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HomeMy WebLinkAbout0084 ALLAN ROAD - Health 84 Allan Road ! Centerville J A = 194 001009 1 { rClfO�o UPC 12543 No. 53LOR *P0 -coH�� HASTINGS, MN c v� a .; I ic?q-00/- 007 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 01 rn °M 84 Allan Rd. r.., Property Address Julie Clymer a Owner Owner's Name information is 6e4g6 V1,I L e Ma. 02668 08-24-2018 ' required for every : page. City/Town State Zip Code Date of Inspection �a �k! t1Fi Inspection results must be submitted on this form. Inspection forms may not be altered in an'y way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information SlI- 13oZ on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael T Bisienere use the return Name of Inspector key. Cape Septic Inspections Q Company Name 624 Old Barnstable Road Company Address Mashpee Ma. 02649 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 08-26-2018 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 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �6 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Allan Rd. Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 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: ® 1 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: This 4 bedroom home has a H-10 1500 gallon septic tank and a H-10 D-Box feeding 3 leaching chambers. At the time of the inspection there were no visible signs of past hydraulic failure. 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.doc•rev.6/16 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 M 84 Allan Rd. Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will 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.doc-rev.6/16 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 84 Allan Rd. 'M Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 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. I . ❑ 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 1/2 day flow t5ins.doc•rev.6/16 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 84 Allan Rd. M Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 page. Cityrrown 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 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. 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. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 84 Allan Rd. Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® 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): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 44plus GPD t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 84 Allan Rd. Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date Commercial/Industrial Flow Conditions: 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Allan Rd. Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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 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): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 V Commonwealth of Massachusetts w u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 84 Allan Rd. Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 191. 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): Depth below grade: 12"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: Standard H-10 1500 gallon septic tank Sludge depth: 1" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts H u Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 84 Allan Rd. Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 36" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I would recommend the new owner put the tank on a maint. plan with a local septic pumping co.The Barnstable Health Dept. has a list of local septic pumping co. 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 84 Allan Rd. Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 84 Allan Rd. Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The H-10 D-Box had no visible signs of leakage or evidence of past hydraulic failure. 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.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ 6 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 84 Allan Rd. Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ 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.): At the time of the inspection there were no visible signs of past hydraulic failure. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6/16 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 84 Allan Rd. M Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): t5ins.doc•rev.6/16 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 84 Allan Rd. Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 45- st1 f Fr�r, ;yJ t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 TOWN cOF BARNSTABLE LOCATION, Py Uky s SEWAGE ii ZbO Z ' ,S O S— ASSESSOR'S MAP iIOT 0" INSTALLER'S NAME PHONE NC. 00 SEPTIC TANK CAPACITY ! LEACHING FACUM:(type) (size) 3 I NO.OF BEDROOMS BIIII.DBR owNER Sc flank a- - PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland 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) O Feet Furnished by Q ' i� X 3 3 3b �3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 84 Allan Rd. Property Address Julie Clymer Owner Owner's Name information is required for every West Barnstable Ma. 02668 08-24-2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record Y 9 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: I augered a hole to twelve feet to show 4 plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Allan Rd. Property Address Julie Clymer Owner Owner's Name information is West Barnstable Ma. 02668 08-24-2018 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed E System Information— Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file G� C,.,� e. pf ,� vS Fe e� t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is required for every Centerville MA 02632 April 13 2014 page. Citylrown 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 A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not David D. Coughanowr, IRS use the return Name of Inspector key. Environmental Company N Company Name P.O. Box 1265 Company Address West Chatham MA 02669 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of uh co Title 5( 10 CMR 15.000) �Ho a !r% MgSSy C �? ® asses �o` DADVID tim Conditionally Passes ❑ Fails r ❑ HANOW Needs Further vaQu 0.-tl Phgy cal Approving Authority cz� r1 0 s Lf— w �S�pPROVE���� �� � � FM INsp�c ,..� April 13, 2014 CDInspetor 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. VJ I �j t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is required for every Centerville MA 02632 April 13, 2014 page. CityTTown 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: Inspector's Note==> The septic stem described herein is deemed to ass this Real Estate Transfer p p Y p Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. Removal of garbage grinder is recommended. 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. a 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 witha 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-oldis available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is required for every Centerville MA 02632 April 13 2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is required for every Centerville MA 02632 April 13, 2014 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 asses if the well water analysis, performed at a DEP certified laboratory, for fecal Y p Y � P ry, 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 '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is required for every Centerville MA 02632 April 13 2014 page. Cityrrown 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 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is required for every Centerville MA 02632 April 13, 2014 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ 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): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is Centerville MA 02632 Aril 13, 2014 required for every P page. Cityrrown State Zip Code Date of Inspection D. System Information Description: System was installed by Hickey in 2003. Number of current residents: 3 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 222 gpd 9 ( Y 9 (gpd)): Detail: 2012: 79,000 gallons 2013: 83,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is required for every Centerville MA 02632 April 13, 2014 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner 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 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): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is Centerville MA 02632 Aril 13, 2014 required for every p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1+ years. Certificate of Compliance for new system issued 12/23/2003 (Permit#01-74) Were sewage odors detected when arriving at the site? ❑ Yes ® No 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.