Loading...
HomeMy WebLinkAbout0213 COUNTRY CLUB DRIVE - Health 13 COUNTRY CLUB DRIVE Barnstable A — 340 = 041 r Commonwealth of Massachusetts W Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments' ,M 213 Country Club Drive Property Address Tom Shack Owner Owner's Name ✓ information is required for every Cummaquid V\S+f-V&&• MA 02637 `05/17/2012 ° page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information ---- on the computer, IL use only the tab 1. Inspector: key to move your ra cursor-do not Ricky Wright t use the return Name of Inspector ' key. B & B Excavation,lnc. r� Company Name 14 Teaberry Lane .. Company Address Forestdale MA 02644 City/Town State Zip Code 508-477-0653 S 14595 Telephone Number License Number B. Certification'ert flcatlon 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: ' r3 ® Passes ❑ Conditionally Passes E] Fails } ❑; Needs Further''Evaluation.by the Local Approving Authority 5/18/12 . Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board L 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 3x a report to the appropriate regional office of the DEP. The origina:l•should be-sent to"-sh the system owner and copies sent to the buyer, if applicable, and the approving authority. • ****This report only describes conditions at the time of inspectionrand under_#1p priditions of use at that time.This inspection does not address how the systintwVilNperfor'On'ithe future_under the same or different conditions of use. �•1 . �n+• :�. . • t5ins•11%10 Title 5 Official Inspection Form:-Subsurface Sewage Disposal System•Page 1 of 17 , Commonwealth of Massachusetts = W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 213 Country Club Drive Property Address Tom Shack Owner Owner's Name information is q required for every Cumma uid MA 02637 05/17/2012 page. Cityrrown 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: ' B) 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): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pag'e2 of 17 Commonwealth of Massachusetts ., _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 213 Country Club Drive Property Address Tom Shack Owner Owner's Name informationumma for every q is required C uid MA 02637 05/17/2012 page. City/Town state Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont:): ❑ 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 [I'Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑.ND (Explain below): ❑ distribution box is leveled or replaced '--'El- •❑ 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): C) Further Evaluation is Required by the Board of Health: - ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, - safety and the environment: ElCesspool 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` t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17, Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 213 G„M Country Club Drive v Property Address Tom Shack Owner Owner's Name information is q required for every Cumma uid MA 02637 05/17/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any)' determines that the system is functioning in a manner that protects the public health, 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 .1 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. 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 x El Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool rEl Discharge or ponding of effluent to the surface of the ground or surface waters ® i° due to an overloaded or clogged SAS or cesspool El 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 9 x than /2 day flow t5ins 11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 213 Country Club Drive Property Address Tom Shack Owner Owner's Name information is q required for every Cumma uid MA 02637 05/17/2012 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a.public 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 2000gpd- h ❑ ® 10,000gpd. ❑ ® 