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Home My WebLink About0078 BRETWOOD LANE - Health 7 OREOhTWOOD LANE CEN,TERVILLE 1..68-129 jP i K 1 RECYCLfpCo UPC 12543 ' NO. 53LOR o �SL co HASTINGS, MN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp. Owner Owner's Name -information is Centerville MA 02632 December 15, 2010 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out I t form s on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name ree 189 Cammett Road Company Address Marstons Mills MA 02648 City/Town State Zip Code 508.428.1779 SI 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority December 15, 2010 Job#10-294 -' --� I spector' Dates Signatu a The system inspector shall submit a copy of this inspection report to the Approving Authority (Bpardr,� of Health or DEP)within 30 days of completing this inspection. If the system is a�'shared system or r 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 7 and copies sent to the buyer, if applicable, and the approving authority. exr ****This report only describes conditions at the time of inspection and under theconditio'ns 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. l,ins•09I08 Title 5 Official Inspection Form:Subsurf4SewDisposal Sy tem•Page 1 o1 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp. Owner Owner's Name information is Centerville MA 02632 December 15, 2010 required for State Zip Code Date of Inspection every page. Cityrrown 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: Leaching system had no standing water or evidence of surcharge. Recommend pumping tank in next 12-18 months. 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): Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 15ins•09/08 Commonwealth of Massachusetts W Title-5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp. Owner Owner's Name information is Centerville MA 02632 December 15, 2010 required for every 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-09108 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 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp. Owner Owner's Name information is required for Centerville MA 02632 December 15, 2010 every page. Cityfrown 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp. Owner Owner's Name information is required for Centerville MA 02632 December 15, 2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 15ins•09/08 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 �w 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is Centerville MA 02632 December 15, 2010 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back 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-09108 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 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp. Owner Owner's Name information is required for Centerville MA 02632 December 15, 2010 every 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: Unknown 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 1? Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp. Owner Owner's Name information is required for Centerville MA 02632 December-15, 2010 every 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: Unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09108 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 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp. Owner Owner's Name information is required for Centerville MA 02632 December 15, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Leaching system installed: 7/21/04 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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.): Septic Tank (locate on site plan).- Depth below grade: 1 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: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 3 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp. Owner Owner's Name information is required for Centerville MA 02632 December 15, 2010 every page. City/Town 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 27 Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Recommend pumping tank in next 12-18 months. Liquid level was found at bottom of outlet invert and tees were intact and clear. 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp. Owner Owner's Name information is required for Centerville MA 02632 December 15, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp. Owner Owner's Name information is required for Centerville MA 02632 December 15, 2010 every 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.): Liquid level was found at bottom of outlet pipes, no solids or high stains present. 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: 15ins•09/08 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 w 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp. Owner Owner's Name information is required for Centerville MA 02632 December 15, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Five 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.): Interior of infiltrators were video inspected with no standing water or evidence of surcharge found. 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 l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp Owner Owners Name information is Centerville required for MA 02632 December 15, 2010 every page. CityfTown 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 ICI II Commonwealth of Massachusetts Title 5 Official Inspection Form u_ S bsurface Sewage Disposal System Form Not for Voluntary Assessments ., 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp_ Owner -- --- Owner's Name information is required for Centerville _ MA 02632 _ December 15, 2010 every page. Cityrrown 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 • r / / i r r / / / / f / r r .