HomeMy WebLinkAbout0105 BEECHWOOD ROAD - Health -105 Beechwood Road
Centerville P
A = 252 035
I
....
We
ti
UPC 10259No.H1630R
MAsTIMQ8, MN
' ' '
0
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftpliLAtion for disposal *pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Log-40. 0 ��j((]®Q(, Owner's Name,Address,and Tel.No.LE
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. De si ner's Name,Addre s,and Tel.No.
t�3 ��(Cc v� con �� �z-b6 chezTL, env o anl7-?e,L�
Type of Building:
Dwelling No.of Bedrooms V Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.requ' ed) gpd Design flow provided gpd
Plan Date 15 5 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) each t n 5 11l
_+('� n cn le S z'-A
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issue this Bo Health.
i Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
No. � Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: `
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zipprlcation for Disposal 6pstem (Construction Permit ,I
Application for a Permit to Construct( ) Repair( ) Upgrade,( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot o. !Q 5 e�(,OQQ p Q� Owner's Name,Address,and Tel.No. tt''
Assessor's Map/Parcel �
Installer's Name,Address,and Tel. o. Designer's Name,Address,and Tel.No.
-8-1 3 e,� cC(VoLho o 509-1477-06 a_hCZT`l nvrvonme� f�/
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(min.required) 330 O gpd Design flow provided gpd y
Plan Date ( (/�5 (� Number of sheets Revision Date
Title
K
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 6) f)z o(i b U Len Gh i n c; o 5 t it (Z
4Ccni_hfS
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 this Board of Health.
igned. _ Date hit t
Application Approved by 1 / 4 Date 7 4V
Application Disapproved by v ` // ✓ y Date
for the following reasons
Permit No. i. L[ Date Issued fflI101
/ v
------------------------------------- ------------------------------------- ----------- --------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by TN t ( +f n
at I(�5 -Re Pr ykJn() 0-?/o� has been constructed in ac
with the g�o)visions O of Title 5 and the for Disposal System Construction Permit N .
Installer �t' `dated >
PD 1 l 1 �J i/ Designer (- \ J i V f
#bedrooms Approved design flow, / gpd
The issuance of this p. \lIermit shall not be construed as a guarantee that the system will nct on as desigA
Date I, X 1 ( � Inspector �,i I,1,., ✓<
i0
-----------------------�----_------------------------------------------------------------1------------------------ -----------
' No. '�J � Feet/
y THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
Disposal *pstem Construction Permit
Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( )
System located at D P{'l � )O/)O1E / , J 4 n
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:Constructor st be co leted within three years of the date of this permit. /
Date mu Approved by
Town of Barnstable
�F`"E'O o Regulatory Services
Richard V. Scali,Interim Director
* BARNSTABLE,
9�A MASS. ��� Public Health Division
1639n
TF . Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer&Designer Certification Form
Date: /1- )9 -IS Sewage Permit# 20)5- y p$ Assessor's Map\Parcel
Designer: Env;r-onrncn-la.) Installer: _ B i,(3 ExCmya4;oA
Address: QO S3 pX g 1 Address: ,y Tc.0.5c r r&4 LN
�c�cr�oy�l. .00ri �oCcS'�o�a�c.
On 1 J -16 J S R�i S3 C KCAVa4;0A was issued a permit to install a
(date) (installer)
septic system at 105 GCGC*kt,)OoA QCA based on a design drawn by
(address)
-Do.uc Flo l\crau dated )I-IS- IS
(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. 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 in compliance with the terms
of the I\A approval letters(if applicable)
5XXY jkk of 4O
DAVID y�N
(Installers Sig r ) FLAHERTY, JR. N
No. 1211
9�QlST�a�o
s
(Designer' ignature) (Affix Des' p 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.
QASeptic\Designer Certification Form Rev 8-14-13.doc
TOWN OF BARNSTABLE
LOCATION f 0$�C3ccc�c,JOOr� RoL SEWAGE# 2015" yO$
VILLAGE Cc n4cr U) ) 1 C ASSESSOR'S MAP&PARCEL ' j a-0 3_S—
INSTALLER'S NAME&PHONE NO. S 46 Q CX(3aV0.A i 01\ q-n -0 G53
SEPTIC TANK CAPACITY `: 1000 !Jo. )
LEACHING FACILITY: (type)`�Z'Trcncl.c S (size) Z X 3 x 33
NO.OF BEDROOMS 3
OWNER r i c_ Rroc&S
PERMIT DATE: COMPLIANCE DATE: I ( l
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
Al " '-lo'10"
3 -
Iq2' 4y�y,� a •
s • a A
A3' SZ" REAR .
33-
134 - 35'
c ZS
•
f) 4
Town of Barnstable P#
Department of Regulatory Services
Public Health Division Date
200 Main Street,Hyannis MA 02601
l /�
Date Scheduled �//t/tl` /3 Time/ Fee Pd.
