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HomeMy WebLinkAbout0097 BRALEY JENKINS ROAD - Health 97 Braley Jenkins Road ONE Centerville A= 171-137 s S M E A D No.2-153LOR UPC 12534 smaad.com • Made in USA fevc FORUSMNDOPSgp OLM OFMSFIPWMW 0 W W WSRPROC+RAM.ORC t Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 97 Braley Jenkins Road : Property Address John & Mary Lieto ? Owner Owners Name information is Centerville Ma 02632 9/22/2018 required for every page. City/Town State Zip Code Date of Inspection {5 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 u�q A. Inspector Information �� 1 !3 on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Company A Lane Co ,my Company Address Centerville Ma 02632 City/Town State Zip Code 508-658-3456, 774-248-4850 SI 4522 sean@smjonestitle5.com 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 9/22/2018 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 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 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: The dwelling located at 97 Braley Jenkins Road is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 2 precast leaching chambers. The system was found to be in proper working condition at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form !le Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 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 '/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form IP F, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M, 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 331.5 gpd provided Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑' Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: 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 �n p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 page. Cityrrown 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: system repaired 4/16/2002 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.5 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.): Joints ok, no leaks or blockages. Vented through roof t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? opened covers and took measurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Outlet cover is on a riser. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 L Commonwealth of Massachusetts ja Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 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: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9P 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owners Name information is required for every Centerville Ma 02632 9/22/2018 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.): s.a.s. consists of 2 precast leaching chambers. Leaching facility was found dry at time of inspecition with a stain line 6"from bottom. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 page. Cityrrown 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 pfi Nr O Gib fl .4 1 30 b i 30%, AZ 7,y'(o 6 t 3s'(, A3 /it, G 7 qs AY i5 6Y 53 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 page. Cityrrown 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'+ 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: Groundwater elevation was established by accessing Town of Barnstable groundwater contour maps. 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 L Commonwealth of Massachusetts 1 Title 5 Official Inspection Form 1- } Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �r 97 Braley Jenkins Road Property Address John & Mary Lieto Owner Owner's Name information is required for every Centerville Ma 02632 9/22/2018 page. Cityrrown 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 r Commonwealth of Massachusetts Title 5 Official Inspection Form - - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 97 Brailey Jenkins Road Property Address Lieto Owner Owners Name information is required for every Centerville MA 02632 