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HomeMy WebLinkAbout0029 HOLLY LANE - Health (arnstable 9 Hollv,Lane , =336 631 1 e �ach.usetts 331c Commonwealth of M Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is required for every Barnstable Ma 02630 5/29/2019 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information f4 �'� on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. Company Lane Co � Company Address . Centerville Ma 02632 Cityrrown State Zip Code 508-658-3456, 774-248-4850 SI 4522 sean@smjonestitle5.com 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 --�' 5/29/2019 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. 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. 1D % t5insp.doc-rev.7@6/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page"1 of 18 V r Commonwealth of Massachusetts Title 5 Official Inspection Form do Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is required for every Barnstable Ma 02630 5/29/2019 page. City/Town 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: The dwellinglocated at 29 Holly Lane Barnstable is served b a Title V septic stem consisting of a Y Y p Y 9 1500 gallon septic tank, pump chamber, distribution box and 8 Quick 4 leaching chambers. The system was found to be in proper working condition at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments >� 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is required for every Barnstable Ma 02630 5/29/2019 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 pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to.determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.do6•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is Barnstable ' Ma. 02630 5/29/2019 required for every page. Cityrrown 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 fail unless the Board of Health (and Public Water Supplier, if any)_ determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption,system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No - ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 0 ® 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 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is Barnstable Ma 02630 5/26/2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 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 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section 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 ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is required for every Barnstable Ma 02630 5/29/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes'to any question in Section C.5 the system is considered a significant threat, or answered "yes'to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ Has the system received,normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS).on,the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 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 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is required for every Barnstable Ma 02630 5/29/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual). 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 0 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 ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown 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 <�a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is required for every Barnstable Ma 02630 5/29/2019 page. City/Town 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: gallons How was quantity pumped determined? Reason for pumping: 15insp.doc•rev.7/26/2018 Title 5 Official fnspeclion Form:Subsurface Sewage Disposal System•Page 8 of 18 f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is required for every Barnstable Ma 02630 5/29/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool t ❑ 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: system installed 8/31/2006 per.town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ® 40 PVC , ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leaks or blockages. Vented through roof t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is required for every Barnstable Ma 02630 5/29/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.), 6. Septic Tank(locate on site plan): Depth below grade: 1 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 gallons Sludge depth: 611- Distance from top of sludge to bottom of outlet tee or baffle 3' + 211 Scum thickness Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. l5insp.