Soil Suitability Assessment for Sew ge Dip sal
Performed By: y V l / lf'��`
Witnessed B ;
LOCATION&GENERAL INFORMATION
cation Address / S Owner's Name
CC��l t e 1 f� Q 7-0 3 Z Address 4 MA�VN,,vCr- 57-
Assessor's Map/Parcel: �527/3 S Engineer's Name
NEW CONSTRUCTIONREPAIR Telephone# 1166
Land Use �G S Slopes(%) Surface Stones Distances from: Open Water Body >/Ovft Possible Wet Area /0U ft Drinking Water Well�( - ft
Drainage Way�ft Property Line (.j 0 ft Other ®®®®�
ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
E . 9
OTH-1
Parent material.(geologic) Depth to Bedrock /`r A
Depth to Groundwater: Standing Water in Hole: / Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL-HIGH WATER TABLE ``
.—. _
Method Used:-
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: IndexWell level Adj.factor Adj.Groundwater Level
' PERCOLATIONaTEST 13�ime
Observation /1
Hole# Time at 9" �
n 1�Depth of Perc _ Time at 6"
/j
Start Pre-soak Time rci LI Time(9"-6")- 3-e Z
End Pre-soak �`2
Rate Min./Inch LZ
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) ' ,
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100'of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
s ,h
DEEP OBSERVATION_HOLE LO_G„_w_ Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel
0 2 4 , QV
T
Y
DEEP OBSERVATION HOLE LOG Hole#
_ie .—. ------_—_-_- __�__-�._
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel
D- G0 -3
3 --3 S
3 7 20 ,-
DEEP OBSERVATION HOLE LOG Hole#
_____._.,_. -_�. . _ ______
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
DEEP OBSERVATION HOLE LOG .,.. Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Graven
Flood Insurance Rate Map:
Above 500 year Flood boundary No)f Yes
Within 500 year boundary No— Yes
Within 100 year Flood boundary No_X Yes
Depth of Naturally Occurrine Pervious Material
Does at least four feet of naturally occurring pervous aterial exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring p ious material?
Certification
I certify that on It 1�ta&
(date)I have passed the soil evaluator examination approved by the
Department of En511f
otection and that the above analysis was performed by me consistent with
the required trainiand p ce scrib m310CMR 15J1611
SignatureDate 5
Q:)SEPTICPERCFORM.DOC
i
Town of Barnstable Barnstable
krftlld
.� Regulatory Services Department``-," j
RMMSPABM I
N"
�03 # Public Health Division
9.
Fp" 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Richard V.Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 7014 1200 0001 0358 5920
October 21, 2015
Eric J. Brooks ET AL
4 Manning Street
Reading, MA 01867
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 105 Beechwood Road, Centerville,MA was last inspected
on 9/11/2015,by Brett Hickey, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system"Failed" under the guidelines
of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Static liquid level in the distribution box above outlet invert due to an
overloaded or clogged SAS or cesspool
You are ordered to repair or replace the septic system within one (1)year from the date
you receive this notification.
i
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH �a
CA R.S., CHO
Agent of the Board of Health �,7.0.1
QASEPTICU.etters Septic Inspection Failures or Future EAU 05 Beechwood Rd Cent Oct 2015.doc
Parcel Detail Page 1 of 3
x
Logged In As: _ Parcel Detail Tuesday,October 20 2015
Parcel Lookup
Parcel Info
Parcel ID�252-035 Developeer Lo LOT 153 �
Location;105 BEECHWOOD ROAD r � Pri Frontage r,10
Sec Road I Sec
��-_ Frontage
Village ICENTERVILLE Fire District C O—-MM
Town sewer exists at this address N�- Road Index;Oa 111
Asbullt Septic Scan: Interactive5 ,
252035_1 Map =
Owner Info
Owner 4BR O, ERIC J ET AL Co owner y
Streets '4 MANNING ST Street2
City READING ( State FM—Al zip 01867 Country
Land Info
Acres;0.26 use Single Fam MDL-01 � Zoning RD-1 f Nghbd 10107
Topography";Level �~ �� Road PaveW
Utilities Public Water,Gas,Septic I Location
-w Construction Info
Building 1 of 1
Year-
Built 11960 Strucruct t Gable/Hip Wall all Wood Shingle
"
Living 11192 Cover Roof,; sp Ah/F GIs/Cmp ( Type pe None AC 74
Area „
r- - _ In Bed .�...a., �:`6AH SAS "t
t w-
�� $MT
Style Ranch Wall iDrywall Rooms 3 Bedrooms 1 o's1; 4 e
Model Residential ( Int Hardwood -� Bath 2 Full-0 Half ) k� .
