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0456 BAY LANE - Health
456 Bay Lane A= 187 —066 Centerville SMEAD No.2-153LOR UPC 12534 sm"d.eom • Yado in USA SH N111spM1�NOD4KtW TOWN OF BARNSTABLE q LOCATION 15(p �> U4• SEWAGE# 2bL —O(o VILLAGECi— 1AI —V1 t, LE ASSESSOR'S MAP&PARCEL •� (� INSTALLER'S NAME&PHONE NO. ?>.Ou� SEPTIC TANK CAPACITY 100n A.4 lL LEACHING FACILITY. (type) ���j c_ CA&AMZ size) NO.OF BEDROOMS 3 OWNER C LE01&r.(( INC-L 1&.1 K 5 V- PERMIT DATE: 3 Iq I y COMPLIANCE DATE: 3' Separation Distance Between the: Maximum Adjusted Groundwater.Table to the Bottom of Leaching Facility tJp Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY l C 2 • -21 14 3 R 3 C_ ` .7 Z� t1•"� 28.5. z. 6-91 ns 9 n-A �.3 !!��J TOWN OF BARNSTABLE I LOCATION )(P 'J` �l SEWAGE# '2—o 2-1 '- Z)Z (O VIT,LAGE ASSESSOR'S MAP&LOT_]q(-/2 INSTALLER'S NAME&PHONE NO. CVR� COA SLLOL'C. Se" y,(Ces SEPTIC TANK CAPACITY OMS-kt J op 9 AA ®yy c7 A4 LEACHING FACILITY:(t pe) 2-5 tw�� a��wQ't S (size) 3• / a (3' NO.OF BEDROOMS q BUILDER OR OWNER A O-�k O P T ��7 PERMIT DATE: / /I- 2 0 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 A3= 33 5 (ZE-r+rL aF Noos( - 3°,i°" la, C l ,�� �_ CIO. 0 9-1 — Fee C THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pphratiou for Misposai Opstem Coustrurtiou 3permit Application for a Permit to Construct( ) Repair X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. q,' ' GA4 W G'VML6 Owner's Name,Address,and Tel.No., Assessor's Map/Parcel d Installer's Name,Address,and Tel.No. 50?, Designer's Name,Address,and Tel.No..5M-X'73—d3`g'T 343 e P 11.l��Tbl s 0% Type of Building: Dwelling No.of Bedrooms J PAR PEuyrT Lot Size ';L I t C 3— sq.ft. Garbage Grinder( ) Other Type of Building 41R I(S RAV No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided .3 �� gpd Plan Date ,/ 7 —3 �. Number of sheets Revision Date Title `t-5(OAN CADS Size of Septic Tank I ,g�De) C &) Type of S.A.S. L L L Am ' Description of Soil Nature of Repairs or Alterations(Answer when applicable) (,���� Z'�� d� 5071r1( , yC- C. Le9 Lc- l`;R= Pl@C9 � c t PDC: Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heg4h. Signed Date 3_5 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 02-f— 00 Date Issued ---- 4. rr n l TO. v — Ip� - Fee t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Misposal �bpstrm (Construction Permit C> Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components'= Location Address or Lot No. 5 GA4 UU C'U n.05 Owner's Name,Address,and Tel.No.,G�U� vT ZIEC.1tVSK� P*7 Assessor's Map/Parcel g Installer's Name,Address,and Tel.No. j 7 y,$gT'I Designer's Name,Address,and Tel.No.SC*-}73-O 3 T 7 c -S P 5 �'. Type of Building: gpt1NCz -L PAN* Dwelling No.of Bedrooms 3 Fes. ' Lot Size pt �(�?j± sq.ft. Garbage Grinder( ) Other Type of Building EN)r(AL No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3530 gpd Plan Date 5 3 ZQ;2. Number of sheets ( Revision Date Title S�—r7Ay LAO-E -- Size of Septic Tank 111,16n�r-3 /J Type/of S.A.S.�5 L C__ 16 Description of Soil e b s F S, ,LJN b !�« / 6e_,� &) KW Nature of Repairs or Alterations(Answer when applicable) V 5C- J'�(j_(; '`��-o G4".L),J s`-"t'G( , hC. b U I �UAAcL_ - 3 sib=S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Hea h. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ,7 V - I— ��� Date Issued - 9 M1. _______________________________________________________________________________________________________________________________________ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(x) Upgraded( ) Abandoned( )by C, at (� � /4J C� 7 (J lC.(,C: has been constructed in accordance 4- with the provisions isions of Title 5 and the for Disposal System Construction Permit No. 2o7! 661dated Installer Powag-r A boa d 0 Designer #bedrooms Approved design flow n 330 gpd The issuance of this permit shall not be construed as a.guarantee that the system will c'on;.m d designed. Date (1 Inspector No. U 1 � Fee� — THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair()6 Upgrade( ) Abandon( ) System located at� ��� /�1� � CaJ _U!Ll .0 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit�� �1 Date Approved by iJ Town of Barnstable Regulatory Services Richard V. Scali, Interim Director BARNSrABLE, 2 �� Public Health Division f% 39. Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 3-16-21 Sewage Permit# ZOZ( 070 Assessor's Map\Parcel 187/66 SC Er��t�eeric►Designer: _ .1 �} S�1c-, Installer: Robert B. Our Co.,Inc. (RBO) Address: 2BSy Cranberry Otaa wo y Address: 363 Whites Path it a5 k ware_ %-M HA 6 2 53 8 South Yarmouth,MA On Z) Z� RBO was issued a permit to install a '(date) (installer) septic system at 456 Bay Lane based on by (address) —S G i✓n 5 i� o e?e-r 41�} Th C, dated 3-3-21 (designer) X 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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. 'Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed i iance with the terms of the AA approval letters(if applicable) ;;.or��SSgcyG ; J"L CHURCHILL Jit N sta ler's nat CML .41 4 'QO �F (D ner's Signature (Affix De i p Here) PL SE RETURN TO ARNSTABLE PUBLIC HEALTH DIASION. 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. QASeptic\Designer Certification Form Rev 8-14-13.doc r tIHMWET Town of Barnstable "4 Inspectional Services Department B` MAS& ' Public Health Division o1639. "� 200 Main Street, Hyannis MA 02601 . Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 8111 February 23, 2021 ZIELINSKI, CLEMENT A TR 456 BAY LANE CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 456 Bay Lane, Centerville, MA was inspected on 01/25/2021 by Michael Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE ARD OF HEALTH Tho n,— ,S,,GHO Agent of the Board of Heap Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\456 Bay Lane Centerville.doc IKE ray Town of Barnstable ��•B 1679 I�' Inspectional Services Department Inspectional Public Health Division 200 Main Street, Hyannis MA 02601 Off ice: 508-862-4644 Thomas A. McKean,CHO FAX: 508-790-6304 Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems'' (broken cover, relocation of a pipe, relocation of riveway due to H-10 components, etc) Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: • Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts 064,161a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 456 Bay Lane u Property Address Clement Zielinski Owner Owner's Name information is Centerville Ma. 02632 1-25-21 required for every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information vI# Is 12.3 filling out forms on the computer, use only the tab Michael Sears key to move your Name of Inspector cursor-do not Robert B Our Co INC. use the return Company Name key. 363 Whites Path. Company Address South Yarmouth Ma. 02664 City/Town State Zip Code 508-477-8877 SI 14430 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 ����•��`�CN OFtMgs 2. ❑ Conditionally Passes MICHAEL ',m: o: SEARS 3. El Needs Further Evaluation by the Local Approving Authority s o: No.SI14430 :c1' 4. ® Fails 1-25-21 Inspector's ature 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 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -� 456 Bay Lane u Property Address Clement Zielinski Owner Owner's Name information is Centerville Ma. 02632 1-25-21 required for every page. Cityrrown 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: 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 c� Commonwealth of Massachusetts �n Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u— 456 Bay Lane. Property Address Clement Zielinski Owner Owner's Name information is Centerville Ma. 02632 1-25-21 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 cam, Commonwealth of Massachusetts +n Title 5 Official Inspection Form I e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 456 Bay Lane u� Property Address Clement Zielinski Owner Owner's Name information is Centerville Ma. 02632 1-25-21 required for every page. Cityrrown 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 ® El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c Commonwealth of Massachusetts �. Title 5 Official Inspection Form ,i; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Bay Lane Property Address Clement Zielinski Owner Owner's Name information is Centerville Ma. 02632 1-25-21 required for every page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ 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 Title 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 <-,�!