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HomeMy WebLinkAbout0029 INDIAN HILL ROAD - Health _ 29 Indian Hill Road, Cumma quid A= 336-056 Barnstable No. 4214 1/3 BLU o ESSELTE 10% O ® C 0 -w l6 Y-- qfi rt,,� (&)YM 4 Commonwealth of Massachusetts 33�0 06 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , 29 Indian Hill Road Property Address Donald Murray Owner Owner's Namey information is Barnstable ✓ Ma 02630 12/29/2018 required for every page. Cityfrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered n any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information SI# 135 �4 a{ filling out forms C ., 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. , 74 Beldan Lane �V Company Address Centerville Ma 02632 Cityrrown State Zip Code v—' 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 12/29/2018 Inspectors 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. 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 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: The dwelling located at 29 Indian Hill Rd Barnstable is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 2 precast 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 o118 usetts. Commonwealth of Massach Title 5 official Inspection Form �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 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): El 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). Th Y q p P 9 Y p pe(s) e 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 Commonwealth of Massachusetts Title 5 official Inspection Fora <la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Indian Hill Road Property Address Donald Murray Owner Owners Name information is required for,every Barnstable Ma 02630 12/29/2018 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 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 ❑ ® 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 , p Title 5 Official Inspection Form '- o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No El ® 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 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 coliforffi 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 ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection -Area—,IWPA) or a-mapped-done 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 '� Fa Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 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 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 3 3 Number of bedrooms(design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ 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: current Date t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface'Sewage Disposal System Form - Not for Voluntary Assessments 29 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 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? N 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): . Approximate age of all components, date installed (if known) and source of information: system repaired 7/18/1997 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. 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 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 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: 1000 gallons Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2° 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. 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 fior Voluntary Assessments 29 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 page. Cityrrown 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): 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for'Voluntary Assessments 29 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 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): 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. t5insp.