HomeMy WebLinkAbout4305 MAIN ST./RTE 6A(BARN.) - Health 4305 Main Street/Rte 6A (Barn)
Barnstable. P
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Massachusetts Department of Environmental Management
Office of Water Resources 145912
TYPE OR PRINT ONLY Well C0mpletion Report
1. WELL LOCATION GPS (OPTIONAL) LATITUDE LONGITUDE—' DATUM
Address at Well Location: / f,rakxk-?_ (,A Property Owner/Client:
Subdivision Name:
City/Town: C� C t c,-`A,16_ f City/Town:
Assessors Map 5 Assessors Lot.#: 'L� NOTE:Assessors Map and Lot# mandatory if no,street address available 2
Board of Health permit obtained: Yes SL Not Required ❑ Permit Number\J 2w6f,-1(-- bate,lssued,5102106
2.WORK PERFORMED 3. PROPOSED USE '`v; 4. DRILLING,-METHOD
Q.New Well ❑ Abandon ❑ Domestic C'L Irrigation ❑ Cable a �NAuger
❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal ❑ Air Hammer ❑ Direct Push
❑ Replace ❑ Other ❑ Industrial ❑ Other ❑ Mud Rota" ;❑ Other-
S.WELL LOG Water Unconsolidated Consolidated 6. SITE SKETCH (use permanent landmarks with distances)
Rock T e
Bearing a m m m Other YP
From (ft) To(ft) Zones a (n 0 Material Description , {
NA
5 car,
• � -.� ��=��.-�.�'-`tom.
G A
7. WELL CONSTRUCTION 8.-CASING ,
Total Depth Drilled "^�� From (ft) To (ft) Casing Typeyand Material Siie I.D.(in) Well Seal Type
Date Complete t ' #-��-7 G, 11 41" ;-' t r�e4 SA k
9. SCREEN
-From(ft) To (ft) Slot Size Screen Type and Material Screen Diameter
10. FILTER PACK/GROUT/ABANDONMENT MATERIAL 11. ADDITIONAL WELL INFORMATION
Developed? C Yes "❑ No `
From (ft) To (ft) Material Description ' Purpose Fracture
Enhancement? ❑ Yes '—[S,No:
Method
Disinfected?- ;Yes No
12. WELL TEST DATA(ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) 13. STATIC WATER;LEVEL I(ALL WELLS)
Yield Time Pumped Drawdown to Time to Recover Recovery to Qepth E efow
Date Method (GPM)-",'Z;(hrs&min) (R. BGS) (hrs & min) . (Ft. BGS) Date Measured Ground Surface (FT)
Zc� r�i: ) i' r. 4 ',-��_ , d � � C� : Ca
14.PERMANENT PUMP(IF AVAILABLE) 15.NAMEIADDRESS OF PUMP INSTALLATION COMPANY
c__,' �� � a�r l Horsepower
Pump Qescription _ p r�
Pump Intake Depth r +�b�3( ) Nominal Pum Ca acitY (gPm)
16. COMMENTS
17.WELL DRILLER'S STATEMENT This well was drilled, altered, and/or abandoned under my supervision, according to applicable
rules and regulations,and this r p'ort is complete and correct to the best of my knowledge.
arn�p�-'�-�S8W1�e.'� f in Registration #: t `�
Driller: _ - Supervising Driller Signature: Idtir �.-e
Firm: '•-�S tr Date: 7- Rig Permit#: �►
NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
BOARD OF HEALTH COPY
,.
ENVIROTECHLABORATORIES, ING
MA CERT. NO.:M M 063
8 Jan Sebastian Drive Unit 12
SandwicI4 MA 02563
(508)888-6460 1-800-339-6460
FAX(508)888-6446
Client Name Desmond Well Drilling Location Friary,4305 Rte.6A
Address PO Box 2783 Cummaquid,MA
Orleans MA
02653 Sample Date 06/22m6
Collected By Desmond wells Sample 771me 1:15
Sample Type Irrigation Date deceived =23/w
Lab Order Number Dw-2oo6-24w Well Specs 66/23
oca�on Soisrree Bate Cvllecterl >Titrte Collected
L Cotmttebts
.q
Anal.ys is Re nested Units Recommended Limits Analysts Result I ,'Gfet&od Daie Aseaty�ze Analyzed By
Total Coliform /100 ml 0 0 9222 B 6/22/2006 MC
pH pH units 6.5-8.5 5.97 4500-H-B 6/23/2006 LL
Specific Conductance umhos/cm 500 137 120.1 6/23/2006 LL
Nitrite-N mg/L 1.00 <0.004 300.0 6123/2006 LL
Nitrate-N mg/L 10.0 5.95 300.0 6/23/2006 LL
Sodium mg/L 20.0 9.1 200.7 6/26/2006 MC
Total Iron mg/L 0.3 <0.1 200.7 612612006 MC
Manganese m91L 0.05 <0.008 200.7 6/26/2006 MC
Comments:
Low pH indicates high corrosive characteristics.