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 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is required for every Barnstable Ma 02630 5/29/2019 page. City/Town 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: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): NDimensions: 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' Commonwealth of Massachusetts �m = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is required for every Barnstable Ma 02630 . 5/29/2019 � page. City/Town . 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): 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.): Distribution box was level and in good condition with*no rot. Water level was even with outlet invert with no signs of past backup. t5,nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection form j' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is required for every Barnstable Ma 02630 5/29/2019 page. City/Town 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.): pump chamber was in good condition, pump and alarm functioned when triggered manually. " 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: 8 Quick 4 chambers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ 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 1' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �., 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is required for every Barnstable Ma 02630 5/29/2019 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.): s.a.s. consists of 8 quick 4 leaching chambers in a 36'x11'x8"trench. area surounding leacging facility was dry with no signs of past saturation. 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 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is Barnstable Ma 02630 5/29/2019 required for every page. Cityrrown 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.): a 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 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is required for every Barnstable Ma 02630 5/29/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately 1 G 0 aK in Lx Y-; 1 00 0, � ; 3& X339a60 o A t5insp.doc-rev.7I2612018 Title 5 Official Inspection Form: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 29 Holly Lane Property Address Nile Morin Owner Owner's Name information is required for every Barnstable Ma 02630 5/29/2019 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: 5 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: Leaching facility is raised to allow 4+' seperation between bottom of s.a.s. and adjusted groundwater elevation. 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Holly Lane Property Address Nile Morin " Owner Owner's Name information is required for every Barnstable Ma 02630 5/29/2019 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 16 TOWN OF BARNSTABLE Lt QATIO 11 or- 80L� Lare SEWAGE `°=-LAGE ('C�►�ArA Q ld ASSESSOR'S & LOT SL -3�. 11 . INSTALLER'S NAME&PHO NO. C / d 'ef G VL� SZ�'3�Z8-�110 SEPTIC TANK CAPACITY 1 ` LEACHING FACILITY: (type) [3 in#� t:3ck "� (size) X I O NO.OF BEDROOMS 3 BUILDER OR OWNER O S PERMITDATE: IU 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 � Feet j� on site or within 200 feet of leaching facility) d`l" . Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r - lave lA G. In ee ti�f,7 3y� 01 ;W� No: - "R .. -.