HomeMy WebLinkAbout0074 CAPE COD LANE - Health 74 Cape Cod Lane
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Barnstable
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y Commonwealth of Massachusetts
Title 5 official Inspection Form E
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i
74 Cape Cod In
Property Address
Linda Foster
Owner Owner's Name
information is Barnstable �/ Ma. 02630 6-26-20
required for every
page. Cityrrown State Zip Code Date of inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important: A. Inspector. Information �/ �Q
filling out forms ��Qv�
on the computer,
use only the tab Michael Sears
key to move your Name of Inspector
cursor-do not Robert B Our Co INC.
use the return Company Name
.key.
363 Whites path
ru Company Address
South Yarmouth Ma. 02664
City/Town State Zip Code
�Wx 508-477-8877 S114430
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
��H........OFffy�g sY�i
2. ❑ Conditionally Passes �� .'s9p'�,,
MICHAEL''yN=
3. ❑ Needs Further Evaluation by the Local Approving Authority o: SEARS `"G
No.SI14430 c EF
4. ❑ Fails '`q-:0
/iu„u"Jill 11100`
6-26-20
Inspector's SIg9zrUre 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.
l5insp,doo•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 or 18
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i
i
74 Cape Cod In
Property Address
Linda Foster
Owner Owner's Name
information is Barnstable _Ma. 02630 6-26-20
required for every -
page. Cilyrrown 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:
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.7126/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 18
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
74 Cape Cod In
Property Address
Linda Foster
Owner Owner's Name
information
required for every Barnstable Ma, 02630 6-26-20
-- --
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cost.)
2) System Conditionally Passes(cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced [] Y ❑ N ❑ 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
16.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
15insp.doc-rev.712612018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 cf 18
I
i
Commonwealth of Massachusetts
Title 5 official Inspection Form '
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Cape Cod In
Property Address
Linda Foster
Owner Owner's Name
information is Barnstable Ma. 02630 6-26-20
required for every -
page. CitylTown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fait 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
t5lnsp.doc-rev.7126l2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 or 18
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1
Commonwealth of Massachusetts
_A 0 Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
74 Cape Cod In
Property Address
Linda Foster
Owner Owner's Name
information is Barnstable Ma 02630 6-26-20
,
required for every -
page. City[Town State Zip Code Date of Inspection
I
i
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
Static liquid level in the distribution box above outlet invert due to an overloaded
❑ or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less
than '/2 day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ N 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 C.4.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of to
I
Commonwealth of Massachusetts
s Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1
' 74 Cape Cod In
Property Address
Linda Foster
Owner . Owner's Name
information is Barnstable Ma. 02630 6-26-20
required for every
page. City/Town - State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes" to any question in Section C.5 the system is considered a significant
threat, or answered"yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no" for each of the following for all inspections:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ ® Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
❑ ® Existing information. For example, a plan at the Board of Health.
® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
151nsp.doo•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Cape Cod In
Property Address
Linda Foster
Owner Owner's Name
Information is Barnstable Ma. 02630 6-26-20
required for every
page. Cily(rown 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: 2
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to: -- -
Is laundry on a separate sewage system?(Include laundry system inspection
El 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 NA
g ( Y g (gp ))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: presentDate
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I
�c Commonwealth of Massachusetts
Title 5 Official Inspection Form
7 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
5�
74 Cape Cod In
Property Address
Linda Foster
Owner Owner's Name
information Is Barnstable Ma, 02630 6-26-20
required for every — �--
page, Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 16.203): 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: 10-10-17_
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined? -
Reason for pumping:
l5insp.dcc rev.7128120f8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 118
i
i
Commonwealth of Massachusetts
- - Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
74 Cape Cod In
Property Address
Linda Foster
Owner Owner's Name
information is Barnstable Ma. 02630 6-26-20
required for every •--
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
NA
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: eet
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.):
151nsp.doc-rev.7/2 6120 1 8 Title 5 Officlel Inspection Form:Subsurface Sewage Disposal system-Page 9 of 18
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Cape Cod In
Property Address
Linda Foster
Owner Owner's Name
information is
required for every Barnstable Ma, 02630 6-26-20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
24"
Depth below grade: feet
Material of construction:
0 concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
1500 gal
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500 gal
Sludge depth:
4"
Distance from top of sludge to bottom of outlet tee or baffle
24"
2" -
Scum thickness
8"
Distance from top of scum to top of outlet tee or baffle
12"
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined? Sludge gud eg tape
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
1500 gal tank with both covers at 6" below grade, both in and out tees
15insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Cape Cod In
v� Property Address
Linda Foster
Owner Owner's Name
information is required for every Barnstable Ma, 02630 6-26-20
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cone.)
