HomeMy WebLinkAbout0028 POWDER HILL ROAD - Health _---_
28 Powder Hill Road
A =299 --088
Barnstable
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C29q 098
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 28 Powderhill Road
Property Address
Patrick& Susan Tyrrell �<
Owner Owner's Name
information is / _
required for every Barnstable V Ma 02630 6-1-17
page. Cityrrown State Zip Code Date of Inspection
*y't
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. General Information
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Matthew Gilfoy
use the return key. Name of Inspector
B&B Excavation
r� Company Name
374 Route 130
Company Address
Sandwich Ma 02563
Citylrown State Zip Code
(508)477-0653 S113640
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further,Evaluation by the Local Approving Authority
6-1-17
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system 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 to the buyer, if applicable, and the approving authority.
****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.
t5ins°3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
,�® VS
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 28 Powderhill Road }
Property Address
Patrick& Susan Tyrrell
Owner Owner's Name
information is required for every Barnstable Ma 02630 6-1-17
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D.
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15'304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
System was in working order at time of inspection.
B) 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):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
28 Powderhill Road _
Property Address
Patrick &Susan Tyrrell
Owner Owner's Name
information is required for every Barnstable Ma 02630 6-1-17 '
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will y pass inspection If(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public^health,_
safety and 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 a salt marsh
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
28 Powderhill Road
Property Address
Pa
trick& Susan Ty
T rrell
Owner Owner's Name
information is required for every Barnstable Ma 02630 6-1-17
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply. .
❑ The system has a septic tank and SAS'and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS'and the SAS is within 50 feet of a private water
supply well.
❑ The system has 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.
3. Other: x
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of,sewage into facility or system component due to overloaded or
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
99 p
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
i
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
° M 28 Powderhill Road l
Property Address
Patrick& Susan Tyrrell
Owner Owner's Name
information is
required for every Barnstable Ma 02630 6-1-17
page. CityTTown State Zip Code Date of Inspection
B. Certification (cont.) '
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
i
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
El ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100„feet but greater than 501feet
from a private water supply well with no acceptable water quality analysis.'[This
system passes if the well water analysis, performed'at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ The system,is a cesspool serving a facility with a design flow of 2000gpd-i
10,000gpd."
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CM 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure. I
E) 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 D.
t
Yes No
I
❑ ❑ 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 1
I
If you have answered "yes"to any question in Section E the system is considered a significant threat;
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department. j
t5ins•3113 Title.5 Official Inspection Form:Subsurface Sewage Disposal System-Pagel 5 of 17
i.
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 Powderhill Road I i4^M
Property Address
Patrick&Susan Tyrrell {
Owner Owner's Name
information is required for every Barnstable Ma 02630 6-1-17
page. CitylTown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate."yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner,'occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
{
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection? I
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A) {{
❑ ® Was the facility or dwelling inspected for signs of sewage back up?
I
f
' t
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site? j
® ❑ 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, I
dimensions, depth of liquid, depth of sludge and depth of scum? 1
❑ ® Was the facility owner(and occupants if different from owner) provided with!
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issI e
approximation of distance is unacceptable) [310 CMR 15.302(5)] r
t
_ I
t.
D. System Information
. i
Residential Flow Conditions:
Number of bedrooms (design):- 4 Number of bedrooms (Actual) _4
. l
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 441gpd
I
i
(Sins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 28 Powderhill Road
Property Address
Patrick & Susan Tyrrell
Owner Owner's Name
information is required for every Barnstable Ma 02630 64-17
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? Yes ❑ No
Seasonal use? ❑ Yes ®' No
Water meter readings, if available last 2 ears usage See below
9 ( Y 9 (gPd))�
Detail:
2015-40,000gallons 2016-45,000gallons
Sump pump? ❑ Yes.,® No
Current
Last date of occupancy: Date
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
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments `
28 Powderhill Road
Property Address
Patrick & Susan Tyrrell
Owner Owner's Name
information is required for every Barnstable Ma 02630 6-1-17
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: Owner- not pumped since installed in 2011
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumpedi gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool r t
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records,if any)
El Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
28 Powderhill Road .
Property Address
Patrick & Susan Tyrrell
Owner Owner's Name
information is required for every Barnstable Ma 02630 6-1-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
2011
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
_
Depth below grade: 4„feet
Material of construction:
❑ cast iron ® 40 PVC ❑other(explain):
Distance from private water supply well or suction line: Town
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank (locate on site plan):
Depth below grade: 1 4
feet
Material of construction:`
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
1500 gallons
Sludge depth: 2
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 28 Powderhill Road
Property Address
Patrick& Susan Tyrrell
Owner Owner's Name
j information is
i required for every Barnstable Ma 02630 6-1-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle 34
Scum thickness 1
Distance from top of scum to top of outlet tee or baffle 6
Distance from bottom of scum to bottom of outlet tee or baffle 15"
How were dimensions determined? Measured
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 was in working order at time of inspection with liquid level equal to outlet invert. Tank is not in
need of pumping at this time but should be pumped every two years for maintenance.