• r / r f , • / r / / / r / / r / r'r l / f I f . J i / /.i / f 26 26 34 37 I _ • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °N 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp. Owner Owners Name information is required for Centerville MA 02632 December 15, 2010 every page. Cityfrown 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: 20+ 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: Low area on opposite side of road with no surface water is considerably lower in elevation than SAS Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/00 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 78 Bretwood Lane Property Address Federal Home Loan Mortgage Corp. Owner Owners Name information is required for Centerville MA 02632 December 15, 2010 every page. Citylrown 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 a TOWN OF BARNSTABLE LOCATION �U ��2'rWf� ..�- SP VILLAGE &,01-ga I IQ ASSESSOR'S MAP&PARCEL INS NAME&PHONE NO. r c'C.��C o,nx� 1 I (4n-n-77 SEPTIC TANK CAPACITY 000 LEACHING FACILITY:(type) 1>(nR Ft/cA-o(S (size) NO.OF BEDROOMS OWNER rr,e Re mevc_ r8ori. Cl c,,'( PERMIT DATE: C DATE: l a I lT Ito 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 4 4 \ 4 \ \ \ \ \ \ 4 4 '� \ftftf4J\!\f f4f f\ \ftJ\J\J4l4J\f f.•J f f J / ! f f J f / / / J / f \ \ \ \ h \ \ h h 4 4 4 4 \ \ 4 4 \ 1 \ 4 \ h \ t 4 t \ 1 \ \ \ \ 1 1 \ \ \ 4 \ 4 4 \ \ f J J f J J J J f [ J f f J J f J J f 4 4 t 4 4 4 4 4 4 4 \ 4 t 4 4 t 4 \ 26 26 34 37 Commonwealth of Massachusetts / a� W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 78 Bretwood Lane ) Property Address r— Pedro Dliviera Owner Owner's Name information is r equired for Centerville Ma. 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: q only the tab key , y 1 to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification 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 7/30/2007 Inspec or's Signature Date ='w; 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 sa shared�systern or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall `s'ubmit=the report to the appropriate regional office of the DEP. The original should be sent to the system=owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and and r the coonditio s of use at that time.This inspection does not address how the system will pe orm in the future under the same or different conditions of use. 78 bretwood lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 78 Bretwood Lane Property Address Pedro Dliviera Owner Owner's Name information is required for Centerville Ma. 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. 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 78 bretwood lane-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 78 Bretwood Lane Property Address Pedro Dliviera Owner Owner's Name information is required for Centerville Ma. 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: 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. 78 bretwood lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 41 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 78 Bretwood Lane Property Address Pedro Dliviera Owner Owner's Name information is required for Centerville Ma. 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (coht.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 El ® 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. 78 bretwood lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 78 Bretwood Lane Property Address Pedro Dliviera Owner Owner's Name information is required for Centerville Ma. 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 Elthe system is located in a nitrogen sensitive area (Interim Wellhead Protection El 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. 78 bretwood lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 78 Bretwood Lane Property Address Pedro Dliviera Owner Owner's Name information is required for Centerville Ma. 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no"as to each of the following: Yes No , ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back 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)] 78 bretwood lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 ` Commonwealth of Massachusetts W Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 78 Bretwood Lane Property Address Pedro Dliviera Owner Owner's Name information is required for Centerville Ma. 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection 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 Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Sump pump? ❑ Yes ® No Last date of occupancy: 7/30/2007 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: Last date of occupancy/use: Date Other(describe): 78 bretwood lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 78 Bretwood Lane Property Address Pedro Dliviera Owner Owner's Name information is required for Centerville Ma. 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information 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: 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: New Leaching field in 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No 78 bretwood lane•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 78 Bretwood Lane Property Address Pedro Dliviera Owner Owner's Name information is required for Centerville Ma. 