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 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 D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water Y g ate supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ 0 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 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. t5ins•11/10 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 °M 213 Country Club Drive Property Address Tom Shack Owner Owner's Name information is q required for every Cumma uid MA 02637 05/17/2012 page. Cityrrown 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? ❑ ® 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)] D. System Information Residential Flow Conditions: ' Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): .. 440 thins•11110 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 213 Country Club Drive Property Address Tom Shack Owner Owner's Name information is required for every ummaQ C uid MA 02637 05/17/2012 page. City/Town State Zip Code Date of Inspection D. System Information Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gp ))� Detail: Sump pump? .❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ 'Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts ; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 213 Country Club Drive Property Address Tom Shack Owner Owner's Name information is umma uid MA 02637 05/17/2012 required for every C q ' page. City/Town State Zip Code Date of Inspection ` D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Inf rm i n o at o Pumping Records: a ' Source of information: Was system pumped as part of the.inspection? ❑ Yes, ❑ No If yes, volume pumped: gallons e , How was quantity pumped determined? Reason for pumping:. , Type of System: 4. ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ,. ❑ Overflow cesspool ❑ Privy 4 ❑ 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_Iatest inspection of the I/A system by system operator under contract -Tight tank. Attach a copy of the DEP approval. El Other describe r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17, m Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 5 213 Country Club Drive Property Address Tom Shack Owner Owner's Name information is G required for every Cumma uid MA 02637 05/17/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 8' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): >20 Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order,no sign of leakage or blockage. Septic Tank(locate on site plan): Depth below grade: 4' � feet Material of construction: ® concrete ❑metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No Dimensions: 1500 gal Sludge depth: no sludge t5ins•11/16 Title 5 Official Inspection Form:Subsurface Sewage_Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 213 Country Club Drive Property Address Tom Shack Owner Owner's Name information is q required for every Cumma uid MA 02637 05/17/2012 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle no sludge Scum thickness no scum Distance from top of scum to top of outlet tee or baffle no scum Distance from bottom of scum to bottom of outlet tee or baffle no scum How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound - no sign of back-up. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum,thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 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 213 Country Club Drive Property Address Tom Shack Owner Owner's Name information is q required for every Cumma uid MA 02637 05/17/2012 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 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.): r `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 17 it Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 213 Country Club Drive Property Address Tom Shack Owner Owner's Name information is q required for every Cumma uid MA 02637 05/17/2012 page. Cityrrown 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 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.): At time of inspection d-box appears to be in good condition. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: i - } t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 213 Country Club Drive Property Address Tom Shack Owner Owner's Name information is q required for every Cumma uid MA 02637 05/17/2012 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 y ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: , ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching was dry and appears to be in good condition. No sign of hydraulic failure 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 213 Country Club Drive Property Address Tom Shack ' Owner Owner's Name information is a required for every Cumma uid MA 02637 05/17/2012 page. Citylrown 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): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title- 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 213 Country Club Drive Property.Address Tom Shack Owner . Owner's Name information is required for every Cumma quid MA 02637 05/17/2012 page. Citylrown 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 'Pr w 31 00 A3 = a . 3 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 213 Country Club Drive Property Address Tom Shack Owner Owner's Name information is umma uid MA 02637 05/17/2012 required for every C q . page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >21,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: per perc test performed by Carmen Shay on 1/9/02 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 . . ` Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 213 Country Club Drive Property Address Tom Shack Owner Owner's Name information is G required for every Cumma uid MA 02637 05/17/2012 page. City/Town 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 l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE FC o :.iJ 'E':i IONS/c��OLJy7>Li�a Lf�t'l� SEWAGE # 2UD,2—OS.; VILLAGE UM ASSESSOR'S MAP & LOT 3yq-o�/ INSTALLER'S NAME&PHONE NO. Vlt b SEPTIC TANK CAPACITY 17f1t) /67dy qa--C LEACHING FACILITY: (type) OWE (size) NO. OF BEDROOMS 1 ��� �� BUILDER OR OWNER X lI AM 'N,(,(,( l ra h - PERMITDATE: _ 02- COMPLIANCE DATE: , 3 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 fee of lea king fa � 't ) Feet Furnished by ��f`�S N ft. / 37 ` a 0 431 39 qf7' _ 6. 3. -7 Co-,4 ClL"b cJr.lt No. �-w x 5�5 � 1 n EE Board of Health, MA- APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) RepairX Upgrade( ) Abandon( ) -XComplete System U Individual Components Location Owner's Name W_ v Map/Parcel# 3—tkA R5 Address ,�, a M4 Lot# : Telephone# `7 3-5 wjaq- Installer's Name Q Designer's Name �. V C04,,s Socs Address TA f end Address 31-c ' LA. , MoaK Telephone# Telephone# 115 $—p S)G = L Type of Building ( Q` Lot Size 3Sr (p4b sq.ft. Dwelling-No.of Bedrooms !q —avyr-n� Garbage grinder ( R Other-Type of Building N c No.of persons (5Z Showers (tf',Cafeteria ( ) Other Fixtures l—O-J Design Flow (min.required) 444 !!�A gpd Calculated design flow 'e4z4 Design flow provided gPd Plan: Date Number of sheets+ 1 Revision Date 1 Title *-% EAQM it Description of Soil(s) Soil Evaluator Form No. I aG Name of Soil Evaluator(9-A S Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS -�n a m,%Q The undersi d agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to lace the t in ope ation until a Certificate of om liance has been issued by the Board of Health. Signed �W Date SIGNING ENGINEER MUST SUPERVISE �o4J. a_g INSTALLATION AND CERTIFY IN WRITING Inspections THE SYSTEM WAS INSTALLED IN STRICT ACCORDANCE TO . d 1 �f Board of Health, •'Cf`> YJ`C AMA. -- APPLICATION FOP, DISPOSAL CYST EM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) -Complete System 0 Individual Components Location �2 Owner's Name C�y1 lv Map/Parcel# M � t� � Address • ,.. Lot# f Telephone# Installer's Name ,� S #` Designer's Name 4 Address F,f iell Address 21A _ � Lt,), 'Cy) )JA z Telephone#' n.