Grease Trap (locate on site plan):
Depth below grade: NA
feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other,(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle '
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
° 28 Powderhill Road
1M
Property Address
Patrick&Susan Tyrrell
Owner Owner's Name
information is required for every Barnstable Ma 02630 6-1-17
page. CityFrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
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):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
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
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
^M 28 Powderhill Road
Property Address
Patrick& Susan Tyrrell
Owner Owner's Name
information is required for every Barnstable Ma 02630 6-1-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
DeDepth of liquid level above outlet invert 0 11
P q ,.
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.):
D-box was in working order at time of inspection with no sign of past backup or carry over.
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
*
If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts T
W Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
47M 28 Powderhill Road
Property Address
Patrick& Susan Tyrrell
Owner Owner's Name
information is required for every Barnstable Ma 02630 6-1-11
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
® leaching fields number, dimensions: (20)Hi caps
32'x12.85'x1'
❑ 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 was in working order at time of inspection. No high staining, damp soils or lush vegetation
were present.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration NA
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
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for g p y o Voluntary Assessments
°M 28 Powderhill Road '
Property Address
Patrick & Susan Tyrrell
Owner Owner's Name
information is Barnstable Ma , 02630 6-1-17 {
required for every '
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
}
4
Privy (locate on site plan):
Materials of construction: NA f
r
I
Dimensions
,
Depth of solids
t
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;
etc.):
t
• fi,
,
1
i
fi
�k
' C
e _
v, t
` f
v
' 1
i
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i-
t
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 28 Powderhill Road
Property Address
Patrick & Susan Tyrrell
Owner Owner's Name
information is required for every Barnstable Ma 02630 6-1-17 -
page. CityrFown State Zip Code Date of Inspection
D. System Information (cont.)
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
REAR
A B
Al-20' 131-50' .
A2-26' 132-42'
A3-45' 133-3W
A4=33' 134-66.5'
4.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�^M 28 Powderhill Road
Property Address
Patrick& Susan Tyrrell
Owner Owner's Name
information is required for every Barnstable Ma 02630 6-1-17
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: No GW 180"
feet
Please indicate all methods used to determine the high ground water elevation: .:
® Obtained from system design plans on record
If checked, date of design plan reviewed: Oct-25-2011
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Plan on file with BOH.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
A Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for.Voluntary Assessments
- l
G„M
28 Powderhill Road ..
Property Address
Patrick& Susan Tyrrell
Owner Owner's Name x
information is required for every Barnstable a Ma 02630 6-1-17
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist ,
® inspection Summary: A,B, C, D,,or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
J.
® Sketch of Sewage Disposal System'either drawn on page 15 or attached in separate file
e
l5ins•3/.13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
t TOWN/O)F BARNSTABLE
LO CATION Y-/'O CdAQ� I / /?4-P SEWAGE# 0401 3 -)-a .
'VILLAGE ASSESSOR'S MAP&PARCEL 49q-oat
INSTALLER'S NAME&PHONE NO.,,o .lg�a no✓e i s o f >
SEPTIC TANK CAPACITY l
LEACHING FACILITY: (type) o �.✓�,%reyae) 3 2 5(
NO.OF BEDROOMS
OWNER S,V,,t g O� ���-► a �✓
PERMIT DATE: 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
� v ,
� ST
� .3"3S
f� Lf= 33
4
Po�1
No. ®I ✓ r v Fee' ( 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ftpliration for Disposal 6pstem Construction permit
Application for a Permit to Construct( ) Repair(/,/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Add ess or No. �JF Ol f�''l
Owner's Name,Address,and Tel.No.
S l"oW d' //I� lJ S/�2 i� ( � ��''-• /a r✓
Assessor's Map/Parcel C r=
Installer's Name,Address and Tel.No," De(! �r's Na e,Addres agd Tel.j o.
!�L 2 a .✓ /� s,
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank l LT O O Type of S.A.S. :101 s/�7 rZsa jb 02j"
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. AllSigne �� Date l D (s
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. oD( f — 3 ?o Date Issued 16 �o
x o' V Fee' / V
Nlo. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2ppYication for ]Disposal 6pstem Construction hermit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lqt No. �1 fJ Owner's Name,Address,and Tel.No.
1-7
Assessor's Map/Parcel �j �/ p �` { sA
Installer's Name,Address and Tel.No. Designer's Name,Address,and Tel.No.
