HomeMy WebLinkAbout0026 RYDER LANE - Health a
26 RYDER LN
Barnstable
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Commonwealth of Massachusetts
�o Title 5 Official Inspection Formal
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�.
26 Ryder Lane
V
Property Address `
f•-
Karen Phillips '
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
required for every
page. City/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 LX 0 3-
on the computer,
use only the tab Brett Hickey
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return Company Name
key.
374 Route 130
VQ Company Address
Sandwich Ma 02563
City/Town State Zip Code
asmA.d (508)477-0653 S113747
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ❑■ Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
Brett Hickey ,Digitally signed by Brett Hickey
Date:2020.061812.05.56-0400• 6-15-2020
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 has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc-rev.7/26/2018' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
r '
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
+ w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
v-
26 Ryder Lane
Property Address
Karen Phillips
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
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:
■❑ 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 complyingse tic tank as approved b the Board of
P 9 P P PP Y
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
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}
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
........... � 26 Ryder Lane
v� Property Address
Karen Phillips
Owner Owners Name
information is Barnstable Ma 02675 6-15-2020
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (coot.)
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):
❑ 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):
t
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will'protect public health,
safety and the environment:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurtace Sewage Disposal System•Page 3 of 18
' P
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�T Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
26 Ryder Lane.:
Property Address
Karen Phillips
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
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
❑ 0 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
t Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
26 Ryder Lane -
Property Address
Karen Phillips
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
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
❑ a Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ 0 Liquid depth in cesspool is less than 6"below invert or available volume is less
than '/2 day flow
❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ a 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 water supply
well.
❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ 0 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.]
El The system is a cesspool serving a facility with a design flow of 2000 gpd-
❑ 10,000 gpd.
❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Force:Subsurface Sewage Disposal System•Page 5 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
26 Ryder Lane
Property Address
Address
Karen Phillips
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
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
El ❑ :Pumping information was provided by the owner, occupant, or Board of Health
❑ 0 Were any of the system components pumped out in the previous two weeks? .
0 ❑ 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?
0 ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
❑ El Was the facility or dwelling inspected for signs of sewage back up?
n ❑ Was the site inspected for signs of break out?
0 ❑ Were all system components, excluding the SAS, located on site?
El ❑ 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?
❑ 0 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:
El ❑ Existing information. For example, a plan at the Board of Health.
❑ Q 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
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
26 Ryder Lane
u�
Property Address
Karen Phillips
Owner Owners Name
information is Barnstable Ma 02675 6-15-2020 .
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
3 3
Number of bedrooms (design): Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330/GPD
Description:
Number of current residents:
2
Does residence have a garbage grinder? ❑ Yes El No
Does residence have a water treatment unit?
❑ Yes rol No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes RI No
information in this report.)
Laundry system inspected? ❑ Yes F!] No
Seasonal use? ® Yes [E No
See below .
Water meter readings, if available (last 2 years usage (gpd)):
Detail:,
2019- 25,000gallons 2018- 24,000gallons
Sump pump?, ❑■ '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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
........... / 26 Ryder Lane
Property Address
Karen Phillips
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
NA
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: Owner- last pumped 1 year ago
'
Was system pumped as part of the inspection? ❑ Yes ❑■ No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
r
t5insp.doc-rev.7/26 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
AN
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
26 Ryder Lane
L
Property Address
Karen Phillips
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
❑ Septic tank, distribution box, soil absorption system
❑ Single cesspool '
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Tank, pump chamber, d-box and SAS
Approximate age of all components, date installed (if known)and source of information:
1996 per plans
Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No
5. Building Sewer(locate on site plan):
31
Depth below grade: feet
Material of construction:
❑ cast iron ❑. 40 PVC ❑ other(explain):
Town water
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
� .
t. .
