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HomeMy WebLinkAbout0045 AUTUMN DRIVE - Health 45 Autumn Drive Centerville A= 167- 005 IN UPC 12634 NO.2_ 112OR MAiTiMOY.YY oat Commonwealth of Massachusetts ,ie Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ; 45 Autumn Drive Property Address Roman Sidlovskis 0 Owner Owner's Name information is required for every Centerville Ma 02632 4-3-19 page. City/Town State Zip Code Date of Inspection r Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. y 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed.based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑■ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority i 4. ❑ Fails Brett Hickey ° '°�°e�""" 4-3-19 a.n wa.r,o,ou.m.+=mr�e.�ae..®.�uo�.�.,ous "aa.:mie.a.w ias:os o.m Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form l; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 45 Autumn Drive �l fi Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑■ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system was in working order at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Autumn Drive Property Address Roman Sidlovskis Owner Owners Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 45 Autumn Drive Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Autumn Drive V Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ a Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ El Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ El well. portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ El Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ El The system is.a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ El The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Autumn Drive V Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No El ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? 0 ❑ Has the system received normal flows in the previous two week period? ❑ a Have large volumes of water been introduced to the system recently or as part of this inspection? Q ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ El Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? El ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ❑ 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: 0 ❑ 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Autumn Drive Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 3 3 Number of bedrooms(design): Number of bedrooms(actual): 330/GPD DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: 3 Number of current residents: Does residence have a garbage grinder? ❑ Yes E] No Does residence have a water treatment unit? ❑ Yes 0 No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes F!] No Seasonaluse? ❑ Yes [E No See below Water meter readings, if available(last 2 years usage(gpd)): Detail: 2017-47,000gallons 2018-48,000gallons Sump pump? ❑ Yes ❑■ No current Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form gal Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 45 Autumn Drive Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner- last pumped 2016 Was system pumped as part of the inspection? ❑ Yes N No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 i Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .v 45 Autumn Drive Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: 0 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): Approximate age of all components, date installed (if known) and source of information: . 