HomeMy WebLinkAbout0021 SURREY LANE - Health 21 Surrey Lane
Barnstable
A=298-049
`t'
Commonwealth of Massachusetts -
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
21 Surrey Lane
Property Address
Haqy & Jean Hilton
Owner Owner's Name
information is
required for Barnstable MA 0630 Jul 25, 2008
very page. City/I own y
State Zi Code Date of Inspection
�
Inspection results -p ults must be submitted on this form. Inspection forms may not be altered in any
1 way. -
Important,
When filling out A. General Information
forms on the '
computer,use 1. Inspector. s
only the tab key
to move your cursor-do not Patrick M. O'Connell
e�
use the return Name of Inspectorcl
_
key. Septic Inspection Services Co. {
t .. .
Company Name ;—
r� 189 Cammett Road 4- '
Company Address '' —
Marstons Mills - MA 0 648
City/Town State Zi Code ' —
508-428-1779 S1 12855cn
Telephone Number LicenSE Number
B. Certification
I certify that I have personally inspected the sewage disposal sy tem 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 prop r 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 Passe ® Fails
❑ Needs Further Evaluation by the Local Approving Autlio ity `
July 2 ,2008
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. -
08-201 Hilton.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15
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i
Z4 Commonw alth of Massachusetts
Title 5 Official Inspection orm
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
21 Surrey Lane
Property Address
1
Harry& Jean Hilton
Owner Owner's Name I
information is Barnstable MA 012630 Jul 25, 2008
required for Y _
every page. Cityrrown State Z p Code Date of Inspection
B. Certification (cont.) -
Inspection Summary: Check A,B,C,D or E/always comp ete all of Section b
A) -System Passes: F
❑ I have not found any information which.indicates that any of,the failure:criteria described
in 310 CMR 15.303 or in 31b CMR 15.304 exist..Any f ilure criteria not evaluated are
indicated below.
Comments:
z—
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 he replacement or repair, as approved by
the Board of Health, will pass..
Answer yes, no or not determined(Y, N, ND) in the ❑ for he 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 axfiltration or tank failure is imminent.
System will pass inspection if the existing tank is repla ed 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 y ears old is available.
ND Explain: q
❑ ,Observation of sewage backup or break out or high Ste tic.water'level in the distribution box due
to broken or.obstructed`pipe(s),or due to a broken, settled or uneven distribution box..System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
08-201 Hilton.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15
I
Commonwealth of Massachusetts
Title 5 Official Inspection orm
_
-I -Subsurface Sewage Disposal System Form - Not for Volun ary Assessments
�M. 21 Surrey Lane
Property Address
Harry &Jean Hilton -
Owner Owner's Name
information is required for Y ,Barnstable MA 2630 Jul 25 2008
_
every page. City/Town State:, ip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
k .
❑ distribution box is leveled or replaced.
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced
obstruction is removed
ND Explain: 4
C) Further.Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by th Boar`d of Health in order to determine if
the system is failing to protect public health', safety or I he environment.
1. System will pass unless Board`of Health'deterrnines 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 50ifeet of a surfaCE water
❑ 'Cesspool or privy is within 50 feet of a borderi ig vegetated wetland or a salt marsh
2. System willfail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a ma,ner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorpt on 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 th SAS`is within.a Zone'.1 of a public water
supply. ..r
f ❑ The system has a septic tank and SAS and th SAS is within 50 feet of a private water
supply well.
08-201 Hilton.doc•08/06 Title 5 Offici I Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
Commonwealth of Massachusetts,;, ;
Title 5 Official Inspection orm `
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 21 Surrey Lane
Property Address
Harry & Jean Hilton
Owner Owner's Name
information is Barnstable MA 2630 Jul 25, 2008
required for Y
every page. Cityrrown State 2 ip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS i 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, performe at a DEP certified iabo�atory, for coliform
bacteria indicates absent and the presence of ammonia ni rogen 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: e
Yes No
® . El clogged
of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to t e surface of the ground or surface waters
due to an overloaded.or clogged SA .or cesspool
❑ ® Static liquid level in the distribution box' above outlet'invert due to an overloaded
or clogged SAS or cesspool
El ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than_day,flow
O ® 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 Drivy 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.
08-201 Hilton.doe•08106 Title.5 Offici I Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
• I
Commonwealth of Massachusetts ,
Title 5 Official Inspection" orm•
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 21 Surrey Lane
Property Address ..
Harry&Jean Hilton
Owner Owner's Name
information is Barnstable
required for MA 02630 -July 25, 2008
every page. CitylTown State 2 ip Code Date of Inspection
B. Certification (cone.)
D) System Failure criteria Applicable to All Systems (co t.):
Yes No
❑ ® 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 crit ria are triggered. A'copy of the analysis
and chain of custody must be att ched to this form.]
❑ ® The system is a cesspool serving a acility with a design,flow of 2000gpd-
10,000gpd.
® ❑ The system fails. I have determine that one or more of the above failure
criteria exist as described in 310 CIV R 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 either"yes"or"no"tc each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system I's within 400 feet of a suiface 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]l of a public water supply well
If you have answered"yes"to anyquestion in Section E th 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 wner should contact the appropriate
regional office of the Department.