«- Telephone# Type of Building 4:1 Lot Size 3S1 (44(o sq.ft. Dwelling-No.of Bedrooms -• -FiC\C2_ci-r•� Garbage grinder WIA Other-Type of Buildirk' fT8n_Q No.of persons Q Showers (v<Cafeteria (�) Other Fixtures (•. Cry �etx 1� eC`�!1 L�ttok { c-��r�"�.1`�n Design Flow (min.required0 U gpd Calculated design flow Q Design flow provided gpd Plan: Date { I I U Number of sheets Revision Date Title Cv 4aC� `5d Description of Soil(s) �c n,�c,C V-<C, i`�i. C9 C\ t Soil Evaluator Form No. Name of Soil Evaluator` 020 EA S H A-'bate of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS C3� C;� 12 •S1 •��'� ��C> . The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to/place the to in op ration until a Certificate of Com fiance has been issued by the Board of Health. Signed �(�- Date �- Inspections • 3 No. (JD� U�S FEE ' C®MMONWFAIT14 ®ff MASSAC14US ETTS Board of Health, / �{��Y� MA. i CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System w The and rsigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired,Upgraded (r),Abandoned ( by: L UQ b e.Y :S ( �o he v 1 S S e �� at 1 i2 4, , . has been installed in accord nce with the provisions of 310 CMR 15.00 ( itle 5) and the approved design plans/as-built plans relating to application No.2oo�-05-5- , dated Approved-Design Flow (gpd) Installer / J LL et-1S Designer: t _ i Inspector: Date: The issuance of this permit shall not be construed as a guarantee4hat the system will function as,designed. No. 0l).1 - 0 FEE .S V C®MMONWEALT14 OF MASSACHUSETTS Board of Health, J��� � r)' MA. +, DISPOSAL SYSTEM CONSTRUCTION PERMIT >= Permission.is hereby granted to; Construct( ) Repair ) Upgrade( ) Abandon( ) an indi-6dual sewage disposal system at �>,l3 C u.f)44V ('.1AJ.6 �V,4e_ as described in the application for Disposal System Construction Permit No.a 0J 05 Y dated 1 Provided: Construction shall be completed within three years of the date of this permit. All loc 1 onditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health e TOWN OF BARNSTABLE '� LOCATIOIsb�/c��DlJYf�i7aL Lr 'L� SEWAGE # 260.2-aSS VILLAGE ( rn ASSESSOR'S MAP & LOT INST4LER'S NAME&PHONE NO. SEPTIC TANK CAPACITY nflIJ /Sbd aa-,e LEACHING FACILITY: (ty (size) NO. OF BEDROOMS cc..1 J// BUILDER OR OWNER_W1 I1/�m ,_SU ya ,) PERMITDATE: �'� g 0, COMPLIANCE DATE: 3 D Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet i Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility). Feet i Edge of Wetland and Leaching Facility (If any wetlands exist within 300 fee of lea hing fa ' 't�) � Feet Furnished +� yo j i I L'1 37` o 431 39 ' -4) q7� a A3 &!5 CARMEN E. SHAY (508)-548-0796 ENVIRONMENTAL SERVICES,INC. P.O.Box 627,East Falmouth,MA 02536 April 23, 2002 RE: Certification of Title V Septic System Installation: Residential Property—213 Country Club Lane, Cummaquid, MA Dear Sir or Madam: On April 18, 2002, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at 213 Country Club Lane, Cummaquid, MA, based on a design drawn by Shay Environmental Services, Inc, dated, January 19, 2002. I Certify That The Septic System Referenced Was Installed Substantially According to the Plan I Certify That the Referenced Above Septic System Was Installed With Changes but in Accordance With State and Local Regulations, Revisions or As-Built Plans/Sketch will Follow. The Septic System Was Not Installed Per State and,Local Regulations and Corrective Action is Required. If you have any questions, please do not hesitate to call the undersigned at (508)-548-0796. Sincerely, CARMEN E. SHAY ENVIRONMENTAL SERVICES,INC. OF o CARMEN o E. " HAY #,v No. 1181 Carmen E. Shay, R.S., C.S.E. .� President c/s T r.