7. Grease Trap(locate on site plan):
� I
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.):
B. 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
ISinsp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
:- Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
74 Cape Cod In
Property Address
Linda Foster
Owner Owners Name
information is Barnstable Ma. 02630 6-26-20
required for every
page, cilyrrown State Zip Code Date of Inspection
D. System Information (cont.)
I
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 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.):
D box is 16x21 with 5 outlet pipes, box is at 28" below grade
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Commonwealth of Massachusetts
-- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
!� 74 Cape Cod In
Property Address
Linda Foster
Owner Owner's Name
information
required for every Barnstable _Ma. 02630 6-26-20
- - - —
page. CityrTown 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:
20
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc-rev.712612018 Title 5 OlWal laspecl on Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
_ . Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
74 Cape Cod In
Property Address
Linda Foster _
Owner Owner's Name T
information is Barnstable Ma. 02630 6-26-20
required for every --
page. Cityrrown State zip Code Date of Inspection
D. System Information (cons.)
11. Soil Absorption System (SAS)(cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
SAS is 20 biodiffusers in a field pattern, field is clean and dry with 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.712612018 Title 5Offiicial 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
74 Cape Cod In
Property Address
Linda Foster
Owner Owner's Name
information is
requireegWred for every Barnstable Ma. 02630 6-26-20
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.):
I5insp.doc•rev.7/26/2018 Title 6 Official Inspoction Form.Subsurface Sewage Disposal System Page 15 0118
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
<t: 74 Cape Cod In
Property Address
Linda Foster
Owner Owner's Name
Information Barnstable Ma. _ 02630 6-26-20
required for every
page, Cllyrrown State Zip Code V Date of Inspection
D. System Information (cunt.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet, Locate where public water supply enters
the building. Check one of the boxes below:
® hand-sketch in the,area below
❑ drawing attached separately
A
y
o �
tSinsp.00c rev.712612018 Title 5 OificW Inspeclion Form:subsurface Sewage Disposal Syelem Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
74 Cape Cod In
Property Address
Linda Foster
Owner Owner's Name
information is required for every Barnstable Ma. 02630 6-26-20
page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
132"
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
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers -(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Test hole 4-23-11 _
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•Pago 17 of 18
c Commonwealth of Massachusetts
- --, Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
74 Cape Cod In
l'.roperty Address
Linda Foster
Owner Owner's Name
Information is required for every Barnstable Ma. 02630 6-26-20
_—.�.
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
tached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
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t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page I of is
TOWN/OF BARNSTABLE
LOCATION ?y --y e (?"d (a:t.c SEWAGE#_ Z0 I 1 —
VILLAGE ASSESSOR'S MAP&PARCEL J 77- %u
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /rd a rl,u
LEACHING FACILITY:(type) (?u� 4re S(ot(a (size) /c/.f Y Z u
NO.OF BEDROOMS
OWNER vto'a AvsAA
PERMIT DATE: rr'' Z? - 1.11 COMPLIANCE DATE: 1 Z-
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility & to // 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
ffI
RNI FUSHED BY 6,40ewial.e
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No. � Fee
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
II' Rpplicatfou for �Df pogaY 6pmem Cafe—sfructiou permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon(j ❑ Complete System ❑Individual Components
Location Address or Lot No. ValA Owner's Name,A�ress,and Tel.No.