08-201 Hilton.doc-08/06 Title 5 Offidaa Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15
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Commonwealth of Massachusetts
W Title 5 Official Inspection, Form
W p
Subsurface Sewage Disposal System Form Not for Volunt ry Assessments
21 Surrey Lane _
Property Address
Harry &Jean Hilton
Owner Owner's Name —
information is gamstable MA 0 630 Jul '25, 2068
required for y
every page. Cityrrown t State dZ p 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 b the owner, occupant, or.Board of Health
❑ ® Were any of the system components umped out in the previous two.weeks?
❑ ' Has the system received,normal flows in the previous two week period?
El
® Have large volumes of water been int oduced to the system recently or as part of F
this inspection?
❑ ® Were as built plans of the system obt fined and examined? (If they were not
available note as N/A)
® ❑ - Was the facility or dwelling inspected forsigns of sewage backup?
® ❑ Was the site inspected for signs of`br ak out?
N ❑ 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'baffl s'or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
®, El Was.the facility owner(and occupants if different.from owner)provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size-and location of the Soil Absorption System (SAS) on the site has
been determined based on;
❑ ® Existing.information. For example,.a lan at the Board of Health.
® Determined in:the field (if any of the failure criteria_related to Part C is at issue-
El
approximation of distance is unaccep able) [310 CMR 15.302(5)]
08-201 Hilton.doc•08106". t f r Title 5 Off ici 1 Inspection Form Subsurface Sewage Disposal System•Page 6 of 15
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Commonwealth of Massachusetts_
W Title 5 Official Inspection .6rm
Subsurface Sewage Disposal System-Form - Not for Vol tary Assessments
21 Surrey Lane
Property Address
Hayy&Jean Hilton
Owner Owner's Name
information is Barnstable MA 2630 July25, 2008 required for ' .
every page. City/Town - State Zip Code Date of Inspection -
D. System Information
Residential Flow Conditions:
P
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow.based on 310 CMR 15.203 (for example: 110 gpd.x#of bedrooms):, 330 -
Number of current residents:, 2 —
Does residence have a garbage grinder? _ ❑ Yes ® No
Is laundry on a separate sewage system?[if yes separat inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes No
Water meter readings, if available last 2 ears usa e 304 gp0 gal:
- g ( - y 9 (gP ))� 304 gpd.
Sump pump? 0 Yes ® No
Last date of occupancy: Currently -
Occupied.
Commercial/Industrial Flow Conditions:
Type of Establishment: = '
Design flow (based on 310 CMR 15.203): Gallons per day(9Pd)
Basis of design flow (seats/persons/sq.ft., etc.): =
Grease trap present? y ❑ Yes ❑ No
Industrial waste holding tank present? 0 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):
08-201 Hilton.doc•08106 Title 5 OfficiE I Inspection Form.Subsurface Sewage Disposal System•Page 7 of 15
i
Commonwealth of Massachusetts
u Title 5 Official Inspection orm
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments`
t
21 Surrey Lane
Property Address
Har &Jean Hilton
Owner Owner's Name
information is Barnstable MA 2630 Jul 25, 2008
required for y
every page. City/Town - State Zip Code Date of Inspection
D. System Information (cost.)
General lnformati n
Pumping Records:
Source of information: Tank purnped every three years.
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 absorpti n system
❑ Single cesspool
El Overflow cesspool
Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
Innovative/Alternative technology. Attach 3 copy of the current operation and ;
maintenance contract(to be obtained from system owner)
El Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of-information:
1986
Were sewage odors detected when arriving at the site?. ❑ Yes ® No
08-201 Hilton.doc-08/06 Title 5 Offici I Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15
Commonwealth of Massachusetts .
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
�M 21 Surrey Lane _
Property Address
Harry &Jean Hilton
Owner Owner's Name
information is required for y ,Barnstable MA 630 Jul 25 2008
—
every page. Citylrown State Z`p Code Date of Inspection
D..System Information (cont.)
Building Sewer(locate on site plan):
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.):.
r
Septic Tank(locate on site plan):
Depth below grade: 6"• —
x 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: 8.5' long x 5.2'wide- 1000 gal.
3�'
Sludge depth:
Distance from top of sludge to.bottom of outlet tee or baffl 27 —
2„
Scum thickness —
Distance from top of scum to top of outlet tee or baffle 6 —
Distance from bottom of scum to bottom of outlet tee or ba a 12 —
How were dimensions determined? Measured _
08-201 Hilton.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
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1
f
Commonwealth of Massachusetts
Title 5 Official Inspection orm
Subsurface Sewage Disposal System Form - Not for Volu tary Assessments
21 Surrey Lane
Property Address
Harry & Jean Hilton
Owner Owner's Name
information is y ,Barnstable MA 2630 Jul 25 2008-required for 6 .
every page. City/Town State Zip Code bate of Inspection
D. System Information j ont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, .
liquid levels as related to outlet invert, evidence of leakage, etc.):
Li uid level was found at bottom of outlet invert, tees are intact and clear.
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 b e —
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outle tee or baffle'cendition, structural integrity,
liquid levels as related to outlet invert, evidence of leakag , etc.):
Tight or Holding Tank(tank must be pumped at time of ir spection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
08-201 Hilton.doc•08106 •Title 5 official Inspection Form,Subsurface Sewage Disposal System•Page 10 of 15
Commonwealth of Massachusetts :.
Title 5 Official Inspection orm
Subsurface Sewage Disposal System Form - Not for Volu tary Assessments
21 Surrey Lane
Property Address
Harry &Jean Hilton
Owner Owner's Name
information is Barnstable MA 2630 July'25, 2008 • _
required for
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank(cont.)
