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Home My WebLink About0026 AURORA AVENUE - Health 26 Aurora Ave Centerville A= 251-117 V S M EAD No. 2-153LOR UPC 12534 smead_com - Made in USA 2 J�qf�CYCQI, �s �ST.CON cc Cr ARER USED IN THB WDUCT UW Jf' REQUIREMENTS OF THE SFIPROMA CERTiFlED SGURQNG VAffW-qVWGRUtORG i Commonwealth of Massachusetts -�/V Title 5 Official Inspection orm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 26 AURORA AVE Property Address 'v-- r. BAKER Owner Owners Name I.2= information is required for CENTERVILLE MA 02632 6-15-15 every page. Cityrrown State Zip Code Date of Inspection .. Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the / 1/0q' computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 5084204534 S 14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The.system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-15-15 Inspec,OK 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. S t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 5 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM IS LESS THAN 2 YRS OLD AT TIME OF INSPECTION B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructedpipe(s)or due to a broken settled or uneven distribution box. System will Y 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 Forth: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 �M 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 1 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 26 AURORA AVE Property Address BAKER Owner Owners Name information is required for CENTERVILLE MA 02632 6-15-15 every 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 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3113 Tifle.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 y 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every page. City/Town State Zip Code Date of Inspection D. System Information Description: STSTEM CONSISTS AF A SEPTIC TANK D-BOX AND 2 500 GALLON CHAMBERS WITH 4 FT OF STONE Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2013----------—301 2014----249 GPD Sump pump? ❑ Yes ❑ No Last date of occupancy: 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every 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: PUMPED IN JULY OF 2013 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 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: S.A.S INSTALLED IN JULY OF 2013 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.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: LIGHT/MODERATE t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every 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 Scum thickness LIGHT Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK WAS FUNCTIONING PROPERLY AT TIME OF INSPECTION 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every page. Citylrown 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.): BOX LEVEL NO LEAKAGE OR SOLID CARRY OVER Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): CHAMBERS ARE LESS THAN 2 YRS OLD AT TIME OF INSP 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every page. Cityfrown 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every page. City/Town 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every 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: NONE AT TIME OF PERC feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 26 AURORA AVE Property Address BAKER Owner Owner's Name information is required for CENTERVILLE MA 02632 6-15-15 every page. Cityfrown 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 f Assessing As-Built Cards Page 1 of 2 TOWN OFBABSTABLE LOCATION uwc, AUP SEWAGE# 2013-�7G VILLAGE Ce,+tc v ILA ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONENO. 64 s Gow,41m, 2oz Yy -to SEPTIC TANK CAPACITY imy ,r4S -r LEACHING FACILITY:()pe) �oo (size) j X 3 x z_ NO.OF BEDROOMS �� OWNER J�j PERMITDATE: a ' COMPLIANCEDATE: ', Separ�ionD�sdnceBdweaathe: Va�C�ro�^'�"�'� Mazimom Alluded GmuodwaterVc to h Bobm of Lurching Facility Private Watcr Supply Well and Leaching Facility V aoy web azist g s0e or within 200 fed of leaching k1V) Feet Edge of Welland aad Leaching FacilOy gamy wedands as within 300fedoflaahingfacil ) Fed FDRNISHEDBY 31411 i �3 • 4 I '�Ack http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=251117&seq=1 6/17/2615 i Assessing As-Built Cards Page 2 of 2 A - 0 b - http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=251117&seq=1 6/17/2015 r No. I Fee l v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Mispo8AY *pstem Conetruction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ACS A✓to rc- 4✓`e,1 ) Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Z S/ — // C v, l/p Jauts Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �tj r. L~S t vC,,1&5 Type of Building: Dwelling No.of Bedrooms .3 Lot Size fdj 515 sq.ft. Garbage Grinder( ) Other Type of Building havS z No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 'jQ gpd Design flow provided !,31,s gpd Plan Date G Al b Number of sheets ` — Revision Date Title Size of Septic Tank Arxltp l- � Type of S.A.S. 5� Aet�• r r( (� C Lor Description of Soil Nature of Repairs or Alterations(Answer when applicable) � �,�� /✓Z'c�J �7 6�. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. igne Date Application Approved by Date d l 3 Application Disapproved by Date for the following reasons Permit No. Date Issued 7 _d No.`J'"/ Fee /v THE COMMONWEALTH.OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for MisposAl 6pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. p A J/p r6 4 ✓ t ] Owner's Name,Address,and Tel.No. ` Assessor's Map/Parcel ;. 5 1 - t l 7 C vt 1/p Jrm•r g 'r3G Jt r/ Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. A 5-J,tc W('a 1�T NC i t Type of Building: Dwelling No.of Bedrooms Lot Size • &41 2 1�5 sq.ft. Garbage Grinder( ) Other Type of Building l/e,,,,S No.of Persons Showers( ),"Cafeteria( ) Other Fixtures .i/ Design Flow(min.required) 1140 gpd Design flow provided --Z 54$ 4 -gpd Plan,- Date G`w b tl Number of sheets *2 - Revision Date � Title \_ ! Size of Septic Tank x/ht/N< Type of S.A.S. 5C.70 cu, 1-a re,ayc f rat f C�1apd► Description of"Soil / Nature of Repairs or Alterations(Answer when applicable) �, „�� ' � /1/Z"r.✓ r7.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 tr Compliance has been issued by this Board of Health. Date Application Approved by Date ! q,17 Application Disapproved by Date for the following reasons f, Permit b Date Issued .. j_ _-_ ___ ___.______._-___._-_ _._ _.__.______-__.__ ____ ________________ _-________._____ _______ �.. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS F Certificate of Compliance ��.-�` THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( P Upgraded( ) Abandoned( A 79 irr,,,?, 1 6x_ at AJ f has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N«�,/3 9�7 dated Installer a..�a _r��,o N j_NC Designer „ 0-1 #bedrooms Approved design-flow f gpd n The issuance of this permit shall not be ons ed as a guarantee that the system wi ltio as dlesigned. �fJ �U/ Date Inspector V U ------------------ - - -- --- --------------------------------------------------- �y No. Fee Q { THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS q disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) t w- System located at G_- A j A K.P"a-r r u t and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must 'e compl ted within three years of the date of thiCb Date � Approve �, 08/02/2013 07:45 5084775313 ENGINEERING WORKS PAGE 01 Town of Bamstable Rory Services 'Iriomae F.Creiller,Dfreetar Pic H 'We Uomas McKean,Director 2" Street, Hyannis,MA 02601 Offloe: 508462A644 Fax 508-790-6304 Date, ` i3 Sewage Perak## 5!3 - A slor's Map/Paml �. /�f 1-7 boaftr wo r.1dt, laic. Instaiier: Addresr: 12 W. C M s:t :. I CA zd. Address: a'mX LI, on was issued a permit to install a ate A inWier) septic system at based on a design drawn by rzK/ (V\C ess �' li cj WLtL ('-� dated fa 1 j- eL—I certify that the septic system referenced above was installed substatttiatly according to the design, which may include minor approved changes such as lateral relocation of the distrd-bution box and/or septio tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e, greater than 10' lateral relocation of the SAS or my vertical relocation of arty component of the septic system) but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required)MIN 11W and the soils were found satisfactory. . RJR T. WE'R E tstsller's Signature) civil (Dw tgner sSignature) (Affix Design TH MVISION. R WATE " VVILL NOT BE I§SUER &214M BOTH THIS FORM AND AS— BUILT! BARNSTABLE PUBLIC DM51QN. IVA ` qAo�ftmMesignerw6floeflon form.dx Town of Balrn le - ,, ' Department:of Regulatory Services �i F ._ _ Pl�bl><c Health Div><son Hate saJq.n� 200 Main Street,Hyannis'MA 62601 f . ` �Qa CtJ .: bate.Schediiled Time Fee Pd. - rr Soil Suitability Assesswnt for SewageD.-isposal y Performed By �ei-�i c �n1-e c Witnessed By �� 5. d��a3 'C LOCATION& GENERAL;INFORMATION Location Address Z Z ro h1 v(—b aak Address Assessor's—map/parcel: 2,57 1 /11-7 Engineer's Name �y��d"1� i'" NEW CONSTRUCTION REPAIR ! Telephone# S0�r—-23 7--y'7 G Land Use R e;-, _Q m 11 a I Slopes W I. .Z .Surface Stones �G� Distances:from: Open Water Body ft Possible:Wet Area ft Drinking Water W611 ft Drainage Way ft Property Line, d t ��ft .Other ft SKETCH:(Street name,dimensions of lot,exacrlocations.of test holes&perc tests,locate wetlands?n proximity wholes) / 16( + ` cn ❑o 0- M Parent material(geologic) Jt��S Depth to Bedrock N14 Depth to Groundwater. Standing Water in Hole: /" _. �d�w^?Veeying from Rlt:Faae Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER FABLE Method Used: Depth Observed standing in obs.bole: _ _ In. Depth to still mottles: Depth to weepingfrom side of obs.hole: In. Groundwater Adjustment ft. Index.Well.# Reading Date: Index Well lover,. _.. Adj;fictor AdJ- 0duM-Wdtd1evel,,,m, PERCOLATION TESL' We Time Observation �2 Hole# / �c Time at 9" Depth of Perc ° �� 2 Time at 6" Start Pre-soak Time® .