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HomeMy WebLinkAbout0084 BENT TREE DRIVE - Health 84 Bent Tree Drive Centerville P A = 168 022 No. 42101/3 ORA ys 10O 0 0 f . � t \ \ . § § i ) j � � ) ) } � 7 \ ) � ) � � ] � ) . ) \ � ] � � � ] ) A f {. r A r "f}}1( i a� 7 1 1 I y +1+ {r } ,� .]r� i A x 1 :,. , - � Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 84 Bent Tree Road, Centerville M - 168 P-22 Property Address Susan & Gaetano Gregory Owner Owner's Name information is required for every 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Troy Williams key to move your Name of Inspector cursor-do not Troy Williams Septic Inspections use the return Company Name key. 19 Hummel Drive Q Company Address South Dennis MA 02660 City(rown State Zip Code (508) 385- 1300 S1682 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails September 29, 2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c , Commonwealth of Massachusetts �n 1p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Bent Tree Road, Centerville M - 168 P -22 Property Address Susan & Gaetano Gregory Owner Owner's Name information is required for every 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 'System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): Sewage Disposal System•Page 2 of 18 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:SubsurfaceS g p y 9 I Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Bent Tree Road, Centerville M 168 P-22 Property Address Susan &Gaetano Gregory Owner Owner's Name information is nn 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 required for every y y p page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form I Subsurface SewageDisposalstem Form - Not for Voluntary Assessments l System 84 Bent Tree Road, Centerville M - 168 P-22 Property Address P Y Susan &Gaetano Gregory Owner Owner's Name information is NJ 07002 September 29 1040 Kennedy Blvd Unit 602, Bayonne p , 2020 required for every page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal no other failure criteria are triggered. A co of the analysis must to or less than 5 ppm, provided that 99 PY Y be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments l; V � 84 Bent Tree Road, Centerville M - 168 P-22 Property Address Susan & Gaetano Gregory Owner Owner's Name information is 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 required for every y y p page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any pertion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a,design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Bent Tree Road, Centerville M - 168 P -22 Property Address P Y Susan &Gaetano Gregory Owner Owner's Name information is 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 required for every State Zip Code Date of Inspection page. City/Town C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health out in the previous two weeks? ❑ ® Were any of the system components pumped p ® ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 84 Bent Tree Road, Centerville M - 168 R-22 u, Property Address Susan & Gaetano Gregory Owner Owner's Name information is 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 required for every y y p page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms). 440 gpd Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: N/A Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage(gpd)): 19=45,000 gals. 18=48,000 gals. Detail Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Bent Tree Road, Centerville M - 168 P -22 Property Address Susan & Gaetano Gregory Owner Owner's Name information is 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: N/A Type of Establishment: flow Design based on 310 CMR 15.203 : N/A g ( ) Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: N/A Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A N/A Last date of occupancy/use: Date Other(describe below): N/A 3. Pumping Records: Source of information: Last pumped on 7/15/18 per info from BOH. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form lip Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 0 84 Bent Tree Road, Centerville M - 168 P -22 Property Address Susan & Gaetano Gregory Owner Owner's Name information is required for every 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: D-box and leaching were installed to existing tank on 7/16/18 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 18" 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.): Lines were found clear at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form Not for Voluntary Assessments 84 Bent Tree Road, Centerville M - 168 P -22 Property Address Susan &Gaetano Gregory Owner Owner's Name information is 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 18"with riser to 6" P 9 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: 6'X10.5'X6' 1500 gallon 4" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 2' 8" none Scum thickness 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 16" How were dimensions determined? probe/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.): Pvc inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 