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0003 BENT TREE DRIVE - Health
3 Bent Tree Drive A= 168— 032 Centerville SMEAD No.2-153LOR UPC 12534 aen*ssd..aom - Ys►da in Uiiw ' �udMwswoouaw SFIOMFIED � .°"° ornEsao.00rw s mcm WMNMFWGMiLm Town of Barnstable P# Departmi ent of Regulatory Services J J Public a ealth Division DateI MASS. rFD �� 00 ►fit,Hyannis MA 02601 Date Scheduled Time Fee Pd. 0 Soil Suitability Assessment fog- S 5ge Disposal Performed By: Witnessed By: LOCATION& GENERAL INFORMATION Location Address 3 6�� Owner's Name 0t f Z v e e C e^ k rC Address 3 &eot T Tr�*-e Assessor's Map/Parcel: Z. Engineer's Name 1,1AA.1a NEW CONSTRUCTION 1 iREPAIR _ Telep hone# SO �J Z t7 Land Use I a,,fi 0.1 Slopes(` ) — &:,/`a Surface Stones G Distances from: Open Water Body �J A ft Possible Wet Area N 1 fl ft Drinking Water Well N 16 ft Drainage Way_N I _ft Property Line —3 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands In proximity to holes) S r-3 p - z 6D 07C-) I`�i"ran `��. • Parent material(geologic) ICibal U _W' A Depth to Bedrock Depth to Groundwater. Standing Water in Hole: N`�. Weeping from Plt 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 1<. Index Well# Reading Date: Index Well level____ ___., Adj,Factor— Adj.droundwater Level PERCOLATION TEST D1110.1J3113 T11ne l o___•�o�o eM Observation Hole# �(J� Time at 4" Depth of Perc D l0 Time at G' Start Pre-soak Time @ 'Ud Time(9"G") End Pre-soak 5 00 RateMin./Inch L�.Y�^�n u\Cl'1 Site Suitability Assessment: Site Passed Sit-Failed: Additional Testing Needed(YIN) 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 DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil- Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. o i ten cy,.%Gritvel) 0 lo 3L N1l,S [.o e-rc, e_ l�l, t, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. (Longistency.%Grave M SL �e 3 � 11- �A 1AC,S to ` 2 sle 2$-ao C K Sand DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Conai teflry.%O e ' t DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stotte3,Boulders, Consistency, Flood Insurance Rate.Map: Above 500 year flood boundary No Yes . Within 500 year boundary No V+ Yes ' Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi�° s[Material exist in all areas observed throughout the area proposed for the soil absorption system? ----1------If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required train*A g,expertise and experience described in 10 CMR 15.017. SignatureCY�=J—0, 9) P - Datb I q 13 Q:\,S.EPTlCTERCPORM.DOC No. �O ' " r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Nsposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade('v'j Abandon( ) ❑Complete System [01ndividual Components Location Address or Lot No. �.�—���� Yam!- Owner's Name,Address,and Tel.No: ,�-7' C`d5'K�3 Assessor's Map/Parcel 1 ?a «�, ,� :cru"�►I.e Installer's Name,Address,and Tel.No.,M`a— SS'S Desi er's Name,Address,and Tel.No. 3 Type of Building: Dwelling No.of Bedrooms Lot Size ae,_sq-ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ® gpd Design flow provided �Cj�� gpd Plan Date 1 Number of sheets ` Revision Date Title Size of Septic Tank `'SC'40 Type of S.A.S. Lex; cMVvt4g ►` ' Description of Soil�s y-zG Nature of Repairs or Alterations(Answer when applicable) 5 �CZ�•3rc� �.,,c�—�-�i C�ttu�7ze �G c�S' cl`�c�J.S cs� +�'y�l,�.� L�.n,a C"� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date i c Q2 Application Approved by Date 0 —f / Application Disapproved by Date for the following reasons Permit No. �0 1 `2 Date Issued - No. �O I ' �.:: c _._. _�° Fee E THE COMONWEALTH OF MASSACHUSETTS Entered in computerCOMMONWEALTH Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS f implication for disposal *pstrm Construction iderntit t. Application for a Permit to Construct( ) Repair( ) Upgrade(Vy Abandon( ) ❑Complete System [�,I'ndividual Components i Location Address or Lot No. Owner's Name,Address,and Tel.No. 7-30? Assessor's Map/Parcel c �? Installer's Name,Address,and Tel.No. - `� S 5' Designer's Name,Address,and Tel.No.Wig_ Sot S� Type of Building: Dwelling No.of Bedrooms, Lot Size T`��r as3 ss1.