Floor Rooms
Heat Total Grade Average Plus Type Hot Air I Rooms Rooms
Stories 1 Story Fuel 'Oil Found-
ation Epical rvf
Gross Area fi$"2'696
� �
Permit History
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=18638 10/20/2015
Town of Barnstable
s r
+ lARN3fAHL6,
p �9 ,�� Regulatory Services Department
rED MA't�
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Richard Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 7/6/15
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
ONE (1) YEAR DEADLINE CRITERIA
)(Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑Any portion of the cesspool within a Zone 1 to a public well
❑Any.portion of a cesspool 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 a driveway due to H-10 components, etc)
❑Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code
§360-9.1)
OTHER
Repair deadline:
Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
I -
Commonwealth of Massachusetts #00 �
w . Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
105 Beechwood Road
Property Address
Eric Brooks& Christopher Luongo
Owner Owner's Name
information is xr
required for every Centerville Ma 02632 941-15
page. City/Town State Zip Code Date of Inspection �..-
`,F I
IA
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information
filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Brett Hickey
use the return Name of Inspector
key.
B&B Excavation
,Q Company Name
14 Teaberry Lane
Company Address
Sandwich Ma. 02644
Citylrown State Zip Code
(508)477-0653 S113747
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
❑ Passes ❑ Conditionally Passes ® Fails
❑ Needs Further Evaluation by the Local Approving Authority
9-1V15
Inspe or's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
***This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
1pwa VS
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 105 Beechwood Road
Property Address
Eric Brooks &Christopher Luongo
Owner Owner's Name
information is required for every Centerville Ma 02632 941-15
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins°3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
105 Beechwood Road
Property Address
Eric Brooks& Christopher Luongo
Owner Owner's Name
information is required for every Centerville Ma 02632 941-15
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 105 Beechwood Road
Property Address
Eric Brooks& Christopher Luongo
Owner Owner's Name
information is required for every Centerville Ma 02632 941-15
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
® ❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 105 Beechwood Road
Property Address
Eric Brooks & Christopher Luongo
Owner Owner's Name
information is required for every Centerville Ma 02632 91l-15
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
® ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
105 Beechwood Road
Property Address
Eric Brooks &Christopher Luongo
Owner Owner's Name
information is
required for every Centerville Ma 02632 941-15
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
N - Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
105 Beechwood Road
Property Address
Eric Brooks & Christopher Luongo
Owner Owner's Name
information is required for every Centerville Ma 02632 941-15
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 4
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d see below
9 ( Y 9 (gP ))�
Detail:
2013- 126,000gallons 2014- 113,000gallons
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
105 Beechwood Road
Property Address
Eric Brooks&Christopher Luongo
Owner Owner's Name
information is Centerville Ma 02632 9 1-15
required for every i
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: owner- last pump 5 years ago
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
I
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M , 105 Beechwood Road
Property Address
Eric Brooks &Christopher Luongo
Owner Owner's Name
information is required for every Centerville Ma 02632 911-15
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
1986
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
2'3"
Depth below grade: feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
At time of inspection building sewer appeared to be in good working order with no sign of leakage.
Septic Tank (locate on site plan):
1'3"
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 gallon
Sludge depth: unable to measure due to backup
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
t
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
105 Beechwood Road
Property Address
Eric Brooks &Christopher Luongo
Owner Owner's Name
information is required for every Centerville Ma 02632 941-15
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top 9 of sludge to bottom of outlet tee or baffle NA
Scum thickness NA
Distance from top of scum to top of outlet tee or baffle NA
Distance from bottom of scum to bottom of outlet tee or baffle NA
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.):
At time of inspection septic tank appeared to be in working order but tank was backed up. Tank is in
need of pumping at this time.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
Date
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
105 Beechwood Road
Property Address
Eric Brooks&Christopher Luongo
Owner Owner's Name
information is required for every Centerville Ma 02632 9{1-15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
105 Beechwood Road
Property Address
Eric Brooks& Christopher Luongo
Owner Owner's Name
information is required for every Centerville Ma 02632 941-15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert Over
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.):
At time of inspection d-box was in poor condition and in need of replacement. D-box was backed up.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
105 Beechwood Road
Property Address
Eric Brooks& Christopher Luongo
Owner Owner's Name.