Y evu C� lartx 1111 C fn A4 F6,544A
Assessor's Map/Parcel '2—1 _// 7 y C` � eve,
Installer's Name,Address,and Tel.No. �. 7 �� >7 Designer's Name,Address and Tel.No. o9 7 3 U� 7
t
�'�, �.t�/r ��► r�/ f R C`^,1 i�^.�
c,n,tite4 LC
Type of Building:
Dwelling No.of Bedrooms Lot Size IS-;!S-ci sq. ft. Garbage Grinder ( )
Other Type of Building /�. S No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 730 gpd Design flow provided 3 S S: Z gpd
Plan Date S/— 3 — P t Number of sheets ( Revision Date
Title
Size of Septic Tank I 'o Type of S.A.S. (90 /KZ' 3(01 49
Description of Soil /)"ZtJ S�-ytLv
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to lace the system in operation until a Certificate of
P P Y P
Compliance has been issued by this of Heal
Sign Date 7 //
Application Approved by e Date
Application Disapproved by: Date
for the following reasons
N
Permit Date Issued
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
n PUBLIC HEALTH DIVISION -•TOWN OF BARN waiuctioln
E, MASSACHUSETTS Yes
2pprication for Diipb!6 7Y' Abp!Arm . permit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,A�dress,and Tel.No.
C' ('�'�
Assessor's Map/Parcel a 7 _�� ?y C' l-C Cool
Installer's Name,O Address,and Tel.No. y 7 7 9-� 7 7 Designer's Name,Address and Tel.No. a' 3- .077 7
� n� o
-Y'-0 R^J%t%f1/ I To Cn JLn.1 n
l r1u 11.AA of a 1
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size /S` ! S(j sq. ft. Garbage Grinder ( )
Other Type of Building n
yp g /)-P S No.of Persons Showers( ) Cafeteria
r''Other Fixtures
Design Flow(min.required) .730 gpd Design flow provided 3 S S Z gpd _
Plan Date �(- 8 f t Number of sheets r l f Revision Date
Title
Size of Septic Tank lj-oo
"/ �Type of S.A.S. d1V ✓Z' 1?&/ (p
Description of Soil /).�2. S�/n(/ q2
�Y
Nature of Repairs or Alterations(Answer when applicable) a
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 Heal
Sign Date - r 7
T.
Application Approved by -/fl o Date
Application Disapproved by: .ate
for the following reasons
Permit No. .� Date Issued
--------- - - - - ---I-
----- -- --- ----------. -44 --.—� —_-- T
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 f 2 r 1-01
at 7 Y Pu �a h.C. has ee c nstruc i ccordance /
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated f1 Z?
Installer 1�0-prtu;rf �',. ,�,.5.� Designer J c• 4'v1a+„�
#bedrooms 3 Approved design w 2S S- gpd
The issuance of th's pe it shall not be construed as a guarantee that the system ill rrct on as deigned. �-
Date ` �. 1 Inspector k
- No. /"l`rl.:f � � -- -------- --- \.--- Fee
THE.COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS
1wisspogal *proem Cow6truction Permit -
Permission is hereby granted to Construct ( ) Repair ( ✓) p,.rade ) Ab[[a do• t /�
System located at 7 �r /cZox�. l�lfs �f'1 /�f�`
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Constructi �t be co'pleted within three years of the date of this p it.
Date ug Approved by /^ rKs
05/20/2011 13:11 FAX 5084283928 CAPEWIDE IM003/006
-.Town of Barnstable
Regulatory Services
Thomas F.Geder,Director,
Public Health Division
47e' Thomas McKean,Director
200 Main Street, Hyannis,i19A 02601
Office: 508.962.4644 P4x: 508-790-6304
Date: 5-1b^(� Sewage Permit# �o t1 i l Assessor's Wtup/Paircel 2-7 1/ i l
Installer&Designer Certification Form
.Designer: SG Engtneec(�n�, Tnr, Installer, C:a(�zwidc. E�nier�r(se_5, GGG
Address: 2&5Y Ccea g-r Hi w2>t A Address- "Ow v44- Sri
On -2�� �t -+cue �� was issued a permit to install a
date (Installer)
septic system at 7_ `1 -CQC CCd 140L based on a design drawn by
(address)
�G ac.n mee((As -rcC, dated P1Ve ..23'2cll
desgner —
V 1 certify that the septic system referenced above was installed subsuir tially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septics stem referenced above was installed with ma'or chap` es i.e.
t of greater t than 10' lateral relocation of the SAS or vertical relocation any component
of the septic system) but in accordance with State &Local.Regulations. Plan revision or
certified as-built by designer to follow. Stripout(if rey ' 'nspe,;ted and the soils
were found satisfactory. �,�lri w�
JOHN L. '
CM4FlCriILL � :�
CIV.