% 456 Bay Lane u Property Address Clement Zielinski Owner Owner's Name information is Centerville Ma. 02632 1-25-21 required for every page. Cityrrown 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 ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form _ FI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 456 Bay Lane Property Address Clement Zielinski Owner Owner's Name information is Centerville Ma. 02632 1-25-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 2019-155000ga12020-161000gal Detail: Sump pump? ❑ Yes ® No Present Last date of occupancy: Date t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c , Commonwealth of Massachusetts Title 5 Official Inspection Form �1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments <,V � 456 Bay Lane. Property Address Clement Zielinski Owner Owner's Name information is Centerville Ma. 02632 1-25-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No 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: 2016 Was system pumped as part of the inspection? ❑ Yes ® 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 Commonwealth of Massachusetts �- Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Bay Lane Property Address Clement Zielinski Owner Owner's Name information is Centerville Ma. 02632 1-25-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1-13-83 #83-40 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 30" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet 4 Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 c Commonwealth of Massachusetts �- Title 5 Official Inspection Form <I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 456 Bay Lane u Property Address Clement Zielinski Owner Owner's Name information is Centerville required for every Ma. 02632 1-25-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 20" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1000 gal If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal 1" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 29" 0 Scum thickness Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Sludge judge, tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000 gal tank with in tee and out baffle in place both covers 20" below grade t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 I Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 456 Bay Lane u Property Address Clement Zielinski Owner Owner's Name information is Centerville Ma. 02632 1-25-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 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): 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 <f\ Commonwealth of Massachusetts j� p Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Bay Lane Property Address Clement Zielinski Owner Owner's Name information is required for every Centerville Ma. 02632 1-25-21 page. CitylTown 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): Depth of liquid level above outlet invert 2" 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.): D Box is 12x8 with 1 outlet pipe, D Box walls are gone and needs to be replaced, box is at 36"with cover at 18" below grade t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 456 Bay Lane V� Property Address Clement Zielinski Owner Owner's Name information is Centerville Ma. 02632 1-25-21 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.): * 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: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 AN, Commonwealth of Massachusetts Title 5 Official Inspection Form IIP Subsurface Sewage Disposal System Form - Not for Voluntary Assessments `.............. !