HomeMy WebLinkAbout0141 BAY LANE - Health 141 Bay Lane
Centerville
186 007
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OcwctEo
UPC 12534
ILL�-iNyRjR
MASTIM88.NM
/ TOWN OF BARNSTABLE
LOCATION �ep� 44e,6 SEWAGE #
Q
VIIsAGE -'�- ,V:--<--VASSESSOR'S MAP & LpT� G
INSTALLER'S NAME&PHONE
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OWNER
AWl 41.1
PERMITDATE: COMPLIANCE DATE:
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 an L ng Faci .ty (If an wet ands exist
0within 3 o h W1,
Feet
Fumished ty
L
TOWN OF BARNSTABLE
LOCATION �7'�� SEWAGE# D 7—
VILLAGE f ASSESSOR'S MAP&PARCEL /8G Ae,4 7
INSTALLERS NAME&PHONE NO. dsdo
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO.OF BEDROOMS /
OWNER .2;�_ 19.`Gl'
PERMIT DATE: COMPLIANCE DATE:
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
�rVoo
Ta�--50 •�� r1
ksYsr.� • s
LI
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TOWN OF BARNSTABLE
LOCATION SEWAGE #VT
�? — 5S
VILIAGE C ASSESSOR'S MAP & LOT ®AS
INSTALLER'S NAME&PHONE NO. R (?-O-ZA .��.Ac. S'OB- N3a-0530
K CAPACITY 3 3 ss
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: COMPLIANCE DATE:
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 aciGty) Feet
Furnished by Z�il,cc c c- �Z�
f
C
,
No. 556a Fee /00
t
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
appuLAtion for lniq gal 6pgtem Construction Permit
Application for a Permit to Construct( . )Repair(/)Upgrade )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No. JLA k ZCL��,�, j, Cg o�0Lj,h:g, 6� Owner's Name,Address and Tel.No. �SQ .a�v
5 V,5Mi,) vca4 Z
Assessor's Map/Parcel c�, yCoc e1 P�o C a 2'J A
Installer's Name,Address,and Tel.No. "- -0&30 Designer's Nam ,Address and Tel.No. `SO6-L ,S- CJ3(I/
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 1%J k�ro k� Q Q rA,V C,�Cttnn kA4_
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of Health.
Signed 0a, fLd Date // dui 16-7
Application Approved by Date
Application Disapproved for a following reasons
Permit No. MQ;;1—5�5Zd Date Issued
..♦ F_ .�..-. r' - :-st,'.:. 7-t `;k� -''k:._.. _.T ,-. . . ' r:.i r-.......-.a.. .,.C:r;.� ?r,yy.. +., !.
,9 ,,:• q ^ ��/ „ t^— -N Fee /0D
o �f ll�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
;r
*PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS
,,
ZIppYication for 33ioozal *raem Construction Permit
Application for a Permit to Construct( . )Repair Upgrade�)Abandon( ) ❑Complete System ❑Individual Components
N.4
Location Address or Lot No. IN t ( `1A j C e j j,:,j ��Q. Mt Owner's Name,Address and Tel.No. r&t, 73Q .OG W
LSV9pN �CFNZ
Assessor's Ma /Parcel G
141. ;tey ku.
Installer's Name,Address,and Tel.No. SQg_ M �(j$3� Designer's Name,Address and Tel.No. jU$-��� gj?j11j a
R �`t ,, 11 C � (( (�/�4`1l`� A W. Cc)x J•O'SQ ec. 2 M
Type of Building:
Dwelling No;of-Bedrooms- Lot Size sq.ft. Garbage Grinder( )
Other TI pe of Building -No:-of'Pe4ons Showers( ) Cafeteria( )
Other Fixtures - -
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
r� Title
Size of Septic Tank Type of S.A.S. 4 ?.
== -
Description of Soil;
Nature of Repairs or Alterations(Answer when applicable) 1 v G (` Limp r.�Q VIA k 81 ,
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been,issued by this,Board off Health.
r Signed _Date !1 `k 4_
Application Approved by f Date a
Application Disapproved for tLe following reasons
Permit No. 111100-4 5-5qp Date Issued k2
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
r Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded ) `
Abandoned( )by ,e
at LV has been constructed in a ordance
with the provisions SpT�irt1le 5 and the for Disposal System Construction Permit Na .209-4- dated
Installer CJ L/ Designer °�- PG X
The issuance of this permit sh. t b co strued as a guarantee that th s�wili,n designed.
Date Inspector
—//''��----//,^, ------ _---•' ---�� — ---/� �-
No. r (n//i(/ 5��1/ i r Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Mizpozal *patent Construction Permit
Permission is hereby granted to Construct( Repair( )Upgrade X)Abandon
System located at �41 eCev% 1. .• CP s�
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
1
Provided:Co tructi n must be completed within three years of the date of this p
Date: '
A`y r ved b �� i
!� pp o y
CT-_o_w_]
Regulatory�:Se rvices
Thomas F.Geiler,Director
��� Public Health Division
►`� Thomas McKean,Director
200 Main Street;. Hy_annis;MA,02601 '
Office: 508-862-464/4 Q Fax: 508-790-6304
Date: Sewage Permit# O— S�-�Assessor's Map/Parcel IS /?
Installer&Designer Certification Form
Designer: Installer: 0 y2
Address: g0�- �3 `� Address:
O 2 Co(oZ LC----)
On was issued a permit to install a
(date) (installer)
septic system at 1 41 CL=x-ILC(L 0"based on a design drawn by
(address)
dated 11 bs lbr
(designer
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and theme soils
were found satisfactory.
