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HomeMy WebLinkAbout0043 BRIARCLIFF LANE - Health 43 Br'_arC iff Lane Centerville P A = 208 110 1 a f N, //ll -"�CYCffpclo UPC 12543 No._53LOR Ao57.COW�r HASTINGS, MN TOWN OF BARNSTABLE LOCATION LJ _J&f SEWAGE# ;10 l 9-- 3:>S VILLAGE ASSESSOR'S MAP&PARCELAQ8 J)o INSTALLER'S NAME&PHONE NO."J_ u, Jr SEPTIC TANK CAPACITY LEACHING FACILITY: (type) e (size) 12,1010 NO.OF BEDROOMS OWNER­jrar PERMIT DATE: q-30-I4 COMPLIANCE DATE: / 2 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_1 y c (�� C20Ir Flo qT `® - 41- i 1 C, . l� -3 r �3 C, - 2Y w -37 s No. ® � �335 FEE COMMONWEALTH Of MASSACHUSETTS Board of Health, APPLICATION FOP, DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to Construct( Repair( ) Upgraded Abandon( - XComplete System ❑Individual Components Location C1"c' �q ylR Owner's Name I.Son'?,"t Map/Parcel# V-l 1 0 Address y-5 ge ., j� Lot# &,1-A )'2lch M 17�' Telephone# '07_Z-9Z__Z1I9V Installer's Name ®� e�✓tDvVy� �� Designer's Name li-Ce- PI c Address !!< el �dl�-C rV��f'�P /'�/� L,)Z(j Address I? L'u, 7-' rj Azd �r`eS/zit 0. Telephone# � ®_ ( Telephone# s0 7 - 1 - dZ�� Type of Building /Ze S,-C4 144,0 Lot Size 1 , Zao -(,q.ft. Dwelling-No.of Bedrooms Garbage grinder( ) Other-Type of_ Building . -_= ; /Vy//- No.of persons Showers( ),Cafeteria( ) f Other Fixtures Design Flow (min.required) ::7z 3d gpd Calculated design flow 0 Design flow provided 353% - - gpd Plan: Date 9 1�Iumber of sheets 2 Revision Date Title Preocs� �Qpd1f�� S^i;",% U;,o9n%_rU fkow" 43 B mm'-cU J� u, j! tj -C"A\-I Description of Soil(s) oZc" Soil Evaluator Form No. Name of Soil Evaluator lot_kr M(_5-k 1-tl Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further, o no to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date © Inspections ------_----------------------------- ------------_-__---_....--- �,,.,_ ... .__...�__.,_.�.,.y.�._..�..._..� •v,No'.,,�.� FEE~( COMMONWEALTH OF MASSAC14USETTS F , ,,., . . Jr1 r:z .+ S :t Board of Health, -S L ,MA. ^ .. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION,PER IT Application for a Permit to Construct( ) Repair(") UpgradeX) Abandon( - A Complete System ❑Individual Components 1 Location 4l 1j Owner's Name laorint"t Cqe-'r-,4&.I) Map/Parcel# "'2r® $—I 1 0 Address q-5 grC arc. 60 1-&-v/l f Lot#G.o.-A. JP/Ct 1i 94 /7�r 00 9 Telephone# Installer's Name p.A,t(1.7.vn IHL Designer's Name oarr � n/ ,.--- �vt Address�o,t7i r(����Cvl r J�FIL!� d'263e Address C►-0.5STC't� f�f/ 1 el�vS Q Telephone# 50Ef V.66— 15'9 Telephone# :;r,"0j:,_ 77_3'3J 1144- a Z 4 y y Type of Building t° q.1Ze. S• �✓� "/-'f � � `' � I.otSize J�i 'Zoo --sq.ft.� Dwelling-No.of Bedrooms r� "�' "Garbage grinder ( ) Other-Type of Bu_ilding. No.of persons Showers( ),Cafeteria( ) Other Fixtures Design Flow (mifO;equired) ::7i 71d / gpd Calculated d�"sign,flow ?l?J 0 Design flow provided 35':57 -- gpd Plan: Date 91 IJ 17Number of sheets rM .. Revision Date i Title Fro �*os-j Srw+,,L S, i-k nn eq f G�. j f v�-� 3 5 ma _r__u �r�-tvt I-C"A 4 rA, A { Description of Soil(s) F G,r.V � oZ� J� Soil Evaluator Form No. Name'of Soil Evaluator Lk, 0�/1 L1r, ,k1-AA Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS t F wf ,The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furthejagrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. i Signed Date �0 iA,. 140 — Inspections NJ /rJ C.1-01-CVCC'.l t�OCC011 UIX,COCC;CCcCJ�f_�'..'JO«Otic> -No. (� ' FEE 1 COMMONWEALTH LTH OF MASSACHUSETTS Board of Health, �3� 1�'�5. - LL'� MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ;4 Complete System ' h The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned O by: tv at 4 3 wf a ' L-o C a a ti-d�v/ 11.i has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No: dated 101, 1,� i,Approved Design Flow .3 U (gpd) Installe - Designer: Inspector: Ile Date: The issuance of this permit shall not be construed as a'guaranee that the system will function,as designed. G GCi'i,':'G�, R �`* ii..� - - --s.+�--�'`s.�-�.C�_.-�.43�:w.C�2.S�6^^_.Li�.CL�'::C.yyt ^.0(l�G CaC*3•.;U. tz. ^:C_•tirf=�^F.. �.:i:Y!"iP mil. .-'��3:.:t?�se;arl+y-(Y;1''•�,^_e..=�.,i. FEE ( 1 COMMONWEALTH Of MASSACHUSETTS Board of Health, MA. ➢ ISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) UpgradeX ) Abandon( ) an indh idual sewage disposal system at el 3 Qr�:a„fe 1- ff L , . �e...t-�rJ \t t f as described in the application for Disposal System Construction Permit No. dated 9 / Provided: Construction shall be completed within three years of the date of this err 'tf 1 local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Charlestown,MA Date C1 I7Ul/ 1 Board of Health { E Town of Barnstable F SHE? ReguiatJry Services � � a 1 Richard V, Sca)i,Interim Director 9' �` ' i Public Health Division �a .o-39.r Thomas Wkean,Director 200 Main Streetil Hyannis,KA 02601 I Fax: 508-790-b304 office 508-862-4644 a l:nstaller & Designer Cert;fic:ti"Fot its. 1 ' Assessor's I°,�ap\Pareel ` O Ila Datellh �`� l d Swage Perm��# o�C�1L�=I -�- Jnstaller, Desi er: E n Ads? ess: GZ. (Ay C am. _^ `, � Address: On _ jt,,, ,,, (vL t was issued a permit to install a was (installer) 2J c cA �.4' Cck based on a design drawn by Sept:c system at (address) i S (vk�, dated ( 4 VLQ (design.e, acco to ly I certify that-the aseptic system referenced above was ess such asled 1 ateral rlel anon of-the the design, which. may include minor approved g distribution box 'and/or septic tank. Sty I p out (if required) was inspected and the soils were found satisfactory. r changes i.e. _ �= w,• ed-above was installed with malo g ( I certify that the septic System z..fe_enc. d eater than 10' lateral relocation of the SAS or any.vertical relocation of la c visionor accordance,W� ith State �_, Local Regulations, of the septic system) met to follow- trip out (ifs quire)was inspected 1ci the soils certified as built by designer were found satisfactory. - "bov i was constructed in C.Q Jpliance with the terms cif I certify that the�yste referenced a ,: the T_\A approval•letters ( 'applicable) ,,, _S,aller's Signature) (Designer's Signature) (affix Desf Mere) I (RITTICATE �LIE EASE RETURN T O BARN'O T �� I SUED UNTIL M CHI 0 COiII'LIA1 OE l� IL B T CARD A RE�EI_YETI DY THE : STADI�E PUBLIC I EAE'IT3 DTVISI�C�, TY YOU. Q:I SepdcVDesigner ce tizication Form Rev 8-14-13.doc Town. of Barnstable Regulatory Services Richard V.Seali,Interim Director 4 $ Public Healtb Divisian ThoWas McXesa,Director te�v- nuis,MA 02601 200 Main Street,�� Fax: 508-190-6304 Office: 508-862-4644 SteMI Homeowner Certi�irm ore Forms for Alternative � property Address: Assessor's Maparcel:Massachusetts n i Ott � �w6/1 n �o��r� `�`"'� aertificacion _ PropprtY Owners Name: the follvwaing � in the In accordance witkl DEP alternative system approval letters, lace the Qwner of record, The Q`owner of record must p in£ortnation is required by , the infor�rtation. applicable box ne%t to each lute certifying p� rova�letters. � ❑ T have been,provided a copy of the Title 5 I/A tt;rhuology pP . (15 page Standard Coz<ditions letter and the specific technology letter) ❑ I have been provided with the owner's MaUuEa ❑ ® I have been provided with the Qperatioi.and Maintenance Mangy lftll my �j For Systems installed under a Remedial Use Approval,I afire respaztsibilitics to provide a Deed Notice as required by 310 CMR 15,287(1Q) and the,Approval responsibilities to ❑ For Systems L stalled under a p e Approval vat o an neJse wiOwDer,a agree tO fulfill r quired by my prgvide writtcri natifiaation of the ApprD Y 310 CmR 15.287(5) ® ❑ If the design does not provide for the use of garbage grixtders,the restriction is understood and accepted (� ❑ Whether or not covered by a warranty, I understand the requirement to repair,replace,modi�y or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety em.d the ` environment,as defined in 310 CMR 15,303 I? Fonri,ie 'C-mp62i agree to comply with all terms and conditions above. r Owners printed name %Tb-11 rs Signabdit Note: form must be submitted along with, the sentic ava>bem disoassl Der° A W g2jpJAeation for aII-1\8 ®tens inala ' aonstrrtctao>a airy dts, with and i#hont 'affvtsat stone)..and with C8IJnft1-.Ae$iM OftdA or greoted design criteria. �I Q:15epticUA hwcowncr cortification.doe 3 Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs Department of Environmental Protection One Winter Street Boston, MA 02108.617-292-5500 DEVAL L.PATRICK RICHARD K.SULLIVAN JR. Governor Secretary DAVID W.CASH Commissioner APPROVAL FOR GENERAL USE Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: CULTEC, Inc. P.O. Box 280 878 Federal Road Brookfield, CT 06804 Trade name of technology: CULTEC Chambers; model: Field Drain Contactors C4; Contactor EZ-24, 100, and 125; and Recharger 180, 280, and 330XL(hereinafter the "System"). Schematic drawings of each model are attached and made a part of this Certification. This approval allows the installation of the above identified chambers without aggregate. Transmittal Number: W037676 Date of Revision: May 22, 2014 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection hereby issues this Certification to: CULTEC, Inc., P.O. Box 280, 878 Federal Road, Brookfield, CT 06804 (hereinafter"the Company"), for General Use of the System described herein. The sale, design, installation,and use of the System are conditioned on compliance by the Company, the Designer,.the Installer and the System Owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Approval constitutes a violation of 310 CMR 15.000. MU 22, 2014 David Ferris, Director Date Wastewater Management Program Bureau of Resource Protection This information is available in alternate format.Call Michelle Waters-Ekanem,Diversity Director,at 617-292-5761.TDD#1-866.639-7622 or 1-617-574-6868 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper I Certification for General Use Page 2 of 5 Technology:CULTEC Chamber Revision date:May 22,2014 I Design Standards 1. The models listed in Table 1 are covered under this Certification. Table 1. Chamber Dimensions Dimensions Invert Model* W x L** x H Height Inches Inches Field Drain Contactor C4 48 x 96 x 8.5 3 Contactor EZ-24 16 x 96 x 12.5 6 Contactor 100 36 x 89 x 12.5 6 Contactor 125 30 x 75 x 18 12 Rechar er 180 36 x 76 x 20.5 14 Rechar er 280 47 x 84 x26.5 20.5 Rechar er 330XL 52 x 84 x 30.5 24 * All models also include a Heavy Duty(HD)model for H2O loading. ** Denotes Cultec chamber installed length. 2. The System is an open-bottom leaching unit molded from high density, high molecular weight polyethylene (HDPE) with a 3.5 to 4.5 ounce non-woven geosynthetic filter fabric cover(CULTEC No. 410TM). It can be installed without aggregate or distribution pipe as an absorption trench or as a bed or field. If the System is installed with stone aggregate then the"Effective Leaching Area" in Tables 2 and 3 is not applicable, and must be designed in accordance with the provisions of 310 CMR 15.000. Table 2: Effective Leaching Area for Trench Configuration for New Construction and Remedial Sites' Effective Effective Model Leaching2 Leaching Area Area SF/LF SF/LF Field Drain Contactor C4 NA 3.54 Contactor EZ-24 3.9 NA Contactor 100 6.7 NA Contactor 125 7.5 NA Rechar er 180 8.9 NA Rechar er 280 NA 6.44 Rechar er 330XL NA 74 '-Effective April 21,2006,310 CMR 15.251(1)(b)maximum trench width is 3 feet. 2.Effective leaching area is equal to 1.67(bottom width+(2x invert height))for Systems 3 feet or less in width. Certification for General Use Page 3 of 5 Technology:CULTEC Chamber Revision date:May 22,2014 3.Effective leaching area is equal to 1.00(3 +(2x invert height))for Systems with a width greater than 3 feet. °'The maximum trench width allowed to calculate effective leaching area is 3 feet. 3. For new construction or upgrade, the applicant can size the System in a trench configuration, using the effective leaching areas presented in Table 2. 