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18
J.,
c Commonwealth of Massachusetts
19 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
26 Ryder Lane
Property Address
Karen Phillips
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
2'
Depth below grade: feet
Material of construction:
■ concrete metal fiberglasspolyethylene other ex lain
❑ ❑ ❑ 9 ❑ ❑ (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: 500gallons
1211
Sludge depth:
24"
Distance from top of sludge to bottom of outlet tee or baffle
311
Scum thickness
G 11
Distance from top of scum to top of outlet tee or baffle V
1419
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
�= Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
f;
`.............. / 26 Ryder Lane
V�
Property Address
Karen Phillips
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
NA
Depth below grade:" feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain).-
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):.
8. Tight or Holding Tank(tank must be.pumped at time of inspection)(locate on site plan):
NA
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain).-
Dimensions-
Capacity: A'
gallons
Design Flow:
gallons per day
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
t
c Commonwealth of Massachusetts
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.:26 Ryder Lane
V�
Property Address
Karen Phillips
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
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
r
c Commonwealth of Massachusetts
�m Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
26 Ryder Lane
u
Property Address ,
Karen Phillips
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
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: 0 Yes ❑ No'
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Pump chamber, pump and alarm were all in working order when viewed.
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number: .
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
6 hi cap infiltrators
0 leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system ,
Type/name of technology:
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
r,a
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
26 Ryder Lane
u=
Property Address
Karen Phillips
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
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. No evidence of past backup
was observed 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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
l; -
�� 26 Ryder..Lane
Property Address
Karen Phillips
Owner Owners Name
information is Barnstable Ma 02675 6-15-2020
required for every
page. City/Town 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:
o❑ hand-sketch in the area below
❑ drawing attached separately
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t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
26 Ryder Lane
V
Property Address
Karen Phillips
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
NA
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
l4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
26 Ryder Lane -
v
Property Address
Karen Phillips
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
0 Check Slope
M Surface water
■❑ Check cellar
Shallow wells
Estimated depth to high ground water: No GW @ 120"feet
Please indicate all methods used to determine the high ground water elevation:
El Obtained from system design plans on record
12-2-1996
If checked;date of design plan reviewed: 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:
A plan on file at the local Board of Health was used to determine high groundwater.
n
Before filing.this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
l;
2Q;RyderLane
Property Address
Karen Phillips
Owner Owner's Name
information is Barnstable Ma 02675 6-15-2020
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:
0 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: TighVHolding 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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is MA 02637 August 18, 2011
required for Cummaquid
every page. Cityrrown 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: A. General Information
When filing out
forms on the
computer,use 1. Inspector:
only the tab key
to move your Patrick M. O'Connell -
cursor-do not
use the return
key. Septic Inspection Services Co.
Company Name
r� 189 Cammett Road
Company Address
Marstons Mills MA 02648
renm Cityrrown State Zip Code
508-428-1779 SI 12855
Telephone Number License Number
B. Certification
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 oUon sifg
sewage disposal systems. I am a DEP approved system inspector pursuant to_Section 15 340 of:
4 v ) :;77
Title 5(310 CMR 15.000). The system: Ho
r�a
® Passes ❑ Conditionally Passes ❑ Fails CO CU
e
❑ Needs Further Evaluation by the Local Approving Authority _ f
'- I/✓1 August 18, 2011 Job# 11-139
Inspector's Sigrid ure 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•11/10 . Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
q �l I
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is Cummaquid MA 02637 August 18, 2011
required for
every page. Cityrrown 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:
Recommend pumping tank. Leaching system was empty at time of inspection. Pump and alarm were
functioning properly. -
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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is Cumma uid MA 02637 August 18 2011
required for q
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
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 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is required for Cummaquid MA 02637 August 18 2011
every 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:
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
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_day flow
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is Cumma uid MA 02637 August 18, 2011
required for q
every page. City/Town 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.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool'or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 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.