Dimensions: —
Capacity:
gallo s
Design Flow: gallo s 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 co y attached? ❑ Yes ❑ No
Distribution Box (if present must be opened) (locate on site plan):
F
Depth of liquid level above outlet invert —
Comments (note if box is level and distribution to outlets a jual, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Pump,Chamber.(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes : ❑ No
08-201 Hilton.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 '
Commonwealth of Massachusetts
Title 5 Official Inspection orm . .
_ Subsurface Sewage Disposal System Form Not for Volu tary Assessments"
°M 21 Surrey Lane.
Property Address
Har & Jean Hilton g
Owner Owner's Name a .
information is Barnstable MA 2630 Jul 25, 2008
required for - ", y
every page. City/Town State ip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type: +
® leaching pits number:; One 6x6 pit.
❑ leaching,chambers number: -
❑ leaching galleries number: —
❑ Teaching trenches number,length`
❑ leaching fields t 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.):
liquid level in pit is over top of structure, pit is in hydraulic ailure with no effective leaching.
08-201 Hilton.doc•08106 Title 5 Official nspection Form:Subsurface Sewage Disposal System-.Page 12 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
21 Surrey Lane =
Property Address
Hag &Jean Hilton
Owner Owner's Name
information is y ,Barnstable MA 2630 Jul 25 2008 required for '
every page. Cityrrown State Zip Code Date of Inspection
D. System Information'(cont.)
Cesspools (cesspool must be pumped as part of inspect on) (locate on site plan):
P
Number and configuration
Depth—.top of liquid to inlet'invert —
Depth of solids layer
Depth of scum layer
Dimensions of cesspool }
Materials of constructiori
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failur ; 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.):
08-201 Hillon.doc•08/06 Title 5 Officiall Inspection Form:Subsurface Sewage Disposal System•Page 13 or 15
Commonwealth of Massachusetts
r Title 5 Official' InspectionI orm
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
21 Surrey Lane
Property Address — i ------ --- --- --------- --
Harry &Jean Hilton T
Owner Owner's Name
information is Barnstable _ MA_ 2630 Jul 25 2008
required for _ - _ —�__ ,
every page. Citylrown State � ip Code Date of Inspection .
D. System Information (cont.)
Sketch Of Sewage Disposal S stem: Provide a sketch of I he sewage disposal s stem'includin ties .
9 p Y e t 9 p Y 9
to at least two permanent reference landmarks.or benchmarks. Locate all wells within 100 feet.
Locate where public water supply enters the building.'
59,
2
3'
21
Water ,
Service
Surrey Lane
Commonwealth of Massachusetts •"
= Title 5 Official Inspection iForm
Subsurface Sewage Disposal System Form -,Not for Volu Itary'Assessments
21 Surrey Lane .
Property Address €;
Harry& Jean Hilton
Owner Owner's Name
information is Barnstable MA. 2630 Jul 25, 2008 required for y
every page. Cityrrown -State, Eip Code Date of Inspection
r
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water i
® Check cellar
® Shallow wells
i
N/A
Estimated depth to ground water, feet
Please indicate all methods used to determine the high hground water elevation:
I ,
❑ Obtained from system design plans on record
If checked, date'of design plan reviewed, pate
❑ Observed,site (abutting property/observation Kole within'150 feet of SAS)
❑ Checked with local Board of Health -explain: u
❑ Checked with local.excavators, installers - (a ach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
• I
I ,
08-201 Hilton.doc•08/06 Title 5 Official!Inspection Form,Subsurface Sewage Disposal.System•Page 15 of 15
THE Town of Barnstable
F T
Regulatory Services
BARNSTABLE, : Thomas F. Geiler,Director
9$ ib . �0�
pTEo39�a Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-190-6304
REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS
DISCLAIMER
This septic system inspection report was completed by a private inspector who is certified by
the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original or copy of the report;
this Division does not warranty the functionality of the septic system in the future nor does
this Division agree with any technical observations and interpretations contained within this
report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual number
of bedrooms approved at a particular property would be listed on the "Disposal Works
Construction Permit".
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
QASEPTIC Disclaimer Private Septic Inspections.DOC'
TOWN OF BARNSTABLE
LOCATION X SEWAGE#
VILLAGE LAGE 13crn 51'c��t ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO. Ccuu,c wt J „ E . 92 g 9W,?
SEPTIC TANK CAPACITY IoW H i o
LEACHING FACILITY:(type) (i 4t eei p i3to (size) //, Z )(ZS
NO.OF BEDROOMS 3
OWNER C�
PERMIT DATE: C(• la• d COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility .,v G Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) I v` Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY ��Plcy�c2 e �ZLo n des
� 1
a
At 9•`4
4'?•3 _
No. . L._C�U�•- 37 S r T Fee /00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zipplitatton for �Digpogaf *pgtem Conoructton Permit
Application for a Permit to Construct( ) Repair r) Upgrade O Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No. Z 1 5vPp Lj (,&4...- Owner's Name,Address,and Tel.No. 14 11 TdH
jOwAsTpee- 2-2 5vrr-c., �n
Assessor's Map/Parcel 25 9-041 p s 7"4
Installer's Name,Address,and Tel.No. C-'q eew3 & �� �1 r�Spj Designer's Name,Address and Tel.No. e4�,,�,eerikj W,R 4,Y
-P•0.3ox -7(63 1 L w- 4rv3 S (*e,lcis
Ce. ,Tza,.- \e q77-53(3 Com- n✓}l�
Type of Building:
Dwelling No.of Bedrooms Lot Size ZO,2 2-4-1 sq.ft. Garbage Grinder ( )
Other Type of Building 5 i n1�t �✓sm�1 c� No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 gpd Design flow provided 3`�7. gpd
Plan Date q^ l 2.-Lo Number of sheets Z Revision Date
Title 21
Size of Septic Tank 1000 OXS44i t —Type of S.A.S. A
f/
Description of Soil C- e Lh
Nature of Repairs or Alterations(Answer when applicable) fy-,J - i3 O V '1b /utj S. A , S,
a
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 ealth.