84 Bent Tree Road, Centerville M - 168 P -22 Property Address Susan &Gaetano Gregory Owner Owner's Name information is dennevna Bayonne NJ 07002 September 29, 2020 required for every 1040 Kennedy Blvd Unit 602� B y p li page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: N/Afeet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Capacity: N/A gallons Design Flow: N/A gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ i1e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Bent Tree Road, Centerville M - 168 P-22 Property Address Susan & Gaetano Gregory Owner Owner's Name information is 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No Date of last N/A pumping: Date Comments (condition of alarm and float switches, etc.): N/A *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found level and in working order with equal distribution to outlet lines through speed levelers. No evidence of solid carry-over or backup in the past was found at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 12 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Bent Tree Road, Centerville M - 168 P-22 Property Address Susan &Gaetano Gregory Owner Owner's Name information is required for every 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3-500 gallon with 4 stone ❑ leaching galleries number: 33.5' X 12.8'X 2' ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form F�14 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 84 Bent Tree Road, Centerville M - 168 P -22 Property Address Susan &Gaetano Gregory Owner Owner's Name information is 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil was sandy. Chambers had a little water present at the time of inspection. Checked stone and found dry and clean. No evidence of hydraulic failure or problems in the past were found at the time of inspection. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A N/A Depth of solids layer N/A Depth of scum layer Dimensions of cesspool N/A N/A Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments note condition of soil signs of hydraulic failure, level of ondin , condition of vegetation, Com ( g y P 9 etc.): N/A t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form <'I- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Bent Tree Road, Centerville M - 168 P-22 Property Address Susan &Gaetano Gregory Owner Owner's Name information is 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 required for every — -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions N/A _ Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 cam of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Tree ,� 84 Bent Tr Road Centerville M - 168 P 22 Property Address Susan & Gaetano Gregory _ Owner Owner's Name information is 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 _ September 29, 2020 required for every —_.. -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I I I O O a O t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Bent Tree Road, Centerville M - 168 P-22 V Property Address Susan &Gaetano Gregory Owner Owner's Name information is 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 required for every y y p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12.0+ 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: 7/9/18Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found at 12.0'. Bottom of leaching at 6.0'was found not to be located in the high groundwater elevation at the time of inspection. System was installed to plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I 84 Bent Tree Road, Centerville M - 168 P -22 Property Address Susan &Gaetano Gregory Owner Owner's Name information is 1040 Kennedy Blvd Unit 602, Bayonne NJ 07002 September 29, 2020 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 No. p1 QZ Fee v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes —�� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for Mispo8al-6pstem Caristruttion Vermit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or LQQt o.9N -TdCe 'j)0 i ve Owner's Name,Address,and Tel.No. (_'�i-C,f W.,' Assessor's Map/Parcel I (OV_091 I 1 5 ' Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size /7,/S'" sq.ft. Garbage Grinder( ) �� Other Type of Building No.of Persons' Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) d�Lj('� gpd Design flow provided ej5w Y gpd Plan Date -71 Number of sheets 12- Revision Date 77H 5 Title Size of Septic Tank Type of S.A.S. -2 /V -!7,0 Description of Soil Nature of Repairs or Alterations(Answer when applicable) :j szo 51 cAo-) -�[� �f�G✓19®�/S �✓� �� SFG�''r'' 4 s 5����, �� �/wJ 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 ealth. Signed Date 7 %j Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued No. t ! Fee1120., —_ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Di0pasa-6pstem Construction Permit Application for a Permit to Construct Repair(0 Upgrade Abandon Complete System ❑Individual Components i Location Address or L t No.9tj pp\*T�C6 �(i ue Owner's Name,Address,and Tel.No. Cc'^j i-cv V%11 Y Assessor's Map/Parcel C�`�j—o*;(z Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. ; Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grander( ) Other Type of Building (es No.of Persons Showers( t) Cafeteria ,r Other Fixtures Design Flow(min.required) gpd Design flow provided el gpd Plan Date 7 /2//q Number of sheets Revision Date Title f "' Size of Septic Tank �gj-I Type of S.A.S.