information is required for every Centerville Ma 02632 911-15
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1 6'x6'
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
At time of inspection leaching was in hydraulic failure. Leaching will need to be replaced.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
105 Beechwood Road
Property Address
Eric Brooks& Christopher Luongo
Owner Owner's Name
information is Centerville Ma 02632 9 1 15
required for every � -
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
.N W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 105 Beechwood Road
Property Address
Eric Brooks& Christopher Luongo
Owner Owner's Name
information is
required for every Centerville Ma 02632 941-15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
O 3
Q
C D A P3
R 4 G fl
2. 29 ys
3 32 'i 8
4 32 3s
(��Ci,wcfoc� CCd-
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 105 Beechwood Road
Property Address
Eric Brooks&Christopher Luongo
Owner Owner's Name
information is
required for every Centerville Ma 02632 941-15
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 28.5
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: 12-11-86
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 9
you established the high round water elevation:
Y 9
Plan on file at BOH.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
(Sins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 105 Beechwood Road
Property Address
Eric Brooks &Christopher Luongo
Owner Owner's Name
information is required for every Centerville Ma 02632 941-15
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
(Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
COMMONWEALTH OF MASSACHUSEftS
f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
d DEPARTMENT OF ENVIRONMENTAL PROTECTION
M R C gg®
ED
q,4 See
MAR 2 9 2005
TOWN OF BARNSTABLE
TITLE 5 HEALTH DEPT.
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION .Ap 5
Property Address: #105 Beechwood Road ARCr-[ 5
Centerville,MA F C-r
Owner's Name: James Christian
Owner's Address: P.O.Box 461
Hanover,NJ 07936
Date of Inspection: 3/15/05
Name of Inspector: (please print) Mr.Carmen E.Shay
Company Name: CAPEWIDE ENTERPRISES,LLC
Mailing Address: P.O.Box 763
Centerville,MA 0632
Telephone Number: (508)-428-4028
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:
XX Passes PO, kOF�jgs
Conditionally Passes
Needs Further Evaluation by the Local Approving Authori Z CARMEN yN
Fails o E.
0 SHAY
Inspector's Signature: Date: 3/15/05 RT11F\`�oP
FSINSPE�
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of He
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
Excavated cover of SAS. No evidence of hydraulic failure noted. No liquid noted in SAS.
Stain Line noted g30"
****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 INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: #105 Beechwood Road
Centervill,MA
Owner: James Christian
Date of Inspection: 3115105
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
XX 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:
B. System Conditional) Passes:
Y Y
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.
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.
ND explain:
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:
.., ,. — 1,,�,..,.,.,, 2
'Page 3 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: #105 Beechwood Road
Centervill,MA
Owner: James Christian
Date of Inspection: 3/15/05
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria 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:
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: #105 Beechwood Road
Centervill,MA
Owner: James Christian
Date of Inspection: 3/15/05
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
XX Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
XX Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
XX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
XX Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow
XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
XX Any portion of the SAS,cesspool or privy is below high ground water elevation.
XX Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
XX Any portion of a cesspool or privy is within a Zone 1 of a public well.
XX Any portion of a cesspool or privy is within 50 feet of a private water supply well.
XX 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 form.]
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 should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
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
_ 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 11 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.
- .„11,,,.,.,, 4
i
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: #105 Beechwood Road
Centervill,MA
Owner: James Christian
Date of Inspection: 3/15/05
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
XX Pumping information was provided by the owner,occupant,or Board of Health
XX Were any of the system components pumped out in the previous two weeks?
XX Has the system received normal flows in the previous two week period?
XX Have large volumes of water been introduced to the system recently or as part of this inspection?
XX Were as built plans of the system obtained and examined?(If they were not available note as N/A)
XX _ Was the facility or dwelling inspected for signs of sewage back up?
XX _ Was the site inspected for signs of break out
XX _ Were all system components,excluding the SAS, located on site?
XX _ 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?
XX _ 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
XX _ Existing information.For example,a plan at the Board of Health.
XX _ 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)]
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: #105 Beechwood Road
Centervill,MA
Owner: James Christian
Date of Inspection: 3/15/05
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: Unknown
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no):_
Seasonal use: (yes or no): No
Water meter readings,if available(last 2 years usage(gpd)): 2002— 100,000 gallons
Sump pump(yes or no): No 2001 —93,000 gallons
Last date of occupancy: Currently Unoccupied
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(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: Unknown
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
XX 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)
_Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
August- 1986-per Board of Health&Owner Records
Were sewage odors detected when arriving at the site(yes or no): No
6
'Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #105 Beechwood Road
Centervill,MA
Owner: James Christian
Date of Inspection: 3/15/05
BUILDING SEWER(locate on site plan)
Depth below grade: 16"
Materials of construction:__cast iron XX 40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints, venting,evidence of leakage,etc.): No evidence of leaks or damaged
Piping. Venting noted on roof. No odors noted.
SEPTIC TANK: XX (locate on site plan)
Depth below grade: 16"
Material of construction: XX 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: 5' deep x 5'wide by 8' long (1000 gallon)
Sludge depth: 4.75'
Distance from top of sludge to bottom of outlet tee or baffle: 3.00'
Scum thickness: 2"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 14"
How were dimensions determined: Measured
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Structural integrity of tank was ok. No evidence of cracks, leaks,or water infiltration/exfiltration. Inlet Tee present and in
good condition. Outlet Baffle also in good condition. Liquid level equal with outlet invert.