� 'rime(9"•611) C End Pre-soak Rate Min/Inch L 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:\SEPTIC\PERCPORM.DOC DEEP.OBSERVATIONHOLE :OG Hole,# Depth from Soil Horizon Sbi!MikWit Soil'Color Soil Surface(in:) (USDA unsell) Mottling (Structure,Stones,Boulders: 4 %- C_ ` _v DEED'OBSERVAON HOLE LO"G Hole# Depth from. Soil Horizon Soil Texture Soil Color Soil Other Surface`(in.) (USDA) (Munsell) Mottling (Structure,Stones Boulders: . s' SL Ch • ,o U J Z f L ib cPA 3 5y4 DEEP OBSERVATION HOLE LOG Hole# Depth`from. Soil Horizon SoffTexture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon. Soil Texture Soil:.Color Soil Other Surface(in.) (USDA) (Munseiq Mottling (Structure.Stones:Boulders. Flood Insttrance•Rate":Man: Above 500 year flood Boundary` No; Yes Wolin SOO yeiir'boundary No Yes Within lt)U year flood boundary No— Yes D,enth;dL Naturally Occurring Pervious.Material Toes<ac.least�fonr ft:et of naturally occurring pervious material.exist:in ail areas;.observed througla'out the,.. . 4rea__p opedL for the soil absorption system? Y N If not,-what`is the depth'of naturally occurring perviousrmatorial7 Cert tion I certify that on l (date)L have passed the-soil evaluator examination approved by�the P, y y �. De artment of Environmental Protection and that the above anal sis Was performed b me consistent wi r. the regwxed.trainin experttse-and experience descnUed in 310°CMR 15`:Ul 1: Signature Date 4)4EpTIC1PS CMRM DOC y: ,�1 TOWN OF BARNSTABLE LOCATION ' A Arof a A V e SEWAGE# ZO 13 —2 7 C. VILLAGE Ce,4 i-e �c v ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO�� s�rbfow.a sod-Y2o- 53�l SEPTIC TANK CAPACITY ��is�•�S LEACHING FACILITY:(type) X6o oc.-k�on1 (size) 13.I X 2 3 X 0 ---. NO.OF BEDROOMS OWNER •e( i PERMIT DATE: 7130 f/ COMPLIANCE DATE: 1 1 1 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility C C Feet Private Water Supply Well and Leaching Facility(If any wells exist on' site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY /� l 31 .5 ; G-BoT YUgvt `�Ack Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 26 Aurora Ave. Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. 02632 01/11/2010 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information - When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini e cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 arum City/Town State Zip Code (508)428-4028 S14454 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 Fall's Itz ❑ Needs Further Evaluation by the Local Approving Authority _ r 01/11/2010 Yseu Date 7T1 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. L4 jgb t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Dis sal System• e 1 of 17 t Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 26 Aurora Ave. Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. 02632 01/11/2010 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: JIj F� only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 �rmn City/Town State Zip Code (508)428-4028 S14454 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 = 4 01/11/2010 Ins s ig atu 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 10,0.00 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. I ****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•09108 Title 5 Official Inspection Form:Subsurface Sewagd Dis sal System•/Jagb e 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 26 Aurora Ave. Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. 02632 01/11/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B;C,D or E/always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. 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•09/08 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 26 Aurora Ave. Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. 02632 01/11/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a,salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 26 Aurora Ave. Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. 02632 01/11/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 26 Aurora Ave. Property Address David Greenman Owner Owner's Name information is Centerville Ma. 02632 01/11/2010 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 26 Aurora Ave. Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. .02632 01/11/2010 every 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? El ® Were as built plans of the system obtained and examined? (If they were*not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Aurora Ave. Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. 02632 01/11/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon septic tank and leaching pit. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 26 Aurora Ave. Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. 02632 01/11/2010 every 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 26 Aurora Ave. Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. 02632 01/11/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"feet Material of construction: ® cast iron 40 PVC Orangeberg ❑ ® other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 14"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: 1000 gallon Sludge depth: 4" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Aurora Ave. M Property Address David Greenman Owner Owner's Name information is Centerville Ma. 02632 01/11/2010 required for every 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" 0" Scum thickness Distance from top of scum to top of outlet tee or baffle 8„ Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 26 Aurora Ave. Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. 