-13: Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) i i Other Fixtures Design Flow(min.required) -t C':� gpd Design flow provided E; gpd Plan Date Number of sheets ` Revision Date i Title Size of Septic Tank n _ ( k, Type of S.A.S. 0 ,I, m,• Description of Soil ! - Nature of Repairs or Alterations(Answer when applicable)--T, \i A j Date last inspected: j Agreement: rs The undersigned agrees to ensure the construction andbainfe—hance`o$the�nfore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code ariAot to place the'system in operation until a Certificate of i Compliance has been issued by this Board of Health. j Signed Date;,,�i:z) Application Approved by Date Application Disapproved by Date for the following reasons i Permit No. a O ( e�^ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS .. (Urtifitate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( /) Abandoned( )by 7�r.Q I r- --gi61— . , "� at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.A13-G P-7--dated 1-' Installer Designer S � j #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will nctibn as designed. S Date j R Inspector i pp�, � �` Fee } ` ---- � V a---_-- ---,--.--:-_---.----_--------_-_-----_------------------------------ ------- -��-/--------- No. �O 13 i i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction j3ermit Permission is hereby granted to Construct( ) Repair( ) Upgrade(,� Abandon( ) System located at j i 4 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 perm Date �ti O / Approved by y t \ Town of Barnstable Regulatory Services Thomas F.Geiler,Director WANWABM Public Health Division 3 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date•: �,�`� c3 Sewage Permit#Q30-0\'1 Assessor's Map/Parcel 3 Installer&Designer Certification Form Designer: Installer: ����� -�— -� � Address: Address: ,�?c �-Cam.$-►cic.G�' , Mfg C�2.�3�0 ��r�s t�,al��`� C��� On \S-_—)O13 was issued a permit to install a (date)' (installer) septic system at based on a design drawn by (address) dated 11 l 1(3 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required cted and the soils were found satisfactory. ��N OF MALT S LINDA J. GN PINTO (Installer's Signature) I Il . 4 5 •.r G1 S T e (Designer's Signature) (Affix Desi Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WH L NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office forms\desipercertification form.doc ix Barnstable'Health'[apartment 200 Main Street, Barnstable Town, MA 02601 To W, hom t Ma Cor cern;� Y Since 2006.when l hW , yprp at;IBentTree drive,Centerville Ma 02632,C haue nOt made any changes or tm"prgvem nts to the Tome, 'Sverythi'hg in" the home was the same;as is today. Regards. Mike Queeney TOWN OF BARNSTABLE LOCATION '�� �^ l/li SEWAGE#t) 4,� t 3a I VILLAGEG��n r�r✓y�l� ASSESSOR'S MAP&PARCEL k6gq � INSTALLER'S NAME&PHONE NO.%,� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) QnX �g3og,jGo (size) (a$r x yp f k NO.OF BEDROOMS S' OWNER a ��va ` �c,2��-�`nr�•I PERMIT DATE: �( S'( on k:3 COMPLIANCE DATE: 1 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility > S 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 BYZ���-�y �`�•1' �k Ems(,?�� , L(3 .g,,e a TOWN OF BARNSTABLE LOCATION 3 3c�� rc�G '�,]�„ SEWAGE# ,"VILLAGE \V< ASSESSOR'S MAP&PARCEL C5 3 IISFf*bE+WS NAME&PHONE NO! C,,= •`1 ��' �K'�tam 6 wa' S6 'r� cc-C�.1°,� . SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) Cz to NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DA : �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 o 300 feet of leaching facility) Feet FURNISHED BY V l ,'UU J ' - 4�0`6 '' J 3 V � P No.. .`f:�.. .... G Fims.................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE App iratiun for Disposal Works Tonstrurtiun thrutit Application is hereby made for a Permit to Construct ( ) or Repair (/an Individual Sewage Disposal System at- ............... _ :. cation- ess Lot No. � Ow r ��� Address z - -� .. 1.4 Installer Address d Type of Building ,//�� Size Lot............................Sq. feet U Dwelling—No. of Bedrooms--------------=!_-_-......................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building ............................ No. of persons.-.••----•------•_-.--....-- Showers — Cafeteria 04 d Other fixtures ---------------------------------------------------------•-----•----------•------•-------••-•---•---•-•-•-•--•-•---•••......-•---•-•--.............•- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No-.................... Width..............-..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--- ---------------- Diameter-.-.----.--....--.-. Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44` Test Pit No. 2................minutes per inch Depth of Test Pit----................ Depth to ground water........................ 9 --------•--•-----------------•-••--•-----•-•-- .............................................................................................................. Descriptionof Soil........................................................................................................................................................................ x w x -------•--------------------•...•---------- -----------------------------------------•--•-------------------••-------------•-------- U -N•-a--t-u ef Re ra i r os o ¢lterations—Answer w en aPPlicable��� -- A reeme nr ........C=p-J-- ------------------------------------------------..................................................------------k------C--�-----�•.The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha gn -s ued y the oars of health. Signed ----------- ------------------1----- -------------------------------------------------------- ��1 G� ". � Application Approved By -- ---- -------- - -t>................... �. . �1/` "' J `` 'P Date Application Disapproved for the following reasons' ------------------------------------------------------------------------------------------------------------------------------------ -------------------------- --------------------- ----- -- -------------------------------- -- ---------------------- --------------- --- --------- --------- ------------ ------------------------------ Due Permit No. ` ............. Issued -'..- Date------------�............... All No... �{' 16-3 032- Fps... ©vim THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH r TOWN OF BARNSTABLE' Appliratiun for Eliipuuttl Works Toutitrnrtivit ramit Application is hereby made for a Permit to Construct ( ) or Repair ( (/) an Individual Sewage Disposal System at: cation- ddress dr Lot No. -•- Owner Address .................................. Installer 1 Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............4�......................Expansion Attic ( ) Garbage Grinder Other—T e of Building No. of persons............................ Showers — Cafeteria G" Other fixtures ..................-......--•--• - W Design Flow............................................gallons per person per day. Total daily flow--------_...................................gallons. WSeptic Tank—Liquid"capacity............gallons Length................ Width................ Diameter---------------_ Depth............. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No..................... Diameter......-............. Depth below inlet.................... Total leaching area........-_........sq. ft. Other Distribution box ( ) Dosing tank ( ) 4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......___-_.___-_-_--_-. Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a --•-•----••••---••••-•••--••-•....................••••----•••-•-•-•.......-••------••--•._...._..........................................-................... 0 Description of Soil------------------------------------------------------------------------------- ---------------------............................................................ W --V _.......•-•-------••-•-•--•-------------------•-------•-----•------------------------------------------- W UNature of Repairs or Alterations—Answer when applicable./_;_` _ ___ -._.___._.__S%. .............. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ,een is ued .y the board of health. Signed --------------- ----------------------------------------------- Dare Application Approved By .. .!?Y ..... -- .... �•.. +-, Date Application Disapproved for the following reasons: ......................................... ---------------- --------- - ----------------------................. .................. -----.............................. ,r� Date Permit No. ...... �'°"... �....--..... Issued ---------.`.9........./ --�- 'r ----------- # Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' TOWN OF BARNSTABLE — Gezttftett#e of C�ontplinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( Y ) by ----..... � f -- -�' �°� :. ....---- --- --------- --------------- --------------------------------------------------=-- `"' Installer at . ��------------ ........ ------------------ ./lt l/1,-1�X -----...