HomeMy WebLinkAbout0118 FLINT ROCK ROAD - Health 118 Flint Rock Road
Barnstable
1A= 316 -080 - 007
7
L a-P / TOWN OF BARNSTABLE
WiLL
ON ~ L, 4' Ro k SEWAGE # �G 3 7
GE l3 ✓� S �� c.• A SESSOR'S MAP & Lot—Lk S o&0
INSTALLER'S NAME&PHONE NO. Ldd
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) �' (size) C 6 ;?
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: (� �f G COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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 g facility) Feet
Furnished by
qL> ` 0 33 ►
H h = 3�b-�a -doi
yLhlt ION SEWAGE PERMIT NO.
�-d i 17 Z-A
V I L L A G E
741" cl
I N S T A LLER'S N A m E A ADDRESS
o B U I L 0 E R OR OWNER
P�
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
! 7(
J Z---, .
i r �A
TROY WILLIAMS R�C;EE
®
SEPTIC INSPECTIONS UP 6
Certified by MA Department of Environmental Protection TOWN OFN"I_E 508) 760-1819
40 Old Bass River Road
South Dennis,MA 02660
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
9 Department of
[Environmental Protection
William F.Weld Trudy Coxe
Conaror
Argeo Paul Celluccl s.cr
tt covemor David B.Struhs
hs
Comrraasbrnr
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
n CERTIFICATION
ro Pperty Address 1�8 i rn K o c('� l�c�. 13,e— s1 S
i Address of Owner.
9
Date of Inspection: 9111 / L (If different)
Name of Inspeetor��.o yy �: (: H, 130 5�7�A S S
Company Name,Address dnd Telephone Number. 10 ' 0'2 U`JU
Sc c A butt G ,
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
_Zpasses
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature/ Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B,C,or D:
A]- /SYSTEM PASSES:
V I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evahiated are indicated below.
B] SYSTEM CONDITIONALLY PASSES: A114
One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes
inspection.
Indicate yes, no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not)
The septic tank is metal,cracked, atructurally unsound, shows substantial infiltration or exAltration,.or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a Conforming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: W 1 5 t' t i .,l i[,)C,k
Owner.
Date of Inspection:
B) SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced _
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
CI FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require fluther evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
3) OTHER
(revised 11/03/95) 2
SUBSURFACE AGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(oontinued)
Property Add.
Owner.
Date of Inspection:
C1 A
Dl SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
— Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
— Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
— Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
_, Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
— Any portion of a cesspool or privy is within a Zone I of a public well.
— Any portion of a cesspool or privy is within 50 feet of a private water supply well.
— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
eoliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS: J/
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
— the system is within 400 feet of a surface drinking water supply
— the system is within 200 feet of a tributary to a surface drinking water supply
— the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public
water supply well)
NThe owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: ) I / ; N+ �d k
Owner. �.. vrt of S
Date of Inspeotion:
9/
Check if the following have been done:
/Pumping information was requested of the owner, occu t, and Board of Health.
-K P�
None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
ZAs built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
_ZThe system does not receive non-sanitary or industrial waste flow
ZThe site was inspected for signs of breakout.
All system components, excluding the Soil Absorption System, have been located on the site.
The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees, material of construction,dimensions, depth of liquid, depth of sludge, depth of scum.
jThe size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
LI/The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: �� � ��c !n�' /� °c,
Owner.