8-8-16 Were sewage odors detected when arriving at the site? ❑ Yes X No 5. Building Sewer(locate on site plan): 3' Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑ other(explain): Town water Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 9 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form �1�- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Autumn Drive V` Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 2' Depth below grade: feet Material of construction: ❑■ concrete ❑ metal ❑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 1 Dimensions: 500gallons 61t Sludge depth: 3011 Distance from top of sludge to bottom of outlet tee or baffle 211 Scum thickness 611 Distance from top of scum to top of outlet tee or baffle 1411 Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form gel Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 45 Autumn Drive Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Autumn Drive V Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 0" Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in working order at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts 19" Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F' 45 Autumn Drive V Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: (2)500 gallon chambers El leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 45 Autumn Drive Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in working order at the time of inspection. Chambers were dry when viewed. 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): NA Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Autumn Drive V Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f' 45 Autumn Drive Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑■ hand-sketch in the area below ❑ drawing attached separately TOWN AFBARNSTA}�7' LaGATtari '!S.t° tur+ rr sikwar «rknGE =-�► ratic: AsstssoR'is, ircx 1681 t sErrie TANK CAPACrM_ ��sTc7c7�o LEACJUNO FACILrr (type)" N OV eV..nikaar P73RA tT r)ilt 13 9 CC>;4IPT:1ANCEi DATEi ' _ff-j - '"! ll).u.X[Stglfn�tt,�7l5lBt�v1aV{1y7'watQra1'1�Si kf" l�b\nfln of Gxcb3pg I"bixiflty" ECeC " *",`uppty�41tand Lemhutg Facility any wotls errfst:aII-.: site - ;u#"�`a�n�:ata s�cluiaB J?ac',rtry{rf eny.w�iands exist wiihia. . - ;3�3,fet4%nl'.leacluag;faclliRy;� .-,_,Fmf - - f'r7R1�7L5lrS.b:HY a # t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts I1Pw Title 5 Official Inspection Form I�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Autumn Drive v Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑M Check Slope ❑■ Surface water ❑■ Check cellar ❑■ Shallow wells No GW 4' below SAS Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record 7-7-16 If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Autumn Drive u Property Address Roman Sidlovskis Owner Owner's Name information is Centerville Ma 02632 4-3-19 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑■ A. Inspector Information: Complete all fields in this section. �■ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑■ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4,(Failure Criteria)and 6(Checklist)completed ❑■ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included . t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 No. /CN C1 Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpYication for -Misposal 6pstem Construction Vermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. JIS o-Fornf) be v - �eerr's Name,Address,and Tel.No. Assessor'sMap/Parcel /&R `03 / 1' rnafL ,500 LovSkis Installer's N me,Address,and Tel.No. D i er's Name,Address,and Tel.No. aft xcavaFrvn �D� �177 D(o 3 r ineerrn Wc)r-k5 50?-11-77-53 Type of Building: ` Dwelling No.of Bedrooms !J Lot Size sq.fr. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)f 3 gpd Design flow provided gpd Plan Date W I 1�/y 1 1 to Number of sheets Revision Date Title _PrU pQ /Q�ZJIts fjC_ JS 1 e 1 ern p q r Size of Septic Tank / Too gat Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 13u25x2 ' (2 26 5DO 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 Bo of alth. Si a Date -7-7 —I Ld Application Approved by Date Application Disapproved by Date for the following reasons Permit No. � �a, —_, U Date Issued No.�/ /CY ' � y�y Fee A! D '' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y PUBLIC HEALTH DIVISIO0WN OF BARNSTABLE, MASSACHUSETTS lit, �ipYication for Misposal 6pstern Construction permit Application for a Permit to Construct( ) Repair( ) yUpgrade( ) Abandon( _) ❑Complete System ❑Individual Components Location Address or Lot No. 