----------------------------------------------- has.been nstalled in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........-.......-�. .'-. �'� dated --. -._��!'`--�--------- ----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A`S A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. / 1 / DATE.......:J..- ..... - --------.- ------------------------- Inspector' - ...................... S THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 3pa� No..., .. .. FEE................ .... Kiupuual Works Tungtr ion Fermi# Permission is hereby granted..------. A"' to Construct ) or Repair ( �n Individual Se .tg a Disposal System at No........ 11 /!ti? ......-•................•........••-•••-- T Street 4 :/O po •-- as shown on the application for Disposal Works Construction Permit No...._�_!.._.'+..._.�fDated__.._ ..._..,-......._......._ ._ .................. Xa - Board of Health Y DATE. �- .... ---......--- FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS I Hied i ..... - TOWN OF BARNSTABLE t LOCATION 3 BENT TREE DRIVE SEWAGE VILLAGE CENTERVILLE ASSESSOR'S MAP LOT /I YY- !5x INSTALLER'S NAME PHONE NO.ELLIS BROTHERS. CONST. CO. 362-6237 SEPTIC TANK CAPACITY IS-0 f; LEACHING FACILITY:(type) e-y (size) NO. OF BEDROOMS .PRIVATE WELL OR PUBLIC WATER O Lic BUILDER OR OWNER 1{,l Xi 647%5,z j y i DATE PERMIT ISSUED: ` DATE COMPLIANCE ISSUED: f- /a/Z VARIANCE GRANTED: Yes No TOWN OF BARNSTABLE LOCATION 3 BENT TREE DRIVE SEWAGE # � TERVILLE . 'PILLAGE CEN ASSESSOR'S MAP & LOT lylf—®5X INSTALLER'S NAME & PHONE NO.ELLIS BROTHERS. CONST. CO. 362-6237 SEPTIC TANK CAPACITY /S"C Q e LEACHING FACILITY:(type) (,fA//l (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER u Z/ BUILDER OR OWNER ItI'lY DATE PERMIT ISSUED: —` A- r DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �' ti- /3,Qe.� e¢ Na vs� d 3� �� ���U �9�` ��� �s'"� s' ,' ;! J Barnstable Town of Barnstable . A4-ftwica CRY �HEReof �—F '4 ulatoryServices Department g i LE.! 7i lth Division 2007 RAR Public Hea _ 1'•9 MASS. � \�b, .e�q• annis MA 02601 \b� 200 Main Street, Hy Thomas F._Geiler,Director Office: 508-862-4644 Thomas A.,McKean,Clio FAX: 508-790-6304 CERTIFIED MAIL # 7008 3230 0002 5178 2831 December 19, 2012 Michael Queeney 3 Bent Tree Drive Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 3 Bent Tree Drive, Centerville,MA was last inspected on The septic s st Patrick T. Sullivan, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: Septic System is in hydraulic failure lace the septic system within sixty (60) days from the You are or dered to repair or rep date you receive this notification. Failure to re air/replace the septic system with the deadline period will result in future enforcement action: PER ORDER OF THE BOARD OF HEALTH ✓%�as McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\3 Bent Tree Dr.Cent.Dec 2012.doc t Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Bent Tree Drive Property Address _Michael Queeney _ Owner Owner's Name information is required for Centerville MA 02632 December 6, 2012 every page. City/Town State Zip Code. Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the 11� computer,use 1. Inspector: U only the tab key to move your Patrick T. Sullivan cursor-do not Name of Inspector use the return key. Ready Rooter Excavating Company Name P.O. Box 89 Company Address Forestdale MA 02644 rim City/Town State Zip Code 508-888-6055 SI 12843 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. 1 am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority w� 0 December 10, 2012 ; ,z, Inspector's Signa ure ` Date The system inspector shall submit a copy of this inspection report to the Approving Aut0ty (Bard of Health or DEP) within 30 days of completing this inspection. If the system isxa shared§yster r has a design flow of 10,000 gpd or greater, the inspector and the system owneM shall sulamit th report to the appropriate regional office of the DEP. The original should be sent to the system offer and copies sent to the buyer, if applicable, and the approving authority. yn FA ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official InS414Form:Subsurface Sewage Disposal System•Page 1 of 1 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Bent Tree Drive Property Address _Michael Queeny Owner Owner's Name information is required for Centerville MA 02632 December 6, 2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) 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",('�', N, ND) for