GREASE TRAP:_(locate on site plan)
Depth below grade:_
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:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
r r 7
Page 8 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #105 Beechwood Road
Centervill,MA
Owner: James Christian
Date of Inspection: 3/15/05
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/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: Present (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: equal
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.): One outlets to leach pit. D-Box in good condition. No evidence of solids carry
over.
PUMP CHAMBER: (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,etch_
r
'Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #105 Beechwood Road
Centervill,MA
Owner: James Christian
Date of Inspection: 3/15/05
SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required)
If SAS not located explain why:
Type
XX leaching pits,number:_I—6 x 6 pit with 1 feet of stone around_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.): No evidence of hydraulic failure, ponding damp soil or stressed vegetation. Probed stone with no
evidence of hydraulic failure. Excavated cover of leach pit and noted no liquid. 30"stain line noted
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 or no):
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction:
_ Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
i
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #105 Beechwood Road
Centervill,-MA
Owner: James.Christan . .
Date of Inspection:
SKETCH-OF SEWAGEDISPOSAL SYSTEM k
Provide a skeic f the sewage disposal system includib hes to at leastjvw permanent reference landmarks or
benchmarks Locate all weds wi�100 feet Locate wliere� bl ,waters " 7 enters the buildin
Pu uPP y g
x i
�' e� ''� �}'fi�"-'., ,,�fr n ,} + ' N� ' ,:�? van:, y %�1�`��a} ���.f^M1d�•� "ew,{�^�e�" �,a�,�a.��.�' �
/
C � V\-13`'s
�a•'�E2 U a G-
La.. - am.. _ «*•.�..sa�'- �• «.as�'°Y``"'_�" '-w t��`,'�+- �"s .'>�.`�..+�. `w:' ,w' -:r+: -:s.a ��:..,.".^k�,a:..s•c'�.. '^-_.._,-.
i
` Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: #105 Beechwood Road
Centervill,MA
Owner: James Christian
Date of Inspection: 3/15/05
SITE EXAM
Slope
Surface water -None
Check cellar -Yes
Shallow wells—None
Estimated depth to ground water 40' feet below grade.
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
XX 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)
XX Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
checked with Ouadran2le of USGS May. Estimated Elevation above Lake Weauaauet at 25 to 30 feet above
lake level.
Elev.of Ground=74
Elev.Of Groundwater=33(Elevation of Lake Wequaquet)
Elev.Of Bottom of Leach Pit=8' or elevation 66
Therefore: 66—33 =33+
33 feet separation between Bottom of Leach Trench and Groundwater(assumed).
Groundwater Adjustment using Index Well AIW 27 : 4.5 feet
Adjusted Groundwater Separation=33' +4.5 =37.5 feet
(Refer to attached work sheet)
Grade=Elev.=74 feet
Leach Pit
D-Box
Septic Tank
Bottom of Leach Pit=Elev=66 feet
Adj.Groundwater=Elev. 37.5
I
Permit Number: Date:
Completed by:
HIGH GROUNDWATER LEVEL COMPUTATION
Site Location: Lot No. p`Z Q ajS
Owner: "A Address: .Q'), 1 yAcn :ie.r-
Contractor: i:�,.Pf✓i3mc- g115T. 1 A Address:
Notes: ����-e V ��S(�-Qw✓"t 1,.
STEP 1 Measure depth to water table
to nearest 1/10 ft. ....................... ...... . Date 15 05 33
mont /day year
STEP 2 Using Water-Level Range Zone
and Index Well Map locate
site and determine:
OAppropriate index well.................................................... tW
OWater-level range zone .....................................................
STEP 3 Using monthly report "Current
Water Resources Conditions"
determine current depth to
water level for index well ........................... Q4.1
mo h/year
STEP 4 Using Table of Water-level Adjustments
for index well (STEP 2A), current depth
to water level for index well (STEP 3),
and water•level zone (STEP 2B)
determine water-level adjustment ..............................................:........................................... �1
"t r
STEP 5 Estimate depth to high water
by subtracting the water•
level adjustment (STEP 4)
from measured depth to water
levelat site (STEP 1) ..................................................:.......................................................
... 3 ��
f;
Figure 13.--Reproducible computation form,
15
•' .
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® ZF HSALTIJ
...._.....OF...... .
Appliration for Uiinasa1 Works Tonstrurtiun Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair"( P)"an Individual Sewage Disposal
System at
dae.44...._..... -------------------------------
c ion-Addr s ------------..................................
or Lot No.
W '� � �/ .................•-----.Address
Installer Address
d Type of Buildi Size Lot............................Sq. feet
Dwelling No. of Bedrooms._.................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons-._..__._-__-_..-___-_______ Showers ( ) = Cafeteria ( )
Q' Other fixtures ................................. .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth___-___-__-.._._
Disposal Trench—'.\To. .................... 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---__--______-______---.
rZ4 Test Pit No. 2................minutes per inch Depth of Test t.......... Depth to round water........ . ...........