�� Fe THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ,k PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rptication for Mi5po!gal �bpq;tem Construction Permit Application for a Permit to Construct(4. Repair O Upgrade( ) Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. ,ay Owner's Name,Address,and Tel.No. lip? v►,� fir° �? � �� � js Assessor's Map/Parcel j 7 Installer's Name,Address,and Tel.No.?S_-1* _7Y,?,0 Design '- ame,A,d�ree a�n Tel No. Type of Building: Dwelling No.of Bedrooms ., Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided ��� gpd Plan Date 2/r 6 Number of sheets Revision Date Title Size of Septic Tank %��� Type of S.A.S./ eh,- 1-17Ie< C?A�»�1aT4 S 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-site sewage disposal system in accordance with the provisions o e 5 of the Environmental Code and not to place the system in operation until a Certificate of h Compliance has been issued by H 1 Si ��od C? Date Application Approved by Date Application Disapproved by: Date for.:the following reasons Permit No. Date Issued t*r�. /A00 No. •` f / Ty Fe Entered in computer: t THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC,.-HEALTH DIVISION - TOWN"OF BARNSTABLE, MASSACHUSETTS } Yication"for� i5o.5ar, pgterrY COtt5tructi0tterrrYit Application for a Permit to Construct Repair.( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.14_17 G.✓V Owner's Name,Address,and Tel.No. C_ �Wvv /--� Qom/�/) Assessor's Map/Parcel U Pe` ? ��� ��/�7 S s�Y g Installer's Name,Address,and Tel.No. �ya� Desi ner's Name5S,A dress and Tel.No. ze Type of Building: ? 1 Dwelling No.of Bedrooms _J Lot Size�g� G sq. ft. Garbage Grinder ( � Other Type of Building �C�S/p�✓�/'��G.- No.of Persons Showers( ) Cafeteria( ) Other Fixtures t/ Design Flow(min.required) � � gpd Design flow provided �7 y gpd Plan Date 2"/ Number of sheets Revision Date r Title Size of Septic Tank Z:5_01!:� 'Ir Type of S.A.S.//► /I71t�1.7Y cAf%!w 49c4 S Description of Soil Z2-eL1— �,�,�o Nature of Repairs or Alterations(Answer when applicable) Date last inspected: 4 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions o i e 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by hid 'o d oV t Si /1.1 Q i��(� Date Application•Approved.by a /I/. '! �iiC Date r� Application'Disapproved by: r/ Date for the following reasons Permit No. tG' Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTTIIFF�Y,that the On-site Sewage Disposal System Constructed ( ) Repaired (X) Upgraded ( ) Abandoned( )by .1/"J i`&,lye l/ S.0/9 1 at oZ l has been constructed.i accordance • with the provisions of Title 5 and the for Disposal System Construction Permit No � > dated 7 Installer ,1 S Q-4-6 6/7 5 Designer 7 y #bedrooms 3 Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will fu c ion<�ajs Oesi�gned. ,r Date /�d Inspector -- -- -- ------------- --.------- Fee 1�5^dU --- No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE,MASSACHUSETTS Bigpoot *p.5tem Construction Permit Permission is hereby`gran,ed•to Construct ( Repair ( Upgrade ( ) Abandon ( ) 141 System located at �� �✓ l'�/✓�1 1 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructi h must e completed within three years of the date of thi e n ' ,i) Date f� V Approved by ) ES (j Sep 05 2006 1 : 34PM HP LRSERJET FAX p. l FROM s FAX NO.. , rD ep. 01 2006 01:39PM P3 Sep 01 2006 11: 27RM HP LnSERJE.T FAX p. 1 Town of Sarastabie RgulatorY Services 1°ttblic Health DiQieion . .. �'homsa<�cKa�ea,Dlre�vr' 240 Mein Stroey Ryeeak.Nq 0260! t r=: 508.862.4"4 Pox: JO8-700.63ot • ller Des ' o expe Date: Dosi�er. C� V . ta0er: 1reair ' _ Aaare,t: o ryAVShLO c� �2o� • ��s��•� 11�1� o� `3 q a V apumd,to i-mall,R affAhc rryscem an ' —�r„baee�t as a design dawn by s �Pcra�A_. f I wrti r tirai the aePtk'Systeui zofemnood above 1be dents� wbieh aia �nclt a wtis :nfitalw substantially accorclag to dAtribudon bo:�aodlc+i optic r apprweid images enseb $s)atcrai ieloCtttiaa the ._�,. I certlf .dsss 0. = symt�referenced above wag �ed with bazar ohm-see (i.e. >g ffiaa l0' lat+�al:elocSUCO of ter SAS or any vertices!re ceral$� )Piet is$aeoa+d wstb some I locati�a of any ceuttpa�vnt bum by design to h1low. A+e;utadOw. pIM•revisic or ftELLA l' ` r ® NL gM71 P •; s tamp II RZ ammmm ��t>tf6epd , Cad'tWllaa F drm Page 1 of 1 1 � CAPACITY LITERS PER.MINUTE 40 80 120 160 200 240 .280a. 320 360 _ 24 7 ru20 6, Z 16 M. Z W 12mj 4 a/7o Q �- '8 O z �.. q t 0 '0 10 20 .30 44 5D 60' 70 .T80 40; CAPACITY GALLONS PER MINUTE 9 I http://www.femyers.com/images/sse.SRNf4Perf.jpg 8/8/2006 S. STANIDARO SIEVE odIAMBEIR • Is 35 50 TO 140200 1111#�aiMillllis 111 ■■ HillsI lEli■l�ifilinsis M11111!