� y
I certify that the septic system referenced above was installed with in changes,(i.e.,,
greater than 10' lateral relocation of the SAS or any vertical relocation 0 y compo"nentr
of the septic system) but in accordance with State& Loca s. revision orz
certified as-built by designer to follow. Stripout(if req ' t and th(Ps-oils`_'
were found satisfactory.
a STEPKW d. c
00.97P 3
(Installer's Signature)
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
q:\office forms\designercertification form.doc
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TOWN OF BARNSTABLE
LOCATION T� SEWAGE# I>7n
VILLAGE t ASSESSOR'S MAP&PARCEL /JG 7
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITYvc�
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
OWNER 190 Gl{
PERMIT DATE: COMPLIANCE DATE:
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
7 I .
� , �►�yes �,�� �
I
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'V
DATE 1 1 /1 5/05
PROPERTY ADDRESS 141 Bay Lane
Centerville
MA 02632
On the above date, the septic system at the address above was
Inspected. sz- �-
This system consists of the following:
1. 1-2000 gaiion zept.ic tank.,
2.- 1- Dizta.igut.ion 9ox.,
3.- 6- Uow d.i� uzoaj
Based on inspection, I certify the following conditions:
4., 7h.i,6 .iz a 7.itie Five .3ePt.ic 3y,3tem.
5.- The zept.ic zyetem .i- �n paopea woak.ing oadea at the paezent time
SIGNATURE
Name: Robert A. Paolini
Company: Joseph P Macomber & Son Inc . `
Address: P. O. Box 66 �z
r C
Centerville Mass 02632
Phone: 508-775-3338 or 508-775-6412
w
N' rn
JOSEPH P. MACOMBER & SON, INC.
Tanks-Cesspools-Leachfields
pumped &installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 02632-0066
775-3339 775-6412
•
COMMONWEALTH OF MASSACHUSETTS
t EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
a DEPARTMENT OF ENVIRONMENTAL PROTECTION
s`
TITLE 5
OFFICIAL INSPECTION FORM NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: .141 Bay Lane
Centerville MA 02632
Owner's Name: Josh Kouri
Owner's Address: Same
Date of Inspection:11 f.1 r f n c;
Name of Inspector: (please print) ;,Robert A,;P.aol r
Company Name: 9_ , aco gez S:o.n Inc.
Mailing Address: Pox 66
Cen t g A T TTF e, 4.3.6. 02632
Telephone Number: 5 0 8-7 7 5=3338
CERTIFICATION STATEMENT
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:
XXX passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: U< 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.
Notes and Comments
""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.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTIONYORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 141 Bay Lane
Centerville MA 02632
Owner: Josh Kouri
Date of Inspection: 1 1 /1 5/0 5
Inspection Summary: Check A,B;C,D or.E/ALWAIFS complete all of Section.D
A. System Passes:
NO I have not found any information which indicates`fhat any of the failure criteria described>in 3 10 CMR
15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
t.�c •s stem 1.6 .in .¢o erc wo2king oadea at the 12/zezen.t .t.ime.,
S e . y R /�
Conditionally B. System Con y Passes:
NO 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.
Answer yes,no or not.determined(Y,N,ND)in the for the following statements.If"not determined"please
explain.
NO 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.
040
ND explain:
NO 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
obstruction is removed
distribution box.is leveled or replaced
ND explain:
NO The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
I
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 141 Bay Lane
Centerville MA 02632
Owner: Josh KQurj
Date of Inspection: I 1 15 0 5
C. Further Evaluation is Required by.the Board of Health:
NO 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:
n 0 Cesspool or privy is within 50 feet of a surface water
n 00 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
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:
n o 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.
no The system has a.septic tank and.SAS and the SAS is`within a Zone 1 of a public water supply.
n The system has aseptic tank and.SAS and:the SAS is within 50 feet of a private water supply well.
n 0 The system has a septic tank and SAS and the.SAS is less than 100 feet but 50 feet or more frorn a
private water supply well". Method used to determine distance vizua
"This system passes if the well water analysis.,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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:
3
I
Page 4 of 11
INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
OFFICIAL IN SSESS NTS
SUBSURFACE SEWAGE.DISPOSAL:SYSTEM INSPECTION FORM
PART<A A .
CERTIFICATION(continued)
Property Address: 141 Bay Large
Centerville MA 02632
Owner: Josh Kouri
Date of Inspection: 1 1 /1 5/0 5
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no'.'.to each of the.following:for all inspections:
Yes No
X Backup of sewage into facility or system component dueto overloaded.or clogged SAS.or cesspool
v Discharge.or:ponding of effluent to the surface of the.ground or surface waters due to an overloaded or
clogged SAS or cesspool
X Static liquid level in the distribution box.above outlet invert due to an overloaded or clogged SAS or
cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than May flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
_ X Any portion of cesspool or privy is within 100 feet of a surface water supply,or tributary to a surface
water supply.
X Any portion of a cesspool or privy is within a,Zoom 1 of a public well.
X Any portion of a cesspool or privy is within.50 feet of a private water supply well. n.
X 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 coliform bacteria and volatile organic compounds
indicates:.that the well is free from pollution from that facility 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 forlp.j
NO (Yes/No)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. ld 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 10,00.0 gpd to 15,000.
gpd•
You must indicate either"yes"or"no"to.each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_ X the system is within 40.0 feet of a surface drinking water supply
_ X the system is within 200 feet of a tributary to a surface drinking water supply
_ X the system is located in a nitrogen sensitive area Qpterim 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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 141 Bay Lane
Centerville MA 02632
Owner: Josh KoLri
Date of Inspection:i'i/i f S
Check if the following have been done You must indicate"yes"or"no"as to each,of the following:
Yes No
v Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X Has the system received normal.flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X — Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X Was the facility or dwelling inspected for signs of sewage back up?
X Was the site inspected for signs of break out?
X Were all system components,excluding the SAS,located on site?.
X _ 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?
X _ 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:
Yes no
X Existing information.For example,a plan at the Board of-Health.
X _ 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(3)(b)J
5
Page 6 of 11
OFFICIAL INSPECTION]FORM-NOT FOR VOLUNTARY ASSESSMENTS
N
.SUBSURFACE SEWAGE DISP.OSALSYSTEM�INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 141 Bay Lane
Centerville MA 02632
Owner: Josh Kouri
Date of Inspection: 1 1 1 1 sl 0 5
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design)::6 Number of bedrooms.(actual): 6.
DESIGN flow based on 310 CNIR 15.203 (for example: 110 gpd x#of bedrooms):'6 6 0.