P ---------- - ---••......... ........ ._.....•.
ODescription of Soil_- .............••--......--•--.:. .......... -6- � ..............
x
---------------------------------------------------------------------------------------------------------------------- -----------------------------------------•...
U Nature of Repairs or Alterations—Answer when applicable.__ _,j� `...! .................................................
----------------------------------------------............................................................ -/ ............................. ................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i T T L ;of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compli4has issued the and of ealth.f --. --••-• ------ DatieApplication Approved BY ••-•--• .�Q --------•------•.............. --•-------��- ------� -----
Date
Application Disapproved for the follo --•-•-•--•-•••••-•••••••••--•-•------•--••........................•--•-.......................................
•---------•----------------•----------------•-•---•-•---•---•--......._..••---•------•••-•-•••-•--•-••••-•----••---•-••--•-••••••-•••-••-•••••••-----•-•-•--•--•--•-•-••---•-•-----••-•...............
Date
PermitNo......................................................-- Issued.......................................................
Date
NJ F.RB_422p..1.22_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F H EALTf
A!?jWZV............OF...... -- Ss!.al`e -11 ......................
ApplirFatiun for Disposal Works Tonstrnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( �an Individual Sewage Disposal
System at
• ... ..............
. .
' cation-Addr s .----.--•••-••-•-•-•-••-•----•or Lot No.
zc3 t'y ------------------------------------ ----------
f. OWrer Address -• ..._
ai.............. ------------------------------------ --____--•-----------__________----•--•----__. -dres.__......
Installer Address
Type of Building a Size Lot...............:............Sq. feet
Dwelling-moo- of Bedrooms__ _ .................................Expansion Attic ( ) Garbage Grinder ( )
CL, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
P4 Other fixtures ------------------------------•--••--•--
W Design Flow____________________________________________gallons per person per day. Total daily flow............................................gallons.
R; Septic Tank—Liquid'capacity.___---.__._gallons Length................ Width................ Diameter-_-__-_-______ Depth................
xDisposal Trench—NTo_ ____________________ 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 ( )
aPercolation Test Results Performed by............................................ Date........................................
Test Pit No. 1................minutes.per inch Depth of Test Pit.................... Depth to ground water---__--------____-__-__.
Test Pit No. 2................minutes per inch Depth of Test ,it..................... Depth to round water.......... ...........
C�`
p C'�7�---" _ ...._...._.
Description of Soil.__.. ":, ' ________________________
---•-----
x ._._.....••--
V --•--•--•--------•-•-----•-••••--••••--------••-------'-------•--------------"----••----•--••--••-
---------------------•- ........................ ------------• ...................................... ------••`-••-•-.....-.7...__
U Nature of Repairs or Alterations—Answer when applicable...,o_ 1�� "__ ! _.............................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iT"I...
p 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 the, bard of ealth.
Signe � -- -- 60 �J-` //nr
try° -Date
/
Application Approved By------ --- ........ = ------------------------------- `f----_---!- �
Date
Application Disapproved for the following r as ns:--••--•---•-----•--•'-•'------------------------•---•--•---•----•-•--•••------•-----•••-•-•-----•-•-•••--•--••--
---•--•------------•---------•-•-----••-...-----•-----•-------•...-••••••••------------------•--------•-•--...._....:--•--•-----------•------•-•-----•-•••••-•••••------••----•------••••••-------•-----
Date
PermitNo......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL ',H
j ...
A TatifirFate of f ompliFanrr
THL.5.JS 0 IFY, T x the nu vidual Sewage Disposal System constructed ( ) or Repaired
J.
bY------- ' � f `, w r , '
jJ f f ! Ins,Iler r J" --..
_--_--------_-•---
has been installed in accordance witli the provisions.of �i�=��5,pf The State Sanitary Code as descri d in the
application for Disposal Works Construction Permit NoO....... __._____U____________________ dated------- ��_-__________-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE l ...... Inspector.........`-•-`-•r
THE COMMONWEALTH OF MASSACHUSETTS
. BOARD O, HEAD r
r .-........,,�'`, ..OF.....-�,.. i' '' +
-.
N o. FEE...
�iu�uu�.�.• .fir u �.unu�rnnr�i�an rrani�
Permission 'is hereby granted......-,ri_ .......... s.a.a'� ,� -_Y -�
to Construct;(� ) or'Repair ( ) an Individual Sewage �,tsposah'5ysteln j
at No. pf ,,✓ ( ,' �� s�'.� .... •� F- �` --------------------------------------------------------
PP P Street i?L ._C�)� F
as shown on the application for Disposal Works Construction Permit No____________________ Dated_ _---.�._l�_�-_....._ _._....._..
