HomeMy WebLinkAbout0094 PILOTS WAY - Health f `94 Pilots way
Barnstable
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TOWN OF BARNSTABLE
LOCATION lot /,O s td 4Z SEWAGE# Z'0 3 50
VILLAGE ,� �5'f'o, ( p ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. n®tn.� J&Ct%14 r 1
SEPTIC TANK CAPACITY
LEACHING FACILITY.(type) p?-J�Gf�e' �✓ s'r' (size)
NO.OF BEDROOMS 3
OWNER Am esrz�
PERMIT DATE: ���b /I3 COMPLIANCE DATE:
Separation Distance Between the: __J
Maximum Adjusted Groundwater Table to the Bottom of Leaching-Facility Feet
Private Water Supply Well and Leaching Facility Of any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any etlands e ist wit '
300 feet of leaching fac' ' Feet
FURNISHED BY
4
Commonwealth of Massachusetts
,w Title 5 Official Inspection Form '
Subsurface Sewage Disposal System Form Not for Voluntary Assessments s '
94 Pilot Way '
Property Address
Estate of Ann Weaver Gordon r ...
Owner Owner's Name
information is required for every W�Bamstable Ma 02668 10-5-2020 0."
page. Ci /Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information r
on the computer, Brett Hickey v�1
use only the tab
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return key. Company Name
374 Route 130 ,
' Company Address
Sandwich Ma 02563
City/Town 11 State - Zip Code
„eao (508)477-0653 S113747
Telephone Number License Number
a F
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above;the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ❑■ Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
Brett Hicke - 'Digitally signed by eretl Hickey -
y Date:2020.10.oege:54:00-04•eo• 10-5-2020
Inspector's Signature Date
- 3
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable,and the approving authority.
Please note:This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
(„•. r ,IV
Commonwealth of Massachusetts
Title 5 Official Inspection Form
- i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is West Barnstable Ma 02668 10-5-2020,
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes: r
❑■ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
The system was in working order at the time of inspection.'
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired.The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t51nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is West Barnstable yMa 02668 10-5-2020
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (Cont.)
2) System Conditionally Passes(cont.):.
❑ Pump Chamber pumps/alarms not operational. System will,pass with Board of Health approval'if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced `• , ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed _ ❑ Y ❑ N ❑'ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
i
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health,safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5ins .doc•rev.7/26/201 B
P Tltla 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
A - Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
....... 94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is West Barnstable Ma 02668 10-5-2020
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health(and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has.a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The,system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well..
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
❑ a Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ❑ Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form {
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is West Barnstable " I Ma 02668 10-5-2020
required for every _
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No,
❑ 0 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 Y2 day flow
El El obstructed
pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ El Any portion of the SAS,-cesspool or privy is below high ground water elevation.
❑ E - Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ E] Any portion of a cesspool or privy is within a Zone 1*of a public water supply
well. `
• i
❑ E Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ E 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.]
❑ a The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd. -
❑ , E] The system fails. I have determined that one or more of the above failure'
criteria exist as described in 310 CMR 15.303,therefore the system fails.The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a '
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is West Barnstable Ma 02668 10-5-2020
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.) .
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered"yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate "yes"or"no"for each of the following for all inspections:
Yes No
0 ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ E] Were any of the system components pumped out in the previous two weeks?
El ❑ Has the system received normal flows in the previous two week period?
❑ 0 Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
❑ E] Was the facility or dwelling inspected for signs of sewage back up?
0 ❑ Was the site inspected for signs of break out?
El ❑ Were all system components, excluding the SAS, located on site?
0 ❑ 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?
❑ El 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:
0 ❑ Existing information. For example,a plan at the Board of Health.