S3 -7 -7-5
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(A/
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) �'� r] gpd Design flow provided _/ l/ gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank .5- 0 O Type of S.A.S. a A 1-4.) d 1„�t//t�?A 70 a1T
Description of Soil �^
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate.of
Compliance has been issued by this Board of Health.
S i g n e-d Date y6 ,
Application Approved by v Date ,o
Application Disapproved b Date
for the following reasons
Perma No:00( ( �� �e Date Issued 16�,, ,,j - - -
-------__.---_::_---- .:------ -- ._ _
r _ THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( )
bandoned( )by �
tif, has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit Nowt' dated 10 b Zo
n
Installer /" Designer (' ,A l',lr �✓ A ,
#bedrooms L�. . Approved design flow 't o'. gpd
The issuance of this permit hall npt be construed as a guarantee that the Sys em will fu do i ed.
Date 16 Inspecto
-------------------------------------------- ------------- ----------- -----------
NO.e.y 3 "O Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction permit
Permission is hereby granted to Construct( ) Repair�/ Upgrade( Abandon( )
System located at 7 190 w, (2,e
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 pe t.
Date d 10 11 Approved by
01/27/2022 02:56 FAX R 001/001
I
Town of Bari)stable
Regulatory Services
a�t,�% 'Charnils 17. (;t:ila-, Director
�It:1a„ 46 LE. �N Public Health Division
Thomas McKean, Direcior
200 Main Street, Ilyannis. MA 02601
i
Uf(ice�15()8 8h2.4644 Fax; 508-790-6'04
!a i
I1711e:j _�' Sewag a Permitrr :\SRl��tl1''ti ail/Pared � O
I I
iitst►►Iler-& Designer(,crtiliUltion F ortn 1
1
i
!
Drsi�iter _ -- installer; -- , •fit
1
Address: Atltiress:
LAg
011 11, Vb�ST.. wut issiir:d a Bert l it t,, inslf►I I a j
(institllcr)
septic,sysi L:m at
e:.L �3 �`_ . bo� ed tit, ar�n
design dr by
� QC' �.
(addr�tis) . 1
l ertify that the sr;otic Vstcni I-el- r"Ced above Wils inslitlltd ubst�ntially tlCcord lib to
th design- �ahie h ni,ly include 1rliLlclr aElpritvCd Uhiln�,ts such � ILiceral relocation of the
distribution box Auld/or septic rank. STr'ij)OU[ (if raquired) wt s inspected and the soil~
w re found salisfactoL-Y
k
r '
! ertify that Tile Septic sysidill l'e1G1'C1)CCL1 LtbMlt WiU IL1Sl<lllt wa.l hlflj0l' �:hdnges (i.e.
;]eater than I tl' ,ateral locution ul'thc SAS ur oily verticill r4l cation (:),' i1lV eU1TlpQnullt
ot'the septic System) hu ir, e1CL:ordancc Widl Stilre & Local Rc;ulationS. Phln revision ur
c rliliro as-built h. deslu.M Lv.t. 'StI-1110LIt (ifrequircd) a, mspecied alid the sails
vv re fLlurid ,atisr;lctii
;fin la let s Si��naLt
P ire)
PLCr15 RETURNCl BA NSl'A13LF, 1.'t:BL1C X�II'sr�l_;1'H DfV SION. C:1+:12TIF1C':A,ri4:
OF C:O 1PLZAV1'1I.L NOT D� T.S4CJF.D UNTIE I�C}TH MS FORM AND AS-
BiJIL'L Alt1? REC l_I L1) TiY T)FI.1' BAIZNSTABI L FCJI3LIC HLALTII ll1VISION.
THANK YOU.
��JI'F�co 1i�0 C�ltC5l�Ith crrLll0.dli,l'Iatiltsli•. - - �._
1
Town of]Barnstable P#
' Department of Regulatory Services
tM8TAMIM i Public Health Division Date_ l 0 ) 2 31 �
rE16
9. 200 Main Street,Hyannis MA 02601
Date Scheduled- a:� o ) �� Time�_ Fee Pd �.
S011 u�t �ability
i Assessment for Sewage ,Disposal
Performed By: Witnessed By::
LOCATION& GENERAL INFORMATION
Location Address C C IC�C':v,% �1 iz,�, Owner's Name S tar'-
GrCI F c�D� Address C'
Assessor's Map/Parcel: 'Engineer's Name
NEW CONSTRUCPION REPAIR Telephone#
Land Use ';Za5 ldfL�C,,.,\ Slopes(96) 1 D`L Surface Stones Al ar Q-
Distances from: Open Water Body ft Possible Wet Area a UQ f0 ft Drinking Water Well ft
Draihage Way ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
A
t ,
Parent material(geol'ogic)� .3c.�` .. Depth.to Bedrock
Depth to Groundwater. Standing Water in Hole: it �•Q Weeping froM oiojOpce
tit
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE y `'
Method Used:
Depth Observed standing in obs.hole: - In. 'Depth to soil mottles: In,
Depth to weeping from side of obs.hole: In, Groundwater A Justment ft.
