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HomeMy WebLinkAbout2595 MAIN ST./RTE 6A(BARN.) - Health 2595 Main Street/Rt. 6A A = 258-048 Barnstable- 4 I, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name information is �0 required for �a,�hs �l e 0�630 every page. City/Town State Zip Code Date of nsp chon Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist atithe end of the form. Important: A. General Information When filling out I n � forms on the �J computer,use 1. Inspector: only the tab key to move your fl eo h-Pi 111 cursor-do not Name of Inspector use the return ���i0 _ / L C y key. -- d�� Company Name �I Y Company Address reen City/Town State Zip Code r� Telephone 4umber License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training andi experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP aOproved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes M Conditionally Passes ❑ Fails r CS ❑ Needs Further Evaluation by the Local Approving Authority cz� /o sI "'inspector's ignature Date U- C t c' C t The syst m inspector shall submit a copy of this inspection report to the Approving Authority(Board Hof Health or DEP)within 30 days of completing this inspection. If the system is a shared system or O F ' "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 should be sent tot the system owner and copies sent to the buyer, if applicable, and the approving authority. "This report only describes conditidnvat the time of inspection and under the conditions of use at that time. This inspection does Pot,address how the system will perform in the future under the same or different conditions of use. t5ins-09/08 Titie 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments as 9S i�� � s f Property Address owner Owner's Name / 3 �Q �� information is ✓hs �le / /� 0--u3o required for State Zip Code Date o Ins ection every page. Cityfrown B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) stem Sy sses: 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: 8) 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): , t5irts•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address / �O1 R V7 Owner Owner's Name �t information is 341nction required for State Zip Code Date every page. Cityfrown B. Certification (icont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection!if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ 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 ithan 4 times:a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken'pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required!by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will)pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is!not functioning in a manner which will protect public health, safety and thelenvironment: ❑ 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 i5ins-OW08 Tine 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address �AS AV/a ✓1 Owner Owners Name I information is a rhSTF 6�� Qa required for State Zip Code Date f In pection every page. City/Town B. Certification (cont.) 2. System will 'fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public.water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well ❑ The system has!al.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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. D) System Failure criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ❑ �/ Backup of sewage into facility or system component due to overloaded or LJ clogged SAS or cesspool ❑ C / Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 5" below invert or available volume is less than '/2 day flow isms-osto8 Title 5 Official inspection Form:Subsurface Sewage Disposal System Page d of 17 I I Commonwealth of Massachusetts Title 5 Offiicial Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address I --- owner Owner's Name ga;�, information is �s, e aQ 60 �� ��required for State Zip Code Date f In ection every page. Cityfrown B. Certification (cont.) Yes No ❑ ,-�/ Required pumping more than 4 times in the last year NOT due to clogged or u obstructed pipe(s). Number of times pumped: ❑ [� Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Q/ "; Any portion of cesspool or privy is within 100 feet of a surface water supply or 'tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ [a-' :Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ L� Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This System passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000gpd- ❑ 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E). Large Systems: To be considered:a large systernz the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water 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 If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09M Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i i . Commonwealth of)Massachusetts ILM260MTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments S a /'" 16' i v� SJl" Property Address G n/ a ✓1 Owner Owners Name 0�L 30 /0information is s - e / 'required for State Zip Code jD �of I specUon every page. City[Town C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No L� ❑ 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 ❑ /U-1 this inspection? ,—,/ ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) Qom❑ Was the facility or dwelling inspected for signs of sewage back up? [� ❑ 'Was the site inspected for signs of break out? ❑ I Were all system components, excluding the SAS, located on site? L� ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? �❑ :Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ 'Existing information. For example, a plan at the Board of Health. �❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance,is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins•0M8 Tille 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 6 of 17 r Commonwealth