�_<('�'j Cj aA n1 /� �2 U f Description of Soil `_� / j. Nature of Repairs or Alterations(Answer when.applicable) G�{ h ?, —6-cp 9 61&� f --7O 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 l Date Application Approved by Date x Application Disapproved by Date for the following reasons t Permit No. Date Issued ---------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS - BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) `Repaired( � Upgraded( ) Abandelied( )by c�J ;y . c .c at `G/ ,vl �?•�. r�o'er ��orvF//��/� p has been constructed in accordance with ie provisions of Title 5 and the for Disposal System Construction Permit No-.,)Of d ted Installer %�111 Z ,,��,.� L Designer iU// `t f.. ✓r l #bedrooms Approved design flow gpd The issuance of this permit shall of be onstrued as a guarantee that the systemffIet2ias igne t Date IO Inspector --------------------------------------------------------------------------------------------------------------------------------------- No.a D ( '' Fee j THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ' Disposal *pstr onstrUctlon Permit Permission is hereby granted to Construct( ) Repair(� Upgrade( }, Abandon( ) System located at Qj U j •�v{ / � _ /r d'C �vGr✓try t ?�,_. and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date —7 ( Approved by (VVrV,_` �_ 1 TOWN OF BARNSTABLE LOCATION I)( SEWAGE# oZO` -a V VILLAGE rp�Jf- V\� 'e ASSESSOR'S MAP.&PARCEL 1(9 63'_ INSTALLER'S NAME&PHONE NO OAC& (OW 0 Tk-NyC SEPTIC TANK CAPACITY !_1CISI'l�► LEACHING FACILITY:(type) CaCX0 G1\ - "size) NO.OF BEDROOMS OWNER 'D V\O 0 1 1� PERMIT DATE: '7—/3 -(Ej COMPLIANCE DATE: Separation Distance Between the: /tif GNP CceT_�M-e Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility crec Feet Private Water Supply Well and Leaching Facility(If any wells exist ow 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 how ?Ac L QJ -"D-q7 Town of Barnstable °fIK'O�ti� Regulatory Services P� Richard V. Scali, Interim Director BARNSIABLE, ' y MASS' q i639• Public Health Division `0m 'D�Evnnxt" Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 509-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 7-16—lb Sewage Permit# OLQC —A 2 Assessor's Map\ParcelJ_&R__02 Designer: nfj i c, //wor-ks, 1,7C . Installer: Address: I Z W, C(b e w P-14 Address: �,O Voy- IN S Ott �'� �� �.I�`I�) �J��l tic_ was issued a permit to install a (date) (installer) septic systern at 1(�q �j{ �-- f based on a design drawn by I e r ► +,eL (address) WCAU /11C; dated -7 �I2•—� j (designer) I certify that the septic system referenced above was installed substantially g accordin to the design, which may include minor approved changes such as Iateral 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 changcs (Le. 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 constructe nce with the terms of the I\A approval letters (if applicable) tam PETER T. M�£IJTEE CNIL nstaller's Signature) NO.35109 �FQISTER�� (Designer's Signature) (Affix Designer tamp 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. QAScpti6Dcsigner Certification Form Rev 8-14-13.doe Town of Barnstable — �y' Depart' C, ent of Regulatory Services. t$ Public Health Division Date 6- 7KAft 200.Main Street,Hyannis MA 02601 rED µpl A Y Date Scheduled / Time Fee Pd. :A_66 0 Soil Suitability Assessmentfor F Se e 1?ispos l �f�4d Performed By: l'�G!�vt T t.t; ' Jr`�Z Witnessed By: LOCATION& GENERAL.INFORMATION Location Address S� �ie.>�'Tree��. Owner's Name C�re�oy'y / (_e�vt" e,rV/,�� Address sq 7,rez D: �C'�' t Ile, Assessor's Map/Parcel: Engineer's Name�� L Gl�ks C. NEW CONSTRUCTION REPAIR Telephone'# -68 •- q — S-3 j_3 Land Use f Zes1 ,�FQ( Slopes(9'v) "Z Surface Stones . Distances from: Open Water Body A)dly ft Possible'Wet Are��ft Drinking Water Wei Drainage Way � ft Property.Line ft Other ft SKETCH:(street name,dimensions of lot,exact locations of test holes&'pert tests,locate wetlands in proximity to holes) 2 A� ................... Parent material(geologic) y J f5V` Depth to.Bedrock. Depth to Groundwater. Standing Water in Hole: ���Etd 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: Depth to weeping from side of obs.hole: in, Groundwater Adjustment Index Well# Reading Date: Index:Well leveler Adj.factor,,,,,-:;,, Adj..GroundwaterLevel PERCOLATION TEST ifttte ..� Torte Observation Hole# _Z {{ Time at t1" _ Depth of Pere. 2�t 'CSS.L1 Id'✓IS Tlme at 61' Start Pre-soak Time Q ��i/tQ� q '1 'lime(9'-6") End Pre-soak Rate Min:/Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation I-Iole 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:\SEPTIOPERCFORM-DOC DEEP OBSERVATION 'HOLE LOG Hole#„ � Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,% ravel TV 1.0 YSC6 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) ' ' (USDA) (Munsell) Mottling (Structure,Stoncs,.Bouiders. Consistengy.