Date of Inspection: /
RESIDENTIALFLOW CONDITIONS
Design flow: 3 0 plions
Number of bedrooms: 3
Number of current residents: 0
Garbage grinder(yes or no):_A�
Laundry connected to system(yes or no): VC S
Seasonal use(yes or no):_,A,/6
Water meter readings, if available: 6 —
to �. Ut7U o4/(oKS
Last date of occupancy: 9
COMMERCIAL/INDUSTRLAL• /,J I,4
Type of establishment:
Design flow:______gRlons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings, if available:
Last date of occupancy:
OTHER (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
Tla y�'J K'1✓J 4 ,h T'� G.1/4' I t��. T u
Sysiem Pu►Ped as part of inspection. (yes or no)_A/O
If yes, volume pumped: gallons
Reason for pumping:
TYPE(1F 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)
Other(explain)
APPROXIMATE AGE of all mponents, date installed (if known) and source of information: a
h S !!L. I c
_7at
Sewage odors detected when arriving at the site: (yes or no)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
/f SYSTEM INFORMATION (oontinued)
Property Adds: 11 8 r' V` } /1 G k-
Owner.
Date of Inspection-
SEPTIC TANS:
(locate on site plan)
Depth below grader
Material of construction: Zooncrete_metal_FRP—other(explain)
Dimensions: 6 X, Cl I 2C 6 � l O o cl
Sludge depth._ �
Distance from top of sludge to bottom of outlet tee or baffle:oa 5
Scum thickness: 'Y"/
Distance from top of scum to top of outlet tee or baffle: 6
Distance from bottom of scum to bottom of outlet tee or baffle:- /0 �
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of li d level in relation to outlet invert,structural integrity,
evidein of leakagee,•etc.) C_a'- c_ .j�c- -4✓•. k , h uJ„r -1 2 o ^/" s � G1_
O T I P_.A Y�c� ci 6I/ c.t.✓Jn cl � L _ /
GREASE TRAP:A///�
(locate on site plan)
Depth below grade:
Material of construction: _concrete_metal_FRP_other(ezplain)
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:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage, etc.)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: t g F I, H J,_
Owner.t of Inspectio v S /
% /►� /y 6
TIGHT OR HOLDING TANK /1 �,l
(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_FRP—other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX-
(locate on site plan)
Depth of liquid level above outlet invert: le �.
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
T o 4
PUMP CHAMBER:N/4
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Addresac n R v C—
Owner. —1-6, o S
Date of Inspection:
C//rr /tip
SOIL ABSORPTION SYSTEM (SAS):_z
(locate on site plan,if possible;excavation not required, but may approximated PProximated by son-intrusive methods)
If not determined to be present, explain:
Type: / .
leaching pits, number:Q[- b ` 1-Ga�� lo�f" w; p? "S
leaching chambers,number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)�:� �..� a ,
ctir..4 q K` ,7 at
✓ rt
u.if
&J e- .�
CESSPOOLS: A/ 9
(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:
tion:
Indication of groundwater:
inflow(cesspool must be pumped as part of inspection)
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:
(locate on site plan)
Materials of construction::
Depth of solids:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 11/03/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Indude ties to at least two permanent references landmarks or benchmwkcs
locate all wells within 100'
3H a6
3°f33 '
3� aq
ybi
DEPTH TO GROUNDWATER
Depth to groundwater: feet — adjusted high groundwater level
method of determination or approximation: tJ o 0
✓o.� d w�— ,h v, IS
" d i
9
No - q_•3 Fss.... .....�...._.....
m
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........OF......... -_--------------
1100 lirFa#ion for Dhipoii al Workii Tnnitrurtinn Vertuff
Application is hereby made for a Permit to Construct (X) or Repair ) an Individual Sewage Disposal
System at:S �-
... .�::. `......�...._--.... . ............... �to.
A ,twn- ddre or L
Owner Address
Installer Address
Type of Building Size Lot.... � ......Sq. feet
...�..�.
U Dwelling—No. of Bedrooms............. ... .........................Expansion Attic ( ) Garlfage Grinder ( )
'4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria
PL, Other fixtures --------- ---------------------•----•-•---•---
W Design Flow............................................gallons per person per day. Total daily flow................. ..0.........gallons.
WSeptic Tank—Liquid capacity./O.V.gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.._x„jb .sq. ft.
-> Seepage Pit No........_...:.__-__-. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank
d...........