'yS Auf um o b e iv t OL%nj er's Name,Address,and Tel.No. /� 0 y 13) Assessor's Map/Parcel (0 "©3 1 3 A0 mCz(L. SO D v S►C 1 s 2 Installer's N me,Address,and Tel.No. Designer's Name,Address,and Tel.No. C3 r�3 ucrvafrvn 50� �J77 0&53 n �n eev(n (Alc)r-kS JOR- Y7 -7-53 3 Type of Building: ` Y Dwelling No.of Bedrooms V Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) - Other Fixtures Design Flow(min.required)' 330 gpd Design flow provided gpd 7 1 Plan Date (0 1 to Number of sheets j Revision Date Title -PI-0 e rn U C,ra Lie Size of Septic Tank `J �U aQ�. Type of S.A.S. Description of Soil P ( applicable) �v U o_ 1 o i 7' ���ZU c Nature of Repairs or Alterations Answer when a licable 13u25,12 ' (2-), 142 `500 f 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 Boar4lo- alth. Sigeed Date Application Approved by Date 7121167 Application Disapproved by Date for the following reasons A j Permit No. "' 3 Date Issued 7 --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by Q � Ex(-(_l v r f in at �t )�� (�(1'1 t 1 l ) (�l P has been constructed in accordance / / with the pio isio is of Title 5 and the for Disposal System Construction Permit Noa�� �J 6 dated 1-2 /(P L Installer (� P�" {ter D �/ Designer 1 e ! (l Works r" 7 #bedrooms Approved design Aow gpd The issuance of this eimit shall not be construed as a guarantee that the system wi ction�as designed. Date 1f (r 4 .9 0 Inspector v %V- , ----------------------------------------------------------------------------- --------------------------------------------'-)------- No. � .._. Fee �Cn/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Vermit Permission is hereby granted to Construct( ) Re air( ) Up//��ade( ) Abandon( ) System located at 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 musebe co pleted within three years of the date of this p it. Date ��� Approved bT}� �e� 'Town, o'-,"Ral"nislable Y'1 .ha4 Yi V, h?€e)till Vreci€,l;.' .i 73hYn!•I�'3 d..1"'it D t Public 94_ i::lth i J.fr Pill». r S . V "'ajs$ r2€Fl Yi LI'.t ira.',£31 e3 Vi,;"Iq;;ii-q ♦♦ JG! 4/{�1 (/,,. dt?'s�'i{Ei�g .vi §�<I�'��erf..:. � ^ #l,�l6: t3{_tc_.;,t>;t% S�4e Ei': `� � )i� Y ;'sL ..4rifl'Sgf.J A�t32x.� tr-.v�.{�.7���� 4\?.Z.:l�.ti:� `§ ��.u.�1a3�t L.�:i ✓��� �ti-'ls`i2L7 ♦ i ;GCS'€3�1t,_ jJ� I7 i�.7C.�.�\/Q.T�t�f/1 Ma i 3t. .-,.�� fO_T._ .._V' �t•.•G.aJ-Wa.."t�'-dGA'1 4Vt1', l:;f. 1-Ll`lii. to iolscaijc°.. i ,. 2Y.A'!1�`• t�r.,t_�'3'� �.,e 4s% _-i- i +. the �:;;t Jl. t-tl'ti.t f,wv' i_I_lu'k. l.r:!').cT.�f?.: 1, ai.SY},i)liYt.)4- box uxtU:?i iL�(7+: -,aiiL 313lC tw `;Y L? '1? s .:t,!i.s;d iy th.[1 aa;i t ..Yk.. (. c_4§';-- y ow C pk vwical cdoc Sl-,fit o 1 gi ..c r 1. •:..1_., tt. aJ., isti:;;...i.-.:a".1'-h•``sill?.. icy.. { ,,..,tt P _:.YJ t.s(.S-a_:. Nam li 1•?.? l.. r� 1 1 >t i)ti;1:.% ii a M.alt el } s't:�'ASI., Rt,.Al>ItN T €7 I +4r:AB I• PUP1 C I,' . 'S.4E i i`:.�:i g z$Ig a1 OW ON"!:PILI �CF, V IIJ $o I gig�PsT�I3 �1N�as ���s 'l �elt`� 3;�RTM �NP �S, {{�l plat. CARD n 3.,4 FI) ny 3 sJ 9`, ...... �...._.....- ._..._.._....-...._._..._..s _..__..�. TOWN OF BARNSTABLE LOCATION qS Au-Futon -.Ori uc SEWAGE# ZoIL - Z3'3 VIL AGE crrlc »I IC ASSESSOR'S MAP&PARCEL fG$ - 031 INSTALLER'S NAME&PHONE NO. _R 4, R EXCcx VaA i o/l q`7`)- 06 S 3 SEPTIC TANK CAPACITY b50Q go-) LEACHING FACILITY:(type) SDOood Ll c (size) 13 x Z S x Z NO.OF BEDROOMS 3 OWNER Rofnar% S;d1ou5K i5 PERMIT DATE: 771-71 IL COMPLIANCE DATE:T)G Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching-Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Al -3 qof AZ-3yG„ _ 13-2 35 iG A3+G5:5 c3 13-3Z G Q - A4 . (D �� • ZZ oF� Town of]Barnstable P# L�-VS1 Department of Regulatory Services Public Health Division Date �A a63p 200 Main Street,Hyannis MA 02601 Date.Scheduled Time U r-7.p Fee Pd. � Soil Suitability Assessment for Seage Pispos l Performed By: -�e KZE11 4- 1" S� #�e"S Witnessed By- Performed t Cal n � LOCATION & GENERAL INFORMATION Location Address d S /A- r�-U M n_ Dr-I,, ,, Owner's Name kci ��}^b��1 {M, /1„• Address I`(Zz i 1>411q.) 1 4-1 t 0-0,0 Assessor's Map/Parcel: es five 7 I�g��J ( Engineer's Name �, ��� +� h.g ,�eenf�3 NEW CONSTRUCTION AA REPAIR 'L Telephone# �-e 3 dlsu'L� es Land Use N k Slopes 90 p ( ) Z�y Q Surface Stones Distances from: Open Water Body N��� ft Possible Wet Area �?