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank (locate on site plan): Depth below grade: 1 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: 10.5 x 5 x 6-1500 gallon Sludge depth: 6 in t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is required for every Centerville MA 02632 April 13, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 in Scum thickness 2 in Distance from top of scum to top of outlet tee or baffle 9 in Distance from bottom of scum to bottom of outlet tee or baffle 13 in How were dimensions determined? Design plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is not required at this time. Maintenance pumping is recommended within 2 years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is Centerville MA 02632 Aril 13, 2014 required for every P page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �^M 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is required for every Centerville MA 02632 April 13, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at 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.): Distribution box appears structurally sound and functioning as intended. No evidence of leakage in or out was observed. 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.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located explain why: p Y t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is Centerville MA 02632 Aril 13 2014 required for every P page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ 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.): Soils above leaching gallery appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Inspection camera showed concrete chamber to be approximately half full. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is required for every Centerville MA 02632 April 13, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is Centerville MA 02632 Aril 13, 2014 required for every _p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately THIS SKETCH IS BEST VIEWED IN �Qy COLOR FORMAT 1 508 364-0894 EXISTING o DWELLING B � o N�°A- 2 0� oP.�P 0 084 \���Q��� oa o �Q\ Q�h n y m LOCATIONS Z ^' -OF SEPTIC COMPONENTS DRIVEWAY -DISTANCES IN DECIMAL FEET A 8 1 24 16 2 31.5 15 3 33.5 21.5 ALLAN ROAD t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is required for every Centerville MA 02632 April 13, 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 40+ 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: 10/29/2002 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: Approved design plan on file with the Board of Health shows bottom of system to be over 5 feet above the bottom of a witnessed test pit in which no water or groundwater mottling was encountered. Town of Barnstable GIS Department records indicate that the property is over 40 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �^M 84 Allan Road Assessor's Map 194 Parcel 1-9 Property Address Kieth S. Schachter Owner Owner's Name information is required for every Centerville MA 02632 April 13, 2014 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file GEOHYDROLOGICAL PROFILE - NOT TO SCALE z PRECASTW- t DRYWELL BOTTOM OF LEACHING PER DESIGN PLAN r LEACHING IS ABOVE HIGH GROUNDWATER 1V0+ GROUNDWATER ELEVATION PER GIS MAPS t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No. U((/ — S FEE ' r / t� Board of Health,� fP V1 S -�l '� , , MA. APPLICATION FOP DISPOSAL SYSTL 9[ CONSTRUCTION PLRMIT Application for a Permit to Construct( ) Repait-W Upgrade on( ) B Complete System U�I' Adual Components Location BY /9 L L A M f O A� t Owner's Name K2 f 'r'458, Map/Parcel# ctyI Address 64/ A L LA N 20 A ID Lot# Telephone# Installer's Name 9-1 'G 2 Designer's Name Su rV �011$Ge-rpq N) Address Address Vo �✓c R'J i`'�042S1��s IILI rY163 Telephone# — QQ Telephone# Type of B 'n Lot Size / � 38 3 sq.ft. Dwelling-No.of Bedrooms Garbage grinder Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures [ter Design Flow (min.required) % 6 gpd Calculated design flow`'t Design flow provided /J 1`� gpd Plan: Date OCT AcS, WO�L Number of sheets Revision Date Title S c-'e- + `�'G`c - ALA II✓ Description of Soil(s) ST.- e Soil Evaluator Form No. e of Soil Evaluator Date of Evaluation ? 