the following statements. If"not determined," please explain. / The septic tank is metal and over 20 years Id* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial 'nfiltration 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 t nk is less than 20 years old is available. ❑ Y ❑ N ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 2 Commonwealth of Massachusetts UJ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Bent Tree Drive ip Property Address Michael Queeny Owner Owner's Name information is required for Centerville MA 02632 December 6, 2012 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is I eled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a yeaf due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the B and of Health): ❑ broken pipe(s) are replaced Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed /❑ Y ❑ N ❑ ND (Explain below): i C) Further Evaluation is Req iced by the Board of Health: ❑ Conditions exist which req ire further evaluation by the Board of Health in order to determine if the system is failing to otect public health, safety or the environment. 1. System will pass Ness Board of Health determines in accordance with 310 CMR 15.303(1)(b)that th 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Bent Tree Drive Property Address Michael Queeny Owner Owner's Name information is required for Centerville MA 02632 December 6, 2012 every page. CitylTown 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 SASS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and S#S 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 wate analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent a the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided th no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: i 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 Y2 day flow t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Bent Tree Drive Property Address Michael Queeny Owner Owner's Name information is Centerville MA 02632 December 6, 2012 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is with' 400 feet of a surface drinking water supply El El the system is whin 200 feet of a tributary to a surface drinking water supply ❑ 0 the system i located in a nitrogen sensitive area (interim Wellhead Protection Area— I A) or a mapped Zone 11 of a public water supply well If you have answered "yes" any question in Section E the system is considered a significant threat, or answered "yes" in Sect n D above the large system has failed. The owner or operator of any large system considered a Sig ificant 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Bent Tree Drive Property Address Michael Queeny Owner Owner's Name information is required for Centerville MA 02632 December 6, 2012 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back u ? ® ❑ Y 9 P 9 9 P ® ❑ 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): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 GPD t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Bent Tree Drive Property Address Michael Queerly Owner Owner's Name information is required for Centerville MA 02632 December 6, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2011= 178 GPD g ( y g (gl ))' 2012= 144 GPD Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Nov. 3, 2012 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15. 3): Gallons per day(gpd) Basis of design flow(seats/perso s/sq.ft., etc.): Grease trap present? El Yes ❑ No Industrial waste holding to present? ❑ Yes ❑ No Non-sanitary waste dis arged to the Title 5 system? ❑ Yes ❑ No Water meter readin s, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Bent Tree Drive Property Address Michael Queerly Owner Owner's Name information is required for Centerville MA 02632 December 6, 2012 every page. Cityrrown 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: Owners records: Pumped 2007 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Bent Tree Drive Property Address Michael Queeny _ Owner Owner's Name information is required for Centerville MA 02632 December 6, 2012 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System installed Sept. 16, 1994. Certificate of Compliance on file at Board of Health. Were sewage odors detected when arriving at the site? ❑ Yes ® No BuildingSewer locate on site plan): ( P ) 2'10" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: eet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years I Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 11.5'X 5'X 4.10' 1500 gallon Sludge depth: 4" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Bent Tree Drive Property Address Michael Queeny Owner Owner's Name information is required for Centerville MA 02632 December 6, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 3 811 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Tape measure and dip tube. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet concrete baffles in place. Liquid level at outlet invert. Recommend pumping within 1 year. Risers bring covers within 6" of grade. 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 se to top of outlet tee or baffle Distance from botto of scum to bottom of outlet tee or baffle Date of last pumpi g: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,.' 3 Bent Tree Drive Property Address Michael Queerly Owner Owner's Name information is required for Centerville MA 02632 December 6, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Bent Tree Drive Property Address Michael Queeny Owner Owner's Name information rts reuied for q Centerville MA 02632 December 6, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" at time of inspection. 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 inlet, one outlet. Solids carryover present. Staining over outlet pipe shows SAS has been overfull in past. Riser brings cover within 6" of grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump cha ber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 12 Commonwealth of Massachusetts 09 U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Bent Tree Drive Property Address Michael Queeny Owner Owner's Name information is required for Centerville MA 02632 December 6, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 4-w/2' of stone. ❑ 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.): Liquid level 12" below invert at time of inspection. High water staining to top of galleries present. Inlet invert has sign of high water staining. System has been overfull in the past. SAS has been in failure. The system "Fails" inspection. Riser brings cover within 6" of grade. 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' flow ❑ Yes ❑ No t5ins 11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 13 of 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Bent Tree Drive Property Address Michael Queeny Owner Owner's Name information is required for Centerville MA 02632 December 6, 2012 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, si s of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3 Bent Tree Drive Property Address Michael Queenq Owner Owner's Name ition is required forCenterville MA 02632 December 6, 2012 every page. Wrown State Zip Code Date of Inspection D. System Information (cunt.) 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 9h cty ® � r V t5ins-11no rdle 5 offidW Inspection Form:Subsurface Sevrage Disposal system•Page 15 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 Bent Tree Drive Property Address Michael Queeny Owner Owner's Name information is required for Centerville MA 02632 December 6, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >5 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 1994 If checked, date of design plan reviewed: Date 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: ma.water.usgs.gov terraserver-usa.com You must describe how you established the high ground water elevation: Slpoe to rear of property drops well below base of SAS. Test hole in 1994 found no ground water at 10'. Base of SAS 5.5' below grade. Accessed local ground water contours and topo mapping. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposals System Form -Not for Voluntary Assessments 3 Bent Tree Drive Property Address Michael Queeny Owner Owner's Name information is required for Centerville MA 02632 December 6 2012 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 17 l TOP OF FOUNDATION 24"diameter concrete covers (l Vent Route 28 CENTEPM LLE, EL=53.0 raised to within 6"Offin"5h grade 4"PVC VENT /r MA (or as noted) Lnspectron Port and cap with magnetic #CAP BY"5WEETAIR" / marking tape to within 3"of grade 3 " / / \ Existing EL=47.3+ EL=4768± EL=47.2-46.8 MIN Pt A �/J'/./ A\//A 5, 5' 5, 5' 5' 5' 5, 5, o Q d J e�Oz 15"min Cover for H-20Laadm Exiting 45.3-t _ s 1 Existeng 44. _°:;{�f�4 ; ,: "�w xa�y= '• l,L ' 210 Eisting 44.4 4f b 43.,50 m- °z>_ YvLOfC\ USoEwsting A GasBafe 20 4370 4 '� '-� ' �, ,.i• 'i<i m ` "' Longest Run THIRTY TWO(32)AD5 ARC36HC 5.O_ lnspectEon Ports(See Note#4) �e�Ro 30'+ /0` 9' (36/60D2)LEACH CHAMBERS/A(BED Existing D29-6 CONE/GURAT/ON WIT"FOUR(4)KOW5 VIEW / / �'�/p EXl5TIM6 /500 GALLON (/-/-2D Rated) OFE/GHT(,5)CHAMBERS PLAN V I E V V ( I t f . SEPTIC TANK D-f30X LEACH CHAML5fR,5 EL=378+Bottom of Test hoe SCALE: I" _ ►o' SITE LOCUS NOT TO SCALE FLOW P ISO F I LE (H-20 Loading) N 89®48'40"E I .) Assessor's.Map 168 Parcel 32 NOT TO SCALE 3. .5 44 152.19 2.) C 181516 4 ,6 44.2 3.) LC Plan 31043 A Lot 31 40.7 43.2 4.) This property is not in a Zone 11 of a Public Water Supply CONSTRUCTION NOTES _ ` 5.) Flood Zone: Zone C Existing Septic Tank to be ! 44. 44,6 Utilized(See Note#2!) 1.)ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE,TITLE 5 (3 10 CMR 1 5,.000): 1 STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, UPGRADE,AND Existing Septic Components to - Existing EXPANSION OF ON-SITE SEWAGE TREATMENT AND DISP05AL 5Y5TEMS AND FOP,THE TRANSPORT be Abandoned(See Nate#22)4 .9 45.a/ Gravel Dnve^ AND DISPOSAL OF 5EPTAGE,AND THE LOCAL BOARD OF HEALTH REGULATIONS. LEGEND Holly 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED 1N A LOCATION WHERE THERE IS POTENTIAL FOR ? --� f O ��\ Tree o N 12.3 EXISTING SPOT GRADE VEHICLES OR HEAVY EQUIPMENT TO PASS OVER IT SHALL BE DESIGNED TO WITHSTAND AN H-20 I i i �� o - �+ Lri LOADING. IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE ATMOSPHERE. 43 i �i Per `` /� 47.3 `4G 44 6 O 24x5 PROPOSED SPOT GRADE I I Septic O O I I Ae-Built 47.6 - - v --24-- EXISTING CONTOUR 3.)TO MINIMIZE UNEVEN SETTLING, SEPTIC TANKS SHALL BE INSTALLED ON A STABLE /� ! -- it it 24- PROPOSED CONTOUR MECHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. w WATER SERVICE LINE 4.)COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK,THE DISTRIBUTION BOX,AND ► i `� � e L o OVERHEAD UTILITY LINES THE 501L ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN G"OF FINAL GRADE. LEACHING Bth Bdr 4 cn O ' / F I 49. ��� / U UNDERGROUND UTILITY LINES FIELDS,TRENCHES, AND OTHER 501L ABSORPTION SYSTEMS WITHOUT ACCE55 MANHOLES SHALL O --- 47.2 ., +8 7 d ° a HAVE AT LEAST ONE(1) INSPECTION PORT CONSISTING OF PERFORATED 4"PVC PIPE PLACED m / :° Qa�ed ° a a .a...) G GAS SERVICE LINE VERTICALLY TO THE BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH A CAP,TIED WITH MAGNETIC Bdr 5 4 , Deck / `5����we ° �� EDGE OF CLEARING II Existing 5 Bedroom �y MARKING TAPE,ACCESSIBLE TO WITHIN 3"OF FINAL GRADE. Dwelling / ° TP FENCE Bdr 3 I TP-2 ° ,; / a A TEST HOLE LOCATION 5.)PIPING SHALL CONSIST OF 4"SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A / 2 Top of Foundation V MINIMUM CONTINUOUS GRADE OF NOT LESS THAN 2%FROM THE BUILDING TO THE SEPTIC TANK, � he � , s 2/•2, / EL=53.0-+- ST SEPTIC TANK 11 2p- DISTRIBUTION BOX . AND NOT LESS THAN I%OTHERWISE. / / TP f mii, 2nd Floor 49.e DB r ' , / °a a Ses 5011,,ABSORPTION SYSTEM LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4"DIAMETER SCHEDULE 40 PVC(OR EQUIVALENT) NOTED. LINES SHALL BE CAPPED % ��� / G. DISTRIBUTION ! AT END OR AS NOTED. AT 0.005 Ff/FT. UNLESS OTHERWISE NO 25.T LOT 3 I Kitchen Bth Bdr 2 a• 44 7.} LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO(2)FEET BEFORE f - Area=0.39 Acres± I CERTIFY THAT I AM CURRENTLY APPROVED BY THE TO PITCHING TO THE`501L'?,I35ORPTION SYSTEM. D15TR{BUTION BOX SHALL BE WATER TESTED TO / " G� °.a DEPARTMENT OF ENVIRONMENTAL CO MtENTAL PROTECTION PURSUANT AT BENCHMARK '' 3 I 0 CMR 15.017 TO CONDUCT SOIL EVALUATIONS AND THAT ASSURE EVEN DISTRIBUTION. 4G To Corner Concrete \ THE SOIL ANALYSIS HAS BEEN PERFORMED BY ME CONSISTENT Living f P ° 5.)GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR L Bdr I EAVE ALL CONCRETE STRUCTURES EL=50.00(Assumed Datum) WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE � DESCRIBED IN 3 10 CMR 15.017. 1 FURTHER CERTIFY THAT THE IN ORDER TO PROVIDE A WATERTIGHT SEAL. / C0 49.7 ° a.. , Aa A5 RESULTS OF MY SOIL EVALUATION AS INDICATED ON THE 4 9 j HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE I st Floor 05 6& ATTACHED SOIL EVALUATION FORM, ARE ACCURATE AND IN % (Z, ACCORDANCE WITH 3 10 CMR 15.100 THROUGH 1 5.107 DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. 