(1 to ler's Sign a CIVIL t
YV
signer's Signatur Affix esi a s nj,Here)
PLEASE RETURN O BARNSTABLE PUBLIC HEALTH DIVISIUII'. CERTYFICAT
OF C LL4NCE WILL NO T BOTH BIS FORMAS-
B IL CARD ARE RECEIVED BY-THE BARNSTAB E PUBLIC 11 RAI LTH DIVISION.
THANK YOU.
q�nlTirr rimu;J�wiynui'��flil i���iitn lunn.dw: ";
05/20/2011 13:12 FAX 5084283928 CAPEWIDE 121004/006
� r
Z
gf lt.o eti
�3 ar,n � des
83
g s®,o
TOWN OF B,A►RNSTABLE
LOCATION 9 ef Meet t1ad. lcen.c _SEWAGE#
VILLAGE ryIS&&tc ASSESSOR'S MAP&PARCEL aryl? U
INSTALLMVS NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACIl,ITY(type) by Are 361 6 (Size) /.Y.I Y z u
NO.OF BEDROOMS .3
OWNER
PERMIT DATE: q'2,7- L o,j COMPLIANCE DATE:
S4paradon Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility el r/ Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) r Feet
Edge of Wetland and Leaching Facility(If airy wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY CA--
Town of Barnstable
Department of Regulatory Services
Public Health Division
� .
200 Main Street,Hyannis MA 02601 Hate l
Date Scheduled �( I
Time f Fe Pd. w
Soil Suitability Assessment
.for Sewa g e
Performed By: tlWnael eim e.,)�t asposal
Witnessed By: V1 k/c
Location Address j�
LOCATION& GENERAL INFORMATION
I 7 7 Cyt (o Owner's Name ro 57 F r
�h✓n"Sp�, Address Scnvie
Assessor's Map/Parcel:
a7 / 0.11 Engineer's Name 5C EY1�t02ertfKj
NEW CONSTRUCTION REPAIR '
Telephone# 508-273_0 3 7
' Land Use �irt�le �amily d+ue-Ili+n� 7
Slopes(%) Surface Stones
Distances from: Open Water Body —R possible Wet Area
_ —�ft Drinking Water Well __ ft
Drainage Way - -- _ft Property Line 7 io _
---ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands{n proxi
mity mity to holes)
Sep 4,(aGkd( 00)
Parent material(geologic) 60�('.A 1
Depth to Bedrock 7 i32. 4xS
Depth to Groundwater. Standing Water in Hole:.
Weeping from Pit Face -, 132"b 5 S
Estimated Seasonal High Groundwater > t 3 2 S
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: _ ctweeE t6spi-am Ftcm
Depth Observed standing in obs.hole:
Depth to weeping from side of obs.hole: t 32 In, Depth to soil mottles: 13 2 ]n.
in, Groundwater Adjustment
Index Well# Reading Dater Index Well level f[.
-. Adj.hdetbC ,;e�r Adj.Groundwater Level,:-
PERCOLATION TEST ��tp ti-11-1I
O7on ..._..., 'lY3ne ��A'y
H Z — if:21 Hl9
Time at 9"
DePerc 2�-b O v -~ Time at 6" 1 y r9�H
:2
Start Pre-soak Time @ 1%0 3 A11 vn i
Time(9"-6") n3 _
End Pre-soak W-.16 AH
Rate MinJInch
Site Suitability Assessment: Site Passed 2 S Site Failed: N
Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one (1)week prior to beginning.