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 18"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: 8'6"x4'1 0"x57' 8" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 22" 10" Scum thickness Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 8" How were dimensions determined? Measured 78 bretwood lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Bretwood Lane Property Address Pedro Dliviera Owner Owner's Name information is required for Centerville Ma. 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic Tank needs to be pumped heavy solids in tank.Pump tank every 2-3 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurallysound. 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 i 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): 78 bretwood lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 78 Bretwood Lane Property Address Pedro Dliviera Owner Owner's Name information is required for Centerville Ma. 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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' Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Box is Ievel.Box has 2 outlet laterals with equal distribution.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 78 bretwood lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 , Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 78 Bretwood Lane Property Address Pedro Dliviera Owner Owner's Name information is required for Centerville Ma. 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ® leaching chambers number: 5-HC 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.): Sandy dry soil.No signs of hydraulic failure.No ponding or damp soil 78 bretwood lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 78 Bretwood Lane Property Address Pedro Dliviera Owner Owner's Name information is required for Centerville Ma: 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): 78 bretwood lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of.Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 78 Bretwood Lane Property Address Pedro Dliviera Owner Owner's Name information is required for Centerville Ma. 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 lob feet. Locate where public water supply enters the building. I a 0 LD t .,1 ��} ,I 78 bretwood lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 '\ Commonwealth of Massachusetts W Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 78 Bretwood Lane Property Address Pedro Dliviera Owner Owner's Name information is required for Centerville Ma. 02632 7/30/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® 'Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: Bottom of leaching 30' 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 004 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used:Gaherty and Miller Model 12/16/94 Ground water elevations. Used:USGS Observation well data June 1992. Used:Technical Bulletin 92-000701 Plate#2 Annual ranges of ground water elevations. 78 bretwood lane-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Town of Barnstable Op tHE Tp� Regulatory Services STAB Thomas F. Geiler, Director MUM9$ i6 q �0� prFo��A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report;this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. rt' TOWN /OFBARNSSTABLE &_K__r__4_1_Q2jQ I'i,1XATION -t? C OA5_1 SEWAGE # 7-40b -,;5 VILLAGE Cell rY Q1 Ji ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY , LEACHING FACILITY: (type) 7 (size) ��aC�6� ?C r /�J� NO.OF BEDROOMS_ BUILDER OR OWNER 1 'PERMITDATE: COMPLIANCE DATE: > °' Separation Distance Between the: , Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private,Water Supply Well and Leaching Facility (If any wells exist on.site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by - ce No. 0 S—� FEE COMMONWEALTH Of MAS�ACI-I�SETTS Board of Health, l '�c�� MA. APPLICATION FOP, DISPOSAL SYSHM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair9 Upgrade( Abandon( ) - ❑Complete Systemdividual Components Location ,� `` Owner's Name Map/Parcel# 1 Q9 Address Lot# Telephone# Installer's Name , -C _ Designer's Name Address s Address—� " Telephone# I Telephone# Type of Building 73Q n&dek�, - Lot Size I S1 sq.ft. Dwelling-No.of Bedrooms s Garbage grinder ( � Other-Type of Building ®fly No.of persons_ Showers (✓rCafeteria Other Fixtures Design Flow(min.required)gpd Calculated design flow_ tom 4esign flow provided gpd Plan: Date Number of sheets Revision Date Title �� Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator C e� ate of Evaluation__►" DESCRIPTION OF REPAIRS OR ALTERATIONS �a SEC 4sp The and rsigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a es to t to place&7tem4n o eration until a Certificate of ompl7q- Inspections e has been issued by the Board of Health. Signe Date + `1^• i,�` .—.ti .. "' 5 .�` ,{ "i :f f FEE �(l AA . �InL`�} �I(L�`\uTI��//r rII1� `�`\\1 Ly{/.A-�.`�� .+wr+�$TI`�\\ry\ rII'�rII'I� COM O V V V EALJL � F�'�1 ll� 'V/J'�JL lLS y Board of Health, , MA. APPLICATION FOP, DISPqSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair Upgrade( Abandon( - ❑Complete Systeml'`Individual Components Location 'As &A t f�V�*3`� �n Owner's Name �� L .,,0 Map/Parcel# (P I Address I:—. Lot# Telephone# Igstaller's Name t� �t J C_ �C.2 Designer's Name / T SV Address -.