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 eithe,- 'yes" or"no" to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered"yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
15ins•11/10 Title 5 Official Inspection Forms Subsurface Sewage Disposal System•Page 5 of 17
4,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is Cummaquid MA 02637 August 18, 2011
required for State Zip Code Date of Inspection
every page. CitylTown
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?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design):
3 3
Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
330
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is Cummaquid MA 02637 August 18 2011
required for State Zip Code Date of Inspection
every page. City(rown
D. System Information
Description:
3
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No.
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage (gpd)):
Detail
S pump? ® Yes ❑ No
Sump
Currently
Last date of occupancy: Occupied.
Commerciallindustrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203): Gallons per day(gpd)
r �
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:
Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 7 of 17
t5ins-11/10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is Cumma uid MA 02637 August 18, 2011
required for q
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Tank pumped in 2007
Source of information:
Was system pumped as part of the inspection? Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspcol
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-11/10 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
w 26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is Cummaquid MA 02637 August 18, 2011
required for
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
I
Approximate age of all components, date installed (if known) and source of information:
1996
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
2'
Depth below grade: feet
Material of construction:
® cast iron ❑ 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
2'
Depth below grade: 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
10.5' long x 5.8'wide- 1500 gal.
Dimensions:
4"
Sludge depth:
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w 26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is MA 02637 August 18 2011
required for Cummaquid
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
28"
Distance from top of sludge to bottom of outlet tee or baffle
3"
Scum thickness
6„
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
10"
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.):
Liquid level was found at bottom of outlet invert and tees were intact. Recommended pumping tank.
Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 10 of 17
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is Cummaquid MA 02637 August 18 2011
required for State Zip Code Date of Inspection
every page. City/Town
D. System Information (cont.)
I
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:
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
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
l5ins•11110
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is Cumma uid MA 02637 August 18 2011
required for q
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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.):
No solids or high stains present Liquid level was found at bottom of outlet pipe.
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.):
Pump and alarm are functioning properly. Floats are on station and dosing leaching system as
designed.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
r
t5ins•11110 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is MA 02637 August 18 2011
required for Cummaquid
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type.
❑ leaching pits number:
Infiltrators
® leaching chambers number:.
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:,
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Interior of infilreators were video inspected no standing water or signs of surcharge were found.
Cesspools(cesspool must,be' umped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is Cumma uid MA 02637 August 18 2011
required for q
State Zip Code Date of Inspection
every page. City/Town
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts "
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name August 18 2011
information is Cummaguld MA_ 02637 9 --
required for -- ---- State Zip Code Date of Inspection
every page. City/Town
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
4
3 61 Back
Yard
53 62
t
r
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
o; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
26 Ryder Lane
Property Address
Phil Fratantonio
Owner Owner's Name
information is Cummaquid MA 02637 August 18 2011
required for State Zip Code Date of Inspection
every page. Cityrrown
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
Check cellar
® Shallow wells
6-8'
Estimated depth to high ground water: 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: 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 ettablished the high ground water elevation:
Mounded system designed to be"five feet higher than groundwater.'Mound is 5-6 feet higher than wet
area to rear of property.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 16 of 17
15ins-11110 a.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments
°M 26 Ryder Lane
P rop rtY e Address
Phil Fratantonio
Owner Owner's Name
information is CUM maguid MA 02637 August 18 2011
required for State Zip Code Date of Inspection
every page.. Cityrrown
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
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
a
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
l5ins-1.1110
TOWN OF BARNSTABLE
LOCATION ISJ �\Vc,&(— 1. #n�P
,VILLAGE UMM ° _ASSESSOR'S MAP&PARCEL
INSTA—REFI-f2S NAME&PHONE NO. �.l f k'LIL nit
SEPTIC TANK CAPACITY �n
LEACHING FACILITY: (type) D;-? 4�1'Mx r®r-�> (size)
NO.OF BEDROOMS
OWNER
PERMIT DATE: C DATErSP (b I(
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
' J / F J f.f tiF aIt/\Itlt ftf\Jt -f
\I t• • t t t • t \ • t • t • ..
t t \ t t • 4 \ t..\. f%I f f ! f f f F f
f f f F f f / f f i / \ • \ • • \ • t \ •
tI\f\f\ftl.1JtltFtftftJtFtltltltf•ftftft/tF,tF•Jt Jtf�Ftf�Ftft -. -
•ftI\I\I\!•I\ftI\Jt Jt/•Jtf•I\J•F•/\I\/•ftl4JtJ•f\/•f•I•f•/•
f ! f ! f f F f f !