4. Systems installed on remedial sites shall be allowed to utilize the effective leaching areas presented in Tables 2 or 3, or additional reductions in soil absorption system may be allowed. In no instance shall the reduction in the soil absorption system required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. Table 3% Effective Leaching Area for Bed or Field Configuration for New Construction and Remedial Sitest Effective Model Leachings Area SF/LF Field Drain Contactor C4 6.7 Contactor EZ-24 2.2 Contactor 100 5.0 Contactor 125 4.2 Rechar er 180 5.0 Rechar er 280 6.5 Rechar er 330 7.2 5 Effective Leaching area is equal to 1.67 times bottom width only. 5. For new construction or an upgrade,the applicant can size the System in bed or field configuration without aggregate, using the effective leaching areas presented in Table 3. 6. When the System is used with a secondary treatment unit approved in accordance with 310 CMR 15.284 or 15.288, additional reductions in soil absorption system may be allowed. In these situations the reduction in the SAS cannot exceed the maximum allowed under the secondary treatment units approval. In no instance shall the reduction in the soil absorption system area required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. II. Special Conditions t Certification for General Use Page 4 of 5 Technology:CULTEC Chamber Revision date:May 22,2014 1. The.System is an approved Alternative Chamber for use as an Alternative Soil Absorption System. In addition to the Special Conditions contained in this Approval, the System shall comply with the Standard Conditions for Alternative SAS with General Use Certification and/or Approved for Remedial Use (the 'Standard Conditions'), except where stated otherwise in these Special Conditions. 2. New Construction This Certification is for the installation of a System to serve new construction or an existing facility with a proposed increase in flow, for which a site evaluation in compliance with 310 CMR 15.000 has been approved by the Approving Authority and the site meets the siting requirements for new construction, as provided in Paragraph 6 in section II Design and Installation Requirements of the Standard Conditions. 3. Remedial Site This General Use Certification also applies to the installation of a System for the upgrade or replacement of an existing failed or nonconforming system, provided that the facility meets the siting requirements for upgrades, as provided in Paragraph 7 in section II Design and Installation Requirements of the Standard Conditions 4. The System shall be exempt from the minimum inlet spacing requirements of 310 CMR15.253. 5. The System shall have a minimum of one inspection port through the top of one of the chambers. The inspection port shall be capped with a screw type cap and accessible to within three inches of finish grade. 6. When the System is installed in trench configuration, then the system shall comply with these requirements: a) Length(each trench) 100 feet maximum (310 CMR 15.251(1)(a)); b) Width (each trench) 2 feet minimum to 3 feet maximum (310 CMR 15.251(1)(b)). _Chambers greater than 3 feet wide, when specifically approved, are subject to other Special Conditions and limitations; c) The minimum separation distance between any two trenches shall be two times the effective width or depth of each trench, whichever is greater, or where the area between trenches is designated as reserve area, three times the effective width or depth of each trench, whichever is greater(310 CMR 15.251(1)(d)); d) The effective leaching area shall be calculated using the bottom area and a maximum of two feet (per side) of side wall area for each trench (310 CMR 15.251(1)(e)); e) Trenches shall be situated, where possible, with their long dimension perpendicular to the slope of the natural soil. Where possible they shall follow the contour lines (310 CMR 15.251(2)); Certification for General Use Page 5 of 5 Technology:CULTEC Chamber Revision date:May 22,2014 f) Trenches constructed at different elevations shall be designed to prevent effluent from the higher trench(es) flowing into the lower trench(es) (3 10 CMR 15.251(3)); g) The area between trenches may be designated as system reserve area only where the separation distance between the excavation sidewalls of the primary trenches is at least three times the effective width or depth of each trench, whichever is greater(3 10 CMR 15.251(4)) - Chambers greater than 3 feet wide, when specifically approved, shall be separated by three times the actual width and are subject to other Special Conditions and limitations; and h) Effluent distribution lines exceeding 50 feet in length shall be connected and venting provided in accordance with 310 CMR 15.241 (3 10 CMR 15.251(11)). 7. When installed in trench configuration, approved Alternative Chambers greater than 3 feet wide: a) shall be installed with a minimum separation distance between any two trenches of two times the actual width of the chamber, or where the area between trenches is designated as reserve area, three times the actual width of the chamber; and b) shall only be entitled to a maximum effective width of 3 feet for the purposes of calculating total effective leaching area. 8. When installed in a bed or field configuration,the System may be installed without distribution piping, but must comply with the following requirements in 310 CMR 15.252: a) the use of leaching beds or fields is restricted to systems with a calculated design flow of less than 5,000 gpd per leaching bed or field (3 10 CMR 15.252(1)); b) the maximum length of chambers in series shall be 100 feet(3 10 CMR 15.252(2)(b)); c) separation distance between adjacent beds/fields shall be ten feet(3 10 CMR 15.252(2)(0); and d) the effective leaching area shall include only the bottom area, not the sidewalls (3 10 CMR 15.252(2)(i)). 9. For Systems constructed in fill and installed, the System shall be installed as specified in 310 CMR 15.255-Construction in Fill, except the minimum 15 foot horizontal separation distance to be provided between the soil absorption area and the adjacent side slope shall be measured horizontally from the top of the chamber. 