❑ 0 Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable)[310 CMR 15.302(5)]
t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is required for every West Barnstable Ma 02668 10-5-2020
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions: r
3 3
Number of bedrooms(design): Number of bedrooms(actual):
357/GPD
DESIGN flow based on 310 CMR 15.203(for example: 1.10 gpd x#of bedrooms): ,
Description:
Number of current residents:
Does residence have a garbage grinder? t ❑ Yes No
Does residence have a water treatment unit? # ❑ Yes ❑. No
If yes, discharges t&. `
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No
information in this report.)
Laundry system inspected? ❑ Yes' e❑ No
Seasonaluse? ❑ Yes 19 No
See below
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
"WELL WATER"
i
Sump pump? y ° . ❑ Yes ❑■ No
' current
Last date of occupancy: Date
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
- 94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is West Barnstable Ma 02668 10-5-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment: NA
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: oats
Other(describe below):
3. Pumping Records:
Source of information: Owner- last pumped 2014
Was system pumped as part of the inspection? ❑ Yes ❑■ No
If yes,volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
Commonwealth 'C � a th of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments.
94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is West Barnstable Ma 02668 10-5-2020
required for every t •
page. City/Town State Zip Code Date of Inspection
D. System Information (cont:)
4. Type of System: -
Septic tank,distribution box, soil absorption system
❑ Single cesspool `
❑ Overflow cesspool -
❑ Privy ,
❑ Shared system (yes or no)(if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract to be obtained from s stem owner and a co of latest
( Y ) PY
inspection of the I/A system b system operator under contract r
Y Y Y P
❑ Tight tank.Attach a copy of the DEP approval.
❑� Other(describe):
Approximate age of all components,date installed(if known)and source of information:
2013 per plans
Were sewage odors detected when arriving at the site? ` < ❑ Yes ❑■ No
5. Building Sewer(locate on site plan):
1rgn
Depth below grade: feet
Material of construction:
❑cast iron ❑■ 40 PVC ❑other(explain):
>100'from well to SAS
Distance from private water supply well or suction line: feet .
Comments (on condition of joints, venting, evidence of leakage, etc.):
r _
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18
Commonwealth of Massachusetts
--_- Title 5 Official Inspection Form
r i Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments
94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is West Barnstable Ma 02668 10-5-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
9r�
Depth below grade: feet
Material of construction:
FE-1 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
1
Dimensions: 000gallons
10if
Sludge depth:
2611
Distance from top of sludge to bottom of outlet tee or baffle
1n
Scum thickness
611
Distance from top of scum to top of outlet tee or baffle
1611
Distance from bottom of scum to bottom of outlet tee or baffle
measured
How were dimensions 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.):
The tank was in working order at the time of inspection. The tank is in need of pumping
at this time and should be pumped every two years for maintenance.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts `
f
p Title 5 Official Inspection Form
w
fill
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
........ , 94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is West Barnstable Ma 02668 10-5-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.) -
7. Grease Trap(locate on site plan):
" � •
Depth below grade: -NA
feet
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain):
i
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert,evidence of leakage,etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan):
`Depth below grade: NA
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain):
r Dimensions:
` Capacity: gallons
I Design Flow: gallons per day `
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
F
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
v 94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is West Barnstable Ma 02668 10-5-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches,etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened)(locate on site plan):
0"
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.):
The d-box was in working order at the time of inspection.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
l
Commonwealth of Massachusetts
�- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
i J
94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is West Barnstable Ma 02668 10-5-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.):
NA ,
i
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS)(locate on site plan,excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
(2)500 gallon chambers
n leaching chambers number: ,
❑ leaching galleries number:
❑ leaching trenches number, length:
` ❑ leaching fields number, dimensions:
❑ overflow cesspool number:'
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
F 94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is West Barnstable Ma 02668 10-5-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS)(cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation,etc.):
The SAS was in working order at the time of inspection. Chambers were 1/2 full
when viewed.