Nitrate level should be monitored periodically.
Water meets EPA standards and is suitable for drinking for parameters tested.
Date 3 l7
Ro J. Saari
ratory Directo
j� YaJ
rQ +s
f
BRL=Below Reportable Limits Page 1 of 1
*See Attached
7
No.-
- J-1 - Fee— --=------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
DESMOND WELL DRILLING, INC.
;5 RAYBER ROAD,BOX 2783
ORLEANS,MA 02653 ApplitationArVell �Olt�trU(t10It Qr1111�
(508)240-1000
Application is hereby made for g permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
C-0 VA A c?
Location•— Address Assessors Map and Parcel
Odd Address
-------------—---—----------------------------------------- -----------------------------------------------------------------------
Installer — Driller Address
Type of Building
Dwelling ----- -— - — - —
Other - Type of Building------—- - - No. of Persons--------------------- ------
Type of Well-- ems — ------ Capacity-- —
Purpose of Well---- 6��-�-� -� ---
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until Certificate .of Compliance has been issued by the Board of Health.
-.� ��- 6 -
Signe — o — date
Application Approved By date - --
Application Disapproved for the following r ns: ------ --- -- -- - ---
------- --- ------ ---------------- —
date
— -- ------
Permit No. — Issued-----==,------------ --—
date
BOARD OF HEALTH
DESMOND WELL DRILLING, INC.T OWN OF BARNSTABLE
5 RAYBER ROAD,BOX (Certificate Of COMPllall(P
ORLEANS,MA 02653
(508)240-1000
THIS IS TO CERTIFY, That the Individual Well Constructed (Altered ( ), or Repaired ( )
by______ Installer
has been installed in accordance with the provisions of the Town of Barnstable Boa d of ealt j vate Well Protection
Regulation as described in the application for Well Construction Permit No. V a
gted-- ----------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------- — — -- Inspector-- ------ -- -- —------
Fee------=------------
-10
BOARD OF HEALTH
TOWN OF BARNSTABLE
DESMOND WELL DRILLING, INC.
5 RAYBER ROAD,BOX 2783
ORLEANS,MA 02653 �0(ppIicat ion,f or VeYY t,ongtruct ion berm t
ORL O
(508)240-1000
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
�Locatio.n --Address Assessors Map and Parcel —
Owner Address
--------- —— -- ------------—--------
— — - -- ---- — —— --_---= — —
sr Installer — Driller Address -`
Type of Building
Dwelling ---- -—— ----
Other - Type of Building--- ------- No. of Persons--------------------
Type of Well— V!U C �Capacity— —G em -r
Purpose'of Well---1-- =lt -- -
' Agreement:
The undersigned agrees'to i i tall7the 46" scribed individual well in a eoorda ce with the `provisions of The
w-
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until Certificate of Compliance has been issued by the Board of Health.
'i Signed~
ate
Application Approved By ) —� taate7
�M +
;I
Application Disapproved for the following r a ns: -----—---------—--—-- ---— ----
date
I
Permit No. Issued
—�-�T,— — -I 2-- , --- ---------------- -------
-^ date
i
BOARD OF HEALTH
DESMOND WELL DRILLIN ,�CW N` OF B A R N S T A B L E
5 RAYBER ROAD,BOX 2783
ORLEANS,MA 02653
2
(508) 40-1000 Certificate (Of COMPhance
THIS IS TO CERTIFY, That the Individual Well Constructed (.11 `Altered ( ), or Repaired ( )
by------- ---------- =---- -—`-- — - -- - -------- ----- —_—— Installer
at ------------
has been installed in accordance with the provisions of the Town of Barnstable Boa d of a�t G*vate Well Protection
Regulation as described in the application for Well Construction Permit No.� fated-- - -
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------------- -— - — Inspector-----------------------------------—---- -----
BOARD OF HEALTH
I _
DESMOND WELL DRILLING, INCT O W N OF B A R N S T A B L E
5 RAYBER ROAD,BOX 2783
ORLEANS,MA 02653eCr �on$tructionertnit
(508)240-1000
No. T
Permission is hereby granted — —---to Construct (a Nter, ); or Repair ( ) an Individual Well at:
Street
as shown on the application for a Well Construction Permit
No. Vf /i ( / (/� _—
---- r , Dated-- I r ----=�---------------------
------------ -------
/� Board of Health
DATE
�° I
4 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
f�
PART C
SYSTEM INFORMATION(continued)
' Property Address: 4305 ROUTE 6A
CUMMA UID,MA 0 637
�i
Owner: IVERSON,GEORGE
Date of Inspection: AY 17,2002
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference Iandmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
Roe :��
6` 36
t
DESMOND WELL DRILLING, INC.