2/21/2014 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. General Information on the computer, use only the tab 1. Inspector: J key to move your I cursor-do not David B. Mason use the return i Name of Inspector key. David B. Mason V�I Company Name' 4 Glacier Path Company Address East Sandwich MA 02537 Cityrrown State Zip Code 508-367-1617 S1287 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 N // �wD`'� 2/21/2014 Inspec ors�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 appropriatereg�iortaj office of the DEP. The original should be sent to the system owner and copies se tithe buyer applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that ti e:This ins pecti' d es not address how the system will perform in the future under the same o1 diff re f cd difiNs of use. t5ins•3/13. Title 5 Official InspectiVForm: bsSewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M ,•''r 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every Centerville MA 02632 2/21/2014 page. Cityrrown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The information and observations noted in this report represent the condition of the system only on February 21 2014 at 2:OOPM. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal p g pos System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every Centerville MA 02632 2/21/2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every Centerville MA 02632 2/21/2014 page. Cityrrown 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 El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every Centerville MA 02632 2/21/2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every Centerville MA 02632 2/21/2014 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 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 ,M 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every Centerville MA 02632 2/21/2014 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2012; 52,000 gallons and 2013; 45,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary wasta discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every Centerville MA 02632 2/21/2014 page. Citylrown 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: board of Health Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every Centerville MA 02632 2/21/2014 page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: April 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 28"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10 feet Comments (on condition of joints, venting, evidence of leakage, etc.): No negatives observable Septic Tank(locate on site plan): Depth below grade: 30"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: Typical 1000 gallon tank Sludge depth: 3" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every Centerville MA 02632 2/21/2014 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 38" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Scour Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No negatives observable. Effluent level with outlet invert Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every Centerville MA 02632 2/21/2014 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every Centerville MA 02632 2/21/2014 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 Effluent level with outlet tee 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 observable negatives Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 97 Brailey Jenkins Road Property Address Lieto Owner Owners Name information is required for every Centerville MA 02632 2/21/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): 2 500 gallon chambers with 4' stone around. No indication of ponding. No excessive vegetation growth. 