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HomeMy WebLinkAbout0233 COUNTRY CLUB DRIVE - Health ass i,o &-ty Grua Drive- A = 349 —040 Barnstable a TOWN OF BARNSTABLE LOCATION C� m, cf SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 3 3 INSTALLER'S NAME&PHONE NO. few C4911,(-1-R4 U InC SEPTIC TANK CAPACITY I✓U U �fS LEACHING FACILITY: (type) !4, RC_ jAlPj 1-7' (size) /X 36 A JD ` NO.OFBEDROOMS BUILDER,OR`OWNER J ®� i PERMIT.DATE: COMPLIANCE DATE: Id ZIJ JZ Sepaatton Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet' Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by - of b )9-b 95 5' 3 u 3 27' LIo' 37:3 Commonwealth of Massachusetts �n Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments'. r:d 233 Country Club Drive Property Address . Richard Desimone c Owner Owner's Name / ? information is required for every Barnstable MA 02675 11/5/2019 page. City/Town State Zip Code Date:60nspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 5/* Ma379 on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cie Septic Inspections use the return Company Name key. 52 Rivers End Road ICI Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector.in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. y Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Count Club Drive u Country Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA 02675 11/5/2019 . page. Cityrrown 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: This 3 bedroom home has a H-10 1500 gallon septic tank and a D-Box feeding infiltrators. At the time of the inspection there were no visible failure criteria found. 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): t5inspAoc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 ti - c , Commonwealth of Massachusetts p. Title 5 Official Inspection Form _ I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Country Club Drive Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA 02675 11/5/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required p more than 4 times a year due to broken or obstructed pipe(s). The Y q pumping Y system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below) 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 ti Commonwealth of Massachusetts 11 60 Title 5 Official Inspection Form 11 M11 Subsurface.Sewage Disposal-System.Form Not for Voluntary.Assessments - - 233 Country Club:Drive Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA 02675 - 11/5/2019 . page. City/Town - State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool'or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fall 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 aseptic 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 forma . 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 El ® Discharge or ponding of effluent to the surface.of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp:doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 Country Club Drive Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA 02675 11/5/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ED ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6 below invert or available volume is less than 1/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 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 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply - ❑ El Area system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped.Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c� Commonwealth of Massachusetts �� :• Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments Lv 233 Country Club Drive Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA 02675 11/5/2019 page. City(rown 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? ® E Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 233 Country Club Drive Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA 02675 11/5/2019 page. Citylrown 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): 351 GPD Description: Number of current residents: 2 j Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection � Yes E No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 233 Country Club Drive Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA 02675 11/5/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: galion's How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �n Title 5 official Inspection Form y( Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 233 Country Club Drive Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA . 02675 11/5/2019 page. Cityrrown State Zip Code Date.of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): ` Approximate age of all components, date installed (if known)and source of information: 2011 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 44 Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments(on condition of joints, venting, evidence of leakage,etc.): water was flushed and it came freely t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 Country Club Drive Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA 02675 11/5/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): . 3, Depth below grade: feet Material of construction: ® concrete El 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: H-10 1500 gallon 3„ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 33" 3' Scum thickness Distance from top of scum to top of outlet tee or baffle 4" 11 Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. Both the inlet and the discharge covers are raised. t5insp.doc•rev.7/26/2018 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 233 Country Club Drive u� Property Address Richard Desimone Owner Owner's Name information is Barnstable MA 02675 11/5/2019 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.} 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle - Date of last pumping: bate Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): k Dimensions' Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 c , Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 233 Country Club Drive Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA 02675 11/5/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Oil Depth of liquid level above outlet invert 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 the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 Country Club Drive Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA 02675 11/5/2019 page. Cityrrown 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: ❑ leaching galleries number: ❑ leaching trenches number, length: one appx 11x36 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Ala Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� 233 Country Club Drive Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA 02675 11/5/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.'doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 