� " S'9NI7AR1 `? I r cr i FORM 11 - SOIL EVALUATOR FOR Page 1 of No.: Date: 1/3/02 COMMONWEALTH OF MASSACHUSETTS... Barnstable , Massachusetts Performed By: Carmen E. Shay Date: 1/03/02 Witnessed By: Waiver— Per Barnstable BOH Location Address or #213 Country Club Drive, Owners Name: William Sullivan Cummaquid,MA Address: P.O. Box 432, Cummaquid,MA Lot# Map 349 Lot 41 02637 New Construction Repair • X Telephone Number: 508-790-9732 OFFICE REVIEW: Published Soil Survey Available: No ❑ Yes ❑ Year Published: Publication Scale: Soil Map Unit: Drainage Class: Soil Limitations: Surficial Geologic Report Available: No❑ Yes❑ Year Published: Publication Scale: Geologic Material: (Map Unit): Landform: Glacial Outwash Flood Insurance Rate Map: Above 500 Year Flood Boundary: No YesFil ❑ + Within 500 Year Flood Boundary:' No X❑ .,Yes ❑ Within 100 Year Flood Boundary: No, Yes ❑ Wetland Area: None Observed National Wetland Inventory Map (map Unit): Wetlands Consercancy Program Map (map unit): Current Water Resource Conditions(USGS): Month Range: Above Normal El Normal X Below Normal Other References Reviewed: USGS Topographic Map DEP APPROVED FORM 12/7/95 FORM 11 — SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No.: #213 Country Club Drive, Cummaquid, MA On -Site Review Deep Hole Number: #1 Date: 1/3/02 Time: 9:00 PM Weather: Sunny, Warm, 35°F Location (identify on site plan): Refer to Sketch Landform: Outwash Plane Position on Landscape (sketch on back): Refer to Sketch Distances From: Open Water Body N/A feet Drainage Way N/A feet Possible Wet Area N/A feet Property Line 25' feet Drinking Water Well N/A feet Other N/A feet DEEP OBSERVATION HOLE LOG Depth From Soil Soil Soil Soil Other Surface Horizon Texture Color Mottling Structure, Stones, (inches) (USDA) (Munsel) Boulders, Consistency, % Gravel 0" — 8" A Sandy 10 YR 3/2 None 'Friable Loam Friable , 8" — 36" BW None <5% Gravel Sandy 10 YR 5/6 Loam 36" — 108" Ci Silty Sand 2.5 Y 6/3 - None Firm in Place, Friable, & Clay Silty Sand & Clay Y 5 % Gravel 108" — 168" Cs ' Sand. 2.5 Y 7/4 None Med-Coarse Sand, 5% gravel/cobbles, Loose Parent Material (Geologic): Glacial Outwash ` Depth to Bedrock: N/A Depth to Groundwater:°Standing Water in the Hole: None Weeping From Face: N/A Estimated Seasonal High.Water Table 168"Assumed - System to be constructed in C-2 Laver or Remove & Replace to 9' : n I FORM 11 - SOILfEVALUATOR FORM Page 3 of 3 Location Address or Lot No.: #213 Country Club Drive, Cummaguid, MA Determination of Seasonal Hiqh Water Table Method Used: ❑ Depth observed standing in Observation Hole: R inches ❑ Depth weeping from side of Observation Hole: 168" inches (assumed) ❑ Depth to Soil Mottles: inches Groundwater Adjustment: None feet Index Well Number: Reading Date: Index Well Level: h Adjustment Factor: Adjusted Groundwater Level: N/A DEPTH OF NATURALLY OCCURING PERVIOUS MATERIAL: y " Does at least four feet of naturally occurring pervious material exist`in all area observed a throughout the area proposed for the soil absorption system:_ - Yes CERTIFICATION: 4 I Certify That on September 17, 2000, (date), I have passed the soil evaluators examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. , Signature: Date: f 1 DEP, APPROVED FORM 12/7/95 1 / FORM 12 - PERCOLATION TEST Location Address or Lot No.: #213 Country Club Drive COMMONWEALTH OF MASSACHUSETTS Cummaguid , Massachusetts ]Percolation Test Date: 12/21/01 Time: 9:45 AM Observation Hole #: #1 #1 Depth of Perc 108"-136"" Start Pre-soak 9:45 End Pre-soak 9:51 Time at 12" Will Not Hold 24 Gallon Presoak Same Time at 9 Time at 6" Time (9-6") Rate Min./Inch < 2MP1 Assumed @ 108 " Same * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Performed By: Carmen E. Shay Witnessed By: Waiver per BOH Comments: Would Not Hold 24 Gallon Presoak - <2 MPI Assumed P_ 108" System must be Constructed in C-2 Laver of remove & replace to 9' Site Passed X Site Failed DEP APPROVED FORM 12/7/95 • SKETCH OF PERC TEST & DEEP HOLE LOCATION Property Address: #213 Country Club Drive Cummaquid,MA Owner: William Sullivan Date of Pere Test: 1/03/02 Existing House 4 Bedrooms 25' Test Hole #1 F 3 Country Club Drive ' Y �" 'Sep-20-01 13: 52 BARNSTABLE HEALTH OEPT 5087906304 P.02 srsrot