Number of current residents: Z
Does residence have a garbage grinder(yes or no):no
Is laundry on a separate sewage system(yes or no)n o [if yes separate inspection required]
Laundry system inspected(yes or no):n o
Seasonal use:(yes or no):no
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no): no
Last date of occupancy:pa e z e n
COMMERCIA.LarODUSTRIAL
Type of estab.'.int: N 1
Design flow(based on 310 CMR 15.203): gpd
Basis of design;rflow(seats/persons/sgft,etc.):
Grease trap present(yes or no):—
Industrial waste holding tank present(yes or no):_
Non-sanitary waste discharged to the Title 5 system(yes or no):_
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: N14 040
Was system pumped as part of the inspection(yes or no):
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping: .
TYPE OF SYSTEM
X Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_ivy
_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)
_Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information:
unknown
Were sewage odors detected when arriving at.the site(yes or no):no
6
f
Page 7 of l l
OFFICIAL INSPECTION FORM NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 141 Bay rant
Centerville MA 02632
Owner: Josh Krnlri
Date of Inspection: 11 1 5/0 S
BUILDING SEWER(locate on site plan)
Depth below grade: 3 0"
Materials of construction:_cast iron X40 PVC other(explain): .
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
ao.intz a/1/2ea2 tight , No .leakage Vvn#vd fhawlah haaAo 'uen.L
SEPTIC TANK:yz(locate on site plan)' 2000 ga 2 l o nb
Depth below grade: 24"
Material of construction: X concrete_metal fiberglass polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: 1 Z X 5 8"X 5 8
Sludge depth: .t l a c e t
Distance from top of sludge to bottom of outlet tee.or baffle: r a c e
Scumthickness: brace t2ace
Distance from top of scum to top of outlet tee or baffle: —a c e
Distance from bottom of scum to bottom of outlet tee or baffle:Ta
How were dimensions determined: m e a z u 2 e d
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of.leakage,etc.):
l um/z tank eveic 2 eaa.46., Inlet
zp-
7aak tz b 2uc uaa t .6oun .
GREASE TRAP:n 0 (locate on site plan)
Depth below grade:_
Material of constructiow._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: gri�,�
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural`inte liquid levels
related to outlet invert,evidence of leakage,etc.):
related
t2a/2 not /72ezen.t
7
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 141 Bay Lane
Centerville MA 02632
Owner: Josh Kouri
Date of Inspection: 1 1 /1 5/0 5
TIGHT or HOLDING TANK: NO (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/day
Alarm present(yes.or no):
Alarm level: Alarm in working order(yes.or no):
Date of last pumping:
Comments(condition of alarm apd fl at switches,etc.):
Tight o2 holding tan%,s aae not 122ehent
DISTRIBUTION BOX:ye-3 (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
1 akage into 0 out o box etc.):
ox Z16 .leve alas 2 eate-Aa.ez., No Zoeid caltItyvoe2 on leakage .in oa
PUMP CHAMBER: n o (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Paml2cham9en .iz not /22eaent
8
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued):
Property Address: 141 Bay Lane
Centerville MA 02632
Owner: Josh Kouri
Date of Inspection: 11 1 5 0 5
SOIL ABSORPTION SYSTEM(SAS): {locate on site plan,excavation not required)
If SAS not located explain why:
Located zee Rage 90 ,
Type
leaching pits,number:_
X leaching chambers,number: 6
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.):
Loan2y to medium . .sand . No
2y., ege a .ton -iz noamai_.
CESSPOOLS: n o (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 tor no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
ces,6R00. .3 ate not 122e.6eaL
PRIVY: n° (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.):
l a ivy .i-6 not 122e sent
9
Page 10 of 11
QFF,1CIAL INSPECTION FORK,NOT FOR VOLUNTARY ASSESSMENTS
SURFACE SEWAGE DISPOSAL;SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)`
Property Address: 141 Bay Lane.
Centerville MA 02632
Owner: Josh Kouri
Date of Inspection: 11 1 5/0 5
v.
SKETCH OF SEWAGE.DISPOSAL SYSTEM
vide a sketch 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.
s
•
I:
`r 1
t.M
v._ 10
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION,FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 141 Bay Vane
Centerville MA 02632
Owner: Josh- Kouri
Date of Inspection: 1 1 /1 5/0 5
SUE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water `et
Please indicate(check)all methods used to determine the high ground water elevation:
•N 0 Obtained from system design plans on record-If checked,date of design plan reviewed:
cle s Observed site(abutting-propprty/observation hole within 150 feet of SAS)
V"Checked with local-Board of Health-explain:A Q„1 0 f Xn,2d
no Cheeked:with local excavators,
installers-
� in 1 s-(attach documentation)
[e sAccessedUSGSdatabase=explain� e/2ow g e, m a u.s
You must describe how you established the high ground water elevation:
ll�sed. : Ca e Cod Comm.izion 1datea 7agie Con.touah And .1)uktie Glate. SuPP4
ldeii head aoteet.io•n a)zeas ma Se t 1995
Idatea aesouneez o.1-lice cage cod comm.izzon., -
Leaching
Pit "°%'. Beet
f Pit High Groundwater Ad}ustment 1.8 ft per Frimpter Method
Groundwater: cet Below Bott o m 0'
Therefore,the vertical.separation distance between the bottom .
of the leaching pit and the adjusted groundwater table is
feet. `
• 11
n:
91"U"
. .Rlfl9r•�7ZI. ,-.
TOWN OF BARNSTABLE BOARD OF 118ALTII
SUT)SURFACK SFWA09 DI SPUSAL AYSTR,M INSPRCTION FEMM - 1 ART�D CRItTI F1CAT�I N
-TYP6 OA PBIPT C110ALy—
PliOPEIiT y rNSPECTED ,
STREET ADDRESS 141 .. Bay Lane Centerville
ASSESSORS MAP, IILQ.CK AND 'PARCE'L iI �-•-
OWNER's NAME Josh K ri
PART` D ORRTIFICATIVN '
NAME OF INSPECTOR Rojeat Pa.o�n•i
COMPANY NAME
za kh :n.� �lacomI¢a' t. Son Snc
Boy- 66 -Cen4eay.iXXa Rabb' 02632
COMPANY ADDRUSs .----- -•"• Totim•or ty. State. ZIP
strQaS
COMPANY TELEPHONE ( 508. Y 7.5 - 3338
FAX (` 508',1190 � f 578
low
CER'PI'FICATION. STATEMENT
ertif that. I have persoria]:lY .inspected ..the sewageQdillrateeaaridsystem
at
I c Y
this address clad thatmelfa..f nspectiOn.v The inrormation ringpeetionewasaperformed and any
omplete as of the
recommendations regard.illg upgrade., .MaIntena.nce ,' and repair .are oon$is'tent
with my trainipg and exp.q-rience in the proper function' aril maintenanoe of on-
withsite sewage disposal systems ► „ y 1I1;0.