Index Well# Reading Date: li.dex Well level _:_ Adj.1hetor Adj.Groundwater level R
PERCOLATION TEST Date- xhao
Observation
Hole# le V�. } \`•`��s TtmP$t 4"
Depth of Pero 'h lme a[6"
Start Pre-soak Time @ Time'(90.6")
End Pre-soak
Rate Min./Inch
Site Suitability Assessment: Site Passed---lt�` Site.Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Con vation Division at least one(1) week prior to beginning.
Q:XS EPTIC\PERCFORM.DOC
I
''
Depth from
DEEP-OBSERVATION HOLE LOG Hole# _
Soil Horizon Soil Texture
Surface(in.) Soil Color Soil Othcr,
(USDA) (Munsell) Mottling (Structure,Stones;Boulders.
o i ten Y.96 Gravel)
® � Ire >s e3 lV
8 c th M
4.. 2 t
J C� y
tAl' .
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture
Surface(in.) Soil Color Soil Other
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
onsiStengy,%Grave
POW LS
]DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture
Surface(in.) Sail Color Soil Other
(USDA) (Munsell) Mottling (structure,Stones,Boulders.
Co i to c G c
DEEP OBSERVATION HOLE LOG dole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling
(Structure,Stortcy;Boulders.
Consistency,
Flood Insurance Rate Man:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No w Yes
Within 100 year flood boundary No. Yes
Depth of Naturally OceurrinL,Pervious Material
Does at least four feet of naturally occurring pervious aterial exist in all areas observed throughout the
area proposed for the soil absorption system?
If not what is the depth of p naturally occurring pervious material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Environ tal P . n and that the above analysis was performed by me consistent with .
the required training, pe and p rie c described in 310 CMR 15.017.
Signature Date Le( l
. f
Q:1$EP'rICWERCPORM.DOC
-g.rov II. 31
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LOCATION SEW E PERMIT NO.
Q � 7,4 1
V-IL NGE
IN.STA LLER'S N AM& ADDRESS
B U I'L D E It OR O N ER
DATE PERMIT ISSUED 2-;-?
DAT E CO-MPLIANCE ISSUED y
�.
4
;,
' e
l� � �
��, r ��i
b - ® �\�
3
...
THE COMMONWEALTH OF MASSACHUSETTS
�oAR® F 'HEAL
.
�a ,
L ........OF.. ... ..... ...........
s �
.......................
Appliration for Uw ji i al Vitrku T ntitrurtiun Prrutit
Application is hereby made for a Permit to Construct ). or Repair ( ) an Individual Sewage Disposal
syst y . . :�f .... .. Z!"a-.... .. .....
... . .... Location- ress
.... 1114 ............... .... t No. ••••••••••••
-- = ---- --- --- --- ..
a Installer Address (
Type of Building Size Lot .._....;......Sq. feet
U Dwelling—No. of Bedrooms-__---3.................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons..,......................... Showers — Cafeteria
Pi Other fixtures .-.-_�:---__-___
-----------------------------------------------------------------------------
W Design Flow........13:70.........................gallons per person per day. Total daily flow.......\...._.�.C_�........_w-.-_-_gallons.
WSeptic Tank—Liquid capacity/d�... �a7Cons Length.......:........ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Wid •----__--'-�._..•-_.-• Total Length_ _.._.. __.._._ Total leaching area....................sq. ft.
Seepage Pit No.-------f .. ia `eQh e Total leaching area.... 7�.? sq. ft.
Z a 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-__________-_--.---_-__.
Test Pit No. 2................minutes per inch Depth of Test Pit........_............ Depth to ground water........................
�+ ---------------------------------------------------------------------------------------•------------------------•-----------------------.------------------
ODescription of Soil........................................................................................................................................................................
V -----------------------------------------
-------
------------------------------
----------------------------------------------
•------------------------------------------
---------
.---------------
W ••---•----••--- ---------- -----•--•••---•••---••---- •--•----•-•--•••--•----•--•-••-•------•-••....------•--••-••---•----••-•••----•-----------•-•-•--•---•----••-•--•-•----•-••--••••-•----------••••-
UNature of Repairs or Alterations—Answer when applicable................................................................................................
---------------------------•----------------------------------------------...................................------................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITi:L. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has ben issued by the oard of health.