Percolation Test Results Performed by....................�f'.� ��_.�__....._....._.. Date........._...�..IIZI..
a' Test Pit No. Lie
p minutes per inch Depth of Test Pit.................... Depth to ground water........................
V• P P P
44 Test Pit No. 2 .......minutes per inch Depth of Test Pit.................... Depth to ground water........................
...................................-- . •-
O Description of Soil............................... ........ •-•
W -------•••-•----------•-----•----------------------••--•-••----....•---------•-----•----•-•-•-•--•-------••--•-------•-------------•----•-•----•----.......---••----•--•------------•---.......----.....
VNature of Repairs or Alterations—Answer when applicable.........................:...............................:.....................................
---------------- ------------------------•-----------•----•----------------•--------...---•--......-•-------•-•---------------------••--------•----------------------------------....-•------•-----•---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with
the provisions of iITA U 5 of the State Sanitary Code—.The undersigned further agrees not to plac/thhe stem in
operation til a Certificat of Compliance has been issu by the Ith.lamed - •--•-•. •-•--. ••"�-
•-• .•---•-- .
Ap )cation AMIpproved��- �........................ .. ... •••--- •---"•..... -- ...... ---•--..... ..... --- --.....-•--••--
ate
Application Disapproved for the following reasons---------------------•--•---••--.-------------------------------------------••--•---------..........--......_...
----•-•.............•---.•-•-•------------•-••-------------••--•-•-......-----...............---•--....----------..................--------•--•--•-•--•--••-•----•--•-•------•-•---.....-•..---.........
Date
. --�
-----
Permit No............ ...........- ---........... Issued.......................................................
Date
No� -'- Fizz �- .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................OF.......
Apphratiun for Ui4puual Works C onstrnrtion ramit
Application is hereby made for a Permit to Construct (, ') or Repair ( ) an Individual Sewage'Disposal
' System at: ��
.........-- - .�.. .. . .. ..............r. ... ...... / Z..................................................... .- -............ .
L`o tion-Addressf / z Lot 3To
Owner - . - Address
W ••...... % s � � c '' T �J.__ � f . ..... '..1.. Y.... ........... r/ C
f Installer -
Address � � j
Type of Building �, Size Lot.....`f./_`:_..-- / Sq. feet
f -
Dwelling—No. of Bedrooms.............. .........................Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building No. of persons............................ Showers
Q, YP g P ( ) — Cafeteria ( )
a' Other fixtures ..................................
W
Design Flow............................................gallons per person per day. Total daily flow..__...... -"' -"__.._..gallons.
'W Septic Tank—Liquid capacity- r? gallons Length................ Width.._.._...._...._ Diameter._.____...__.... Depth
x .�=f..........
Disposal Trench—No..................... Width._._........._...... Total Length.................... Total leaching area-._: �:_-_sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( ) Dosing tank
Z
Percolation Test Results Performed by--------------------- 7LC?/7............... Date..............
W
Test Pit No. 1_I& ....minutes per inch Depth of Test Pit.................... Depth to ground water.........................
44 Test Pit No. 2��.��3'...minutes per inch Depth of Test Pit.................... Depth to ground water........................
C4 ........................................ ..............•........................... ....:.-----. ..
ODescription of Soil-•--------------------•-- =------•-- ; :_.
�4 ......................................................--......._..--•----------.................•---
U •--.....--••-•--•---•--••-•---------------•--------....--•-----•--.........•--------••-•••........--••--------......-------•------...••••-----•-••--••-------............•-••-------•...........•-••-••.
W
Z. ----•--------------------------------------------------------------------------------------••-----•-----------------------------------•------------...------------------------••-••------....-•-.......
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
-------------------------------------------•----------------------------••----------•-•------------•--------...--------------------------------------------------------------•--•--•--•......•••••••--•-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with
the provisions of TITI.i 5 of the State Sanitary Code The undersigned further agrees not to place the s stem in
operation un it a Certificate of Compliance has been issue by the bo�aT4 of-Ife-a-Ith. /11
/ K . 1 � ed F s�L ...�.✓ J
..