Q:ISEPTICIPERCFORM.DOC
•
rNe
EEP.OBSERVATIONHQLE LOG
Soil Horizon Soil Texture Hole#
(USDA) Soil Color Soil• Other
) (Munsell) Mottlin
g (Structure,Stones;Boulders.
a iten F25 UY�3/jp,
LS lC)Lj
ir
y 2 132 C-
2,5Y
IDS
5/a%6"el) Sntvre to (e5
anA �obuldecS
DEEP OBSERVATION HOLE LOG
Depth from Soil Horizon Soil Texture Hole# _
Surface(in.) Soil Color Soil x eh r
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
6-(. A o i ter) Y.% ravel
e r - Fill
S 16 Yr 5/6 _ -----
9 2-13z G
2..5 Y b/t, - 3'/o stave,) ,� soave ca dies
DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Hole#
Surface(in.) Soil Color Soil Other
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture. Sol Color Sol]
Surface(in.) (USDA') Other a
(Munsell) Mottling (Structure,Stones',Boulders.
Con i t
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
Within 500 year boundary No Lr' Yes
Within 100 year flood boundary No. ✓ Yes
Death of Naturallv Occurrine 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? . Ye-S
If not,what is the depth of naturally occurring pervious material?
Certification
• I certifythat on /o�Z�-y,g •
(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 a d ex p ' nce described in 310 CMR 15.017.
Signature—, Date
Q:ISEPnCTERCFORM.DOC
TOP OF FOUNDATION = 96.1'± FINISH GRADE OVER D-BOX= 94.0'i- 4"SCHEDULE 40 PVC MIN. SLOPE 1 % PROPOSED PVC VENT FINISHED GRADE OVER BIODIFFUSERS= 93,5' - 94.9' GENERAL NOTES
PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER SLOPE @ 2% MIN.
WITH COVER OVER INLET& FINISH GRADE OVER TANK EL.= INSPECTION PORT WITH 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
RISER TO WITHIN 6"OF FINISHED GRADE ACCESS BOX TO WITHIN
FINISHED GRADE OUTLET TO WITHIN 6"OF F.G. 94.6'± (max) 3"OF F.G. (ONE PER ROW) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
@ FOUNDATION = 94.5'± 5"DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES.
20"MIN.ACCESS 9"MIN. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
COVER(3 TYP.) 36"MAX DESIGN ENGINEER.
SEE NOTE 21
PROP. PVC PROP. SCH. 36"MIAX. 6.0' MAX. TOP OF SAS/B.O. = 88.90' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
SEWER PIPE
40 PVC � SYSTEM UNLESS OTHERWISE NOTED.
EXIST. SEWER PIPE MIN.SLOPE�t°6 6" 3" 2" DROP MIN. 3 9 PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
3" DROP MAX. " " MIN.SLOPE Q t% L=6'± JOINTS (TYP.) ELEVATION =88.90' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A
90 8'± 10" 4"PVC IN FROM 1.33' 1 " 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
14" 90.50' SEPTIC TANK 4" PVC OUT TO 0 o, (TYP.) 10.75 (TYP) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
LEACHING FACILITYMww" + 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
90.75' " "
OUTLET TEE 90.30' MIN. 6 90.13' 88.47' �-87.57' (laid flat) 2.875'(34.5" 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
48" .0, (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
GAS BAFFLE 6" CRUSHED STONE (TYP.) 5' IN
tw OVER MECHANICALLY 14.375' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
10.8'TO FND COMPACTED BASE R Q'D
20.0' AND DESIGN ENGINEER.
6"CRUSHED STONE T 5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON AN APPROXIMATE M.S.L. DATUM OF 98.00'(BENCHMARK#1)
OVER MECHANICALLY
TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 82.50' BIODIFFUSERS (END VIEW) ESTABLISHED ON A NAIL SET IN UTILITY POLE#730/5 AS SHOWN ON PLAN.
COMPACTED BASE BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
PROPOSED 1 500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. rl�'BY
BIODIFFUSERS (PROFILE)
' � � ,? ADVANCED DRAINAGE SYSTEMS, INC.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
LENGTH 10' 6" WIDTH 6 8" DEPTH 5' 8" (Dimensions per Wiggin CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
MA)Pocasset,
'CONTRACTOR TO VERIFY THIS ELEVATION SEPTIC TANK PROFILE Precast Corp., DISTRIBUTION BOX DETAIL ARC 36HC (#3616BD) BIODIFFUSERS (H-20) TO THE DESIGN ENGINEER.