- 4
51:
3 -61 .,,Back
'.Yard
62 .
TOWN OF BARNSTABLE
LOCATIOIJ 6k- A SEWAGE # % '1
VILLAGE - i� .✓t .� // ASSESSOR'S MAP& LOT f - 03 7
INSTALLER'S NAME&PHONE NO. c b "" -- S' 2'7
SEPTIC TANK CAPACITY -4 16110 PQ
LEACHING FACILITY: (type) C_o/i[:s (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: -_l "ct COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
i
a
N\j -=�
� 1
-r
�f
3
a
No. t0 / l. .... , Fee $5 0 0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Zfppltratton for Diquaf bpe;tem Cowaruction Permit
Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 26 Ryder Ln Owner's Name,Address and Tel.No. 3 9 4—6 0 4 8
Assessor'sMap/Parcel Cummaquid, MA Helen M Doyle
PO Box 411 , Cummaquid, MA 02637
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 8 5—6 5 3 0
Gam E Robinson Sr Septic Srv . C R Short
PO Box 1089 , Centerville, MA 0263 PO Box 781 , Dennis, MA 02638
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( no
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil Clay
Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic Repair according
to the plans, of C R SHort #1 -809, 1500 gal . tank, 1000g pump
motion With alarm, 6 infiltrators .
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 Certifi-
cate of Compliance has been issued by this B and Health.
Signed Date :2
Application Approved by Date •1 A-9 7
Application Disapproved for the following reasons
Permit No. Date Issued 7
03 y 1
No. ' (o / �' ( Fee $5 0.0.0
T, THE COMMONWEALTH OF MASSACHUSETTS`` I ntered in computer:
Yes
+ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, FAASSACHUSETTS
N.
Z1pplication for �Oi5poml 6p!6tem Construction Permit
Application fora Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 26 Ryder Ln Owner's Name,Address and Tel.No. 3 9 4—6 0 4 8
Assessor's Map/Parcel,, ; . Cummaquid, MA Helen M Doyle
PO j x 411 , Cummaquid, 'MA 02.637T,
Installer's Name,Address,and Tel.No. 7 75—8 7 17-6,/ DA'igner's Name,Address and Tel.No. 3 8 5-6 5 3 0 \
WM E Robinson Sr Septic Sry C R Short
PO Box 1089,,,�emterikille, M. 0 632 PO Box 781 , .Dennis, MA 02638
Type of Building: t
Dwelling No.of Bedrooms 3 Lot ze sq. . Garbage Grinder( nO
'Other Type of Building -IN� ft
f P� iori/ Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
i
Description of Soil ' Clay i'
}
Nature of Repairs or Alterations(Answer.when applicable) Title. 5 rSb;tie Repair According
to the plkas of C R Short #1-809, 1504"a1. tank, 1000g' pump
station With alarm, 6 infiltrators_
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 Certifi-
Cate of Compliance has been issued by this B d Health.