.�. C -------------------------------
Board of Health
DATE.......... •----'--•---'•---------'-••-----••-•-------------------------------
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
TOWN OF BARNSTABLE
LOCATION 6-)wcac\ -Rs)- SEWAGE #
V11.1.AGE CeX'-) ASSESSOR'S MAP & LOT S 5
�SPEC'� /�
H��NAME&PHONE NO. 6,14pr-W i r &SI" 5+�Ay
SEPTIC TANK CAPACITY t ,coo G yr% 4.
LEACHING FACILITY: (type) Le p cix 7%A- (size) �0 Mo
NO. OF BEDROOMS .3
BUILDER OR OWNER CAM'ef, C*kQ,STtPA
PER.MI T DATE: 1 a-11—Et, COMPLIANCE DATE: 1 a- 11 8(.
Separation Distance Between the: , ,�
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 2195 i 5ef Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) A Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of le ching facility)_ 1.� I�t Feet
Furnished by AQ.Mroa Ht�`�
6jLs•�1r.�f�, �'i�5 � �� ,,
9 �5
TOWN OF BARNSTABLE ~ �
�(J /
L.•CATION SEWAGE
VILLAGE ASSESSOR'S MA Si LOT
INSTALLER'S NAME Si PHONE NO.
041 -
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS P4JVATE WELL OR PUBLIC WATER
BUILDER OR OWNER /
DATE PERMIT ISSUED:
DATE . COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
r
ir
Ila#
All
BE
TIGHT AND
TOP OF COVERS FOUNDATION EL 98 � BROUGHTOTO WITHIN R6" OF FINAL GRADE SEPTIC SYSTEM PROFILE . Flaherty Environmental Services
EL. 10000,0 0 ( to scale) INSP. PORT W I 3" OF GRADE P.O, BOX 81
2" PEASTONE OR EL.97.0't CLEAN SAND Yarmouth Port, MA 02675
GEOTEXTILE
4" CAST IRON or EQUIVALENT VENT (IF RE UIRED)
MIN. PITCH 1 4" PER FOOT FILTER FABRIC 508.362. 1657
a"SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE
FLOW LINE
17 (first 2'to be/evel)
18' 9% go
;,'•; L,EXIST. —�"` --►
14'
EL.EXIST —� —
EL.95.3' — 2
' EL.93.53' EL.91.5'
EL.93.T �—
GAS BAFFLE EL.93.5' SOIL ABSORPTION SYSTEM r
INSTALL NLET TEE
1" ABOVE OUTLET INVERT (2) TRENCHES XW X 331 X 2'D USING 5' (4' MIN.)
''g;''•; .: PERFORATED PIPE AND SURROUNDED
CLEAN, DOUBLE-
1000 GALLON SEPTIC TANK a----� STONE WASHED 3" TO 1 z"STONE
WASHED 3i TO 1�"
(DATUM: ASSUMED) EL. 86.5
BOTTOM OF TEST HOLE EL. 86.5'
98 USGS ADJUSTMENT; N/A LOCAT/ONMAP
GROUNDWATER ELEV: N/A
NO TH
97 BENCHMARK.
�5�11pOp TOP OF FNDN Rt.28 _
EL. 100.0'
2
10,
t
EXIST, LP O op✓Q Locus1 Beachwood Rd. �c
TH-1 LP c!`
EXIST, S.T,
20, EXISTING tip �'s Neck
10, DECK 3 BR 1
DWELLING NTS
12,5 LOT 153 ,
GARAGE 11,550 SFt � �ZNOFAfgss9
(SLAB) DECK �o� DAV CGS
O,
F H R.
2
G/STER
\ \\ SgNI TAR\P�✓
97 \ / 98 DATE:17/15115 REVISED: REVISED:
/ J ®®® SITE AND SEWAGE PLAN
FOR
B & B EXCAVATION INC./
ERIC J. BROOKS
SCALE : 1 = 3 0' 105 BEECHWOOD ROAD
CENTERVILLE, MA
REF:PS 199 PG 83
PAGE 1 OFZ
......................................................................................................................................................................................................................................................................................................:...................................:...........................................:....................................................................... ..
..................................................................................................................................................................................................
GENERAL NOTES DESIGN CALCULATIONS SYSTEM DETAIL Flaherty Environmental Services
P. 0. Box 81
1. ALL PRECAST COMPONENTS'TO BE H-1 D Yarmouth Port, MA 02675
RATED. ALL COMPONENTS WITH ANY NUMBER OFACTUAL BEDROOMS 3 508.362. 1657
ANTICIPATED VEHICULAR TRAFFIC TO BE
H-20 RATED. GARBAGE DISPOSAL UNIT NO
2. THE DESIGN OF THIS SYSTEM DOES NOT 6' ❑B s. PORT
ALLOW FOR THE USE OFA GARBAGE TOTAL ESTIMATED FLOW 3'
GRINDER. (110 GAL/BR/DAYX 3 BR) 330 GAL./DAY ;,;:.• •: ,. ..• .. ..••.,.:...•.: .