& REPORT TO ENGINEER IF DIFFERENT NOT TO SCALE NOT TO SCALE NOT TO SCALE
10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT.
11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
-_'_ REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
-�... �. I DATA
s` o o APPROPRIATE AUTHORITY.
PERC NO. 13242
- INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
v '' 7 • EVALUATOR: Michael Pimentel, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
THEY SHALL WITHSTAND H-20 LOADING.
> ► U� �. ra .» `-, C.S.E.APPROVAL DATE: Oct. 1999 DATE: April 11, 2011 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
o � .g TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
�` � + T { MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
Lu 0 ELEV TOP= 93.50' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
MAP 277 ELEV WATER= <82.50' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
M PARCEL 13 LOCUS PERC RATE _
t J t\ 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
F SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
DEPTH OF PERC = 16. PROPOSED PROJECT IS LOCATED WITHIN:
MAP 277 s � � ° �� '� � �
sS°4 , • TEXTURAL CLASS: 1 ASSESSORS MAP 277 PARCEL 11
CID
PARCEL 6 ,; 191 010"F 0 ,,F`•... 0 _
-
__ __________-_____:_._ _.___ OWNER OF RECORD: LINDA L. FOSTER
-go-- 39' a' I ADDRESS: 74 CAPE COD LANE
' / LOCUS + O 0 93.50 BARNSTABLE, MA 02630
PROPOSED 1,500 j C6 Fill
GALLON SEPTIC TANK '� 92- EXISTING a o 6" Loam Sand 93.00'
' y
92.83 FEMA FLOOD ZONE C
3-BEDROOM `-�`� _ .-. � °' A 10Yr 3/1 ,
EXIST. CESSPOOL TO BE PUMPED / DWELLING � 8"
AND FILLED WITH CLEAN SAND TOF = 96.1'± MAP 277 ° v Loamy Sand COMMUNITY PANEL# 250001 0005 C
B
PARCEL 11 : 9 a 10Yr 5/8 1 17. DEED REFERENCE: BOOK 8767, PAGE 270
PROPOSED DISTRIBUTION BOX EXIST. i o a 60" 88.50
1 DECK f s 15,150 S.F.± 18. PLAN REFERENCE: PLAN BOOK 179, PAGE 67
96 19 ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION
PROP. TOTAL 20 ARC 36HC . o `" `� 0 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
(#/3616BD)BIODIFFUSERS (H-20) ,' CID �`L Q Medium Sand FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
IN A FIELD CONFIGURATION / / \` 5 81 " 2.5Y 6/6 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
btu L-c1 #73uit� 3 - C (5%gravel; some
2.50 ` • /1 21. IN ACCORDANCE WITH 31.0 CMR 15.401 -15.405 THE FOLLOWING LOCAL UPGRADE
c
cobbles i�boulders)
APPROVAL IS REQUESTED FROM 310 CMR 15.221 (7):
co sy�� j py (1.) A 3.00'WAIVER(3.00'-6.00') FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM.
�� . LOCUS PLAN
93.5' P 2 ,f o� SCALE: 1"= 1000'
95.01
/ y g`� 132" 82.50'
0f MAP 277 No Mottling, Standing or Weeping Observed
EXIST. CESSPOOL PARCEL 12 T P
I TO BE REMOVED o DESIGN DATA EST IT DATA LEGEND
PROPOSED 4"PVC VENT PIPE; o �O� y� I
PERC NO. 13242
Cep \, ;� INSPECTOR: David W.Stanton, R.S.