of(Massachusetts Title 5 Offi!cial Inspection, Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments J Property Address g s 4 0'/ G V 1 Owner Owner's Name 11 � l s information is G✓h ST°+�` j� o)610 Fequired for State Zip Code Date Ins cdon every page. Gty,Town D. System Information Description: //0� lot �ox a J�oo �� s� asxia �� d Number of current residents: Does residence have*:a garbage grinder? ❑ Yes No { Is laundry on a separate sewage system? (if yes separate inspection required] ❑ Yes No Laundry system inspected? ❑ Yes No Seasonal use? ❑ Yes Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ° Last date of occupancy: Date Commercial/Industrial Flow Conditions: f Type of Establishment: Design flow (based'on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow ('seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste idischarged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t t5ins•o9m Title 5 Official In speetloh Farts:Subsurface Sewage Disposal System•Page 7 of 17 r Commonwealth of Massachusetts Official Insipection Form Title 5 O Subsurface Sewage Disposal System Form Not for Voluntary Assessments as9s � s - Property Address // 3T at Owner Owner's Name 1 /�A D�6 •7O ? �q �� information is G 1-45 required for State Zip Code Da of I pection every page. City/Town D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information a oo'� Pumping Records: lile�v, S 0-7 �w Source of information: Was system pumped as part of the inspection? ❑ Yes a No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool Priory ❑ 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): System. 8 of 17 t5ins•09108 Title 5 Official Inspection form:Subsurface Sewage Disposal i 1 f t t i Commonwealth of!Massachusetts F Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments _ C�s Property Address I Owner Owner's Name f J �/� 0,16.30 3 /D /information is �e !required for i every page. Cltyrrown State Zip Code Date I spection D. System Information (cunt.) Approximate age of all components, date installed (if known) and source of information: a 00 2 Were sewage odors detected when arriving at the site? ❑ Yes Er No Building Sewer (loccate on site plan): J Depth below grade: feet Material onstruction: 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.): Septic Tank(locate on site plan): l/ Depth below grade: feet Material nstruetion: 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 � 0 Dimensions: Sludge depth: P (sins•09M 7iue 5 Official In. specGon Form:Subsurface Sewage Disposal System•Page 9 0l 17 j i Commonwealth of Massachusetts 'Q T'itle 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address Owner owner's Name information is �e Q�63 o 3 /o rewired for Cityrrown State Zip Code D of nspection every page. D. System Information (cont.) / Septic Tank (cont.): Distance from top of sludge to bottom of outlet tee or baffle 7 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 )-o Ze CJ How were dimension', determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, ' liquid levels as related to outlet invert, evidence of leakage, etc.): 1 cirri"► �✓1 �0 T V% C/ (O-ICJI�)041 I Grease Trap (locate on site plan): i Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): i { Dimensions: aScum thickness f Distance from top o 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 157n3•04108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 I f I r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments C�s T Property Address I Owner Owners Name information is ,�/� required for State Zip Code Dat of I pection every page. City/Town D. System Information (cunt.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i i Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): i Depth below grade: Material of construction: ❑ concrete ❑ metal El fiberglass ❑ polyethylene ❑other(explain): Dimensions: I j Capacity: gallons Design Flow: gallons per day i a Alarm present: El Yes ❑ No i Alarm level: Alarm in working order: ❑ Yes ❑ No j Date of last pumping: Date i Comments (condition of alarm and float switches, etc.): t 1 t { 1 t I Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No I 15ins•09M Title 5 Official Inspection Form:Subsurface Sewage Disposal system'Page ttort� x I , f Commonwealth of Massachusetts Title 5 Official Inispection Firm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1�2S Property Address O 1 r^ N Owner Owner's Name / //// information is �ylc�Glh,s� o required for Date In ection every page. Cityrrown I State Zip Code D. System Information (cunt.) Distribution Box (if�present must be opened) (locate on site plan): Depth of liquid level;above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage!into or out of box, etc.): mp Ze, i Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5iru•o9108 Tine 5 official Inspection Form:subsurface Sewage Disposal system•Page 12 of 17 r Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments C215, 6 t 4 Property Address J Owner Owners Name / 6 -70 3 /o information is Gig s�1G lQ / required for state Zip Code Date Ins ection every page. City/Town i D. System Inforrhation (cont.) Type: f� ❑ leachling pits number: ❑ leaching chambers number: ❑ leaching galleries. number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: r ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.): 74 / 0 S� ins oZ -411'e" i Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): f Number and configuration i 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 13 of 17 t5ins-moe Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner owner's Name information is required for State Zip Code Date of I pection every page, CitylTown D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I i I I Privy (locate on site!plan): Materials of construction: j Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ' I l 1 i i l 9 i I t5ins-09M Zille 5 Official Mspection form:Subsurface Seviage Disposal System-Page 14 of 17 i . f 1 Commonwealth of Massachu6etts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name I I information is N i* �/Q 0d oo '7 /L / required for a every page. Citylrown j State Zip Code Datelof I.