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 Subsurface Sewage Disposal System Form -Not for"Voluntary Assessments 29 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 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: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.cloc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 a Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -'Not for'Voluntary Assessments 29 Indian Hill Road ' Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 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 2 precast leaching chambers with 4' stone. Leaching facility was opened and was found to have 1' standing water with a stain line only 1" higher. 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 Ib Subsurface Sewage Disposal System Form -Not for'Voluntary Assessments 29 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 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.): t5insp.dpp .rev.•z/25(2Q.1$ Title 5 Qffipial Inspepticnform:Subsurface Sewage Disppsal System•.Pegg 15 pf 10 c� Commonwealth of Massachusetts Title 5 Official Inspection Form '- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 Ci !Town State Zip Code Date of Inspection page. tY P p 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 lk 13 Y o Al 3Y o ❑Z �2 47 A3 N 1 63 �Sr t5insp.doc•rev.7/26/2018 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 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 . 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: 12'+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: pate ❑ 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: Groundwater elevation was established by accessing Town of Barnstable groundwater contour maps. 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 Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -'Not for'Voluntary Assessments 29 Indian Hill Road Property Address Donald Murray Owner Owner's Name information is required for every Barnstable Ma 02630 12/29/2018 page. Cityrrown 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 sectio n. ® 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 18 x $ tV. PtA 3 inch f Val AM k{+t k YL4 -'d�'{' 6 �3�6•rbii z r • - 'tom ea t l-.K..'+,.�L d Jt'1• y '�hT�Wp'44, #rY bl \ W OR W WIN A NOW t J J r tt tt b ts MINT a j �.�;_ _�,. .: � - -. ; - �' ._ _ _ uwr ���- ._ �-. ,: .. _ �� . _� _� - _ _. ��— � '�� c ,- `'-�� �. _,__ � -- � ._ �- f _ - _- \`�� �, _ - �; ''�� r �� I S y � U ��. � �� �: 1. �f, E � ae r � i l It�• s c i � ;4 ..� r..�i�r�'' �to � �� � � �� 1 ® i � �► �� � a� � � 1����� � �� � � F r ,i ,iU: .oti� �rMM Rcrn,e'-!m�tr OV or ILA. � � \ . . � . \ � ( �d m. a w,«1 x, 2le „ \\ .. . !r ram-. k AI TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Health Division Date Issued Conservation Division s Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address 611 1101-1 tll 1�Oef Village ✓`'f�^ �'� O, nw era-, eYL��M1 Address Telephbnev, Peit.R'queue t t�'ri��� ,�rz�✓l �- p I �c Pr�r-� , c�- Square feet: 1 st floor: existing proposed - 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Pro ectUal atioi Construction Type "' " Lot Size • 1. V Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family [ t Two Family ❑ Multi-Family(#'units) Age of Existing Structure �rS• Historic House: ❑Yes MrNo On Old King's Highway: di/Yes ❑ No Basement Type: 1611 ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of.Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count (not including baths): existing new y `FirstFloar Room Count Heat Type and Fuel: as ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 0'No Fireplaces: Existing New Existing wood/coal stove: ❑Yes_i9 No Detached garage: ❑/existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: N existing ❑ new size Shed: ❑ existing ❑ new size = Other: Zoning Board of Appeals - A Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 0 No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 1` I�, �Fa�ne:� � 2,� y �et�pho�'�n Nurnber _ .cM q- 73�j r Ill,Add (ss. I ✓I�i�V� �o�d License# Home Improvement Contractor# . fEr ailN `A r � `� l� &.061 Worker's Compensation #' 'A L COI�STRIJCTION DEBRIS RESU T�IyN�pG FROM TgH�IS, PROJECT WILL BETAKEN TO t . or It 4- Sri TOWN OF BARNST AnLE LCi-A`F'ION (1 t' C << SEWAGE # �17 yr.—,,4'GE C ll rV\ M4i U t ASSESSOR'S MAP& LOT�3,3- e, Tl- A``A I,ER'S NAME&PHONES NO. SEPTIC TANK CAPACITY -e(e/ST ZQ 6 C) �� c LEACE' G FACIUN: (type)_•0`- �1® tC.. C ni-(- (size) tJ f NO.OF BEDROOMS ' 1 C BUILDER OR OWNER V�I PERMITDATE: -J//, / 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 orwtti feeE nf:lelti f. lity) Feet Edge of Wetlandand Leaching Facility(Ifpanetlands exist n ,ten within 300 feet f leaching fa ' ' !\�O �C Feet Furnished by LnA A A-o S�- 3 XAV DGax �� J r No. 3V 47 a�" FeeV/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migaal *p5tem Construction Permit Application for a Permit to Construct( )Repair(D/)AUpgrade( )Abandon( ) El Complete System ❑Individual Components Location Addres r Lot No. Rwner'�NkAddj ss and Tel.No. Assessor's Map/Parcel n F �p CV.MMCjrtv`J Installer's Name,Address,and Tel.No. Designer's Name,Address and 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank C -_ Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) U (_ C 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 Enviro de and not to place the system in operation until a Certifi- cate of Compliance has been issue y this Board o alth. r Signed Date 11 I GI 7 Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued .soNo. f � _ Fee - / THE COMMONWEALTH OFx SSACHUSETTS Entered in computer: ' Yes PUBLIC HEALTH DIVISION -TOWN OF-BAR.NSTABLE., MASSACHUSETTS 01pprtcatton for Mt5pogar 6pgtem Contrurtion Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Addres r Lot No: ' Rwner's Nam ,Add s an Tel.No. Assessor's Map/Parcel rt '3 f C MMG�%j (j Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 8w�� Quo uc�:E 7 t �T S ` - �k c,-, Fs( 3� Type of Building: Dwelling No.of Bedrooms ` Lot Size sq.ft. Garbage Grinder 00 Other Type of Building No'of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plin Date Number of sheets Revision Date'4 Title t. Size of Septic Tank Type of S.A.S. Description of Soil Nature of Re airs or Alterations(Answer when applicable) /So U r„�v� ��2��o G-cx Y � Date last inspected: tw 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 Enviro ode and not to place the system in operation until a Certifi- cate of Compliance has been issue y this Board o lth. 3 Signed Date 7111 Application Approved by 01 Date 9' w Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance / THIS IS TO CE , that-th _On-site Sewage Disposal System Constructed( )Repaired (v)Upgraded( ) Abandoned(�by ; (-,I at D� !-r\dk7 W k 2 V has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 yi dated 7 // -- 9 2. Installer CO r� *�^-�- t✓`r^S S Cot ,esigner C A-c V'P,_ Ack S The issuance of this permit shall not be construed as a guarantee that the system will funct•on as designed. Date (} Inspector �. `c -- 0/ 7 - � -- — No. Z Y -------- ------------------Fee �0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mt5pogal *p.5tem Cori.5tructtou Permit Permission is hereby ranted to Construct( )Re air('n�Upgrade( )Abandon( ) System located at j G `� j 1,t �� ( c� 1�..d 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:Construction must be completed