�� v c ., ,1�_ Address �� (0A� F cx:T�Y� Telephone# ` �� ,. ^� �� Telephone# Z!9- Type of Building S\�_Q� O.\ Lot Size S1000 sq.ft. Dwelling-No.of Bedrooms v a ,� (A") Garbage grinder (( rA Other-Type of Building {V fJt`1Q. No.of persons ?)_ Showers (00�Cafeteria ( 00"0' —Other Fixtures P Design Flow(min.required) gpd Calculated design flows ! _ esign flow provided=j31.`Z gpd ��s Plan: Date %q,04- Number of sheets Revision Date ,,.:.Title 76 Q e - 'V,C`` t (� �l Description of Soil(s) zc _ Q� Soil Evaluator Form No. Name of Soil Evaluator C('n1¢✓" Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The find signed agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a eess jtoo��njot to place/tth.i /sy/st�emin operation until a Certificate of Compliance has been issued by the Board of Health. Signe )G:I7Q(1W 6� '�L/""( Date /(�I M, Inspections t`:,%:"5.•.-....... ..'y:.:.:.i,. :..—,;-.. :=.i'Y�'-;-tF ::-'4.4 �.—e-_ ,.:.. _ ."a� —.a-s,=.. __. '—_.--rc�—... __ — — _ _y No_). 3S� FEECOMMONWEALTH OF MASSACHUSETTS Board of Health, J a_.�-n -5112 Nif . MA. CERTIFICATE OF COMPLIANCE Description of Work: � dividual Component(s) ❑Complete System The undersigned hereby,certify thatthe Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded,Abandoned ( ) by: U�J ,to at i has been installed in accordance with the provis ons o/f 31 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. W T`�'�, dated 1 7�a r)0 !. Approved Design Flow, (gpd) Installer J �,_ \Designer: Inspector: /• �- Date: L o� The issuance of this permit shall not be construed as a guaran ee that the system will function as designed. No. FEE ( 00 C®MMONWEA T14 OF MASSAC14USETTS A Board of Health, _ {' S?� MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to- Construct( F) Repair( ) Upgrade(/ r Abandon( ) an individual sewage disposal system F at r5 l�.d�� (� `{r� ! as described in the application for Disposal System Construction-Permit No.J)boL/.3 jij dated ^V,_ Provided: Construction shall be completed wi in three years of the date of this er t. All l0 1 condition/s�must be met. form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date o�(�U Board of Health V TOWN OF BARNSTABLE- -LockhON WQ716 Lo.e SEWAGE VIL)AG ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �7 SEPTIC TANK'CAPACITY LEACHING FACILITY: (type) (size) ?7� - K�r NO.OF BEDROOMS BUILDER OR OWNER / PERMTTDATE: C 0 COMPLIANCE DATE: / Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on.site or within 200 feet of leaching facility) Feet Edge4of W?et1and and Leaching Facility(If any wetlands exist -�`� within 300 feet of leaching facility) Feet Furnished by d �`AA V �, � if ° •� w bit 6 � 'i TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGES ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMrTDATE: 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 Health Complaints 27-Jul-05 Time: 2:23:00 AM Date: 7/5/2005 Complaint Number: 18229 Referred To: DAVID STANTON Taken By: JOAN AGOSTINELLI Complaint Type: CHAPTER II HOUSING Article X Detail: ILLEGAL OPERATIONS Business Name: Number: 78 Street: BRETWOOD LANE Village: CENTERVILLE Assessors Map_Parcel: Complaint Description: There are 8 adults who are unrelated. There are on average 8 cars there during the evening but there are numerous from time to time. Person who purchased the house lived there for a few months then moved out and rented it. People are living in the basement. There are 3 small bedrooms. Some carpenter work has been done with some room partitions there. Actions Taken/Results: DS WENT TO SAID LOCATION. SPOKE WITH TENANTS, THAT SPEAK BROKEN ENGLISH. COMPLAINT IS IRRELEVANT TO HEALTH DEPARTMENT. THEY HAVE A SEPTIC FOR 3 BEDROOMS 2004-356. THEY ARE OUTSIDE ZONE OF CONTRIBUTION, SO IF THEY WANT MORE BEDROOMS THEY CAN JUST ADD ON TO EXISTING SEPTIC AND PUT IN MORE BEDROOMS. NO VIOLATIONS OBSERVED, NO FURTHER ACTION REQUIRED. Investigation Date: 7/25/2005 Investigation Time: 2:05:00 PM 1 TOWN OF BARNSTABLE LOCATION 7 &—CZ GeV D4 LXAZ SEWAGE # �Z&bA��® VILLAGE CPAmZ/U t e �ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ' LEACHING FACILITY: (type) (size) • NO.OFBEDROOMS BUILDER OR OWNER PERMITDATE: c 0 COMPLIANCE DATE: t' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by a, Q L 6 T:MUd :ai wdLb:To nHl t oo2-zz-inf Town of Barnstable Regulatory Services 1 Thomas F. Geiler, Director .A�cAHM ""S& Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-86246 4 Fax: 508-790-6304 Installer& Deshmer Certification Form Date: 21/04 I Designer: —Shay Environmental Services Installer: Roberts Septic Service Address: 3 Thatches Lane Address: 5 Trenton Street �-q-zt )~almouth MA,02536 Yarmouth, MA On 7/20/04 Roberts Septic Service was issued a permit to install a (date) (installer) septic system at 78 Bret wood Avenue Centerville based on a design drawn by (address) Shay Envirognental Services dated 7/19/04 (designer) ' X X I certify 1hat the septic system referenced above was installed substantially according to the desi , which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify hat the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the sef tic system) but in accordance with State & Local Regulations. Plan revision or certified -built by designer to follow. of nstal er's ipiture) 'CARMN �. $ $HAY (Designer' Signaturq)U (Affix Here) PLEASE RETT RN TO BARNSTABLE PUBLIC HEALTH D ON. CERTIFICATE OF COMPLI CE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. • i Q:Heal th/Septic/Des iiner Certification Form ZOO/L00 2 XVJ ZZ:ZO VLOZ/6L/OL