INOTYCE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM i, hereby certify that the engineered plan signed by me dated hB ILI concerning the property located at C \j ,_ meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no cornrriercial or business uses associated with the dwelling. • The soil is classified as.CLASS 1 and the percolation rate is less than or equal to 5 nunutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests ac the site without a health agent present. • There is no increase in flow andror chance in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching 'facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater, cable using the Frimptor method when applicable) Please complete the following- pp Al Top of Ground Surface Elevation (using GIS information) �O•�' B) G.W. Elevation 18,M- -F adjustment for high G.W..g��_. _ .p�(fl•�-�'D, FER.ENCE BETWEEN A and B (00 S i G\IED D ATE: - NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. 01 q:h__Ilh trldtc perccxmp Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: �e�11��]�Q�� Lot No. Owner: W;JJ1( fy% 5Q i%A Address: 2 ...y Contractor: �� LNI�• SdC'S• Address: LAW �G�MOti't'N Notes: STEP 1 Measure depth to water table ^ b to nearest 1/10 ft. �Q.� l�..s 0��� �Ci t Fr..... Date 1 LI(,J�— mont�day/yea—r STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... tw ©Water-level range zone..................................................... STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to O water level for index well ........................... mon /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 2B) determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment(STEP 4) from measured depth to water z�•� levelat site(STEP 1) ............................................................................................................. ` ,mmission: USGS Well Data - December 2001 Page 1 of United States Geological Survey Observation Wells service to Cape officials, engineers and other interested parties, the Cape Cod Commission publishes monthly ,undwater data gathered by its Water Resources Office. olo ical Survey USGS d States Geological ) N monthly from Unite Y ( are taken g shown below The water level measurements sY ' observation wells and compiled during the last week of each month. They are published as-soon as possible.thereafter. Listed below are nine out of the 61 wells measured across Cape Cod by the Commission's Water Resources Office. These nine are employed d as index wells to be used with Technical Bulletin 92-001 to predict high groundwater levels. p For your convenience, we've also provided links to USGS national and state data. See the kilt cohmin in the table and the footnotes below. For further information, please contact Hydro I16gist Gabrielle Belfit at the Commission offices (508-362-3828). December 2001 Departure from Water Record Record Average" Location Well No. Level* High* Low* g ; Monthly Overall �Itcr-lo ci Barnstable 230 =26.3* 20.5 26.6 -2.1 " -2.6 413956070164301 Barnstable '�A1-W � � 27.0 20.5 414154070165001 2471 ,_ Brewster BMW 21 12.8 6.9 13.3 -2.3' -2.7 414518070020301 Chatham CGW 138 25.7 20.9 26.6 -1.3 -1.7 41410007001 1.101 Mashpee MIW 29 9.9*** 5.6 10.0 -1.0 -1.4 413525070291904 Sandwich DZ 47.8 45.9 =-O -0.5 414418070241601 SDW 53.1 45.8 55.1 -2.6 -3.1 414124070265901_ Sandwich 253 Truro TSW 89 12.8*** 10.2 13.0 -0.6 -0.7 �420206070045901_ Wellfleet WNW lj7E== 12.8 -1.3 -1.9 415353069581401 n�a I X Measurements are iri feet below land surface: n ' *X 's Mea'suremerts are in feet above mean sea level. ; . *`** New onthly; low m { UfSGS'iatiotial 'level database provides historic data, hydrographs, and site maps. Tlie USGS compilesahe above data and other water levels into a monthly, online Water Resources Current a Conditions Report that covers all of Massachusetts. 1/3/200 Zt http.//www.capecodcommssion.org/wells.htm O ROUTE 6 , A tea,d L n J L asLCUS MR 10 mina from s-x< V .ACCESS d �houae toe Septic to *NOTE.