Signed Date — r
Application Approved by Date .I' /�,-7r'
Application Disapproved for the following reasons 3
4 '
Permit No.-'- "2Date Issued E ' '+�_,� � —�7 7
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Doyle (tertif irate of QCOmpliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( x )Upgraded( )
Abandoned( )by Wm E Robinson Sr Septic Srv.
at 26 Ryder Ln, Cummaquid, MA =-ias been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 7— h f dated — , — A 2
Installer Wm E Robinson Sr Septic Srv, Designer r R Short
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date ` A, Inspector
---------------------------------------
No. 9 2— Fee $5 0.0 0
THE COMMONWEALTH OF MASSACHUSETTS
Doyle PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
'Wigpo5ar *pgtem (Construction Permit
Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( )
System located at 26 Rviler "ne,Cummaquid, MA
by WM E Robinson S-- Septic Sry
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit. ,
Date: �� /? — 9 2 Approved by �ct
j
l
TOWN OF BARNSTABLE
LOCATION O-L ✓ � �` �` SEWAGE #
VILLAGE �' �� -�► �^'� ASSESSOR'S MAP & LOT.�� - 03
INSTALLER'S NAME&PHONE NO. 7 I o b
SEPTIC TANK CAPACITY S F Z' 1
r'../�� s (size)
LEACHING FACILITY: (type) s �_
NO.OF BEDROOMS
BUILDER OR OWNER rc
PERMIT DATE:—
/ ,. -7(7 COMPLIANCE DATE:
Separation Distance Between the:
Feet
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility
Private Water Supply Well and Leaching Facility (If any wells exist
Feet
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist Feet
within 300 feet of leaching facility)
Furnished by
t<
4o S. TA«. �L '
a
7'-6"
3x3 CD
N
N
1
ti
N
2-6-
A
rd
Co
iAit,
leave acess for crawl space
7,6
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t
SOIL EVALUATOR& PERCOLATION TEST FORMS
Page I o(,r
Town of Barnstable
9A MaT1A8M t Department of Health,Safety, and Environmental Services
A .
1639.
1. Public Health Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6165
FAX: 308-775-3344
SOIL Suit.,71-)IhlyASsessiile,tit fOh Seuyage DIS�)O.S�l1
ASSESSORS MAP NO; -3-6 -
PMCM n r /
NO. -. Date: , g yl!
Performed By: `c Date:
Witnessed By:
l.ocellon Address l� L Owner's Name n f�%
�Fi yli!Al,e41 v e
Lot 0: Address,and P 4 ,13 (DX ¢ 1 /
�-
Assessor's Map/Parcel: Telephone p 394
�' - G
,�/-- �
NEW CONSTRUCTION REPAIR
Office Review
Published Soil Survey Available: No Yes ✓
Year Published 1 9 9 3 Publication Scale ! : zSciQa Soil map unit C e R
Drainage Class I V.S Soil Limitations �• / Y +-"� /l e-1,- c.
Surficial Geological Report Available: No Yes
Year Published ! 5 9! Publication Scale 1 : 3/G, 8 Q o
Geologic Material(Map Unit) 3 e v L h E *-,t tc f o P c"r,_r v e,r .18 CIx f erve
Landform / o c t a/ t et k-c d r rl �n I +r-!r --
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Wetland Area:
National Wetland Inventory Map(map unit) �d
Wetlands Conservancy Program Map(map unit) 1\16
Current Water Resource Conditions(USGS): Month 0-
Range: Above Normal ✓ Normal Below Normal '
Other References Reviewed:
DEP APPROVED FORM- 12/07/95
Page 2 orj—
P ES/Z
I,ocalion Address or I.,ot No. 2 L+ R- -40r t'j -U✓t+nti a v��, 114i9S.s
Oar.-site Review
Deep Hole Number Date: /111419(. Time: / O ' va Weather
Location (identify on site plan)
Land Use 2-*-s rJG7 L ;c. / Slope M) / Surface Stones X/, 'Z -n
Vegetation L c, a..v .,
Landform Cvr/t, c ,a/ 2:> e/.,
Position on landscape (sketch on the back)
Distances from:
Open Water Body ,//.a feet Drainage way All.,. feet
Possible Wet Area feet Property Line 3 O e feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE LOG'
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface (inches) (USDA) (Munsell) Mottling (Structure, Stones, tloulcfers, Consistency, %
Gravel)
S c,. y 2,S y
.r N <a -
/ 4+ a —
rr
4 S
� cc
< rr
\'v e, t
/ zo rr
Parent Material (geologic) G C- C3 _ DeptlgoE)edrock: �f/f
tr
Depth to Groundwater: Standing Water in the Mole: L Q Weeping from Pit Pace:
Estimated Seasonal High Ground Water.MAI APPROVED FORM- l:%07!95
F0101 12 - 1'ERC0I.,AT10N 'I'ES'1' .