Zi1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED FAILED INSPECTION JUN 15 2004 TOVViv OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION QQ Property Address: 78 Bretwood Lane SNAP Centerville, MA 02632 Owner's Name: Ann Burke PARCEL ; Owner's Address: LOT Date of Inspection: May 5, 2004 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 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: Passes Conditionally Passes Neods Further Evaluation by the Local Approving Authority ✓ Fai s Inspector's Signature: Date: May 12, 2004 The system inspector shall subm 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 t Page 2 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 Bretwood Lane Centerville, MA Owner: Ann Burke Date of Inspection: May 5, 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. 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 I obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 Bretwood Lane Centerville, MA Owner: Ann Burke Date of Inspection: May 5, 2004 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 Bretwood Lane Centerville, MA Owner: Ann Burke Date of Inspection: May 5. 2004 D. System Failure Criteria applicable to all systems: You must indicate either"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 '/z 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 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 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.] Yes (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 System: To be considered a large system the system roust 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. 4 I i Page 5 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 78 Bretwood Lane Centerville, MA Owner: Ann Burke Date of Inspection: May 5, 2004 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: Yes No ✓ _ 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)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 78 Bretwood Lane Centerville, MA Owner: Ann Burke Date of Inspection: May 5, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 5 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): pd 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 Source of information: Unavailable 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 ✓ 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: Installed approximately 1978-per owner Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 Bretwood Lane Centerville, MA Owner: Ann Burke Date of Inspection: May S, 2004 BUILDING SEWER(locate on site plan) r Depth below grade: Materials of construction: _cast iron _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: ✓ (locate on site plan) Depth below grade: 12" Material of construction: ✓ 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: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" 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: 12" How were dimensions determined: Measuring 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.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. GREASE TRAP: None (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.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 Bretwood Lane Centerville, MA Owner: Ann Burke Date of Inspection: May 5. 2004 TIGHT or HOLDING TANK: None (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: Pallons 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: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was broken down structurally and needs to be replaced. PUMP CHAMBER: None (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.): 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: 78 Bretwood Lane Centerville, MA Owner: Ann Burke Date of Inspection: May 5, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required). If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 Qal.) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The leach pit was full. Liquid was up to the inlet pipe. The pit appeared to be in hydraulic failure. The bottom to grade was 8.5'. The cover was 2.5'below grade. CESSPOOLS: None (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: None (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.): 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: 78 Bretwood Lane Centerville, MA Owner: Ann Burke Date of Inspection: May 5, 2004 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. a i a3 03 3 3 3a 3 i y s3 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: 78 Bretwood Lane Centerville, MA Owner: Ann Burke Date of Inspection: May 5, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 50 +/- 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: Topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using a Barnstable topographic may and water contours map, the maps were showing approximately 50'+/- to ground water at this site. This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection andlor this report. 11 p- r� TOWN OF BARNSTABLE LOCAIION -7 o 'Jr�Tc�.00� /AA-L ► E # -VILLAGE, ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SM SEPTIC TANK CAPACITY I UUb INSPECTION LEACHING FACILITY: (type) R7 COx C' (size) (Nb NO.OF BEDROOMS 3 BUILDER OR OWNER QVr k4L PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland 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 f cility) 9 Feet Furnished by 4-b �DrG l3Ac�C �q C3 a 1 a3 03 3 y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �1v! .... . .............OF..........LRf f.................................... ApplirFation for Disposal Works Tnnstrn.rtiun Prrmit Application is hereby made for a Permit to Construct (>0 or Repair ( ) an Individual Sewage Disposal System at: ��.,�!...