Country Club Drive Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA 02675 11/5/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 Country Club Drive Property Address Richard Desimone Owner OwnePs Name information is required for every Barnstable MA 02675 11/5/2019 page. Cityl-rown State Zip Code Date of InsP ection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two rmanent re ference 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 = 3a ' I } A - ac) � C a 3 = 5 E JV f . i I .. t5insp.doc•rev.7/26=1$ Title 5 Official insp ection Forth:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. 233 Country Club Drive Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA 02675 11/5/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 11 plus feet 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: I augered a hole at a lower elevation and I shot it with a transit to show 4 plus feet. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts 1. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 233 Country Club Drive Property Address Richard Desimone Owner Owner's Name information is required for every Barnstable MA 02675 11/5/2019 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn.on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included - V - �rJ t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 4r A -- L° s 6 No Fee_15 THE COMMONWEALTH OF MASSACHUSETYS' " Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUS ETTS Y implication for Disposal *pstrm Construction Permit Application for a Permit to Construct(� Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2_33 6py, 2 I C4,b O,,- ner's Name,Address,and Tel.No. 5 62` 7 L • 49 Assessor's Map/Parcel 34 ��p �R��6mv-X-e �do� v rn Installer's Name,Address,and Tel.No. P Designer's Name,Address,and Tel.No. SCI Type of Building: l ' Dwelling No.of Bedrooms c Lot Size 3,2`I"— sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers Cafeteria( ) Other Fixtures Design Flow(min.required) M gpd Design flow provided 33(� gpd Plan Date 1 Number of sheets , Revision Date Title 1 Size of Septic Tank I T©U Type of S.A.S. Description of Soil 422�_. 'got, n Nature of Repairs or Alterations(Answer when applicable) /1/Vim/ timy,g Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. C- --_S�nedd Date Application Approve , ' Dates / Application Disapproved by Date for the following reasons Permit No. 7�r Date Issued ~ *T / t` `�// g� ,:;�` . Fee /5 6 1l0' / - / / 4' - 1 ^ I �v"Entered in computer: THE CO�M&Nl", EALTH OF MASSACHUS' r� f PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHU�ETTS Y W 0(ppiication for Disposal 6pstem Construction Permit'. Application for a Permit to Construct(/_ Repair( ) Upgrade( ) Abandon( ) ❑Complete System- ❑Individual Components Location Address or Lot No. Cc,,J k r7 ���1 j r ,O ner's Name,Address,and Tel.No. <��, 7 b u4? Assessor's Map/Parcel 34 /� (fi t F 1 q rr- ' 0 f Installer's Name,Address,and Tel.No. ^ Designer's Name,Address,and Tel.No. Type of Building: '- Dwelling No.of Bedrooms Lot Size 31,2 4 Z sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers(\ ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 0 gpd Design flow provided a 33(D gpd Plan Date U_-10 Number of sheets Revision Date 141, Title f Size of Septic Tank ISTOC) Type of S.A.S. "Y Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: , Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-sitessewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved>�y „1L+L Date 'd / Application Disapproved by Date for the following reasons Permit No. y Date Issued A, l/ T --------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO RTIFY,that the On-site Sewage Disposal system Constructed _ Repaired( ) Upgraded( ) Abandoned( )by at 3 3 C" has been constructed in accordance with the provisions of Title 5,anA`the for Disposal System Construction Permit —44 1 dated /ID Installer Designer 4` 3 tA'o _ #bedrooms Approved design flow 3U gpd this permit s.all not e construe as a guarantee that the s ste ill fun Aes,,gned-_____.. The issuance oft s P g y Date Inspect r No. z-1 q t Fee G THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( Repair(/) Upgrade ) Abandon( ) System located at G='U� C , P U 1 4 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be co pleted within three years of the date o 1�t�his ermi . Date ,// Approve Town of Barnstable Regulatory Services Thomas F. Geiler,Director BAM> Public Health Division ,MASS p`� � Thomas McKean,Director 200 Main Street, Hyannis,MA 02601" Office: 508-862-4644 Fax: 508-790-6304 Date: Sewage Permit# 2 011-4 41 Assessor's Map/Parcel 3 4 9/4 0 Installer& Designer Certification Form Designer: SWEETSER+ ENGINEERING Installer: PKM CONTRACTING TERENCE M. HAYES, R.S. Address: 203 SETUCKET ROAD : Address: P.O. BOX 775 SOUTH DENNIS, MA 02660 EAST DENNIS, MA 02641 On 12/2 9/2 011 PKM CONTRACTING was issued a permit to install a (date) (installer) septic system at 233 COUNTRY CLUB DR. CUMMAQUIIbased on a design drawn by (address) TERENCE M. HAYES,. RS dated 12/20/2011^ (designer) X I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocati of the SAS or any vertical relocation of any component of the s is system) but in a or nce with State & Local Regulations. Plan revision or certifi d a -built by designer o fol w. Stripout(if required) was inspected and the soils we u to .,kA OF Mg8,y. g°= TERENCE y�s� M. o — (Installer' HAYEs • No. 9711 0 FGIsTe SgNITAR\ (Designer's Signat (Affix DesiAREMfamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc "A ° Y# Department of Health opme� - SRfetY',Pnd.Environmental Services g � Publ�re =���I� D `vr4on Date `+ o?tO'M Main Street,Hyannis MA 02601 N6Ii�p:'. r 1110 Date Scheduled OU ,$ Time Fee Pd. �(��— • r Soil Suitah l ty Ass-esment : a Disp oral � J ` Performed By:,�.C�l�c a4 Witnessed By: �j �IJ• .,4.........., 1 {�. ?EMI•:•••.,• :;,•':ti:':';':"••'.,:.'. ..'M 4'C .Eves•'' ....... .•,�•.'�t�•f '•1••' rep'" '•:. .......• ...:..:: .::::.:}• ?:tit.•.,}•.::::::::.:.:::::::::.::.:::::::.t:'•ii::is}:: ..G'ou.��� �� ��' Owner s°Name:}:•:•:..............::..:•:.::,:,;•;:•}a;;:::::�:::::<;::;:::.�:;;.:�;::::.:::.�:: Address Assessor's Map/Parcel: Engmeer's.Name �(yrcl�1 NEW CONSTRUCTION REPAIRI !/ G Land Used Slopes(%) / Surface Stones` Xof Distances from: Open Water Body N0 ft Possible Wet Area�_ft Drinking Water Well Drainage Way /N0 ft 8 Properly Line ------__It Other. SKETCH:(Street name;dimensions of lot,exact i locations of test holes&parr tests,locate wetlands in "roximtea, P a ry to holes) C- n•:n� A S= o r Parent material(geologic) 9 1 Depth to Bedrock C_ Depth to Groundwater4 Standing Water m.Hole: — ..._ Weeping.from Pit Face ivo.,r� r Estimated Seasonal High Groundwater ---- x«iV16t}lOd Used:.:. ::.0>}: ::.::.:w:::..•+::r:�<,•».::.:•�'.�+'.�1� ±�y�s �:� ''Y .�s�.� ::•t?