•pection D. System Information (cont.) I 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 lic water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately i 1 6z0 7 a 1 H,n R� sew � i �i- '2a` r 63 15ins-OW08 TiUe 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page t 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address U" ;a Sl?91 et �f Owner Owners Name information is �y1 fL N610 � /o required for �`' every page. Cityfrown I State Zip Code Date o Ins ection D. System Information (cunt.) I Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtainedl 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) L� Checkediwith local Board of Health - explain: A/C � � I ❑ Checkedi with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: i F I j i i You must describe how you established the high ground water elevation: I i G Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•09/08 Title 5 official Inspection Form:Subsurface Sewrage Disposal System-Page 16 of 17 I i r N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I Property Address © T w Owner Owner's Name 1�lforrnabonis 6 a/NS7—vf� rquired for State Zip Code Date o nsp on every page. City/Town E. Report Completeness Checklist { Inspection Summary: A, B, C,D, or E checked i Q/Inspection Summary D (System Failure Criteria Applicable to All Systems)completed [�S stem Information— Estimated depth to high groundwater System either drawn on page 15 or attached in separate file Sketch of Sewa�je Disposal Sys p 9 i i i i I I I i . } I i i j I i t i I i i i l5 ns'09/08 Title 5 Official Inspection Form:Subsurface Sewage Dispo"System•Page 17 of 17 t i I E 4 Town of Barnstable Regulatory Services Thomas F.Geiler,Director Public Health Division . Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 2_-Z3-1© Sewage Permit# Zoo9-`19 7 Assessor's Map/Parcel 25$ y i Installer&Designer Certification Form Designer: BAS S R-JYM EN&J/Vk t,1 G Installer: to YVA 3161V✓ Address: 13 X )1 6 3 i Address: sox q 2 Z On I-t6—o� Mt�1. `� aKa:h was issued a permit to install a (date) (installer) septic system at 1515 pllbllm 6 A based on a design drawn by ;(address) HASH 21V8►L FA)61t\RF01V�j dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but!in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) was inspected and the•soils were found satisfactory. 1 (Installer's Signature) i *(Deftsiignn�es i ature) A i 6 n mp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. ON. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU. q:\ofTice fonns\designercertification fortn.doc j i j I I iI I KEY: EXISTING CONTOUR:---- SEPTIC SYSTEM DESIGN SEPTIC SYSTEM SECTION PROPOSED CONTOUR:••••••••••••• n EXISTING SPOT ELEVATION:26.5 FLOW ESTIMATE: 2"PEASTONE PROPOSED SPOT ELEVATION:© ---BEDROOMS AT 110 GAL/DAY a 330 GAL/DAY 115 3 COVERS WITHIN 8" 3/4"-1 1/2" TEST HOLE: 0P UTILITY POLE:-p- TOP OF OF FINISHED GRAD WASHED S' FENCE LINE: - SEPTIC TANK: FOUNDATION _ INSPEC HYDRANT:�- 330 GAL/DAY-LZ DAYS=A91 GAL - _ •' RETAINING WALL:® USE 1500 GALLON SEPTIC TANK 11 3 MAX. ' COVER V.O (1'MIN) `- LOCUS LEACHING AREA: I (ELEV.SF PIPE 1500 105.75 fN CESS POOL) n S P GAL ELEV. USE 2-500 GALLON CHAMBERS(8.5'x 4.8'x 2'EFF.DEPTH WITH 10 E TIC TANK _ ION MAP -1-- ELEV. ELEV. 1(21,693 SF) 4'OF STONE ALL AROUND (25'x 12.8'x 2'DEEP) ELEV. K AP:258 PARCEL:48 16, PAGE:111 SIDE AREA: (2S'+12.8')x 2.2=151 SF (0.74)=112 GAVDAY 18"OF STONE UNDER OR 25'x 12.8'- -s. ECHANICALLV COMPACTED) 104 0 2.500 GALLON CHAMBERS BOTTOM AREA: 25'x 12.8'=320 SF (0.74)=Zn GAUDAY TEE SIZES: ELEV 4'OF STONE ALL AROU! INLET:6"UP,13"DOWN (25'x 12.8'x 2'DEEP) ELE CAPACITY=349 OAL/DAY OUTLET:6"UP,14"DOWN GAS BAFFLE (H-20) AT OUTLET TEE - - THA 1 7. TH TEST HOLE LOGS FILL FILL LIVING ROOM BATH DIN BTH ENGINEER: THOMAS McLELLAN,P.E. A HORIZON A HORIZO RM - .LOAMY SAND LOAMY S/ WITNESS:TIM O'CONNELL,R.S. 54' 10YR 413 ,5 42" 10YR 4/3 KITCHEN ROOM 8 HORIZON B HORIZO DATE:8.28-08 LOAMY SAND LOAMY SF 2nd FLOOR CL PERCOLATION RATE:<2 MIN/IN 66" 10YR 6/8 - 101.5. 54" 10YR 8/8 01 HORIZON Cl HORIZ,' FINE SAND - FINE SANI OO,n� 84" 2.5Y 7/2 .0 84" 2.5Y 7/2 DECK 3. C2 HORIZON C2 HORIZ( ✓ SANDY LOAM SANDY LC ROUTE 6A / " 2.5Y 612 0 1 " 2.5Y6/2 C3 HORIZON C3 HORIZ( PPROX.LOCATION OF FINE SAND FINE SAN[ XISTING WATER SERVICE GARAGE 1 0" 2.5Y 7/2 0 188" 2.6Y 7/2 1 Edge oPpevement 102\ BED BED .. - - ' ROOM BATH RM NOGROUNDWATER ENCOUNTERED \ Na7800"E IF _102. 161 FLOOR NOTES: _.. _ .. .... EXISTING FLOOR PLAN 1.VERTICAL DATUM:ASSUMED 2.MUNICAPAL WATER IS AVAILABLE. g1,30^E 112�\\ \\H'2 \\ - 3.SCHEDULE 40-d"PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. N 13• 108 OT \ \ _\ \ 4.ALL PRECAST UNITS SUBJECT TO TRAFFIC LOADS TO CONFORM WITH AASHT0 H-20 SPECII 114�\\ `m n\ \ TH-1 \\ 5.PIPE PITCH=114"PER FOOT(UNLESS NOTED OTHERWISE). \ \ 118\ \\�; �108� 104 6.FIRST T OF PIPE OUT OF D-BOX TO BE SET LEVEL. 118\ 109 \ \ 7.THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE USE OF A GARBAGE \ \1 \ \ PROPOSED POLY LINER \ \\ \ \ \ 45'x 2'DEEP 8.ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE STATE OF MASS.EN\ b 120�\ \\1 S7 - / \ \ TOP OF LINER-105.0 BOTTOM ELEVATION 103.0 CODE(TITLE FIVE)AND LOCAL HEALTH REGULATIONS. 122, \ - 9.CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. 10.GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO EXCEED 3'. 