% 456 Bay Lane v- Property Address Clement Zielinski Owner Owner's Name information is Centerville Ma. 02632 1-25-21 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.): SAS is a 1000 gal pit pit is full up to inlet pipe system is failed 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 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 �w Title 5 Official Inspection Form yI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Bay Lane Property Address Clement Zielinski Owner Owner's Name information is Centerville Ma. 02632 1-25-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Cap Commonwealth of Massachusetts Title 5 Official Inspection Form IIb Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .............. !% 456 Bay Lane. — u Property Address Clement Zielinski Owner Owner's Name information is Centerville Ma. 02632 1-25-21 required for every State Zip Code Date of Inspection page. CitylTown 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 Q L____17 From Of 03. 3 A ( — 36 a_ qo 3-N5 O�O�`0-,6 OF rA4gollii��� "� �•b gam: MICHAEL '.N. SEARS 3 :* No.SI14430 r co F • . t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form tI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Bay Lane u- Property Address Clement Zielinski Owner Owner's Name information is required for every Centerville Ma. 02632 1-25-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 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 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: System fails needs perk test 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 Commonwealth of Massachusetts Title 5 Official Inspection Form I4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 456 Bay Lane V Property Address Clement Zielinski Owner Owner's Name information is required for every Centerville Ma. 02632 1-25-21 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 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 LOCATIOW SEWAC PERMIT NO. VILLAGE INSTALLER'S NAME i ADDRESS JOHN A. AALTO BACKHOE SERVICE 150 Walnut nut Street West Barnstable Mass. 02668 ® U I L D E R OR OWNER J / DATE PERMIT ISSUED OAT E COMPLIANCE ISSUED >/�� 4 , 4 k IVY, M�y2 f/ N6.. S�7.._.......... Fim.....Y ............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH T . .......................OF... !� 'IL,Tr G'c� .......................... ............. Apphration for Uhipaa al nxk/� Tomlrurfiun .rrmit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal I System at: ¢ .A4 ..__` ................. �il!7`� Lrl� ........ Lam_. ff fJ..-------......-----------._....------------------------------•----- cati -Address or Lot No. -----�.. d..tl/� ?__- Q. .-- 6.1�__._ lr�i ._..� Owner Address a ��tM.. : , -7D------------------------------------------ t�,v _._ T- � � rr,�a` . Installer Address PQ Q Type of Building Size Lota.t__6{©_____ -----Sq. feet 14 Dwelling—No. of Bedrooms_____..................................Expansion Attic Garbage Grinder 04 Other—Type of Building ....................__...... No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -•-•-----•--•--------- -- W Design Flow______ 3_.____gallons per person per day. Total daily flow..3:Q..............................gallons. WSeptic Tank—Liquid capacityLd—VA.gallons Length-------------_ Width................ Diameter________________ Depth................ Disposal Trench—No_ ____________________ Width....... Total Length_..____.____)...... Total leaching area....................sq. ft. Seepage Pit No------------- ------ iameter--------g...... Depth below inlet......fcz_......... Total leaching area...!�Pq_.sq. ft. Z Other Distribution box ( Do ' tank ( ) n � 1�_xit 2.f.�. ur-1 �a�c3s -3 Percolation Test Results Performed by-L2� __ __ ___. ____ _________�__._._______.____ Date__.__...___.........____._____..___..-- a Test Pit No. 1_____-Z.....minutes per inch Depth of Test Pit________ _ ____ Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ------------------------------------------------•----------•-•----•-----•---•--....