12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
NA
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
~ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is required for every West Barnstable Ma 02668 10-5-2020 •
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy(locate on site plan):
NA 4
Materials of construction:
Dimensions ,
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5lnsp.doc•rev.7/26/2018 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18
,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is West Barnstable Ma 02668 10-5-2020
required for every
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
❑■ hand-sketch in the area below
❑ drawing attached separately
B
A'
A2.51'6"
Driveway O 81 or
82.66'
o .
0
Whit
15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form,
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments,
.. /,�y 94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner
Owner's Name
information is West Barnstable Ma 02668 10-5-2020 `
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information.(cont.)
15. Site Exam:
❑■ Check Slope f
■❑ Surface water
Check cellar
❑■ Shallow wells
No GW @ 152"
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
El Obtained from system design plans on record
10-5-2020
If checked,date of design plan reviewed: Date
F
❑ Observed site(abutting-property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
r
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
A plan on file'at the local Board of Health was used to determine high groundwater.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t51nsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1i1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
J 94 Pilot Way
Property Address
Estate of Ann Weaver Gordon
Owner Owner's Name
information is West Barnstable Ma 02668 10-5-2020
required for every
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
❑■ A. Inspector Information: Complete all fields in this section.
❑■ B. Certification: Signed&Dated and 1, 2, 3, or 4 checked
�■ C. Inspection Summary:
1,2, 3,or 5 completed as appropriate
4(Failure Criteria)and 6(Checklist)completed
�■ D. System Information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal_System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
i
151nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zipplitation for Disposal *pstrm Construrtion Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. O C4-16 K Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel J3
Installer's Name,Address,and Tel.No.S'o� y� a 77 Designer's Name,Address,and Tel.No. O �{7753i3
4Les EX AL/� , ze- c weJrkS
Type of Building:
Dwelling No.of Bedrooms Lot Size ,Dy sq.ft. Garbage Grinder( )
Other Type of Building3j��y — No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided 3`J gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
�Description of Soil J `e 6 o
Nature of Repairs or Alterations(Answer when applicable) S� T 4�q
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 ode and not to pl e e system in operation until a Certificate of
Compliance has been issued by this Board a ` ( 6 , (3
Signe Date 1 rr
Application Approved by Date O
Application Disapproved by Date
for the following reasons
Permit N . Date Issued
,! No. Fee
THE COMMONWEALTHIF
�OF MASSACH`US.ETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN •BXRNSTABLE, MASSACHUSETTS Yes
9pplication for VsposaY *pia ',ut Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Aba don( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 9 i G f S Wa Owners Name,Address,and Tel.No.
ri z,.' I
Assessor'sMap/Parcel
Installer's Name,Address,and Tel.No.,5'ag V77 p/77 Designer's Name,Address,and Tel.No. S�O� </775313
1
41.5 �Q t f'/ l d
Type of Building:
Dwelling No.of Bedrooms Lot Size GL/ sq.ft. Garbage Grinder( )
Other Type of Building /�,oy Lo„ No.of Persons Showers( ) Cafeteria( )
Other Fixtures 2
Design Flow(min.required) J� gpd Design flow provided 3 5 IF- gpd
Plan Date Number of sheets t Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil `� -e--e ?6 o
Nature of Repairs or Alterations(Answer when applicable) S� P �1 G V1
E
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 ode and not to pl -dlfile system in operation until a Certificate of
Compliance has been issued by this Board o eal' '. f
Signe Date
Application Approved by Date L f S —
Application Disapproved by Date
for the following reasons /
r _
vPN'� �� r � Date Issued f I
TH.w:COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site SewageDisposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by /\on S ekCa aa�t NC' 7';,,C
at �i -S has been constructed in accordance
with the provisions of Title 5 and the for Aisposal System Construction Permit No.—SO 13 -Oddated
Installer� 1EXC,(4 f 1 G T_ vt C Designer
#bedrooms ,� Approved design flow 3!7 gpd
The issuance of this permit shall/not be construed as a guarantee that the s(stem will nct o \designed. _
Date L//� Inspector
,r
-----------------------------------------d --------------------------------------------------------------------------------------,�
-------------
No. C) 13 -- 13(� Fee '�a�;/
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
30isposal QPp6tem Construction permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
System located at �U t'� 16 C_1_JGi C9
J
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 be completed within three years of the date of this permit
Date ��" j Approved by
_ _ I
Town of Barnstable P#
Departinent of Regulatory Services
Public Health Division Hate Z 7 10
> A .
sasq �d' 200 Main Street,Hyannis MA 02601
Date Scheduled I �`� / �-� Time Fee l Pd
.