•:+:<•>:;•;:•>:• f PI�✓G•�J•r .:WiA...r..::::.:viSN.•:w}}:%•:{•}:i{:ti'i:•S .\ i4tiL1 ;. ,5�< ti.titi,+ir r�!; _• Depth Observed standing 1n obs.holei ,i9' """' ��" Depth to weeping from side of obs.hole: r in. Depth to soii:motties: nJ�-✓6— N index Well tF_ RAndtns Date: 0�� In• Groundwater Adjustment in ~Jndex Well level _ Arii•factor ft Adj.Groundwater Level :::....:::::ii:}t;{}`}}}S::•}:::}i>}}:t':;:t•1}:tt•;t•;ty:;:x,: '•:n� .} .;,�{.. :.:...n....,.. .:..t},'�•'�' ::}{.:'�{.at`Q.•, .,:C}::::�.y;::': Observation Hole.J! Depth of Perc y 1i.9�� A Time at 6" Start Pre-soak Time® 0 a ---- / Time(9,'-6') 2w'f'J End Pre-soak ` �y .car✓ 9 ,j Rate MinAnch --T Site Suitability Assessment: Site Passed �. Site Failed: Additional Testin Ne g eded(YIN) Original: Public Health Division Obse Copy: . Applicant rvation HoleData To Be Comp!eted on Back---_.� - ( : ;.•::. ..... .. '•. I r.��.N..n,. Oth �,f� � � : ':C•16i'+' {s.Y � * i>. o ;;.�:z•>$$::«i«<•:ai:•.;;••:::.. Soif Color Boulderes: ' ii Soil Horizon Soil`Texture (Mansell) Mottling (Structure,Stones, iipth (USDA) ° Surface(in.) X AL (7— 1 ..y;...::�•::••Y4':::$+:ri$�'i;:;:....•n••:. �.''�'•. .. Nr: 'Y$'::::;r:•:•::;:i4:;:•'{::;$$<:Ly$$$•n$<•,: 4:; :...:.........: •.' •.:$:•:tii:•$.};•'rK4:•:•$:§•r$$:•: •, •i:..isi.`L:$$:•:v/$$::•:�$Y�$$$$:•,:•:<8$+2�$:•:•$$: .. •� •�•� 'LSo'll` eiitu •i Sor•ifCo fo n ....•��S its ru�ctu ret,h Stones,o n es , 0 u ld e r es. ,Depth =onzon S(USDA) �unsell) Mottling (S o Surface(in.) 77 .........:....::..; ..:.....:::::�::::::;;:+ ;::...is •:••:••.:::::;::..; .::.::. ... . %it .. then z .. >:•. •F.;i.: .r. Soil io r y o So Houldere Deed from",`••••� ••••lSoil Horizon !•�•LSoil Texture� unsell) Mottling (SWcture,Stones, (USDA) (M ° Surface(in.) /L � l � /Ud � � S to Y/L y �•�: ., ;•}, I}v �'i}tip ......... fi%�#: .•':�`0a� .. .:>:� ..,i. •::�?•r.. Other.. •''�< .. .>::.,.. .>:..•..:.L:c::i;.ii soli ""•I es•Aoi er µ�S d�:r i•�i:.i: I Depth from' " ;. Soil Horizon So(1 Texture (Mansell) Mottling (Structure,Stones, ou (USDA) ° Surface(in.) to 110 to Yip l3 t Hour„e„r . NO�te� ' ✓ - ' ' Above 500 year flood boundary No Yes x. ✓ Yes Within 500 year boundary No / 1/ Yes. . Within 100 year flood boundary No- -Trrin Pe ious_Nii1 �1 Doe s at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? rp.�itication roved by the ` (date)I have passed the soil evaluator examination by me consistent with I certify that on l �� erfortned by Department of Environ>rtental protection eriend hat thebed uv7 0 analysis 15.017.5. the required training,expert! P Date rt TOWN OF BARNSTABLE L LOCATION � � C0� CEO SEWAGE # J CQi VILLAGE AS MAP & LOT t 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:r(typc) �/ F�L� (size) I X 3 x jQ h " NO. OF BEDROOMS- BUILDER OR OWNER {, PERMITDATE: // COMPLIANCE DATE: IQ 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 L'eachingTacility (If any wetlands exist within 300 feet of leaching'facility) Feet Furnished by fn Al C, 90 APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION L 07- /3 60VAI T R Y GL-03 PR I►OE NO. . P VILLAGE 6(/M M Aa if/D DATE 11-)2 -12- APPLICANT T- MC-5 iJYR1V' FEE/OO j gJ (non-refundable) ADDRESS 96,5 CEA1TRC ST, TA-MA-G. 124A-IMI NA oal10 TELE. #(6122 S z Z' 70 7�- ENGINEER DOI^//1!