-•---•---....._.......................................................... 0 Description of Soil...._,e.1!1. r1� ____..,-/Y&.,40..____ -------------------------------------------------------------------------------------------------------------- x t., W ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ UNature 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 TI'A 1Z 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the and of health. s.�-.. e-�.. Sied ................. a Application Approved By... ---- - ----------------------------------•---....---•---------•-••-•-------------------- r .... , --------------- Date Application Disapproved for the following reasons-----------------------------------------------------------------------------•--•-----------•------•-•-•--------- -----------------------------------------•--•--•-•---------------------------------._...---------------- Date PermitNo......................................................... Issued....................................................... Date 'No------------------7v FRB......f..... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF.... ! �/li,j fl �----------•---.............................. AplifirFation for Bitipm al Work,5 Tumitrnrtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..L.¢mac Ceti .?UI�G....... .L°T-�...?---------------------------------------------------•---------------- .. -. .............. .. cati Address or Lot No. `s = -¢ I ' G c .....!_. �. � �l�r -� ----------. .......... Owner Address W �O ffN %•.. �d L•�-•••.......................... ALdlr� �.� ' ir'/I!/ /�f.................. ,-� ! a � Installer Address U Type of Building Size LotAl—'/...............Sq. feet Dwelling—No. of Bedrooms......................................Expansion Attic (/ji)i t" Garbage Grinder (A,)>i P4 Other—Type of Building No. of persons............................ Showers — Cafeteria dOther fixtures ..... lG G_--___.____.___ _--___. W Design Flow....... ..!� .x 3_--_-gallons per person per day. Total daily flow..3- C1..............................gallons. WSeptic Tank—Liquid capacity!U dq.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 ----•-•--••---------------------••...••------------------•-•---•-----------•---•--•-•............--- ---.............. ---------------------------------------- DDescription of Soil.....Z?9,,gP f''!......f Am'.0.................................................................................................................... V ---•--•-----------•••-•••••----------------------------•-.......---•-•--••------••-----•-•-•---•--•---.....----•------•--------------•---•-•--•--•---•-•--------------••......_...........-•----•-•-••-- W -----------•--------------- ...............................................................................................................................................:........................... VNature 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 TITER 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the 140ard of health. Si fled. -. -------------••---. �' �=..-. i .. ApplicationApproved By.. •--•----•--•-•--------•-----••--••------•---•-•-•-•---•-•-........-•-•--•-------•- -• , .�° ° ......... Date Application Disapproved for the following reasons:................................................................................................................ --------------•-----...------------------••-•----------------•---•---•----•------•----.......-------------•-----•--•--•-••-•-----•------••-•-•-•-•-----•---...•-•••-••--•----••------•--•-----•--•------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF......................................................................... Tatif iratr of TampfiFanrr IIS'" p / FY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) � Installer .. ...... .•............... ..........................------�-....