Signed Date 5^ I Z^ Z,0®
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No. 2 0 3-7 '3 Date Issued —` ^ 1 2.•- Z 0 b 5 L .
y,�.« ... t.'s.--:-^.y�.,,j.� .�,,,.-.,•-.+.+."a`w'i.A...,•ki-4�%-.;r'^r'•'�•^ .,:q..ai•-:•,-.-%.as..:vy:.:.�_s.:.�:w�..Ri•:'.ar.r.-.:.x..:-- -,,;m.:r-;.. : � �:ram. Y. _.,., .n
No. Fee e 20��- 37 3 oo _
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:.
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zlpprication for �Bigpogar *pgtem Cangtruction Permit
Application for a Permit to Construct( ) Repair`(/ Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No. ' 1 5vrr�L j Owner's Name,Address,and Tel.No.. { T Uy
t Off ASTpGke Zt Svrrc., �_A
Assessor's Map/Parcel _49 a -Dyq
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
F.O. 3Jx 7�3 lZ.w• C✓asF,cic3
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size 2 Q, 2 2-$ + sq. ft. Garbage Grinder ( )
Other Type of Building 5 �!(e �✓� 1 v No.of Persons Showers( ) Cafeteria( )
a Other Fiktures
Design Flow min.required) 3 3 O d Design flow provided y-7.�f d
g ( 9 ) gP. g . P gP
Plan Date^ q- ( L Number of sheets Revision Date
Title Z 1 �J�+!✓✓yam
-Size of Septic Tank E 1 000 0/-S 1S4111 i 1 Type of S.A.S. �" gwjeis A+) S o -
Description of Soil gig ..! y2� `I f
Nature of Repairs or Alterations(Answer when applicable) f\Q� 0 V _T (U.-i
Date last inspected: t- Z00%
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 ealth. c�
Signed Date 94 ( Zi �iOO A
Application Approved by Date
Application Disapproved by: Date
r t
for the following reasons
Permit No. '--7 7,, Date Issued 2 Z
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERT FY,that the On-site Sewage Disposal System Constructed ( ) Repaired (y,) Upgraded ( )
Abandoned( )by y e j �.
at ,//�, (s -� �J�4/i!S �144�' has been constructed in accordance
with the prov sions of/Title 5 and the for Disposal System Construction Permit No.Z008- 3 3 dated
Installer '' Designer �1
#bedrooms r Approved de g�ow S 3 p gpd
The issuance of this permit sly II of e co strue Aa a guarantee that the system i !fund.• s designed. J/ ! d
Date / Inspector
No. 2-00 — S72, Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
Migpogal �bpgtem Congtruction Permit
Permission is hereby granted to Construct ( ) Repair .) Upgrade ( ) Abandon ( )
System located at ( : Qr''((!A., I:,A.rt,4-
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this hermit.
Date 1 - 1.2 — 2CJ G Approved by ��
1 09/16/2008 18:08 50847753131 ! 1 ENGINEERING; WORKS PAGE 0-1 �(
I
'down of Barnstable
I E
14
y j ' Regul#totS@PV1Cesji
r�
Thomas F.Geiler,Director c
t f pubL'c Health,Divisio> =f
, Thomas McKean,]Director
' + I 200 MN a Street, Hyannis,IV1A 02601 r
! i if
3 i 5O$-8624fi44, Fax: 508-790-t 304
toevvage ll'er�lt# ` Ck?�S !3? AsHes�or's M,�p/Parcel q di
'j � ? � i � e I E E ' f � i i� •
i l r F6[0
u 1
Deel$ner: �1 k?Add
tt S Installer:
_ Addre .,
On • '�•O Q i ai ! Wy i !• ' yl
� 3 issued$permit t0 instill a. ?j
} ( i ( 1 (instal
'' [ J 11 Y'/� !septic system at _ 1�h q based on a design drawn by
f
j` 1r 1• �� . . date(
7� I certify that the septic system,referenced above was installed substa�tti�J�y according to '
the desip, wh>ch may include mid approved changes such as labcrsl re on of the
' distribution box aindi'or tic`-tank. S ut if was ins
j .scp tripo ( requii+od) petted and the soils
were found satisfactory.
I certify t1sat the septic systm referenced above was installed with changes (i.e. p
MOOT than 10' ;latual relocation of the SAS or any;verticai ifty component k
of the septic syst�)1but in accordance with State&,Local revision or
certified as-built:by designer to follow. Stripout(if req d the'soils
} were found s'atisiitctoiy r ! PETr$ T. G
MtENTEE
1 u CIVIL
Na 35109
4 er'5 Si ! k i# .