Check one: 040
,
Systeul PASM
ion whic.M I have -conducted has .,n•vt' found any information .
The inspection
which indicates tliat the system fails to adequately, protect .publio
health or the envirv#)ment as defined in- .110 CMR. 16i'301* Any failure
evaluated are as stated in the FAI'LUTM CRITERIA see.tion of
criteria Dot
this. form.
T— System FAILED*
The inspection which I have co'n ted 'has •�faund that the system fails to
protect the public liealtll and the environment in aevo'rd-ace with Title
61 310 CMR 15 , 3Q3, and as - specifically noted on PART: C - . FAILURE
CRITERIA of this inspection .f
Inspector Signature*
_ �Da�t$
rn6OC py of this certi,fic�: ahmust •be provided 'to : the •QWNER-, tht. BUYERre applhaa'b1*) and th!s DQARD Or HEALTHw
* I i the inspeeti on FAILED., th�a .owner' .ox Qperator s:hal�, . upgrs►de'the system.
within dne year of the dalt•e of the i.n06ection, unless. a];'lowsd ar requi;red
",•^v i ded in 110 CMR 16 3 ---A- a
DATE: 9/13/02
PROPERTY ADDRESS: 141 -Bay-Lane
--- --- ---------------
02655
------------------------
On the above date, 1 inspected the septic system at the above adggWIVED
This system consists of the following:
1 . 1 -2000 gallon septic tank. SEP 2 5 2002
2. 1 -Distribution box. TOWN OF BARNSTABLE
3. 6-Flow diffussors. 2-Rows of three. (Dry) HEALTH DEPT.
Based on my inspection, I certify the following conditions: �`�
4 . This is a title five septic system. ( 78 Code)
5. The septic system is in proper working order at the present time.
6. The six diffussors are presently dry.
7 . House has been vacant since 1999 .
SIGNATUR
Name: J .- P . -Macomber-jr .
Con1pany :Joseph P_,_ Macomber & Son, Inc .
A d d re s s :__Box _�tz............
-_men-t-erv_U1R,_ba-_Q-2-632-0066
Phone:--508-775-3338
-------------------
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPH P. MACOMBER & SON, INC.
Tanks-Cesspools-Leachflelds
Pumped & Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 02632-0066
775.3338 775.6412
i
-\ COMMONWEALTH OF MASSACHUSETTS
7 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 1 41 Ba)z Lane
Cpntervil 1 e, Ma Gs
Owner's Name:e ;a des �7. 8r�wn
Owner's Address: 31 5 East 76th St.
APT SC, NY NY 1 nn21
Date of Inspection: q/1 -4102
Name of Inspector: (please print)JoseAh P.Maeomber Jr.
Company Name: ,7_P_Macomber & Son Inc.
Mailing Address: Rox 66
Centerville,14ass . 02632
Telephone Number: 508-775-3338
CERTIFICATION STATEMENT
I certify that 1 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
rrainine and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP
appCoved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
J/- Passes
_ Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails !
Inspector's SignatureAs/� Date: �'�J5- -
d"
The system inspector sh 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.
Notes and Comments
""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.
i
Title 5 Inspection Form 6/15/2000 page I
Page 2 of 1 I
OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 1 41 Bay Lane
Centerville,Mass.
OwnerCharles J. Brown
Date of Inspection:9 13 0 2
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
A 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:
160 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.
Answer yes,no or not determined (Y,N,ND) in the for the following statements. If"not determined"please
explain.
--O 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
exisitng 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.
ND explain:
_ev 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
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 141 Bay Lane
Centerville,14ass .
Owner: Charles J. Brown
Date of Inspection: 2/13 10 2
C. Further Evaluation is Required'by the Board of Health:
�L Conditions exist which require farther 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
�G Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
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:
.e,D 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.
,00 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
4d 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 feet or more from a
private water supply well". Method used to determine distance /T
"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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:
3
Page 4 of I 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:1 41 Bay Lane
Centerville,Mass,
Owner: Charles J. Brown
Date of inspection: 9/1 3/02
D. System Failure Criteria applicable to all systems:
You must indicate 'yes" or"no" to each of the following for all inspections:
Yes No
ackup of sewage into faciliry 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 distri ution box above outlet invert due to an overloaded or clogged SAS or
/cesspool /_ �m� /�l�d 5;�di'S ( O-Y,>
k/>-iquid depth in4ev--pool 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 Q .
_ 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 ponion of a cesspool or privy is within a Zone 1 of a public well.
_ v y ponion 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. (Tbis system passes if the well water analysis,
performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility 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.)
(Yes.'No) 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 o
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 now of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no" to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_ no
system is within 400 feet of a surface drinking water supply
— Zthe/Ith
system is within 200 feet of a tributary to a surface drinking water supply
system is located in a nitrogen sensitive area Interim Wellhead Protection Area— 1— Y g ( WPA)or a mapped
Zone Il 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.
4
I
Page 5 of I I
OFFICIAL. INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Properry Address: 1 41 bay Lane
Centerville,MasS_
OwnerCharles J. Brown
Date of lospectioo: 9/1 1/07
Check if the following have been done. You must indicate "yes"or"no" as to each of the following:
Yes No
umping information was provided by the owner, occupant, or Board of Health
Were any of the system components pumped out in the previous two weeks '
i
/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 pan of this inspection ?
v 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 ?
4z — 'Alas the site inspected for signs of break out ?
!✓ _ Were all system components,�luding 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 facilityy 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:
Yes no /
s/ Existing information. For example, a plan at the Board of Health.
411 Determined in the field (if any of the failure criteria related to Pan C is at issue approximation of distance
is unacceptable) 1310 CMR 15.302(3)(b))
5
Page 6 of I 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 1 41 Bay Lane
Centerville,Mass.