00-yS3" S- DESCRIPTION OF REPAIRS OR ALTERATIONS - The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections o No. cx/ 5 t _, f FEE /00 4,4 Board of Health, jr u.t/�P MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(^)�Repalr ) Upgr deAban on( ) - NComplete System L9^In5ividual Components # ; Location $ A L.L A Al RO A 1/7 � © Owner's Name Map/Parcel# — CT Address 841 A LA N 2D A l�) Lot# l Telephone# Installer's Name t G 2 Designer's Name p./6ftp 'Address 3 —- - Address �0 b' c(�,�� �t•,aQ2�p,uS /�,l fL t ✓�l�/ Telephone# �' n ` V_.h Q -- U 0 Telephone# ✓ Type of.Buuildigg Lot Size / 7¢ 38 3 sq.ft. Dwelling-No.of Bedrooms % Garbagergrinder Other-Type of Building No.of persons Showers ( •Cafeteria ( ) Other Fixtures s Design Flow (min.required) /�j 4� d gpd Calculated design flow / �0 Design flow provided / gpd Plan: Date i AOD'�L Number of sheets Revision Date Title S,-fp "t` W 9 C./9 u✓ 5 x Description of Soils) STD C A Soil Evaluator Form No. s / �' ame of Soil Evaluator, Date of Evaluation •� "' . �+ DESCRIPTION OF REPAIRS OR ALTERATIONS 1 •� The undersigned agrees to tall the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and- }. further agrees to not to place##,the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed+*^*- f n - Date � � t sj � M Inspections t , No.C7OOJ—50-5- FEE COMMONWEALTH OF MASSAC14USETTS l PF Board of Health, 1A S�a-�I P ' MA. CERTIFICATE OF COMPLIANCE Description of Work: Cl Individual Component(s) ®-Cromplete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( Repaired ( ),Upgraded ( ),Abandoned ( ) ~ by: c at iq4 pk) K0A 1 has been installed'in accordance with the provisions of 310 CMR 15.00 (Title 5) a9A the approved design plans/as-built plans relating to application No.aOW`50 T dated le -0�2 Approved De i' Flow/�y (gpd) Installer hh� �- q , Designer:y0 xki'e U✓Vn CC/h5Q at`,lnspector: 1 # N V '. Date:1 1-4 The issuance of this permit shall not be construed as a guarantee that the system will function as desi __gned. _ No.,,IM�-.SO.S FEE /yUi r• COMMONWEALTH OF MASfSACHUSETTS c Board of Health, &f It sYa r ( MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct(4--T Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at 6 I 4< w/V AU A I as described in the application for Disposal System Construction Permit No.900-50-5 dated Provided: Construction shall be'completed within three years of the date of this permit. AILloca itions ust be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health - �� Fim....�—�15)dLj....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................. ------- �W-�---......OF........�Q:rn S�.................................................... ApplirFation for Disposal Works Tonstrnrtion rumit Application is hereby made for a Permit to Construct ( vl�or Repair ( ) an Individual Sewage Disposal System,ato __.q.... .Ci.:f/ a n (qo a d Centxrv't l It AkA .................. . ___M` n. tn• .- _. . P._0_.....3aX. :... _n1 r j.: ..._ D bC. finer W/ l�Vt.I' !e............../ C W- W ! L t.l.. — /to 1. ..................... .. . -•-•--•--••--• •--- ---- ...... � nstaller Address •�� 'j g� Type of Building ���Q� Size Lot____________________ _____Sq. feet �.� Dwelling—No. of Bedrooms.__ _./____�___/___ .................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building p, yp g Q ____ No. of persons..:......................... Showers ( ) — Cafeteria ( ) Pa Other fixtures ____..---••--•-•-------••-- W Design Flow...............:. gallons per person er day. Tota aiy Aow.___._._______3:3 ____________._.__-ga)loit WSeptic Tank—Liquid capacity-1CMgallons Length__��_k."_- Width_________....__._ Diameter________________ Depth______._8..r_. x Disposal Trench—No ____________________ Width ....... Total Total Length............ Total leaching area_______-_____ sq. ft. Seepage Pit No--------------------- Diameter.__..._;________ Depth below inlet______�'.......... Total leaching area.... _sq. ft. z Other Distribution box (v-) Dosing tons( ) r" l�'f�'1 / C'CAN L•©� • S Percolation Test Results Performed by.......................-•-------....................--.................... Date__---- ............----••-.......... Test Pit No. 1... __�Z_-.....minutes per inch Depth of Test Pit______&:..j-_____ Depth to ground water_._.__/4 _________. Test Pit No. 2...4Z.....minutes per inch Depth of Test Pit------!............ Depth to ground water.....-��_____________ ----• -----_••- UW . n O Descri ti 'of Soil-- --5- � {~ =t-•------. ° . '2 AM--- A---� �� _0A ' 2--...I.. a. __......... - te�_�q m-,---- • ac..._.saa n t- Arne n �S Q '� - ._.. _0. ............... wx !u s fit. .0 rtr» --------• ........... oteai r � _ f � iQN Agreement: c_-2-r,, T undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the rov•sions o ''I'H : 5 of the State Sanitary Code— The undersigned further agrees not to place the system in o era • unt• ti of pliance has bej�bytkeT�o h*'&f1A,_ t l- � y 815 �r / SiSi ed•-....... ---•-....