10. The System is exempt from 310 CMR 15.287, specifically items: (5) requiring written notification of alternative system prior to property transfer, (6) need for a certified operator, (9) need for an operation and maintenance contract with an operator and (10) deed notice requirement. I i 'Fri F I LT R AT O R" I M-1530 tanks Features & Benefits The Infiltrator IM-1530 is a lightweight strong and Strong injection molded durable septic tank. This watertight tank design is polypropylene construction offered with Infiltrator's line of custom-fit risers Lightweight plastic construction and heavy-duty lids. Infiltrator injection ; and inboard lifting lugs allow for molded tanks provide a revolutionary ; T; easy delivery and handling improvement in plastic septic. " ` ` Integral heavy-duty green lids that tank design, offering long-term interconnect with TWTm risers and exceptional strength and pipe riser solutions watertightness.g J • Structurally reinforced access ports eliminate distortion during 4 ' installation and pump-outs e" T Reinforced structural ribbing � and fiberglass bulkheads offer , ., additional strength s Can be installed with 6"to 48" of cover Can be pumped dry during pump-outs Suitable for use as a septic tank, 4 s pump tank, or rainwater (non-potable)tank Inlet Side No special installation,backfill or Infiltrator water filling procedures are required TANK CUTAWAY TW Riser System ma's h Partition baffle wall `` 'yo HEAVY DUTY LID `. CUTAWAY Reinforced 24"structural access port Structural bulkheads AM CUTAWAY ed water tight mid-seam i connection � f�tip i1 i rrotecting me tnvlronmeni wim innovative wastewater tireatmem somions INFILTRATOR` _- _.._.-._. _-_--_.--- ---_.---------_--- water technologies IM-1530 General Specifications and Illustrations LIFTING LUG(TYP.) RISER CONNECTION(TYR) - LIFTING STRAP(TYP.) The IM-1530 is an injection molded two piece mid- seam plastic tank. The IM-1530 injection molded plastic design allows for a mid-seam joint that has precise dimensions for accepting an engineered O O 0 6,.7 EPDM gasket. Infiltrator's gasket design utilizes o oEXTERIOR technology from the water industry to deliver O 0 O WIDTH proven means of maintaining a watertight seal. The two-piece design is permanently fastened 175.6[4,4601 EXTERIOR LENGTH using a series of non-corrosive plastic alignment dowels and locking seam clips. The IM-1530 is assembled and sold through a network of certified ( Te v TOP VIEW- __ J Infiltrator distributors. OUTLET TEE (TYP.) I 54.5 11.3841 EXTERIOR Working Capacity 1537 gal(5818 L) HEIGHT SEAM CLIP (TYP,) Total Capacity 1787 gal(6765 L) LIFTING STRAP Airspace 16.9% (TYP.) Length 176"(4460 mrn) --, 7-- _ END VIEW Width 62"(1567 mm) Length-to-Width Ratio 2.8 to 1 024.0[610]ACCESS PORT 04[102] WITH LOCKING LID(3) Height 55"(1384 mm) PVC OR ABS INLET TEE PVC OR 10.1[2571 FREEBOARD Liquid Level 44"(1118 mm) P OUTLEE VC ABS T TEE Invert Drop 3"(76 mm) NLET — 16.9% PAC AIR S OUTLET 3o PER 761 CODE 0.2(5]WALL ( Fiberglass Supports 4 440 L THICKNESS PER [1.118] Compartments 1 or CODE LIQUID 2[511X 2]51] DEPTH FIBERGLASS SUPPORT(4) Maximum Burial Depth 48"(1219 mm) (TYP.) Minimum Burial Depth 6"(152 mm) Maximum Pipe Diameter 4"(100 mm) SIDE VIEW Weight 501 Ibs(228 kg) •_ _ �. __.�__���s-.. _�.__ _• �___._. � �� CONTINUOUS TANK TOP HALF •% ELASTOMERIC GASKET TANK INTERIOR SEAM CLIP ALIGNMENT DOWEL TANK BOTTOM HALF 4 Business Park Road P.O.Box 768 Old Saybrook,CT 06475 .. •,°' - __ —^."`a" —� N F I LT R AT O R� 860-577-7000•Fax 860-577-7001 MID HEIGHT SEAM SECTION�� 1-800-221-4436 — -— ` _'.` water technologies www.infiltratorwater.com U.S.Patents:4,759,661;5,017,041;5,156,488;5,336,017;5,401,116;5,401,459;5,511,903;5,716,163;5,588,779;5,939,844 Canadian Patents:1,329,959;2,004,564 Other patents pending.Infiltrator, Equalizer,ouick4,and SideWinder are registered trademarks of Infiltrator Water Technologies.Infiltrator is a registered trademark in France.Infiltrator Water Technologies is a registered trademark in Mexico. Contour,MicroLeaching.PolyTuff,ChamberSpacer,MUItiPOrt,PosiLock,QuickCut,QuickPlay,SnapLock and StraightLock are trademarks of Infiltrator Water Technologies. PolyLok is a trademark of PolyLok,Inc.TUF-TITE Is a registered trademark of TUF-TITE,INC.Ultra-Rib is a trademark of IPEX Inc. ©2014 Infiltrator Water Technologies,LLC.All rights reserved.Printed in U.S.A IM21 0214 Contact • • • • Department for :11 4436 oFt►E,� Town of Barnstable P# Department of Regulatory Services ran BARNSTABLE, Public Health Division Date 7 MASS. .� 9�A 1639• ��� 200 Main Street,Hyannis MA 02601 f�' RFD MAC A j" a Date Scheduled_ (J l ( Time Fee Pd. � P.wt Soil Suitability Assessment for Sewage wosal Performed By: 1e+,-_ tA,c A k.0 Witnessed By: V-4 LOCATION & GENERAL INFORMATION Location Address 43 A 4 Owner's Name �P�tn�¢itlL�lf Address �3 ��"rG1 �J_ �--etil-erV•.��Q �'IF't- CJZto�Z. Assessor's Map/Parcel: g— D Engineer's Name NEW CONSTRUCTION REPAIR- Telephone# Land Use 'Z.e-S r C� Slopes(%) Surface Stones Distances from: Open Water Body 7 _ft Possible Wet Area ft Drinking Water Well ft Drainage Way I'jf/9_ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) � r ox - A I I i I 1 I i Parent material(geologic) Depth to Bedrock e 1 Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: _in. Depth to weeping from side of obs.hole: _in.. G oundwater Adjusninc-t Index Well# Reading Date: Index Well level. Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time _ Observation — I Hole# Time at 9" _ it Depth of Pere � Z� Time at 6" _ C. I Start Pre-soak Time @ Time(9"-6") vi End Pre-soak 1' Rate Min./Inch / Site Suitability Assessment: Site Passed. V Site Failed: Additional Testing Needed(YIN) _ i „original: Public Health Division Observation Hole Data To Be Completed on Back-------•---- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1)week prior to begim:ing. Q:\SEPTIC\PERCFORM.DOC �a S DEEP OBSERVATION HOLE LOG Hole# 1 i pth from Soil Horizon Soil Texture .Sdil Color Soil Other urface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. _ Consistencv.