� w � � 'tip �'
9n@r s Si9nmfi�. (Affix Designer's tMp Here) 4
it
RETURN(DcW
1 T D
AMUh BY THE IMNSTABLIK P LIC
I
9"b#Eice i' . fono.dor 1 1 i
oF�
Town of Barnstable P# 1//
Department of Regulatory Services ✓�
, aT Public Health Division Date
a6J9. �� 200 Main Street,Hyannis MA 02601
Date Scheduled D A�?Time Fee Pd.
w '
Soil Suitability Assessment for Sewage Disposal
Performed By: Witnessed By:
LOCATION& GENERAL INFORMATION
Location Address ( 5.+lre�� LPL Owner's Name 40aml a-;
r lhC�t 19r0`i t Address �i( v,f
Assessors Map/Parcel: Z.�I O l0�{c( Engineer's Name ,1��'
NEW CONSTRUCTION REPAIR Telephone# S y L$
�II__ /
Land Use .S /G�e✓1 A Q1 Slopes Surface Stones
Distances from: Open Water Body? U ft ',Possible Wet Area 2W ft Drinking Water Well U ft
t �
Drainage Way �2-UL ft Property Line 130 ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc.tests,locate wetlands in proximity to holes) - -
a
36t�
i
Y .
�i
4'
_ s j
Parent material(geologic)�4 C3 4 �CJ�W Depth to Bedrock * IS -6
Depth to Groundwater. Standing Water in Hole: /'J/ -Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: __ _ __ in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level- Adi,fhctor,..,.aa Adj.Groundwater Level-
PERCOLATION TEST >�ate x'Ime LG
Observation
Hole# Time at 9"
Depth of Perc �'— / 3 Time at 6"
Start Pre-soak Time @ - 2 , Time 9"-6")
End Pre-soak Q
Rate MinJInch ---
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one (1)week prior to beginning.
# Q:\SEPTICIPERCFORM.DOC
DEEP OBSERVATION HOLE LOG Hole#
Deptkfrom Soil Horizon Soil Texture .Soil Color Soil Other
Surface(in.) (USDA) (Munsell Mottling (Structure,Stones;Boulders.
Consistency, Gravel)
�j2 2d L S 6 6
DEEP OBSERVATION HOLE LOG Hole# 2—
Depth from '' ' ' Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
p_ � }� 5 L � o r•2�/ j
Zo l a yi'z-G/y
DEEP OBSERVATION HOLE LOG Hole#
Depth from x Soil Horizon,. Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Cnite Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
onsi en
Flood Insurance Rate May:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No— Yes
Depth 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? S
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required t ' ' g,expertise and experience described in 310 CMR 15.017.
Date
Signature
0�
Q:\.SEPT MERCFORM.DOC
t
�p THE T Town of Barnstable a Barnstable
Regulatory Services Department ��1e,r;acftv
BAWSMABM w 1 F _
MASS. Public,Health Division m
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
r
a,
August 6, 2008
Harry&Jean Hilton
21 Surrey Lane
Barnstable, MA 02630
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 21 Surrey Lane, Barnstable, MA was last inspected on
July 25, 2008,by Patrick M. O'Connell, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Failed" under the guidelines
of 1995 TITLE 5 (310 CMR 15.00) due to the following:
Liquid level in pit is over top of structure, pit is in hydraulic failure with no effective
leaching.
You are ordered to repair or replace the septic system within sixty (60) days,from the ,p
date you receive this notification.
Failure to repair/replace the septic system within the deadline period"will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Donald R. Desmarais, R.S.
Agent of the Board of Health
CERTIFIED MAIL#7006 2150 0002 1041 7620 u
Q:\SEPTIC\Letters Septic Inspection Failures\21 Surrey Lane.doc
LOCATION SEWAGE PERMIT NO.
LICIT
`VILLAGE �{sE121
INSTA LLER'S NAME i ADDRESS
AQ86 a,/4(-A-- AWI Ay S T. W, SA lf% £
�R'.. UILDER OR OWNER
r
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED Jr �,
f
frx]DCnA� ( ' r 6,K4
SV-PTC. -rAN L4AGIt
\ ' P i r
s rno.t PACK
,- -�
n�
No.. :�. Faa. ---------U
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1.�? u............OF.... LR` ..........................
Appl ration for Disposal Works Tonstrurtiun Permit
Application is hereby made for a Permit to Construct (11-ror Repair ( ) an Individual Sewage Disposal
System at
or
Ad res °�-i �....... ......................................................Lot
No.
»..........................................
Owner Address
a ...................I............._ ....... ........•-----........................... ......._....... ....................--.. '--........................................
Installer Address
Type of Building . _ Size Lot.MfZ.Z5........Sq. feet
aDwelling—No. of Bedrooms.......... ............Expansion Attic ( ) Garbage Grinder ( )
aOther—Type`,of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
aOther, fixtures ................................... ..........-•-------...... ........_.. •-.......
W Design Flow.........1 .........................gallons per person per day. Total daily flow..............:..... jo..........gallons. .
W Septic Tank—Liquid capacity' allons Length.'3-�6"Widthl�-� W.Obiameter�:-:.--. DepthS A
x Disposal Trench=No. ................. Width......'............ Total Length....................Total leaching area_._............----sq .