.- y- �� 'P Signe .. ....... --•.. ... . .... --
,� e
APPlicafionApproved BY----�-- -----=-------------------- -------•----••-------------------.-.........------- -----------•--------•--•----------------
(/ Date
Application Disapproved for the following reasons--------------------------------------------------------------------------------------------------•---•-••---•---
/j� -------------•--------•----....._...-------•---------------------------•--...-------------•---------------------------------------------•--------•---Date-----....--'--
�/° - Permit No.__... y.......---------------------------------- Issued.......................................................
- Date
. No..'./ .� -- Fxs �l.._..............
I THE COMMONWEALTH OF MASSACHUSETTS
BO�e R® F H E L3�
.......O F...
Apptirn#ion for Disposal WorkS T struriion rantit
Apgkeation is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System .. -- .....
.. .......... _ ...---- .-- 7. .
Location-A ess or Lot N
w............ ....... . . ........................._.... ........................ ... .... .... ...................--
..... .. . .. .
}vner Addre.
W .............
Installer Address U
QType of Building / Size Lott.=/_ ...--.Sq. feet
U Dwelling—No. of Bed-rooms................_.._......_._.:.___...Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building .... No. of persons............................ Showers — Cafeteria
a YP g P ( ) ( )
Otherfixttjres -•---��-------------------------------------------------------------------•------•-------------------------------.-
W Design Flow.._......;6— •---------------------gallons per person per day. Total daily flow__........._�Q1,17.................gallons.
WSeptic Tank—Liquid capacity--.-..__ ons Length................ Width-............... Diameter---------------- Depth................
x Disposal Trench—No..................... Width--_ _.....____._.. Length........__._._. __. To leaching area....................sq. ft.
Seepage Pit No..._.,/��met ................... -----. .----..-.--. al leaching area . --_sq. ft.
Z Other Distribution box ( ) Dosing tank
Percolation Test Results Performed by........................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit--------_........... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit------_............. Depth to ground water........................
--•-•--•--••----•••-••••••-••---•-•-••••--•--•-------•-•--------------------------------------------.........................................................
0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
W
U -----------•••-•••••-----•---•--•---------•---•---------•---------------••......--•..........•-----......---•-----•---•-----•-•------•------••---•---•-•--------•------------------'•-------••--•-------
W --------------------------------------•-----------------------------------------------------------.........................................
UNature of Repairs or Alterations—Answer when applicable z .........................................................
' �.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLL p of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee •ssued b the and of heal .
Signed ----_. ...... ... . . ... ---••-•-'•-•- -• ................................
Date
Application Approved By...
.'...
Date
Application Disapproved for the following reasons:-------•--------------•---------------------------------------•----------------------------..................._
.............................••-----•----•---....................---------•----------------•-----------------•••------•-.-•-- --••-•-----•c--•-••-----------•�-----------•-----•----•-•--.........
Date
Permit No..................... - Issued--'-
................... Date g;".'Y'i- ..F.^
rA�k
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL H
x. ....OF ............................
s °4 Trrtifiratr of Tnntplianrr
THIS TOeCERTIFY, hat e Individual Sewage Disposal System constructed or Repaired
S.... ( )
by......... .. .... ..
__. .. "'
at --- -------- -•-- ............•-------------------•--•--•-•-
------------ --- -------------------
has een installed in accordance with the provisions of TIT13 j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No----------------------------------------- dated------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WIL FUNCTION SATISFACTORY.
DATE......... . ... .. .` ................................ Inspector_...._ ------.......... --------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEAL —
7
....OF.. ........................ ............ .......... ..........................
No.._....��'r....... FE :.................
iopooa orks ion nrrrntit
Permission y granted = ........... ....
to Construct or Repair an In 'vidual Se > ge osal
at No.---•-- •. ••-•-���... ---• f •-
Street
as sh non the a lication for Disposal Works Construction Permit o_____________________ Dated.......................................... ^
pp p
f
0 of Health
DATE........��— 5.-.? --•......................... .........
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
r k& L..�4 14 L.OW s 110 0 G•PD.
use t ooc! 6A,L.. `9 p
pj,�5F'05 t..� LJSE t o0o GA.L... 0
.,UXWA" AMEA. = 150 S.T=. Z4 (—
ic>o 2.S = :2 "75
CEO 405=. )c 1 .b = _ rad s P D. pi EXP. is
TOTAL. -pt_.Sl6Q = 425 G.•RD•
-r c>TQ t- ID,a•t of FL-OW = �33b 6.PR. Prop
PEf1GC)L T10Q CZATE to 2m W, Q2 Lr--%.
fir, .1AD
E'Ak+1ER
'V
Tod' Fuo :iao.o
. ,.,..-;ter �•�-:..--�%�� .
• 4'pv� lug.