5 RAYBER ROAD,BOX 2783
ORLEANS,MA 02653
(508)240-1000
Title 5 Inspection Form 6/15/2000 10
_ - TOWN OF BARNSTABLE 0C:A';'ION r-3®� R7— �A SEWAGE # �°O-' A07
VILLAGE C U M A A®o o l ASSESSOR'S MAP & LOTS + ��
INSTALLER'S NAME &PHONE NO. ?4 J,6
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OWNER Z V S oN G�oR'� £
PERMITDATE: "� 7 COMPLIANCE DATE:
Separation Distance Between the: -. 4
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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ter.
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a � :
y TOWN OF BARNSTABLE
I OCA:ION 713 O-5- 7- SEWAGE #
VILLAGE e (/191/d'! 4 QU 17) ASSESSOR'S MAP & LOT 3S4 - f
1`5,0FcT&r / A
N-5- � S NAME&PHONE NO. A r� A—I CO
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS ��aa e.
BUILDER OR OWNER 6" -Eolf U- £
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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NO... Fizz 15 -'.�............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliration for Uifipwml Works Tomitrnrtiun Frrmi#
Application is hereby made for a Permit to Construct ( ) or Repair (/,<an Individual Sewage Disposal
System at:
-•...........Z�.3 o3---•-° .T. :---....--•-----•--•----•-•-.......---•--•--- ----..-M=- ,��..........................-••--=---•---------------------•---....------•-
Localion \t cs- or Lot I�o.
......................__.__..._..---........------.._..-----------.-,-------.---==----.--... -----••----y----
....
�Owner Address �/
Installer Address
Type of Building Size Lot............................Sq. feet
U►., doos.--•----- £•--•-------------Ea Expansion Attic ( )Dwelling—No. of Ber Garbage Grinder ( )
ok Other—Type of Building ---------------------------- No. of persons---._---.------------------- Showers ( ) — Cafeteria ( )
a ----------------- Mons --er person per day. Total daily flow----_--_-_...-.___---_____.-.---_.-__.-. -gallons.
------
W
Design Flow-Other fixtures --_----.-----.-g< p p p y y
1:4 Septic Tank—Liquid capnity........---gallons Length---------------- Width---------------- Diameter................ Depth................
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 ( )
Percolation Test Results Performed by................... --------------•-•-----•---------•--------------------- Date........................................
Test Pit No. 1.:..............minutes per inch Depth of Test Pit-------------_-_-.__ Depth to ground water........................
f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a .......................................................... _--------------------•--------•--.... .....: .........
0 Description of Soil........................................................................................................................................................................
x
W ---••------••---------------•----••---•--••••-•-•--••-----•-------------------------------------••------•-•-•••------- ------------
U Nature of Repairs or Alterations—Answer when applicable--------------------- -- /01.C_E........
... ......... 4._ ............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System_bA.2,ccordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complia has been issued by the board of health.
Sign ......... .= ..............:....................... .................
J/� o
Application Approved By .............. °V�.............-ec ............. - /� %Z
Application Disapproved for the following reasons: .... ........................... ............................... ....................................................... ..
...............----..........................._.....................-----.. ._.......... -.------ .................Date---------------
..................
Permit No.
�a(��..�.........-1----------------------- Issued .... 1.7,v ...........,.-.....
ate
No—
...............: lJ Fas....:5 . .............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratinn for Diripwial Workii Tomitrnrtion rumit
Application is hereby made for a Permit to Construct ( ) or Repair (/-f"a_n Individual Sewage Disposal
System at:
f 3n5 G1�7 �� l�l 7 �r
.......... Location-Ad ress --�',------------•---------7 ---•...-or Lot No. .............