02632 01/11/2010 every page. City/Town 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•09/08 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 ° 26 Aurora Ave. ,w Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. 02632 01/11/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Box present. 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.): 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 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 26 Aurora Ave. Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. 02632 01/11/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil,'signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.Pit was dry st time of inspection.Stain line observed 26" below invert. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Aurora Ave. M Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. 02632 01/11/2010 every 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 ;dap Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ■ t Zoom OutIn 11 IC R.r s< r c t F i _ 9 �..r r i i r r r , , i _ r i �.dlfpD ve r r Set Scale 1" = 20 I Aerial Photos MAP DISCLAIMER f nn.irinht 7f1(1F_7f1f1Q Tn„in of Rornetohle IIAA All rinhtc reeenn r 1 1 1^/0 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Aurora Ave. M Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. 02632 01/11/2010 every 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: Bottom of LP 50' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain. ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: . You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 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 26 Aurora Ave. Property Address David Greenman Owner Owner's Name information is required for Centerville Ma. 02632 01/11/2010 every 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 N0.. THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEA TH UW"-----..--oF... ... sl. .J. ��-- -------------- Applira#ion for Disposal Works Tunitrn.rtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at - -_.... o.��.� ocation- ddressCam- n---------------------------------- ------ � e --- ----------------------------------..... Owner Addr a �. % 19 �,y1--.... ------------------------------------------------------------------------------- Installer Address C Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of ersons___________________________ Showers � YP g -------------------•-----... P - ( ) — Cafeteria ( ) Otherfixtures -------•---•------------•------•-----------------------------------------•---------------------------•---------------•-• -----• W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter------------.... Depth................ xDisposal Trench—No. .................... Width.................... Total Length.....................Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by ---------------------------•--••----------•------•- Date a Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water------_-_---------_--_-. fz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ...... x Description of Soil ••• - -- - -••- sr� c.� ------------------------------ _-------------------------------------------------------------------------_----------------------------------------------------------------------•-------------' W U Nature of Repairs or Alterations—Answer when applicable.--------f OL)--.` .................................................. ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasheensued by the board of�health. �� A Q r� Signed_. e. =\ ►-mil G .�!�l•---------••-- ---41� Date Application Approved By....................--- = - --• ------....._.._ -------------f:ne-0 Date Application Disapproved for the following reasons_............................................................................................................... --------------•-----•--------------------•---•-----------•-------•---._...-------•-----_.....--------.....---•-----------------------------------------------------------•--------------------- -------- Date PermitNo......................................................... Issued..... -•1i�. - ---- Date F ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD.. OF HEALTH -) __ ........................_..........:.......OF............ ....... ............................................ Apptiration for %V-011a Application is hereby made for a Permit to Cons an or Repair (A ) Individual Sewage Disposal System at: ll� ......................................... ............................... ........ ""Z....................................................................................... Location-Address Lot No. ..............................................................................Z........... ........................................... ......*-------------*.........*............Owner ......( .L�r ess I) !i lu ( ) � - ! )....jZvc.... ................................................................................................. ............. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( '4 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( Otherfixtures ........................................................................ .............................................................................. Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width._.............. Diameter-__-___---_..-_- Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.............._..... Depth below inlet.................... Total leaching area..................sq, f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit___.__.............. Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit_..___.............. Depth to ground water........................ ............................................ .................................................................................................... 0 Description of Soil-----------------;__r.....................;..................................................................7..................................................... ....................._................................................................................................................................................................................. .........................................................................................I............................................................................................................... Nature of Repairs or Alterations—Answer when applicable_-____-, .............?. .................................................... ................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T 1Z 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.....I...... ..............Vl/'14 ...................................... .......... ............ Date Application Approved By.................. . . ..... ... ............... ...... !'-00-------- Date Application Disapproved for the following reasons:..............oN'w............................................................................................. ......................................................................................................................................................................................................... _pate Permit No. ....... Issued........�............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............... .....................OF............................ ... ......... ............................ THIS IS TO CERTIFY,"Rat the Individual Sewage Disposal System constructed or Repaired by...... .....I......L; . A/I Y, ................. ...... ...... ................. .................................................................. ............... ................ I• J)'/ /,/" // i J / Installer 7 .. at ................ .......i........;.....................................................................................................I..................................-------------- 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.._0.0_144 W................ dated_.._....-_....___.....__._._.-__.•.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM .1N LL FUNCTION"FACTORY. DATE..... ....................................................... Inspector__ ................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. .......... 0 F.................................................................................... .......................... FEE........................ Disposal Workv T.FaInstriglion Fam-ft Permission is hereby granted........... ........................ ...................................4.................................................. to Construct or Repair an,Individual'-Sewage Disposal System 7 .............................................................( at No.. .....................LrI....14e...... Street as shown on the application for Disposal Works Construct ermit No..................... Dated------..__---_-**--------- ... . . . . . ......................................... ._.. �Bo .f Qih DATE....oq-10'—.040.................................................... FORM 1255 HOB13S & WARREN. INC., PUBLISHERS Oc) � y�G1� LO ION �? f 4SEWAGE PERMIT N0. VIL E ( f CC,� � "l INSTA LLER'S NAME i ADDRESS BUILDER OR OWNER n, c77:L> i DATE PERMIT ISSUED DATE COMPLIANCE ISSUED I � r > 3ei C-L 1060 LO000 et, ( � . �� r -100— EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE Lakeview ° P EXISTING LEACH PIT —W EXISTING WATER SERVICE /� Ave TO BE PUMPED, FILLED WITH OVERHEAD WIRES SAND AND ABANDONED N i HO„ Lakeside Dr TEST PIT �, �I\ P°neRd �� $ BENCHMARK:_ EXISTING SEPTIC TANK LEGEND TOP OF TANK, EL.=67.57 / 68,38 INV.(OUT)=66.24E Ff � I Gam` 8 � •�+` NCE c 0 ENE N �2 2 3 BENCHMARK SET uror / 5 CENTER OF TOP STEP I i w ue� �\ 10 2 �S ' EL.=69.84(ASSUMED DATUM) �� Wegvacjuet Lake Ave n \\ TP , W x 69.58 I CA LOCNOTU SMAP w 67,96 N�a: LE 'I I 6996 �� 1 '5• !� TP 2� . I + 9�5 M FI HP D �w3 /69:5 69.84� x'7 .54 x 70,20 GENERAL NOTES: . o x x 7 .89 69,95 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL �C14 a0. x 69.33 SPIN E2 BOARD OF HEALTH AND THE DESIGN ENGINEER. �O CID2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS I O 68,38 PATIO I I! a OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE I 0 / x 6 LOCAL RULES AND REGULATIONS. I 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 8.67 6 �� x 69,1Z TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE I x S x 68,87- -6�� '� DESIGN ENGINEER. O �j 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING _ 2 6 8.7 4 v x 69'7Q O FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN x EX/STING BH O rnY } ENGINEER BEFORE CONSTRUCTION CONTINUES. HOUSE 2611 68, �/� / 9 " I 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 68. 