••-----------•------•------••----------•--•---------•-•-•----- ........................../ _..._ '— � Appi'ic ion Approved BY -•--•- ���----.... .--•------------------------•-_•---- Date A ication Disapproved for the following reasons:................................................................................................................ -----•...........................•••-----....._...••-•-------......-•----•---•-•.....------._...--•----•_.._---------•-•---•--••---••-------••----------------•------•---•••--•----••-•---•----=-•••••--- Date Permit No. -_.___ . ........ . _ Issued. Date -- ---. . No ../O THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - (Jt ..........OF......... " ---•-----------------------------------••-•......---------- ApphrFa#ion for Bispvii al Works Tonstxnrtiun rumit Application is hereby made for a Permit to Construct ( ,4 or Repair ( ) an Individual Sewage Disposal System at: ... c ••-- tlon dress ....._...:�. __C'�_�:.�......1_.�. �:..1....�J/:``c���}��..--•------C------------------- - �- ,/fir__...... � x � �----------� .---... ae V C. Owner l_/o r o / f / t �. �. A d ess , PQ J_ staller Address L' ! 3 K3 Type of Building Size Lot............................sq. feet Dwelling—No. of Bedrooms___..- --f .........e................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _..g ._�1.;�.>L� _.._._ No. of persons____________________________ Showers ( ) — Cafeteria ( ) dOther fixtpres .---.....---•-----------•-----•-•-•.............•----------•-------•-------•--•---•-••------------------...••••-•--••-•---........-----..........-•-- W Design Flow............-.: .......................gallons per person per day. Total daily flow.............. ...................gallons. WSeptic Tank—Liquid capacityl.CCL)_gallons Length._�'k,�'._. Width -__��.... Diameter................ Depth.`�._'�,._`.{... x Disposal Trench—No..................... Width.................... Total Length.................... Total,leaching area___ .---__--•-----sq. ft. Seepage Pit No.........1----------- Diameter.....�9_........ Depth below inlet......(2........... Total leaching area_Z:-^(-�?......sq. ft. Z Other Distribution box (✓) Dosing tank ( ) � r: a Percolation Test Results Performed by.._...___...�J ry)..1_._ '. �! _... .' _____________________ Date_...______:__ ._:_ .'� 0-. Test Pit No. L."_2..._._minutes per inch Depth of Test Pit......i.L�........ Depth to ground water.__...�5__'----------- riI Test Pit No. 2---KZ......minutes per inch Depth of Test Pit...... _`-"t:......... Depth to ground water-_--_I -------------- �+ Soil_..L _ ..� �r)1 t �:_:. ._�CJ�ay t-1 t1.2 I 3t-!_�: L_i 17 ...................................... D Description of .........................( ._,.....f. i C......saI_ad-•_r____ ���I_�_t..._f 1.�.�C�.�.).__�✓f_.__�.�.� �__ � S_�____.__�_C�_ _...� t. __ W7 �- ..------.......__ .... . --- ....... ...... ... _,.. 23. .......... V Netqrze of-_ iss rat s— ..L _ `.. .. �1_r112 .•----.2 . ls-'--_!dlJ Q..-----,�=!!.4. *l'... .. - ---------------------- Agreement: f`ri�/ l C r 'r, Tllw, undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the ro sions of,iITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in o er (pn uno.f. ti e of j mpliance has been issued by t e b a d of hea lth15 S>gned----- •........:..... ..........................k................. / / ^.la)/ Applic tion Approved By...... ' ^r ......... (1 -----------------------------r��. P f Date ica.tion Disapproved for the following reasons______________ _ .......................................................•----•-------•------- ........-•---- -•..................•---......----.....------------•-------------•--•--------•--•---.---••-•••-•-•--•-•--•-------------•--------•--•------•-••-•----------•--------------•-----------•--•------••-•-•--- �t�/ Date PermitNo...........................! 4------------ Issued....................................................... Date THE•...COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHJc�`�v �- Iry Tntifirate of TompliFanrr THIS IS 0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-•---•----'� c f�: (-�..t....._Lt..:..._ou r== ..�-0�.._�_!_?.(_. ------•--....