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 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every, Centerville MA 02632 2/21/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every Centerville MA 02632 2/21/2014 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 I I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every Centerville MA 02632 2/21/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 14+ 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: 2002 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Abutting information on file ® Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 97 Brailey Jenkins Road Property Address Lieto Owner Owner's Name information is required for every Centerville MA 02632 2/21/2014 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 77 'WNL OF BA—iSTAi3if SEWAGE#_ 7r—141 y GL i F -- �'--� �i3T.a:.t,$R'S NgA.q�G?fiONE YO.12cib�N cc�,. s�p1 G r.Mst talDnCr—,Y_ NC, OFBF„DROO!'15 ` RU'LUER OR O"TR. F(/rT S 1j �iAi f'L�rrrnn 1�: � I C�MPLdAtiCE OATS: +Lj /o SePoraton Di;casec qe �lnzinu, m Aajuaed fJrp:.tIldW!c-T,,ki�] Rrivstc}Te(er Su Iv"V ".._• I r?. tL'aadLexfuce Rati:i. o:t 7 (�irAnr wcl's etis: E•7gc of wei!an:l d,,�.:�ctn: 300 feet r,iear Ali' L�,.+eflawu ets. " 21r$f+tility) i i 141A f /f'�7 I I i � I i 1 � l� 1 J I Fee $No. 'n / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS 01ppIication for Moaal *pgtem construction permit Application for a Permit to Construct( . )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 97 Braley Jenkins Rd. , Centerville M. Dumas Assessor's Map arce Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Daniel Johnson P O Box 1089, Centerville 804 Main St. , Osterville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Residential No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 310 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets 1 Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil: coarse sand Nature of Repairs or Alterations(Answer when applicable) replace failed s a s with 2 dry wells ( 25'L X 12 'W X 2 ' H ) keep xistinQ sc—tic tank Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by this Bgdrd of Heal Signed c Date © , Application Approved by Date U Application Disapproved for the following reasons 0 Permit No.era y� ,�� Date Issued � vM . _ ► - 2©fly yC1 ` No. Fee$5 D THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:• V ✓ -. Yes ' kpUBLIC HEALTH,DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS, . . 0[ppYication for Dtgaar *potem Congtruction Permit Application forla Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System L1 Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 97 Braley Jenkins Rd. , Centerville M. Dumas Assessor's Map/Parce , Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Daniel Johnson P O Box 1089, Cenbbrville 804 Main St. Osterville ape of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Residential No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets 1 Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil coarse sand Nature of Repairs or Alterations(Answer when applicable) replace f ailed sas with 2 dry wells ( 25'L X 12'W' X 2 H ) , keep existing septic tank- 4 y s« Date last inspected: a ' Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by Vs Bo d of Heal h. oo Signed j Date ii )� Application Approved by �x—1 A,.. Date 1 Application Disapproved for the following reasons Permit No. 7 G o? I P7 Date Issued v ------------------------ THE COMMONWEALTH OF MASSACHUSETTS Dumas BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( Upgraded( ) Abandoned( )by Wm. E. Robinson Septic Service at 97 Bralev Jenki nc R3 . Centerville has been constructe i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.�r1 u - y1 dated I 2 Installer Wm. E. Robinson Sr. Designer Dan Johnson The issuance ofIstnt t shall not be construed as a guarantee that the sys will f g ction as a gned. Date Inspector —� — y. Fee— — — -------------- -- N. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Dumas liopoal *p$tem Con$truction Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 97 Braley Jenkins Rd. , centerville and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Cons ction must be completed within three years of the date of this permit.. Date: Z Approved by C� r 5/?S/Ol NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated `�f 5'l o� , concerning the property located at meets all of the following criteria: • This failed system,is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable]' Please complete the following: A) Top of Ground Surface Tlevation (using GIS information) 5-6 B) G.W. Elevation 35 +adjustment for high G.W. 43 DIFFERENCE BETWEEN A and B /3 -X SIGNED : ' DATE: S��y��� NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder.percexmp F TOWN OF BARNSTABLE LOCATION 97 AeA le/ T3 injs 6A Q SEWAGE # Q00c9- 1Y9 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Ratoto-3-pK4 Skt2f�C 77S'-2776, SEPTIC TANK CAPACITY 11,000 LEACHING FACILITY: (type) (size) 12 )(.1 S a2 NO. OF BEDROOMS 3 BUILDER OR OWNER mi4,7-CE(tA5 bo^c PERMIT'DATE: o /o"/B x. COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ® „? V ` LAD LOT 286 f LOT 285 LOT 28.3 25: 16 DECKS LOT 282 0 O 46 O O 14 37t 0 to N 13 N 19 LOT 284 M 12 00 BRALEY JENKINS ROAD RES.ZONE: RC FLOOD ZONE: C THIS MORTGAGE = NSPECT I QN PLAN IS FOR TOWN: CENTFRVILLE E3AREGISTRY OWNER: S.L.S. REALTY TRUST NK •USE ONLY DEED REF: BUYER: MARCELLA DUMAS a BEVERLY SHUMAN DATE:• 11/22/88 - PLAN REF: 306/22 SCALE: I '= 30' ere y certify that -t a building shown on this plan is located on EAN OF M VANKEE SURN/EV the around as shown. ;nd 3°�t ' �► s9 CONSULTANTS Position does �: cantor= to the zoning law' setback requirement of PAULk yr, ?0. RASPBERRY-LANE BARNSTABLE - MARSTONS MILLS and does not lie within the special y MASS 02648 flood hazard area as shown on SS1�P th •u•d. 'flood map dated lgNO SURVEy�� This P n n ade from an instruaent Paul A. Merithew, :'PLS survey , not to be used for fencer. eLe 8818 I TOWN OF BARNSTABLE LOCATION 9-7 6,ejA16V 7f�AALtws ROAD SEWAGE # a00,9, /Y'F VILLAGE ASSESSOR'S MAP & LOT 71 I� INSTALLER'S NAME&PHONE NO. _4ZG'6"S0Kj 5E12+1( 77.S'—'9776 h, SEPTIC TANK CAPACITY 1 a oo LEACHING FACILITY: (type) a 17i��/c,. �S (size) i 2 X ,1 S)(1Z NO. OF BEDROOMS BUILDER OR OWNER MA17—ce(64.5 DU111,4S PERMIT DATE: yI/1o,; COMPLIANCE DATE: �ZIG/O;L Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist g 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 Llama ' t7 No. .......... Fim$ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ApplirFation for Disp ti al Works Tonstrudion runfit Applicationxis hereby made for a Permit to Construct ( � or Repair ( ) an Individual Sewage Disposal r Syst at: ..... --- ------ ......... ocafj Address or ot io. W �/���N �1--. f��� �dress 2 �• woe �%/f - M Installer oiu Address / U Type of Building Size Lot.���_-4.5-__._Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attie` Garbage Grinder-+­),�-- at Other—Type of Building __l_._.4—. '"_' fiTo. of persons....... s--__-_-._______ Showers ( - —Cafeteria-(­� Otherfixtures ------------_-_- •--- --------------------------------------------------------------•----•-------•----------••--•-•-•-•---------•------------ W Design Flow...................... ....gallons per person per day. Total daily flow.__.....:.�� �_._ ........_......gallons. .�uq VRdV � 2r/ W Septic Tank—Liquid capacttyl__.__...gallons Length________________ Width._�_�..._ Diameter................ Depth:,�_._._ x Disposal Trench—No.................... Width.................... Total Length..............1 Total leaching area-----.-.__�_�__;-.`..� ft. Seepage Pit No.=_..:._�............ Diameter... �(_..... Depth below inlet__i��..... Total leaching area•.�` .sq. ft. Z Other Distribution ibox ( L4--` Dosing tan,- '-' Percolation Test Results Performed by.........------:�%.... ,.a Test Pit No. i...___'..__.___.minutes per inch Depth of Test Pit_lz�........ Depth to,ground water.... �_..__.___..