1 P aiZ
Location Address or Lot No. 2- G, i2 y ��,.. L a .¢. ..-r a r "w IpVe*e
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test*
Date: / ///¢/9 C Time:, L ® o c)
Observatioo Hole ##
Depth of Perc
Start Pre-soak i o ; 3 4 4 0
End Pre-soak
Time at 12"
,r
Time at 9"
1.3
41
ii� a3, o0
Time at 6"
Time (9"-6")
Rate Min./Inch
" Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed [Er Site Failed ❑
........................................................... .......... .. .....
Performed By: 44i2 1.
Witnessed By: j!F W �. Soo
,^
Comments:
DET APPROVED FORM-12/07/95
FORNI I I - SOIL ENALUATOIt DORM
1r.1g 4 t►r-"'
Location Address or Lot No. Z-7 2 e's cc rn L° u 17�
Ott-site Review
Deep Hole Number Date: / r�/���G Time: d =a Weather
Location (identify on site plan)
Land Use 7Z es<We,.r t 10-1 Slope (%) / Surface Stones
Vegetation .,A,&-, s7
Land form /c,<- / .D,r/� os.r C
Position on landscape (sketch on the back) . .
Distances from:
Open Water Body AJ/^ feet Drainage way W,7 feet
Possible Wet Area .v/'i feet Property Line 3c t feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE LOG'
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, %
Gravel)
2s 4- h l
r i 2 ..s-
z , t cl� Y-0
G MIN
� S a
Fvl GAT LVER7-PFMP0"9Sl5ZTM50TA[-AR
Parent Material (geologic) G G 13 De pit toBedrock:
i/
Depth to Groundwater: Standing Water in the Hole: °Q __ Weeping frorn Pit Face:
i.
Estimated Seasonal High Ground Water.
DI-Y APPROVED FORM 12107J95
FORM 11 - SOIL EVALUATOR FORM
Page.3 cl-.,r
P eaiz
Determination for Sogenyal Higlt Water Table
Method Used:
Depth observed standing in observation hole.................. inches
' I
El Depth weeping from side of observation hole.................. inches
❑ Depth to soil mottles .................. inches
❑ Ground water adjustment .............:. feet
Index Well Number ..,�.�.�✓Z47 Reading Date .%<A�XX 4 Index well level ...2 Z . g I- e' 9 c
Adjustment factor .... ... ✓
Adjusted ground water level ..... c.$..�..........
Death of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system? !'e J
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on iUo,s q 9 (date) I have passed the 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.
Signature - ,_ Date J
BENCHMARK 4" SCHEDULE 40 PVC PIPE T SOIL TEST
TOP OF FOUNDATION I _ ___ 20 FT. MINIMUM --_ MIN. PITCH 1 8" PER FT. CLEAN SAND J //• i
i 2" LAYER OF _ DATE OF SOIL TEST
ELEV. = _�`� `� 10 FT. MINIMUM 2" PRESSURE PIPE moo,33 1/8" TO 1/2' RTC•
SOIL TEST DONE BY C R. SHO P. �
150 PSI MINIMUM ELEV. - / WASHED STONE WITNESSED BY �' j �'
(ASSUMED) 6,J p --__�- ,qJ"s = VENT
CONCRETE �---- - - OBSERVATION HOLE 1 f OBSERVATION HOLE 2 ELEV.- g �.