/ ft Drinking Water Well � f-S p"� Drainage Way � a ft Property Line .S 11h{t Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) N rlr *, 7�-z 130. }/-- Parent material(geologic) J V''v'J C"` Depth to Bedrock Depth to Groundwater. Standing Water in Hole: A b Weeping from Pit Fate /Estimated r-- Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in.obs.hole: 'in. Depth to sell mottles: Depth to weeping from side ofobs.hole: in. Groundwater Adjustment f[• Index Well# Reading Date:. Index Well level , Adj.faetor- Adj.Groundwater LuYel r a PERCOLATION TEST Date Time Observation y Hole# Time at 4" Depth of Perc 24 G c. ( ovu Time at 6" J Start Pre-soak Time @ _ Time(9"-6") tA•�-, End Pre-soak Rate Min./Inch. Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) 4 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:\SF-PTIC\PERCFORM.JDOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA). (Munsell) Mottling '(Structure,Stones;Boulders. lu Consistency. rev l j DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil. Other Surface Oa.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. ons' en m— el 2 - qj (3 (, S l� ! ecl Sam DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) j (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency.%O e _ i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistert Flood Insurance Rate Maps Above 500 year flood boundary No— Yes-4 Within 500 year boundary No__: Yes ; .- Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil'absorption system? 'e� If not,what is the depth of naturally occurring pervious material? Certification I certify that on t 9 (date) I have passed the.soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required tr '"' ,expertise and experience described in 310 CMR 15.017. Signature Date g Q:1SBP`i'IC�PERCFORM.DOC ;Z ®d � No77.--•--: ✓�.�:L:.---- Fes$... :.�`C......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -- Town...........OF....Barn.sita le------------------------------------------------------ Appliration for Disposal Works Toustrnrtiun Vamit Application.is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal Y System at: ..........45._Autumn Drive .............•-------•--•----•--...-•--------•--••--••----•-•-• ............................................... ...................._......_............... pcation-Address Joseph LandL1 Centerville°r I°t N ......................_...................... .....------•---.-..-------------•--•---------- .....................-------- -•-•- -.--- ----------- ..... .....--••-----•• , Owner Address a JoSeDh P: Macomber & Son_ Inc: Centerville .............. Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................ . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal 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........................................ aTest 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........................ a .........................................................................................................................................----••----.......... 0 Description of Soil----DMW---& Grayel_......--•---•--------------•--......----------------------------------------------- U .............................................................---•--------------------••••••-•••----------...--------------....-------•---•------------------------------------------•-------•---......... W ---------------------------------------------------------------------------------------•----------••---------------------------------------------------------------------------------------......------ UNature of Repairs or Alterations—Answer when applicable_1 m10OQ___gallon__overf.lox.________...........