Owner:Charles J. Brown
Date of Inspection: 9/13/0 2
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): ,� Number of bedrooms(actual): '6�
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms):
Number of current residents: 6
Does residence have a garbage grinder(yes or no): A5:
Is laundry on a separate sewage system (yes or no): tZ [if yes separate inspection required]
Laundry system inspected(yes or no); S '
Seasonal use: (yes or no): y
Water meter readings, if available(last 2 years usage(gpd)):House vacant. Last water useage
Sump pump(yes or no): VO 1 999-3000 gallons.
Last date of occupancy.,
COMMERCIAL/INDUSTRIAL
Type of establishment: r9
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.): 4R
Grease trap present(yes or no):—�
Industrial waste holding tank present(yes or no):.
Non-sanitary waste discharged to the Title 5 system (yes or no)i4_e
Water meter readings, if available: �0
Last date of occupancy/use:Imo_
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:None available
Was system pumped as part of the inspection(yes or no):
If yes, volume pumped: O gallons-- How was quantity pumped determined? .LGV
Reason for pumping: 40
TYPE OF SYSTEM
L OF
tank,distribution box, soil absorption system
Single cesspool
/0 Overflow cesspool
/tom 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)
Tight tank i,k Attach a copy of the DEP approval
Other(describe):
Amx4z
im to age! o I components,date installed(if known)and source of information:
% F
Were sewage odors detected when arriving at the site(yes or no):1407
6
Page 7 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:1 41 Bay Lane
Qenterville,mass.
Owner:Charles J. Brown
Date of Inspection: 9 13 02
BUILDING SEWER (locate on site plan)
Depth below grade:
Materials of construction:,tpcast iron �' 40 PVC Vdother(explain): NA
Distance from private water supply well or suction line: /6171-
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight.No Pvir3PnnP of leakage The system is
vented throug the house vents.
SEPTIC TANK: (locate on site plan) ,wo*��--v
Depth below grade:
Material of construction: ✓concrete ,4,�d'metal,ee fiberglass._/A polyethylene
/l/pother(explain) WIT
If tan}, is metal list age:A Is age confirmed by a Certificate of Compliance (yes or no):,&b (attach a copy of
certificate) f , V
Dimensions: 1Jie-x c� P,& � "',
Sludge depth` , —
Distance from top off fudge to bottom of outlet tee or baffle,. .G
Scum thickness:7-<ezee—
Distance from top of scum to top of outlet tee or baffle .tzc-�—
Distance from bottom of scum to bottom 9f outlet tee gr 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.):
Pump the septic tank annually.Garbage disposal is present.
Inlet & outlet tees are in place.The tank is structurally sound
and shows no evidence of leakage.
GREASE TRA (locate on site plan)
Depth below grade: 1(1 J
Material of construction:-4,�concrete metalyi4fiberglass,Prolyethylene,Aother
(explain): ,G
Dimensions: ZA '
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: M
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Grease trap is not present
7
Page 8 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Propert) Address: 141 Bay Lane
ervil1e�Mass.
Owner: Chales J, rown
Date of lospectioo: 9/13/02
TIGHT or HOLDING TANKr&&,__(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of consr uc : eAconcrete A!A_metal ,&y fiberglass ,{//9 polyethylene,t#_other(explain):
Dimensions
Capacity. gallons
Desien Floes: ,/J/Q gallons/day
Alarm present (yes or no): ,6JW
Alarm level: 4l,4 Ala in working order(yes or no):
Date of last pumping: A
Comments (condition of alarm and float switches, etc.):
Tight or holding tanks are not present
DISTRJBUTION BOX: (if present must be opened)(locate on site plan)
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.):
Distribution box has two laterals.No evidence of solids
r No evidence of leakage int c ut ot trie
PUMP CHAMBERtL�(locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
ii
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Pump r'h�r is not present
8
Page 9 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 141 Bay Lane
Centerville Mass.
Owner: Charles J. Brown
Date of Inspection: 9 2
SOIL ABSORPTION SYSTEM (SAS): Zlocate on site plan, excavation not required)
6—Flow diffussors 2—Rows of three
If SAS not located explain why:
Located: See Page 10
T�r•�e
Al0 leaching pits. number: Q
leaching chambers, number:!°-Akev
leaching galleries, number: Q
leaching trenches, number, length: O
yV leaching fields, number, dimensions: O
.(J8 overflow cesspool, number: O �?���
420 innovative/alternative system Type/name of technology�y�� ,�y�
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc )
Lnamy -,and o andy loam to medium fine sand.No signs of
hydr--a-ulir failure or =ondi nq Soils are dry Vegetation is
normal. House has had no use since 1999
CESSPOOL9t4r,�(cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: Q
Depth — top of liquid to inlet invert:
Depth of solids layer:
Depth of scum laver:
Dimensions of cesspool: tiA
Materials of construction: A1j¢
Indication of groundwater inflow(yes or no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
rps-spools arP not present
PRIVYAja(locate on site plan)
Materials of construction:
Dimensions:
Depth of solids: !V
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Privy is not present
9
PW IOo/ ll
OFFICLA! INSPECTION FORM — NOT FOR VOLUNTA—RY ASSESSMEN-rS
SUBSURFACE SEwACE DISPOSAL, SYSTEM INSPECTION FORS
PART C
SYSTEM INPOR -ATION (conilnvco)
P,op,rr� oo,,,,:141 Bay Lane
C e n ervi e, a s.
0-o<<.Char les J, rown
011c of Inip(ciioo:9 13 02
SKLTCH Of SfwACC DISPOSAL SYSTEM
Ao oc c itcich o! i�c is .cl, oiipoiil iyiicm Inclv")s Ilcl to 11 Ict)l rwo permtncnl tacrcncc I�Cmvc,
'nc�invti loc"� cu .,iii in 100 fcci. Logic whcrc pvblic wiicr cvpply cnicti the Cviloinl
rTh
th
� i D
10
Page I I of 1 I
OFFICIAL, INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Propem, Address: 141 Bay Lane
Centerville,Mass.