within three years of the date of this permit. Date: -7 — 11 9 7 Approved by ✓ � TOWN ttOffF BARNST LE LOCATION SEWAGE # VILLAQE' ` C � ASSESSOR'S MAP& LOT • b�� MIAL-LER'S NAME&PHONE N0. _' S(u r\ SEPTIC:TANK CAPACITY LEACIi�-;G FACILITY: (type) y�0 OtL LP�+�(siu)�U /U LfI_/1p C NO. S OF-BEDROOMS � BUILDER.OR OWNER y-�1 C PERMITDATE: IlI Ir'I 7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility r Feet Private Water Supply Well and Leaching Facility (If any wells exist on site:or.:aitlis:l .feet of Isactii ,flity) Feet Id Edge of:Wedand.and Leaching Facility(If etlands exist l ,�n within'300 feet f leaching fa ' ' �/y/ �C Feet Furnished :by:: : ;A Ao s�- 34 J- IN L, c 6s (0s First Floor 26' 13'' 13' - nMi Living Area, � e�r�o r. W An v tN N --Closet_ 2 Car Attached 61 18,- ---- h W y{ - 28' N -- _ _ _ - _ Bat o 1 . .�..n aOD r.la two 4vr �x taw�* w:max.w\w 1aai x� *yra.w a�ssx�1 ro � UTO-% I 'Bath \i?'c?�. „�.�.+u�i.• T`4f'Y\'�,ti4+VE�:1 1 1 � 4J�M"1'\'4:5.\ ..- -' r� _.,.,...- - ..■/�. /��+p Den i t ._.V Wet �" t Dining, .��,y 1 «�w.���� „�. :�, Area d in +aro'w�u'w�.ti.Q„r w:-�w�*' w��.tiSww� ,...,, w�titiSw�: tw'w}`�wti 3,�•S\tiryT.'w4•*.� .,w.....a•. stith�4 . . _ .._. _..._...... � Bedroom, U\wS84 wl. rti ♦ aS'9+,`S`c+k'51: `A5T.a`..,"k '�..+1+:' 1- �� CIs 9e�ia.`fv'K.S eS'�,s'Sw..�yq,7'y`s 1\ti+'+.�.ti1'a�a�s.�+a,•1w\ti�s.�" ~ unary Kitchen 0' in c•�..'�x�c r`yex^wti<'wywwwr.Swti��w.yZl�i`t.www�w?.�w'�+:.��cw _ ��wcsw ti w�aw: w az wwtiw�cx vw�ti�aw.a�taw+. 8 a W 15 12.5 13.5 '�'Si w�i�>*w!�`•\+ `KwS`'1`�lT?:4 1�1.�Sti:].111`l1ll`s` •1�.4\A' _ 23' 8' 41' � I I I I I I i till IP I 1 L_. I I I ! I I _� r'• I . i ' `�l i I _'I I i I I ! I I j !, I+II _ I I ! i - I �.. L i_ ; I f , 777 TJ , .. 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I i � I I� i i I I I i I I I � I I I ��1'� V►�s I i I � � � I � I I v'I"�... � I I I"71�� �. ASSESSOR'S MAP NO. PARCEL (I (-- ATION SEWAGE PERMIT NO. `' 86-722 a,? Tr.dj an Fj i i l Znpd _ Minim. VIL!L AG.� _ 33�- USA Barnstab C mmol. V 1 I N S T A LLER'S NAME 6 A DRESS CASH'S TRUCKINCT IDI.C . Box 7, YarmouthFort, Ma. 02675 0 U I L D E R OR OWNER Robert H. Belting p Box 171 „'Cum-maquid, Ma. 02637 DATE PERMIT ISSUED 7/22/ 6 ,7 DAT E C0MPLI•AN.CE ISSUED g 14 86 1 B 1 1 No......... • 'Z Town Building Fizz...... THEM. cr?S v - . BOARD F HEALTH _................OF.... ........ Appliration for Bispo ial Works. Tonstrnrtion -remit Application is hereby made for a Permit to Construct ( ) or Repair (p,<�n Individual Sewage Disposal Sy at: ti 6R-xyc7r)_ .... ... .. . ... ...__...�._. ------- -------------------•--•-•-----.....---------------•-----...........----...................-------• ion-A ress or Lot No. .. _._.. .. .. •--------•-------------•-...- ------•-•------. -..--......7- --------.----- .......... W Ad s. Al •-.•-dres ............................... ................................. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms---------------------------- -_-.Ex anion Attic p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................. Showers ( ) — Cafeteria ( ) dOther fixtures = --------------------------------•------.....--•---•---------.....-----•.._........-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank,—Liquid capacity............gallons Length................ Width................ Diameter--------........ Depth................ x Disposal Trench—No. .................... Width...................._ Total Length....................Total leaching area....'...............sq. ft. 3 Seepage Pit No...................... Diameter..........:... Depth below inlet..................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------:.................................... Date......................................... ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..--.................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........--.---......... a --------------------------------------------- *......... •.......... •--------•-•-••---•--------------.....--------------- --.--------------_---.------------ 0 Description of Soil....................................•-••---.....------..........------....-----•------------------------------------•---=----............-------•-•..........--•-•••---- V -------------------------••--•------•-•--------------------------.....--- ------------- ----------------------•- .-•---------.----- - ----.-------••----------- xW -- ------------------ ••--•---•-•- . _� ,.or z -- U Natu�e_of airs o Alt rat' ns r when a $(� — PPS Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT:..Y: 5 of the State Sanitary Code.—The undersigned further agrees not to place the system in . operation until a Certificate of Compliance has bee iss ed by the boarrftSi ed... -- ---- ------ --- ---------- --------- �----Z-�= •- - - Application Approved By---.......--------••••--• .:-••---•-••- -•-------••• --•------ ---- Z_.... Date Application Disapproved for the followi reasons:.----•---------------------------------------•-• ............................................................ ..........................••............---,-•--•-••-------••----•••...-------••••-----•••-----•-----..................-•-----------••---••-----•-....-----------•---------•--•------•--------•-.......... Date PermitNo......................................................... Issued...........................................:.........._ Date No....... ... F$s..... a......_ THE COMMONWEALTH,,OF MASSACHUSETTS BOARD�OF`�I-IEALTH .........:.OF. 4 . rlirtttilan for Disposal arks Tonutrn.etiun ramit. Application is hereby made for a Permit to Construct' ( ) or Repair (y ) an Individual Sewage Disposal System at �j �o¢"uori-A/ ...ddress or I. ................F .i � � - --izY 1 t .. ... Ownei W �. .k 1. it 1� / l.F � �rl 1f1� •� _ Ji. Address............................................. ,.� --•---•----=---•- ; ......... .............. ................... • -•---•---•-•-----•----------••-----•----.....--••----.........---........ Installer Address Type of Building i,It l ;? f r Size Lot................................Sq. feet aDwelling—No. of Bedrooms............................................Expan`sioj Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building --•-._-------•-•_-_-----•-• No. of persons............................ Showers ( ) — Cafeteria ( ) p" Other fixtures --------------------------------- , Q Design Flow.............................................., t allons er--- -----•-----------------•-------•---------------------...---------•--------•-•-•----..__............---• Wg P person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity, ........ gallons�^�Length____--•----•--- Width. ..... Diameter................ Deoth................ Z x Disposal Trench—No ...... Width .._._ Total Length Total leaching area..................sq. ft. 3 Seepage.Pit No................... Diameter........ ........ Depth below inlet..............,_,' .,G'Total,leaching area..................sq. ft. Z -'Other Distribution box ( )�' a Dosing tank,( Percolation Test Results Performed by............... ...........................................: 3Date_....___._ 'N... j . Test Pit No. 1..:...::.......minutes per`inch Depth of Test Pit I. .:y?..`._._ Depth to ground water........................ f�. Test Pit No. 2................niinufes'lper inch Depth ofiTest`\Pit..f................. Depth to ground water........................ DDescription of Soil..................... _ ;=:.:................................. 