% rave '1 a-s 6 DEEP OBSERVATION HOLE LOG Hole# Depth from. Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consis.tellcy. Gravell DEEP OBSERVATION DOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,$oulders; onsi en n Flood Insurance.Rate Ma Above 500 year flood boundary No Yes Witlum50o year boundary No Yes Within A year flood.boundary No Yes,.. Depth of Mturally Occurring Pervious Material Does at least four feat of naturally mcurringpervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occumng pervious material? Certification +� ( � (date)I have passed die soil evaluator examination approved by the I certify that on ) P Department of Environmental Protection and that the above analysis was performed by me consistent with the required tra' g,expertise and experience described in a lO CUR 15.017 Signature Date Q:\.SBi'TICIPERC FORM.DOC f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information / filling out forms on the computer, I� use only the tab 1. Inspector: key to move your cursor-do not Shawn Mcelroy use the return Name of Inspector key. Upper Cape Septic f� Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 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 9-26-11 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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. a ****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 Inspection Form:Subsurface age Disposal System•Pa 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is Centerville MA 02632 9-26-11 required for every ' page. City1rown 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: r System is in good working order with no sign of failure. 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 exflltration 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-11/10 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 a 84 Bent Tree Dr �M Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 page. City/Town 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 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4�M 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 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 '/2 day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 page. Citylrown 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•11/10 - Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ` 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 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 (f 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 page. City/Town 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 years usage (gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: 8-2011 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•11/10 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 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: N/A 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 UA 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 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is Centerville MA 02632 9-26-11 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (f known) and source of information: 1994 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 42"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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 36"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: 1500 gal Sludge depth: 12" t5ins-11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal Syslem-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 0 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 16" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of-leakage. 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 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 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 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 0 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.): Good condition with water at working level and no sign of back-up from field. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 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 Forth -Not for Voluntary Assessments 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 1 0-i nfi ltrators ❑ 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.): Infiltrator leach field in good condition with no sign of back-up into d-box or surrounding sand. 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•11/10 - ,.. . Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I'I Commonwealth of Massachusetts W Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 page. City(rown 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �,M y 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 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 e a -D 30 9-0- ao' 'C t5ins-11/10 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 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar El Shallow wells Estimated depth to high ground water: 10 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 10'. 