-•---------------------------------------••------•--.... // ( � nstallerf �_ at.. tom_...>..c...................................................` , . C`.. ..zs ...................................... 1 < has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as d scribed in the application for Disposal Works Construction Permit No. '' (.c?. �1__ da.ted_..._I/ ................. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ; DATE................ 1.?./ '� ......................................... Inspector............... . ------ ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T�?­ ... .....OF..............�&rn.s.-f�a�-�. ............... N '�-tc.� FEE .�.�._b.......... �i �a atlThkv �_ o at Permission is hereby granted-------------- ......-%�........jLosal . r �.-•-------•-------...._......... to Constr o Repai an Indiv ual S.aae rage y tem at No.- Street as shown on the application for Disposal Works Construction Permit Noe>-'*_ 1.0- 5 Pated....1/_�/ ��' ............ ......................... ------- -------------------•--•-----•----....---.. DATE_ .r C. Board of Health -- --...`......... FORM 1255 A. M. SULKIN, INC., BOSTON r , _--- --__ ' 17 � -- M 12-1, 3 t �.-'4.t+g ; t. ., 1. .� •tip '� / / � � / ` .. le Y' '�"'{�1�1,. 7•. ';, S \fir �/' X f�i' 1 / `.. � ./� � ` 1 r� �� � ". c - : ./ r" `�/ t'� I •-J r-'—. 7 � '��!e� �{Gaa.•'`� Se�35oea. ,. sz f3 : " .:, 'a . /.. �- _ 4� 'r 7Y. AtY!.F Y4 t l _ Y. ix• I' �j -0/dT fir a`r .i"'� 11 -�Lt6D $ i -z , k r 7 �' �� �,• ' .7-bY ,'1 ('�• - �,t�F� 4 r Z� / J 36. > w tpo 6 W ZF ry k`{,p+ x x ✓ U'rn-� ' ,. Ll L + �tn'1'• �./v�.(l Ic'r'�Y �:7,•'F;/ Yx � ' { .\1 � / � � 1 0 h4�t Y.Yvt ����� ,•,t :+ ! r.� f ;.a 4 0 � y G .. r J� � M`�,,,r a 3t[;�' yl � 1.44E r i ,5� �� Fy ��5 }.` t`,,,.•, ` �. .. \ � VI '7 /! } 34 �'�ifi -- t a` r Y ?'• \ � .. � , � .. XZ ALBERT j ' WIpRSE; * N r 4 1 j s;pia No 1095 'IV o- ` "� A \M � ; �xa FS �QNAL4a F s g ?Z' E CERTIFIED PLOT PLAN EXISTING $3.POT,::EL,EVATION 0 0. ���Z� 0F 1.+EX1$TLNO - O - o 7 yA AL4-A �✓ °FINISHED Y CONTOUR SPOTr>'ELE.VATI ON '�' �Q 0 Rn� T FINISHED ' CONTOUR " 0 ELDREDGE No. 19387, I N PPROVE �\D:��BOARD OF, HEALTH °��;'�~rG/il'�t�E� r,l �� d.4.A a^Ir•A -STko 11 `AGENT SCALEt / " ¢O DATE LDROGE ENGIN£ER/NG'C0.7N CLIENT cKc-oN I CERTIFY THAT THE PROPOSED EQISTE:AE t REGISTERED JOB.NO.,8�4o G7 BUILDING SHOWN ON THIS PLAN ' LA,ND CONFORMS TO THE ZONING LAWS } ENGINEER SUR-VEYOR DR gY' OF BARNSTABLEt MASS. BY { � _HYA_NN I S, MASS ` SHEETS OF DA E REG. LAND SURVEYOR� :: President: Member of: ROBERT BRUCE ELDREDGE,R.L.S. ELDREDGE ENGINEERING CAPE COD SOCIETY PROFESSIONAL ENGINEERS AND LAND SURVEYORS OF LAND Associates: MASS ANDOC.CIVIL ENG NEERSEVORS ALBERT A.MORSE,P.E.,R.L.S. COMPANY, INC. AMERICAN CONGRESS ON PHILIP WEINBERG,P.E.,R.L.S. SURVEYING AND MAPPING / �7 / AMERICAN SOCIETY FOR CJPE9 ESEE%E0. -`eEg CIEEZEa TESTING AND MATERIALS -'and 712 MAIN STREET 3 G�+ csuzvet�ozs o ,o° nO1nFvu HYANNIS,MASS.02601 ✓ TEL.(617)775-2244 Dec. 27 , 1985 Board of Health Town Office 267 Main . Street Hyannis, Ma. 02601 Re: McKeon Custom Design, Lot 9A, Allan Road, Centerville, Ma. Job No. 84067 Gentlemen: A final inspection was made on Dec. 26 , 1985 and the results are as follows: DESIGN AS BUILT Inv. at foundation Elev. 133.0 Elev. 133 .2 Inv. at Septic Tank Inlet., It 132.8 Inv. at Septic Tank Outlet 132.0 132 . E Inv. at Dist. Box Inlet " 131 .8 " 132 . 1 Inv. at Dist. Box Outlet 131 .5 131 .9 Inv. at Leaching Pit 131 .0 131 . 7 - The system appears to have been installed substiantially in conformance to the minimum. desi'gn standards specified in our sewerage plan dated 9/16/85, revised. 11 /13/85. Sincerely, Eldredge Engineering Company, Inc. Robert B. Eldredge, R. L. S. President RBE/j ne President: }. Member of ROBERT BRUCE ELDREDGE.R.L.S. N N CAPE COD SOCIETY of PROFESSIONAL ELDREDGE EENGIANQLANO SURVEYORS �N GI -EERI -G MASSNEERS ASSOC.Of LAND SURVEYORS Associates: - - AND CIVIL ENGINEERS - ALBERT A.MORSE,P.E..R.L.S.. COMPANY, INC. - - - AMERICAN CONGRESS ON PHILIP WEINBERG,P.,E..R L.S. - SURVEYING AND MAPPING n / AMERICAN SOCIETY FOR fCJ.i1tEZEL[ GJ\EUISE'EZEU TESTING AND MATERIALS lgnc� - - C.iviL 712 MAIN STREET 2 c MYANNIS,MASS.02601 CJUZ VEUOZi. it - TEL.(617).775-2244 January .2 , 1986 . Board. Of Health Town. office 267 Main Street Hyannis, Massachusetts 02601 Re: McKeon Loc: 9A Allan Road, Centerville,' Ma,,. Job #84067 Gentlemen: A final inspection `was .made on Dec. 26 , 1985 and the results are as . follows: DESIGN AS-BUILT Inv. at Foundation. Elev. 133 .0 Elev. 133 .2 Inv. at Septic Tank Inlet " 132 . 