-----ig4-p .. ....... _. --•----•-•----------------------- r ............ .• Location-Addres or Lo No. 1. - �H ./_.. -�10 dl .�•---•-------.-. ....�� ? / 4 Owner , Address ... ... •- Installer Address QType of Building Size Lot_. ��d_•-•--_-.Sq. feet U Dwelling—No. of Bedrooms.................... _....Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building _ _ ...• No. of persons..........Z------------- Showers ( /) — Cafeteria ( ) Q' Other fixtures .................................. W Design Flow.................. /Q.................gallons per person per gday. Total dail_,y flow.............. 0.................gallons. WSeptic Tank—Liquid capacity1Pf_�®__-gallons Length,...�....__. Width__:5......... Diameter---6 De th...,5_....... x Disposal Trench—No. .................... Width....................Total Length......... ... Total leaching area....................sq. ft. Seepage Pit No-------.'..�..-------- Diameter........k......__ Depth below inlet...... ........... Total leaching area_ ( ...sq. ft. Z Other Distribution box (X) Dosing to ( ) a Percolation Test Results Performed by.............. P_.... .6".4?_'i ..._ ._ Date..../d, �'�� T Test Pit No. I._.4dr_Q_.minutes per inch Depth of Test Pit-_____.1o2------- Depth to ground water.&�_AoXom44d Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil---------/ - ..... l ......El'� - - -- - -- - x w UNature of Repairs or Alterations—Answer when applicable._.__........................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal_System in accordance with the provisions of TI'L 1Z 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu4 by he boar of health. Signed.......0106 •-- . -------•----•------- --•--/` Dat ' Dat�y 7 ApplicationApproved By--••-....A--=---------------------------------••---••-•---------•-•--..........--•-- �/-- -4 ---... Date Application Disapproved for the following reasons:-------•-------------.......................................................................................... ---------------------------•------------------------------•-----•--.....--•-------'---------------•-------------------- -- '`---•---------------••---•---•••-••---- / Date Permit No....._..` .... Issued ! Date .5' do THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y*b Appliration for Disposal 10ork.6 Tonstrur#iun .ermift,� Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage'Disposal System at: �r� ........ as .._... � : .... '- .4 ................................. ►..................................................... Location•Addres or Lot N _......._. -�r . =--------------- --�-0-------? :-•-�` v ... .. yer O,,w,n,_ + D_ ,/ Address Installer Address Type of Building Size Lot_ gj4----------Sq. feet ,., Dwelling—No. of Bedrooms________________...____.....................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building `� --- No. of persons..........3-------------- Showers ( 1) — Cafeteria ( ) dOther fixtures •-•-•----•-----------•---•--•-•-------------•----------•--•-------------•--------•------------•----------•--------------....--------......--•...__.. W Design Flow................. _l.[Z__._ .:____gallons per person per fday. Total daily flow_______ �'-•-- ..................gallons. WSeptic Tank—Liquid capacity/040 _gallons Length -.-0------.. Width _ Diameter._,$........ Depth__,S"....... x Disposal Trench—No_____________________ Width:................... Total Length.................... Total leaching area____ :_____......sq. ft. Seepage Pit No______ _________ Diameter .__/►_________ Depth below inlet___..,!.._.___ Total leaching area_ ...sq. ft. Z Other Distribution box ) Dosing tank ( ) '—' Percolation Test Results Performed b f `�:,_.._ _ __ Date__ : '_ �' Test Pit No. 1__o,_0___minutes per inch Depth of Test Pit......./ _______ Depth to ground water/j/ds r"a4s4n,t4d. Gz, Test Pit No. 2................minutes per-inch Depth of Test Pit...._............... Depth to ground water........................ a -•• --• -•-- _ ,j ------------------------------ ---•---•---------------------- _--------- •.... �J;.D Description of Soil---••••••- i •- p .....• t x W -----------------------•---- --•-•-•---•-----•--•---------••-------••---•-------•-•-----------------•-•--------------_._._..------•---•----•-------------•------•-•-•-••---- ...---=- UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----•--••----•----•---------•-•.............•••--•----------------------------------•-•--...-•--••--->--•--.....-----------------••---------•--•----•--------•-------=-=-----=--------------•••----••--• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLij 5 of the State Sanitary Code-The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue_d by he boarA of health. Signed 1 V ._ _. wr '--•--• -•----- -- ---r �t Daer Application Approved By...... 'I f................•----•-•----------------•--•---•-----------------•--•------ -•--------f `.......... Date Application Disapproved for the following reasons_________________________________________________________________________________________________________________ ...........................•-••-•-----------•----------------•--------•---------..._.._..