Soil Suitability As essment or Sewn a Ds osal
.f p
Performed a z /N'l .r✓K S �-"Z-
Y' Witnessed By:
LOCATION& GENERAL INFORMATION
Loeadon Address -`
J � �/G�-f-S- �� alner's Name A-.r1 K C CN<rdf/r�
- A �A Zl�� io, � �,'—Address
Assessor's Map/Parcel: ��-7 G C Engineer's Name.
NEW CONSTRUCTION REPAIR Telephone# — �j�— �{�.61
Land Use �cSi dt¢�n ?� 1 Slopes(%) Z (— Surface Stones
Distances from: Open Water Body z-OJ�' ft Possible Wet Area i C'' ft Drinking Water Well �. t C2D ft
Drainage Way "� A' ft Property Line �^ft .Other ft
SKE'T.CH:(Street name,dimensions of lot,exact locations of test holes&:perc tests,locate wetlands?n proximity to'holes)
' n
a
Parent material(geologic) "'T�' ` (� Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: N Weeping from Pit Face
Estimated Seasonal High Groundwater I SZ
DETERARNATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in, Depth to s411 mottles: In.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index.Well.# _ Reading Date: - Index Well level Ad),thetor— Adj.droundwater Level
PERCOLATION TEST gate, Time..r�"
Observation
Hole# 2 n Time at 9"
A��lys's
Depth of Perc 4 � Time at 6"
Start Pre-soak Time® Time(V-6")
End Pre-soak
Rate Min./Ineh
Site Suitability Assessment: Site Passed x Site Failed: Additional Testing Needed(Y/N)
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 Conselcvation Division at least one (1)week prior to beginning.
Q:\,SEPTICIPERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture .:Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders`,
Consiiter&. v 1
A
S ` kd its/
s
toy
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil ' Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistency.
6 - boy CS
C)� ,M S 1Q L(0 c.
5V-Q- CA^NOq, S. s .
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture_ Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. tar ve
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure;.Stones',Boulders.
Flood Insurance Rate Map:
Above 500 year flood boundary No— Yes __
Nit tin yea. c— j _
Within l00 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
' all areas.obse
rved throw hout.the
Does at least four feet of naturally occurring pervious material exist to t
area proposed for the soil absorption system? �S --
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on < «`t_s (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 training,expertise and experience described in 310 CMR 15.017.