Owner Address
-...
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms.__-__.---''--G- -}_---________________Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ____________________________ No. of persons._.-____-___-_-.-___--_--__. Showers ( ) — Cafeteria ( )
aI Other fixtures ________________ _________.__. _ .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1x Septic Tank—Liquid capacity------------gallons Length------_--_--- Width-_.___________ Diameter__.------------- Depth................
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 ( )
� Percolation Test Results Performed by.......................................................................... Date........................................
a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
LZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
ODescription of Soil........................................................................................................................................................................
U ----•---....-•----------•-•-------------------------•--------.....-.........-•---•-------•-•--------------•-------------....._..------...------.....----•------•----•-----..._............--•••••--•----
W -----------------------------------------------------------------------------------------•---------------------------- - •-----------_--••--
U Nature of Repairs or Alterations—Answer when applicable_____..................................................._....._......fin'..._. ............
..--•---••--------------------------------------•----------•-------------------•---------•-----------------------------------------------------------------------.._....._.._..........------------•-•..
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Sign( ............................. .. .
. --.....:.- -...-- .- -....-..-.._
1 Dare
Application Approved By ..............vl� .- � -- _ ....�`��/J..%........
� Daie
Application Disapproved for the following reasons: . . ......................... . . ............................ ................. ....................
..................................................................................................................................................................................I..... ........................................
r__._ Dace
Permit No. 00 a.---....2.G. .-... - Issued .------5 -/-7/0 2
l� ....................._...........
jDace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
CITe r#ifi ate of 1011omplianre
THIS IS TO CERTIFY, That the Individual Sewage Dispsosal System constructed ( ) or Repaired
by ---.- 9... ( 3---- ' .�C o 3 5 ✓��< i� ' �" ,..- r ��..................................
--------------------------------------- ------
t� C2.5 ' /1 ,�l/¢ r v"�,✓yl Crr o f �... .-- .....
at .... ........................................... .............. ....... ..
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. .........-_- dated .... 1.........
.._-.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. c;
DATE.. .......................�...�....�...�- ...... Inspector .! - -....-...._._...............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
-_J FEE--=.._U__. ..._..:..
v
Disposal Workii Tanotrutuan "rrmit
Permission is hereby granted---------------------------------------------- .._.-..---_.-------•••--_
to Construct ( )_or Repair (t,) an Individual Sewage Disposal System
atNo.......................................................................:<.:y._ !.. f..l_...- )
Street
as shown on the application for Disposal Works Construction Permit\No._v) Dated.....5....................
�.. ._-.,. i_
/ v Board of Health
DATE---- -----' '....... -•--•---------------------------------------•----
FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS
I -
TOWN OF BARNSTABLE
LOCATION
SEWAGE #
VILLAGE C v M A 440°'-1 ^ ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHO NO.
SEPTIC TANK CAPACITY
0(size)
LEACHING FACILITY: (type)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE:
S'( ? - O ;� COMPLIANCE DATE: S`/ `) c;
Separation Distance Between the: Feet
Maximum Apjusted Groundwater Table to the Bottom of Leaching Facility
Private Water Supply Well and Leaching Facility (If any wells exist
Feet
j on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility (If any wetlands exist
Feet
within 300 feet of leaching facility)
Furnished by
n
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-- COMMONWEALTH+OF MASSACHUSETTS
EXECUTIVIJ OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
350 MAIN STREET MAP ®�....,...,,.
B WEST YARMOUTH,MA PARCEL , 4,,,
508-775.2800
LOT •� 4--
TITLE 5 ( �
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
MAP 350 PAR 49
Property Address: 4305 ROUTE 6A
CUMMAQUID,MA 02637
Owner's Name: IVERSON,GEORGE
Owner's Address: 290 KINGS TOWN WAY-#224 z
DUXBURY,MA 02332
I /
Date of Inspection MAY 17,2002 /TName of Inspector:(please print) JAMES D.SEARS OWCompany Name: A&B Canco HFMailing Address: 350 Main Street
West Yarmouth,MA 02673
Telephone Number: 508-775-2800
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 the inspection. The inspection was
performed based on my training and experience in the proper function and maintenance of on site sewage
disposal systems. I am a DEP approved system inspector pursuant to Section 15.346 of Title 5(310
CMR 15.000). The system:
X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
ails
Inspector's Signature: Date: 7 ° '
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 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 DEP. The original should be sent to the system owner and copies sent tot
he buyer, if applicable,and the approving authority.