1 •-- -- A --' U ..................................................... _...--............................._........_.........ti ............................. .................................................... ....................................... _.: .. m s .� r ........................... U Nature of Repa/irsjor Al}tera�tiJyons—P!�{A�n�s/[wge+r when apph�`��' � (•• � /l. I._......•.• ..._... fi•..----....,............. The undersignedq agrees to install t3 e� foredescribed Individual Sewage D s osal S. stem in accordance with � ri T i<�� .tr`C, i;' ...' 5... a.' .tg_ P �, the proti�isip is�of �I. u�f, h, State Sanita_y�Code— The7u: ersigned further agrees not to.place the system in operation until a Certificate of Curnpl>an e'�as-been ssued�by dme boa d of he31t1% / y �,... �...t,,,,�'f` ..-,�•. ram~-•`_• �::,cL. si Pa_ _. �- ` 4 c - ,! w y.:.� .... Applicatio{}�nApprYyove}d T. '_.`, L Date ����/t Application D"isapproved`fo the oflow asons `Z _ cs � +�- t . . _..........................................................."r •-.-':=---- ------• of eP`,T r. ...... e /� •ems. � :yy Y. C, Date - } - Permit No....=A..........f Issued. �_ f�a . Date ....... t ✓71✓» Gam:— THE COMM WEALTH OF MASSACHUSETTS r . } BOARD'',OF HEALTH - t `� Fd !."�!.' -'/ .v... ��:........................... } &rtifffttu n'f � nttrlti nr- 4:1-111-11C4, THIS,19",T�OCERTIFY,,pThat the Jend vidual Sew zgk-Disposal System constructed ( )' or Repaired ( I-)- may.....................( ...!� rl�`� ti7� p ... _� � ,, x c 3-- at..........:.?�,.,7+ tPdj.. [ i:!:Jis �l� � ........... ----- -. ... -been installed in accorMinee with the provisions of TITL j of The State Sanitary Codelas described in the applicati lf-01r- oVorks Constuion P yI . !?... dated........ !. : �_%.....t ' THE ISSUANCE Off-THIS- CERTIFICATE SH;ALL NOT,BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILLr FUNCTION SATISFACTARY: }........ _ _ -DATE.... -- ;.�. �`�... r ' ......---•-------------`...�` Inspector--•---(-�_ .........------------•--------- THE COMMONWEALTH OF MASSACHUSETTS " - BOARD OF HEALTH :...' ... �. ....... .O F..........., '......... ......................... No...... �a 4-0................ �iu�uuttl� ur�,� �u utrtiun �rrmit Permission is hereby granted_.__....t ....... �?/. _.. .. ................. a. ............. ....... to Construct ( ) or Repair ( i,.)"an Individual Sew ge Disposal Syste at No................ _ /� iA An t " I d t - G ------------------------------------------------------- Street as shown on the application for Disposal Works Construction Permit No------- Dated.__ ....... ........•-•--•..._ DATE--------•--- i i ----------------- •------- 1 t. N (( a sa-o° '^ (+/-)EXISTING o 4'-8" 5'-4" 4'-d' PROPOSED EGRESS WDW w � N' ~ '-G" NW FURNACE PROPOSED I PROPOSED b STORAGE STORAGE PROP. UNFIN15HED w o BATH UTILITY a + O z lD w (V EXISTING GIRT N W J Q V. ,�_d�� 8„ U 3'-0" 5'-0` t0ii (+/-) 5'-0" 7_0" 7-4-- N 3'_0- ? PROP05ED STORAGE cal v oN N � N O PROPOSED Z Z FAMILY ROOM b o N a b o w W o U N K _ 4UNFINOHED PROPOSEDLu BASEMENT PLAN PROPOSED STORAGE BASEMENT � I-u a I — Q m C, uP U_.I FF 1 EA5TING u-. GARAGE SLAB DRAWING NO. Al - 1 . .fir,? ,.. ;;, ,,,_ •; ,;,. ;S^. -y-.. cr 3sa 9. 3 1 GENERAL NOTES : ACCESS COVERS MUST BE WITHIN INVERT EL Et%A T I ONS : DESIGN CRITERIA : 6' OF FINISH GRADE �9' MINIMUM. INVERT AT BUILDING: _ 97, 53 DESIGN FLOW: I. THIS PLAN 15 FOR THE DESIGN AND CONSTRUCTION BM-TOF 3 MAXIMUM COVER INVERT IN SEPTIC TANK: -96. 0 ___BEDROOMS AT�J�G. P. D. PER OF THE SEWAGE DISPOSAL SYSTEM ONLY, EL-99�5-3-, FIRST 2• TO k: BE LEVELS /-MIN 2' of PEASTONE INVERT OUT SEPTIC TANK: 95. 75 BEDROOM EQUALS 330 G. P. D. 2. ALL CONSTRUCTION METHODS AND MATERIALS AND j -------- - r/ /N VER T IN D l S T. BOX: 95. 