` at
..
Application Approved BY-------- �'" - d/ z',G�+..-� ... ... ....................... ....�... ......---
ate
Application Disapproved for the following reasons:-----•--------•-----•----------------------------------•----------------------------------......------......•--
..-----•---------•--.......•-•---•-•-----•---••-••••-••-------•••••------•--•--•------••.........................-•••..........•-•-----•-------•--•---••••-•--------------•••••--------••---•---••--••---
%yi Date
PermitNo..............SS........................ ---------- Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF, HEALTH
/ ��. •2L d
................................................
Trrtif utttr of Tomplittnrie
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (, ) or Repaired ( )
Y = • . .... ••----••••----•-••••.................•-• -•-•--••.
1 Installer +' f
at. ' ......._..
has been installed in accordance with the provisions of TIT 5*0e State Sanitary.Code a de ri ed in the
application for Disposal Works Construction Permit No------- f
dated...
ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST ED AS A GUARANTEE THAT THE
SYSTEM WILL FUNK ON ATISFACTORY.
I'
DATE..............................:7� �5�1 Inspector =
THE COMMONWEALTH OF MASSACHUSETTS
.� BOARD OF HEALTH
N( / .....0F A h.`a .......... so... ..
giupouttl Vorkp Tonstrnrtion Permit
Permission is hereby granted----•---••-•---- :> s'f , '' I L� .1...
. �' _..._.._ .�, ........._..
to Construct ( or Repair ( ) an Individual Se a e_Disposal System
j .......
Street
as shown on the application for Disposal Works Construction Permit No _ y ated___ !,.�. (.........
.,_............ �. ...f ...................... `
DATE_ � Board of Health
FORM 1255 A. M. SUL IN. INC., BOSTON ,F
a
I h .
1(0
,-c
Z �
Y
40 ? b sue. xrz'
07s` % 1
43
03
r 14Z , y '
LEGEND
EX STING SPOT - ELEVATION OAO CERTIFIED
PLOT PLAN
EX' STING CONTOUR -°--- 0 - - —
F1 ISHED SPOT ELEVATION Gor 7 roar Paaie ,�o.va
MISHED CONTOUR --- 0 _��.✓��,�✓.���--
NOTE: The lucatiun of any existing underki-ound sewerage, - IN
wells, or other utilities shown on tY.is plan is approx-
imate only as determined from records and/or verbal
i.nt3ormation . The contractor is responsible for_ .the
vezlification of the existing locations 'in the field. SCALE1 �"; 40 _DATE e 3 5 !o =
4DREDGE ENGINEERING CO IN i✓ v�`S I CERTIFY THAT THE .PROPOSED
CL.IEN?�—
BSag4 BUILDING SHOWN ON THIS PLA►�
EGISTERE REGISTERED JOB PdO.._._._-.-
CONFORMS TO THE ZONING LAWS
CIVIL LAND DR.BY"_, „� L E MASS
ENO NE
ER URV OF 13i4T !S
712 MAIN STREET CH. BY, K � -� -----
HYANN I S, MASS. SHEET/ OF DATE REG. LAND SURVEYOR
�.- - _ : _ -_-_ , _ -- :,: _ ;_— -. --=•-_`:_.�� LSE � rDTA-:�lETE�C i1/f . -.7-E._..COYER._. >'
I S,4AL1. BE BROUGHT TD GRADE. (,-+%✓ EXTrP.'q ,y,
YGONCRETESt"pVC f>/PE I 'Ay EAVy C/� ST /r?DN CO{/fir? $N�}LI- !3E USED
�'OYEIIrs M/N. P/TGN /iV �R/VEH/A y
` � �B�PE.Q FT.