%'Gravel)_ c —�O L S 1eYa `I/Z. 3(0- 7 G 511.,,a( y ' DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,.Stones,Boulders. Cons' epSy,_%G el)• ►'d Yfz-/y I DEEP OBSERVATION HOLE.,LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other S rface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consiste cv%Oravel) I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soli Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. ° U,�6 0[ayel)-- I I Fiood insurance Rate Maa: f Above 500 year flood boundary No— Yes _ Within 500 year boundary No Yes Within 100 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material Mes at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? .... If not,what is the depth of naturally occurring pervious material? Certification I certify that on t� ��a (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 10 CMR 15.017. Signature -- Date I Q 1\S Bp nCTERCFORM.DOC Page 1 of 1 Stanton, David From: PETER MCENTEE [peter.mcentee@gmail.com] Sent: Monday, August 31, 2015 8:38 AM To: Stanton, David Subject: 43 Briarcliff Ln Dave, Tom has said that I can use the adjusted groundwater from the abutting property (33 Briarcliff Ln). I have adjusted all my elevations to the benchmark used for 33 Briarcliff Ln. I have shown the soil logs two ways. Both are accurate. I prefer to use no. 1 to avoid confusion. Is that ok with you, or, do you want me to show it as illustrated in no.2. (see attached) Pete Peter T. McEntee PE - Principal Engineering Works, Inc. 12 West Crossfield Road Forestdale, MA 02644 Tel/fax (508) 477-5313 9/29/2015 » PROP. 1,50 1500G m TANK _ N o ... ' _.r,r ie � Ta «�•ts r: 1 + 9 �WpC1511NG W NIATER..SERCE PIT sz ," r v s LOCUS to 33 6RIARCLtFF A. � LOCUS MAP _ to jyat / INFORMATION LOCUS IN RMATION 4' �. !"",..! u,0' - - ` TITLE REF: BK 11862 PC 348 T< fj PARCEL ID: MAP 208 PAR. Tit RESTRICTION s 4 n 0(,,i # ';: � ' , PROPERTY IS SUBJECT TO ESTUARIES )`g� 0 LL CiA� 11- , SEPTIC SYSTEM �e, y REPAIR PLAN LOCATED AT: aIt—� r I i 33 BRIARCLIFF LANE CENTERVILLE, MA � PREPARED FOR xi } PATRICIA MURPHY s' x Gallo i#, ,» 29 . DENCH MARK E(I5T. CE55POOL5 W FEBRUARY 2, 2012 FNAIkFT +.P4TF C no I.O I-J"J PULNNdEA+0 CORNCR * - (TAA'tKI'A$LF L',DATUM - SCALE: 1'=20' D DESIGN CRITERIA. ..2 BR OEED RESTRICTION NEEDED'• GENERAL _ No. 1140 DEMON FLOTW 2 BEDROOM k I I GAL/OAY/DR-220 GPO I.ALL cmAw 4 To THIS',PL4N MUST DE APMr 6Y THE LOCAL 10.mSTM LEACHING AND SPdLS TO BE PUMPED,CRUSTED.:AND REMOVED ' G/ IOATIO OF HCAI.TN AN O THE DESIGN.ENGINEER. PER 11TLE S. (LOCATED WI119N PROPOSED FOOTPROOT OF NEW LEACHING) FOIL TETf1URK CUES: CLASS I DESIGN PERCOLATION RATE: 42 MUI/IN 2.A{,L N'Oldf AND WTERW$SWIl CONFORM TO 1NE REOUIREMEMS 11.43 FOUR NOTICE FOR ENGINEER CERTIFICATION '�H Ilk OAR049 CRIMOER; NO � - LOCAL RULES ANOF THE RATE D WAIIATHIHS.000E.TIIU 5,AND ANY APPUINBIE It INS MAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY SEPTIC TANK;226 Gpd x?OOK- 440 9Pd:USE NEW I,500/3000 2-COMP.TANK 3.THE PAX DISPOSAL SYSTEM SHALL NOT BE BAOKFILLED PRIOR AND IS NOT TO DE CONSIDERED A PROPERTY LINE SURVEY - TO NISPECIWNN�0 APPROVAL DF THE DDARD OF HEALTH AND THE 13.INSTALL�40 m0-�0 TOEPRAS SHOWN BREAKOUT, SECTIONS OF SOIL REMOVAL PUMP 01"arril USE am SECOND COMPARTMENT OF3IGN CNW I.ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DKTERNO p FRou nrosE sHown HEREON SHALL BE REPORTED To THE DESIGN 14,NO PRIVATE WELLS WITHIN 150 FT.OF PROPOSED LEACHING MEYER & SONS, INC. LEICHINO MG REQUIRED:('{0 ►297.29 SF, ENWNCER BEFORE CONSTRUCTION CONTINUES, 15-A PIPING TO BE 4'SCH 40•1/0-/FT(UNLESS SPECIFIED) BOX Q L 5.A ELEVATIONS BASED ON ASSUMED DATUM. 16.REMOVE A UNSUITABLE SOILS S FT.AROUND LEACHING TO EL 29.92 OR P.O. BOX 981 Rluew qA,C 0.Twe DpE„SIGN—NEER IS HOT RESPONSIBIfi FOR THE fNLURE OF P MGLTCN FOR PPROP.EOUR�PEECTION SDUR NO CONSTRUCTI�ON�a TOP OF'C'LAYER AND REPLACE WITH CLEW MEDIUM SAND PER TITLE S. uSLr I TgENGFj of L1 _ TIC AR.to IP (38'INVERT) UNITS - NO STONE 7 WATER SLIMLY PROMOED BY TOWN WATER SVWF. EAST SANDWICH, MA. 02537 0.A AREAS DIBTURBEO DURING CONSTRUCTION SHALL BE RESTORED TRENCH OESIGNf(GENERAL USE APPROVAL FOR 5.70 SF/LP OF CHAMBER) To A CONDITION WEED UPON BETWEEN OWNER AND CONTRACTOR. (508)362—2922 (CHAMBER) I I UNITS x 6 LF x 5.70 SF/LF-J10.45 SF 9.R SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE TOTAL AREA THECON O AONNO OF A UNDERGROUND UTILITIES,PRIOR TO BEGINNING DEVON FLOW PROVIDED; 0.74CPD/V(316.45) 235.05 CPO > 220 CPO req'd SHEET 1 OF 2 J 1367 PRIOR -71 � A r a PROP. , 500/500G v err , 2-COMPARTMENT SEPTIC TANK x : lip R a 77— . 45.76 fL N b � , I C7o.02 ft : J t PO 1 e P P1 10 rt t 7ol ft �/ \0 I t WATER 1 LINEV 1 i A C) / 1 i Nf t ! LL LL rn 20 t X LJ a r i r ` mop.an � � t DRIVEWAY 1 e 1 1 a 4 1 98.80 f t BENCH MARK EX15T. CE55POOL5 PAINT SPOT ON see note I 0 BULKHEAD CORNER ELEVATION = 30. 15 BARNSTABLE GIS DATUM 1614 � # n Elev. T P — 2 Depth E30m T P -- Depth '0 31 .50 �0" 31 .64 A _ A LOAMY SAND LOAMY SA ND 1 OYR 3/2 31 .Q 10YR 3/ S" 31 .20 7 LOAMY SAND LOAMY SAND 1OYR 6/8 1OYR 6/8 x 19" 29.93 20" 29.92 - C MDIu + SAND MEDIUM SAND PERC TEST 2.5Y 6/4 0 27.50 2.5Y 6/4 Q 20.75 129" 20.85 'OR TE.cTNnt_F 1: FlR.1'F GROUNDWATER OBSERVED AT 129» EL. 20.75 GROUNDWATER OBSERVED AT 129" EL. 20�85 WELL: MIW-29 ZONE: D INDEX WELL: MIW-29 7.ONE 0 INDEX 7.9 ADJUSTMENT: 3.7 Ao LEVEL 7.9 ADJUSTMENT: 3.7 f t. I.EVEt..' *ADJUSTED GROUNDWATER: EL. 24.45** **ADJUSTED GROUNDWATER: EL. 24.W* F STEM UPGRAD F, _ PRO P n '-:-;-F D S,FPTl L P ; -.-.;i .TOP OF Pw2m 7ANx NOTE: MAGNETIC TAPE TO BE PLACED OVER ALLPUMP CHAMBER o-aox ♦ MVNOATION INSTALL RISERS W/IN e•OF FINISH GRADE INSTALL RISERS b FNISH GRAPE INSTALL RISERS WAN 6• FINISH GRAB 5 30.47 EL�.Ot EL.JO.Ot EL3f1.Ot F.G.EL 32.Ot _ 00 32 FINISH GRADE- . YEW ry •).. .� ... .. ..a MIN.COVER OVER S.A,S- . 9' -, MAINTAIN 2N MIN SLOPE OVERLEACHING AREA INSTAII.ONE INSPECTION PORTS(IKN.) a f • _ *yx SON a E 4 L SON'(NAX) prdjYm CELLAR FLOOR ; (as-_u AiS m V . io• FORCE INV.�30.0 .. . 1 - INV RT - (ra n•W tat .r _`4 xa1 Na Etc 23• INV..J0.20..E L-.B� O 5. 1N(MIN.) INVERT-- �I1MLJ TEE SHALL NOT ExiEND . •.. I�,4w11111oR . iY 12 , -.17* 8�(USE DBwS)�.. ..LI 'I TRENCH OF 11 UNITS AT--.5/UNIT. 55'{ROW Exist. 7,47H INV.ELEV.•29.90 OIL ABSORPTION SYSTEM (PROFIt El •(A�INV. 27 _ Am INN..26.20 RESTORE VEGETATIVE COVERalJi lNv 27tC6 PROPOSED 1,500/500 GALLON. INV,�26. 2-COMPARTMENT SEPTIC TANK BACt(FlLL WITH CLEAN PERC SAND NOTESI.1)CONTRACTOR SHALL VERIFY ALL EXISTING _ TO..TOPOF C1•IAM8F3i5 PIPE INVERTS PRIOR TO CONSTRUCTION. r.• r - 2)TANK AND D-BOX SHALL BE SET TRUE TO GCUSOICALLYY COMPACTED SIX BREAKOUT=TOP ELEV.