- GAPE LNGll1 60_Rj1VQ;, l/VG. TELE. # 6 � ^ �l'S�fil DATE SCHEDULED IVOV 12- ,; 41 2 Applicant's Signature • • . • •ASSESSOR'S MAP & LOT NO. . .J�/Q'P. 3g-9. . • • Fi4 REEL. . O . . . . . • . . • . . . . . . . . . . SOIL LOG SUB-DIVISION NAME CVMMAQVID DATE AJOV /2- , 1992_ TIME 11:00A-M EXPANSION AREA: YES NO .Toe+'"C'E' ENGINEER TOWN WATER J/ PRIVATE WELL Teuna Alnno 9 BOARD OF HEALTH Jnh�'f Al-Eo EXCAVATOR i Sketch: (Street name, etc. dimensions of lot, exact location of test `holes and percoloation tests, locate wetlands in. proixmity to test holes) NOTES: i W (Y 30 2.0 T"N•i J 7 �.LD?" ARNi >`sA s. O)AI,A CIVIL t 00RAL ROAD. PERCOLATION RATE: /A// l A16H ai..so,s CL' It-q•S TEST HOLE NO. 1 ELEVATION : TEST HOLE NO..2 TEST 1-f®VE NDa 3 1 'jr0P-+ 5'I19EL •S o.o . 1 7-OP I 70P fi v'8 2 2 EL.4-q.� �a E�•�1-SAS 3 C&AY 3 3 . 4 4 5 6 6 CLAY 6 7 7 9 8 10 M�"D .. : 10 I� Mr-Ds D EL 'f-o.S LUM E L.3 q.$ 12 _ 12 I-- I2�1ET� EL.38.s 13 13 -`� .3g,5 15 s}H✓D 14 14 I ,/O I� EL.36.0 15 EG. 36,O 15 wA-r R A/0 16 M Q 16 .P00v W T R WATCG R �=00VD r ov'vD , 4 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING' PITS x ) LEACHING TRENCHES. UNSUITABLE FOR SUB-SURFACE SEWAGE: REASONS: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION COMPLETED IN ENTIRETY BY P.E. AND RETURNED TO BOARD OF HEALTH RETAINED BY APPLICANT s r Zvi vo� _F n 2D I D (V\t IT ..� a it t , i( 4 4 i J ► ►t t:t ► ,t - 2.4LS� _. _. .. - r4� !t -_VIP : IZ— f `WAL�. '' I - Loit r Z. ---- ._ i o j , t " 9 i 00 I a i I I A SCALE. G/6 APPROVED BY: DRAWN BY J g� Luce vS�r1D2 6�4p� DATE• 11 REVISED REG�S�w? pROFESSl�NP DRAWING NUMBER Of Io �-� Co rvy6 o V WTS 0-fo W VV [ Y ' 1 t f CN jam` // 1 i I - 6 l' -US 42 WALL- _ 1 �i. t t= ► 1� i if � E I � !1� �} 1-� tom, 1 ; .._.------_- OF S USFT q o ���09 o y(zp�'$9�a� Q = SCALE: /�'�,I f i !f APPROVED BY: DRAWN BY J A REG\s��C���` DATE: �d -^ �l. 'j; REVISED v ROFESSO) \ DRAWING NUMBER .A TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR OR CRAWL SPACE 10200 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB DATE OF SOIL E � � ELEV. CLEAN SAND TEST BR 0 1_ _ __ CONCRETE INSPECTION PORT WITNESSED DO BSOIL TEST YD YDESMARAIS. IN_RING COVERS 4" SCHEDULE 40 PVC PIPE 7LOAM. V.= _98.9 AND SEED LAYER OF OBSERVATION HOLE - k: _ OBSERVATION HOLE 3 ELEV.-_ 98.3 MIN. PITCH 1/8" PER FT. 1/8" TO 1/2" PERCOLATION RATE _<,_A__ MIN./INCH --94___ INCHES WASHED STONE DEPTH HORIZ TEXTURE COLOR MOTT. OTHER O&S MAX. OR FILTER FABRIC VENT DEPTH HORIZ TEXTURE COL MOTT. OTHER �00 4" CAST IRON PIPE X MIN. I NOT REQUIRED 0-4" A LOAMY SAND 10YR NO ROOTS 0-3" A LOAMY SAND 10YR5/1 NO ROOTS (OR EQUAL) MINIMUM L - \ 3-20" B SANDY LOAM 10YR7/4 ROOTS-- 4-17" B SANDY LOAM 10YR, ROOTS - - -- -- ---- - pyyyy ___ ___._._ 20-84" C1 SILT LOAM tOYR7/3 PITCH 1/4" PER FT. L Vt4LERS TEE �_ \ 17-68" C1 SILT LOAM 1OYR FLOW LINE °' 68-144" C2 FINE SAND t 0Y'RF _ 84-132" JC2 FINE SANG 10YR8/1 144" 86_9 ELEV. _ -'�t,�Q- MIN. 2.0" 0 0 F- 1__ o NO WATER ENCOUNTERED AT NO WATER ENCOUNTERED AT t32" ELEV. _ _ 87.3 ELEV. s _--'� LEVEL o SEpH I EELEV. a _11d.T0 GAS ELEV. _ _.0.17- 6" SUMP ELEV _ QQ_ 0' ELEV. _ _ t7_ --98.9_ OBSERVATION HOLE 'I ELEV.=__97_7 OBSERVATION HOLE 2 -- PERCOLATION RATE _�._�_ MIN./INCH AT 99 INCHES BAFFLE DISTRIBUTION I ELEV. s DEPTH HORIZ TEXTURE .;OICY MOTT. OTHER LI ID OUTLET 4 HIGH CAPACITY INFILTRATORS WITH BOX -�+��- STONE IN AN � 0�8" A LOAMY SAND tOYRA '� NO ROOTS DEPTH HORIZ TEXTURE COLOR MOTT. OTHER __ _.- __._ _.