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 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 84 Bent Tree Dr Property Address Marguerite Moran Owner Owner's Name information is required for every Centerville MA 02632 9-26-11 page. CitylTown 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 Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BA RNSTABLE LOCk T'ION �3 �'1 T / r� SEWAGE VILLAOE Ce`'i �eT y .'j` ASSESSOR'S MAP Sc LOT f INSTAL)L EWS NAI1 ffi&PHONE NO. SEPTIC TANK CAPACITY /.�V O i• t�LEACHNG FACILITY: (type) r` �i' (size) NO,O bi6i&//I6V1JMJ_ 4.1 { BUELDER OR OWNER. j FE IT®ATE:---- COWUANC.E DATE: I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feel Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ' .-W- Feel EdSe of Wetland and Leaching Facility(if any wetlands exist within 300 feet o leaching facility) �-� (FNe Furnished by S C W n �i( `��/ v Kzeenr- c- - �... Q f V f 1 I ' ',0 30 ' a-p- Rot • COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 4 DEPARTMENT OF ENVIRONMENTAL PROTECTION � gee TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 84 Bent Tree Drive Centerville MA 02632 Owner's Name: Phillip Moran y Owner's Address: Same �•,L 3�f Date of Inspection: October 24,2005 Job#05-327 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 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: OFt�q�� i _X_ Passes •, �, Conditionally Passes Needs Further Evaluation by the Local Approving Authority = P RIC u''+'% Fa' M. i Date: 10/24/05 .w` Inspector's Signature: ---� %��j'�r�Fl�•' �. The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of 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¢ffice of Xjj� a DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the appr(:vipg authority. Notes and Comments: System in good condition,tank is not in need of pumping at this time of leachinco g system has no standing water. C3 21 ****This report only describes conditions at the time of inspection and under the conditions of pse at that . time.This inspection does not address how the system will perform in the future under the sam or di ff nt .rr conditions of use. Title 5 Inspection Form 6/15/2000 page 1 , . � 4 �` 4_ Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 84 Bent Tree Drive,Centerville Owner: Phillip Moran Date of Inspection: October 24,2005 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 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. 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: Tit1a G TncnantGnn T:nrm 411 VIAM 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 84 Bent Tree Drive,Centerville Owner: Phillip Moran Date of Inspection: October 24,2005 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: Titlr+G Tnenartinn 17nrm A/1 ci)nnn 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 84 Bent Tree Drive,Centerville Owner: Phillip Moran Date of Inspection: October 24,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. —X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this 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 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. Titles 4 incnartinn Fn—Oil u)nnn 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 84 Bent Tree Drive,Centerville Owner: Phillip Moran Date of Inspection: October 24,2005 done. You must indicate" Check If the following have been do es"or"no"as to each of the following: y Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? 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? X_ _ 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? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems'7 The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _X_ _ Existing information. For example,a plan at the Board of Health. 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)] Titla S Inenartinn Fnr 411 VIAnn 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 84 Bent Tree Drive,Centerville Owner: Phillip Moran Date of Inspection: October 24,2005 FLOW CONDITIONS RESIDENTIAL 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 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)): 2003—31,000 gal.2004—34,000 gal.=89 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,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: Tank pumped 3/5/02 Source of information: WPC Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM —X_Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _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: Compliance date: 8/12/94 Were sewage odors detected when arriving at the site(yes or no): No Titla S (nenartinn Fnrm(./1 S/7!1!1!1 6 Page 7 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 Bent Tree Drive,Centerville Owner: Phillip Moran Date of Inspection: October 24,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: 2' Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 2' Material of construction:_X_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10.5' long x 5.8' wide—1500 gal. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle:32" Scum thickness: trace 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: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Liquid level at bottom of outlet invert tees are intact and clear.Tank is not in need of pumping at this time Recommend pumping every three to five years. GREASE TRAP: No (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.): Titla G Tnonantinn Rnr tin r%iinnn 7 Page 8 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 Bent Tree Drive,Centerville Owner: Phillip Moran Date of Inspection: October 24,2005 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): No solids or high stains observed. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): T41a G Tnonan+inn Rnrm lii VIMA 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 Bent Tree Drive,Centerville Owner: Phillip Moran Date of Inspection: October 24,2005 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: _X_leaching chambers,number: Ten infiltrators. 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.): Observed no standing water in SAS. CESSPOOLS: No (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: No (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.): Titles G inenc+�tinn Fnrm�ii�nnnn 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 Bent Tree Drive,Centerville Owner: Phillip Moran Date of Inspection: October 24,2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. Bent Tree Drive Driveway Water service #84 24 26 3 41 1 Ten Infiltrators T41a Rnrm 411;1,)nno 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 Bent Tree Drive,Centerville Owner: Phillip Moran Date of Inspection: October 24,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 25 feet 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: 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) X Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el. 10 and topo map shows property above el.35. Titla G incnartinn Rnr (.il ai)nnn 11 TOWN,OF BARNSTABLE LOCATIciN ''i' ��y� SEWAGE # VILLAGE �z,�Tr"c��J�4¢, ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) lAlf:r- 44S ��®� (size) G r�,4 31, NO. OF BEDROOMS PRIVATE WELL (�R''PUBLIC WATER BUILDER OIOWN �� DATE PERMIT ISSUED: V/i��f� DATEr COMPLIANCE ISSUED: � VARIANCE GRANTED: Yes:' No Pq� �► TOWN OF B STABLE LOCATION 1 SEWAGE # 41 R,. � /c, V 1,LAG -7 ` ASSESSOR'S M" & LOT NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) > (size) NO.OF BEDROOMS BUILDER OR� PERMITDATE: COMIRL16,UCCE, DATE: ®� Separation Distance Between the: �' //t see- CAO� 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 i • i e No. '. Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS ,0 BOARD OF HEALTH TOWN OF BARNSTABLE /I ApV trativu fox Div.-ip t Sal Works Tomitrurtion thrmtt `b Application is hereby made for a Permit to Construct ( ) or Repair j) an Individual Sewage Disposal stein at: ..1.... .�� �-�-� -•--•-----...--•.....•••-•---••-•-••---•.................. .•--•-••••---•--•-•---•-•••-------•--•-----•-•-•--•-----•--•-•---...---- -•----------------•----• L ation. ddr,ss — or Lo No./fir''�f�1/r o���� _ 1 . �!!!I 4— v Ad ss �'/. �'/1 ....v�. W 1 Installer Address Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms------------. ------------------ ---Expansion Attic ( ) Garbage Grinder ( ) ok Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) A4 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. ------l.......... Width------46_-_-------- Total Length_ -j; Total leaching area....................sq. ft. 3 Seepage p ge Pit No........... _.... Diameter.................... Depth below inlet-----/........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water..................... Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a' ----•-•-----------------------•-----------------••-•-----••••--•-•-•-•-••-•-•------•-•----------•••.......................................................... 0 Description of Soil........................................................................................................................................................................ x U •--------------••-•----••-----••--•-•-••-•••-•-•-••--••-•------•••-•••••-••---•-----•--•----•-•--------••-•--------•••-----•-------------•-•-...-•••-•-----•---•-•--••---•••-•--------••-•-•••-•-•-•---- W ................----------------------------------------------------------------------------------- --------------------------------------------------------- ............................ UNature of Repairs or Alterations—Answer when applif ble_.1 �-u�_ 4-._._1.5 ......S 1. 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 h ee iss ed th board of health. Signed -- -------- ............... .... .. .............. �' c � �-------------' ---------- --Dare-------------'-- Application Approved By -----------( ..�c. ---------------------------------------------------------------------------- ------.Y..—.1L-.....��...C.�. Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------------------------------------------------- ......... ...... ................... ... . ............... . ......... . .............. . ........... ................. . . ---------------------------------------- Permit No. ...... L/.............�-&,:5_7 D------------ Issued ------------------------. ---------------------------Da----....... a[e �-, .�.. _ ©� 4. �� • . � - � �� . '..-,,.- �'. ����� 1�.,, ' _. 'ti. � � �, - `� -'a � .. ` t , K Nol.y...'/Z 5- F:zB...--s�a..�-.