------------••-----------------•--------------•---------------------•-----------------------•-•----•----------- a Date PermitNo......7 '_�................................._ Issued_....................................................... Date `THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTHY 1 �y y 1 its /1F. (.-.... fr ..............OF..... ...........................- `r� 7 THIS IS TO CERTIFY, That the Individual Sewage D' osal System ccpnstructed ('O or Repaired ( ) by--------- . ..... ....... _ r '--------...... --._........_..._...-••••-------•-- alley at................Ldt --•-•� ----•-.! .f %rtv -----L'� ............. `"� � r ................-------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit do :....................... 'dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST LIED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. /' ,"», DATE t/� --•------------- Inspector... .. ai a M; �0- tJ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ;HEALTH '- No 73-.It .... FEE.. .5.......... . �i��rrr��1 nrk� ��nn��ruan. �aattt :...Permission is hereby granted__.__.___ " �� .... _.__ _ t ...... to Construct (V ) or Repair ( an Individual Sewage Disposal System ' w at No.----------fi t-1-•-•-'--�-4--- �:ft'1.`..._ ...-- --�,r.--�'-� ---- ------ ---- - r K; street as shown on the application for Disposal Works Constructions Permit ........ :. - , � - i Board of Health DATE---...-/ .._-Z-/---............................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS T3 �A , .� My�s •2 r3 1 Z c T 2-7 I r 2 •t t u � J�- Z + f tV ... 1 "s r,,.. O\ Q I o `gym a +a L OT 26 e 00 2 3 4! ~o�� ROBERT << w 1. P. BUNIKIS No.22162,�Q i 1• j 4 .P A �L� /,Viita ►STEP ,IS%ONAL ENS CERTIFIED P PLAN PLO A,E:X{STING SOOT ELEVATION Ox0 ' EXISTING ,, CONTOUR p 26 13fir:7 n !-0 ! , FINISHED CONTOUR " 0 CEn/� � V/LLE i N- A PP.ROVED : BOARD OF HEALTH �� ,�� J � �� ` B J 54% e P + DATE _ AGI'NT SC.A� E / _-.�O DATF !'E FDREDGE ENGINEERING C 3 lNG T 7c-n�q c, L `1 CLIENT I CERTIFY THAT THE PROPOSED {: ' GISTERED `REGISTEf ED I JOB N0. ? �� BUILDING SHOWN c N THIS PLAN CIVIL LAND ! CONFORMS TO THE ZONING LAWS DR. BY A .A . 1vl ENGINEERS, SURVEYORS / - OF BARNST BL _ MASS. ta3 N , MAIN S" 7'2 MA,,N' ',T CH BY : R SG ` YARM0UTii, May HYANN!`; M,i;' -2 ` SHEET .- /- OF DATE REG . LAND' SURVEYOR _ -E /F E/Ti�/ER SrPT/C T.4NFC !).P � ' ' 1VG P/T ARE 'MORC- .THA1V- /2"B�40PV /D FT M/� _ __ u r,�-,fAPam, 24"�/AM ETER CONG'.�'FT.E CON.ER ' SJ,►A Z BE 19AFOU6/47- -rO G/?AOE. A/✓ EXTRA CONCRETE TlPI�C P/PE MJN. r `�q ST /20/Y CC I/ER Sf��4LL DE USE.0 i / PITCH CovERS r IF /N ,nRIvEbvAy L o y9 PE,Q FT 6ACKF/LL 4" CAST J o r rT . r os z�1• 2 LAYER IRON P/PE �'t 1000 4L o aO a aI M/N. /TCN r — ° • • a • • a e r e G ��n ) '.1 c u ` r ` S.EPT/C 7A A//C Li IF...� D157, �7 . ..I �� l D n f'i • 0 � � o o ® e 1 e a nn ' a� � -I'rir.'. r, �. 60X o B p � e o ® o o ! e e�n D � • v c �.e e eEFFEC>-/VE r 'Q d .3/4 - L I'o ° ' ° ° pEPTJ1 • o o "r B o o WAS))` STOiYE _ �c �,,, a� r e ei ® o ® o o • o� p p !P PiPEC.AS T SEEPAG E /NVeA-r el-EVAT/ONS _ tD 1 Oslo ® ® o a e✓ oaQ°I� G/7 OR _`QU/✓. CL. INVERT AT BU/LD/NG ?? T -!O F . 6 D/AM INLET SEPT/C TANK _5_6 ,5_FT _!�� FT. D/AM C SEE Tf1BUL.A7 N�� OUTLET SEPTIC TAIVH FT. ----- '-- ---- /NL.ET U/STR/BUT/ON BOX T .5'ECT/ON OF I 0UrLE7-D/5TR/BUT/0N BOX FT. //VC.ET LEACHING Gi T ,, FT. SEWAGE ®ISM®SA L .SYS'T.=-./a9 7- f�J/_,A7111 L EACA///V es P/T ? DES/GN CRITERIA SCALE �4 = / o'" oil, _v/9N A —FT. D/HENS/GN 45 FT. NUMBER Of BE�RoOMS 3 O/HENS/nN C—:. FT. G,4ReAGED/SPOSAL UN/T___.. SO/L LOG I. TOT L E5T/M47-E0 FLoA,v_33 t] G.4L..1DAY SOIL TEST */ SOIL 7-_K7ST#2. ` ,• TEST NUMBER-OF :-EACH/NG; PITS_ !^ELEY. 7 O ELEl�_ ,DATE OF SOIL TEST 3 D 7 $ _ S/OE LEACHING PEiZ P/7- � _,S`Q, 'FT. sr evrro/Yr LE,gcil/NG pER P/T 7 RESULTS ew/TNESSED BY /�_ ��/K S SQ. �T. r _ f'ER COL.o.T/O/v RR TE / 2�0_ ZL�� -OA'M A I � __ M//V//NCH _ SQ, FT. Svf�StJ1� PERCOLA7"/ONRA7E JUL z RESERVELEACNI/VGAREA_ S.P. FT. II L(?T, z 6� ,B,�e ROSERT F P. BUNIKIS - st+'✓'U k p No.22162�0 4,, • gi—DREP6Z E1VCr1 NEER N A90, I a� �Q INC.a.S' �o�� $S•.'O �L. t K r,., : 7/Z MA/M ST. 33 NO.Hit//V OAIAL ' NO GI=O'U/VO .t4A7''eR ENCDIJ/VTE'ri�P HYANN/S� /! ASS. So. Y it RMUt/TH�MASS. ` Jo's /VD.: -BA4 IJ eeoOA —(A-V-.- - ------ --------- --- - T" I-Upog� - ------ - ---- ------------ -------- ---- -- rN ------ --- - i 1 10' min. from 'NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. SECTION A -A OUTLET PIPES FROM 10PAN ITL1Y tom"Wd VENT PIPE O Least 24 Inches tall) ALLExisting Foundation house to septic tank Schedule 40 PVC w/Charcoal Odor Eater PROFILE VIEW OF ADDITION TO LEACHING SYSTEM DISTRIBUTION Box SHALL BE , ,$ Septic tank coven) must be SET LEVEL FOR AT LEAST 2 FT. t2• CONCRETE COVER TOP OF FOUNDATION ELEV. 100.00 (Assumed) 3` of 1/e' -1/2' washed Peastone a within 6 In. of finished grade i-•.. r-_ or ` Grade over Septic Tank - 98.00 Grade over 0-Box- 96.00 ads over SAS - 96.00 3/4' to 1 1/2 " Washed Gushed Stone 2 KNOCKOUTS 5.5 ' t 1Y INLET a• G`aa4'� At1t S - 0.02 3 HOLE H-10 l DIST. BOX 3' IAaximum Coves Top Load - Elev. e9323 \� 6' j ,? ° gip•/ OUTLET .; 14' EXIST. s=0•01 or Greater - _ 2 it kot""d LtN 7 NEv P>pE H 1,000 GAL. S- 0.01" . foot . 15.5 S fir" » p 25' p 0"Effective 4" - SCH. 40 x d ' FROM EXIST, FOUNDATION w R SEPTIC TANK In Depth (`T a >., a W � Pvc T� 0 20 5 Units e 6.25' = 30' PLAN SECTION CROSS-SECTION �! Q, f CONCRETE FULL FOVNOA ?, a H-10 0 3, m"/' 4.¢n,•'`- ---'• (: > a TO REDUCE ° ' ri 0.83' (10 Inches) 3 1 F 2 \ Q !i m WATER VELOCITY ° R rn ^ 31.25' SYSTEM PROFILE 6 b.of 3/4"-1 ,/z• � IN o-Box a a 37.25' 3 HOLE H-10 DISTRIBUTION BOX > compacted stone > O N Not to Scale c o r \ c > u 0 ro rn Effective Length NOT TO SCALE iv 1R0# ' 4' 4' ° SOIL ABSORPTION SYSTEM (SAS) ® "�� ! 