3. MUNICIPAL WATER IS AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 660 GAL.
4. ALL CONSTRUCTION TO CONFORM WITH
310 CMR 15.000 AND ALL OTHER SIZE OF SEPTIC TANK 1000 GAL. (EXISTING)
APPLICABLE LOCAL, STATE AND FEDERAL :' > >••"r
CODES AND REGULATIONS. SOIL CLASSIFICATION _1 >. :'-•" • " ::..:::•:.:-:::
5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLA TION RA TE <2 MIN./INCH 33'
VERIFY ALL ELEVATIONS AND DETAILS
AND REPORT ANY DISCREPANCIES TO EFFLUENT LOADING RATE 0.74 GAL./DAY/FT2
DESIGNER PRIOR TO CONSTRUCTION OR
ASSUME ALL RESPONSIBILITYY, LEACHING AREA
6. INSTALLER/CONTRACTOR IS BOTTOM: (XX33)X2= 198�FT2iw IQ 9
RESPONSIBLE FOR MAINTAINING SAFE SIDES:
WORK AREA, VERIFYING ALL UTILITIES [(2'X33)X2+(2'X3)X2JX2= 288•F7-2
AND NOTIFYING "DIG SAFE" TOTAL = 486•F72 9' MIN, OF S❑IL
1-888-344-7233 72 HOURS PRIOR TO X 0.74= 359'GAUDAY
( ) 2'° OF PEAST❑NE OR FILTE+R FABRIC
CONSTRUCTION.
7. ANY CHANGES TO OR DEVIATIONS FROM USE(2)TRENCHES OF PERFORATED PIPE SURROUNDED BY
THIS PLAN MUST BE APPROVED IN i"ro 1 j"STONE,EACH TRENCH CONFIGURED AS 2
WRITING BY FLAHERTY ENVIRONMENTAL X WIDEX 33'LONG AND 2'DEEP
SERVICES AND LOCAL BOARD OF 3/4' TO 1 1/2' WASHED STONE
HEALTH. RESERVE LEACHING CAPACITY N/A
8, FINISH COVER OVER COMPONENTS IS 3,
NOT TO EXCEED 3'PER 310 CMR 15,000
UNLESS SHOWN PER PLAN. TRENCH END VIEW NTS
9. ALL ABANDONED SEPTIC SYSTEM
COMPONENTS TO BE PUMPED DRY AND
FILLED WITH CLEAN SAND OR REMOVED SOIL EVAL UA TION
AND REPLACED WITH CLEAN SAND, rEsrHoiE#1
10.ALL COMPONENTS TO BE PROVIDED Evaluator- DavidD.Flaherty Jr.,RS,REHS jN°FMgSs
WITH WATERTIGHT ACCESS.PORTS SE#2755 DA D
WITHIN 6"OF FINISH GRADE. BOH witness: David Stanton,RS
Date: November 13,2015 p
11.ALL SEPTIC TANKS, DISTRIBUTION P#.• 14895 H R.
BOXES AND PIPING TO BE INSTALLED 2
rH-1 ELEV.s7o' TH 2 ELEV.97.0' N 1
WATERTIGHT.
12.NO KNOWN WETLANDS OR WELLS 0"-13" A LS toYR3/2 0"-13" A LS 10YR3/2 SqN/SARRN
WITHIN 100 FEET OF PROPOSED
LEACHING. 13"-37' B LS 10YR 5/6 13"-37" B LS 10YR5/6
13.THIS IS NOT A CERTIFIED PLOT PLAN
AND UNDER NO CIRCUMSTANCES IS THIS
PLAN TO BE USED FOR ZONING OR PERC
BUILDING PURPOSES. 37"-126" C CMS 2.5Y6/5 ELEV'92.6' 37"-126" C CMS 2.5Y615 5%Cobbles %Cobb/es
SITE AND SEWAGE PLAN
5
14,LOT IS SHOWN AS ASSESSOR'S MAP 252 certify that on November 12,2002,l have passed FOR
PARCEL 35, the examination approved by the Department of B & B EXCAVATION INC.
15. LOCUS PROPERTY'S PROPOSED SYSTEM Environmental Protection and that the above ana/ysls
APPEARS TO BE WITHIN AN AQUIFER has been performed by me cons/stant with the ERIC J. BROOKS
required training,expertise,and experience described 105 BEECVHWOOD ROAD
PROTECTION DISTRICT(ZONE II). G.W.ELEV.N/A G.W.ELEV.N/A in 310 CMR 15.018(2)."
CENTERMLE, MA
BOTTOM TH-1 ELEV. 86.5' BOTTOM OF TH-2 ELEV. 86.5'
PAGE2 0F2
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