=30.25 INCH CRUSHED _ -- :. INV. ELEV.- 29.90 IN'310 CMR 15.221(2). 3)INSTALL INLET&OUTLET TEES AS REQUIRED, BOTTOM ELEV.= 29.58 _ 4)GAS BAFFLE W/FILTER TO BE INSTALLED ON OUTLET TEE 283 As MANUFACTURED BY NFL-TIRE, LIBEL OR EQUAL. SEPTIC SYSTEM PROFILE T.P.Ex�AVAT10N OR C W. (EFFECTIVE VAOIH - 1 x 2.83' • 2.83' - 5)INSTALL SANITARY TEE IN D-BOX N.T.S. (5.03 PROVIDED) USE 1 TRENCH OF 11 UNITS-NO STONE _ ,.. _ ADJ. GROUNDWATER EL.=24.55 _ * INSTALL f'PVC CONDUIT TO HOUSE FOR WIRING PROVIDE WATERTIGHT CONCRETE RISER ixTH WATERTIGHT-JOINTS.PARE HIGHS WATER'ALARM 1MTHSEQURED COVER TO GRADE TYPICAL SECTION. FLOAT-To(�2000 HICH WATER ALARM PANAL ON SOIL LOG S .,. CIRCUIT SEPARATE FROM CIRCUIT TO THE PUMP, NOAA 4 JUNCTION BOX CORROSION RESISTANT P : 13533 -_ - At UGUID-TIGHT CABLE CONNECTORS SUPPORTED HOISTING CABLE 7x19 STAINLESS STEEL. BY 1-1/4'PVC CONDUIT.JOINTS TO BE MADE DATE: I/6'DIAMETER. /1.760 I.B.STRENGTH. - WATERTIGHT 'SOIL JANUARY 30, 20/2 2'BALL VALVE r/UNIONS SN7i.80 PVC EVALUATOR: DARREN MEYER, R.S., CSE 01614 PC INV.(IN)-26.20 GEORGE FISHER�•MODEL NO.560.OR EQUAL WITNESS: DON DESMARAIS. BARNS. BOH 2'SCH.40 DISCHARGE TO 0-BOX - EIn. .TP-1 O�pth .o«. . TP--2 _(moth ALARM ON EU 24.14 2'SCH.40 TEE r/CLEAN-OUT CAP - _ - 31.50 A 0" 31.60 A 0" PUMP ON EI.U.23.54 PROVIDE 1/4'WEEP HOLE IN DISCHARGE • 31.0 - LOAMYtOYR SAND AN 6" 1 LOAMY�SAN .. .5 PUMP OFF EL:23.20 2 PIPE FOR SELF-DRAINING FORCE MAIN - -31.20 7• 3 a g y 2'BALL CHECK VALVE SCH.80 PVC B07T011 OF IM:P.C.a..22.20 100 P.S.I.FLOMMATIC MODEL No. 208S - LOAMY SUNG LOAMY SAND IOYR 6/8 1CYR 6/6 RRONOE�.. wlitlr..AN c Dwm - 2'SOH.40 PVC DISCHARGE PIPE d .. FLOAT No.I:PUMP l7NlOFF(09ARNES 073818 OR EQUAL)) 29.92 C 19' 29.93 C .20' FLOAT N0:2i ALARM ACTIVATION(BARNES 073612 OR Ed/AL) _ 2'BARNESDISC SEV412 PUMP,2 H.P.SOLIDS V BUOYANCY CALCULATIONS - 2'DISCHARGE PASSING2'SOUDS OR EQUAL NOTE PUAiPCHAMBER TO BE FACTORY WATERPROOFED AND SEALED MATH TNOROSEAL OR EQUAL PERC TEST MEDIUM SAND MEDIUM SAND Lp PUMP O ACCESSORIES AVAILABLE AS A UNIT O 27.50 2.5Y 6/4 2.S(6/4 THROUGH MOM PRECAST CORP.,BOURNE MA.(800)564-6774 2-SAIIPAftflIFM cr_ P�r,� .PUMP 4 ACCESSORIES AVAILABLE THROUGH VALUAMSON ELECTRIC(781)444-6800 Yla8822'x 7'x 2.25 x 624:11,793 itw 20.75 129" 20.85 129" PUMP DETAIL nmueA`^� 1a'x T x.75 x 120-7.xo be . 14,000 IW FOR TESI11di/1• TV ,. ._ N.T.S. + �.1 V> tl1R H+ROUNONATER OBSER/m AT 129' EL 20.75 GROUNDWATER OBSERVED AT 129' EL 7,660+14,000.21,360 1H> 11,793 IG MDOf WELL; NIW-29 ZONE: 0 INDEX WELL:-MIW-29 ZONE: 0 1E14,1,: 7.9 AWUSTMEM: 3.7 IL LEVEL: 7.9 Awisr EMt. 3.7 fty DOSING & STORAGE REQUIREMENTS SEPTIC TANK BUOYANCY CHECK O.K. •+AAIU$TEp GROUNDWATER:0.24A5•• •. A .. tN OF +�f DAILY FLOW: 220 GPO DOSING REQUIRED: 4 CYCLES/DAY (SAND) DARR��q y 220 T 4 . 55 GALLONS/CYCLE PROPOSED SEPTIC SYSTEM UPGRAtiE P ME DISTANCE REQUIRED BETWEEN PUMP 33 BRIARCLIFF LANE, CENTERVILLE, M No. 140 "' ON AND PUMP OFF FLOATS: 55 GAL/CYCLE -i- 125 GAL/FT = 0.44 FT/CYCLE (5") Prepared for: Patricia Mu h STORAGE REQUIRED ABOVE WORKING LEVEL' 220 GALLONS LEnginsering Surveying byt SCALE DRAWN STORAGE PROVIDED: S IINC. MaCDougal Survey N;f.S. DIINV.(IN) EL'26,20 - ALARM ON EL' 24.14 •2.06'STORAGE PROVIDED 2.06' X 125 GAL/FT - 257.50 GALLONS AM402587 (508) 419-1086 REV. DATE CHECKED DMM .Y. x V i M a � I (DomesticU.S. Postal Serviceg CERTIFIED MALT. RkEIPT . ,. ar For delivery information visit our website at www.usps.com@ Ln M Postage $ O Certified Fee M Return Receipt Fee Postmark Her p (Endorsement Required) Q O O Restricted Delivery Fee = j O (Endorsement Required) , (V Total Postage&Fees $ � \ rq C3 SHM LLC M % Debora Brodeur I 30 Blossom Avenue L— Osterville. MA n2655 Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailpiecer' w ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery°. ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an Inquiry. j PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sip ure item 4 if Restricted Delivery is desired. �-� 13 Agent ■ Print your name and address on the reverse X iAddressee so that we can return the card to you. B. Received by(Printed Name) Ct ¢D�li ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No SHM LLC % Debora Brodeur 30`Blossom Avenue - s. Service Type ❑Certified Mail® ❑Priority Mail Express' 0Sterville, MA 02655 ❑Registered ❑Return Receipt for Merchandise -� � — ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (transfer from service laaeq '''7 014 112 0 0 0 001 t 014 4992 PS Form 3811,July kl3�' Domestic Return Receipt �www� UNITED $TATE > If is • Sender: Please print your name, address,.and ZIP±4®in this box• j I ' I _ I Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 I I iis:'.gi�1 ..ii::t�iiii�•ii�i• i..i iii:S::ii{{i•ii ::i F p �• ii: :1.� ! � +I. :?• 31 -i S i i ' 3iii � �iiii i I l .:a Town of Barnstable Barnstable Regulatory Services Department aftwWaCh MAM Public Health Division I 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7014 1200 0001 0358 4992 August 18, 2015 SHM LLC %Debora Brodeur 30 Blossom Avenue Osterville, MA 02655 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. RE: Letter sent August 8th 2015, we are sending corrections to that letter. The septic system located at 43 Briarcliff Lane, Centerville, MA,was last inspected on 5/27/2015, by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails under.the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level,<12" below pit(per Town Code 360-9.1) • Need to replace Distribution-Box,walls are gone. d A • Tank should be pumped You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\43 Briarcliff Ln Cent Jun 2015.doc r Failure to repair/replace the septic system within the deadline period will result in future enforcement action. Zas ORDER OF THE OARD OF HEALTH C: cKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\43 Briarcliff Ln Cent Jun 2015.doc u n•02 1512:00p /I p.1 { Commonwealth of Massachusetts Title 5 Official Inspection Form ;1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Briarcliff Lane Property Address Deb Brodeur Owner owners Name / information required for every Centerville V/ MA 02632 5-27-15 page_ CitylTown State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General information nuuullUr oln the comp ung out ter,pu forms 0 `` �������H OF .. use only the tab 1. Inspector key to move your JA M ES cursor-do not ,lames D.Sears use the return Name of Inspector s r" key. CapewideEnterprises,LLC i Q �. Q Company Name 153 Commercial Street _ 14� n5.INS III `�\````` Company Address _Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S 1623 Telephone Number license Number B. Certification 1 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 16.