Notes and Comments
****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.
Title 5 Inspection Form 6/15/2000 1
1 - 1
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 4305 ROUTE 6A
CUMMAQUID,MA 02637
Owner: IVERSON,GEORGE
Date of Inspection: MAY 17,2002
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes: X
_ 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:
B. System Conditionally Passes: N/A
_ 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.
Answer yes,no or not determined(Y,N,ND)in the 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 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.
ND explain:
_ 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
obstruction is removed
distribution box is leveled or replaced
ND explain:
_ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health)"
broken pipe(s)are replaced
obstruction is removed
ND explain:
Title 5 Inspection Form 6/15/2000 2
Page 3 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
Property Address: 4305 ROUTE 6A
CUMMAQUID,MA 02637
Owner: IVERSON,GEORGE
Date of Inspection: MAY 17,2002
C. Further Evaluation is Required by the Board of Health: N/A
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 the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh
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 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 colitorm
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,provided
that no other failure criteria are triggered. A copy of the analysis must be attached to this form
3. Other:
Title 5 Inspection Form 6/15/2000 3
Page 4 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
Property Address: 4305 ROUTE 6A
CUMMAQUID,MA 02637
Owner: IVERSON,GEORGE
Date of Inspection: MAY 17,2002
D. System Failure Criteria applicable to all systems: N/A
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded
or clogged SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
X Liquid depth in pit is less than 6"below invert or available volume is less than''/z day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
X Any portion of the SAS,cesspool or privy is below high ground water elevation
N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a
surface water supply
N/A Any portion of a cesspool or privy is within a Zone 1 of a public well
N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well
N/A 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 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 or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.)
NO (Yes/No)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: N/A
To be considered a large system the system must service a facility with a design flow of 10,000 gpd to
15,000 gpd.
You must indicate either"yes"or"no to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of asurface 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 Il 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 is 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.
Title 5 Inspection Form 6/15/2000 4
Page 5 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 4305 ROUTE 6A
CUMMAQUID,MA 02637
Owner: IVERSON,GEORGE
Date of Inspection: MAY 17,2002
Check if the following have been done. You must indicate"yes"or"no"as to each of the following
Yes No
X Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X Was the facility or dwelling inspected for signs of sewage back up?
X Was the site inspected for signs of break out?
X Were all system components,excluding the SAS,located on site?
X 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
X 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)has been determined based on:
Yes No
X Existing information. For example,a plan at the Board of Health.
X 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(3)(b)]
Title 5 Inspection Form 6/15/2000 5
I
Page 6 of 11
OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 4305 ROUTE 6A
CUMMAQUID,MA 02637
Owner: IVERSON,GEORGE
Date of Inspection: MAY 17,2002
FLOW CONDITIONS
RESIDENTIAL
Number of Bedrooms(design): 2 Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203(for example:'110 gpd x#of bedrooms: 220
Number of current residents: 0
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NONE [if yes separate inspection required]
Laundry system inspected(yes or no): NONE
Seasonal use(yes or no): N/A
Water meter readings,if available(last 2 years usage(gpd)): 2000 25,000/2001 17,000
Sump pump(yes or no) NO
Last date of occupancy: UNKNOWN
COMMERCIALANDUSTRIAL
Type of establishment: ROAD SIDE STAND,GARAGE
Design flow(based on 310 CMR 15.203): 220
Basis of design flow(seats/persons/sqft,etc.): SAME AS HOUSE
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged to the Title 5 system(yes or no): NO
Water meter readings,if available: SAME BUILDING AS HOUSE
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: N/A
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: gallons—How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
X 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)
Tight tank Attach copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
1980 PERMIT#80-232,NEW DISTRIBUTION BOX MAY 17,2002,PERMIT#2002-209
Were sewage odors detected when arriving at the site(yes or no): NO
Title 5 Inspection Form 6/15/2000 6
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 4305 ROUTE 6A
CUMMAQUID,MA 02637
Owner: IVERSON,GEORGE
Date of Inspection: MAY 17,2002
BUILDING SEWER(locate on site plan): X
Depth below grade: 4"
Materials of construction: Cast iron X 40 PVC _ other(explain)
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK(locate onsite plan): X
Depth below grade: 8"
Material of construction: X concrete metal fiberglass polyethylene
_ other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1,000 GALLON
Sludge depth: V,
Distance from top of sludge to the bottom of outlet tee or baffle: 29"
Scum thickness: 0"
Distance from top of scum to top of outlet tee or baffle: 12"
Distance from bottom of scum to bottom of outlet tee or baffle: 18"
How were dimensions determined: ASBUILT AND TAPE
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 AT WORKING LEVEL.INLET TEE,OUTLET BAFFLE.TANK AND COVERS 8"BELOW GRADE.NO
SIGN OF OVERLOADING SEEN IN TANK.