Owner.Charles J. Brown
Date of Inspection:/1 3/02
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water,,O' feet
Piease indicate check all methods used to determine the hi ,(check) high ground water elevation:
ND_ Obtained Erom system design plans on record - If checked, date of design plan reviewed: NA
yE(3_ Observed site (abutting property/observation hole within 150 feet of SAS)
NCi Checked with local Board of Health-explain: NA
yN_9__ Checked with local excavators, installers- (anach documentation)
yES__ Accessed USGS database-explain: http//town_barnstable.ma.us.
You must describe how you established the high ground water elevation:
Used: Gahrety & Miller Model. 12/16/94 Ground water elevations at sea level,
Used: USGS-Observation well data, June 1992
Used: USCSq-Technical hulletin 92-000-1 Plate #2 Annual ranges of ground
water eleva4�91`ct`r n
cl
Leaching
Pit .eet
Groundwater Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method
Therefore, the vertical separation distance between the bottom _.
of the.leaching pit and the adjusted groundwater table is
feet.
I
11
' •ff^It-itl'R�.'rT fTT�lrr'!'1i�i?'TT'IIS"S.TT:'.'T�'TTT:�.TTCtT'1TISTVITY'91LT.1'tlt �.. .T�T"T'T'T�T3�T-..-.
1 TOWN OF Barnstable BOARD OF HEALTH
,SUBSURFACE SEHAGF DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION 1
.•••T•^.�T••••.•♦—T.I t���T T III•IT.'1TI T1tT STRiI'T11'P—'.'1 f�l'TR'f�R'RT"TR1TRtfJC T7 '
rtnrf rt'►mrnr.*a'**rrrrr+r.•.—rrr'r•�• �..�
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRES$ 141 Bay Lane Centerville,Mass.
ASSESSORS MAP , BLOCK AND PARCEL # 186-007
OWNER' s NAME Charles J. 'Brown
PART D - CERTIFICATION I
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber & Son Inc:''"
COMPANY ADDRESS Box 66 Centerville Mass. 02632
Street Town or City State L(P
COMPANY TELEPHONE (508 I 775 - 3338 FAX ( 508 ) 790 -1578
R
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true , accurate , and
omplete as of the time of .inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems ,
Cheone :
System PASSED
The inspection which I have conducted has not found any Informationwhich indicates that the system fails to adequately protect public
Health or Lhe. environment as defined in 310 CMR 15 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA sectioll of
this form .
System FAILED*
The inspection which I have conaicted has found that the system fails to
Protect the Ptiblic health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection for
Inspector Signature Date
copy of this c . fication must be provided to the OWNER, the BUYER
One
where applicable ) and the DOARD OF IIEALI'll.
If the inspection FAILED, the owner or operator shall upgrade ' the ayetem
within one year of the date of the inspection , unless allowed or required
otherwise as provided in 3.10 ChiR 15 . 305 ,
partd . doc
r
ZL e- <
Iv .�.1.. .�as,x - Fes$.--..u..D...............
14 QO THE COMMONWEALTH OF MASSACHUSETTS '--CT TO APPROVi\L }
�\9 \ BOARD OF HEALTH ;:�'fA8LE CONSERVATICiN
l J ��
`.. OF.... COMMISSION
Application for Diipoiittl 19orks Tomtrurtioo Famit
Application is hereby made for a Permit to Construct ((/�`or Repair ( ) an Individual Sewage Disposal
System at
__..__._........ .-�-Address.............................. .................................................
- Lot No. ............. -
cation-Address or Lot No.
•-•-•-.....� ... brs. = ---.l�..`. .ov......................... ....................................
..�,..... Wit... ......... --
/y� � �jAddress
Wl?c�.C/.�r_5.: ..•.-• `' ................................... .... ?-!GF� ..... S --------•--•--••--------•--
FM-1 Installer Address '
UType of Building Size Lot...7?. _7®---._._Sq. feet �"
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ................................................
W Design Flow...........5 .......................gallons per person per day. Total daily flow____.._.. d---•-••-••__.........___.gallons.
WSeptic Tank—Liquid capacity? 4gallons Length.............•.. Width................ Diameter................ Depth................
Disposal Trench—No..1...C3...... Width......' ....... Total Length-___" S._�---- Total leaching area....44�...sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed ;1.. .�............. Date...9/A/V` .........
0.4
1_4 Test Pit No. 14.7N.�_.minutes per inch Depth of Test Pit...!!' '¢ _... Depth to ground water-------------------
Li, Test Pit No. 24.xWo..minutes per inch Depth of Test Pit....: ... Depth to ground water...7
................
"
P+ --------•--------------------------------------- ---------------------------------------•-••------....----------•-•--•-----••------------..._...............
i-� Description of Soil O/4. .._ .. �jli 4:.S !�.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
VNature of Repairs or Alterations—Answer when applicable_��.e c:6,__u `..7Ri_.1�� ra - .�.Gnc�
Jl-21c�.--See�K�G.ntli+--- � � e..
Agreement:
The undersigned agrees to install the aforede Cribed Individual Sewage Disposal System in accordance with
the provisions of TITLZ 5 of the State Sanitary o I — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b ' issued U the b d of health.
Signed............................. ... ............ ......•. --•---
Date
Application Approved By....... —----------------------•-- ..... . ---16 .. ........
ate
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------••--•-
•-••••••••••••••--•--•-•--••--•••-•--•--•-•--•-••••-•-••••-•-------••........-••••-•-•--•-••-•--••••-•---•••-•••••-••-•-•••••-•••••-•-•-•••-••-••-----------•-•••-••••-••--............................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH b'� ,(
............. .......OF.... :ems............................
C1rdif iratr of Tompliaorr
THIS IS TO CERTIFY, T t t e Individual Sewage Disposal System constructed (s/f or Repaired ( )
by--.--------�..... — -------------•--•----------------.----...........................-----•----------••-•-••--•-----•••---••---------..._..---
,�j . stiller
at------------ 1! . ..... l�----------------------------------------------------------------------------------
has been installed in accordance the provisions of T ALE j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit N<�?...45-.�,s................ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
0 5-
LOCATION SEWAGE PERMIT NO.
4t A Q
VILLLAGGEE
INST ,LIE 'SNFl"L
i ADDRESS
/� ..
