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HomeMy WebLinkAbout0201 OAK STREET (CENT./W.BARN) - Health 201 Oak Street W..Barnstable P - A. 173 014003 ` I o 1 i 0 jp o , TOWN OF BARNSTABLE LOCATION "ZrD 1 dAK S'-} SEWAGE# Zo Z 1 - Z3t4 VILLAGE CO. ASSESSOR'S MAP&PARCEL r)3.01q•003 INSTALLER'S NAME&PHONE NO. C,j cicccL oAio/\ 4w7-)- 06S3 SEPTIC TANK CAPACITY J 9 LEACHING FACILITY. (type) SOpgQ) i_Ic.(3� (size) 13 x 33 x 2- NO.OF BEDROOMS q OWNER RU55GJ I PERMIT DATE: &• Z 3. 2 COMPLIANCE DATE: xq 1,2-1 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 1 n A1- Z2'G S.I. yz AZ' 2s 32 • W9 ' Froni A3- z� ' a n 63' S9',o„ ® O Aq- r 3 N . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes • Y Application for Misposal *pstem Coustruetion Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System [X Individual Components Location Address or Lot No. 2.01 Oo►k Strew ai• tfn. Owner's Name,Address,and Tel.No. Zia,,d!S QuSS %k Assessor's Map/Parcel 113 ' 014- 0 0,3 1,01 Oo& $3. W. &xn5}a6y Installer's Name,Address,and Tel.No. {a 1 Q 4Acp jj#,% jqt. Designer's Name,Address,and Tel.No.ttlgtM6(% Qoct5 311A 9,6t,1e• 13o SQ"do"Cr, SoB C 4%s WA Rd. Farv%WoW $08•4-n•$sl3 Type of Building: DwellingNo.of Bedrooms Lot Size +� �3�Ipc(l sq.ft.� Garbage Grinder(1.10) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 440 gpd Design flow provided H94 gpd Plan Date ('p 1 12 I 'L% Number of sheets 'j, Revision Date Title Size of Septic Tank `Ltcieki ct). 1$O O Type of S.A.S.(a) Soo c n Cham6o Description of Soil b" OWNS Nature of Repairs or Alterations(Answer when applicable) kAr.3640•kion 0f MW db3 ac1d C3) JtJO A�I�On Conner \rix 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. Si ed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. - Date Issued �. . y- t •�� is .. tC No 4a t / a;. r ;, Fee ...�,., i : sTHE COMMONWEALTH OF MASSACHUSETTS Entered in comp uteri hes� PUBLIC HEALTH DIVISION TOWN Of BARNSTABLE, MASSACHUSETTS application for -Misposar �6pstem Construction 3permit t13 141plication for a Permit to Construct( ) Repair W Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. Z,o t Q ak St c e c 1 W° [?c\i n• Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Q 3 201 00A- Sk. V3. &,(r)s fo u Z Installer's Name,Address,and Tel.No. (� �C:Y t� {io tat. Designer's Name,Address,and Tel.No. souk 130 Sa�,e�,,',�r Sog. W4.Ota53 12 W.Cco>SF\etc\ R,c+. ' 0 ",ldalc. SOL W11- sit ' Type of Building: ' w' DwellingNo.of Bedrooms Lot Size * 1 3 i to I sq.ft.- Garbage Grinder(�0) Other Type of Building No.of Persons Showers( ) Cafeteria( ) >n Other Fixtures Design Flow(min.required) LAq 0 gpd Design flow provided S gpd Plan Date (j t Z l 21 Number of sheets Revision Date 1 � Title Size of Septic Tank fix;-{, t pn Type ofS.A.S. 3) 500 paklo� Chnn.b,cc is - Description of Soil ' `e p. L\n c Ky . :h Naturer' of Repairs or Alterations(Answer when applicable) r1(�c,��((n�i u n C nee.l 0,n e, - 3) '�,o o A j o^ ' ��G,`� C-DYY�aIQ C,�vt'1 V �c� •Pv i�.,'�n\. 11 1 ��~ Date last inspected: s= 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. F Signed .Date (A!� 2 Application Approved by _. Date rt Application Disapproved by Date for the following reasons Permit No. Date Issued ------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by {)t qA r 0\ark4 at 1 p( (Sc.V has been constructed in accordance - with the provisions of Title 5 and the for Disposal System Construction Permit NO. � dated /A!D,3/c ) "#Installer EX C GNU rXA 1 on k(1t - Designer i nL,nooc 10 j k o a f kk� ' J #bedrooms Approved design flow gpd The issuance of this permit shallnot be(cc6nstrued as a guarantee that the system will f Moti©n as designed. Date 1(� -( "" Inspector tJ No. Fee , Y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstetn Construction i3ermit Permission is hereby granted to Construct( ) Repair(x) Upgrade( ) Abandon( ) System located at -n t C1rk1t `-)k c o e 1-- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mus%be completed within three years of the date of thiss permit Date If ! Approved by-=- Town of Barnstable Regulatory Services Richard V.Scali,luterirn Director 'U" 630. Public Health Division s� Thomlals.McKean;Director 200.Main Street,Hyannis,MA 02601 Office: 508-862 4644 Fax: 508-790-6304 Installer&Desianer Certification Form Date: I-zq/Zt Sew e Permit# Assessor's Map\Parcel 1- 0 14'003 Designer: Inc, Installer: 1 Address. 1 Z Wi Cr ts,sP—.-/c/ Address: 1J 7&ke C-1 MA oz6q an was issued a permit to mstall.a (installer) septic system,at -Z-0-t Cc'_ If . /i, based on a design drawn by (address) n Zell n fVGK4s (Z.� 'Z( 1h dated C,rD (des;%gnei) I certify that the septic system referenced above was installed substantially according to the design,which may include minor approved changes such as lateral relocation of the. distribution box and/or septic.tank. 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 ofa. y component of the septic system)but in accordance with State&Local Reputations, Plan revision or certified as-built by designer to follow. Strip.out.(if required)was inspected and the soils. were found satisfactory. I certify that the system referenced above was constructed in with the terms Of the I\A approval letters(if applicable) Installer's ign 1� to.35 ' ots ' (Designer's Signature) (Affix Design ' °re) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE L NOT 'BE ISSUED UNTIL BOTH ,THIS FORM AND,;.A - RVIALT:1 CARD 4RE:REGEIEVED'BY THE:BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q.septiewesigner certification Form Rev 8-14-.13.doe Engineers note This certification is limited to an es-built inspec lion of sWern components as.insfalled prior to:backfili.The engineer did not supervise construction of the system Tha-installer assumes responsibility for ail materials,workmanship,hackfilling tospecified grades with proper compaction and setting nserstcoven;as shown on the design plan. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name information is required for every T ffA9 A/-1-1—A9C E NA e26&9 e3—f (— 14 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. Importantoutfhen A General Information fillingng out formrm A.s on the computer, use only the tab 1. Inspector: key to move your cursor-do notes use the return Name of Inspector key. r Company Name 7Z9 Company Address City/Town State Zip Code 1 �-�2� Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspector's Signature Date The system inspector shall submit a copy-of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to-they,,apt,.rnpriate.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 allthority. ****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 �1he same or different conditions of use. .. Title 5 Official Inspection Fonn:SubwOace Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Him Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address f L`r i L(Z— Owner Owner's Name information is TAcg J S LC required for every GAa-f page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: 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: / ✓.P s-E!..2 yc.r ��-t-[cr►t� rc Yc�c,► `� ca�.�( N14 B) System Conditionally Passes: ❑Xplease ystem components as described in the"Conditional Pass"section need to be paired.The system, upon completion of the replacement or repair,as approved by ealth,will pass. Ch "y " "no"or"not determined'(Y,N, ND)for the following statements. If"not dete exp The septic tank is metal and over ears old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structural ound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old available. ❑ Y ❑ N ❑ ND(Explain below): Title 5 Official Inspection Fomc Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w •` ��( Dom— S� Property Address t Owner Owner's Name information is required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ,% B) System Conditionally Passes(cont.): ❑ Obse \abage backup or break out or high static water level in the distribution box due to brokcted pipe(s)or due to a broken,settled or uneven distribution box.System will pass in (with approval of Board of Health): Ell s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ n is re ved ❑ Y ❑ N ❑ ND(Explain below): ❑ n box is leve or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a ye\Kh): structed pipe(s).The system will pass inspection if(with approval of the Boa �of❑ broken pipe(s)are replaced ❑ Yxplain below): obstruction is removed ❑ Yxplain below): �lA C) Further Evaluation is Required by the Board of Health: ❑ Co-n-f exist which require further evaluation by the Board of Health in order to determine if the system is fai m tact public health, safety or the environment. 1. System will pass unless BoaraW.4dQalth determines in accordance with 310 CMR 15.303(1)(b)that the system is not function ' a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address .ReC-e—r Tin Owner Owner's Name information is required for every page. City/Town State Zip Code Date of Inspection B.//Certification (cont.) /`� 2. �d=eXat l fail unless the Board of Health(and Public Water Supplier,if any) dete the system is functioning in a manner that protects the public health, safend environment: ❑ T system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a rface water supply or tributary to a surface water supply. ❑ The Sys m has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system h a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic to and SAS and the SAS is less than 100 feet but 50 feet or more from a private water sup ly well". Method used to determine dista "This system passes if the well water analys performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the prese of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failur ritena are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No'to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ �- Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 1Liquid depth in cesspool is less than 6"below invert or available volume is less IN than Y2 day flow Title 5 Offidal Inspection Form Subsurface Sewage Disposal System•Page 4 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w r' Property Address Owner Owner's Name information is 4/S 7 A 13 e-15-- required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ rVI` 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. ❑4 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑,u/a Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑p4 Any portion of a cesspool or.privy is within 50 feet of a private water supply well. ❑ply 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.] ❑N/a The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ —A The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a N14 de " n flow of 10,000 gpd to 15,000 gpd. For large sys ou must indicate either"yes"or"no"to each of the following, in addition to the questions in Section Yes No ❑ ❑ the system is within 400 fee surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary urface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Inte ' Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply 11 If you have answered"yes"to any question in Section E the system is considered a sigm nt threat, or answered"yes"in Section D above the large system has failed.The owner or operator of a rge system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments d� sr 4 Property Address Owner Owner's Name information is �/ 2 required for every "r'` '�'Q'�S/"7a �C Cl s� � G G� page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ( ] ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ 1� Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined?(If they were not available note as NIA) W ❑ 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? EP ❑ 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 ons frle-4AI 6-�lJ-92 ,�/,vsP /D-/�1-O Z rvt ❑ Existing information.For example,a plan at the Board of Health. K ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CM 15.302(5)) D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Title 5 Official Inspection Form:subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is �• � j�[F X1,4 OZIo6P, 9— required for every State Zip Code Date of Inspedion page. City/rown D. System Information A / Description: � �• / gW //.,�-�1 S*S S=I.t/ + A-&-+uvr Number of current residents: Does residence have a garbage grinder? ❑ Yes W No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes [�Z No Laundry system inspected? ❑ Yes ❑ No/4�'f4 Seasonal use? ❑ Yes [�t No Water meter readings,if available(last 2 years usage(gpd)): T ss^oar m 7 _l l 2S Sump pump? ❑ Yes No Last date of occupancy: Date /f// Commercial/Industrial Flow,Conditions: Type of stablishment: Design flow(base 10 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons s etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: Title 5 Official Inspection Forrrr Subsurface Sewage Disposal S •Pegs 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name information is required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) X14 Last date of occupancy/use: Date other(describe 4aw General Information Pumping Records: 414*1 t5 Source of information: Was system pumped as part of the inspection? Yes ❑ No i5vys� �'T If yes,volume pumped: gallons � How was quantity pumped determined? tr,S yv� i n Reason for pumping: Type of System: XSeptic 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): Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts 1. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Q/Gc/ TL-2 Owner Owner's Name /7i/.¢�/� information is /j/. 112A/�tIS jX 13CC- 77-44 required for every State Zip Code Date of Inspection page City/town D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: Z 'PT f Were sewage odors detected when arriving at the site? ❑ Yes P( No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron 0(40 PVC ❑other(explain): Distance from private water supply well or suction line: fee Comments(on con ' ion of'oi s,v nting,evide a of leakage,etc.): fi Septic Tank(locate on site plan): Depth below grade: feet Material of construction: concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain) 414 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No A114 , '/X 5�(Sr /,mad 5•T Dimensions: S-P XAO G Sludge depth: Title 5 Official Inspection Form:Subsuface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name information is ��/�,y�is�/3 required for every /f f page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge t,bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle 2g3�i Distance from bottom of scum to bottom of outlet tee or baffle How were di nsions determined? omments on pum c rt� ation i lets a uue fee o affl dition structu al integrity fi uid levels as re ted to outlet inve vidence of leakage, tc.): � Q /✓1 Gre e Trap(locate on site plan): Depth bel rade: feet Material of construc ❑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 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address �lGG�T�2 Owner Owners Name information is required for every T /��E page City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, 1/ liquid"I 7!�as related to outlet invert,evidence of leakage,etc.): Ti t or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth bel grade: Material of const 'on: ❑concrete ❑ al El fiberglass El polyethylene El other(explain): Dimensions: Capacity: aeons Design Flow: gallons er day Alarm present: ❑ Yes No Alarm level: Alarm in working o r. ❑ 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address �jGc i T�/Z Owner Owner's Name information is 1 /_ � required for every !�� page. City town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above zv-e--l e invert� v� omments (note if box is Iand dlstrib tio% 0 ou I s equal,Cyevidence of solids caryove any evidence of leakage into or out of box,etc.) Ua� N/A Pump Chamber(locate on site plan): Pumps in ing order. El Yes El No Alarms in working or ❑ Yes ❑ No Comments(note condition of p chamber,condition of pumps and appurtenances,etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): �Ff SAS poi located, explain why: 1 �l�s��� 4 eW 4-- oZ Title 5 Otfidal Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name information is Gj/, rS I-4 6 CE � O2&&E3 :�//— /¢ required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. leaching chambers number. .��,y�" � � ❑ leaching galleries number. ❑ leaching trenches number, length: leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/alternative system Type/name of technology: Comments(n a conditi n of soil �ignjof hydraulic failure(evel of ponding damp soil, ondition of getation,etc ��'' P �a n J f ��z y 1 -4 ag Ce ools(cesspool must be pumped as part of inspection)(locate on site plan): Number and co ration Depth—top of liquid to inlet inv Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ Title 5 Official Inspeclion Forth:SubsurP"Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts c' Title 5 Official Inspection Form P4 VA Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owners Name information is required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.): Privy(locate on site plan): I Materials of c ction: Dimensions Depth of solids Comments(note condition of soil,signs of hydrauli 'lure,level of ponding,condition of vegetation, etc.): Title 5 Official Inspection Form:SubsuAace Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments C5'7 Property Address Owner Owner's Name information is /4 required for every page. City/rown State Zip Code Date of Inspection D. System Information (cont.) 