- Date
Signature
Q:\.Ev ICI?ERCFORM.DOC
r
down cape engineering, inc. SIEVE SOILS'ANALYSiT94 PILOTS WAY BARNSTABLE,MA
•
DATE OF REPORT`:2/27/13�
.JOB : GRAIN SIZE ANALYSIS-SIEVE TEST
SITE: 94 PILOTS WAY BARNSTABLE, MA
LOCATION: ENGINEERING WORKS TEST HOLE
SIEVE ANALYSIS weight Sample(Grams): 255.7
SIZE "WEIGHT RETAINED %RETAINED = %PASSED
-__-... .. (SUm.............. ....-,. --------- ....., n_
1" 0.0. " 0.0°f°: 100.0/°
0.01 0.0%: 100.0%
00 00°los. _100.00
-------------�_ ....................... .._ ......,.....,---------------------a-------
3/8'" 0.0: 0.0% _ 100:0%
0 0 0 0% 100 00/0 i
10 10.3 _ 4 0%: 96 01°
......... .... . ..... »__------_ ° ......_........., °
20 -- 47,5 18 6% $1.4°l°
------ ----;_ ....,.... -.._,.,..... •,----=--------------_�...-•--.............._
#40136,7 53.5%- 46.5°l°
0 173 8. 68 0/°' 32 0%
0 218 2; -y_--_- _85.3%- ^ 14.7%
100 = 232 0' 90 7%0 . 9_3%
00 244,51 95.6%„ 4.40/c
PAN: 2510 100.0%l 0.0%
SAMPLE. 255.7 ------ - -
NOTETEST ON PASSING#4 ONLY, 1.7%RETAINED ON#4<45%O.K_
RESULTS;
SOIL CLASSIFIED AS AASHTO AA-b(GRAVEL&SAND)(UNCOMPACTED)
PERCENTAGE OF MATERIAL PASSING#4 SIEVE :
#4 100% (TEST ONLY MATERIAL PASSING#4) OK
#5010%-100% OK
#100 0%°-20% OK
#200 0%-5% OK
SAMPLE MEETS TITLE 5 FILL SPECIFICATION
>95%SAND
RESULTS:PERMEABLE MATERIAL-CLASS I<2 MIN./IN.MATERIAL
NONCOMPACTED ,;t�At.SOIL DESCRIPTION: SAND _
�� 6 5
04/25/2013 11:02 5084775313 ENGINEERING WORKS PAGE 02
Tom=of Barnstable
Sato" Services
T onm F. Geller,Dlreetor
Pub& HeRM Division
Tlio�aas 1Vllell�ean,Director
200 Main 8tvet, Hyannis,MA 0260I
Office: 508-Ka4644 Fax: 5W790-6304
Date: 0 Z'Jr 1%'5 Sewage Permitt# Assessor's Map/Parcel Z 31 —d jV�
ller&Desismgr Qdificsfign Form
T14.� +-Q,e _E.
a
Designer: ., 1ric , Installer: _ nd► a ct.,�g
Address: lz W, Crb a s Qr.1at TU- _ Address: gz.� (Z44'.0A
A-
Un was issued a permit to install a
septic system at 94 fi loks W. 13. bassed on a design drawn by
ass _.�
worw I «r.c dated 7, 2 7K 13 ,
(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 (Le,
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)w . ted and the soils
were fo tisfacto tj OF.
PETER T.
MCCENTEE
'or s 5lgnature) CIVIL
�No.�tD9 4
(De
Q�
signer's Signature (A x Design
SE &LUM O BARNSTAM FU
Mg MULTHDIVISII LATE
ggMajMCE MUL NUT BE 1q1JE UNTEL BOTH XMS FORM
CE VED BY THE BARNSLARLE PUBLIC HEALTH D
gAofflco fa m Meaignerccrtifieation foawaoc
-44' -- EXISTING CONTOUR waLRoao
y %
x 100:98 EXISTING SPOT GRADE N LOCUS
�. -O.-H.W-OVERHEAD•WIRES o
EXISTING WELL J v_
m � o
'NEST PIT Route 6A ° ¢
® BENCHMARK o
� a 3
F • LEGEND
TBM NO. 2 s' r a ao a U
m d
• UTILITY POLE/TOP OUTLET BOX ' s -
EL.=41.80 (ASSUMED DA TUM)
�. TBM N0. ) ROUTE 6
` LT,'OU7SIDE COR/BOTT, :STEP LOCUS MAP
EL.=41.06 '(ASSUMED DATUM)
NOT TO SCALE^
Or / x 3.90` x 34.6
x,30 IV 843p
. 2
o,. W
` - x 36.30 37:70 2�8 54,
x 35.03 //
m STRIPOUT BOUNDARY \ �,� 38.00 ,% LL /
38.72-
SEE NOTE •1 1 \ / x 36*636 99; -�8 +3
+38.6
?... .. +.38.34
x 39.1 + 38.05
-x 36.52 39.99 _.