�. P� Test'Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to•ground water........... :... '.__.. P4 ' •-•---••----------------------•• ................................................ Description of Soil -' Z.----•---- ................ V -•-•-•-----------------•••-•--•-•-•....-----------------•----.....------------..........-•-•---•-•-••--•-•------------------------...-•--•------=--•------......------..._...-----•----•----------- W , x •-•-••-•••-•---------r..---------•-----•-•....--••--••-••------•-•••-•..................•------•-----.._..--------•-----------.....---•--------------......-----------------------•-•--•---•--•---•••- U Nature of Repairs or Alterations—Answer when applicable____--•--------------------------------------•:__.__._..__...__...__._._.__._......__...._.._.. a -----------••--•-•---------------------------------•---------------•-••-------------------•---•--•---•----•------......-•-••••................. Agreement: , The undersigned agrees to install the•aforedescribed Individual Sewage Disposal System in accordance with the oprovisions of iI't1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until,,a Certificate of Compliance has been issued by the board of health. h Signed...7, -------�,�,�.,-------------- Application Approved BY (? -<:2..A ---------•------••-----•-•-•------------------ _,_�! r Date Application Disapproved for the following reasons:.............................................................................................................. -------------•-------•--------------------••----•--•------------------------...---•--------•• }fvwr . Date Permit No.......... �5 ..........................._ Issued-....................................................... Date � y t J) r t s r FEE.............."'-� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 3 T U i/vA,..' ApplirFa#ion for Disposal Works Tonstrn.rtion 1hrmit Application yip hereby f�a_Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .},�s 4T ca � c� � Lam/-a / � `J �.-�` -•� �2 -�Z: ....--. ......................................... -----••----...................._...-----------........... ...---- rLoca' d-Addrr—eVss L` —^�' / ..._ V . -�n ..........................� ors---t---•I4•-o-.------------ .----.----.. Address ./..-� // Installer Address /ZT-0 Type of Building Size Lot............................Sq. feet a Dwelling—No. of Bedroom..... ..................•...............Expansionn,,�Attic'() Garbage Grinder p, Other—Type of Building ...................... No. of persons............................ Showers ( ) — Cafeterias-) aOther fixtures-----.. ................................................................. ...........................----------------•---------.-------•----•------- d Design Flow...................:5_' ...........gallons per person�,per�day. Total daily flow-------: .:�...�.....•...__... 11on� i C)C)O 8 Septic Tank—Liquid capacity............gallons Length.............•.. Width-_--- Diameter................ Depth......_......... Disposal Trench—No..................... Width 7.�............. Total Length.....�...�Total leaching area..... } sq:ft. ..Seepage Pit No_____________________ Diameter...- ...-......... Depth below inlet........'_____..... Total leaching area..................sq. ft. Z Other Distribution box ( L)/ Dosing tank('`) '-' Percolation Test Results Performed by._......'�-�.:`� "'.. W � . .......--•---------------------•--------------- Date-----------..........----- ---- � - Test Pit No. 1________________minutes per inch Depth of Test Pit--7 ___7.......... Depth to ground water----� ---- }. 0:4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q'+ --•••••-•••••-••-•--••---•••--••--•/----•-•--------------•-----.....--..........�._...• ..- . O P -- � . � �. ..f------------- Description of Soil----------------------•-................. ...--- -----..