� n
FLr //�jj
CIF OR OWNER
OXT E P-ERMIT ISSY E D
DAT E COMPLIANCE ISSUED
-, s
� r
--og-/ Fps ... ...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....................OF.... g7Z �-- Thy.��'L .. ..............................
.Appliraffau for Uiiposal Works Tooitrurtiou- amijt
Application is hereby made for a Permit to Construct (c4 or Repair ( ) an Individual Sewage Disposal
System at: � 19
.............�__.............'.............................................................-.. ....I-----_----------••---•---------•-----•--- -_..--------........................-•----.
I cation-Address or Lot No.
. ................. ..._..,....... _... ......._... •--••-........... r
Owner-- Address
a ------ .................� --......................................... C ?
Installer Address
dType of Building Size Lot_.._._.. a.� -•-----Sq. feet
Dwelling—No. of Bedrooms............._ _...__.............._....;Expansion Attic ( ) Garbage Grinder ( )
`4 Other—T e of Building No.. of persons............................ Showers — Cafeteria
a Other fixtures ---------------------------•-•-- . .
w Design Flow..............`.... .......................gallons per person per day. Total daily flow......_..G @__.._.................._.gallons.
rx Septic Tank—Liquid capacity.5�o.gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No. ...... Width......`.1:..._._.._ Total Length--__ ........ Total leaching area.... %. -.--sq. ft.
3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by...��.=�.r3� t`c:����✓;__ ^- .-............. Date.-/!? j_�1 �
f
aTest Pit No. 1�._!?! ?...minutes per inch Depth of Test Pit..._f`�._..... Depth to ground water____-- ---"-"-----I_.
Test Pit No. 2f5_r?^itt-a.minutes per inch Depth of Test Pit----- _.. Depth to ground water..... ��......._...
Rai ...................................................... ......_......-•••-•-•-•.............._..._..........................................•----.......--•-
IJDescription of Soil ••••.....-------••............... ....•-----••---••-•••-•--•--------••--•---••••---•............-•-•---••••••••-• ••---•---.-.................
------------------------------------------------------ ----------------------------------------------------•--- -•--- . ----•-. -••--•---•-••---- ••---•-------•---•-
U 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 TTT� 5 of the State Sanitary —The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b !n issued the b d of health.
Signed--------•-•--------•-------••----------------�-•---•--•-• ........ ..........................
Date
Application Approved By...... --- �,�• x ��,...�.-.' ...... ...................... --. �✓rt�'........
ate
Application Disapproved for the following reasons:................................................................................................................
......-••-•--•----••-••...-•-•-••--•-••--••-•••--•••••---•--••-•••••-••••••••••-••••••-•--•-............................................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............. irk../t/........OF... `->� /l{; •L'.............................
Tatifiratr of Tomptianrr
THIS IS TO CERTIFY, That, Individual Sewage Disposal System constructed (✓S or Repaired ( )
by........... ,.._. _ ''_-------------------------r-••---•.......--•--•-•............--••-•----•------...................._••••••......--••-----....._
Installer +
has been installed in accordance with the provisions of TTTLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit N ?-.. �.IS................ dated----------......................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.........--..................................................................... . Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......OF...... ✓ T/�_ GGT...........................
No .
�i��os�,� ork� �oo�#ror#ion rroti# .
Permission is hereby granted....... ....y..e... --------...•.................•----................---•--.............----
to Construct (___-�or Repair ( ) a di Aal Sews e Dis osal stem
- .I..
at No. .. .�......-- - ' ---------------------•-------•-----------------------•-----....------....
Street
as shown on the application for Disposal Works Construction Permit No...... �`.__..__.+Dated.....•....................................
-----------------------------------------/� /C i oard of Health
DATE............................................('-�-.- .............
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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MGINEEIIING
DO1GtV .. ..
. . . . ims
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T4 NPPROVEO 9Y' 'H
i
.... .
-
a
LOCATION 1L114P
CON,STRIlCTION NOTES.• Minimum Building Setbacks Not to Scale
Front 30 ' 28
I 1. NO HERBICIDES TO BE USED ON SUBJECT LOT. Side Rear - 10 ' R��(E
z
2. DRIVEWAY TO BE CONSTRUCTED OF PERMEABLE MATERIAL. �IT1i PL�1 W PS
R�JE cn
BEjVCHWRK sU
J. EXISTING DRIVEWAY SHALL SERVE AS THE LIMIT OF WORK. 1"= 20 ' TOP OF C.B. FND
WITH THE EXCEPTION OF THE PROPOSED BUILDING SEWER, ELEV.= 15.20'
NO DISTURBANCE SHALL OCCUR TO THE WEST OF THE DRIVE (M.S.L. DA TUM) P�
4. DISTURBED AREAS SHALL BE STABILIZED AND REVEGETA TED LOCUs
AS SOON AS PRACTICABLE UPON COMPLETION OF GRADING.
5. ALL 'EXCESS EXCAVATED MATERIAL SHALL BE STOCKPILED TO PROPOSED H-20 COVE
THE EAST OF THE PROPOSED GARAGE AND SHALL BE PUMP CHAMBER RD.
(335 GALLON
REMOVED FROM THE S17E UPON COMPLETION OF CONSTRUCTION. EXISTING SEPTIC SYSTEM TO REMAIN r'o CAPACITY) -I¢-
(APPROXIMATE LOCATION PER o
6. GUTTERS AND DOWNSPOUTS CONNECTED TO DRYWELLS, OR INSPECTION REPORT)
CRUSHED STONE ® ROOF DRIPLINE, TO BE UTILIZED TO ■ C.B.
CONTAIN RODE RUN-OFF FROM PROPOSED .GARAGE. �
7. ANY ADDITIONAL WORK BEYOND THE SCOPE OF THAT WHICH E,1,
IS SHOWN HEREON WILL REQUIRE CONSERVA T70N COMMISSION �' Assr's. Map 186
APPROVAL. r CB Z 9.4 \ \ Parcel 7
�
L.C.P.# 9403E Lot 48
0 0 00N.
'$
PROPOSED ADDITIONAL \ GAS
C SHED \.� ,MARK
°o� S.B. 2 �` -- -� DRIVEWAY'�T),F.1'9. 1 p� 0 2 \•��
_- :.. .