COVERS -
- - z 1 CU. FT. OF PERCOLATION RATE s MIN./INCH AT 4 J INCHES PERCOLATION RATE "`_ MIN./INCH AT INCHES
,rA. ,oo.S+ cooI CONCRETE DEPTH HORIZ TEXTURE COLOR MOTT. OTHER DEPTH HORIZ TEXTURE COLOR MOTT. OTHER
`r R/ ANCHOR - - Sated - -- -S�^ d -
�7 4" CAST IRON PIPE 97gr " y 2•S Y 2•;f i
- �G �P ---- ---- ...---- z-1" /9,P
(OR EQUAL) MINIMUM -- ,0. f_. --
PITCH 1 4" PER FT. �� N1LEVEL o d�, 2.S
6" SUMP -ELEV. _ /°a / 7 i ._ _ i __ _ ^ ° .J ELEV_ _�� _-�_ 4S -� [oa..�_ _ 6�'F Et `T4.44 So •,dy 2. SY
- ---- FLOW LINE 1 - G H/ CN C o+► A4 C/ 7"Y - �, nQ 2.SY ---- _
I / AtJ Ar 4. rit i{ rOR s w/ Z Gp C� I .s and
ELEV. Y� 52 10" ( DISTRIBUTION ELFV z ,V s) //'Af1{ y"TRENCH FORMATION 2' WELL�lW=47 -- l --- -- - 72
MIN. l Co. G?L -- ---- -
1 a 3/8" DRILL - - -- - ZONE
GAS HOLE BOX SOIL ABSORP I ION b. INDEX _?.r_•g_
9(,. 9J BAFFLE TO BE WATER TESTED AD,I<1ST__ 2•
ELEV. - 9
ELEV. a i �O „n 3/4" TO 1 1/2" SYSTEM (SAS) ! we C ` .5 and �� c
0 CHECK WASHED STONE
VALVE
LIQUID OUTLET (TO BE PLACED ON FIRM BASE) USGS PROBABLE WATER TABLE ELEV. _ _S Z
-DEPTH--------1EE----
-�- E L �1 OBSERVED WATER TABLE (I + / 14/ 'i) ELEV. 2DI i ---- ��
4 FEET 14 INCHES � 500 GALLON PUMP BOTTOM OF TEST HOLE ELEV. - - WATER ENCOUNTERED AT ELEV. g`"� `" WATER ENCOUNTERED AT 4 ELEV.
5 FEET 19 INCHES 6 FEET 24 INCHES SEPTIC TANK CHAMBER PUMP CHAMBER CALCULATIONS
- FEET 29 INCHES
8 FEET 34 INCHES /� i ELEV. AT INVERT INLET 9G O REQUIRED FLOW PER CYCLE 25 X 3,3 O = S2 'r GAL./CYCLE
ELEV. AT ALARM ON VOLUME PER CYCLE &2 5' GAL./CYCLE / 7.48 GAL./CU. FT. _ / �_ CL). FT./CYCLE DESIGN CALCULATIONS
ELEV. AT PUMP ON - •O VOLUME OF WATER IN PIPE 3.14 X 0.00694 X eo-_ FT. - �'�C6. F1.
SEWAGE DISPOSAL SYSTEM PROFILE ELEV. AT PUMP OFF - _� TOTAL MINIMUM VOLUME PER CYCLE // S" CU. FT. NUMBER OF BEDROOMS -
80T70M OF INSIDE PUMP CHAMBERb'S DISCHARGE // CU. FT. / 34.67 CU. FT./FT. = FT. (1000 G.S.T.) GARBAGE DISPOSAL UNIT ^✓�
NOT TO SCALE BOTTOM OF OUTSIDE PUMP CHAMBER b�_ STORAGE CAPACITY -3 3-0 GAL./DAY / 7.48 GAL./CU. FT. ;' 34,67 CU. FT./FT. FT. TOTAL ESTIMATED FLOW
8d
_ /• 2 7 REQUIRED _t PROMED LEGEND: ( //O GAL./BR./DAY X -3 BR.) 3-30 GAL./DAY
REQUIRED SEPTIC TANK CAPACITY j
i0 GAL.
e U O 1A IV C y G on 4 tJ 4 A r- /GN 1 : G O oa 6:'S.TT) EXISTING SPOT ELEVATION OOxO ACTUAL SIZE OF SEPTIC TANK /3. GAL.