GREASE TRAP(located on site plan) N/A
Depth below grade:
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:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as
related to outlet invert,evidence of leakage,etc.):
Title 5 Inspection Form 6/15/2000 7
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 4305 ROUTE 6A
CUMMAQUID,MA 02637
Owner: IVERSON,GEORGE
Date of Inspection: MAY 17,2002
TIGHT or HOLDING TANK: Ma (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/day
Alarm present(yes or no)
Alarm level: Alarm in working order(yes or no):
Date of last pumping
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: X (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 IS CEMENT,ONE LINE IN,ONE LIEN AT 28"BELOW GRADE WITH COVER 6"
BELOW GRADE. BOX IS NEW MAY 17,2002.
PUMP CHAMBER: N/A (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.):
Title 5 Inspection Form 6/15/2000 8
f ,
Page 9 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 4305 ROUTE 6A
CUMMAQUID,MA 02637
Owner: IVERSON,GEORGE
Date of Inspection: MAY 17,2002
SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
X leaching pits,number: 1
leaching chambers,number:
leaching galleries,number
leaching trenches,number,length
leaching fields,number,dimensions:
overflow cesspool,number:
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.)
LEACHING IS ONE 1,000 GALLON PRE CAST PIT.PIT IS DRY AND CLEAR.PIT IS 4' BELOW GRADE
WITH COVER AT 20". NO SIGN OF OVERLOADING OR SOLID CARRYOVER.
CESSPOOLS: N/A (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 or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.):
PRIVY: N/A (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.)
Title 5 Inspection Form 6/1.5/2000 9
I
Page 9 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 4305 ROUTE 6A
CUMMAQUID,MA 02637
Owner: IVERSON,GEORGE
Date of Inspection: MAY 17,2002
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch 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.
� I
Title 5 Inspection Form 6/15/2000 10
I
Page I 1 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 4305 ROUTE 6A
CUMMAQUID,MA 02637
Owner: IVERSON,GEORGE
Date of Inspection: MAY 17,2002
SITE EXAM
Slope.
Surface water
Check cellar
Shallow wells
Estimated depth to groundwater 27.3 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observation site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
'Checked with local excavators,installers-(attach documentation
X Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
USGS WELL DATA
WELL AIW 247 27.3`
ZONE B 6.6'
ADJUSTED 20.7'
Qf I
0, �3y
Title 5 Inspection Form 6/15/2000 11
L 0 A TJO N S E AGE PERMIT NO.
f -,
VILLAGE
I N S T A LLER'S NAME i ADDRESS
f1 E T a if-14-0 G
B U I L D E R OR �WN ER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED ��� _ �
r
f l \
HIV P
,
ola
. f
r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............. .......OF.......!J• f'.M�.'+� �v-�7,
Appliration for Diopooal Works Tonolrnrtion ramit
Application is hereby made for a Permit to Construct ( or Repair ( ) I iduA Syage Disposal
System at:
.. 1Jo�S-VL ........--- .... .,Q� '�.1........-•......----•--•...........................•-•-••--•---•----
cation- d ;ess Nq'�
.. �� r_. l .
Owner ddress
ax ...........L..�:!I".5�................. ���.°.., 1 .HG u r �`7�'. �.......----..........
Installer Address
Type of Building Size Lot... -----Sq. feet
Dwelling—No. of Bedrooms...........Z �..............Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ----------------------------T*4
• • ----------------------- ---------•---•--------------.--------------
1�. - C` .
W Design Flow.. . f�. ...__......_.___..gallonsseas per day. Total daily flow.._........._Z _40................gallons.
WSeptic Tank—Liquid'capacityZ�gallons Length&-.�U_"Width.A!7:10a Diameter................ Depth..'.
x Disposal Trench—No. .................... Width.................... Total Length..................... Total leaching area....................sq. ft.
3 Seepage Pit No--_-_------------- Diameter........L4....... Depth below inlet......4v�414
otal leaching area..2�_�....sq. ft.Other Distribution box ( ) Dosing tank ( ) F"► - -,
Percolation Test Results Performed by.....�4'AA!...... ............................................ Date.......�... —_�__0........
a
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...........