GAS
BANK 1 METER �� .o ' . rra• •.... .,..•
\®
. ....... ... .. EXISTING GARAGE /{ory 'LOT A8 W/ONE BEDROOM ELECTRIC
a
r .: .• : .,.
�o >2,` • -:E...'...... '.•.•.•. UNDER METER eM G
28,307 S.F._2� c -- / D CONSTRUCTION / :•. . .
\\ 0.6'4 Ac. \Z - , �� /.•_ : ........-�....; T.O.F. EL. = 10.63 ® WATER
\� 1. . cs..... , . .`_�' �►f _WATER
\\ o .'....'..'."...'.': \. VALVE
i
,-' VALVE
T BANK 2 r a:...... .....
o -yam :. . :Sr/NG
o y.•. :: .. •.:: flRIV� .. • . W... Exastin u+ell to a `abandoned
SHED 9 gilled and
\•
sealed with clean died clay, neat
/
b \ T BANK 3 �� —w w- -\-` �y w--�-�.� � "_w':- �.'HL-- ;:w Pam' y, t
-`` cement grout, concrete grout. or bentonite
-.. .. .. �____________ _ pellets in such a manner as to pl�vent it
� 14.14 \ .. ' . Y _---__--
\ 12" HOLLY Y r ------ Jmm acting as a conduit ,tbr pollution to
\ ' \ - -- ---_ the groundwater.
\ Y
10
BANK 4 r /
EXISTING ij••''' /
a I / ROCK WALL
1 Ly'JECTDR PUMP SPTCIFICATIONS. 4. PUMP SHALL BE EQUIPPED WITH AN AUDIO AND VISUAL ALARM,
INSTALLED IN A BUILDING TO PROVIDE ADEQUATE WARNING IN CASE
(
" OF PUMP FAILURE. ALARM SHALL BE POWERED BY A CIRCUIT� 1. PUMP SHALL BE MYERS. SRM4 (0.4 H.P.), OR APPROVED
1\ o >00 YEAR FLOOD ZONE EQUAL,' AND SHALL BE CAPABLE OF PASSING AT LEAST 2" SEPARATE FROM THE PUMP POWER.
\\ \ SOLIDS AT A DISCHARGE RATE OF FT. 50.2 GPM 0 11.6 TDH.
ZONE' A>0 EITV. 5. CHECK VALVE, AUTOMATIC CONTROL AND CONTROL BOX SHALL BE
\\ _ »
\\o \ 2. PUMP SHALL BE INSTALLED IN STRICT CONFORMANCE WITH AS SPECIFIED BY PUMP MANUFACTURER.
\\ MANUFACTURERS SPECIFICATIONS.
6. CONTRACTOR SHALL PRESSURE TEST FORCE MAIN TO ASSURE
J. PUMP CONTROLS SHALL BE MOISTURE PROOF AND OPERATE IN
WATERTIGHTNESS.
�r \\ THE FOLLOWING SEQUENCE. 7. PUMP AND ALARMS SHALL BE INSPECTED AND MAINTAINED IN
LECL—1Vn \\ ) PUMP PUMP ONE ACCORDANCE WITH MANUFACTURER'S SPECIFICATIONS
\\ 2 1, C) ALARM ON
\\ 8. IT IS RECOMMENDED THAT A SLIDE RAIL SYSTEM OR EQUIVALENT
Test hole location -\\ APPARATUS BE INSTALLED TO FACILITATE REMOVAL OF PUMP
COVER TO FOR INSPECTION AND MAINTENANCE.
->0 Existing contour \\ PROPOSED 2" DIAM. FINISH GRADE
\\ SCH. 40 PVC THRUST BLOCKING SHALL BE
—>O-- Prnposed contour \ FORCE MAIN. PROVIDED AT ALL BENDS TO
----- - WYE TO 4" PV PREVENT DISRUPTION OF PROPER MIN. FINAL GARAGE
r i FUNC770NING OF LINE. T.O.F. ELEV 10,63
L''x2st2ny GRADE = 9.1
r i I Septic, tank
L------
2' ;E E
DIA. >8'
rJi "
D Stribfztion box - TO DWELLING . ' 2 DIA. FORCE MAIN SALE 4' DIA. >�' �`_�' SITS' PLAN SH0TY1N6! PROPO,S'�'D CARAG�'
SCH. 40 PVC oo-BLEEDER
r-----------------,
E'xZStin ----Flow line r HECK /NV. ELEV
yy EXISTING 4 DIA.
����, Absorption System SCH. 40 PVC TO "D" BOX INV. EL. 6.13 VALVE R //yV, 8.50 a �'r �r �/
3" '� % E1.=6.13 4" CAST IRON PrepQi 7"eCG f07.• �J U�J 1`1 N CA NZ
Inv. �l Exist. 2000 .. (SEWAGE EJECTOR PUMP) PUMP N o
■ C B Concrete bound = 9 ss '. MYERS' 7" o. SCHPD.4o A rT
CauonCapacity SRM4 OR PUMP OFF P.V.C. PIPE Location: �Y� B,41 L,4NG� (��NTL'R t� A
—G— 6s'aS service-existing • ' Pl T APPROVED 9 suMP
• EQUAL. . BOTTOM ELEV.=2.3
4'-10" DIA. Ryder �' TYilcox, Inc., P.�'�c P.L.S.
STEPHAME J.
zJ
--�—f— �'lectric service-existing .. .. . . . .. . . ..... .. . . ..•.•• - " 3 Ciddiah Hill Rd.
-� semm
E'lectric service-pmposed PROPOSED PUMP ChTAMBER P. 0 Box 439 Scale: 1" _ ,90 ' wo�tta
W— Water service-existing AV scams So. Orleans, MA.,02662 Drawn by A71zb <_
335 GALLON 4'-10" DIAM.
Tel �508� 255=8312 -May >O, 2007 ,
®-- Water service-propr7sed Date � � -
I H-20 PUMP CHAMBER l
® UTILIZED. INSTALL ON A Fax.(6-08� 940-,9306 Revised 11115107 - pump chamber
Well location .
LEVEL, STABLE BASE. (MIN.
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