Mrs , 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) • SOIL ABSORPTION ,� ZONE 8 FEET 34 INCHES SEPTIC TANK 3/4 TO 1 t j2 INDEX CEx! S rt,vG,) WASHED STONE SYSTEM (SAS) n' ADJUST DESIGN CALCULATIONS t5or of -5*4Aj.v nLEVf 877. ,� USGS PROBABLE WATER TABLE ELEV. _ _ NUMBER OF BEDROOMS GARBAGE DISPOSAL.UNIT ....�4_.. SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( -7 //7/010) ELEV. - NOT TO SCALE BOTTOM OF TES? HOLE ELEV. _ - TOTAL 'ESTIMATED FLOW ( 110 GAL/BR./DAY X SR.) C GAL/DAY REQUIRED SEPTIC TANK CAPACITY ' r-s p /o0 GAL t / " ACTUAL SIZE OF SEPTIC TANK_ GAL SOIL CLASSIFICATION . DESIGN PERCOLATION RATE -•��-- GALS Y/5f . . : r_ EFFLUENT LOADING RATE LEACHING AREA. iI'x 37` 4- 54 .- y SO. FT. LEACHING CAPACITY AREA X RATES ` GAL/DAY" S 7 A 74> 3 4� T-ow" LEACHING CAPACITY -GAL/DAY NOTES- 4, 3 G _.._. WORKMANSHIP AND MATERIALS SHALL CONFORM 1.O 'D.E.P. " g7` _ 1 2 ` 9 7�, • 1. ALL N THE'TOWN OF A,r/rs � - L� �' J q TITLE 5 AND .P -- RULES AND C1Z r REGULATIONS-FOR THE SUBSURFACE DISPOSAL OF.SEWAGE. 2 ! Nf �."'�- a "-, t`` 2 ALL COVERS TO SANITARY UNITS SHALL BE,BROUGHT TO . Sce /a0 T 1/ WITHIN 6';OF FINISHED GRADE. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF 1 j ' NJS / �•fi•�. WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER ,OR YAWN >' e 10,FT. OF DRIVES OR'PARKING AREAS. '1-1-20 LOADING SHALT. BE ` USED .UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS.; t + Cam?] 4. ANY MASONARY.UNITS USED TO BRING COVERS TO GRADE SHALL fu 99 G �---- - - 1� BE MORTARED IN PLACE. . 97 g ,£ �, --+- �. _ __ 4 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH ' I _ _. ,. D=ED OR ZONING REGULATIONS. OS�INER. f APPLICANT IS TO I) 1t cv CA71C H .8og,-'"l o l OBTAIN SUCH <DETERMINATION FROM APPROPRIATE AUTHORITY. �'t: r Cl.7 S. UTILITIES SHOWN ARE APPROXIMATE ONLY. EXCAVATION CONTRACTOR IS TO CALL 'DIG-SAFE' AT 1--888-344-7233 AT LEAST 12 HOGS isc 7pN PRIOR TO COMMENCING WORK ON SITE. % tc,r o `- 7.`CONTRACTOR IS TO VERIFY GRADES AND E EVATIONS`AS WELL AS � SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE ANY VARIATION 2� 9 1S.TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER se !, r �3 IMMEDIATELY. �y _ 8. PARCEL` IS IN FLOOD ZONE �.; _:w._ __�_ 9. LOT iS SHOWN ON ASSESSORS MAP /.3 AS,PARCEL " _ - 10. EXISTING SEPTCCS ARE TO BE PUMPED AND BACKFILI ED. NSW t)/S is Q�X \ 11. ALL UNSURABLE MATERIAL SMALL IRE PMJOVED Ftd OU UNDO'AND FOR , G A MINIMUM OF S• AROUKa LEAAcmiNO IrAcuw A1ab BE REPLACED A4TH }+ !2 EL 4 C f}7 a�: MAIMAL AS SPECIFIED IN 310 CMR I&255:.(3)." l F' EAICOVAe EE trl 0 w --c�v, 9s;L�u } - tqs Sf/Gtnr�/ I Z. uti Z/ 77/4eF fS 7-e= ,Q� v-P7.1- 0 4 7-4T.D %i.S @tE-XxA. pfz/o++ „rca rye .sT�I r � GctnJST c/C "/aa,' 113 �. APPROVED: BOARD , OF HEALTH M a, _ . DATE AGENT '`,.j �' ._.__._._.._�..___ _._._�._T_._.._�; L 2a/moo TL'a'.."r'Th✓c�G�"..'�' uusc �r� PR{?POSED SEPTIC DESIGN X T— _ A r, rr-���. FOR H PROJECT LOCATION Ul LJJIa16- pE2 C ETLT/F� � . CRAIG "H SHORT - PLC�r �t_r�? w z3 Y PROFESSIONAL z�oWAj C��-�" .e�A,1 cr-e,Ll ,67 wr, I • ENGINEER z"c £��r1�"ta 4/�7/88 sr. •�-,� = � t'' 508�: P.O.:BOX 1044 .7'o A4iV > 1, wI ra c s 398-8311 SOUTH DENNIS, MASS 02660 A OF ��• >aA�t� IG� DATE -712OPAIG G�o� SCALE •I" .� G^�G f a 0 I � sHcRT • REVISED JOB No. 70 CIVIL No. 27,483 s LOCATION MAP. REVISED . SHEET OF- 01998 CRAIG R, SHORT, P C