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 r O r c-! ZZ —6 f � _ z �� •r C-Z 27= D'� � -Z 21 --0 '� ��3 Z�-�/ E-3 ��� • 2-3 1n� Title 5 Official Inspection Forth SubsWace Sewsga Disposal System-Page 15 of 17 f Commonwealth of Massachusetts j Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Property Address Owner Owner's Name information is � /1tiST/���t• required for every State Zip Code Date of Inspection page Cityrrown D. System Information (cont.) Site Exam: ( Check Slope l j Surface water le /1 QQ/GETS/,OC-pC'Lprz1l�Jo��T�Jk/rT�,tiQ>1 /'0 ' OCheck cellarclvl57 ( ' Shallow wells -13 I i,,,, AAX '7/ 1� Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record / ' s�w4w'0��G-3 0-9� If checked,date of design plan reviewed. Date ❑ Observed site(abutting property/observation hole within 150 feet ofSAS) with local Board of Health- ptehecked � rla��t✓r���G•Z ) Try z ¢-7 92 ❑ Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: �99Z You must describe how you established the high ground water elevation: 6 �I / Ad j - 9 Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owners Name information is required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary:A, B, C, D,or E checked Inspection Summary D(System Failure Criteria Applicable to All Systems)completed System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Tide 5 Official Inspection Form Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS ' EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ► DEPARTmENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A RECEIVED CERTIFICATION Property Address: 201 Oak Street N O V 13 2002 West Barnstable MA 02669 Owner's Name: Yvonne Pina TOWN OF BARNSTABLE Owner's Address: Same HEALTH DEPT. Date of Inspection: October 14,2002 4�I Name of Inspector: PATRICK!rL WCONNELL Company Name: SEPTIC INSPECTION SERVICES CO. `^► Mailing Address: 189 CAMIETT ROAD MAP 1 MARSTONS A1H LS MA 02648 Telephone Number: (508)42&1'e 9 PARCEL. - CERTIFICATION STATEMENT LOT - I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: �� L)L!:�zaDate: l< �aZ The system inspector shall submit h 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 Recommend pumping tank now and every two years. ""This reportt 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. If II Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 201 Oak Street,West Barnstable Owner: Yvonne Pina Date of Inspection: October 14,2002 Inspection Summary: Check A,B,C D or E/ALWAYS complete all of Section D A. System Passes: _X I have not found any information which indicates that any of the failure criteria.described in 310 CMR 15303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Paste: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with 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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 201 Oak Street,West Barnstable Owner: Yvonne Pina Date of Inspection: October 14,2002 C. Further Evaluation is Required by the Board of Health: Conditions exist which require fi -ther evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System wilt 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form 3. Other. Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 201 Oak Street,West Barnstable Owner: Yvonne Pina Date of Inspection: October 14,2002 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or dogged SAS or cesspool —X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. - X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface — water supply. X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ 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.] No (YestNo)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. K Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to l.5,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no — the system is within 400 feet of 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 H of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat.under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. f. Pages of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 201 Oak Street,West Bar nstable Owner: Yvonne Pina Date of Inspection: October 14,2002 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? N/A_ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X — Was the facility or dwelling inspected for signs of sewage back up? _X _ Was the site inspected for signs of break out? _X _ Were all system components,excluding the SAS, located on site? X _ 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? _X _ 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: Yes no X_ Existing information.For example,a plan at the Board of Health. X_ _ 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 FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 201 Oak Street,West Barnstable Owner: Yvonne Pina Date of Inspection: October 14,2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 1 10 gpd x#of bedrooms): 440 Number of current residents: 3 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [ifyes separate inspection required] Laundry system inspected(yes or no):— Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 344 Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCMUMDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/personslsgtetc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records None available Source of information: Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--Now was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X 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)No _InnovativelAlternative 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 age of all components,date installed(if known)and source of information: 10—I I years old.Per town records. Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:201 Oak Street,West Barnstable Owner. Yvonne Pina Date of Inspection: October 14,2002 BUILDING SEWER X (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron X 40 PVC—other(explain): Distance from private water supply well or suction line: 30' Comments(on condition of joints,venting,evidence of leakage,etc.): Pipe in good condition. SEPTIC TANK- X (locate on site plan) Depth below grade: 8" Material of construction:— — — X_concrete metal fiberglass—po]yethylene other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):-(attach a copy of certificate) Dimensions: 11"Long X 6'Wide X 6'Tall Sludge depth: 1 %" Distance from top of sludge to bottom of outlet tee or baffle:26" Scum thickness: 3%" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Recommend pumping.Baffles intact GREASE TRAP: No (locate on site plan) Depth below grade:— Material of construction:—concrete metal fiberglass__polyethylene other (expo): — — Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 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: 201 Oak Strom,West Barnstable Owner. Yvonne Pina Date of Inspection: October 14,2002 TIGHT or HOLDING TANK: No (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: gallonstday Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened) (locate on site plan) Depth of liquid level above outlet.invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Box set level.Flow equal at all 3 outlet pipes. Pi.1MP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): r Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 201 Oak Street,West Barnstable Owner. Yvonne Pina Date of Inspection: October 14,2002 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ _X_leaching chambers,number: 5 Infiltrators leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions. overflow cesspool,number: innovativefahernative system Typelname of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): No damp sod or excessive vegetation. CESSPOOLS: No (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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)-- PRIVY: No (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.). r Page 10 of i 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Properly Address: 201 Oak Street,West Barnstable Owner. Yvonne Pina Date of Inspection: October 14,2002 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. So qz zz Zoe r Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 201 Oak Street,West Barnstable Owner.Yvonne Pina Date of Inspection: October 14,2002 SITE EXAM Slope None Surface water done Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 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 local Board ofHealth-explain: Checked with local excavator%installers-(attach documentation) X Accessed USGS database-explain: USGS topo maps and T.O.B.website. You must descnbe how you established the high ground water elevation: Groundwater contour map shows water at or below elevation 40. USGS topo map Shows lot at elevation 60. Bottom of infiltrators 4 feet below grade.Gives more than 16 feet separation to groundwater. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Applirution for Disposal Works Tonsfrurttuu Frrutit Application is hereby made for a Permit to Construct ("/) or Repair ( ) an Individual Sewage Disposal System at: t1 ....CA-AC .S'r26� G���� L 6- L l/?c 3 ........ ----------------------------------------------------- --------------••--------•...... o T.....- ,---Location-Address or Lot No. ..L.�Lt ner �� [-- +L.�S/=1_! .......... .._ _.[1.... .�v: PO Installer Address VVV UType of Building Size Lot... Z.A -------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `44 4 Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures -------------------------------- - W Design Flow............... 5-..........__.._.__...gallons per person per day. Total daily flow.__..._.. ' ........................gallons. WSeptic Tank—Liquid capacity_As�L.gallons Length ZO'..".... Width..f'eIe__ Diameter................ Depth__-s ..8,." x Disposal Trench—No.......1.......... Width...... O......... Total Length.... ` ---- Total leaching area...- ......sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.............................................................. ........... Date----- Z_.._...... a Test Pit No. I...155�..?-..minutes per inch Depth of Test Pit.... Depth to ground water.... .v (i, Test Pit No. 2...L:L_._minutes per inch Depth of Test Pit----- Depth to ground water___. 't ... 9 ----------------------------------••---------------------........•-•---------------......._.................................................................. 0 Description of Soil.... . 42"' w0 X—Y-S-we Z�'"-36 .S4.47!! _-_ ----- • ----------------------•----------•-----•------•-------------------------......----.----- 4fy4v / ---- ------...-- F ---•---•---------------------------------------•--•---......-------•-----•-----•-••••.....------....--- V 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 TITLE 5 of the State Environmental Code—The unders' ned furth r agree not o place the system in operation until a Certificate of Compliance has en 'sued by the oard of h th. Signed----------------- = '.. ....................... - --------- . ........ Date ApplicationApproved By ------------------ 3� .............-..................................------------- .......... Date Application Disapproved for the fol owing reasons- ---------------------------------------------------------------------------- --------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ Permit No. .......... a--- ..7..- (........................ Issued Da-----'-'.............. Date-...-..-.-...._ —'--------- -te--...... rir. Y THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ' TOWN OF BARNSTABLE Appliration for DWposal Yorks Tonstrnrtion ramijt Application is hereby made for a Permit to Construct (&/) or Repair ( ) an Individual Sewage Disposal System at: t CA-rG .STne&T C&-.vTLZ-)21/ie-LE'' .Lo7- '`" 3 \�, Location-Address or Lot No. V4'A1'./ VP. . - - /!7/'YLS n/5.........1we-4- - ..............