3 Seepage Pit No._:,� �. ... Diameter......I�.-..... Depth below inlet....AV......... Total leaching areaE"1. Q q.t,. _
Z Other Distribution box ( Dosing.tank
Percolation Test Results Performed by.... 01WAt'�6 �......... Date....5..... :.......
.a
Test Pit No. L.A. A -� ...minutes per inch Depth of Test Pit.-L I...... Depth to ground water..WUtF....,
f=, Test Pit No. 2..:�Z-.minutes per inch Depth of Test Pit...IA925 ..... Depth to ground water...�I��
`'. �►. �+ a+ as
O Description of Soil..... ve.� ............
Ux Nature of Repairs or Alterations Answer when applicable... .................. •.
P — -..............•--
.......... .� i:°F��............. .�_�......._. .P�?.�l �A a�25.......: �....SYS .�!V.......t..ss�
Agreement: j i,U(21 1 M-6
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with-
the provisions of LITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by thp board of health.
Signed..... /.`!_.:. y`.._...>............................
...... _2� ._..
` \0 Date
Application Approved By- _. . ._ ^:... ..................................................
Date
Application Disapproved for the following reasons:...............................................................................................................
...---•-•..............:...................................................................•----...................--•-•-•-•--••--•--........----........:..........--•-----..........................._
Date
Permit No.... ...- .�.. :...___ Issued................ ...................... ...._
Date
FEB
THE COMMONWEALTH OF MASSACHUSETTS
_ . BOARD OF HEALTH
.............0F.... .................................
Applirtttiun for Disposal Works Tonstrur#ion Permit
Application is hereby made for a Permit to Construct (zWor Repair ( ) an Individual Sewage Disposal
system at:
vNo..........................................
... 3 i ( La aeon Address or Lot
1 " .`�t .., i t" to# ....... .. .....••---._. .. .._.......... ........._.................... .
Y Owner - -
............................
.......... ............ ��
.••---.............•......._.................... .......--••--•----•••--••----•-•--___-_.........._......... ................._................
Installer Address
Type of Building. i,: Size Lot.G:>:%';' ...Sq. feet'....
., Dwelling—No. of Bedrooms.....................-`..Expansion Attic ( ) Garbage Grinder ( )
`4 Other—T e of Building ............... No.. of ersons.........___._...........___ Showers —
Ga4 YP g ••---•-----•- P ( ) Cafeteria ( )
QOther fixtures .---•--•..........................................................-----••-•---..........._............-----•-----........_............................
WW Design Flow...... 110 ..._.gallons per person per day. Total daily flow.................: ...........gallons
W Septic Tank—Liquid -capacity C.-Drigallons Length.`�= .y.'Width 1 Diameter DepthS r 4,.�#
x Disposal Trench No .................... Width....................Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No. !Ck.k-= Diameter...... e�') Depth below inlet.... . ....... Total leaching area!�O!�..Isq. ft.
z Other Distribution box (VIT, Dosing tank ( )
0-4 Percolation Test Results Performed by.. ,F l+ ..! I .......... Date._' ?."-! F�
,.a Test Pit No. 1.. minutes per inch Depth of Test Pit I M tL___ Depth to ground water 11�(�
tit Test Pit No. 2..."S_ _minutes per inch Depth of Test 'Pit ..... Depth to ground water h--1� �
ai ,1► �� '� 1 �1til rt ...t"�1...... y' .................................1 tD..............
0 Description of Soil..... t �- U (---W�I1 �� " �Ga�' L: 1���# �
..----
"►'� 5Eat 2T'SS 1...................-- 1 �► ill l���^�'_..54 1 ...1. •�3�•Cl Q��r 1���'
W 1i�+l' "`,�(. I I M k1 lvlt -t��-,tt�l i`'-�C y .....
U Nature of Repairs or Alterations Answer when applicable _._, ____ rnM ._.__._._. a�?.1__.-__-_`:= ..................
�>v- �
C5.Q_r!. `�......... . c -� n r�p�? n� ... 1/ F ul ... Lcsc 'TL ca'(��
._.... ............... - -_..._ .._._..
Agreement: f J tN{ l Z 1 w e5
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of AITLW 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed......:.-a?�.. :.-.�:.. ................................. -�.. /.....................2 _..
ffDate
ApplicationApproved By.. = ..................•••-••-•......._.._.....-�......__---•-•----•-- - --....(... Date .....
Application Disapproved for the following reasons:...................................................................................:............................
...............................•---...........,..._..............---•-•--••--.........--•• .._.....................................................................................................
Date
Permit No......................................•---------...._.........._...... Issued.--------------..........................
• ...........
Date
.. .. __. .y...,...- _- --,N.._., ra., .•ram.-. ...t.«...-..._...r.. _ .«. _..m..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Trr#if irate of Tomplittnrr
THIS IS�TyO. CERTIFY, That the Individual Sewage Disposal System constructed (�).-oc Repaired ( )
by...................:!�:!. ............... ---._ .............. .................---........................................................
q �t_,_f�� •Inataiier
it..................�-( / •,� ,f r f+,�l ____— == rn ......----............__•___--..............-•-••-.............................
has been installed in accordance with the-provisions of TITLE 5 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 CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.. ` .......�: ` ........................................... Inspector.. ..,............................... .................
'.,.».,..-...n....,........r,..».,,.r r--...,. ,.:.�-,...,». ,Y.,-,.._...:.,_r r r ...♦::•a r,a.. .•a.; ,q««, a.a..a. .•... .a, r. , . a.y,..