-c nk - ;I PP ; Existing.Foundation ep NOTE. ALL i ES ARE TO BE 4 SCHEDULE 40 P.Y.C. ta'� b tar* wve» must Ds T.G.F. 103.00 . . . � hsi n. � rod. .. . .,. ..,. . . ... .. - - . s s �. . .,e 0 Qrods owr Tank 1D.20 s s•ot+� and.aMr a-eax t� , over sAs aaxoo SIS'CT�'ON 1! A oral R 0 y SING SYSTEM L R oar . -vrrW OF LEAe -s o.oz Nam _ l 1 wJ rater i 20 olsT eox 3• cewr c �+ � SI , a i to is w Washed Crushed Starre i „4 to 1 Wad i NF PIPE t /2 NEW ,500 G w THE ACCESS COVERS FOR THE.SEPTIC TANK, 0" i+oot - W Peaetone ,l F F@AYDAT1t?i cv 3a 3' of 1/8 i/2 Washed SEPTIC TANK � DiSTRIBUTtON BOX AND LEACHING COMPONENT _ h 2a' 2 , H 20 / SHALL BE RAISED TO WITHIN a of M o r-• +v --+ .-r+ a CONCRETE IFTAl FOU > 9 to FINISHED GRADE 1 ay aD y GAS o � I, STEEL REINFORCED PRECAST CONCRETE INSTALL TUF TiTE BAFFLES OR EQUALS , g 3. 3.6'p ON ALL OUTLET TEE ENDS _ ROUT bA2000, + _ e 8 PLAN MEW 1 I SYSTEM PROFILE i; a. ,, ` LA V s a cov�Rs Not to Scale EPPectNs ialal4fi O C] ,C7 � G7 A ' 3-2 > > C7 Q b - 1,w 2' Sr mtlon 29S a is a B� i pa GENERAL, NOTES Note PVC TEE MANDATORY IN D-BOX INLET s t .ti. , w .. ,i r.. 4 8 h of S 4-1 1 Z9.5 DUE TO DRAMATIC ELEVATION I 3 wax dowanw 1. Contractor is responsible for Di safe notification compacted .tone .75 �.75 nr saEr Pa g. INLET man r mh.i d to atmot Tand protection of all underground utilities and pipes. DIFFERENCE FROM TANK TO D-BOX Wye P _ .r9 P P }�" r Bottom of Test Hole t Elev.=st.Oo 2. The septic tank a ` distn ion'box shall' be set Effective Length a ne, ,o level on 6"-of 3 r4 -1 1 ¢.2 stone. - / J s r , . ackfill should be clean sand or ravel with no 3 B g _ SOIL ABSORPTION SYSTEM SAS a: 4-0'min. , NOTE. New P From Fou Batton to be t - . rt Pipe n Routed to Side . u��+ stones over 3 In size. _ _ PRECAST EA RING UNITS / WIGGINS subject inspectiondurin installation Comer To Fadlltate Now Septic Tank Location At Elevation As Shown] Note: All leach Imes t be ca 500 C CH 20 LEACHING 4. This'system is s b) ct to g _ o pp at ends w/PVC cape. •+r .. _ , b Carmen E.;Shay - Environmental.Services, Inc. .. y _ NOTE. SEPTIC SYSTEM MUST BE INSTALLED BELOW C 1 SOIL Not to Scale . LAYER ,,. •r ... ..,• , . •t• :.... . •, t 5. -The`contractor shall .install his system In accordance f ' (ELEV 88.00) OR A 5 ' STRIP OUT W91LL BE REQUIRED ALL AROUND tC-o' e'-e' with Title V of the Massachusetts state code, the approved plan NOTE: ALL COMPONENTS MUST HAVE RISERS TC) WITHIN 6' BELOW GRADE and Local Regulations. CROSS SECTIOL END SECTION • , 6. If, during installation`the contractor encounters,any NOTE. ALL COMPONENTS TD BE H-20 INCLUDING TANK, D-BOX AND CHAMBE72S soil conditions or site conditions .that are different from those shown on the soil to or in our design TYPICAL 1500 GALLON SEPTIC TANK 9 g Installation must halt& immediate notification be made to Carmen E. Shay -� Environmental Services, inc. NOT TO SCALE ay; 7. No vehicle or heavy machinery shall drive over the FOUNDATION ' .SEPTIC TANK '-+- D-BOX --a-20'---+► LEACHING FACILITY C H 20 LOADING ; N? �-�---,44septic'system unless noted as H-20 septic components. 8. Install Tuf-Tate gas baffles or equals on all outlet tee`ends. 9. An Distribution Lines:shad be 4 diameter Sch. .40 NSF PVC papas. 10. All solid piping, tees & fittings shall be 4" diameter PERCOLATION TEST Schedule 40 NSF PVC pipes with water tight joints. 11. SITE and SurroundingProperties are not Connected P 40 50 Date of Percolation Test: JANUARY 3, 2001 to Municipal Water. 