8 Inv. at .Septic Tank Outlet " 132.0 . 132 . 6 . Inv. at Dist. Box Inlet " 131 .8 " 132 . 1 Inv. at Dist. Box .Outlet 131 . 5 " 131 .9 Inv, at. Leaching Pit " 131 . 0 " 132 . 3 The system appears to have. been installed substantially in conformance . to the minimum design standards specified in our sewerage plans dated 9/16/851 revised 11 /13/85. Sincerely, • ELDREDGE ENGINEERING COMPANY, INC.. Robert B. Eldredge, R.- L. S. President RBE/lld COmpl,eIed. by - ' -- t HIGH GROUND-WATER: LEVLL COMPUTATIOtJ i { - Site Location: fha Lot No. � Owner: ' G ^/ 6`/°�7 Address: --- Contractor:,, Address: -- y . Notes: x s=kt STEP l Measure depth to wader table x x`" N to nearest ft AA IT ,.1/10 , . . . date 7 "C,�h STEP 2 Using Water.-Level Range Zone 1 and Index Wet 1 ,Map .;Locate sate ;and determine: A) Appropriate .i ndex swe 1 . . . . ZY-7 Water level range zone TMd�4 STEP , 3 ? .;Using monthly report''Current' ,-Water Resources Conditions" .determine. current depth to 2%S7 water level for .index well mo yr f �ws "- > STEP !♦ Us,ing Table of Water--level { Adjustments for: i ndex .we 1 1 ` < STEP .2A —, current depth to water. level for index:we i 1 • " ' (STEP.3)., .and .water-:level 'zone. (STEP 26) dete�rmi ne• • • • • . . . • . • l 5 s, water-level adjustment STEP 5y .Estinate depth -to high water .by subtracting .the water- { y : level adjustijrent (STEP •4) k from measured depth: o water ,. {.e 7 : " l.evl at site (STEP:'L) . . . : . U Y] x t ; • . . . . . . . . . . . t A 9 M� Bt , X K^ • F p 4 S w,.., [+.:,-,,.,f# W, a...0 r .v"... .. ..'......,, ,....�� - .k � ,..„. 4• T.., .:'a'-- 'h'xw -M- Xd S': 'k .F ,'Ny, k � T:., :L.i' 4 a � `1 �w+�?.J�+,. ,_ .. -, '-- _..- ,,.. ;v. ..aS.a, r .-,,..- M ,:,'. ...+ .i :S,. ,a..L.• .a ,a ,y��' ="a y �?, t,, rur i. �.....F. c ,,,`:,i-.i.'.y,y..r a,. st.,�. „. e,,,,.;$-e a.:d - ..h. a , +•...?3+•"n6.,.y,<. �. [t qf:..>s, 'rt,, ,.uR �"r :5 a:, M'*w -Y_ b .¢,z. 'W'J — v. ! a" Yr". ✓.N. , ...'::,.:: .9.. i�' w.'. �R .A�.♦ ..S•n.,'^F •.< �`�`• "= �•�, ,`�` ��g t _� E/7'iYER b:TNE,^S PT/G�TAN' •� OT �20 FT-.M/N r N' Gf,l1iY / `PIT % 1-i�E ,MORE T/r:A."� 12BELO.J�V EA G Al 'CONCRETE"COPCP. a � T�AGITAOE.' �';N-E 41 r , StJAI- 8 BROl1GHT_ XT Q'PYG' P/AE; CONCRCTE N EA V y;C/!1 S T /R'O/Y. p Y4R SHi4 MIN- P./TCN /F/N 17R/✓EN//4;Y EL, x3 o COYERSAFR 4 •' . .- 2.J MIN. CONC,��'TE b7t.1DE CO✓ER CLEAN; SANO w A a BACA'F 1 LQU/O L EYEL r a 2*LAYER = /J?OON.P/PE 0 0 D ° .` � • ; • • .i . D o WA S HFO.57I7NE y Pon fT S.EPT/C TANfC BOX o s ° r . $ • .'. r D • r► � � • DEPTH • � 1 • �o a H/A$NED STaNE . a _ � / X•z.S - 377 t ..0 1 1. • • • • 1 • o p.o PiPECAST SEEPAGE - {z - GA L �DA.. y 7��OR T PAury 4yoELEY4 �O NS INVERT AT OU/LD/NG . 133-'c FY. ` 3 2 f"I vi.4M. C(SEE raauLAT)on� !HEFT .SEPTIC-TANK 3z.8; F7: - f OUTLET SEPTIC TANK i32 16 FY. !3! GRouND H/ATEfC TABLE /�•9J< ELGdi. /z3.o P�- /NLET D15TR/8l/T/ON BOX SECT/ON GF M H/6i> eZ441✓PI 007LETD/ST1%/Bl/TION Box'131 7 SEJVAGE A/SIDOSA L SY.ST&J�f �����s //VLET LEACII/NG f'IT 3r.o Fr. - TA9lJLATION LEACHING PIT . } s DIMENS/ON A FT 3'CALE Y4y. u.jAi D/.►lEN3/aN $�--FT. DESIGN CRITERIA 5� ftvnr rr y,.`-ma's'�+,••r ; D/HENS/ON C�_F T. ^7�N, NUMBER OF®EADROOMS 3 5fc ► 1 G,AReAGE D/5POSAL. UNIT NdNE SOIL LOG SOIL TEST TOTAL E3T1AA"TEG FLOW 3 3 y 6.41-.1DAY SOIL TEST At/ SOIL 7ES7-!#2 NUMBER OF LEACM11VG P/TS_ .9 F�tY. 3�<� ELFY, GATE aF.SOIL. TEST SIDE(,EACHIN/G FtER P/T / Sig PT. /� f v _ Z 1� ; 0 - 2- J RESULTS h//TNESSEG dY BOTTOMLErgCN/NG PER P/T 3 $Q. FT, /�A/Y] & L�fry cgc f'ERC0L�1T/ON /SATE At/ LESS MIAIIINCH ,5u35a/4. PERCOLAT/QN RATE A2 Z- t1-'MJN.1/NCA1 T07,44 LEACH/NG AREA ESQ. FT. 4 SugsD/L Z ,_ Z,o RESERVE GF14CNIN6 AREA 7-6 4' SQ. F T- 2-=— 1 3 M D, c Fir/6 Sv r L 7 T�s P- `fS3o So^?c-- Fi v T 17 A A L_Z-4N >;D. ls��+ �,i':�Fa,�,.r• SBPMD�C�2dt✓� Gog �3LE5 So�-i oxr AN lZVI'G.LE C w T� cv/313�s - ti ti . .; AL r T� Gl ll`�' W TErz 6F a iI EL Of$EDGE EAIGJIhlE�Rl1YG CO'JNG. 4J, �� •c� ti1pRSE c�1 HYRNN/S,./vIASS. rN at ` No.10951�Q �� LIFL lf7.O 7/2 J►9A/N ST. s CL!E/V T: M cKE o�✓ DR7 /6/F-C Pj`\ .iP �o i�Tc��/ ❑ NOGROl1N(7 .Yi�i4TE�. ENCOU/VTS/ �� (� GRO UNO yvATER'AT ELEV ,IOB /VD: "R4 O b SHE.E7'?OF � I I � ox I-T i -- . IL 0 I y \. I I � yam• ��_ 7 (DD. : I m �l O i r n :.' � .. .� . _,� �. .. ' .. ' i .. I' i 1 � • �� `I � � -- - . .. . .. ... , r--- - . . . I � f , � 1 � � ,i � � � � �� .. j � � � � i � � �� �_ . .� , . . q' � I .