■ 1 11 no lillii■■ I11#1■�■ �I lllinmmilllliINM 111111s■ 1111!■■ WIN ■ 3111■■MM11I1.1 �=11111®■■® rlllim■m .. IIII#i ■�f► 111i■Emil llli■■00�i111!■■--1-11111-■0 _ ., i111#■■■Allllli!!!� I! ii�i�l@111■■■-I11I11■�® it1I1■■i�ll��l�■!� f1 1!■■�IIl11■■■�Illlli■■ . , i11I1i■■�flll'!i■�■�illl!■■■-! II i■■�lil#Iir■ 111II��i-f1111■�i�lrlll■�■ 111 !1■�llfil11li1�■ Illll ■■!■luill ';i■!■■11111l�■ lllll■■■=111111mm 11111 ■ 1111�i�irllli II11 a■�lII � • Mills 1111ni 1111 lI1 ■�1I1 NO 1 � 1i11i�i■ 1 111111 11 1 ■ HIM EM ! I M Iilif �■ 1on r 111 a■MIll1Eio■m 1111 ■■m11111i`!r ■ IIIi ■■■■lI1 �I1 i® illl ■■mi1111i '2mill 1111 ■■ I111 I • 1111 !no 111 '01I1 II ■■ lI II 11111i■i 1111�■mil Ilt�■� it ■ i I11 ti���il 1i ■i�1�1I#��■�1I111 ■ I 1 !1 1 ��11111 ■ice ��11�■■�Ir111•,■■ ,I# HIM M,•„ f 1 i FROM '"i FAX NO. Jul. 24 2006 11:05AM P3 "e� JU!.24.P008 11'-00AM BENNLTT & 04E,11LY N0.034 P.3 ] ENNETT O'RELLLY Inc. M at 1679 Main street 46 4067 FO . P.O.80X 1557 000 Fax BwAlar,MA 0201 Sieve Analycle IDQU and Cornputaatlon Shoot Job Number 4554 Date: jq zl,2006 Job Namct; Bd+s River Paglneteiag,2s Horiy 1.oe4 t2>m»4> Samplo Numbor; Sample Collected 8y: Tam bkUna,2V-37 below ffmd Sample Tooted 8y: D.Jeff Cronin ° Note3: Semple ells v t to a Wdim to C9=Send. WEIGHT R11TAINED PERCENT CUMULATIVE PROJECT SIEVE OPENING BIEVE MANUAL IN MESH IN ORAMB RETAaNBD PERCENT SPQCIPIC,ATION MILUMETER6 (Cumulattvo) ICumuls6vc) FINER (us013) 2,>!e 8 23.50 S.S S.S 94.3 068n3e:end 2.0 +0 4.3 1.0 6 5 93.5 Ca©f60 sand 1.10 18 . 41.2 9.6 16.1 833 Medlum Sand ,6 39 147°0 343 50A 49.6 Madlum Band 20 00 12$3 29.2 79.4 20.4 Finn Sand .19 100 51.8 12.1 - 91.7 81 fUa Bend .076 200 21.S $10 9b.7 33 Fins fend PAN PAN 13.1 3.1 90.8 .2 SinlGlsay PASSED MESH SIEVE TOTAL Semple Weight Wot; awn ey :8umpie Weight Dry: w :Peroont Moloturo: Sample Weight Passed Through Sleveo.42sli FROM FAX NO. T 'INSep. 01 2006 01:35PM Pi f pep b! 2006 11:a7nM HP �RSERJF.T FflX T �'/ P .t..' TamrB Of 42rnStable Regulatory-Services • I I TLdmus F.Geller,Dti ear'. Public Resit►M18161, Thomas WK,ean,Director. ��� 200 wlal>s S�eei,Dya� MA itZ50! . Pax: 508-79.0.6304 . je�ller� Desietaer a � ' Date; cl IV Installer: . Address: .� Ar%T Address: ort 6 u ailery/)'J iuedapmWit to wl ll,Ad/ septic system at R -�,^based on a dasign drawn by Q dead (� I Miry thAt'the septic syste-in referenced above was installed substantioll the de+i80. which tufty incly�m1wr apF'�od obangea scab as]aisle!Te10C do of the d stdbut;on bo;.and/or septic sue-. certify that.the septc ssyyssttoa tefere,�ced above boater than 10' lateral re 0"i,00 of*SAS or wag w ed with rt�jar cbmises (i.e, of the septic system)but in.accordance with 5 Y vertical relocation of arty w atment Clod se-bWt by desigw to follow. 0&Local RWatious. plan rev,o1an or OF AS J. a ��� 9No.,W71 - p x °szS tamp ere U C BL A .1t 1L� Y' r Haalth/Sepd Q*dwfas pow, .r Sep 05 2006 1 : 34PM HP LASERJET FAX p• 2 .................. - ^ TOWN OF BARNSTABLE LOCATION d� 1'1/�i SEWAGE # Va LAGE C L Yn1M.4*a) ASSESSOR'S MAP &LOT 336 3-7 INSTALLER'S NAME&PHONE NO. �>'a R�� + Il1e +�nT' So8 3 g8�I Ja SEPTIC TANK CAPACITY LIry I LEA.cHiNG FACILITY: (type.) f V �.l (size) NO.OF BEDROOMS IBUILDER OR 0.WNE PA � �a S PERMITDATE: O COMPLIANCE DATE: 3 i7oio Separation Distance Between the: I Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet k Private Water Supply Well and beaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(U any wetlands exist A Feet within 300 feet of leaching facility) Furnished by O b Qe .02 I Y � a. TOWN OF B.ARNSTABLE LOCATION SEWAGE # T'7�1 y VILLAGE (���, �M,� �U I Y ASSESSOR'S MAP & LOT � N INSTALLER'S NAME & PHONE SEPTIC TANK CAPACITY ( 000 �4�`mow Lo71 FA LEACHING FACILITY:(type) (sue) NO. OF BEDROOMS PRIVATE WELL O PUBLIC WA BUILDER OR OWNER S b VV DATE PERMIT'ISSUED: -7 DATE .COMPLIANCE ISSUED: E; ^f r sl 7 VARIANCE GRANTED: Yes No rf t 0 3o x a 3 'T�tEN�la- No.ff.7`2—.o THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....U�et ll�c........OF........ Cnv.1n ................................... Apphratuan for Uis�osaf Works Tonstrurtiun rqm t Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage. Disposal System at .............. ._ 4_VI.V....Lr4 i . ..................... . wAa.15N_u1.w- ...•---•-•--....... ........ -•Location-Address or Lot No. .............._>.2_v_ kk4 _lam .4.. ................... -----•--------------=—i-L-7�....................--••••--•-......__.............. Add r—� ( ress a .................1 1�Y.r... ?fit-✓ .........._..... ....... 4? .... .!. Y.S.1.�11r.�.. .............;.. .. Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms.... .................. ............Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures -----•----------•-•-•-••••...............••••- WW Design Flow....... .......................gallons per person per day. Total daily flow.........:. ................gallons. WSeptic Tank-Liquid capacityl=..gallons Length.......... Width....'._...... Diameter................ Depth................ x Disposal Trench—No.............:...... Width. �......_...Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No.........1-........ Diameter.._ ...... Depth below inlet.... ..........Total leaching area-....,............sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by............................................................ Date.... Test Pit No. I................minutes per inch Depth of Test Pit..........I:........ Depth to ground water.....................:-. 1.4 44 Test Pit No. 2................minutes per inch :Depth of Test Pit.................... Depth to ground water........................ - : .....:...:.................. ............. ......_____... _••---.......... .... . ....... ...... .... 0 Description of Soil---.........��'?!� �...-...Slit` ...•7N1!: T� �`�. -�r...��----�:��----•----- -- v ------------------------------------- l.0 ...1�,....... ......................... -- U Nature of Repairs or Alterations—Answer when applicable ._.fit.xxk. ..-`t �'2.1.1_..__..CSS.fl.oc�.� j..... Agreement The undersigned agrees' to install the aforedescribed Individual Sewage Disposal System in accordance:with the provisions of iITI.i 5 of the State Sanitary Code—.The undersigned further agrees of to place the system in operation until a Certificate of Complianc d b the boa a . -a signed.. `. Date Application Approved By-••............................••••-•••••-•••••--••••••-••-•••-•-•-......-:........----........_' ..................... ................... 'Date Application Disapproved for the following reasons:...............i............................................................................................---7 -•----••........................•----...................----.......-•--•-------------------......---..._.......•-••-•---•-•--................---•••............••••--•.._.....................•......._ Date PermitNo.....8..2_ �-.�0•-.................._.... Issued....................................................... " Date ` �a6-•rVl...J�a - _ � �-nM - J�'..+s...�.+.'�,-�..'.._+�.�....+..r_-w - -. _ ':, ���.,..-�;A..1wr...as..�'e"a._..r-+.aw��.Y...^�w_..,s`-, `.-r..`.6.wwr-r�ss_...v"�._�•--...,...,..,.��..r..iw.�. ..-.-r.nw.r- 'r'"-`A" 0-7 No..O.L.122 THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH s e - ; g __rim ........... Appl ration for Disposal Works Tonstrurtinn Errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: l'i_--•( f l�r..... :.. �c: ............._........... E_.� w� e ^` Location-Address or Lot No. ........ .................. .................... ......................................._.............. Own e Address Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms.---.3...................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 0 Other fixtures --------•-----------------------••-•--------•---._...._.... WW Design Flow.......:-:5L.