0 20 Test Performed By. CARMEN E. SHAY- R.S., C.S.E. 1"R i5 Results Witnessed By. WAIVER - Excavator, ROBERTS SEPTIC SERVICES Percolation Rate: Less Than 2 min./inch ® 9 FEET BELOW GRADE. THE PROPERTY LINES ARE-APPROXIMATE AND COMPILED -FROM THE SURVEY PLAN GENERATED BY -- MERCER .ENGINEERING CORP. OF YARMOUTH, MA Test Hole ENTITLED " CUMMAQUID HEIGHTS SUBDIVISION PLAN', BARNSTABLE, MA } No. 1 DATED MARCH `26, 1968 l DEPTH SOILS ELEV. AND IS'NOT INTENDED TO BE A SURVEY PLOT .PLAN LOT, #10 LOT #1 f LOT #12 0 9&00 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN , THE SEPTIC SYSTEM INSTALLATION. Sandy Loam 10 YR 3/2 Ar 94.75 THERE ARE NO WETLANDS LOCATED WITHIN A 200' RADIUS Sandy Loam OF THE PROPERTY tOYR a/e CB D.H. CB D.H. e'-36r e. 92-00 ND FND Silty Sand NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE do say FROM THE EXISTING SEPTIC SYSTEM TO BE DISPOSED N 29d O1' 40" E XS Y 8/3 OF AS PER BOARD OF HEALTH SPECIFICATIONS. 195.00 36--108 C, as.00 Mild-Conroe EXISTING TANK & LEACH PIT TO BE PUMPED DRY & ------- ---------------------•------------------------ 108 f 0�' -----�----------------------•------__.._------�---------_�--_---- --�- sand FILLED WiTH CLEAN FlLL MATERIAL' , 26 Y 7/4 106 ------ --------------------------------------------- ------------- ----------- -------•--_ ----------------- --- 106 toe•-lee � et.a 164 ------- ---- 104 ASSESSORS MAP - 349 LOT - 41 ZONING - RESIDENTIAL ------ - 102 ON C , Perc #1 FLOODZ E Exist. 1000 ,- Depth to Perc: 110' to 128' t, Perc Rate C1 min./inch - l.- Sr crik _ - .. =N, -- U%ATt3'Ynirtiiti__A_..zCn` i•r�wiuS IOC ` ------------------------------- --------•r-___-- i --- - --- ---_-_-_ _ _ _ fl�v ., G.a� t .; `lHtl'CE �Rt: iV0 WEitA t7s L ------ ---- ---------- BOTTOM OF TEST HOLE Elev. 81.00 OF THE PROPERTY A ADJUSTED H2O Elev. = No Adjustment Required. W 1 LOT 14 O O� Failed - �---- Leach Pit 35 8.46 S.F. t " SWIMMING �' ;,INN SM BE LEGEND O POOL a tEVEI FM AT LEAST s ' ,, CQ„97t CO ,. a �i 8XO DENOTES PROPOSED --- as' tr .U£T SPOT GRADE � EXISTING 4 a,nFT � ' FENCE BEDROOM r DENOTES EXISTING HOUSE tom, X'104.46 SPOT GRADE 11 -- -_------- -------- - ----------- ----- ------ -- 98 _ 4o i 98- --- - - - --------- --- - 4' SCH. T 1.7e' x 97.97 _ - - _ 2 i500 aa-a. TOF ELEV, 100 PLAN SECTION CROSS-SECTION TEST HOLE 11 Septic Tank pi. pL PROPERTY LINE .LOT 13 9S------- -- -- flt -s4 9f,--__--___;- ---- ---- 96 # . ..LOT #15 I. 1 0 a' #213 �� 3 HOLE DISTRIBUTION BOX H-20 LOADING PROPOSED CONTOUR :-s+r-� Tr-r-•� -r,� NOT TO SCALE It, $�,_ 97------97 EXISTING CONTOUR iNOTE SEPTIC SYSTEM MUST BE INSTALLED BELOW C-1 SOIL LAYER ti. 1 , -�_ DEEP TEST HOLE & ELEV 86.00 OR A 5 ' STRIP OUT W;LL BE REQUIRED ALL AROUND ...rs...•�_ir:. .�i:sit / ---------------- t ) 1, �, i Design Calculations PERCOLATION TEST LOCATION fy - Y Number of Bedrooms: 4 Equivalent to 440 Gal.pboy 1 Garbage Grinder. No FENCE NOTE: ALL COMPONENTS TO BE H-20 INCLUDING TANK, D-BOX AND CHAMBERS I �! a leaching Capacity Required: 440 Gal./Day (MIN.-.PER TITLE a PROJECT BENCH MARK O Septic Tank : 2 x 440 Gal./Day - 880 USE 1,500 GAL Septic Tank PRIVATE DRINKING WATER WELL o TOP OF FOUNDATION � SOIL ABSORPTION AREA: Using percolation :rate of CZ min./inch � j X 94.23 ' ELEV. = 100 (assumed) ,,1 � Bottom Area: 0.74 gal/sq._ft. x 400 eq. ft. 420 gallons -----�- -------------- ---- ----- REVISIONS 94 - - - -- -`�` � ��. o Sidewall Area: 0.74 gal./sq. ft. x 200 eq. ft. � 188 gallons bI -,� Providing: 450 golions NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6' BELOW GRADE -- ---- "�� NO. DATE:. DEFINITION ttt Use: (3) PRECAST 500-•C UNITS, HAVING A 2' EFFECTIVE DEPTH, TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES AND co 2.75' OF WASHED STONE ON THE ENDS. UNITS TO BE SEPARATELY PIPED AND TO BE SEPARATED 2' APART. 92 PROP, OSED f95.0®' JpAd PREPARED FOR .- XN 29d of 40n E 90.5o SUBSURFACE SEWAGE DISPOSAL SYSTEM • OF #213 COUNTRY CLUB e-l\fe e n v WI LLiAM J . SULLIVAN�'® �T1l1'� � �.� � ..� � CUMMAQUID, MA S - � (50 FOOT RIGHT OF WAY) P O. BOX 432i`� 9 PREPARED BY: CUMMAQUID, MA 02637 vyn�` �a, ��N OF AagSVc^;\r� �j { � 1 F Er SHA Y r a p l'1 � ow C - E. '^ �Y E)MMONNEArTAL SERVICES, ,INC.y A f ? � 34 THATCHERS LANE r� NCv1 c � !�/' l ��' CG7 GISTF � � EAST FALMOUTH, MA' 02536 ,- sq �� .. NITA 'Ill" /� . k / TEL FAX . . ,508.�548-0796 mil. ` r y SCALE: W T 1 =20 DRAWN BY. CES DATE: JANUARY 8 2002 0 PROD CT SD-284 FLENAME. SD284PP.DWG SHEET 1 OF 1 