/ .
a.t
/ ! \ �� _- - �__+ e •f lawn
/ �y .3994,E e�g �i4
38.54 $-- .. 39.91 ,� 1� DECK \ x.39.07
lu
Cb 390
to 7 4 x x 0.27--- \`4�----_���/'- \\^ ^
CD
O cti _
.... .88tV N
- 40: `} '+41.19
x 41.03
21 41.
T 03 �Ex�snNc 4' 'j o (a ENT. HOUSE(#94) �?' X ao.9e Q +41s1 ?.
7 x VENT �13� 40. s
38.96
38.72 1:'
�/ ��f�O I �9.73 ,. 142.0 / 4T96 �\
r TP 1 �,fQ 1 J . 3 \
f 0 39.25
,9, Q /' x,,&60 x 41.22 / \\
SpiL4'74
- 3 2
40.1 L1fo
G +42.98
/ / S KE39.22 ' 38.92 \
k. ^\ Ij
i
cli
40)
03
00
SHED -- ---
i .�_,a .'\ z.��
, :\. o LOT •2 z -
40.4 x
U.
L J \'
237-059--
39.58 4. •^ �.' 35,049 S.F.t '
x a2s -N
r� P
` u , EXISTING: SEPTIC. TANK
GENERAL NOTES:
TOP'OF'TANK, EL -3B.95 '
INV.(OUT)=37.62 ^, 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE:LOCAL ,
BOARD OF HEALTH.AND THE DESIGN ENGINEER. `
TING L EXIS EACH FIELD r
-' 2. ALL WORK AND MATERIALS-SHALL CONFORM TO THE REQUIREMENTS
(APPROX.-PER;OWNER) z OF THE STATE ENVIRONMENTAL CODE, TITLE V,'AND ANY APPLICABLE"
TO BE ABANDONED— LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW:
4205 i' ;qt�- -LOCAL REGULATION Chapter 397-8(E);,Well Locations:'"
EXISTING LEACH PST . 4 ,' 1) A 45' variance S:A.S. to Well (locus),_ for an .105' setback
(APPROX' PER OWNER) 2) An 21 variance, D-Box to Well .(locus), for a 129'•setback. '
2
TO'BE P.UWPED; FILLED WITH. 4 ,. 3• THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED 'PRIOR
SAA/!� AND ABANDONED.: TO INSPECTION AND, APPROVAL BY THE BOARD OF,HEALTH AND-THE
DESIGN ENGINEER:
4. ANY CONDITIONS ENCOUNTERED. DURING CONSTRUCTION DIFFERING'
DRIVEWAY AREA SELECTED FOR-FOLLOWING REASONS: FROM THOSE SHOWN HEREON.SHALL BE-REPORTED TO THE DESIGN:',
ENGINEER-BEFORE CONSTRUCTION'•CONTINUES. -
1) GRAVITY FROM EXISTING TANK POSSIBLE
2) NO PONDING OVER' S.A.S: 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
v 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF` +
3) +DEPTH OF COVER +ACHIEVED •`
' � p • _ - � '• THE CONTRACTOR OR.OWNER ,T0 NOTIFY THE LOCAL BOARD OF
" !n 4) PUMPING NOT;REQUIRED HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
°2 0 5) ACCESS WITH MINIMUM DISRUPTION TO PROPERTY 7. WATER'.SUPPLY PROVIDED BY PRIVATE WELL F
Po.o 8. THERE ARE NO ABUTTING WELLS WITHIN 150' OF THE`PROPOSED S:A.S.
9. ALL AREAS CLEARED FOR•CONSTRUCTION SHALL BE RESTORED AS `
+ \ a�' �'. AGREED UPON 'BY OWNER`AND CONTRACTOR OR"AS OTHERWISE.