O Description of Soil... "- G
x
U Nature ofTpiaalirs or Alterations—�r when applicable.:. ..................
-----------------------------------•------------------------------------------------...-•------------------.....-•--------------------------------------------------------------------.........---.•••.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage.Disposal System in accordance with
the provisions of iITLij 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has een issued by jhe board Of health. ;
_._.
Da
Application Approved By....'••••• ... --- .... '....................
Date
Application Disapproved for the following reasons:.................................................................................................................
......................................................-•.........................................................
'. Date
PermitNo.......................................................... Issu�/_.2 - •-• -•-••-----...........-----
No........2--•---...... FE$.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ""
1 �/`.
....---.....-4.LL1..................OF............. .c? ...._.....:... ................
ApplirFation for Wpas al Works T anstrnrtion ramit
Application is hereby made for a Permit to Construct �X) or Repair ( ) an Individual Sewage Disposal
System at:
_..,..�. �. t` � Vic.......
- . ----------------------
_..
��6 � K ro' 1�
---- .......
W Owner d ' p, o
a .......... .............. ....... ..... t......................
Installer Address
Type of Building Size Lot--- ...Sq. feet
U Dwelling—No. of Bedrooms..........2 R.OA��.--................Expansion Attic ( ) Garbage Grinder ( )
pP-I Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
QI Other fixtures ....t,...........: :........
W Design Flow...........l.l.Q.......................gallons per pep®"Rer day. Total daily flow.........ZZ ...................Olons.
WSeptic Tank—Liquid*capacitytt=gallons Length S.`tea."_.. Width4-.l4C)"_ Diameter................ Depth 5-�N
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No----------_-------- Diameter.....V. ........ Depth below i et..... otal leaching area...UP.77...sq. ft.
Z Other Distribution box ( ) Dosing tank (� k�• t. t '
'�' Percolation Test Results Performed by....... _._Q. ..... ...............: ..._._..
Date 3 •20
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per- inch Depth of Test Pit.........:............ Depth to groundwaterZA
..,.r.�._.___.. ..__._...
26
Description of - 1
---2--
-•--•-
UNature of a s or A to tions—A saver when applicable______________________________________ __
---------------------------•------•----------------•-••--•------•------------------........------------•-----• .......................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIE "5 of the State Sanity y Code— T e undersigned further agrees not to place the system in
operation until a Certificate of Compliance has en 'ss d byXie b ie e
Signe •. -----• •... •------•--• •-•-••• ------
.............Application Approved,BY r / .--.•� W — ....._............Da..................
Date
Application Disapproved'f or the,following reasons:-------•-......................................................................................................
y -
...................................................................................................................................................._....................................................
Date
Permit No:......................................................- �., Issueds . ........-----------
Date s
i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HE;A" T,
....... ..., OF.......... �4.. ... ..•... :... f'................................
Totifiratr of ToutpliFatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
bY------•-•........................ ----
----
-----------------
--------------
---------------------- ..........
..............
...........
------.... ---- ---------------
.- Installer ''�n
�1 N�
has been inst led in accordance with the provisions of T 'L j of The State Sanitary Coke as desc ' m the
application for Disposal Works Construction Permit No._ 1�....:;LJ.A.......... da.ted_........ -�." ��..__......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM- WILL FUNCTION SATISFACTORY.
DATE.... ........................................ Inspector::
", - .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL H
Ol ... .... F..
...�
- Z ......................
No... � FEE 3 d
.....�i���a��a1 nr��;��an��rn�tuan �erntit
Permission is hereby granted...........------U ....••--=•-----•-•-•-••------•-••----••-••••••.....•••-•-••-••---•-....-----............_.....--•-••
to Construct or Repair ( ) an Individual ewage Dispos System f.
at No..0 . .,----� --- ...... . / ----------------••--••---••••--•
.. L2 Q•
�r,: _
Street
as shown o application for Disposal Works Construction Per- •t No ....Z..___.... Dated..........................................
r DATE ..........................................................