5'SOIL REMOVAL 11.FIELD SURVEY PROVIDED BY TERRY A.WARNER,P.L.S.,HARWICH.MA, (SEE NOTE 15) 12.THIS PLAN REQUIRES THE REVIEW AND APPROVAL OF ONE OR MORE TOWN DEPARTMENT $ - CONC.RET.WALL ��O�y 1 I IS SUBJECT TO CHANGE UNTIL SUCH TIME. BENCHMARK AT 13.EXISTING CESS POOL AND LEACH PIT ARE TO BE PUMPED AND FILLED WITH SAND OR REM ro yC y 114 DRIVE 1 MAG NAIL I I ' \ ELEVATION=110.12 14.D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. \ 108 15,ALL UNSUITABLE SOIL(S WI RANDY LOAM APPROX.120"DEEP) THIN 5'OF PROPOSED LEACH, IS TO BE REMOVED AND REPLACED WITH CLEAN MEDIUM SAND, 16.PIPE INTO CESS POOL WAS NOT VISABLE AT TIME OF INSPECTION. CONTRACTOR TO VERII c-y"�"-• /'�7'\7�?'i \I 1, 1 11 I OF PIPE AT HOUSE AT TIME OF CONSTRUCTION. SITE PLAN \\ \I 1 11D I-OCATION: �pP��NOFe+gr9c 2595 ROUTE 6A, BARNSTABI $, STONE RET.WALL��, 124�- She 1112 m 2nd BENCHMARK AT THOMAS J. bG 120�i 11i/ o MAO NAIL McLLLLAN PREPARED FOR: A'112 122�� ELEVATION-,116.57 o CIVIL aq• a 9No.36471 a RICHARD&ERNESTINE PAS] NEW 1 0p, ST P,4Y p'r R-7x11 I a TOWN OF BARNSTABLE FLOCATION Z 59 5 (; SEWAGE# U)Qe� 49'7 VILLAGE Rww^Joa %_ ASSESSOR'S MAP&PARCEL 258 Z 9a INSTALLER'S NAME&PHONE NO. P thL J `T i rl. 508 M-700-11 SEPTIC TANK CAPACITY 1500 a s LEACHING FACILITY:(type) e�a«�zrs ;.. s��e2 (size) ZS x 12.6 Z NO.OF BEDROOMS OWNER 4,atra� PERMIT DATE: COMPLIANCE DATE: J L= I$-®g Separation Distance Between.the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Ny/Q Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) NUJ' Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) JV�A Feet FURNISHED BY rt w Vo r ri n O� No. Fee THE COMMONWEALTH OF MASSJkCHUa ETTS , Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Zisposal 6pstem Construttion permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) z Complete System ❑Individual Components Location Address or Lot No. L59 15� Q o�.tE CA Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel ZS!2$ 1116 Qi`� ,J Past ai.^ .508-%Lj-4kf4Q Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 3 '-r;LkecL, P;a.4oa yrz Dz,,,n,; ,�� ots;sq Tl.ar.as McLQl�ow Fo.�� NCz C_ (Z,nws oz6yl so Aos Type of Building: �L,S;J, e Dwelling No.of Bedrooms J Lot Size _-I,� L:sq.ft. Garbage Grinder Other Type of Building 7 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3 4 g gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 15043 Type of S.A.S. orecl,.s Description of Soil Lprt,` F��L Sal Nature of Repairs or Alterations(Answer when applicable) C. Ces, ^rs u.(J /So Ch Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed : �����-� Date 61-LO-0 A Application Approved by Date f/ .,)-6-d Application Disapproved by Date for the following reasons Permit No. Date Issued 4_' li: ,r-'_.� :i�VIO r `k_ Fee ! od, THE COM WEALTH OF MASS'ACHUS'ETTS 4 Entered in computer: Yes . PUBLIC HEALTH DIVIS10 TOWN OF BARNSTABLE, MASSACHUSETTS 21ppritation for Bisposal *pstent Construction J)ermit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ]Complete System ❑Individual Components Location Address or Lot No. Z59 5 jZ,,j, GA &o ttm J,(, Owner's Name,Address,and Tel.No.. * Assessor'sMap/Parcel ZSa yQ� Qi�l,w' Pasl,o�o.. SOS-36y-ti4k9 Installer's Name,Address,and Tel.No. L Designer's Name,Address,and Tel.No. 7 T4�cec� P.o./ L4C t63q T�or.at McLQ��an p0, 13a,� 11GI E. DCnn;f 02641 5 --7 I t,- 70o 3 �` _ Z Type of Building: - Dwelling No.of Bedrooms 3 Lot Size 21, C1 sq.ft. Garbage Grinder V) Other Type of Building 3 No.of Persons Showers( ) Cafeteria( ) , I$ Other Fixtures Design Flow(min.required) 3r1 gpd Design flow provided 349 gpd r Plan Date Number of sheets 2 Revision Date Nlk, Title Size of Septic Tank 1500 Type of S.A.S. Z nrnc S Description of Soil Lgo.. 5w j 4 F.^Q ,Gel Nature of Repairs or Alterations(Answer when applicable) !-orn,ra �r� Ces, no ns� n ! < ALL, /S O O r d bn, G SAS Date last inspected: Agreement: ; The undersigned agrees to ensure=the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of _ Compliance has been issued by this Board of Health. _ Signed Date /I-ZU-08 Application Approved by Date 0- , (p Application Disapproved by Date v for the following reasonsa ; Permit No. o� i7� - Date Issued �., - - - -= -` �---"'-------- --------------------------- ------------------- -- -------------------------- -------=- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS ' Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(X) Repaired Upgraded( ) Abandoned( )by M -7r . at 2.5q S N has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 00 Y--Yq?dated Installer r( -TT- — Designer T h M LL ( v orYa. j c�..e #bedrooms Approved design flow 34 9 and The issfuant,ce`ofthis permit shall not be�onstruefd as a guarantee that the system functi�on/as design/Jd:, ,` ® �� , Date rF f����lr�lrr� i��1�� i. s/7 � Inspector //.f✓.d ���lr'�'�n��'I/1�� 'l.al/C_j ---------------------------------- --- -------------------------- ----------------- No. olccla-L//e:17-7 Fee 6 THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION=BARNSTABLE,MASSACHUSETTS 30isposal &pstem Construction j3ermit Permission is hereby granted to Construct(4,) Repair QK) Upgrade( ) Abandon( ) System located at Z 5 q 5 2A 4; and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must bb/ee�completed within three years of the date of this permit. r �= Date (� t/Q t /(� 1 Approved by (�{ �� /� Town of Barnstable P# Department of Regulatory Services lAMMBLE. : Public Health Division Date tbsy �e� 200 Main Street,Hyannis MA 02601 = jfD MA't� r Date Scheduled ! Time Fee Pd. Soil Suitability Assessment for Sewgc e Misr oral Performed By: Witnesse: d B y: f ���—�K! )CATION & Q-ETtAL.INFORI1 ATtON /y /� . Location Address Owner's Name (JK )k Address ' Assessor's Map/Parcel: $�—�� �Q✓` v Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use Slopes(%) 5- Surface Stones Distances from: Open Water Body 2�� ft Possible Wet Area ft Drinking Water Well NA ft Drainage Way ft Property Line 5 1 36l ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) �b.0V �e6.b7 NTH-1 .,a s } Parent material(geologic) 0(X�t lA S� A' ^ Depth to Bedrock Depth to Groundwater: Standing Water in Hole: 'y�I"v Weeping from Pit F 200 Estimated Seasonal High Groundwater 2-7 DETERMINATION FOR EASO NA'E RIGI3`A T E V V. Method Used: &A Depth Observed standing in obs.hole: in. Depth to soil mottles: __. - .in. Depth to weeping from side of obs.hole: Im Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj,factor _�� Adj,Groundwater Level PERCOLATION TEST Ante � Observation Hole# Time at 9" O h Depth of Perc 78 Time at 6" ac Start Pre-soak Time @ C ' Time(9'6") J + `� End Pre-soak ✓ MIN Rate Min./Inch. Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/l) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\,SEFnC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistent %Gravel y8 k S� A LS Ib Nq, 3 16Nti 6 a GI FINS, SA•)J Z.5 7 2 1 2,0" C Z SAlvvl LRAM 2. S h d Z t� o C 3 •FJNS SAN') z.51 7 Z DEEP OBSERVATION HOLE.LOG Hole# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel N2N �5 ID ti S Lr S p►�rL U G I F 1 ive 9A,J Z.S 7 Z SAlvrzf Lam 2 51 L „ 2.15 7 DEEP OBSERVATION HOLE LOG Hole.# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell Mottling (Structure,Stones,Boulders. Consistent %Gravel DEEP'OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color % Soil Other Surface(in.) (USDA) (Munsell) Mottling '(Structure,Stones,Boulders. Consistency, o r 1 Flood Insurance Rate May: ' Above 500 year flood boundary No— Yes._V Within 500 year boundary No L/ Yes Within 100 year flood boundary No 7� Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Lit 5- " N If not,what is the depth of naturally occurring pervious material? 126 Certification , I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required trai ng,expertise and experience described in 310 CMR 15.017.`• IJ-1q,DO Signature Date Q:\SEPTIC\PERCFORM.DOC It I Town of Barnstable Regulatory Services Q, Thomas F.Geiler,Director eip Public Health Division a ►`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 . Fax: 508-100-6304 Date: L.-Z-V I C Sewage Permit# Zcx�S-49.7 Assessor's Map/Parcel Installer&Designer Certification Form Designer: 5AS5 9-lVFTL,eA)&1 c(LlN6 Installer: EA rbT TO/VE Address: COX )I43 Address: BOX qZZ E: �J�NNI J /YlA OZ6 i >7FNN),I Nil,Y MA 07�6 On (I-26—cam M�zk "3 .I`a�c was issued a permit to install a (date) (installer) septic system at.. 2's I p RO� BS 6 A based on a design drawn by (address).. R}4�S OV611_ i=1)61NM-R4N6 dated (designer) _ /I certify that the septic system referenced above was installed substantially.according to the design, which may include minor approved.changes such as lateral.relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State:&Local Regulations. Plan revision or certified as-built by.designer to follow. Stripout.(if required)was inspected and the soils were found satisfactory: t, NaFM4 (Installer's Signature) o McL'-LL o347 (Designers i ature) '6,Af 15, estgn Stamp Here) PLEASE RETURN TO BARNSTABLE-PUBLIC HEALTH DIVISION._.CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. ` THANK YOU. I gaotfice formAdesignercertification form.doc TOWN OF BARNSTABLE a FOCATnTON,,,:�096' Za7-(O?/X SEWAGE # l LAGS' ASSESSOR'S MAP& LOT p -P, INSTALLER'S NAME&PHONE NO. 'k SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER 1/./1f�d��t PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and.Leaching Facility(If any wetlands exist within 300 feet f c ' acility) Feet `,`Furnished by XrLj J oo/? L 9 t t I � 9 V COMMONWEALTH OF MASSACHUSET A dp EXECUTIVE OFFICE OF ENVIRONM L AW„AAS DEPARTMENT OF ENVIRONMEN J TLLECC `hI�ON ONE WINTER STREET, BOSTON, MA 02108 292-U00 25 1991 ,•� t0"0E9AR%1 HkiNDEPrABLE WILLIANI F WELD �► T R L DY COXT Govcmor -� SrrcLin ARGEO PAUL CELLUCCI E DAVID B STRURS Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissionc: PART A M old / Mf CERTIFICATION Prom' Address 2595 Route 6A Barnstable,MASS. Address of Owner: Vivian Franklin Date of Inspectio a . P n:7/22/97 (If different) 620 Setucket Road BOx 1147 Name of Inspector: Joseph P. Macomber Jr. Brewster,Mass. 02631 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Joseph P. Macomber & Son,_ nc . Mailing Address: BOX , Centerville , Ma . 02632=0066 Telephone Number: 5U8-7 r 5-333t5 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: � v Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES:• �Ihave not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B) SYSTEM CONDITIONALLY PASSES: WO 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. /lei V_ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection: or unsound, shows substantial infiltration or exfiltration or tank h n whether r n m metal, is cracked structurallyu sou t o septic tank, o of e , failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:llwww.magnet.state.ma.us/dep Printed on Recycled Paper L . . T7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2595 Route 6A Barnstable Ma Owner: Vivian Franklin Date of Inspection: 7/2 2/9 7 BJ SYSTEM CONDITIONALLY PASSES (continued) 44:2i?, Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced A,V The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: A/n Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 15 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: �1a Cesspool or privy is within 50 feet of a surface water 6Ld Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: &0 The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. VC The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. &6 The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance R/� (approximation not valid). 