THE COMMONWEALTH OF MASSACHUSETTS t �G/IU`s4� Q1p
BOARD OF HEALTH C c-rz ' `� �"--
e-c. "D)j 7 avS
No.. . .C. Z .........................................OF.:............................:........................_.........,._....__......... .�.�.v.�.
13ispos forks Tons#rurlion Permit
Permission is hereby granted....... _. ~�t-- � ................
r
to Construct (—)or Repair ) an .Individual Sewage Disposal System
at No.. ?(......�.z ?...•-- ' ware a ....... ?........ i.11 ................................................................................
„-
Street
as shown on the application for Disposal Works Construction Permit-No.................... Dated...... ..f{... �-... ,
f................................................... !
a...
j Board of health
'-'7
DATE....................
�......... .._
. Nora
LEGEND
- -- EXISTING CONTOUR
---- 260/ x 1.00.98 EXISTING SPOT GRADE o ROUTE
p� 42
PLAN BK N 9°2427 E 99 — PROPOSED CONTOUR a
-
' 133.99' 99 PROPOSED SPOT GRADE
W EXISTING WATER .SERVICE LOCUS
it
EXISTING SEPTIC TANK G EXISTING GAS SERVICE SJ`e�s 4 GrLn
(LOCATION TAKEN FROM RECORD
AS—BUILT PLANS) dG — UNDERGROUND WIRES gF
TOP OF TANK, EL,=98,42t
INV.(OUT)=97.0yt _ TEST PIT yr g n
¢ 99.62x' BENCHMARK c �
O e° S
BENCHMARK: j ( `r98.5,9 x''
- O
SCREW SET IN RR TIE / a:
ELEVATION = 100.00 {
(ASSUMED DATUM)
LOCUS MAP
` j • ''x. 99.18 .` �: NOT TO SCALE
,�t l b'• fmm EXISTING LEACH PIT
4 �. . • o f �av4n_ _:. t x 8.180 l ,: (LOCATION TAKEN FROM RECORD
105.72�X .. Edge L J Ov
9 AS-BUILT PLANS)
` _ �• .VENTTO BE PUMPED, FILLED WITH
1� o + 99 os � SAND AND ABANDONED GENERAL NOTES:
1 i ''-- _ 1
- -1 M- �- 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
106,07 x� l d (i �__ 7 ' --_�L- 1 / STRIPOUT UNSUITABLE SOILS BOARD OF HEALTH AND THE DESIGN ENGINEER.
103 84 -'�7"� _i__Jf ADJACENT TO LEACH PIT, IF L. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
1 ENCOUNTERED (SEE NOTE 11) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
w-- TP-2 LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW:
1 (x 99.46 10 /6. 3 310 CMR 15.405(t)(b):
DECK i ; % �Q � � - 1) A V variance to the 3' rnoximum cover requirement; for no greater
1T N / / 99 4 x // �� cLa _� than 4' of cover. S.A.S. shall be vented and H-20 Rated.
I ap fl 1 ,,/ 3. THE SEWAGE DISPOSAL SYSTEM-SHALL NOT BE BACKFILLED PRIOR
/'� / ! i / /" /;. -' t ^p TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
,� / DESIGN ENGINEER.
/ ,. ISTING' j �,i
/ / _ - 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
z / % / i-HOUSE (#21�/ Q� Z FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
/ ,
/ i '� ENGINEER BEFORE CONSTRUCTION CONTINUES,
GARAGE r T.O.F.=107.63t/�/
�(r.�ir 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
cellar floor.-1-0O.Of 1 33r'x ` ✓
i p 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
Attu
1 105.70 x G 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
x 107.05 . 106,75 �x fy 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
10 .75 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
DIRECTED BY THE APPROVING AUTHORITIES.
10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
DRIVEWAY (� THE LOCATION OF-ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
G� CONSTRUCTION.
11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
OF q
IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE. S.A.S. AND/17QpJ9� REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 2�5(3).
LOT 36 y� yG 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
5 G PETER T. INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL.
3 APN 298--049 �� o McENTEE 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
v CIVIL IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
G7 20,228±SF q N 35109
I �9 £P5I��``° PROPOSED SEPTIC SYSTEM UPGRADE PLAN
125.00' -I 21 SURREY LANE, BARNSTABLE, MA
S 7°30'00" W of �6 Prepared for: Harry Hilton, 21 Surrey Lane, Barnstable, MA 02630
EDGE OF PAVEMENT Engineering by: SCALE DRAWN JOB. NO.
+ > 'U" 1"=20' P.T.M. 228-08.
LANE >° Engineering Works
SURREY A 6 12 West Crossfield Road, Forestdale, MA 02644 DATE
CHECKED SHEET N0.
(508) 477-5313 9/12/08 P.T.M. 1 Of 2
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
.FINISH GRADE SHALL NOT BE < EL:96.33
CELLAR FLOOR EL.=100.0t FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D=BOX PROPOSED S.A.S. 21" - 5-4" POLYSEAL OUTLETS
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL INSPECTION PORT OVER END UNIT CHARCOAL 2" 2" -4" POLYSEAL INLETS
T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE VENT
EXISTING F.G. EL.=99.2t F.G. EL: 99.2t F.G. EL. 100.3t
/ MAINTAIN 2% GRADE (MIN.) OVER S.A.S. N � :. O O
INSPECTION 00
L = 2' L = 7'(MAX) PORT
® S=1% (MIN.) 0 S=1% (MIN.)