••--•--•------•••-•-----------• -•�------ . „._.. W UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: C"4 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT : 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. _ .... ...... ----------------------•---------•--------a "I14 Application Approved By Ate-- ........................'R = .......... ........................... Date Application Disapproved for the following reasons:.............................................................................................................. ..................................•-----....-•--•--•-•------------------------•---------•--•----...•......---...---..._........._.....-------•----•----------------------•------••-•----•-•----....------ �" Date PermitNo......................................................... IssuecL--................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF..................................................................................... Qrr#ifiratr of ToanpliFatta THIS IS TO CERTIFY That theIndividua; Sewage D'sp sale 5,�-sum constructed ( `�or Repaired ( ) n1 b --------•-----------------------------------•------- �Ut--- 1�� '. - . ._... �. c..�...Y. 1_ r a // Installer s ,, C,C/,]I!C, V l l..-(—C± has been installed in accordance with the provisions of TI�ofe Skate Sanitary Code as debe m the � a-75 application for Disposal Works Construction Permit No_____ .................................... E THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO TRUE® AS A AANTEE THAT THE SYSTEM WILL FUNCTION S /H-S CTORY. aC:,: . .. .. f DATE.................../r_ -r�,f.._ . ..-•------•-----------. Inspector..... C ---;. .............. ....................... THE COMMONWEALTH OF MASSACHUSETTS J� BOARD OF.� HEALTH ...............OF..................... .................................................... No............ --:...--- FEE.....::............ * Disposal _. orkg Tons#rnrtion �eraatt� ���� � c-k�.. Permission is hereby granted -.... to Construct ( r Repair (( an l�an.-Individual Sewage s oos stem G�'T" 28A C '( �xJa �� L�JZ2Vr atNo............................................................•- -••--•---•-----••----•-•-----..--••-•......---- Street as shown on the application for Disposal Works Construction Permit No Date ................ � .......... © ••-•-•--•................................ Board of Health DATE-------------- ---.. ----� .-- ---�- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS y OWN OF BARNSTABLE LOCATION I O VILLAGE CQrL2C ASSESSOR'S.MAP 6z LOTM �� 7 ch INSTALLER'S NAME & PHONE NO. e'Y SEPTIC TANK CAPACITY `O O O LEACHING FACILITY:(type) (size) 604-:) NO. OF BEDROOMS _PRIVATE WELL,OR UBLIC WATE BUILDER OR OWNER DATE PERMIT ISSUED: G DATE COLIPLIANCE ISSUED: l s- F VARIANCE GRANTED: Yes No �-- �r e vat 3 f act" S VL LEBEL SOLLOWS DEVELOPMENT CORPORATION, INC. 362-9411 131 Old Route 132, Hyannis, MA 02601 December 3, 1987 Mr. John Kelly Barnstable Health Director Barnstable Town Hall 367 Main Street Hyannis, MA 02601 RE: Lot 283 Braley Jenkins Road Dear John: This is to certify to you that I have inspected the installation of the septic .system by Hickey Construction at the reference site: and found it to be contained on the lot as proposed. (See attached plan) . From my inspection, it appears that the abutting property owners have encroached on the subject property with their lawn and thus their concern when the leaching pit was placed right next to it. If you have any questions or if I can be of further assistance, please contact me at the above. Sincerely, Cra' R. Short Chief Engineer Lebel-Sollows Development Corp. , Inc. CRS/cm cc: Hickey Construction I s;- ry NW (///�] �. �QV CE RT [ FI ED PLOT PLAN L0CAT10N:CE•�/T ,�lJIGGE��iq• FOR* G Sc3 G.Go�JS �Gu,OE.'y7���p.