0 MAINTENANCE OF THE SEPTIC SYSTEM SHALL - I - 11 ]Vlp 3/4' - 1 1/2' GIA. INVERT OUT DIST. BOX: 94, 83� NO GARBAGE GRINDER CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL • T2 WASHED STONE -BOARD OF HEALTH R£GULAT!ONS. .53 1: 4.83 _ 87.0 1 95 ' _ INVERT /N EACH CHAMBER : 89. 0 SEPTIC TANK REQUIRED: } L---____ ,3 OUTLET 2-500 GAL LEACHING CHAMBERS BOTTOM OF LEACH CHAMBER : 87. 0 3. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER ! D-BOX W/4' STONE AROUND. I2.8 'X 25'X 2• -�- -J�--G. P. D. X 200% - _.-_660 -GAL . f _ AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER i 1000 GAL ADJUSTED GROUND WA TER: N7A SEPTIC TANK PROVIDED: 1000 GAL . (EXIST) THAN 3 ' IN DEPTH SHALL BE CAPABLE OF WITH- SEPTIC TANK L 6' CRUSHED STONE BASE OBSERVED GROUND WATER: _ N/A STANDING H-20 WHEEL LOADS. (EXISTING) BOTTOM OF TEST BORING #1 :75.5__- SOIL ABSORPTION SYSTEM REQUIRED: 4, ALL SEWER PIPE SHALL BE SCHEDULE 40 OR PRO, ILL- : NUT TO SCALE DESIGN PERC RATE - 5 MIN/INCH APPROVED EQUAL. 1 V SOIL TEXTURAL CLASS 5. BEFORE CONSTRUCTION CALL "D/G-SAFE'. _ EFFLUENT LOADING RATE - 0 Z4 GPD/SF J_0_GPD O_7AGPD/SF 446 S. F. 1-800-322-4844 AND THE LOCAL WATER DEPT. /_ - FOR LOCATION OF UNDERGROUND UTILITIES. 0 ,4 D PROVIDED: 2 S00 GA- L EACH_(�(G CHAMBERS 6. VERTICAL DATUM /S ASSUMED. FOR BENCH MARKS SET. R W/4_STONE ARID-,_ A-47l S. F. SEE $I TE PLAN. H I L L _ - il 7. ALL UNSUITABLE MATERIAL AND REMAINS OF OLD SAS -% I ND I AAT �0- ENCOUNTERED BELOW THE INVERT OF THE LEACHING SOILTES T P I T DAi TA FACT L I TY TO BE REMOVED FOR A DISTANCE OF 5 AROUND DOWN TO THE CLEAN SAND LAYER (APPROX /6•) / I ND I CA TES I ND I CA TES I 77.25 I / PERCOLATION OBSERVED AND REPLACED W/TH SANG IN ACCORDANCE W/TH T/TLE 5. �® / / TEST = GROUNDWATER / {F 8. EXISTING SEPTIC TANK IS TO BE INSPECTED FOR -� y i / j TP* I TP• 2 _ CONDITION OF TEES AND OR BAFFLES AND REPA l RED IF REQUIRED. GRND EL.92.9 GRND EL, 94.5 r ®1�' +� I 1/ G. W.EL. N/A _ G. W.EL. __N/A .9. INSTALLER SHALL NOTIFY THE DESIGN ENG/NEER SHOULD WATER METER PIT, ' SITE CONO I T/ONS VARY FROM WHAT IS SHOWN ON THIS PLAN, , ; TO*s �I HORIZON TEXTURE COLOR OTHER HOR/ZON TEXTURE COLOR OTHER / SANDY IOYR � i 1 I l 1 1 r ! L L A LOAM 3/2 , r J G l L TEST BORINGS I I _ -'' !°j� j I ,l 24- ............................................................ 90.9 8' ...193.8 I ; , SANDY /OYR G SANDY IOYR 2 'I / 4 ! qti Al L OAM :2 D L OAM .4 ?, _., a'g 4 4•_�.............. ..... ..... ... ...................... y�. 5 SANCY ,)Y GRND EL.. 96.5 GRND E-L. 98.5 I I L � T S 6 C�C 8� I i / R C COMPAC � G W.EL. N/A ;. W,EL . N/A - I I T lOYk I 20023 f S. F. a.laa I a LOAM 4/6 11 SILT LOAM 6/8 p _ 96.5 0 ' --i 98.5 1 I 42 - ........................................... .............. 89.4 TRACE SAND SANDY COMPACT IOYR FILL SILT LOAM 6/8 TRACE SAND PACT4 -1 92.5 IIIf Com t, "•. COMPACT S I L T I I - I :• I I --i f S I L T LOAM I p l ► ro j I - -i j LOAM I I ` I I I NO WATER NO WATER m, ------ ------- -- -- -- 83.9 /08' _ Zo 16'- - -; I I a m I EXWING TWO BEDROOM i I I _ ._-__-.._ 80.5 I .,� Z I DWELLING I I a ATE: CLEAN � MEDIUM - I I ► TES T B Y: S TEPHEN HAAS I � •tl I a - - MEDIUM COARSE J f I I I •.WI I I SAND SAND TO I , I I I I • a I I 2 I NO _WA TER 75.5 16 - i--NO WATER 82.5 , • LA,. I i ,pp . I ( EXISTING f .......................... r � •.,... 1 I 1 DATE: JUNE 23. 1997 LEACH PIT fXISrINc� N : ► '► T C S 1' .S ti, G ' �= J G IVI w '--`- aEorTlr / , r ^ TEST BY. STEPHEN HAAS I •---- ---- �. -- ' ROSE of SHARO� I 2.0 / 10 // !I 2.9 / A'D / A N" f/ / L R 0.4 O 1,4 P 30 6 . PA R CEL S 6 I2•LARCH i - SOIA REMOVAL BARNS TABLE I I m . w' I qK SEE NOTE,6. HARBOR D-BOX - 6 A R /V S TA & L, E ( C uMMA o U / o ) MA I'SPRU I I l?'WPL / // t F R L P A R D FOR . 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