• — -- ••-- .... W � �n Owner �J�A�ddr��ess k�l� i ,__�p/� 11 w > C i�,1 7.�'i/ /%/ll7c !?� !L,/�(' ... ,-a -------------in_ - -e..,.....4 ..... � � Installer " � '- Address Type of Building ¢ Size Lot-_.___.__-.__41..___..Sq. feet �., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............. No. of persons...._........_........_..... Showers — Cafeteria P I Other fixtures ...................•--•--...... - 475-W Design Flow............................................gallons per person per day. Total daily flow..__...... ....._....._.._......gallons. 1:4 Septic Tank—Liquid ca.pacity../-s'oo.gallons Length.Z.'K...... Width..'!".. Diameter................ Depth..- Disposal Trench—No.-.__/....._..._ Width-----.ed......_ Total Length......_-•fl_....... Total leaching area--- ...---sq. ft. Seepage Pit,No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by._.......�!'..�fl.._...&_..... ``u �_..._-. Date...-.` ? ,� .......... aTest Pit No. 1...L._Z..minutes per inch Depth of Test Pit....... a. Depth to ground water..... <_ ....._._.. ' Test Pit No. 2....:�_ ..minutes per inch Depth of Test Pit-----f' ... Depth to ground water...-.�¢' ....__.. a. O Description of Soil-----o .,_ ZZ4" WooaCo q > Svc-SoiC Z¢H 3L " Ce/�j2sE- s-'4•'-` 'o -- -------------------- •----- --------------•--------------------• ---------------------- -- .�+ � /� 3 ... /a8" ��/Fi vE- S.9-�vla /o S."- /�9.." Ga/�72.�'� W ----!'`'=-�__-sro.v ..... �`'¢„_ Z ....!....".I............,.....-----S'•Mvt..---------------------------------------------•----.... UNature 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 TITLE 5 of,the State Environmental Code—The undersigned further agrees not,to place the system in operation until'a Certificate of Compliance has issued by the board of hee/alth. Signed' J- �..... .... f - Dates Y Application Approved By _................. -A-AM, ....... .AV ee = e g Application Disapproved for the following reasons: ......... - - - ---------------------------------------------........................................... ..------------------. ---------------------.........-•----------------- ....................................... Permit No. �%j----'. .................. f GT (7A � ........................ Issued ......................................................... D ate...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE kCertifira a of �ontylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by---------------------------------------------------------................................................. ----------------------------------------------------------------------------------------------....................................... Installer at .,------ ^' ..........0.10...15----....�-T..-- .. -� ._r�..� �/ -----------••---------------------------------------------------------------------------------------- has been installed in accordance with the provisions o TITLE ITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ................................................ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------------------� -b.-`--�.. ... -... .=1------_---- Inspector ........---- ............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE nrk� �on�ir�r#ion �rrmi# Permission is hereby granted. -/ 1• •- .....-------•...............•...........................-----...............---...... to Construct (.,ol) or Repair ( ) an Individual Sewage Disposal System atNo...........:let.!� . -' O--a'q.d = .............�'2: � �s_11� ---•--•----•-----•-----------•---------•---•------•----------------•-•-------.... Street as shown on the application for Disposal Works Construction Permit N4:.:a941.. Dated.......................................... ........................................... _•....... DATE.--^--••................................................................... dl"- Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS - 4 No......................._ Fss............._....._..... _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dispasal Workg Tnnitrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................-__...._...................................................................... --••-••-••--------------•------•--••----------•••..........•-----------------.............._------ Location-Address or Lot No. ......................_--........................................................................ ---•-'•'----•-------•--......•-••-•.._......._._...•-•----•------••--------------..............--- Owner Address W Installer Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Otherfixtures ------------•-----------------------'-------•-•'-•----.--'-•-•-•--•••••----'--•--••--••--••--•-•••--•----•-••'•-••••"-•'----'......_---'-'........... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity-------._...gallons Length................ Width................ Diameter................ Depth---..--•-.--.--- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a ,.� Test Pit No. 1................minutes per inch Depth of Test Pit•.-..-.-..._--_----- Depth to ground water......................... G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......----...........--. ----•-•---------------------•------•---------•-----------...•-•-'••-----•---••--•------•-•--•-....__........................................................ 0 Description of Soil:....--------•--'------••----•-•-•------••----------------------------•-----'.---------------------'-•------••--------•---••-••---•---•-...._......-'-'----.......•--- x V ------'-'-'----"--'•-•'---••••-'---•....-•-••--•---"------••--'-'---•--•-----'---••--'--'-'-----...