3) OTHER I (zevimed 04/25/97) Page 2 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2595 Route 6A Barnstable Ma Owner: Vivian Franklin Date of Inspection: 7/2 2/9 7 D) SYSTEM FAILS: You must indicate ei;•.er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The bans for this determination is identified below. The board of Health should be contacted to determine what will be necessary to correct the failure. Yes No i -K/ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped n. r privy is below the high groundwater elevation. An onion of the Soil Absorption System, cesspoolo p vy g g YP P Y Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. Q LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: 1410 The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. I _ (revised 04/25/97) Page ] of 10 l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 2595 Route 6A Barnstable Ma 02630 Owner: Vivian Franklin Date of Inspection: 7/2 2/9 7 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No y Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and'the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recentiv or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components,-4+ luding the Soil Absorption System, have been located on the site. ��yQL The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum —The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)) M (revised 04/25/97) Pegs 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Properly Address: 2595 Route 6A Barnstable Ma Owner: Vivian Franklin Date of Inspection: 7/2 2/9 7 FLOW CONDITIONS RESIDENTIAL: Design flow .p�/bedroom for S.A.S. Number of bedrooms: J Number of current residents: Garbage grinder (yes or no):-&V Laundry connected to syste yes or nol:,Y,S Seasonal use (yes or no): r, -2 Water meter readings, if available (last two (2) year usage (gpd): ��T"✓ � AA Sump Pump (yes or no):" Last date of occupancy: / COMMERCIAUINDUSTRIAL: y� Type of establishment: Design flow:-124-gallons/day Grease trap present: (yes or no),do industrial Waste Holding Tank present: (yes or no)-42W Non-sanitary waste discharged to the Title 5 system: (yes or no)z�/ Water meter readings, if available: /> Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING GRR,EC RDS and squrce of infol _ Jl��� mation. Y. 17'1 p SIA1 �iSy System pumped as pan of inspection: (yes or no) Q.i If yes, volume pumped: �gallons Reason for pumping: (52�s�iGND� TYPE OF SYSTEM /f/ Septic tank/distribution box/soil absorption system Single cesspool Overflow-ee"PvVl Preew5T /ODD gw'zvp Privy 00 Shared system (yes or no) (if yes, attach previous inspection records, if any) ;G I/A Technology etc. Copy of up to date contract? Other PPROX MATE AGE of all components, date installed (if known) and source of information: Pg_� •sltr#� ��6� . Sewage odors detected when arriving at the site: (yes or no) (rrvioed 04/25/97) ➢ay• 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2595 Route 6A Barnstble Ma Owner: Vivian Franklin Date of Inspection: 7/1 2/9 7 BUILDING SEWER: (Locate on site plan) Depth below grader Material of construction: _ cast iron 40 PVC_ other (explain) Distance from � I water supply well or suction line — Diameter Comments: (condition ofJoi ts, venting, evidence of leakage, etc) SEPTIC TANK:A2C14/- (locate on site plan) Depth below grade: /l�p Material of construaion:Qilconcretaf,4metaV,/ Fiberglass4/APolyethylene� ther(explain) If tank is metal, list age 4/ Is age confirmed by Certificate of Compliance M (Yes/No) Dimensions: ,U Sludge depth: 104 Distance from top of sludge to bottom of outlet tee or baffle:,A- Scum thickness: A)lQ Distance from top of scum to top of outlet tee or baffle:_JA— Distance from bottom of scum to bonom of outlet tee or baffle:_ How dimensions were determined: 1)41 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP:"C' (locate on site plan) Depth below grade: Material of construction:ZOJ oncreteVAnetal4l,&iberglass4/APolyethylene OVAther(explain) Dimensions: Scum thickness:�L Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:�ig Date of last pumping: I Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) G y-6;R ea r,4 J12 1.5 1W 7' .SeArT (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2595 Route 6A Barnstable Ma Owner: Vivian Franklin Date of Inspection: 7/2 2/9 7 TIGHT OR HOLDING TANK:Voly-(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grader Material of con struct ion:IYLAoncreteNAmetal V&iberglass 4�Tolyethyleney/Iother(explain) Dimensions: 4)'41 Capacity: kh gallons Design flow: gallons/day Alarm level: (f Alarm in working order&AYes;ijL4No Date of previous pumping: Comments. (condition of inlet tee, condition of alarm and float switches, etc.) ! h64d,,Ap 72146RI SVF Lo�ti� DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: 10 Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: 'Vmle— (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2595 Route 6A Barnstable Ma Owner: Vivian Franklin Date of Inspection: 7/2 2/9 7 SOIL ABSORPTION SYSTEM (SAS): ;locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Ty pe: Y i leaching pits, number: leaching chambers, number: leaching galleries, number:, leaching trenches, number,length: Q leaching fields, number, dime ions: C? overflow cesspool, number: Alternative system: n.;i, Name of Technology: A)A Comments: (not co dicion of soil, si ns of hydraulic failure, level of ponding, condition of vegetation, etc.) r CESSPOOLS: (locate on site plan) Number and configuration: -�f Depth-top of liquid to inlet gen: +/ Depth of solids layer: 4 Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: otJfye_ inflow (cesspool must be pumped as an of inspection) Comments: (note condition of soil, signs of tedraulic failure, level of ponding, condition of vegetation, etc.) 5yamP A9 4-ld UL,7, PRIVY: d-�,(fe (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.) I a (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2595 Route 6A Barnstable Owner: Vivian Franklin Date of inspection: 7/22/97 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) I i i �o p b h Q I ' 1 (r.vi..d 0A/25/97) Page 9 of 10 II J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2595 Route 6A Barnstable Ma Owner: Vivian Franklin Date of Inspection: 7/22/97 Depth to Groundwaterp Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) �etermine it from local conditions Check with local Board of health Check FEMA Maps _Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how- you established the High Groundwater Elevation. (Must be completed) J.P.Macomber & Son Inc. installed the precast leaching pit in October Of 82 no water encountered at 121 . The house is on a high knoll is at least 201 higher than the road. )revised 04/25/97) Pegs 10 of 10 r t• ,-.ter.