: DIRECTED BY THE-APPROVING AUTHORITIES. s r
;p° t 10. IT SHALL BE THE RESPONSIBILITY,OF.THE CONTRACTOR TO VERIFY
se 4 OF •. 'THE LOCATION OF ALLUNDERGROUND UTILITIES, PRIOR TO BEGINNING
:;"+•m ��� 04s�q CONSTRUCTION. _
11.,'WHERE.REQUIRED; CONTRACTOR' SHALL REMOVE`ALL UNSUITABLE SOILS
o PETER T. G� IN THE AREA,BENEATH:AND FOR 5'• ON ALL SIDES,OF..THE S.A.S. AND
McENTEE ,REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 .CMR'255(3).
{ CIVIL. 12. .AREAS-REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
No 35109. INSPECTED-BY 'HEALTH DEPARTMENT PRIOR TO BACKFILL.-
a:- 13. THIS PLAN'IS-TO BE. USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
�fPSIF �C� IS NOT TO BE_CONSIDERED A PROPERTY LINE SURVEY.
- -PROPOSED SEPTIC SYSTEM' ' UPGRADE PLAN
Vc.
. 941 PILOTS WAY,�4`WEST BARNSTABLE,: MA
" Prepared for: Ann Gordon; 2114 Main Street, West Barnstable, MA 02668
CALF
1. 0 N0.
Engineering by: S DRAWN, JOB.
OWNER OF' RECORD En ineerin Works, lnc. �r 1"=30' P•T•M• 111-13
p
GORDON, ANN 9 9
2114 MAIN STREET 12 West Crossfield Road; Forestdale, MA 02644 DATE CHECKED SHEET NO.
:•47.64� WEST BARNSTABLE,. MA 02.668 (508) 477-5313 - �' - 2/28/1-3 P.T.M. 1 Of 2--
$ ' A NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL.36.0
FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
SEPTIC TANK
INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BOX ` " PROPOSED S.A.S.
OUTLET AND SET TO 6" OF FINISH GRADE INSTALL' H-20 RISER, FRAME INSTALL_ H-20 RISERS, FRAMES & COVER SET TO
T.O.F. & COVER SET TO GRADE -GRADE OVER .ONE CHAMBER (MIN.) FOR INSPECTION.
EXISTING `',. F.G. EL.=38:9t
F.G. EL_=39.4t ,, , F.G. EL.=38.9t VENT
L =.21; L 4;
® S=1% (MIN.) ® S=1%,(MIN.) 2" LAYER OF 1/8" TO 1/2"4"SCH40 PVC 4"SCH40 PVC.
6" DOUBLE WASHED STONE
(OR APPROVED FILTER-FABRIC)
14 - 6 24" eaaaaaa
•� EXISTING 48" LIQUID EFF. DEPTH aaaaaaa 3 4- TO 1-1 2- DOUBLE
INV.=37.62t / /
LEVEL 4' 5.2' 4' WASHED STONE
-INV.=36.17
GAS BAFFLE INV:=36.00 .
PROPOSED D—Box EFFE&IVE.`WIDTH = 13.2"
H=20 RATED. INV.=35:50
EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS
SURROUNDED WITH STONE AS SHOWN
H-20 RATED
NOTES: TOP CONC.'-ELEV.=36.6
1) CONTRACTOR SHALL VERIFY ALL EXISTING=PIPE BREAKOUT ELEV.=36:00 ease
FF
INVERTS, PRIOR TO INSTALLATION INV.. ELEV.=35.50 seas
A.