/
� . .. . C9/�,1 4 P Board of Ae �
�-=
FORM 1255 HOBBS &'WARREN, INC.. PUBLISHERS
SOIL TEST INVERT ELEVATIONS NOTES:
DATE OF SOIL . TEST 3�Zo�8d INVERT AT BUILDING 99 o FT. ALI. WORKMANSHIP AND MATERIAL'S
WITNESSED BY 2D:�/ INLET SEPTIC TANK '19,- FT. SHALL CONFORM TO D.E.Q.E. TITLE 5
PERCOLATION RATE--2 MIN./INCH OUTLET SEPTIC TANK 9�• 7— FT. AND THE TOWN OF �iae�vsr�R RELES
�t= 99.rINLET DISTRIBUTION BOX �� 9 FT. AND REGULATIONS FOR SUBSURFACE
OBSERVATION- HOLE I . OBSERVATION HOLE Z DISPOSAL of SANITARY SEWAGE
ELEVATION =/o/� ELEVATION- OUTLET DISTRIBUTION BOX 97. 7 FT.
0 , p" �- TFSr/J01�E 3' INLET LEACHING PIT ' 97, -i/ FT.
rov r Too EL = /D/.3 BOTTOM LEACHING PIT 9/• ! FT.
S'�FSoi -
S�Noiu�y ��Y/SQtio DESIGN CALCULATIONS
n ra.,%ley H �h NUMBER OF BEDROOMS .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . z
GARBAGE DISPOSAL UNIT... .
TOTAL ESTIMATED FLOW (1/0 x?—BR.).., zzo GAL./DAY
_ 138 - REQUIRED SEPTIC TANK CAPACITY. . . . . . . . . . . . GAL.
Gtr o.v IVNi T.t' ,,,:�-->-�:-s• - ACTUAL SIZE OF SEPTIC TANK TO BE INSTALLED.— / o0o GAL.
Leo, r�No LEACHING AREA REQUIREMENTS
SIDE WALL AREA z s GAL./S.F.
BOTTOM AREAL GAL./S.F.
/✓o yz0 .y�o sr-fo, ,c LEACHING CAPACITY ( BOTTOM SIDEWALL ).. .... . . . .. . �`�� GAL.
o� 2 T RESERVE LEACHING CAPACITY. . . GAL.
TOP OF � o �r. .�i.,i
FOUND.
ELEV.=/ol..S' CONCRETE 4 SCH. 40 CLEAN SAND
COVERS PVC PIPE CONCRETE
MIN, PITCH COVER
/ 11 1/8 PER. FT.
�.s 12 MAX. 2% MIN. PITCH
�.
• . FLOW LINE N 2�� LAYER OF I/8"-_i/Z1
WASHED STONE 3
:., 4" CAST IRON -� 3/4- 1 1/2" s
PIPE- MIN. PITCH , o �= 04 p WASHED STONE
1/4. PER FT' DIST. o —�-- -- — PRECAST LEACHING
BOX apn caw D c BASIN OR EQUIV.
W n
LL b b zC77-
• _. _ /UOD GAL W n �8.4,�NST,g3L� _MASS..
SEPTIC �T
� '�r R. J. O' HEARN INC. RLS, R$
TANK �o ,. ,,.
1348 ROUTE 134
i EAST DENNI -3 , MASS.
PROFILE OF GROUND WATER ,TABLE
SEWAGE DISPOSAL SYSTEM roe No.Bo-cc8 CLIENTZeesow
NOT TO SCALE DATE SHEET -OF z
2 a
® ,
_ I l
;r . k01 i /
9 9
�
R
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o ,
M
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y;
i
71
R.eoPosrd 2 ,aoc�y, p
i 5
1
E�S'�"NT/,o L<y Tf/E SAivE
Yt \ N
_ I • .� I //V O/S•e-EPA/.e
d�✓
LEGEND
EXISTING�� SPOT ELEVATIONS 0,0
EXISTING CONTOUR- 0- - - -
FINISHED SPOT ELEVATIONS U-0
FINISHED CONTOUR-0 ' PROPOSED PLOT PLAN
APPROVED: BOARD OF HEALTH 8,q eN ST,4 BL E
, MASS,
DATE AGENT Lor `�9/'lQr,,. sT -/Prx. •��
CERTIFY THAT THE PROPOSED R. J. O�HEARN, INC, RLS, RS
BUILDING SHOWN ON THIS PLAN 1348 ROUTE 134
CONFORMS TO THE ZONING LAWS EAST DENNIS , MASS.
MASS.
— ' DATE 3 z-�J60 SCALE'
JOE3 N0. eo—CG6 CLIENT:TvFesc�/
DATE REGISTERED LAND SURVEYOR DR. BY SHEET OF Z