-.......... frM1 _ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the.provisions of TITU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en s d by the board o iealth. 1 ne .. .. .•------------- 1 ----------- - Date Application Approved BY t .�.- :...-- Date Application Disapproved for the following reasons:...................._..--•--------•---•--•................................................ ----.......... --•--•-----•--•-•........................••--------••----•--•---•----------•-------•-•-----•----------------------..._...--•---------------------------- -----_ �- ------------------.......... k , Date PermitNo......................................................... Issued--- ttie..M--.... . ....... Date %!-.... FEB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....,.:.OF.....B..�.:�c.U.': ....................... .............................•-------------.._..............-_.._. App irttfiunN for DWIl i al Workii Cnunitraar#iun ramit Application is hereby made for a Permit to :Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..... ^^ ....................•.......... ..._..._-•--••..•••---....._......... ---._...--•----------•-•.............--•- t riLocation-Address 1, 1 Cor Lot No- ----------•_•----------_........---,.....--'Owner....................... .•........-----.......-----•---•--•------!_.__Address ......---•--------......................._ -------------------------- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms________________________________ _____Expansion Attic ( ) Garbage Grinder ( ) U Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures ________________________________ _ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width.................. Diameter---------------- Depth................ x Disposal 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... (z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ....................................-....................................................................................................................... O Description of Soil...................... ._�_'__ ----=-------------------------------------------------------- ------------------------------------------------------------------------- x c, ---------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable...___:_'____.f..............................................�''' ---------------------------------------------------------------------------------------------•------------------------.-.----------------------------------............................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance k6eeq,/&,rued by the board of-health/, Date Application Approved BY ,d.. d..............................` � �' Date Application Disapproved for the following reasons__________________________ '::__.::__.=................................................................... e .............•--•••••-••••••••---....-•--••--•••••-••--•--••....-_••_._._...-••---•-•---•••••-•-.:.._..._.•-••----------•------------------------------------------------------------------------------ �. Date .. -� r1•I' =- Permit No.----- --�k---- ---------•----•------ ---._.... '' Issued_--•-�- - Date THE COMMONWEALTH OF%MASSACHUSETTS BOARD OF HEALTH ` .........................��:.: ......OF.. ` ...s':; t. �.... .............................................. Trrtifiratr of Touty iFangr THIS IS TO CERTIFY, That the Ind duftl Sew zge Disposal System constriict�d (z s)r or,n Repaired ( X) -- . 11 t . _ by....... 11 __...'___..__....•--•-••-' -••••-••-•-••--••-.._ Insta'.ler .- Y........................S = at ti� l�u�urr�n Lrr�� : :;�i,�I'��?1e , Land1 has been installed in accordance with the provisions of TI S ST�e`State Sdatedy-/��`"" ►c 1—j4be in the Code as application for Disposal Works Construction Permit No.... 7_____________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI FUNCTI N SATISFACTORY. _ ckIt _ 1 ' .. DATE Inspector . .. ---------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............................OF.........-.......................................................................... r �, No.._......:._ !..