aaaaa Mama
2) D-BOX SHALL BE SET LEVEL & TRUE TO GRADE ease BaBaa
ON A MECHANICALLY COMPACTED 6" 'CRUSHED BOTTOM _ELEV.=33.50
4' 2 X 8.5'=17.0' 4'
STONE BASE, AS SPECIFIED IN 310 CMR-15.221(2). 4' OF NATURALLY OCCURRING
3) INSTALL INLET & OUTLET TEES-AS REQUIRED. , s PERVIOUS MATERIAL EFFECTIVE LENGTH = 25:0'
4) CONTRACTOR' SHALL INSTALL AN APPROVED EFFLUENT 5' (MIN.) ABOVE G.W. T, ,
FILTER ON THE OUTLET TEE. LEACHING SYSTEM SECTION
BOTTOM OF TP, EL25.6
SEPTIC SYSTEM PROFILE '
N.T.S. -
SOU IOG
SOIL EVALUATOR: PETER` McENTEE PE
DATE: '�FEBRUARY 22, 2013 (REF.#13,875)-
WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT
ELEV. •TP-1 DEPTH ELEV. TP_2 DEPTH
,38.7 A 0„ 38.3 A 0 .
SANDY LOAM SANDY LOAM
j DECK 36.7 B 10YR 4/2 24" s 36.3 .B 10YR 4/2 24„
SANDY LOAM SANDY LOAM
__. _
5 2, 10YR 5/8. 42" 35 0 10YR 5/8 40"
-
C1 CY =
•L 53,7 /EX�ST/N!i SILT LOAM SILT, LOAM''
5Y 5/3 ` "5Y 5/3'-
' ENT. HOUSE#94) UNSUITABLE UNSUITABLE
T,D.F,-41 it 30.0. C2 104„ 29.6 C2 104"
STRIPOUT TO
Q I 9 MED. SAND MED. SAND
NI a 2,2• 10YR 5/6 EL:=29,6t 10YR 5/6
O
' .. SAMPLED
7.0
26.0
152"
.HORIZON)
' PERC RATE 5 MIN/IN BY,SIEVE ANALYSIS("C2" ON)
NO GROUNDWATER ENCOUNTERED
SPIKE3.22 �-
SHED ®E3®®®® ®®®®® ` 37"
• �k
w ®aa®® ® ®®®® _
of 102" �. :..
S.A:S. LAYOUT
4" KNOCKOUT.
DESIGN CRITERIA - 20p DlA, COVER
NUMBERI OF BEDROOMS: 3 ,BEDROOMS -.4:' KNOCKOUT.- 4" KNOCKOUT 62" '
SOIL TEXTURAL CLASS: CLASS 'I
- 0.74 GPD/SF (PER SIEVE-ANALYSIS) ,
DESIGN PERCOLATION RATE: 5 MIN/IN 4" KNOCKOUT
A
DAILY FLOW: ` 330• GPD r '
DESIGN .FLOW: 330 GPD r ,
GARBAGE GRINDER: No 500 "GALLON CAPACITY, M-20 LOADING
EXISTING., SEPTIC TANK: 1000-GALLON, CAPACITY CHp�ABCpc
LEACHING. AREA REQUIRED: (330 GPD) = 445.9 `SF -
74 GPD/SF N.T.s _
USE 2"500'-GALLON -LEACHING.*CHAMBERS IN SERIES PROPOSED `SEPTIC SYSTEM UPGRADE PLAN
SURROUNDED BY DOUBLE WASHED,STONE—ALL-SIDES 94. PILOTS . WAY, WEST BARNSTABLE, MA
SIDEWALL AREA: 2(13.2' .+'25.0') X 2 = .152.8 S.F.
BOTTOM'AREA: 13.2' x 25.0' _ •330.0 S.F. Prepared for: Ann Gordon, 2114 Main Street, West- Barnstable, MA 02668
' TOTAL- AREA:... ..... ;.... ....::....482.8 S.F. s Engineering by: ,. SCALE DRAWN JOB: No.
t Engineering Works, Inc. N.T.S. P.T.M. 111-13
DESIGN FLOW PROVIDED: 0.74 GPD/SF(482.8 SF) = 357.3 GPD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET.No.
(508) 477-5313 2/28/13 P.T.M. 2 Of 2