��0 SCALE: / = �" DATE: REFERENCE �/ jz=-/ ,-/G G,o S I CERTIFY TO THE BE F MY KNOWLEDGE AND BELIEF FROM INFORMATION RC IRE THATTHE/`--oy•y0-47-"0v SHOWN ON THIS. PLAN S L CATED 0 -E GROUND AS SHOWN EREON, OF JOSEPH AT P E SSl O N AL LA,lIfD . SURVEYOR M. =� MONAHAN, JR J. M. MONAHAN JR. & ASSOCIATES No. 1 ° , PROFESSIONAL LAND SURVEYORS & ENGINEERS lyISTE��,��` TOWNE PLAZA - 900 ROUTE 134 SOUTH DENN.IS, MA. 02660 SUS '. J.N. 87- ii� ssz - - r .., .. ..: .. ,, '.. .:: A ..,;.., ., ., a •. .:., S01 L L' OG"i , _HATE- WITNESSED BY. 47 • j 04 , I G � 7- 2 Al46 Ou 0. w �t Viz,3 AG 7- VRl : + J� � Z :p` ELEV. TOP OF FOUNDATION i►�tA'NHOLES AND COVER TO BE BUtL't WITHIN t,l • - ��, -�,' t2" OF FINISHED GRADE . `+. . . FINISHED- § RADE .IAA t N. 2 SLOPE 1 � '�• ' ,✓r''` of 4"CAST tR0 OR ., ., ,..:.•.... :.. PVC 40 tST ' PVC - SC ° < PVC, CH. 40 _w r !�`fTCH i f -�' i`+/ !A- FT.. 2 LEVELS tDto r MIN. a LAYER 1r) rz 6Z 0 1/,�!#T z's, ! _ I NVf RT GALLON - INVERT !3T INVERT ^ 1 �. f/1 VO ; tr n 10 BoX ;OC3 , a., 34 - 1 2 :DIA. ;. INVERT CTANK ' ' �C a / , . SEPTt .a t. I ;. .. INVERT AS 17 INVEtt"t,,'; n w At"L RO N r... - 10 A{3 E GARB a- ..t< =; ELEV. OTTOtut - fvtlN. GRINDER . ... _ �7• „� • 20 IUtfN 1 a , -- r —xi, �—. hbt E CE V. PROFtL. E OF GROUND WATER fiABLE 39.c r = �" " # SANITARY DiSPQSA ,.. SY EM I I NOT, TO .SCALE. DESIGN DATA BEDROOMS CONSTRUCTION OF ' SANITARY DISPOSAL DESIGN F LOW . GAL. DAY I4 Zvi � 47 � SYSTEM SHALL CONFORM TO MASSGAL.,� LEACH RATE �-- M1N.' INCH E NVt R0NME-NTAL CODE ` TITLE V (REVISED 7—I - 77� 1 AND THE TOWN OF "'�y°' ", .�•.' PROPOSED LEACH CAPACITY ; HEALTH s a I y SEPTIC TANK; DISTRtSUTtON BOX AND LEACHING PITTO BE OF REINFORCED CONCRETE : GAL. DAY � MIN. CONCRETE STRENGTH 3000 PSI , MtN, STEEL' STRENGTH 2O,0 OOP 5t H to DESIGN LOADING • DRIVEWAYS NOTTO` BE LOCATED OVER . SYSTEM UNLESS H- 20 DESIGN LOADING IS USED. #L'LP-1PE'S 'A`ND F {TTIN"GSTO BE WA'TERTIG`HTAND TO„ BE OF- CAST IRON O'i� SCHED,' 4O P,V. C. , SATE P1.: A t` SH. . 0F .. . sHs S .HOWI [ G PROPOSED CGNSTRUGT_10N LEGEND <a c �a't ". ... -,. 7- -, V _ .� r F C,1 R _ . R ,0 19 BOAR D OF A s c �. H E LT 1 D A`T E PER _ __ .�. f2EFEVE CE: �' ,r BUILDING SETBACK REGULATIONS EXISTING CONTOUR t6 BUILDING INSPECTOR IN' P CTOR R B UILDUNG „O P CONTOUR _. _ RO POSED _ i , . - .DATE -:; : AGENT ,�,,; 6 e . E N ., 3.. COMM { SS { ONER . � `, , -EXISTING SPOT E L E:VATION 17, ro MIN. FRONT SETBAC K ,* f ICE C PRt� POSE D WATER SE#�V W . . � .a . ivtlN. t E SETBACK ,. _ _. 5 D s�, 41 TES r HOLE LO CAT tO N MIN, REAR SETBACK ' Rep 0 T . �rO L7— �r P R OF E S S I CJ t�A L. ,L A IV DS t,�t R '�O R S B� E N G t N E E ft 5 0,� 58$ MAIN' STREET RTE.-6A AST aENNtS-' MASS ' Elm DISTRIBUTION BOX H•10 S S/ta. REMOVABi.E CAPER 'SCH 40 OUTLET LATERALS DISTRIBUTION BOX TO MEET SHALL SE SET LEVEL FOR A 1 TEST PIT DATA REQUIREMENTS OF 310 CMR MINIMUM OF THE FIRST TWO 15.232(WATERTIGHTNESS, FEET AND CONNECTED TO CONSTRUCTION,ETCJ. 2" EACH DISTRIBUTION LINE I Performed B , Daniel WITH SOLID SCH40 PVC PIPE y� B. Johnson NO.OF OUTLETS: 2 4"SCH 40 6" Date: March 26, 2002 00 0 6"(MIN) o'� MECHANICALLY CRUSHED 0 o STONE(<•3/4 OIA.) TP-1 (EL. = 97.8) STABLE LEVEL BASE 0�� 6" 0/A, 10YR3/2 T oarny sand '98 E - 2 6" Bw 5 R5/8 Loam LEACHING DRY WELLS •5W GALLONS ,� sand g�SA 4 isr��G 26" - 48" Cl, 2 . 5Y6/3 Loamy sand „ENO"CROSS SECTION Iv8"Obse2" C2, SHWTYB/3 Coarse sand I T, MODEL SHOREY PRECAST CONCRETE No Observed_ Groundwater r FiNAZ GRADE TO 8E STA81L¢ED p� E A0, „ � �.��c FlNiSHED GRADE(5LOPE �.fl2) PERCOLATION TEST DATA o �Ep?� rA�KS / = y?� SF+cM1�7� i ` = 12'(M!N) 1 _... H -10 Ma c ; 26 2002 0 0 �, t �ENL�N+AoLi( � SSW � •, , _.. `- � it / i� /g_ .� )<!atP: r� !' � � f` -roo. c �t9 ga+t c ca © r /4'•f/2"DOUBLE --� BEN LEACHING DRY WELLS 2 ' 04 tC.- ,2 - bA, L-P9LL5 B'S' LX4'1WWX2'1"H WASH PEA STONE p, P srEa To ra4 ; `_ �� ._ .. �s'�x �z'w xx'� Soil Class : Class I (0.74 G/sr) - 4' © c� c .� c� 4' C"C,-L.4LL� Pere Rate: < 2 MPI 'T`'-ILj OVERALL LEACHING AREA 3/1"•f 1!2"DOUBLE 25'LXf2'WX2'H o � � 21�� Q Q � WASHED STONE v.•,T t i s.,oj Depth c:f_ PerC Test : 48" moo' E a �p,{.k� ��» �oJl� A� _.________._.T.___.. .._._..