47.2 i 13.37' Q I Oj IN ACCORDANCE WITH 3 10 CMR 15.22 1, ALL SYSTEM COMPONENTS SHALL B F LOOK PLAN E MARKED WITH 5 86 5740"W a' MAGNETIC MARKING TAPE. f ° NOT TO SCALE 48 1 1.)THERE ARE NO KNOWN WELLS WITHIN 100'OF THE PROPOSED 501L AB50RPTION SYSTEM. o 12.) FROM THE DATE OF THE INSTALLATION OF THE 501L ABSORPTION SYSTEM UNTIL RECEIPT OF AUtu rri n Drive, VARIANCES REQUESTED Linda J. Pinto, Certified Soil Evaluator THE CERTIFICATE OF COMPLIANCE,THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT 40' Public Way `ZN OF USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. Local Upgrade Approvals: 3 10 CMR 15.403 13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS Variances: 310 CMR 15.22 1 (7)General Construction Polo CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE /` Realuirements for Ail System Components: T E PLAN DESIGNER. � 7 TEST HOLE LOGS ►.}Soil Absorption System > 3G"Below Finish Grade 14.}THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE „ _ � Surveil Work b �Qs�tTE BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE SCALE: I - 2O i 57"Held 2!"Variance Reduested SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT (not to Exceed 72") (not to Exceed 30) A & M Land Services AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE 15 REQUESTED. 8.2-±-) 618 Route 28, Suite 3 15.) LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL RE RESPONSIBLE FOR Test Hole#I (EL=4 West Yarmouth, NA 02673 DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO Depth Layer Soil Class Soil Color Comments C, C� /^ (� /� �` /� C� Ph. �508) 799'-19'79' Eh28ll.• aI1a71BIId®COmeast�et COMMENCEMENT OF ANY WORK.THIS INCLUDES, BUT IS NOT LIMITED TO, REQUESTS TO DIGSAFE, SY5 I E I V 1 V f-51 G N CALC U LATI O N ANY PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. 0"-18" Fill 18"-20" A Fine-Medium Sandy Loam I OYR 3/2 Prepared for: I G.)CONTRACTOR SHALL VERIFY THAT ALL WA5TELINE5 ARE CONNECTED BY WATER TESTING 20"-30" B Medium Loam Sand I OYK 5/G FWAGEDES/GN FLOW REQUIRED:5 BEDROOM CFO kF_0 G y //O GPD/BEDROOM=550 GPD REQUIRED WITHIN THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. 3G"-1 20" C I Medium 5and I OYR 7/4 Perc @ GG" Michael Queeny 5EWAGEDE5/GN FLOW PROI 1,9f,9 THIRTY TWO(32)ADS UNfT5/N BED 3 Bent Tree Dr., Centerville, MA 17.)CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY CONFIGURATION/N FOUR(4)ROWS OFE/GHT 0)UNITS EACH SEPTIC SYSTEM COMPONENTS. Prop05eGl cJ' eWacje D15pO5aI SyStP-M Test Hole#2(EL=47.8±) Ut=L(550/0.74)/f4.8 FT2/FT)/S.OLFJ =3/ADS UNITS -, tl'zj 18.) INSTRUMENT SURVEY CONDUCTED FOR PROPOSED WORK ONLY. SITE PLAN SHALL NOT BE REQUIRED(32 PROVIDED) r 3 Bent Tree Dr., Centerville, MA USED FOR STAKING, OR ANY OTHER PURPOSES. Depth Layer Soil Ciass Soil Color Comments 568 GPD PROVIDED>550 GPD REQUIRED Pre ared b 19.)THIS PLAN DOES NOT CERTIFY, GUARANTEE OR WARRANTY COMPLIANCE WITH DEEDED OR 0"-1 5" Fill p Y' ZONING BYLAWS,SPECIFICALLY, BUT NOT LIMITED TO,SIDELINE SETBACKS AND BUILDING HEIGHT 15"-17" A fine-Medium Sandy Loam I OYR 3/2 SEPTIC TANK CAPAC/TYREQU/RED: 550 GPDX200% _ //00 GPD REQU/RED RESTRICTIONS: OWNER 15 RESPONSIBLE FOR OBTAINING SUCH A DETERMINATION FROM THE 17"-28" B Medium Loamy Sand I OYR 5/G 5EPTIC TANW CAPACITY PROVIDED. EXl5TING /500 GALLON SEPTIC TANK APPROPRIATE AUTHORITY. 28"-120" C I Medium Sand !OYR 7/4 A GARBAGE DISPOSAL/S NOT PERMUTED WITH THIS DES/GN FLOW CSN .����� 20.) IF SOILS DIFFER FROM THOSE SHOWN IN THE SOILS LOGS, DESIGN ENGINEER IS TO IN5PECT �,�� THE SOILS PRIOR TO PROCEEDING WITH INSTALLATION. DATE OF TE5TlNG: 01/03/13 P#13531 , ' ���1 2 1.) EXISTING 1 500 GALLON SEPTIC TANK TO BE UTILIZED. PVC TEES TO BE INSTALLED ON INLET 501L EVALUATOR: LINDA J. PINTO, P.E.,C5N ENGINEERING AND OUTLET PIPES IF NECESSARY, AND A GAS BAFFLE INSTALLED IN THE OUTLET TEE. BOARD OF HEALTH AGENT: DON DESMARAIS, BARNSTABLE HEALTH DEPARTMENT INSPECTION NOTE: D 2O 4O '' GO t P.O.Box2030 Phone:(508)298-3250 PERCOLATION RATE: LESS THAN 2 MIN/INCH IN"C"LAYER Teaticket,MA 0253B Fax: 508 548-5478 22.) EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH GLEAN SAND AND PRIOR TO FINAL INSPECTION BY THE ENGINEER,SYSTEM ABANDONED IN PLACE. AREA TO BE COMPACTED TO MINIMIZE SETTLING. NO GROUNDWATER ENCOUNTERED NEEDS TO BE COMPLETE INCLUDING BUILDUP FOR COVERS. SCALE 1"=2O' - G\CSMRR-Bent Tree\RR-BerrE tree-5DS Plan.dwg Date:0 1/07/13 Scale:As Shown By:I-JP Check:PvSTA I Project No.C5NO296