9* T.O.F.=69.7* 6 68:71 O!� 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF PORCh Z 1 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. STONE::'':-,:.,... I 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. DRIVEWAY, ,. x 68. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS $pp x 68,57 < AGREED. UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 6B-. LOT 2 x 8,17 DIRECTED BY THE APPROVING AUTHORITIES. x 68.06 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 67,54 M B L 251 11 f THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. �68,25 x 10,238—t-,SF /� 1 67.39 67,60 100 0�, �� \ 1 1, WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 1' ON ALL SIDES OF THE S.A.S. AND 67:28 S �S � / REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). THE �?40" E I �P�� OF MgsS9C� PROPOSED S.A.S. IS A BOTTOM AREA ONLY SYSTEM. PROPOSED STRIPOUT 67,14 e qe BOUNDARY IS SUBJECT TO THE APPROVAL OF THE BOARD OF HEALTH. poveme o PETER T. Gs E-/�/ �� n � 67�32 �` � �, 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE V McENTEE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. E v x 67.28 CIVIL `n x 7,49 No. 3IL 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND p, ® o NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. P LE catchbasin Q t r �EGISTE �Q 66.59 a I FFSSIO t ��,G`� PROPOSED SEPTIC SYSTEM UPGRADE PLAN 26 AURORA AVENUE, CENTERVILLE, MA 67.46 /2f ( 3 SPIKEI JI Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 OWNR OF RECORD Engineering by: SCALE DRAWN JOB. NO. BAKER, JAMES R Engineering Works, Inc. 1°=20' P.T.M. 166-13 Ill@Ef f 26 AURORA AVENUE g g CENTERVILLE, MA 02632 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 6/21/13 P.T.M. 1 Of 2 r NOTE: FINISH GRADENT BSHALLUNOT BE <PROPOSED: FOR A DISTANCE OF 15' AROUND THE — PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D—BOX PROPOSED S.A.S. 1 ° 75.g'63.2' ' INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL RISER & COVER OVER EACH CHAMBER AND cn T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6' OF GRADE SET TO 3' OF F.G. TO' SERVE AS INSPECTION PORTS v 0 1 Ln 69'95 EXISTING F.G. EL.=69.3f F.G. EL.=68.5t F.G. EL.=69.4(max.) ; o Sp E2 L 25' a max.) , L = 27' j 0)\� \? ® S=1% (MIN.) ® S=1% (MIN.) ® S=1%5(MIN.) .17, Off+ 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 1 2" LAYER OF 1/8" TO 1/2" DOUBLE WASHED STONE 1o"I WMM (ORAPPROVED FILTER FABRIC) 14" aaaaeaEXISTING 48" LIQUID aeaaBaa ----3/4" TO 1-1/2" DOUBLE LEVEL WASHED STONE W ajW EXISTINGAD° INV.=65.87 4' S.2' 4' GAS BAFFLE INV.=65.70 EFFECTIVE WIDTH = 13.2- N �, HOUSE&16) INV.=66.24t 3 OUTLETS (MIN.) T.O.F.=69.7f' EXISTING INV.=65.60 Lz EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN PORCH H-10 RATED TOP CONC. ELEV.=66.4 S.A.S.LAYOUT NOTES: BREAKOUT ELEV.=66.10 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=65.60 ease aaaa INVERTS, PRIOR TO INSTALLATION. aaaaa aaaaa 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=63.60 GRADE ON A MECHANICALLY COMPACTED SIX OF NATURALLY OCCURRING 3' 2 X 8.5'= 4' 17.0' 3' 11 INCH CRUSHED STONE BASE, AS SPECIFIED EFFECTIVE LENGTH = 23.0' ®®Ea Ea IN 310 CMR 15.221(2). PERVIOUS MATERIAL 5' (MIN.) ABOVE G.W. I— ®Ea®®Ea® ® Ea ®®® 33" 3) INSTALL INLET & OUTLET TEES AS REQUIRED. LEACHING SYSTEM SECTION - � ®®®�®® ® ® ®® 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE NO G.W., EL.=58.6 z w AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. N Z ®ka-® SEPTIC SYSTEM PROFILE 102" N.T.S. SOIL LOG- ` 4" KNOCKOUT DESIGN CRITERIA DATE: JUNE 17, 2013 (REF#14,033) 20" DIA. COVER SOIL EVALUATOR: PETER McENTEE PE(SE#1542) NUMBER OF BEDROOMS: 3 BEDROOMS WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT 4" KNOCKOUT 4" KNOCKOUT 62" SOIL TEXTURAL CLASS: CLASS I ELEV. TP— 1 DEPTH ELEv. TP-2 DEPTH 0 DESIGN PERCOLATION RATE: <2 MIN/IN 68.6 A 0 68.5t A 0 11 DAILY FLOW: 330 GPD SANDY LOAM ? SANDY LOAM 4" KNOCKOUT 68.1 10YR 4/2 " 68.0,. 10YR 4/2 DESIGN FLOW: 330 GPD B 6" B 6 GARBAGE GRINDER: NO SANDY LOAM SANDY LOAM 10YR 5/6 500 GALLON CAPACITY, H-10 LOADING LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 65.6 10YR 5/6 36" 65.7i 34 CHAMBERS .74 GPD/SF C C PERC EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 36'/48" N.T.S. PROPOSED D-BOX: 1 INLET, 4 OUTLET (MINIMUM), H-10 RATED USE 2-500 GALLON LEACHING CHAMBERS IN SERIES { PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE-ALL SIDES 2 D. SAND MED. A D 26 AURORA AVENUE, CENTERVILLE, MA SIDEWALL AREA: 2(13.2' + 23.0') X 2 = 144.8 S.F. Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: 13.2' x 25.0' = 303.6 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:..............................................................448.4 S.F. 58.6 120" 58.51 120' 1„=20' P.T.M. 166-13 PERC RATE <2 MIN/IN.' ("C" HORIZON) Engineering Works, Inc. = 331.8 G.P.D. NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74(448.4) (508) 477-5313 6/21/13 P.T.M. 1 Of 2