----------------------------------------------------- , has been installed ira c�rdance with the provisions of TITLE �5,�f T�e State Sanitary Cod 6e-'as r' ed in the application for D al Works Construction Permit No-kJ------- ................... da.ted__.,� "�'`, ._...... ................. THE ISSUA, E F THIS CERTIFICATE SHALL NOT BE CONST AS A GUARANTEE THAT THE SYSTEM 1!� U ION SATISFACTORY. DATE � ................................................... Inspector •. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0 F..................................................................................... PJ No.- = FEE........................ fitnn��rnr�Uan rrnti# Permissioneby granted --- - ------------••---•-•--------------•--•------------•-•---------------------------------•------.------------------.----- to Construct�("'�) or Repair .adr�al*Storage Disposal System at No. ......•••.......:..... ...... ............... Street as shown on the application for Disposal Works Construction Permit o:._______ _________/at ._.._. ��-_.. ..... ----------•-•••.•--•-- - / ...--------- $oard o DATE................ ��---° �.....---....----•----------..... / FORM 1255 HOSES & WARREN, INC.. PUBLISHERS // LOCATION fly � SEWAG U PERMIT NO. VILLAGE 17; e.i.-iq L�-- INSTALLER'S NAIVE i ADDRESS JOHN A. AALTO BACIKHOE SERVICE 15TValnut Street West Barnstable, Mass. 02668 B U I L D E R OR OWNER DATE PERMIT ISSUED DATE C0IAPLIANCE ISSUEQ �j� 27 , kk 4 ' yy' 6 s 1 N Gus= F AIA k of - � B a=D RQ oM 6'6. L,g n� E WO GA%Z5AGE 66uwDs2 - p�►►��( FI-OW : 110 x 3 = 330G.P.0 i 5EPT1G TAWK =' a30x150'/• U5E- %000 GAL. Pr 1 _ AaA 015Po5At_ P1T usC- t000 GAL. \ I N T�w►� 5►DG.WALI. ARF,1► r 1�0 5,F \ io 150 5.F 50TTOM AREAS .. Y0 aF. TH 5o 5.F x 1•o A �j•O G•P o" z 3't -roTAt- D6.516.N * .42-5 G.Po _ 'OOAJZ' .JT/D/v 0 -TOTA1•- pA I t-Y 1:%-01K = 33o G.Po �,�� P,to{� i I PE2GOL.ATIo►J RA?E r I''IN ?-MIN OP LS55 \ QD of ~, � OF M sq Zo 4*s-- S� FT O`' ALAN Py \ I RICHARO ' SAXTCR JONEfi No.2-:04Ci0 o '5100 I �`C/ST.£a4 e 4c 4 ja� 4roo suev�s� � � �' k` � `Z o,s z HOLE I133 `Y . . ,�5e - l o o v ""j .� Lc¢ - 016T. INS. GAS. Zj -- - S�BSoi�. (00O ljvX ZZ•G TANK � PIT INV. INY. `� ZZ�2 ZZ•�- � I� `I Mm wlTu !: 1•/3/4•I�i VIASUGD ' 6ToN6 ' "III' C t=RT 1 t=t G D P I.-oT PI-A." I PROFILE LoGA-TIOW COnJ77 rzVt L L E No SCALE ScAt_E r": 40 VP_ l21281>?' 1 CERTt1+Y THAT ?Nt^ t-o�IJ�AT►oN 5l1ovYN --- 1'16.Qr=oW G0MPL45 LOT 8 A► 0, SC---r5ACX R.6Qv112.EMENT> OF 'C1�E- 'T0WN OF ?,A"STWGUC AND 11, +JOT- L/AQD Ccxj2..T 4-c) I CPEMD)ub� t_OGp.TED MIITNIW N6 F OOD PL-v.IN DAIT L- TA BAXTGV-i Wvs INC.. ' REG I SZ ti✓Q6•V'tA►J D 5 u i�.V�Yoes I I �� Tu15 Pt_�•1�1 !�i N�1' gA5W:1 od Ary o3TEiZ.Vit_t.Fr MASS. Iu5- uMEN"C 5u2VGY4-rNE 0r-V.5f-r-5 SQOUL2> I wo-r [3C_ U jC.(,)Td DCTC�S',J�IN[ l.e.,T' APPLle P,.W r f�iLV/A S-(._vi/A FINISH GRADE OVER D-BOX= 26.9'f FINISH GRADE OVER CHAMBERS= 27.0' - 26,5' G C N F R A NOTES fT.O.F. EL.= 27.8'f SLOPE @ 2% MIN. OVER SYSTEM 3/4 TO 1-1/2 DOUBLE WASHED PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE 4" SCHEDULE 40 PVC MIN SLOPE 1% INSPECTION PORT w/ACCESS BOX WITH METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE OUTLET TO WITHIN 6"OF F.G. COVER TO GRADE (SEE NOTE#20) 2"OF 1/8"TO 1/2" DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES. @ END. EL. 27•3'f F.G. OVER TANK EL. = 27.0't - �5" DIA. OUTLET(S) STONE OR GEOTEXTILE FILTER FABRIC _ 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE TOP OF SAS= 24,03' PLACE RISERS ON DESIGN ENGINEER. _ PROPOSED 4" 9"MIN. , 9" MIN- CHAMBERS w/PIPED 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL /- - EXISTING 4' SCH. 40 PVC 36" MAX. , 23.20 36" MAX. BREAKOUT EL=23.70' INLETS TO 6"OF SYSTEM UNLESS OTHERWISE NOTED. SEWER PIPi.. SEWER PIPE FINISHED GRADE 00 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN = 6" 3" 2" DROP MIN 3„ 9„ L=5Tt o o ELEVATION =23.70' FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE SAS. UNLESS A 2 DROP MIN.SLOPE @ 1% PROVIDE WATERTIGHT a o 0 0 0 0 4" PVC IN FROM JOINTS (TYP.) o 0 0 �`b o 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF SEPTIC TANK 4"PVC OUT TO O o O j THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. � 113 �--*24.1'-, � � CONTRACTOR TO PROVIDE 14 ��_-- j 1.00' o0 0 0 • LEACHING FACILITY o 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN o 12" " o 0 o THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL r , o 0 0 00 0 0 6. SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 23.50 MIN. 23.33 01. 