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �r r5j \` TOWN OF BARNSTABLE I A liratiun for Disposal Works C onstrurt"tun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (�,/) an Individual Sewage Disposal System at: / .r' �.o r% l>2,vim L ,�r�/�✓� ,�� ----------------------------------------------------------------------------------------------••• -•-----••-•-•----•---•---•......--•••-----...---------•........--------------•-•-•-•-•---••------- L ation- ddress �— or Lot No. ......................--- ••-•---•-------------- ------------------------------•-----.-...-----•---------•-------------.---- . ------- Owner W U/L c_tiT/ U - 7& Add ss Installer Address UType of Building Size Lot----........................Sq. feet ,., Dwelling—No. of Bedrooms--------------�.-_--_-_--.--_-------_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------------------- W Design Flow.............. ..................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity 9 gallons Length---------------- Width---------------- Diameter---.------------ Depth................ x Disposal Trench—No. -------/.......... Width......w------------- Total Length_4—?Z A Total leaching area....................sq. ft. Seepage Pit No............ y----- 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water-.-`--.---.-_---..---.-. 444 Test Pit No. 2................minutes per inch Depth of Test Pit_----------------- Depth to ground water........................ P4 •.......... ....................................................................•---...._-----------......................................................... 0 Description of Soil..................................................................................................................................... .................................. W U -------••--------------•---------------...-••----••-----•--•------•--•-•--•--•---••---------------•--•-----------------------------•-----•--------------••---•--••---•----•...-•--------------•----•---- W ----------------------------------------------------------------------------- -------•----------------------------------------------••----------------------••----•--------••-••-••-----•------------•. U Nature of Repairs or Alterations—Answer when applicable--JN-,5 _..._. �_._/......... .� !..`.........�.�-q�' --......-----../ .........../ lJ L __ Tl_. "D12�-- ln .Tr/-& , SZ 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-bee iss edfby the board of health. Signed .........._ -....%tic. -...... - w- ....... -------------------- Dace ApplicationApproved By --------- .... --------------------------------------------------------------------------- ........'.. 11..-..... c..�- Application Disapproved for the following reasons- ---------------------- ------------------------------------ ..---------------------......---------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ........ .................... / Dace PermitNo. ...... ...... ----------------- Issued ------------------------............................................. Dace ----------------------------------- --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 01Prtifirate of Q-11amplian e THIS IS TO CERTIFY,;That j4e individual Sewage Disposal System constructed ( ) or Repaired ( �) by ------------------------------------- f--- -Z%G l--l T 1 �G.�J ti1 c.7-r7 rlrl -- --- - - ...... - at ..... .. . t...t��..�.......... �--..._...._.'�J- N'----- , �c. _----------�-�-.1-�------------- �C' ta�f1--�L tJ�..t - ..� has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. _-. -----L/6... 7..7. dated ..._.-.--------------._-----------------_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE - ---------J 1...------------------- ------ -- Inspector • ` J....... J THE COMMONWEALTH OF MASSACHUSETTS /6 F V!, ) BOARD OF HEALTH / g TOWN OF BARNSTABLE No.-•f.•�!"--.'�!�_.S FEE..�2U.. .... � Disposal Works Tuntrttrtiun "rrutit _ Permission is hereby granted.............. f r-�: ?'!--._...._-----.................. .....� to Construct ( ) or Repair (',=) an Individual Sewage Disposal System at No. --------->�..................................c ' Street--- ---��....-----�)-2---J�<--------------- .. � L J►--t� aa as shown on the application for Disposal Works Construction Permit No.1_q_' __4_�Gated..__....e3...��-.el.f f........ ...............------•----------N -------------------------------------------------------- Q , !( ` Board of Health DATE................... `j ................................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS —99 ——EXISTING CONTOUR LOCU x 100.98 EXISTING SPOT GRADE W EXISTING WATER SERVICE G EXISTING GAS SERVICE H.W.—OVERHEAD WIRES TEST PIT JiJ�n BENCHMARK ti o P Ra LEGEND 0 0 3 r LOCUS MAP cN 1 I NOT TO SCALE 08.87 STAKE + 110.63 O I I � S EXISTING S.A.S..A.julk �2'3S TO BE ABANDONED OR REMAIN 1 40•• E CONNECTED WITH BULLRUIV VALVE, �� 00.3g• FOR FURORE USE 110.41 \ it 2 EX/STING SEPTIC` TANK y� 108. j4 TOP OF TANK, EL.=107.22 / I x INV.(OUT)=105.89f 107.36 � � 110.6 w 110,13 106.8 o :� LOT 7 x �2q° f ;gQ� �'f..:. o .: . �x 17,153±SF 106.41 109.65 �" : TP-1 o ...: x TP-2- BENCHMARK SHED COR./BOTT. STEP 111.25 EL.