____ . SCE ULE OF ELEVATIONS 8'6"' TO lMPLYIoTSOFNG DRY WELLS \ + � _. ._ .__... ._ __.._.._._W..._s__,._._..._ TO COMPLYWiTHTHE REQUIREMEN 310CMA15.252 k"oundation FfEl���.bt � r^, Irty, Out (e.�:t5tina 5 I _ t e 9 Inv. }r Septit. x tLR �_,. ...�- Tanl. (e g} , } O In�.r +�k. SeG�t1.�:. Tank rex }� �N Inv in Di + ' ) 1 t r , y; . 80 .. E�A� Inv. Out Distribution Box 94 63 inv In Dr . y Wells A4 . S5 } Bottom of Dry Wells 92 . 55 B`attom(TP-l } No pbs . Grp/ESHwT 96. g 1 . Ali construction methods shall conforn� to the Title V (310 CMR 15) and the Barsntable Board of Health Regulations . There are no known private or public wells within 100 feet/400 feet, respectively, from the proposed leaching F�xisting Contour 98 4 area . i . . Prcprased Contour -.,... ._., 3. Existing SAS to be pumped and removed prior to Test Pit installing the new septic tank/pump chamber. Finished Floor EI(-•vAtion �'tB No changes are to be made in the field without the approval cf trie Board of Health and the design engineer. �rZA(.L y JF.N K►nl S �oqA Basement I"loc�r Elev S a+_ic�rD 5 . Proposed leaching area is not designed for use with j Water Line ___�__ garbage disposal. . Ga3 Line ----G �_____ t . Contractor to notify Dig Safe 72 hours prior to constrI:sticn. (800) 344-72.33. - 7 . Property line information taken from Plan Book 306, plan 22 . .Deptic Plan} not to be used as a pr,5perty line survey. 8 . vv _ izontally around the roposed leaching area _.,.._. .._.._.�......_______...___.._...._.......� - _ ,... Remo P 5 feet h o r ' p ot? ti `, and vertically, appro4imately 4 feet (topsoil , subsoil , C1 loamy sand layer and zany I each.11:e� impacted sC i -turn tr,=. �'X2R`. ing SAa '3f.C� rF�pl ` ill kRF'fr w45M fy^� t+ODN PENNY to 3l0 LNSR 1.�, 255- for r pec..ifa.�.at 1C7RS C)1r fill ( nd) • Leh , - ; z total amount of fill rer= red is approximately 20 c.ubic O�__ " ?Y a o ; ? r __.....__ Ya rc3 s_ SC�+LE: AS .fhnn/ o ,•.�� r�r� �f� T,•��� I 0 Q' 'EO_G 2 I W 0 ° V NEXEMS' NA LA 4% S...f1LC•VLAi'1Vl�S 2 �° e Y c,q o yit z SNUDAA h z y j 6l �u �- r .3 Bf- i � 3 L M a t � '� �_ r rooms (EY.ist nr.l) i y �° 1 i0 C,PD/Bedroom X i k?eUrC` lffls 330 CPD LAZAAus 2 Percolation Rate - < 2 MPI (TP-1 ) 2 : ioYEic R� d i L OGu S +�E i 1 Its OCAS Soil Class : Class- T (0 . 74 G/SF) 7' W Eb EN sMi1N RD ' y 00� W VElu o 0 0�` �Y�'fU�, i3t yp Z= cAa 6� << 4"SEff Q, ,f`a r? a DAvI R.O w NEy Z r hp91% ` 11 k:'ROP SED LEACHING �: �— * G'APT N L3°N�Y _I_ ._RA SDI+MON-Mmmm p " vR�£ W''-• --- t EM1 yx O DEARsC RO I 4hf I ��D00 f 0.nCa w LA 7 Ni<! r ' � �ARtE TON l..'ry YYe.LIs: G tit G5+ L 11 ,L,�'.y' 1�A ,ti G1 (: j0� P cxoserW -. .sra v _ 0 e / :_ O OS Y 0 E� 6aCwr �� de A.rea�: i 4 .] h C1• s f �� + P i 11 MAX sN p, t. ,p• 3.��tal � i9+shy 7pMt � Q' (�~Gw�F �hQ��i` TatalmL�r�l��E14���...+:��cs � �9 p 9J y tA Z 05 �p� f d p A ERN S /I I,h ��qq 3 92*1 '�d1 1 1 yla �oT +,Vv �N�PPRD o°`� J`�` Nt N D 1�44 vac c i Fs �� r F �ti ,a of o OtA � ~c� "t ljjekL 1 S � Iec � M C �'!N M C. 11 r .. Q P. I lb r rARA' �} 2 0c s o ENSE Hoed 04; � a, r CENTER o G I _ rtRTlb++7� t veR„f,R i. ' 28 -P M� ,EY �' r =Ar V 1 L L E LA RCM ` �9J Qa a` c` r',*,M ' ♦ fD[r+ • cA ANDREA T Fv s7JN ~�'ilQF •d- �► `�fS \ s Y< >.. 4 RCN 40 I �� )6f avo �^_�':7 p a LE8'S --.•-_-».�-_..._4 ,.5=.as+ I ice"' ( \_2S_ 9� r 94 61 ZISrar=rgvrcanl i ELLS I I r,.v(r AS/�-7L11 i� �` A N IOJ:7 &A LkOA 9,0 S,S f A-�3oo) 1 W �� F^�STALLZV > r't1 4 IV a 3� -4 Ctt 4 J Tt I T f1 u 86 ,,,p �;�.•. rr1�': SUBSURFACE SEWAGE DISPOSAL SYSTEM 97 Braley Jenkins Road, Centerville DANIEL. ! o " SCALE: Aa sbawa APPROVED BY DRAWN BY as .i DATE: 4/5102 Daairl s Jobosoa a,s. Jatinson o ( t) 420-1741 I © 0+�� Q+.1a Qr3o Qr4o OF�o pfb� �r'74 iwlc: 97 sraley Jenkins 1bad, dntnavilla, M71 03632 W �'�7'v' �'�`1y0 �t„q� /"�:}O i^Y!U I^# .C 't'r�°3T'' a , i)' j" \ - 64 DfMWtNGl NUMBER ff012 i :�4 f` �! .� ag/cz by: $04 Main $treat, mdto a. oatervil", AMR 02GS9 J-764 u I v I