1 9 c - _2.5� 6 in.of 3/4'-1 1/2' $ 10' -T I INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE O'BRIEN GENERAL NOTES compacted atone EffectNe width (OR EQUIVALENT Not to Scale NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE w o 1. Contractor is responsible for Digsafe notification m Bottom of Test Ode 1 Elev. m ` No Groundwater Observed o 132,32' NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18 /EFFECTIVE HEIGHT IS 10" and protection of all underground utilities and pipes. - `- -� 2. The septic tank and distribution box shall be set level on 6" of 3/4"-1 1/2" stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation NIF Resolve Family Trust by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance TEST I EST (Z M with Title V of the Massachusetts state code, the approved plan and Local Regulations. __ __ LOT #28 6. If, during installation the contractor encounters any Date e Percolation Test: JULY 16, 2004 - soil conditions or site conditions that are different Test Performed By. CARMEN E. SHAY, R.S., C.S.E. 11 1 100.00' � - ------------- Results Witnessed By. WAIVER ( per Barnstable B.O.H.) 11 \�� from those shown on the soil log or in our design SHAY ENVIRONMENTAL SERVICES, INC. ` 1 installation must halt & immediate notification be Percolation Rate: Less Than 2 MPI ® 36" �� LOT #26_ 2 made to Carmen E. Shay - Environmental Services, Inc. 7. No vehicle or heavy machinery shall drive over the 15,000 Square Feet +/- septic system unless noted as H-20 septic components. 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. 4" PVC �� `�\ �\ ,.---------- 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. Test Hole VENT �� \ �\ ,'� 10. All solid piping, tees & fittings shall be 4" diameter No. 1 � ` \ ��\ �\ % 90 Schedule 40 NSF PVC pipes with water tight joints. DEPTH SOILS ELEV. CID 11. Municipal Water is Connected to ALL OF The Residence and Abutting Sandy �� •�=> 3 .25• Loam `� ` ``� Properties Within 150 Feet. 8.75' .. " r;a THE ARE AND INES ATE 10 Y 3/2 \� ,: ,. � \�`� \�\ COMPILED PROPERTY ROMLTHE SURVEYPPLANMGENERATTED BY BAXTER & NYE of OSTERVILLE, MA 0"-12' A 95.00 \��\ Failed i \�`� \\�`� \�� ENTITLED " SUBDIVISION PLAN OF LAND IN CENTERVILLE, MA Sandy Leach Pit 's Loom 1 ��-�� • S`'-r �\ �� DATED DECEMBER 10, 1976, & PLAN BOOK 316, PAGE 61 and The ,o rR s/a 11 + ► 4.i `� `� `� DEED DESCRIPTION ( BOOK 8466 PG 075) 12`- 36" B• 93.00 1 �� ,' D-BOX ` `� `� IT SHOULD BE USED FOR NO PURPOSE OTHER THAN sand N/F Resolve Family Trust 1\\ - \ \ \��\ THE SEPTIC SYSTEM INSTALLATION. 2.5 Y 7/4 �� ` \� LOT #27 EXISTING LEACH PIT/CESSPOOLS TO BE PUMPED OUT AND 36"-132' G 85.00 �� 20' ,>�` REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE \ �� FROM THE EXISTING LEACH PIT/CESSPOOLS TO BE DISPOSED q DECK - - - --- -- - _ I - _ - OF-AS PER BOARD OF HEALTHSPECIFICATIONS.- NO _ WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY EXIST. 1000 gal. -`-Septic Tank �,' 1 ASSESSORS MAP 168 PARCEL 129 1 �x� ,' EXISTING ` f' ASPHALT - ` r LEGEND G NV! D 3 BEDROOM v' DRIVEWAY V l O ' Perc #1 HOUSE Depthto Perc: 36" to 54" � ,''�/ 104X 1 DENOTES PROPOSED Perc Rate= Less Thu 2 MPI #78 I �� SPOT GRADE Groundwater Not Observed No Observed ESHWT ADJUSTED H2O Elev. None 9 6- I X 104.46 DENOTES EXISTING 11 1 ,� SPOT GRADE PROJECT BENCH MARK i/ rl t TOP OF FOUNDATION i ' i E �� +�-` PL PROPERTY LINE ELEV. = 100.00 (Assumed) - ,% %�/ `�-------- ---- 88 96P PROPOSED CONTOUR »� I _ '�'' +- -��- - -86 -97 EXISTING CONTOUR - 1 --- _ 84 ------ ----- 2-18' DIAM. ACCESS MANHOLES ��'�' '' 1 1 --- - 82 92- ------------- , __1 ---- DEEP TEST HOLE & 00.00' , 1-' 80 PERCOLATION TEST LOCATION 180 ---��--- = - 6 FOOT STOCKADE FENCE ' o ---------------- \ r THE ACCESS COVERS FOR THE SEPTIC TANK, --------------- INLET -- DISTRIBUTION BOX AND LEACHING COMPONENT �j+ Tj]r V T T 7� T T • T GRADSET E SHARLL BENRAISED TO W 6 INCHES HIN 6-FINISHED B R l Y�' O ®L -A V E 1 `r CJ k= nNt%iM STALL GRADE. P LOT PLAN INSTALL TUF-T1TE GAS BAFFLES OR EQUALS STEEL REINFORCED PRECAST CONCRETE (40 FOOT RIGHT OF WAY) OF PROPOSED SEPTIC SYSTEM UPGRADE PLAN VIEW PREPARED FOR /- 3-24' REMOVABLE COVERS MR . S T E V E N D A L LA L I S I AT 4. 3 rmin. clearance 7 8 B R ET W O O D LANE INLET e- min`.F 2" min. Inlet to outlet 3 CENTERVILLE MA e' min- OUTLET _ �--r--b-I•� ts' ' - � - s• -r x � s -r Design Calculations � PREPARED BY: ' E r 4'-0" min. . o f ob ov Sat" _ Liquid depth s r +nH; Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Mina per Title V) �_, S Garbage Grinder: No Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) o E '' AR111�'N E. A�11 11u/� l Y .• �• \; Septic Tank - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL Septic Tank. v ENVIRONMENTAL SERVICES, INC. p 0 20 40 50 g_O• a' -10' i SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. = 273.8 gallons �� CROSS SECTION END-SECTION. crsTER P.O. BOX 627. Sidewall Area: 0.74 gal./sq. ft. x 78 sq. ft. 58 gallons S P� EAST FALMOUTH, MA 02536 Providing: = 331.80 gallons gNi.tA� TEL/FAX : 508-548-0796 USE EXISTING 1 000 GALLON H-- 1 0 SEPTIC TANK Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, SCALE: 1 "=20' TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE SCALE: 1"=20' DRAWN BY: CES DATE: JULY 19, 2004 NOT TO SCALE ON THE ENDS. No STONE UNDER. PROJECT#SD604 FILENAME: SD604PP.DWG SHEET 1 OF 1