—n .r—+r..•..-..r.r..-..s-l.n.*.,+.rrn:•.�.•.+..n.:+,.r'+..n+...s+.ti.+r�rr.vr mn m-►-s--rma-a.-,.-'---,--- - .- TOWN OF Barnstable WARU OF HEALTH SUIISURFACF SF.KA(;F, DISPOSAL ,SYSTEM INSPFCTION FORM - PART U - CF.ItTIFICATIO�1, �� '.. -- { ... •--..I.. T.T.!11•R:1T1 T T.411t T'R\'�—•.1 r11R�\�f11•r T1.R�'�Y'•Rr'11.�.��1'1 1'•+n I.lm�1.9-m•.r.-� —r-r r- - - -TYPO OR PRINT CUARLY— PROPERTY INSPECTED STREET ADDRESS 2595 Route 6A Barnstable,Mass. ASSESSORS MAP , DLOCK AND PARCEL # OWNER ' s NAME Vivian F�ranfrlin PARR D - CERTIFICATION I NAME OF INSPECTOR Joseph P. Macomber Jr . COMPANY NAME Joseph P. Macomber & won , Inc . COMPANY ADDRESS Box 66 Centerville , Ma. 02632-0066 Street Town or City 5tat. I P COMPANY TELEPHONE (508 ) 775 -3338 FAX ( 508 ) 790 -1578 CERTIFICATION STATEMCNT I certify that I have personally inspected the sewage disposa-1 system n _ this address and that the information reported is true , accurate , and complete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . ZC, ne : steln PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 , 303 . Any fail (I . e criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED `\ The inspection which I have con hcted has found that the system fails to Protect the public health and the environment in accordance witli — tie 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILUP.Z CRITERIA of this inspection orm . Inspector Signature Date ,)ne copy of this certification must be provided to the OWNER , the BUYER ( where a p p 1 1 c a b 1 e ) and the BOARD OF II EALI'lI • If the inspection FAILED , the owner or operator shall upgrade the eyote ^ air- iin one year of the date of the inspection , unless allowed or require,' otherwise as provided in 310 ChIR 15 . 305 , partd . doc /C �G w - P7 THE COMMONWEALTH OF MA.SSACHUSETTS DEPARTNWNT OF E ONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. Junc 8. 1995 Acting Dircctor of the ton of Witcr �PoUutfi�onCo�ntol LOCATION SENIAGE' PERMIT NO. VILLAGE INSTA LLER'S NAME i ADDRESS R U I DER OR.�..- rU E 4 L� DA -T E P ERMIT ISSUE D /0-�� DAT E COMPLIANCE ISSUED 1191,11 9 , ! 1 w • � _w i 1 f� 40 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct or Repair (4--)rlan Individual Sewage Disposal System at: ------------------------ ss wner Address Z Other Distribution box ( ) Dosing tank ( ) U Nature of Repairs or Alterations—Answer when applicable.-.--------------- t................ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL Ili LE 5 of the State Sanitary Code— The undersigned further ag es not to place the system in operation until a Certificate of Compliance has bee issued by the boar f health. Date Date ----------------`------`-----'--------------------`--------------`--`------------`------ »^te Permit Date ' No.... �... .: s FEs.....t'....r. l THE COMMONWEALTH OF MASSACHUSETTS BOARD O:F" HEALTH ..............OF....... r { d ......J/ { 5� Appliratiou for Disposal Works Tonstrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair (4 )"an Individual Sewage Disposal System at 3 .. .... .... .. ................................................ .__ __ ._ ... ..... .._.. ................. } "I tication-Address d or Lot Now J1 ✓S� °r�; ' .f'l�� f .................. 'Owner -dress ' ...... .. 3(- ••'•j y._ -------..`^.r�:...r: .--`:, :.:.:a... .. _ _....._._� r.......::�.:! /.:,..,.�............................................. Installer Address d Type of Building Size Lot.....................:......Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures _-----------_ -_-------------•--•--•---•-. WDesign Flow............................................gallons per person per day. Total daily flow..............,.............................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................. Diameter............._-_ Depth................ W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. x 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..................................- --•-------------••-------- ------ ••••-_. Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit_._._.............._ Depth t� ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 ` / , --<' O Description of Soil................... • - - x ---- ---------- ..----••••-•-•----------------------------------------••••-•----------------------------•••-••••-••---•-•--•-••--•-•••---•-••--•------•--•-••-----•-..-----•------•--•-•-•-•••----••. U Nature of Repairs or Alterations—Answer when applicable__________________t'_":/.f,c_'',e,_ _.___f:f_��1_ s �i �� ----- -- ------------------------------------------------•--------------------------------...............---•-•---•--------------..._.--------------------------------------------------------•------......_.: Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with . the provisions of TITiis 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boardYof health Signed .. • . . /......-- .......... ............................. /r ate Application Approved By....... Date Application Disapproved for the following reasons:.............................................................................................................. ....................•-•-••--------...........---....--------•---------------------------....-•----------.-------------------•••-----•-•--•--•----•-------•--•••---------------------------------•••-•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t .. .... 4_ y- TrrtifirFatr of TompliFaurr THIS-IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired --by '"`by-------------'-............