�.......................gallons per person per day. Total daily flow......... . ................gallons. WSeptic Tank=Liquid capacity.1.0 gallons Length....._?._.. Width.... ..... Diameter................ Depth................ x Disposal Trench—No..................... Width.:. .....__......Total Length........_.._. ....Total leaching area...................sq. ft. 3 Seepage Pit No.........I.......... Diameter-._`�t.�- ..... Depth below inlet........L/......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by------•-•---•-------•.......•--•-•••-•--------------•-------------...... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2..............:.minutes per inch Depth of Test Pit................... Depth to ground water........................ x ^-------- --------------------------------------------------------------•............... ._.............-_...-------.---.-------------......... ....... O Description of Soil............ .:Y� �r...... Ka v� v? �M� u: c�_n�e=._ ..................... W UNature of Repairs or Alterations-Answer when applicable......7�,i .' .._-! ....!=�.��.......fn,,- <� ��� �... ...... --..._._. �_4A:s:t:.�....�_.. �_� ._._s YTct_�....`t ,,<- 1�------ °'� ct-xG?....P% ..... .1.4=�•- ��`--P Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of .m I TAU- 5 of the State Sanitary Code— The undersigned further'agrees of to place the system in operation until a Certificate of Compliance habeen issue d by the boar(Kof Beal-'-� Signed................L.. ........, ._ ....... -.- �.. t. Date ApplicationApproved By.................................................................................................. ....................................... Date Application Disapproved for the following reasons:............................... ___ .....................•-------....----......:::......----•---------•---•----------•----...........--•---.......----•-•-•---.........-••---......---•.........--•-•-••.....•----•-•--------•--•--......._ Date Permit No..... ..7- ,a -- Issued................................................ Date '----------------------------------------------------------------- ---` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 Trrtifiratt of Tnmpl aurr THIS IS TO CERTIFY, That the-Individual Sewage Disposal System constructed ( ) or Repaired ( by-.................... ..•._....------. . ... ----------•-------•----..._.....................---...-----------.................._....•..._ + Installer at..............................••. 1..... .... N;_% ' == ' 1^ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... ................ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. C� DATE................... .. ....:.��. ..------------------------- Inspector �Lx `' � ! .............. k __--------._-- .- - ------•----.- --------•- - --- ------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. Fes. .......... Disposal Works Tunstrurtiun rrrmit Permission is hereby granted_.... � ._ �.: :.................�. '" c'.............................................._.... r to Construct ( ) or Repair ( j):an Individual Scw age Disposal System ...................... % Y t.. ^ � _..................................... Street as shown on the application for Disposal Works Construction Permit NOV- �Gy... Dated....................•..................... / 7 •--------•-- ... .................................. DATE_ { /�f� /r� Board of Health .............................................................................. I N LOCUS SEPTIC SYSTEM DESIGN SEPTIC SYSTEM SECTION 2" PEASTONE FLOW ESTIMATE: COVERS WITHIN 12" OF COVER WITHIN 6 OF GRADE 3/4" - 1 1/24 " �( 3 BEDROOMS AT 110 GAL/ DAY = 330 GAL/ DAY 109,37 FINISED GRADE WASHED STONE la1.AN 'ATOP OF FOUNDATION � NE INSPECTION COVERO BE WITHIN 6" OF GRADE) 2" PRESSURE LINE COVER SEPTIC TANK: TEE AT PRESSURE INLET (1' MIN) INSPECTION PORT 330 GAL/DAY x 2 DAYS = 660 GAL ELEV.