EXACT LOCATION PER OWNER
j N65 3, _ Y PP� GOO E LPYOU�I A �`
,10 C' _pFtNP� 9L� o c9� NUMBER OF BEDROOMS (DESIGN) 3 EVALUATOR: Michael Pirientel, E.I.T. ( ��' EXISTING SPOT GRADE
W1D 0 u� C.S.E. APPROVAL DATE: Oct. 1999 - -- ;-0 - - -- EXISTING CONTOUR
PROPOSED INSPECTION PORT WITH /' °j �40, DESIGN FLOW 110 GAUDAYBEDROOM
ACCESS BOX TO GRADE (TYP OF 5) ! / i 2j.\ DATE: April 11, 2011 50 PROPOSED CONTOUR
i � TOTAL DESIGN FLOW 330 GAUDAY
TEST PIT#: 2
Benchmark#2 \ DESIGN FLOW X 200 % = 660 GAL/DAY ELEV TOP= 95.00' EXISTING OVERHEAD UTILITIES
Nail Set in Pavement
Elev. =96.59' USE PROPOSED 1,500 GALLON SEPTIC TANK ELEV WATER- <84.00' w-^w^ EXISTING WATER LINE
Approx. M.S.L. Benchmark#1
MAP 277 Nail Set in U.P. PERC RATE _ <2 min./inch GAS -- EXISTING GAS LINE
PARCEL 10 Elev. =98.00'
Approx. M.S.L. DEPTH OF PERC= 42"-60" -� TEST PIT LOCATION
INSTALL 20 - ARC36 HC (#3616BD) BIODIFFUSERS (H-20)
TEXTURAL CLASS: 1
O O PROPOSED 1,500 GALLON SEPTIC TANK
SWING TIES PLAN SYSTEM CAPACITY -
SCALE: 1"=20' (TOTAL L.F. OF BIO'S)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD 0" 95.00' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE
(100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING/DAY Fill
A Loamy Sand
g" 94.50' E3 PROPOSED DISTRIBUTION BOX
TOTALS: 8" 10Yr 3/1 94.33' LJ PROPOSED ARC 36HC(#3616BD)BIODIFFUSER(H-20)
TOTAL NUMBER OF BIODIFFUSERS: 20 Loamy Sand
#74 TOTAL NUMBER OF COUPLINGS: 0 B 10Yr 5/8
EXISTING TOTAL LEACHING AREA: 480.0 42" n 91.50'
3-BEDROOM TOTAL LEACHING CAPACITY: 355.2 Perc REV. DATE BY APP'D. DESCRIPTION
DWELLING
60" " " 90.00'
SWING-TIES MEASUREMENTS HCA TOF = 96.V± PROPOSED SEPTIC SYSTEM UPGRADE
NOTE: PREPARED FOR:
DESCRIPTION HC1 HC2 EXIST. EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE Medium Sand
DECK DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER C 2.5Y 6/6 CAPEWI DE ENTERPRISES
SEPTIC COVER IN (1) 31.2' 31.6' "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED (5%gravel; some
NOTES: HC-2 DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST MODIFIED cobbles&boulders)
SEPTIC COVER OUT(2) 38.6' 35.9' o JANUARY 11, 2011). TRANSMITTAL NUMBER=W000052. LOCATED AT
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. BIODIFFUSER CORNER(3) 45.1' 46.9' (1 74 CAPE COD LANE
o � BARNSTABLE, MA 02630
BIODIFFUSER CORNER(4) 52.1 41.4 0
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE BIODIFFUSER CORNER(5) 69.2' 61.0' (3 (2 132" 84.00' SCALE: 1 INCH = 20 FT. DATE: APRIL 23, 2011
LOCATION OF THE PROPOSED LEACHING FACILITY TO 0 10 20 40 so FEET
ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS BIODIFFUSER CORNER(6) 64.1' 64.9' 4) No Mottling, Standing or Weeping Observed
PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH H'�F'°Igss, PREPARED BY:
IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. RESERVED FOR BOARD OF HEALTH USE ?`yG h`tiJ, JC ENGINEERING, INC.
(6 JOHN L.
CHURCHILLJR. n 2854 CRANBERRY HIGHWAY
3.) PROPERTY IS LOCATED WITHIN THE BARNSTABLE cI
WELLHEAD PROTECTION OVERLAY DISTRICT. No 807 EAST WAREHAM, MA 02538
144, ,�,.�,,_ �F
SITE PLAN 508.273.0377
�� s
5) p` Drawn B MCP Designed B MCP Checked B JLC JOB No. 1970
SCALE: 1" =20' y� 9 v� v-