___ FEE..:.................... UhimFa1 Works Tunotrudiun ramit Permissionis hereby granted----- -- -•-•------•--••-•---•-•-•------•••----•••--•••-•••-•-•------....-•••-••••-•••••-•••......................•-•••••..__.._.._._.... to Construct,( ) or Repair ( ) an Individual Sewage Disposal System at No..`t� .t.-4lG ro4l Uj.'.-vtr^ ','01r,; T*VI I Ie. Lanai --------------------------------------------•-------•--------•------•------.-------------------••--•-----••-------•---•-•••------•-----•--•-- Street as shown on the application for Disposal Works Construction Permit. , 074 o._____.__ j___ ,: ated____��.~_�_f 77..._.. ,�" /a Board of Health DATE_1--. w .-••••-•...-•--•--•-••••---••...............•-.....--•-- FORN 1255 HOBBS & WARREN, INC., PUBLISHERS L 0-GAXTION SEWAGE PE IT NO. , VILE: E INSTALLER'S NAME & ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED 4 7-7 DATE COMPLIANCE ISSUED /,4 M �� �7 1 �� *���9 �;�'"� � � D /a��T/�.� ��il'�"' } EXISTING CONTOUR N ' BENCHMARK x 100.98 EXISTING SPOT,GRADE `�6P 7 CURB STOP AUTUMN LANE (EXISTING CESSPOOLS W EXISTING WATER SERVICE EL.=99.37 G EXISTING GAS SERVICE i (APPROXIMATE) H. V�OVERHEAD WIRES E 103.50 PK SET TO BE REMOVED L) a� TEST PIT 100.66 100.00 edg of PoVement 96.73 49 ! 90.59 BENCHMARK uP ` N 60.41' o ;.E::::;; UP LEGEND 101,55 99,3 105.00' �4,43 3 g 95 o x \ \ �/ ❑ LOCUS 10, +{ // ... 3 \o Qa LOCUS MAP x 9,3 (Al NOT TO SCALE \ 96,4 •o .10 4 PAVED w in :.. I .. (n N RIVEWAY` TPI-t .0I � . r a 7 25 PROPOSED 9 '� ''<�? "°'::•.`:'<`,. C. o GENERAL NOTES: IC TANK \ 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 100,31 �9�` � J BOARD OF HEALTH AND THE DESIGN ENGINEER. 1014 98,12 1�12. �{--10' " 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS / EX. SEWER , VENT LOCALOF E STATE RULES AND IRONMENTAL EGULATIONS OEDXCEPT AS TITLE REQUESTED BELOW: AND ANY APPLICABLE INV.=96.3f estimated� ) ��$—_ —310 CMR 15.405(1)(b): 103.95 \ / i i 1) A 3' variance to the 3' maximum cover requirement, for up to GARAGE 6' of max. cover. S.A.S. shall be H-20 and vented. / EXISTING RAISED j1JNDER 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR /RANCH(#45)/ T.O.S.=98.3t TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE // DESIGN ENGINEER. SEWER CONNECTION / 105.04 x T.O.F.=105.4f(REAR) 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING b $ FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN (APPROXIMATE) W / �0 Z ENGINEER BEFORE CONSTRUCTION CONTINUES. O LO x 103,12 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. DECK \ J j I 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 00 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF �n 0 \ 0D HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. N / \ N O / x x 10 5,8 2 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. N 196,30 /29xZ 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. R A R 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS \ AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE .00 \ DIRECTED BY THE APPROVING AUTHORITIES. 0 / "' \� \ I 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 104.90 t CONSTRUCTION. / �0'Jt& 11, WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS / x 10 7.4 9 \ x IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND / REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). / \ Z \� OF Mqs 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 107.54 0 \ �P� s9�d INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. + \ W =� G \ v o PETER T. � 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 2 McENTEE IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. LQ LOT 53 \\ v CIVIL 14. THE HOMEOWNER IS RESPONSIBLE FOR OBTAINING PERMISSION, IF 0 REQUIRED, FROM THE SUBDIVISION ASSOCIATION, TO INSTALL THE LEACHING 16,260 ±SF \ 35109 SYSTEM AT THE PROPOSED LOCATION. o PARCEL ID: 168-031 A&\\\ A�° R ON IF \ PROPOSED SEPTIC SYSTEM UPGRADE PLAN 45 AUTUMN DRIVE, CENTERVILLE, MA 107,27 x 107,23zM 1 15.00' A- x 106,2 Prepared for: Roman Sidlovskis, 45 Autumn Dr., Centerville, MA 02632 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. FENCE LINE N 60°41'30" E 1"=20' P.T.M. 155-16 ROMAN SIDLOVSKIS Engineering Works, Inc. —' 45 AUTUMN DRIVE 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. CENTERVILLE, MA 02632 (508) 477-5313 6/17/16 P.T.M. 1 Of 2 j NOTE:- TO PREVENT BREAKOUT, FINAL GRADE SEPTIC TANK SHALL NOT BE AT, OR BELOW, EL.