0' 000� o c C3 o 0 0 00 00 0 (D0 0 C) 0 00 �o� o 0 00 00� o 0 000 00 00 00 ' 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE + o0 00 00 00 00 0 0 - oo co 0o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY I COMPACTED BASE 2.0 6.0' 2.0' 3.0' 3 0' 3.0' I 5 (NP ) �0' ` AND DESIGN ENGINEER. I OUTLET DISTRIBUTION BOX �P ) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 28.80 TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 15.50' 9.0' ESTABLISHED ON TOP OF CONCRETE BOUND w/ DRILL HOLE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OFOUTLET21 .20 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. 5' MIN. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK LC-6 CHAMBERS CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES CROSS SECTION VIEW_ TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. *CONTRACTORTRTOANYWORK & SEPTIC' T I ' PROFIL DIS r�113b t i"L. ~ ' ), .jA LjEZTAIL CHAMP" "T `IL`-' ELEVATION PRIOR TO ANY WORK & NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONE. STRUCTURES SHALL BE MADE WATERTIGHT. NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE I NOT TO SCALE i - --- - -- -- --- 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM ` ` ' 1 • APPROPRIATE AUTHORITY. PERC NO. SWING-TIES , ,fit, r 1 ;i:- , L,L. e • .'' •;, `3 TPT-21-27 j U.P. #U% ' • •-• ' 12, ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED i DESCRIPTION HC-1 HC-2 i _ ` i .` , . ' I J . , ' .+'• U INSPECTOR: David W. Stanton(BOH) UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR JE(� • j /' ,� * EVALUATOR: Michael Pimentel, EIT, CSE TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. CORNER OF STONE (1) 10.2' 37.7' �y �, �, J : ; C.S.E. APPROVAL DATE: Oct. 27, 1999 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. CORNER OF STONE (2) 19.2' 41.5' DATE: February 16, 2021 EXISTING LEACHING �j ; ��/ f ,� w � = I 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE CORNER OF STONE (3) 39.9' 21.2' �4/ PIT TO BE PUMPED, r'�.� *�' `" ' \ a TEST PIT#: O \ 1 r?3 _f / '`\ ~. © MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. y �, i FILLED w/CLEAN III .- - `- ,- • • ' CORNER OF STONE (4) 36.5' 12.3' C� p tJ t o ,� -`� -`" '"f"'�' V = 00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, �p SAND &ABANDONED_ • ;.�`+ ELEV TOP 27. FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). may ' i ELECT. METER ELEV WATER = < 16.00' r C7 , -•% ',,SC!����(�. ,. � � i� 1 �.- �7�,-r ,, J �._:•_ r• ' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN D (,�.)�``{ : ( PERC RATE = SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. p,• h p EXISTING 1.000 Bad/ / ��\- -_� •,• ,.� "1• GALLON SEPTIC v �,_ DEPTH OF PERC= TANK TO BE USED 4t�- ��:�. ,_ ,, \ • �� E 116. PROPOSED PROJECT IS LOCATED WITHIN: IN THIS DESIGN • s - TEXTURAL CLASS: I ASSESSOR'S MAP 187 L07 66 5s � • OWNER OF RECORD: CLEMENT A. ZIELINKSKI, TRUSTEE OF THE o 40' � CLEMENT A. ZIELINKSKI REVOCABLE TRUST 01127.00' ADDRESS: 456 BAY LANE LOC Fill 26.6TCENTERVILLE, MA 02632 MAP 187 . ' r' `• 11�° .. . FEMA FLOOD ZONE X �' / / �' �\ LOT 65 )) aM -.� ��, _. . B Loamy Sand 10Yr 5/6 COMMUNITY PANEL# 25001 C0563J • Land .<� • p1' t , ti �•. .� ;• ' 18" 25.50' 17. DEED REFERENCE: L.C.C. #209280 / ,.