Z7 M/M. CD/VCR� TE
CLEAN SANG
�A
eAC.+CF/LL
I �_
LI�dIlO LEIiEL 1`-
1 q"DIA. _ "LAYER
f4 SCHEDULE O
... <1, p.Yc. P��E . � /ooa .._, G.4�. ° • ao 11 • • • • • • 1� DoQo
tr3 M/N. P/TChI DIST. yyASHED S7rJNE
SEPTIC rA/VEC . 1 • • . 1 ,• <•q
. •
. - BOX o • • 8 • r • •
:,i a �d y p � 1 IEFFELT/VL • . • 4 - � �2 •.
r t.
V • . • • OEPTN • • • •. o o WASHED 574NE 4
., a 'PiPECAS T SEEPAG E
r/3 �. �. 93 = °` .• r • • s • • 1 •! e•• e E V s/7 OR EQU/V-
x)veA r EL E{/AT/aN S
• o• A a �E S7,
INYERT AT OC//LDING.: :..q' '`o ET /�/T �.q, cJ SEE T�gBULATION
- -... _.
/NZ ET..SEPTIC T.4Nlf g'3:k FT /Z FT O/AM. C
g4JTGET SEPTIC TANK 9FT GROUND OU P1,47 TABLE ``
t
/NGE7r DISTR/BUJ'/DN 'BOX FT SECT/aN OF
duTLt7^o�sTRll vrio/v eox q ;z �' 5EWA6E 01SPOSA L- .SYSTEM
/NLET.1-4ACHIVa P/�' 2 o FT TABULATION ,
LEACHI NG P/.T p�MENS/O N A Q S FT.
DESIGN CRITERIA JCALF : %s _ /= o"
O/,q,FNS10N $ �—FT.
E ELa S NUpf R G>..4QAGEo/sPo.rgLvyiT'_NoNE SOIL LOG l
TaTA'L E3T/MATED FLavJ 3 0• .G.�lL.�DAY SOIL TEST / SOIL 7. T*2 SD/L TES7�
" 9 EL�Y, S DATE OF SO/L TEST S ''Za- $
i1(UMBER QF ..E-4CNl,vG p/TS_�: / '_ �ELEY. �"
S%DE t eAG'NING hER P/T._a T SCE. PT. o_Z ,- /_ RESULTS h/1TNESSED BY C ONLOA/
PER COL AT/ON RATE,*/ � � M/Ny NCN
�BOTTOM LF.,•gCX/NG PER P/T�$Q. FT .. LU/i'�
J 0AM le � pw,ecoi,4T/ON RATE�2 M1N,f/NCH
TaTAG LEAG'N/!YG AREA 3o SQ. ,jv�tar L
RESERVE LEi4CN/NGARER -33 0 SQ.: FT.
SoI Lr�s - ys s
9� .• .cow ,'Z /.Z• \. rC. O T" 7 F.0/N r �
/�ST-t�BL.E ,
..� 5n. ELOREDGEENG/VEER/JAG CO,ING. .,, ;
71Z MAIN S7", NYANNlS, MASS_.
;DbNO.GROlJND YYi4TCR ENCOUiVTE�E 0 C�/E,yY: p p.ITE 3 /
'� .9 Q GROUND Yv/�TER A7 6LE1/. F34n o SNEET�OF
;r...... '" JOB No. ��
TOWN OF BARNSTABLE
LG%�+TION I � �` /C`'t SEWAGE# � ^Y3 7 '
VILLAGE D a Is < A SESSOR'S MAP &LOT321 `�-0&b I
INSTALLER'S NAME&PHONE NO. v`►r
`O J
SE PTIC TANK CAPACITY >
(size) X'�
6
LEACHING FACILITY: (type)
NO.OF BEDROOMS
BUILDER OR OWNER
/
PERMIT DATE: to l b COMPLIANCE DATE.
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility
Feet !
Private Water Supply Well and Leaching Facility (If any wells exist i
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist Feet
00 feet of hi f 'lity)
within 3 g y
Furnished by
3q
-z
G� 1