=92.5 --- INSTALL RISERS & COVERS OVER INLET &' FOR A DISTANCE OF 15' FROM THE EDGE OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D-BOX OF THE PROPOSED S.A.S. INSTALL RISER & COVER PROPOSED S.A.S. O SET TO 6" OF GRADE INSTALL RISER & COVER OVER EACH CHAMBER AND T.O.F=105.4f(REAR) SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT 61�' �20 M �'` I N F.G. EL.=101.5t F.G. EL.=99.3(MAX.) F.G. EL.=96.5f F.G. EL.=95.0 to 97.2f 1 'p PROP. VENT I S.A.S. MAINTAIN 2% SLOPE OVER S.A.S. L = 18' S(max.) , L = 29' ® S=1% (MIN.) @ S=1% (MIN.) ® S 1%5(MIN.) EX. SEWER 4"SCH40 PVC - 4"SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2" INV.=96.3t(estimated) 111 E6� DOUBLE WASHED STONE ///// 10"1 " 08 as (OR APPROVED FILTER FABRIC) B' eBa$aaa EXISTING RAISED GARAGE II 14' aaBBBBa aaaaBaa RANCH 45 RAISED INV.= 95.25 46" LIQUID "-3/4" TO 1-1/2" DOUBLE T.O.S.=98.3f LEVEL ADD INV.=92.37 PROPOSES 4' 5.2' 4' WASHED STONE T.O.F=105.4f GAS BAFFLE D-BOX INV.=92.20 EFFECTIVE WIDTH = 12.8' INV.= 95.00 3 OUTLETS H-20 INV.= 92.00 PROPOSED SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN CONNECT TO EXISTING SUITABLE SEWER PIPE DECK EXITING HOUSE, AT OR ABOVE, INV.=96.0t(verify) H-20 RATED CONTACT ENGINEER IF PIPE ELEVATION IS LOWER TOP CONC. ELEV.= 93.1 t THAN INDICATED ON THE PLAN. BREAKOUT ELEV.= 92.50 ease SEPTIC LAYOUT NOTES: INV. ELEV.= 92.00 plima8aaa29a860 aaaaaaaaaaB 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & BOTTOM ELEV.= 90.00 INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. 4' 2 x 8.5' = 17.0' 4' 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' TRUE TO GRADE ON A MECHANICALLY COMPACTED PERVIOUS MATERIAL SIX INCH CRUSHED STONE BASE, AS SPECIFIED 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION ®®®® 0 IN 310 CMR 15.221(2). BOTTOM OF TEST PIT, EL.=84.0 = ®®®®®® ® ®®® 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 37 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE d W ® AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. N Z ®�� SEPTIC SYSTEM PROFILE 102" DESIGN CRITERIA SOIL LOG 4" KNOCKOUT NUMBER OF BEDROOMS: 3 BEDROOMS DATE: MAY 31, 2016 (REF#15,057) 20" DIA. COVER SOIL EVALUATOR: PETER McENTEE PE(SE#1542) SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) WITNESS: DAVID STANTON R.S. HEALTH AGENT DESIGN PERCOLATION RATE: <2 MIN/IN ELEv. TP-1 DEPTH ELEv. TP-2 DEPTH 4" KNOCKOUT 4" KNOCKOUT 58" DAILY FLOW: 330 GPD 96.3 0" 96.0> 0" 0 FILL FILL DESIGN FLOW: 330 GPD 95.1 14" 94.5 18" A A 4" KNOCKOUT GARBAGE GRINDER: NO-not allowed with design LOAMY SAND LOAMY SAND LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 94.3 B 10YR 4/2 24" 94.0 B 10YR 4/2 24" .74 GPD/SF LOAMY SAND LOAMY SAND 500 GALLON CAPACITY, H-20 LOADING PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY 92.1 10YR 5/8 50" 92.0, 10YR 5/8 48" CHAMBERS PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED C C PERC N.T.S. USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 42"/60" MED. SAND MED. SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 2.5Y 6/6 2.5Y 6/6 45 AUTUMN DRIVE, CENTERVILLE, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Prepared for: Roman Sidlovskis, 45 Autumn Dr., Centerville, MA 02632 TOTAL AREA:............................ 471.2 S.F. i Engineering by: SCALE DRAWN JOB. NO. ............................. .. 84.3 144' 84.0 144' Engineering Works, Inc. N.T.S. P.T.M. 155-16 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD PERC RATE <2 MIN/IN.! "C" HORIZON 12 West. Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. NO GROUNDWATER ENCOUNTERED (508) 477-5313 6/17/16 P.T.M. 2 Of 2 1