-•-•----•'-"---------•----•-•'--•---'-'---------••'•••-•--••-•---•'--•-------------•"-'•-•••--••- W UNature 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ------------------------------------------------- ---------..................................... ...........-------------..------------- Date Application Approved By -----------------_------------------------------------............ ------------------------------------------------------------------ ------------- ----------.------------------------- Date Application Disapproved for the following reasons- ------------------------------------------------------------ ------------------------------------ .......----- ----' ------------------------------------------------------------------------------------ ..---------------------------------------....................--------- ------------ Date PermitNo- --------------------- ------ -------- ---- --- -------------- Issued ------------------....----------------...... ...... Date ------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tr r#tftca t.e of Cgampliaxnce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--------------_- . .-- -- ........---------- ---------------------- -------------------....-------- Installer at --------------------------------------------------------- --------------------------...--- --....-----------------------------------.......-- --.............................------------.-------- ----------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ................................................ dated ----------------------------................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................-------------------------------------------------------....................... Inspector --------------------------------------•----------------------------....-- . -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No......................... FEE........................ Disposal Worho T11n.6trnrtion Prrutit Permissionis hereby granted-'--'------•-••'-•---'••••"-"•---•'•.._..._.---...'---....•-------•-'-'-'-'-•----'--------••-••••••'•.................'................._.. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... -•----.......-•................•---•'••-•---••-•-•---•---•-•-'---'-_....._._.......'--•-....--••-....-'- Board of Health DATE................................................................................ FORM 36508 HOBBS&WARREN.INC..PUBLISHERS i Permit Number: Date: Completed by: I HIGH GROUND-WATER LEVEL COMPUTATION Site Location: Lot No. 3 Owner: YVo-✓yE V_ 4:>,Od!3 Address: ^-f 179Z'7v.leS /�IiGL S Contractor: Address: Notes: I STEP i 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. Date 7 5>Z month/Tay/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: (A". Appropriate index well.................................................... Z" OB Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to _ water level for index well ........................... ¢ �z �Z,7, month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water-level zone (STEP 213) determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 1) .................:.................................... / I a Figure 14. Suggested computation form. 13 T 7 ts ` � -- gg -- EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE W EXISTING WATER SVC. G EXISTING GAS SVC. } JdG18- OVERHEAD WIRES TEST PIT EXISTING S.A.S. BENCHMARK . _ (FROM RECORD AS-BUILT) t✓ �n �, a TO BE REMOVED WITHIN THE LEGEND STRIPOUT BOUNDARY AND ABADONED 5' OFF S.A.S. JJJ -- 100.54 100.05 99.7 � y 99.32 � h SEE NOTE 11, SHEET 2 STRIPOUT BOUNDARY _­.; - R J - 98.88 LOCUS MAP + 100.00 - STEE 98.56 �:. AK o 98. 3 ''.•' 98.68 S E t PIK .� 97.94 ENCHMARK , ,, .... ; 1,.; 98.38 I �� COR. OF STEP EL.=101.05 619 b r / 97.30 .87 b\ '1 - 98.73 0 6l / .DRIVEWAY 98.11 o o 9 7. 9700 CIV PARKING �q�K s8 w \\ 9.56 TP 1 `'y �7.83 x TP-2 96.90 96.B0 97.77 G) \ 6.75 \ t� SHED -717----� 6.65 Cp EXISTING HOUSE(1201) x \ 97� T.O.F.=99.8f1 97.04 x 95.27� 1 �\ 0Ut 65M EXISTING SEP77CTANK �wf \ PATIO 97.69 TOP OF TANK, EL.=98.39f _ 9b� 97.68 97.06 INV.(OUT)=97.06t _ DECK +96.68 \ \�\ 6.71 \ k 96. x I'a\72 PATIO / SPIK9 x\ 95.04 \ 93\g6 Co \ x 94.61 :1) I M �a ��� D I �� +•93.69 +93.70 aN. O be 89. 22 r O_ Ni. O / ' SHED / \ I r I 1 r r r , I r I \ r I LOT 3 LOT 2 \ ► 43,641±S.F. I l -5°"A \OF Mgss9cy� o PETER McENTEE v CIVIL S4 �0, No. 35109 S 74 58'07„ E OWNER OF RECORD (p ZL RUSSELL. RANDY II 201 STREET PARCEL ID: 173-014-003 WESTOAK BARNS ABLE, MA 02688 Engineering by: SCALE DRAWN JOB. NO. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 1"=30' P.T.M. 205-21 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. 201 OAK STREET WEST BARNSTABLE MA (508) 477-5313 6/12/21 P.T.M. 1 of 2 Prepared for: B & B Excavation, 14 Teaberry Lane, Forestdale, MA 02644 �f T NOTE: TO PREVENT BREAKOUT, FINAL GRADE SHALL NOT BE AT, OR BELOW, EL.=95.50 FOR A DISTANCE OF 15' FROM THE EDGE SEPTIC TANK PROPOSED D-BOX OF THE PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE PROPOSED S.A.S. INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F.=99.8t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT =99.0t F.G. EL.=99.0t F.G. EL.=98.0t F.G. EL.=98.5t MAINTAIN 2% SLOPE OVER S.A.S. E6" L = 12' L = 23' ® S=1% (MIN.) p S=1% (MIN.)all- 4"SCH40 PVC 4"SCH40 PVC 2 LAYER OF 1/8" TO 1/2"DOUBLE WASHED STONE B aaaSaaat4" 2' EFF, aa®®aaaEXISTING " LIQUID DEPTH aaaeaaa �-3/4" TO 1-1/2" DOUBLE LEVEL WASHED STONE ADD INV.=96.17 PROPOSED 4' 4.8' 4' GAS BAFFLE D BOX INV.=96.00 EFFECTIVE WIDTH = INV.=97.06t 3 OUTLETS (VERIFY) INV.=95.00 EXISTING SEPTIC TANK 3-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-20 RATED NOTES: TOP CONC. ELEV.=96.1 t BREAKOUT ELEV.=95.50 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=95.00 aBaaa INVERTS, PRIOR TO INSTALLATION. aaaa aaaaaaaaaaa aaaaaaa 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND BOTTOM ELEV.