Box qj. Sc-Qric I o'
suv rA04K
Lr,4r-H
PIT
WA5"ED
STow � r?
77
t-V77-ZTIP1E-� P
t.oGn.r1� 'dt�1v�;-Qa�t. L
w-
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� G t�t�T t t=�{ T►-{A T' T t-1�`��L..(.,1 tJG• Show�..1
i-ti.t?t�ty►..1 GC�rIPL�lS �.�/iTF-L T4-►i= SIDE LI►-1E: ( ,.�• �"�?
A,Ut� SETL��CtC k'C-QU►�ENL�:I,.tT; 4F T'NC:. L^.,r.',
JOWL-' ct= !17rJ4"Ct� t-�3 L4or;� i�ouIRT P�Q
r tZCGIS't'c:,t`�ja t...A,►Jt;.,� StJ;~v�.Yvf-•: �
� 05TE>�Vtl,.t.tr o tiC�Sy� �
tIJ�Ci':.It,�tC�.IJ s �iUk�•/�`{ �' Ti�1G UF4=;t�C"�, �i-1Gf�1t_D A.1��'i..l C_15�,1..:kT' '-� �
i-t•;ii" f�iC, U�yC-4:1 1Z.1 i3f�.i'%:C'_tilt►,(L":: LC.3'C" l_lN�°:3 +« �j1�t�T3 `^��t�)�/i`.
SITE LOCUS
ood
*NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. O
VENT PIPE O Least 24 Inches tall)
►.,
Existing Foundation �house'to septic tank Schedule PVC w/Charcoal Odor Filter
BASEMENT FLOOR SLAB - ELEV. 100.00 Provide Risen If necessary D-sox cover must be ESTABLISHED VEGETATIVE COVER
3 R0� 6q
a to bringq^Septic tank coven within 6 In. of finished grade
within 6 of finished grade Orode over D-Box-90.00 de over SAS-95.00 to 100.00 / BACKFlLL WITH CLEAN SAND Z
Grade over Septic Tank- 9e.00 Mh« ••,•• y•• .'`R' t.e;h't .<' `; :l ' "':! '\,'/'� :,. ..°•�' '' ';h ..l:. f;; ...:' :'.
f•;�;M: r •• '•'�,;. �'.,. '::;. .;} y, ::.::.1ti•• •Jf';:.:J..'�.:..: (NATIVE OR PERC SAND)
S- 2
5�0.01 6 HOLE M-10 _ ': •1' •• ', :•. "'r. n,,I.;,1;.::. 1 ;;' `N. Q
TOP OF UNIT ELEVATION 95.0
or Greater
DIST. BOX J• Maximum Cover
12' NEW a PVC CAPPED INSPECTION PORT TO ME ..: t ,; i; + T,' 't;'' ` •:.'�'�y,,j' v
mT. Pia r 1500 GAL. S. INSTAUM AND ` :' a v o �.,.'::J: , '.'•• .
� ` TO BE MITHIN 0•OF GRADE - t•;v,.:t.5: ''.,..;,�• '''"',•",. .��.a":e• �,.,:i,. «.F•;..., •lv, ��•�n
FROM EXIST, FOUNDATION r; SEPTIC TANK 25' °'ot•pw fact INV. ELEVATION 94.50 ::,' '• :i '
�•,, GENERAL NOTES
a, o.s.n. as a to t3'
.�..
H-10 00 'a •:.• ' 1. Contractor is res onsible for Dlgsafe notification. Verification Utilities
CONCRETE FULL n � II � � BOTTOM ELEVATION - 93.58 �• '
iu °i n r pof
v 6 1nyq
.of 3/4•-1 1/2• 7n II > f.60' and protection of all underground utilities and pipes.
2. The septic tank a distri ion box shall be set
composted atone °i 5' MIN ABOVE BOTTOM OF » P P " g P P
- 4 ROWS OF 6 UNTS AT e..2W/UNIT+2 END CAPS-31.50'
Z ; c > TEST PIT OR GROUND WATER 4 8 4 level on 6 of 3�4 -) 1 2 stone.
o B'FF. IIlDTE f2.83' L%S7 o SUITABLE MATERIAL 3. Backfill should"be clean sand or gravel with no
SYSTEM PROFILE 6 In.of 3/4•-1 1/Y
Ta Bottom of Test Hole 1 Elev.-83.00 stones over 3 in size.
Not to Scale compacted stone Groundwater Observed - NONE OBSERVED 4. This system is subject to inspection during installation
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6' BELOW GRADE BOTTOM OF TP-1.: - 87.00 SOIL ABSORPTION SYSTEM (SECTION) by Carmen E. Shay - Environmental Services, Inc.