EXISTING CONTOUR ----00---- SOIL CLASSIFICATION 3I
HE C-H r r�wR .D crCO FINAL SPOT ELEVATION DESIGN PERCOLATION RATE �- MIN./IN.
8.S'X 4.All.? +K ; 9S. 2 - 9/. G) K G 2,4 )922 3 /b J FINAL CONTOUR--� EFFLUENT LOADING RATE . G 0 GAL./DAY/S.F.
SOIL TEST LOCATION LEACHING AREA j�,x �2 ' /4 46 SSO SQ. FT.
UTILITY POLE 4
VV',, G-H T Cif N / Q 7-.19 A./Ae - 19240 /6 J TOWN WATER LEACHING CAPACITY (AREA X RATE) -3`30 GAL./DAY
SSG i c - CATCH BASIN `®� -,C , Gc
GAS LINE ------ .�=--- RESERVE LEACHING CAPACITY 3 3�_ GAL./DAY
6.S�t 4 .A.3�c ( /00.6 - 97. GL)4/1o)* /•j,,CG6 /b.a
Exc0S x / 2, 023 1b6
NOTES: I
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P
TITLE 5 AND THE TOWIJ OF 3,2•L4-' -5 '^'a4j-E RULES AND
REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE.
2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO
WITHIN 6" OF FINISHED GRADE.
-.. . -�,• 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPAELE OF
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WI rHIN
i 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE
all, /} USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS.
1'' a . O 4. ANY MASONARY UNITS USED TO BRIN(, COVERS TO GRADE SHALL
BE MORTARED IN PLACE.
o p Q1 r 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH
APPLICANT IS TO/
DEEDED OR ZONING REGULATIONS. OWNER `
'.'_
- OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR
f p IS TO CALL "DIG-SAFE" AT 1-800-322-4944 AT LEAST 72 HOURS
/ 2 ( 11 I I 9� PRIOR TO COMMENCING WORK ON SITE.
7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS
SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE.
8. PARCEL IS IN FLOOD ZONE _
4 t x 7Q L 9. LOT IS SHOWN ON ASSESSORS MAP _ 3 S AS PARCEL y
N / o / I
V � ( ,/ I � -T--R tN� J„{ f�?A�) 10. PUMP AND ALARM ARE TO BE ON SEPERATE CIRCUITS.
p 11. ALARM IS TO BE BOTH AUDIO AND VISUAL.
puM
12. SEPTIC TANK AND PUMP CHAMBER ARE TO BE ASPHALT COATED
CM4M4Ck + AND HAVE 6 ML. POLY ATTACHED.
Q I ,
13. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER AND FOR
; - - - " � A MINIMUM OF 5' AROUND LEACHING FACILITY AND BE REPLACED WITH
......
-.o _7J.. MATERIAL AS SPECIFIED IN 310 CMR 15.255:(3).
ZF
''- APPROVED: BOARD OF HEALTH
f '^ / i + DATE AGENT
"� /,34 sj ' -' ( PROPOSED SEPTIC DESIGN
FOR
/ G 2 . (D 3Pr - - JE
( PROJECT LOCATION
Lo
SL Z; P,...
CRAIG R. SIIORT
PROFESSIONAL ENGINEER
R � 9 508- P. 0. BOX 781
N _ 385-6530 DENNIS, MASS. 02638
f
9 ` SCALE �►� -` LQ
i �
I
REVISED _7JOB N0.
REVISED
LOCATION MAP �- SHEET / OF
01996 C.R. SHCRT, P.E.
I