�� ; i , _. _.. _ �. I r..._ �' � � �. I� � � I . . Y I ..�. . �;=- 1 I� , � �, � �� � . �. �. _ � ,. _ .. . I �: ;; _-- -=_ � .- . _ . _____.� i T-' .; :; � � , � . , � . � , . � � . . . � � � i i ,1 � I _.-._ _. ...: �, . i � m �I � . .�. �� � :, �� ,� \ � �II o.. ;I o `f ` A � ` . Q ,� ; �I � 1 � � � .. W. BARNSTABL e 124&H BASIN of q.S ROlf7E 6' BRUCE s / \ G. � LOCUS MURPHY N TPrT\ 9No. 749� ALLAN ROAD 'cist�� ET `q/U/7 F,�\P on Iii PAW X su LOCUS MAP LOT 8A kk. ASSESSORS MAP.•19 4/1-9 PLAN REF 100130 ZONING: ,.RF» " GARAGE I r�$�' FLOOD ZONE. C (ON sisal i COMM. PANEL # 250001 0015 C % �' fr' �} L�CIc / ,, 139 DATED. 8119185 Y ) l BENCHMARK I \ 9 ti i , SITE AND SE'WA GE PLAN G TOP OF FOUNDATION , ; I ���, �6. I / OF LAND �r ELEV.=137'(ASSUMED) �, o LOCATE AT PROPOSED . ' 84 ALLAN ROAD b / ADDITION �0 O WET BARNSTABLE, MA. 41, I2� PREPARED FOR 126 129 30 TP s- °; ° \ 2°TP #4 ��`' �`, \�`, �`. KEITH SCHACHTER A.M. 194/1-9 OCTOR7,R 26, 2002 " w� w LOT9A EXISTING SEPTIC SYSTEM (PER INSTALLERS CARD) wa' �} " ' (TO BE REMOVED) —— TANK, D—BOX & LEACH PIT ` AREA = 44,383 S.F. SCALE. 1 = 30 ADDITIONAL TEST PITS —— #3. & #4 (P—5124) B.0.H. — TOM MCKEAN (11113185) LOT IOA 5� YANKEE SURVEY CONSULTANTS 0-2' LOAM l72 06 UNIT 1, 40B INDUSTRY ROAD 2-11' MEDIUM SAND/SOME GRA VEL �a ��. P. 0. BOX 265 (VERY LITTLE CLAY) , MARSTONS MILLS, MASS. 02648 PERC @ 1 MIN. 30 SEC. _ LOT TEL• 428-0055 FAX 420-5553 (BOTH TESTS SAME) 16A J# 53283 DB SH 1 OF 2 EL. = Is7 0 TOP OF FOUNDATION NEW 20' MIN. 10' MIN. CONCRETO COVERS 4" SCHEDULE 40 P. VC MIN. PITCH 118 PER FT. 2"LA YER OF CONCRETE COVER WASHED S719NE EL=133.0' EL=131.0' 6" MAX , i i / / i / , , , , ,/ 4" CAST IRON PIPE B MAX (OR EQUAL) MINIMUM e" MAX PITCH 114 ' PER FT. FIRST 5' �EL SAND FLOW LINE P17rH 1 4 PER FT. 10 =130. 75' lN132.50 )MIN 14" `20'' 00000000000 EL.— /NVERT LEVEL oo 0 GAS 6 SUM e° o 00000000000 000� —1280, !NVERT BAFFLE EL _131.25' INVERT !NVERT ° ° o 0 0 0 0 0 0 0 0 0 0 0 8 EL.—_ _ EL.=131,50' EL.=_131.0' EL.=130. 75' 4' (3) 500 GAL LEACHING CHAMBERS 4 (70 BE PLACED ON Fl" BASE) DISTRIBUTION MECHANICALLY COMPACTED OR 8" OF S7VNE BOA V 12.8' X 33.5' TRENCH FORMATION _1500--GALLONS TO BE WATER TESTED SEPTIC TANK IF MORE THAN ONE OUTLET SOIL ABSORPTION o PLACE ON 6 STONE 3/4" TO 1-1/2" �d PROFILE OF DOUBLE WASHED SmNE SYSTEM (SAS) SEWAGE DISPOSAL SYSTEM (36' ADJ.) I NOT TO SCALE NO OBSERVED WATER TABLE AT CATCH BASIN ON STREET EL = _122 89' OBSERVATION HOLE 1 ELEV== 1333.0' OBSERVED WATER TABLE (6/5/85) EL =_-- 1222.0'__ ti PERCOLATION RATE S,-2 — MIN./ INCH IN MEDIUM FINE SAND ELEV. OBSERVATION HOLE 2 0' LOAM & SUB-SOIL 0, LOAM & SUB-SOIL 2' GENERAL NO TES MEDIUM FINE SAND, CRA VEL MEDIUM FINE SAND, GRA VEL SOME COBBLES Il" WATER SOME COBBLES 11.4'WATER 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. SOME FINES TITLE 5 AND THE TOWN OF _BARN,STABLE---_ RULES AND SOME FMAS 14' REGULATIONS FOR THE SUBSURFACE DISPOSAL.OF SEWAGE. 13' SOIL TEST 2) ONE COVER ON SEPTIC TANK SHALL.BE BROUGHT TO 6/5/85 SOIL TEST DONE BY ELDRIDGE ENGINEERING WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" DATE 0 F SOIL TEST 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF p—4530 WITNESSED BY P.M. CONLON WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE DESIGN CALCULA TIONS: USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. NUMBER OF BEDROOMS . 4 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL GARBAGE DISPOSAL . . . . . . . . . NO BE MORTERED IN PLACE. TOTAL ESTIMATED FLOW 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH INSTALL- ( 110__GAL/BR./DAY x ___4_ BR.) 440 CAL/DA Y DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO (3) 500 GAL LEACHING CHAMBERS SEPTIC TANK CAPACITY 1500 GAL r` OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. WITH 4' S719NE ALL AROUND 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR 12.8' X 33.5' SOIL CLASSIFICATION . . . . . . . . 1 IS TO CALL "DIC— SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS DESIGN PERCOLATION RATE . . . . . < 2 MIN./IN. PRIOR TO COMMENCING WORK ON SITE. EFFLUENT LOADING RATE . •74 CAL/DA Y/S.F. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS LEACHING CAPACITY (AREA X RATE) 454 CAL/DAY SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. RESERVE LEACHING CAPACITY . . . 454 GAL/DAY 8) PARCEL IS IN FLOOD ZONE __" "____—. (33.5X12.8X 74)+(33.5+33.5+12.8+12.8)MX 74) 9) LOT IS SHOWN ON ASSESSORS MAP _L94 AS PARCEL 1_=_9___. PAGE 2 OF 2 JOB 53283