5. The contractor shall Install this system in accordance
Note: Remove soil down to el. 87.00 & replace with Groundwater Observed - NONE OBSERVED HIGH CAPACITY INFILTRATOR CH-20 LOADING)/ GEORGE O'BRIEN with Title V of the Massachusetts state code, the approved plan
and Local Regulations.
EQUIVALENT)
Clean Coarse sand w/pare. rate less than Or ( 6. If, during installation the contractor encounters any
or equal to 2 min./In. before & after placement NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" soil conditions la site conditions that ore different
(5 FOOT STRIPOUT ALL AROUND AS SHOWN) NOTE: EFFECTIVE DEPTH Is tt from those shown on the soil log or in our design
installation must halt & immediate notification be
made to Carmen E. Shay - Environmental Services, Inc.
P E R C 0 LAT I 0 IJ TEST 7. No vehicle or heavy machinery shall drive over the
septic system unless noted as H-20 septic components.
I I Date of Percolation Test; 10/19/11 8. Install Tuf-Tito gas baffles or equals on all outlet tee ends.
I I c Test Performed By. CARMEN E. SHAY 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes.
Results Witnessed By David Stanton - BARNSTABLE BOH 10. All solid piping, tees & fittings shall be 4" diameter
I I EXCAVATOR: SHAY ENVIRONMENTAL SERVICES, INC. Schedule 40 NSF PVC pipes with water tight joints.
W3 Percolation Rote: <2 MPI 0 132" per Sieve Analysis 11. MUNICIPAL WATER IS CONNECTED TO THE SITE and Surrounding
Test Hole Test Hole Properties.
I _ _ No. 1 No. 2
I I I �•`-- EDGE OF WETLANDS DEPTH SOILS ELEV. DEPTH SOILS ELEV,
EDGE OF WETLANDS o 98•00 0 98.00 WDIL.
SANDY THE PROPERTY LINES ARE APPROXIMATE AND
LOGY
10 YR s/2 10'� 3 3//2 COMPILED FROM THE PLAN BY BAXTER & NYE
I I ENTITLED "PLAN OF LAND OF 45 POEDER HILL ROAD, BARNSTABLE
NOTE: EXISTING TANK DAMAGED 0`-12" A o'-12" A N
7.00 7 FOR MR. BRAD SAWYER DATED 4/3/78
s LOAMY LOAMY AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
t I NEW 1500 gallon tank to be installed IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
I I 10 YR 6/6 10 YR 5/6
I i
I , At Same Location of existing tank. 12•-36" e. 95.00 12"-36' 95.00,
THE SEPTIC SYSTEM INSTALLATION.
n a.Sit WA NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
�,sYat
Ct 87.00 36"- 132 C, 87.00
FROM THE EXISTING LEACH PIT TO BE DISPOSED
36"- 132
I I Med-Coarse Maid-CoarseOF AS PER BOARD OF HEALTH SPECIFICATIONS.
Sand Sand
I I 2.5 Y 7/4 15 Y 7/4 EXISTING LEACH PIT TO BE PUMPED DRY &
II 32"- 18 C, 83.00 32'- 180 C, 83.00 FILLED IN PLACE
� I .
ee a
ASSESSORS MAP - 299 PARCEL 088
10Perc #1 ZONING - RESIDENTIAL e
�' PPchRto Per MPI" Refer to Sieve Analysis
S 84�1-2;9' 45"E ---------------
- �$ Groundwater Not Observed WETLANDS ARE_PRESENT WITHIN 200' OF THE PROPERTY AS SHOWN
"5.74' �,'� ----'' ,- No Observed ESHWT
`..- ___ -_< - ADJUSTED H2O Elev. None
------ --�
ALL OUTLET PIPES FROM THE
____- -_�--- �''''' DISTR18UIION BOX SHALL BE
19 .0 SET LEVEL FOR AT LEAST 2 FT. 12" coNCRETE COVER LEGEND
4 BE HOUSE FLOOR SCHEMATIC I r9 I - '
(Description Provided By Owner) I � � 1VT #45 f ,� 2
�. `� 90 6 - 5" OUTLET ' s•;C,.