= 111.3 O O � z USE 1500 GALLON SEPTIC TANK 106.9&107.2 104.71 t�l 105.06 111.17 111.0 EXIST. ELEV. ELEV. o `� y ELEV. ELEV. ELEV. _ 110.3 7d LEACHING AREA: D-BOX �> �>' ELEV. l7 105.31 105.0 6P USE 8 INFILTRATOR CHAMBERS(QUICK 4 STANDARD CHAMBERS)WITH ELEV. 1500 GAL 1000 GALLON DRAIN HOLE (6" OF STONE UNDER" 2'-4' 2'-4' puZ SEPTIC TANK ELEV. PUMP CHAMBER 110.97 F 36' >\�t 5 R 4' OF STONE AROUND SIDES AND 2' AT ENDS (36' x I I' x 8" DEEP) WITH MYERS SRM-4 VALVE ECK ELEV. -_ (6" OF STONE UNDER OR PUMP. PUMP ALARM 8 INFILTRATOR CHAMBERS(QUICK 4 STANDARD CHAMBERS) LOCATION MAP MECHANICALLY COMPACTED) PACKAGE TO BE INSTALLED LOT 18 A (26,370 SF) SIDE AREA: (36' + 11')x 2 x 8/12 = 63 SF (0.74) = 47 GAL/DAY INLET ELEVATION GAS BAFFLE IN DWELLING POWERED WITH 4' OF STONE AROUND SIDES AND 2' AT ENDS BOTTOM AREA: 36' x 11' = 396 SF 0.74) =293 GAL/DAY OF EXISTING SEPTIC TEE SIZES: AT OUTLET TEE BY A CIRCUIT SEPARATE (36' x 1 F x 8" DEEP) ASSESSORS MAP: 336 PARCEL:37 ( TANK = 105.4(+/-) INLET:6" UP, 13" DOWN FROM THE PUMP POWER. PLAN BOOK:328, PAGE:44 OUTLET: 6" UP, 14" DOWN (DISTANCE BETWEEN ON/OFF CAPACITY = 340 GAL/DAY SWITCH TO BE 4") PERCHED GROUND WATER ELEVATION = 105.3 FLOOD ZONE: C (DISTANCE BETWEEN ON SWITCH AND ALARM TO BE 12") TH-1 109.0 SOIL BORING(6-30-Ob) 109.0 N ,� TEST HOLE LOGS O//ANDHO HORIZON ELEV. ELEV. R O ENGINEER: THOMAS McLELLAN, P.E. 12" 10YR 3/2 108 0 168" 95.0 C HORIZON 2nd BENCHMARK �L�Ib WITNESS: DON DESMARIAS B HORIZON SANDY LOAM AT WOODEN STAKE SANDY LOAM ELEVATION = 107.34 DATE: 6-12-06 10YR 5/4 SILT LOAM MIX PERCHED WATER (WITH BLUE CLAY} Y 6/4 PERCOLATION RATE: < 2 MIN/IN 44" 105.3 336-' 81.0 HOLLY LANE 106 107.5 PERCHED WATER AT 44", ELEV.= 105.3 C HORIZON C2 HORIZON ) .,...---- (BARNSTABLE GROUND WATER MAP SANDY LOAM MEDIUM SAND EDGE OF PAVE -.,-�c 107.6 SHOWS GROUND WATER TABLE AT SILT LOAM MIX / - i APPROXIMATLEY 35' DEEP) (WITH BLUE CLAY) + �' 204"1 2.5Y 6/4 1 92.0 384"1 177.0 \ NOTES: 1. VERTICAL DATUM: ASSUMED 106-_. ----� � N83°36'3 ' 2. MUNICAPAL WATER IS AVAILABLE. 207.42' � i '����..__ ~•� 3. SCHEDULE 40-4" PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. i W \ 4. ALL PRECAST UNITS SUBJECT TO TRAFFIC LOADS TO CONFORM WITH AASHTO H-20 LOADING SPECIFICATIONS. i (BLOCK ,PAVED / % PATIO J } 5. PIPE PITCH = 1/4„ PER FOOT (UNLESS NOTED OTHERWISE). DRIVE / GRASS // CEDAR TREE � / 6. FIRST 2' OF PIPE OUT OF D-BOX TO BE SET LEVEL. AREA ,s 1 EDGE OF WOODS +108.6 1 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE USE OF A GARBAGE DISPOSAL. 108 � 8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE STATE OF MASS. ENVIRONMENTAL GARAGE CODE(TITLE FIVE)AND LOCAL HEALTH REGULATIONS. 29 HOLLY LANE f,.�' ...........�.._,..,, EXISTING 4 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. p �-VENT EXISTING to ;� /'i;- ;'•'�� +�� ..�`•a 10. GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO EXCEED 3'. 3 BEDROOM _......;,,.:;r• # DWELLING // i .. ! •! ! 11. ALL UNSUITABLE SOIL(CI HORIZON,APPROX, 28' DEEP)WITHIN 5' OF PROPOSED LEACH AREA IS TO BE top fnd.= 109.37 n / ,.}• . tz / 29.0' �.••3 `•` •~ 108 o REMOVED AND REPLACED WITH CLEAN MEDIUM SAND. INV.= 106.9 INV.= 107.2 ••._,: ..•L'' o 12. EXISTING 1000 GALLON SEPTIC TANK TO BE PUMPED AND FILLED WITH SAND OR REMOVED. EXISTING LEACH TRENCH TO BE REMOVED. SOIL EXISTING LEACH N BORE : ;`' . : \ TRENCH 13. FIELD SURVEY PROVIDED BY MICHAEL LADUE, P.L.S.,BREWSTER, MA. DECK f (SEE NOTE 12) 14. SEPTIC TANK AND PUMP CHAMBER ARE TO BE WATER PROOFED BY MANUFACTURER WITH IPANEX °• �' CONCRETE ADDITIVE OR CONSEAL 55. A 6"EZ WRAP IS ALSO REQUIRED FOR BOTH TANKS. $ o 1EXIS xeT' ;,��• �� \' i ;109 / ! 1 ST PC J �I ; .... 111__..•:•'� GARAGE BED BED RM RM 110 \ 08.3 4 i \ + BREZ LIVING 109 \ WAY ROOM BATH BED 109 BENCHMARK AT EDGE OF WOODS KTCHEN RM BATH MAG NAIL ELEVATION = 109.49 EXISTING FLOOR PLAN 40 MIL POLY LINER 205 73' 125' x 3' DEEP O BOOTTOMOf LLINER = 108 33 SITE PLAN S83°4230"w LOCATION: �,N OF 29 HOLLY LANE, CJMMAQTj% MA s KEY: a THOMAS J. McLELLAN u' PREPARED FOR: EXISTING CONTOUR: - - - CIVIL PROPOSED CONTOUR: .................. 9N1 71 o 4 PETER TANGALOS EXISTING SPOT ELEVATION: 25.5 F PROPOSED SPOT ELEVATION: 25.5 P SCALE: 1" = 20' DATE: 7-11-06 TEST HOLE: UTILITY POLE: -0-- FENCE LINE: - - � BASS RIVER ENGINEERING HYDRANT: RETAINING WALL: THOMAS McL LAN, P.E. P.O.BOX 1163, EAST DENNIS,MA 02641 JOB#M6-23 508-385-3426