_____.._ .........!.............r .................................... :. �r......_._____._____...._...__._......._..__.._..___ ..._ _ __..._ f - Installer `•`^ "'Y�_.. z -J `\. i + / f �r 'for C.jf{ has been installed in accordance with the provisions of TITLE' 5 0 �jjh State Sanitary Code as described in the application for Disposal Works Construction Permit No.___..���_ °`_-_�-____-__. dated.....................................: THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST D A GUARANTEE THAT THE SYSTEM WILL/*UptTION SATISFACTORY. DATE..... d..'Z ..?f.1/ .................................. Inspector.......... ... THE COMMONWEALTH OF MASSACHUSETTS BOAR[ -OF HEALTH ' ....OF..... r7 w r-' r�F ,s Disposal orkp TDuntrnrtaon leran� Permission is hereby granted......... F r r .� x to Construct ( ) or Repair( an Individual Sewage D> posal System 1 .� '"S �t a.: f ¢ /rl , :ear f, Street as shown on the application for Disposal Works Construction P No.......................,Dated.......................................... ...............................................- .�']So5rd of Health DATE.................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS IrL, 'agSe,lv�et�.t TOWN OF BARNSTABLE6 a UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS f_ VALV"AG'f PARCEL NO. ASSESSORS MAP N0. p.C&v a�� DI A L, �r� ��(3 v G14AME4 VILLAGE 6a � � . 1p p s CONTACT PERSON ,4 PHONE NUMBER LOCATION OF TANKS: CAPACITY: ...TYPE OF FUEL AGE: -TYPE: LEAK OR HEMICALM DETECTION 2S_ 9 ��r� Av DATE OF PURCHASE OF: EACH: 1. 2. 73 3. 4. 5. DATEOF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS 'PLEASE PROVIDE A SKETCH SHOWING TIIiE LOCATION OF TANKS ON THE BACK OF THIS CARD. �� �_ �y - I mo N Ex STING CONTOUR:---- SEPTIC SYSTEM DESIGN SEPTIC SYSTEM SECTION p 4 PROPOSED CONTOUR:............. 2"PEASTONE y EXISTING SPOT ELEVATION:25.5 FLOW ESTIMATE: O N COVERS WITHIN 6" 3!4"-1 1/2" ���F� PROPOSED SPOT ELEVATION:25.5 115.3 OF FINISHED GRAD WASHED STONE 3 BEDROOMS AT 110 GAL/DAY= 330 GAL/DAY TEST HOLE: TOP OF -, �, �oQ UTILITY POL : FOUNDATION �� INSPECTION PORT FENCE LINE: SEPTIC TANK: ELEV.- 105.0 fO QO Op HYDRANT: 330 GAL/DAY x 2 DAYS= 660 GAL RETAINING WALL:o � 3'MAX. wUSE 1500 GALLON SEPTIC TANK 113.5 COVER ELEV. IPE fN CESS POOL) 105.75 LEACHING AREA: 1500 GAL ELEV. LOCUS 105.7 105.53 USE 2-500 GALLON CHAMBERS 8.5'x 4.8'x 2'EFF. DEPTH WITH 106.0 SEPTIC TANK • • 102.0 • . • • . • . . . . • . • ( ) ELEV. ELEV. 4 4- ASSESSORS ELLEV. LOCATION MAP 4'OF STONE ALL AROUND (25'x 12.8'x 2'DEEP) ELEV. PARCEL 48 (21,693 SF) MAP:258 PARCEL:48 25'x 12.8' SIDE AREA: 25'+ 12.8' x 2 x 2= 151 SF 0.74 = 112 GAL/DAY (6"CH STONE UNDER OR PLAN BOOK: 195, PAGE: 111 ( ) ( ) __ MECHANICALLY COMPACTED) 2-500 GALLON CHAMBERS WITH FLOOD ZONE:C 104.0 4'OF STONE ALL AROUND BOTTOM AREA: 25'x 12.8'=320 SF (0.74)=237 GAUDAY TEE SIZES: ELEV. (25'x 12.8'x 2'DEEP) CAPACITY=349 GAUDAY INLET:6"UP, 13"DOWN GAS BAFFLE (H-20) OUTLET:6"UP, 14' DOWN AT OUTLET TEE N TH-1 107.0 TH-2 107.0 ELEV. ELEV. TEST HOLE LOGS 48" FILL 103.0 36" FILL 104.0 BATH DIN ENGINEER: THOMAS McLELLAN,P.E. A HORIZON A HORIZON LIVING B RM LOAMY SAND LOAMY SAND ROOM I BTH BED WITNESS: TIM O'CONNELL,R.S. 54" 10YR 4/3 102.5 42" 10YR 4/3 103.5 KITCHEN ROOM B HORIZON B HORIZON DATE: 8-28-08 LOAMY SAND LOAMY SAND 2nd FLOOR CL PERCOLATION RATE: <2 MIN/IN 66" 10YR 6/8 101.5 54" 10YR 6/8 102.5 PERC Cl HORIZON Cl HORIZON AT 78" FINE SAND FINE SAND 84" 2.5Y 7/2 100.0 84" 2.5Y 712 100.0 C2 HORIZON C2 HORIZON DECK <� SANDY LOAM SANDY LOAM 120" 2.5Y 6/2 97.0 114" 2.5Y 6/2 97.5 ROUTE 6A C3 HORIZON C3 HORIZON APPROX. LOCATION OF FINE SAND FINE SAND EXISTING WATER SERVICE GARAGE 180" 2.5Y 7/2 92.0 186" 2.5Y 7/2 91.5 Edge of pavement 102 ROOM BATH BED BED) NO GROUND WATER ENCOUNTERED 10 N 83-58-44"E IP '102 1 st FLOOR NOTES: \ 76.00 1 \\ EXISTING FLOOR PLAN 1.VERTICAL DATUM: ASSUMED 1 0 _ 2.MUNICAPAL WATER IS AVAILABLE. ?3.g130 E 112\ TH-2 3.SCHEDULE 40-4"PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. 0�. \ 4.ALL PRECAST UNITS SUBJECT TO TRAFFIC LOADS TO CONFORM WITH AASHTO H-20 SPECIFICATIONS. 106 5.PIPE PITCH= 1/4" PER FOOT(UNLESS NOTED OTHERWISE). min TH-1 �. 116_ \ 104 6.FIRST 2'OF PIPE OUT OF D-BOX TO BE SET LEVEL. 106 i 108 7.THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE USE OF A GARBAGE DISPOSAL. 118 \ �\ \ �r PROPOSED X 2 DEEP POLY LINER 8.ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE STATE OF MASS.ENVIRONMENTAL TOP 2' LINER=105.0 CODE(TITLE FIVE)AND LOCAL HEALTH REGULATIONS. by 12Q, \ gT BOTTOM ELEVATION= 103.0 .cL 9.CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. 122, 1 \ 10.GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO EXCEED 3'. O 5'SOIL REMOVAL 11.FIELD SURVEY PROVIDED BY TERRY A.WARNER,P.L.S.,HARWICH,MA. Sj�o s (SEE NOTE 15) 12,THIS PLAN REQUIRES THE REVIEW AND APPROVAL OF ONE OR MORE TOWN DEPARTMENTS AND 112 IS SUBJECT TO CHANGE UNTIL SUCH TIME. 72 CONC. RET.WALL "cA�F��Tti t' , G' I BENCHMARK AT 13.EXISTING CESS POOL AND LEACH PIT ARE TO BE PUMPED AND FILLED WITH SAND OR REMOVED. 0, 114 PAVED DRIVE MAG NAIL =110.12 14.D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. 15.ALL UNSUITABLE SOIL SANDY LOAM APPROX. 120"DEEP)WITHIN 5'OF PROPOSED LEACH AREA -- -- l ` 106 IS TO BE REMOVED AND REPLACED WITH CLEAN MEDIUM SAND. 16.PIPE INTO CESS POOL WAS NOT VISABLE AT TIME OF INSPECTION. CONTRACTOR TO VERIFY LOCATION C ``LPN' ` OF PIPE AT HOUSE AT TIME OF CONSTRUCTION. 9QyC�/CPj SITE PLAN .19° oo•• 1 LOCATION: Z ` 1 110 ��N OF A�1 . tiF s� 2595 ROUTE 6A, BARNSTABLE, MA THTA J.STONE RET.WALL-f 124'� She ' 112 cn 2nd BENCHMARK AT o McLCLLAN R, PREPARED FOR: 122 120 11 �0 MAG NAIL �► A- W ELEVATION=115.57 o NoC.36'4710 RICHARD & ERNESTINE PASHOIAN '112.64' o P R=5770.90' o � /Sl 1614 DATE: 8-28-08 Irk- SCALE: 1"=30' NEW PORK' NEW HAVEN m �s/ONAIE��r EN & HARTFORp RqlL BASS RIVER ENGINEERING ROgp CO LFHOMAS J. McL Li - P.E. P.O.BOX 1163, EAST DENNIS,MA 02641 508-385-3426 M8-40