I I 21,788 Sg1,aa.•►� , eet +/- ,-- KNOCKOUTS
`--------------
12' INLET
OUTLET ® DENOTES PROPOSED
-------------------------------------
8X0 SPOT GRADE
DENOTES EXISTING
-- t5 5w w X 104.46 SPOT GRADE
--------- 9
Bedroom Bedroom ; � I � ..- t.75
k PLAN-SECTION CROSS SECTION PL PROPERTY LINE
6 HOLE DISTRIBUTION BOX - H 10 PROPOSED CONTOUR
' - -- -
t ` NOT TO SCALE 97- -97 EXISTING CONTOUR
2nd FLOOR I \�� -- r - --- �, 9g Design Calculations
�� -
DEEP TEST HOLE &
-
t Number 'of Bedrooms: 4 Equivalent to 440 Gol./Day (440 Gal./Day Min. per Title V)
.� LL i ``- _ �� PERCOLATION TEST LOCATION
Bedroom
m° Dining Kitchen 0 Garbage Grinder: No
Leaching Capacity Proposed: 440 Gol./Doy Minimum (Min. Per Title V) FENCE
1�, tee- - 9a Septic Tank : - 2 x 440 Gal./Day - 880 USE NEW 1,500 GAL
U, t co
EXISTING
Living Roo I ,� i --'�---'�`� - SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch PRIVATE DRINKING WATER WELL-
Bedroom 9 I � t - I � 4 BSDROOA( _ram --
�- I L\ ��- Bottom' Area: 0.74 gal/sq. ft. x 595.90 sq. ft, - 441.03 gallons
1 p -'� M I , l aDUs� -- Sldewall Arco: NOT USED REVISION S
9 I TEST HOLE #1 0 Providing: - 441.03 gallons
I o $ A ASPHALT i I DECK NEW i ELEV.- 98.00 �0
1st FLOOR ; �j v DRIVEWAY i '28 15 'gal ,-'' Use: 4 ROWS OF 5- HIGH CAPACITY CHAMBER UNITS WITH NO NO, DATE: DEFINITION
I Cll i � ni y,i �te�llne- ••- tic Tan 0-Box -' STONE FOR AN SAS HAVING THE DIMENSIONS: 12.83' x 25.0'
e 0 30 ,�'� Bottom Area: (General Use Approval for 4.50 SF/LF of INFlTRATOR
'' TES HOL�� 2 5 UNITS + 2 END CAPS per ROW - 31.50 FT
I E ._ 08.00 4 ROWS x 31.5 x 4.73 SFAF - 595.90
`-------------
/ DESIGN FLOW PROVIDED: 0.74(595.90 S.F.) - 441.03 GPD
3-2e DIAM. ACCESS MANHOLES I 28' I I i Note: Remove soil down to el. 87.00 & replace with
10, �' ' t / 31T clean coarse sand w/pert. rate less than or
•f� .�i'r.i4'i{r' •.1-L.•�aLf.4rS1 \..:Y.�, ,
....�, � or equal to 2 min./in. before & after placement
' _ LEACH PIT - (5 FOOT STRIPOUT ALL AROUND AS SHOWN)
_ _ PROPOSED
I -- ------ -------------I I
INLET I ---' PREPARED FOR .
ou 1 -e --'
THE ACCESS COVERS FOR THE SEPTIC TANK, I --' _
DISTRIBUTION BOX AND LEACHING COMPONENT I ,- ,-�"' , IILK SUBSURFACE SEWAGE DISPOSAL SYSTEM
` I / - 1 L�f2.83� Vent
f�% a.�, SHALL BE RAISED TO WITHIN 8" OF I , i FINISHED GRADE. S 80D 47r 36r►E Pipe OF
STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITS GAS BAFFLES OR EQUALS I ee
ON ALL OUTLET TEE E S A R A P E L L M A N
PLAN VIEW UTLNDS ��, 128 7f, #28 POWDER HILL ROAD
l3-24'REMOVABLE COVERS I ,I ' Ilk BARNSTABLE MA
f 4• 28 POWDER HILL ROAD '
3 min. clearance I . PROJECT BENCH MARK
INLET 8•mT L min. Inlet to outlet e•n,>n• ;; ,'
L G,^,,- «,,,� i TOP OF FOUNDATION BARNSTABLE, MA 02 632 .
T7 I I ; °p ELEV. = 100.00 (Assumed) ;N of PREPARED BY:
s'-7• 5'-7• I N Pam, S
N CARHEYV E. SHA Y
4' I
j• Liquid depth I Jr Ri•1i.» i 1 i E.
0 20 40 50 0 L'NVIRONVEN TAL SERVICES, INC.
'`,• •�:,.�. •.,.. �, .+... :f, ,.; ,
I N
�° P.O. Box 1576
sA�r MASHPEE, MA 02649
CROSS SECTION END-SECTION I
TYPICAL (H-20 LOADING) 1500 GALLON SEPTIC TANK I L----------------------------------------------------------------------- ------------ SCALE: 1"=20' tTA
NOT TO SCALE
TEL/FAX : 508-539-7966
M�IN S' TR EE T R T 6� .
(40 FOOT RIGHT OF WAY) SCALE: 1"=20' DRAWN BY: CES DATE: OCT. 25, 201 1
PROJECT#SD-2026 FILENAME: SD2026PP.DWG SHEET 1 OF 1