-/ • '•' • �'r�� ,• �,a��' 18. PLAN REFERENCE: L.C. PLAN#41594-A / - ` ♦ 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. /\ / sr'j ply 7t' 1 • •• •��, V. Public 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY I �� J. i! / - 4 • FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY Benchmark / / / � * #: Landing i n g / <' y ° ' Coarse Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. Top of CB/DH / / P ` o �� Elev. =28.80' L.P / / Q�' ` 1 `" C 2.5Y 6/6 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A Approx. MSL J ! J t,� �L9 a� // Q4,P 1,ram" f DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A OQ- REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. - 27 _ / �� \� - 22. OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL TOF-27.$± LOCUS PLAN REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. f / ! .4 \\ c1S / �Ai / SCALE: 1"- 1000' i 23. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE APPROVAL IS REQUESTED FROM 310 CMR 15.211: op A�` 1 / I (1.) A 9.8'WAIVER (20.0'- 10.2) FOR THE SETBACK FROM THE SAS TO HOUSE FOUNDATION. cis l��y ry O0 #456 No Mottling, Standing or Weeping Observed EXISTING 2-BEDROOM DESIGN DATA S I ! - A P .I' r DWELLING PERC NO. TPT-21-27 NUMBER OF BEDROOMS(EXISTING) 3 INSPECTOR: David W. Stanton (BOH) 50xO' EXISTING SPOT GRADE NUMBER OF BEDROOMS (DESIGN) 3 PER ORIGINAL PERMIT NO. 83-40 EVALUATOR: Michael Pimentel, EIT, CSE - - - 50 - - - EXISTING CONTOUR (2 I ,moo � DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E. APPROVAL DATE: Oct. 27, 1999 50 PROPOSED CONTOUR / .06 _ 1) �- SLEEVE SEPTIC �" PIPE 10 FEET TOTAL DESIGN FLOW 330 GAUDAY DATE: February 16, 2021 �t, I 50 PROPOSED SPOT GRADE (MIN.)OF WATER _ TEST PIT#: 2 a�G� O 2 LINE CROSSING DESIGN FLOW x 200 % - 660 GAUDAY ��i Q MAP 687 USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 26.50' GAS EXISTING GAS LINE / ry PROPOSED w ' ELEV WATER= < 15.50' / DISTRIBUTION 21,403± S.F. a/H/W EXISTING OVERHEAD UTILITIES / BOX ' _ w / PERC RATE _ < 2 min./inch* Q + W W EXISTING WATER LINE �' INSTALL (5) LC-6 LEACHING CHAMBERS DEPTH OF PERC = "C"Soil ! / ( i N w/ AGGREGATE TEST PIT LOCATION PROPOSED (5) LC-6 2\ / / / Q TEXTURAL CLASS: I ! \ CHAMBERS WITH ^ ^ i \ / L j S \ AGGREGATE ` �` TP 1 SIDEWALL CAPACITY EXISTING 1,000 GALLON SEPTIC TANK ' Quo 27x0 l v (LENGTH +WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY \� . F (34.0' + 9.0') (2) (2' ) ( 0.74 GPD/S.F.) = 127.3 GAUDAY 0" 26.50' PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE Fill 4" 26.17' MAP 186 y�, V O � BOTTOM CAPACITY 0 PROPOSED DISTRIBUTION BOX (3 1 �- Loam Sand LOT 84 � _ 27_ Q�' \ (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY B y TP 2 = 226.4 GAUDAY 10Yr 5/6 Q PROPOSED LC-6 LEACHING CHAMBER 26x5' \/ (34.0' x 9.0') (0.74 GPD/S.F.) 18" 25.00' \ .^ N 7? / N �`� STEPS, (4 3 / GARAGE TOTALS: REV. DATE BY APP'D. _ DESCRIPTION 'QF�Iy j f-HC-2 TOTAL NUMBER OF CHAMBERS 5 PROPOSED SEPTIC SYSTEM UPGRADE <� NOTES: TOTAL LEACHING AREA 478.0 SQ.FT. \ ` SLAB TOTAL LEACHING CAPACITY 353.7 GAL./DAY PREPARED FOR: \ EL.=27.6'± 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. Coarse Sand ROBERT B. OUR CO., INC. C 2.5Y 6/6 .,o 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST LOCATED AT PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL 456 BAY LANE \ LF� BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. CENTERVILLE, MA 02632 \2s 3.) PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS ONLY. - - - „ SCALE: 1 INCH = 10 FT. DATE: MARCH 3, 2021 15.50' \ _ 4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A 132 I 1 0 10 20 4o so FEET COURTESY FOR THE INSTALLER. INSTALLER SHALL VERIFY SWING TIE No Mottling, Standing or Weeping Observed atH °F " sqc -� mow MEASUREMENTS IN THE FIELD PRIOR TO INSTALLING THE SYSTEM. a� JOHN L. yG�t., PREPARED BY: CONTRACTOR SHALL NOTIFY ENGINEER IF MEASUREMENTS APPEAR TO BE RESERVED FOR BOARD OF HEALTH USE o CHURCHILL JR. JC ENGINEERING INC. INCORRECT. i * Perc rate taken from Application for " CIVIL H ' '- - - Disposal Works Construction Permit No. No. 4�807 2854 CRANBERRY HIGHWAY 5.) CONTRACTOR TO CONFIRM BENCHMARK ELEVATION RELATIVE TO THE 83-40 on file with the Barnstable Board of EAST WAREHAM, MA 02538 SITE PLAN GARAGE SLAB ELEVATION SHOWN ON PLAN AND NOTIFY ENGINEER IF ! Health. 508.273.0377 DISCREPANCY EXISTS. SCALE: 1"= 10' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.5573