___..: _.. _._ 0-5" A LOAMY SAND 10YR5/1 NO ROOTS 4 TH TEE 14 INCHES (TO BE PLACED ON FIRM BASE) z 47 IS 27' B SANDY LOAM 0YR7, 4 ROOTS FE / TO BE WATER TESTED 11 X 36 X 10� TRENCH FORMATION 5-21" B SANDY LOAM 10YR7/4 ROOTS 5 ET 19 INCHS 1�� GALLVI7 IF MORE THAN ONE OUTLET 127-84" C1 SILT LOAM �10YR7, 3 11 I ovR8,1 --�__ -- 6 FEET 24 INCHES SOIL ABSORPTION ALL-"- 84-144" C2 FINE SAND I -- ____� _. _ _r_ _ . 21-72" C1 SILT LOAM 10YR7/3 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) ZONE - 72-144" C2 FINE SANG 10YR8/t 8 F ET 34 INCHES SEPTIC TANK 3/4" TO 1 1/2" CLEAN -�� SYSTEM (SAS) I INDEX NO WATER ENCOUNTERED AT --144"_ ELI V. _.86.9 _ _DOUBLE WASHED STONE SYSTEM G \�+ / ADJUST NO WATER ENCOUNTERED AT 44" ENV. = 85.7 FREE OF FINES & SILT ` -! UE BE WATER TABLE SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED W TRTALE ( / � ELEV. = NOT TO SCALE BOTTOM OF TEST HOLE ELEV. _ r _ ze DESIGN CALCULATIONS w " NUMBER OF BEDROOMS 3 GARBAGE DISPOSAL UNIT TOTAL ESTIMATED FLOW ( 110 OAIL./Ut./DAY X 3 Wt.) GAL./DAY REQUIRED SEPTIC TANK CAPACITY GAL. ACTUAL SIZE OF SEPTIC TANK GAL. SOIL CLASSIFICATION Y L_ DESIGN PERCOLATION RATE MIN./IN. EFFLUENT LOADING RATE GAL./DAY/S.F, LEACHING AREA SQ. FT. (11X36)*(47XWO/'12) LEACHING CAPACITY (AREA X RATE) M-90 GAL./DAY i1V} 474.33 X 0.74 RESERVE LEACHING CAPACITY 351M GAL./DAY R 104.9 L O T 13 - NOTES: 36,242 f F 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN'S RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO `10R� WITHIN 6" OF FINISHED GRADE. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE 8�8p. USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. % 101.0 x 100.7 4. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO 103.8 / / 99.7 OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS 00) 98.6 PRIOR TO COMMENCING WORK ON SITE. / -SOIL D. 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS 1500 GALLON /TEST \ OX SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION / SEPTIC TANK I • SOIL IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER IMMEDIATELY. 99.8 h� ^' '_�EST\3 j ° c r nrc! is INFt OOD 7n►'c C SOIL 9. LOT IS SHOWN ON AS:st5z:I&Mb MAP _ � A,; o h,,*< / / / TEST 1 `� l9 �h0 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER AND F 2 FOR A MINIMUM OF 5' AROUND SOIL ABSORPTION SYSTEM AND BE 102. / REPLACEO WIT'-! MATERIAL AS SPECIFIED IN 310 CMR 15.255:(3). ,_---(102) t 00.2 ,per / f 96 11, THE INSTALLER IS TO GIVE THE ENGINEER A MINIMUM OF 48 HOURS ySOIL / (2 WORKING DAYS) NOTICE FOR THE FINAL INSPECTION (NUMBER BELOW). (100) �s�, �0 \ R��\ /LIMIT OF 5' O 98.4 OVERDiG 99.2 .� 97.2 x Q- �� � � 97.9 2 100.t \� 6 .0, 98.9 O FrWA` \ / °? 1 E \ / 10 .2 102.2 J • 98.6 \ /� v .� �.I ..r 011�i� �Y 103.89.56 (100) J C 100.9 A APPROVED: BOARD OF HEALTH 100.6 101.2 a4N 8 9V µ � IWX' 101.7 / 04.3 (A ) \ DATE AGENT F , OO \ (102) 102.0 / BARi1vSTA MASS PRCPCSED SEPTIC DESIGN - 102.0 4CUMAlAQU/OJ FOR �O 101.4 \ RICtLAM DEBII�ONE O \ �.157.08 /IF44 102.7 LOC. 233 COUNTRY CLUB DR., LOT 13 .. ?02.9 ��� BARNSTABLE MASS. 102.4 \' 102.8 t 02.8 to2.s �' ►�� � 203 SETUCKET ROAD 50$- SOUTH DENN S,71 MASS. � � 3$5-6900 02660 EXISTING SPOT ELEVATION OOxO i��{/N EXISTING CONTOUR ----00---- I. x DATE DEC. 20, 2011 SCALE 1 " = 20' FINAL SPOT ELEVATION iN s FINAL CONTOUR CF�dT �O,Q SOIL TEST LOCATION '4� REV. JOB NO. 707�oo U TILI TY POLE -0-• TOWN WATER -WW�'� CATCH BASIN GAS LINE LOCATION MAP REV. SHEET 1 OF 1 CLEAN OUT CESSPOOL C.P. {,� C. $8 PRa/ 7070-00 d 70M-•, I&DOG 0 2011 EMS MR etG1NI;f: 4..*sjk ... 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