=93.00 4' 3 x 8.5' = 25.5' 4' TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' OF NATURALLY OCCURRING STABLE BASE OR OR SIX INCH AGGREGATE BASE, AS PERVIOUS MATERIAL EFFECTIVE LENGTH = 33.5' SPECIFIED IN 310 CMR 15.221(2). 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION 4) A GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE EST. HIGH GW, EL.=87.8 AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. SEPTIC SYSTEM PROFILE SOIL LOG DATE: MAY 28, 2021 (REF#TPT-21-153) GENERAL NOTES: SOIL EVALUATOR: PETER McENTEE SE#1542 WITNESS: DON DESMARAID R.S. HEALTH AGENT 1 CHANCES T THIS TMUST IGN ENGIINERB O ED BY THE LOCAL BOA D OF HEALH A DHE DES ELEV. TP-1 DEPTH ELEV. TP-Z DEPTH 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 97.9 0 97.7 O OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE FILL FILL LOCAL RULES AND REGULATIONS 95.6 28" 95.7 24" 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR A A TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE SANDY LOAM SANDY LOAM DESIGN ENGINEER. 95.2 B 10YR 4/2 32" 95.3 B 10YR 4/2 28" 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING SANDY LOAM SANDY LOAM FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 10YR 5/4 10YR 5/4 ENGINEER BEFORE CONSTRUCTION CONTINUES. - 93.4 C 54" 93.5 C 50" 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. PERC 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF F-C SAND F-C SAND THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 2.5Y 6/4 2.5Y 6/4 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 10% GRAVEL 10% GRAVEL 8. THERE ARE NO ABUTTING WELLS WITHIN 150' OF THE PROPOSED S.A.S. 87.8 EST. ADJ. GW-_ 87.8 EST. ADJ. GW-_ 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 85.9 144" 85.7 144" DIRECTED BY THE APPROVING AUTHORITIES. REF. PERC 4/7/92, REF. P#7885 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY PERC RATE <2 MIN/IN. "C" HORIZON THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. NO GROUNDWATER ENCOUNTERED 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS ASSUMING GROUNDWATER AT EL.=85.7, INDEX WELL SDW-252 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND WATER LEVEL 47.3, ZONE B, ADJUSTMENT=2.1 (EL.=87.8) REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND / NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. PROPOSED S.A.S. 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC 3-500 GAL CHAMBERS SYSTEM COMPONENTS NOT SHOWN ON THE PLAN SURROUNDED W/4' STONE �ryf �� � I / DESIGN CRITERIA lb �tK' NUMBER OF BEDROOMS: 4 �O SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) DESIGN PERCOLATION RATE: <2 MIN/IN DAILY FLOW: 440 GPD DESIGN FLOW: 440 GPD .GARBAGE GRINDER: NO-not allowed with design /. XlST1NG E LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF HOUSE(#201) .74 GPD/SF T.O.F.=99.Sf! EXISTING SEPTIC TANK: 1500 GALLON CAPACITY /T/05MT PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED v�P�KOU USE 3-500 GALLON LEACHING CHAMBERS IN SERIES SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES SIDEWALL AREA: 2(12.8' + 33.5') X 2 = 185.2 S.F. DECK BOTTOM AREA: 12.8' x 33.5' = 428.8 S.F. TOTAL AREA:.............................................................. 614.0 S.F. SEPTIC LAYOUT DESIGN FLOW PROVIDED: 0.74 GPD/SF(614.0 SF) = 454.4 GPD Engineering by: SCALE DRAWN JOB. No. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. N.T.S. P.T.M. 205-21 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. 201 1 OAK STREET WEST BARNSTABLE MA (508) 477-5313 6/12/21 P.T.M. 2 of 2 Prepared for: B & B Excavation, 14 Teoberry Lane, Forestdale, MA 02644 I N G3 00 TOP OF FOUNDATION CONCRETE COVER is CONCRETE COVERS 44 CAST IRON 2.•MAX. 12"MAX. OR SCHEDULE 4� P.V.C. PIPE 4 SCHEDULE 40 PV.C.(ONLY) • PIPE - MIN.rilil Peat Y' PITCH 1/4"PER.FT PITCH 1/4'PER.FT F'ow_ PRECAST e EL INVERT .. \-INVERT DIST. INVERT � � G_.�ri f: .,� 1, Lvl �'• EL.49. . 1. „ BOX EL-`r1.7°?.. ' SEPTIC TA . e INVERT /_�a . . �a .. .. GAL. INVERT t a; EL..`G Zy INVERT ��� :i, 3/4"TO 11/2 EL%'t; '? �t'yq'T7o�/ �b� of • � 7v_-?4c0 WASHED S .� � Gon�C. BQu�vD_ L5."o0 ! • � � "• ezGs'B4u� I►: STONE _ 1 _ - r0 leg •' ' L4' -� 570, - Gw PROF)LE OF GROUND WATER TABLE/-ACT w `- SEWAGE DISPOSAL SYSTEM -1 Z NO SCALE \ ; � y ' r , I V �/4' ! I.• ` /L� �` L�! �^•7�Jrii—�T7ve�.i - to','�4 '•s G" P•f �x 7 67- a z • l i SOIL L LOGBY,,WITNESSED _ 454 : w, k'�•Q '� `'� I I 3'� \ � S I ._ BeX \ LE�G,y 7G:`NCfit /j�% 7/y5� TIME./ AH .i�t/a BOARD OF HEALTH DATE �j! . . , . .... TIME. . .' . . : . . . . . . . . . i LZ/ /oar SQJ y��rt/ TEST HOLE I TEST HOLE 2 ��w�i2v E"". -ELG��✓ ENGINEER \� EZ" Tap D/F�uSo S ELEV. .may• 7P. . . ELEV. EZ'-'�9,,3u �\ I �37~ PR"Qos-e � THrtk v /�cu.vD. L3.00 1, w:ac�torr+f 3 \ 24 — &7-. ®R O.R 3 SAA DESIGN DATA ' vG'.egv&-I �L•' �G2ih/GZ sJU MqZ - /-,ir✓�/ vwJvtTi4BGE Mil 72/,qL Ez �70 4y,�a NUMBER OF BEDROOMS LC� q3 h�L..U/�-,��f F7.�E TOTAL ESTIMATED FLOW . ram GALLONS/DAY -�. �`• ,tea; ,.' =Aw D .- p BOTTOM LEACHING AREA ° . SQ.FT. /PIT/,-,/2 o Wi7"� loP. fZ, -7 ��S" �Z �13v d 4rLE /b/ .S ✓D cv!7Z SIDE LEACHING AREA . . . . . . . SQ.FT./ PIT \ SA"I" �� `�� GARBAGE DISPOSAL t✓°•�� . .(50 % AREA INCREASE) SZ� A44 47 7u TOTAL LEACHING AREA G.� `-�'. SQ.FT 1 .' PERCOLATION zz_4i,zG+ RATE LC SS 17JAr1 7W1? MIN/INCH ° /44 ,4G.3a /G5 I / LEACHING AREA PER PERCOLATION RATE .. . . . . . SQ.FT/C,p.D � 1 ) _.. �-� WATER ENCOUNTERED NUMBER OF LEACHING PITS . s/x' /=�Ow " APPROVED- . . ...-: BOARD OF HEALTH 1 LDT DATE . . . . . . . . . . . . . . . . . . . . . . . . . O AGENT OR INSPECTOR OF p�16 OF btgs� Arp o���` goo zp,f7'�10 EDWARD o rt L' ` L a /I i `3 KELLEY H n s 2 LOT j/; No. 26100 • I h ! I Si r-E' /='L�a•� >.�/ �2Ns•7t'9,165> . �C ✓T 1/iGGC- I ' yVoN1,,E I �S/o rL- -- r-zc-vi�7o�,S- ��.sE� o•v �ssv.�•,�3 ?>,47za.y ��/ UAL JJ � ���-►' :I I i