4"SCH40 PVC 4"'SCH4U PVC
N Top View Section
10' 14., s' 11.3" TO D-B O X
EXISTING 48" LIQUID INVERT
LEVEL ADD
GAS BAFFLE INV.=97.00 PROPOSED INV.=96.83 4 ROWS OF 4 UNITS AT 6.25'/UNIT = 25.0'
INV.=97.09t D-BOX INV.=95.94
EXISTING 4 OUTLETS (MIM.) SOIL ABSORPTION! SYSTEM (PROFILE)
EXISTING 1000 GALLON SEPTIC TANK
ESTABLISH VEGETATIVE COVER
BACKFILL WITHW-ftEAN NATIVE OR 75
PERC SAND TO TOP OF CHAMBERS
NOTES: 1) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE
ON A MECHANICALLY COMPACTED SIX INCH CRUSHED BREAKOUT=TOP
STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2), TOP ELEV.=96.33
2) INSTALL INLET & OUTLET TEES AS REQUIRED. INV. ELEV.=95.94
3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE BOTTOM ELEV.=95.00 pI uu nmr�Il
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 2.83' 76"
4) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE 5' MIN. ABOVE BOTTOM OF
INVERTS PRIOR TO CONSTRUCTION. T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=11.3'
EXISTING SUITABLE PROFILE
NO G.W., EL=86.2 MATERIAL
4 ROWS OF 4 - 16" (H-20) ADS BIODIFFUSER UNITS
SEPTIC; SYSTEM PROFILE WITH NO SEPARATION BETWEEN EACH ROW & NO STONE
TYPICAL SEC
TION 16"
N.T.S. WT.s 11.2"
SOIL LOG 34"----..�
DESIGN CRITERIA i PRO - T DATE: SEPTEMBER 9, 2008 (REF#12,343) SECTION END CAP
�`1 �3.6' r iv S•A.$, D i^� SOIL EVALUATOR: PETER McENTEE PE
NUMBER OF BEDROOMS 3 BEDROOMS WITNESS: DONNA MIORANDI R.S. »��
--� j �--�..---- HEALTH AGENT 16 HIGH CAPACITY (HH-20) BIODIFFUSER UNIT
SOIL TEXTURAL CLASS: CLASS I [ ELEV. TP_ 1 DEPTH ELEV. TP-2 DEPTH
DESIGN PERCOLATION RATE: <2 MIN/IN j 22 99 2 0 99 4 0„ MODEL 16" HICAP
i A A
DAILY FLOW: 330 G.P.D. �i j h SANDY LOAM SANDY LOAM LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
/ 10YR 4/2 10YR 4/2 EFFECTIVE LENGTH 75 TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
DESIGN FLOW: 330 G.P.D. /f / ' 98.9 i 4" 99.1 4" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
/'
GARBAGE GRINDER: NO / �' / / / e ° e SIDE WALL HEIGHT 11.2"
i /� � SANDY LOAM SANDY.LOAM
/ ,= f f /�� 'EXISTING�// ^D 10YR 5/8 10YR 5/8 OVERALL HEIGHT 16"
LEACHING AREA REQUIRED: (330) 445.9 S.F.
96.7 42" 95.4 48" 4640 TRUEMAN BLVD
_74 ,/HOUSE (#21) C1 60" C1 OVERALL WIDTH 34" HILLIARD, OHIO 43026
EXISTING SEPTIC TANK: 1 000 GALLON CAPACITY I\� /f�j, PERC '13.6 CF
CAPACITY
PROPOSED D-BOX:: 1 INLET, 4 OUTLET (MINIMUM), H-10 RATED /� /` .! / i 72" LOAMY SAND (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC.
' LOAMY SAND 10YR 6/4 PROPOSED SEPTIC SYSTEM UPGRADE PLAN ,
USE 4 ROWS OF 4 - 16" (H-20) ADS 'BIODIFFUSER UNITS 10 fR 6/4
W/ NO STONE FOR AN S.A.S. WITH DIMENSIONS 1 1 .3' x 25.0' s� 2 Cz 120 89.4 C2 1zo 21 SURREY LANE, BARNSTABLE, MA
(HIGH CAPACITY INFILTRATORS MAY BE SUBSTITUTED MED. SAND MED. SAND
) 2. Y 6/4 2.5Y s/4 Prepared for: Harry Hilton, 21 Surrey Lane, Barnstable, MA 02630
SIDEWALL AREA: NOT APPLICABLE
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.7 SF/LF OF BIODIFFUSER) S.A.S. LAYOUT 86.2 156" 86.4 156" Engineering by: SCALE DRAWN JOB. N0.
Engineering Works
NTS P.T.M. 228-0$
16 UNITS x 6.26 LF x 4.7 SF/LF = 470.0 SF PERC RATE <2 MIN/IN. ("C1&C2" HORIZONS) 9 DATE
R Forestdcle MA 02644
12 West Crossfield Road, CHECKED SHEET N0.
DESIGN FLOW PROVIDED: 0.74 x 470.0 = 347.8 GPD NO GROUNDWATER ENCOUNTERED (508) 477-5313 9/12/08 P.T.M. 2 Of 2