=109.97 110,01 \ x 108.69 105,73 \1 � N .L�.Qj�F.: . • �•.. _�___i__ i — ___ 105.96\ M 1 —� � 110.21 \ II \\ 108.36 110,17 +' J 0 (b II 43 — _ I 109.59 13M 104.91 \ C 09.97 I x�04,21 1 \ 108.6 —— \w I �\ DECK l0 1 I b7.8.4� EXISTING + 109,52 \ . 103.85 1� \ HOUSE (#84) I �• \ T.O.F.=109.9t �.107,99 \� RA �e GA GE 108.07 ` 0 6.\ 102.43 105�76 STONE:;:;• .; �_--\ . \ 84 01 — : ..0 `DRII/EWA Y:' I pc 108.12 101.59 f 107.46 edge of Pavement 102.09 —PI-N,gNDGAP 10,698 PK SET 102,48 Li 102,92 T PARCEL ID: 168-022 ot;.naspu ` PROPOSED SEPTIC SYSTEM UPGRADE PLAN 84 BENT TREE DRIVE, CENTERVILLE, MA Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 OWNER OF RECORD 35ti09 DUBOIS, GREGORY F & o Engineering by: SCALE DRAWN JOB. NO. SUSAN Gam` =20' P:T.M. 190-18 Engineering Works, Inc. 1 84 BENT TREE DRIVE $ 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. CENTERVILLE, MA 02632 '� �'Z (J (508) 477-5313 7/12/18 P.T.M. 1 Of 2 • NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:105.5 SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE INSTALL RISERS & COVERS OVER INLET PERIMETER OF THE S.A.S. AND SET TO 6" OF FINISH GRADE. PROPOSED D-BOX PROPOSED S.A.S. INSTALL WATERTIGHT RISER & PROVIDE ONE ACCESS MANHOLE TO WITHIN 3" T.O.F.=109.9t COVER SET TO 6" T GRADE OF FINISH GRADE FOR INSPECTION PURPOSES F.G. EL.=109.0t F.G. EL.=110.5t VENT F.G. EL.=109.6t � F.G. EL.=110.3t MAINTAIN 2% GRADE (MIN.) OVER S.A.S. j L = 44' L = 23' ® S=1% (MIN.) @ S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 6" U-it0"I 14" G BBB®BBB EXISTING 48" LIQUID aaaaaaa LEVEL } 4' 4.8' 4' J INV.=105.40 PROPOSED INV.=105.23 INV.=105.89t D-BOX EFFECTIVE WIDTH = 12.8' (EXISTING-VERIFY) INV.=105.00 EXISTING SEPTIC TANK 3-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-20 RATED NOTES: TOP CONC. ELEV. =106.1 t 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BREAKOUT ELEV.=105.50 00=105 ELEV. . ease INVERTS, PRIOR TO INSTALLATION. INV. ease eases aBaaa ease eases 2) SEPTIC TANK AND D-BOX SHALL BE SET LEVEL AND BOTTOM ELEV.=103.00 TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX 4' 3 x LS'-95.5' 4' INCH CRUSHED CRUSHED STONE BASE, AS SPECIFIED 4' MIN. OF NATURALLY OCCURRING EFFECTIVE LENGTH = 33.5' IN 310 CMR 15.221(2). PERVIOUS MATERIAL 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' MIN. ABOVE GROUNDWATER LEACHING SYSTEM SECTION 4) CONTRACTOR SHALL INSTALL A GAS BAFFLE ON THE BOTT. OF TP, EL.=98.0 - OUTLET TEE. 3/4" TO 1-1/2" DOU13LELJ WASHED STONE 3" LAYER OF 1/8" TO 1/2" SEPTIC SYSTEM PROFILE DOUBLE WASHED STONE (OR APPROVED FILTER FABRIC) BACK GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL I ECK BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: -310 CMR 15.405(1)(b): 1) A .2' variance, depth of cover„ for a up to 5' of cover. _3,. THE-SEWAGE-DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. gyp, 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING $//ED o FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN d's ENGINEER BEFORE CONSTRUCTION CONTINUES. �q, 51--,% 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 1� / \ �\ 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF // 20)•_`` THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OFYY HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. Gj 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. �'//ice C3;0 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. CV5 / 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS OQO/,�� AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. /S.A.S. LAYOUT 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. SOIL LOG 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). DATE: JULY 9, 2018 (REF#15,703) 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE SOIL EVALUATOR: PETER McENTEE PE(SE#1542) INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND ELEV. TP-1 DEPTH ELEv. TP-2 DEPTH NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 110.2 q 0 110.0 q 0.1 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC LOAMY SAND LOAMY SAND SYSTEM COMPONENTS NOT SHOWN ON THE PLAN 109.5 10YR 4/2 10YR 4/2 B g" 109.3 B g" LOAMY SAND LOAMY SAND 106.2 -10YR 5/6 10YR 5/6 DESIGN CRITERIA 48" 'D6., 47" C C PERC NUMBER OF BEDROOMS: 4 48"/66" SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN MED. SAND MED. SAND (0.74 GPD/SF LOADING RATE) 2.5Y 6/6 2.5Y 6/6 DAILY FLOW: 440 GPD DESIGN FLOW: 440 GPD GARBAGE GRINDER: NO LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF 98.7 138" 98.0 144" .74 GPD/SF PERC RATE <2 MIN/IN. "C" HORIZON EXISTING SEPTIC TANK: 1500 GALLON CAPACITY NO GROUNDWATER ENCOUNTERED PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 3-500 GALLON LEACHING CHAMBERS IN SERIES SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 84 BENT TREE DRIVE, CENTERVILLE, MA SIDEWALL AREA: 2(12.8' + 33.5') x 2 = 185.2 S.F. Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: 12.8' x 33.5' = 428.8 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:..............................................................614.0 S.F. Engineering Works, Inc. N.T.S. P.T.M. 190-18 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(614.0 SF) = 454.4 GPD (508) 477-5313 7/12/18 P.T.M. 2 of 2