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditignally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-2-15 pectoes Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. I t5ins-3113 Ti9e 5 Official inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i Jun'02 15 12:01 p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Briarcliff Lane Property Address Deb Brodeur Owner Owner's Name requir required for s Centerville MA 02632 5-27-15 required for every page. CityrTown 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: Failed System. The system is a 1000 Gal.Tank D Box and pit. 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 0 N ❑ ND(Explain below). i i I I i i 151ns-313 Title 5 Official Inspeellon Form:Su"urraw Sewage Disposal System•Page 2 o117 j I i I f I Jun'02 1512:01 p p.3 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Briarcliff Lane Property Address Deb Brodeur Owner Owner's Name information o e Centerville MA 02632 5-27-15 required for every page. Citylibwn State Zip Code Date of Inspection B. Certification (cost.) ❑ Pump Chamber pumpsialarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (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 ❑ NO (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 E ❑ Cesspool or privy fs within 50 fleet of a bordering vegetated wetland or a salt marsh t5ins.3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 i I f Jun'02 1512:01p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Briarcliff Lane Property Address Deb Brodeur Owner Owner's Name information is required for every Centerville MA 02632 5-27-15 page. Cityfrown State Zip Code Date of Inspedion 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 DE certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: I You must indicate"Yes"or"No"to each of the following for all inspections: i I Yes No Backup of sewage into facility or system component due to overloaded or j ® ❑ 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 j ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in- 1 is less than 6" below invert or available volume is less than %day flow oOO;T ,y gs 46,s'-s-,, Gina-3113 - Title 5 Official kispadion Form:Subsurface Sewage Disposal System-Page 4 of 17 t Jury 02 1512:02p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 43 Briarcliff Lane Property Address Deb Brodeur Owner Owner's Name information is Centerville MA 02632 5-27-15 required for 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 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 CNIR 16.304.The system owner should contact the appropriate regional office of the Department. t5ins•3113 rifle 5 Official Inspection Form:Subsurface Sewage Deposal System•Page 5 of 17 I Jun 02 1512:02p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - 43 Briarcliff Lane Property Address Deb Brodeur Owner Owner's Name information is required for every Centerville MA 02632 5-27-15 page, Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) 0 ❑ 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: I' 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 rains•3113 Title 5 Official Inspection Form;Subsurface Sewage Disposal System.Page 6 of 17 i i i Jun 02 1512:02p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Briarcliff Lane Property Address Deb Brodeur Owner Owner's Name information is Centerville MA 02632 5-27-15 required for every page. City(Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal.Tank D Box and pit. 1 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2013-134,000Gal g ( y g (gp )�' 2014-94,000Gat's Deta i I: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/personsisq.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: I t5fns 3113 Title 5Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 i I i j Jun 02 15 12:03p p,g Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Briarcliff Lane Property Address Deb Brodeur Owner Owner's Name information is Centeryilie MA 02632 5-27-15 required for every page Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: 419/ 12 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 i ❑ Overflow cesspool I ❑ Privy ❑ Shared system (yes or no) (if yes,attach previous inspection records,if any) ❑ InnovadvelAlternative 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 IIA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): 1 I 15ins•3113 Me 5 Offidel Insped;m Form:Subsurface Sewage DEsposal System•Page 8 o1 17 I j i Jun 02 1512:03p p,9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Briarcliff Lane Property Address Deb Brodeur Owner Owner's Name information required for every Certterviti'e _ MA 02632 5-27-15 page. CityrTown state Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1994 Permit#92-565 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20" 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.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 10" feet Material of construction: ®concrete ❑metal ❑fiberglass ❑polyethylene ❑ other(explain) If tank is metal, list age: years I Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal_ Precast H-10 6e Sludge depth: 65ins-3113 Title 5 Offcrial Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 i i i i I Jury 02 1512:03p p.10 Commonwealth of Massachusetts Fill Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Briarcliff Lane Property Address Deb Brodeur Owner Owner's Name informationis required for every Centlervifle MA 02632 5-27-15 page. City/rown stale Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(coot.) Distance from top of sludge to bottom of outlet tee or baffle 24" 4" Scum thickness pe Distance from top of scum to top of outlet tee or baffle O Distance from bottom of scum to bottom of outlet tee or baffle 14" Now were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank at working level. Tank and covers at 10" below grade. In and outlet tee's. Outlet cover under stone patio block's.Tank should be pumped. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: I ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): I Dimensions: I Scum thickness i Distance from top of scum to top of outlet tee or baffle 1 Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form..Subsurface Sewage Disposal System-Page 10 of 17 j i i 1 i Jun 02 1512:04p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Briarcliff Lane _ Property Address Deb Brodeur Owner Owner's Name information is required for every Centerville MA 02632 5-27-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow. gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspeclion Form:Suhsiaface Sewage Disposal System•Page I I of 17 Ju rl 02 1512:04p p,12 Commonwealth of Massachusetts Title 5 Official Inspection Form WSW-Im Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Briarcliff Lane Property Address Deb Brodeur Owner Owner's Name information is Centerville MA 02632 5-27-15 required for every page. CitylTown state Zip Code Date of Inspedion 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.): D Box is 16"x 16"-27" below grade-Wall's are gone w/one line out. Need to replace D Box. D Box under stone patio block's. 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.): - I I I If pumps or alarms are not in working order, system is a conditional pass. i Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: , 15ins-3M3 Title 5 Offlual Inspection Forth subsurface Sewage Disposal System-Page 12 of 17 I I i I f Juri 02 15 12:04p J p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Briarcliff Lane Property Address Deb Brodeur Owner Owner's Name information is MA 02632 5-27-15 required for every Centerville page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): Leaching is a 1000 Gal. precast pit. Pit and cover at 2' below grade 6"water in pit. Stain line at 8"below inlet Wall's are black and still wet up to 8" below inlet. Need to replace leaching. 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 j Materials of construction Indication of groundwater inflow ❑ Yes ❑ No I I t5ins•3113 Title 5 Offidal Inspection Form Subsurface Sewage Disposal System-Page 13 of 17 I i I !i Jun 02 15 12:05p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Briarcliff Lane Property Address Deb Brodeur Owner Owners Name information is required for every Centerville MA 02632 5-27-15 page. Cityrrown 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.): I I . j t51ns•3113 Tile 5 Orfidal Inseeclim Fomt Subwrfaw Sewage Disposal System•Page 14 of 17 i i I Jurt 02 1512:05p p.15 Commonwealth of Massachusetts - Title 5 Official Inspection For m - Subsurface Sewage Disposal System Form Not for Voluntary Assessments 43 Briarcliff Lane Property Address -- -------- ---------- - -------- Deb Brodeur Owner owner's Name ---- ------- —_------------ iequiredfo,a Centerville MA___ 02632 5--27-15 required for every, —_•_. page. Cltylrown 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 beiov ® hand sketch in the area below drawing attached separately I /54- = .5' 1 &4P a � I I i i l I ,wins-3/13 Title 5 Oifdd Wpomon Form:Subsuclace Sewagei Disposal Systam•Page iS of t i Jun 02 15 12:05p p.16 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r` 43 Briarcliff Lane Property Address Deb Brodeur Owner Owner's Name information required for every Centerville MA 02632 5-27-15 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells p Jo Estimated depth t high ground water: 14'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Past Report ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: No G.W. at 14'per past report Bottom of pit at 9',T.H.at 14',T.H. at 5' below bottom of pit. I i i I Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•3113 Title 5 Official ins 1pection Fomr Subsudace Sewage Disposal System.Page 16 or 17 i i Jun 02 15 12:06p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Briarcliff Lane Property Address Deb Brodeur Owner Owner's Name information required for every Centerville MA 02632 5-27-15 page- Cityrrown 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•31113 Title 5 Official Inspection Fornc Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION �� �(/A� CA SEWAGE# V:J LAGE U��U— ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY /0M LEACHING FACILITY:(type) PIT (size) /On NO.OF BEDROOMS OWNER G i O u lin/\0 AL PERMIT DATE: 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 Tl)SiOt,GT Gil .� Foy A t, i 1 a A r3 , a i a9 I F, - - - - - - - (a b 1 a-yS a� � o � 3r,(,k Pao , . Postal (DomesticCERTIFIED MAILT.-RECEIPT 0 For delivery information visit our website at vmw.usps.conne .ol OFFICIAL USE M Postage $ I$ M Certified Fee p.N r� Postmark O C3 Return Receipt Fee r,►/y Here p (Endorsement Required) -�.rr O Restricted Delivery Fee 0 (Endorsement Required) N Total Postage&Fees $ GPS ' — - - - - — - - j SHM LLC N % Debora Brodeur 30 Blossom Avenue Certified Mail Provides: ■ A mailing receipt �. ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ~ ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form W 1)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized aent.Advise the clerk or mark the mailpiece with the endorsement"Restricted'Delivery. in If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 COMPLETE • ■ Complete items 1,2,and 3.Also complete A. Si ature item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) Dat f li ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is de'Very addres e�t from item Ye 1. Article Addressed to: If( S,enter deliverygddY below: ❑ No c' SHMILC 1 Cl) s % Debora Brodeur 30 rBlo sore 3. Sery pe Avenue � OSterville, MA 02655 . ❑certi ail® Pri- ' press"" ❑Registered e ec t for Merchandise ' ❑Insured Mail ec Delivery 4. Restricted Delivery?(Et.) El Yes 2 Article Number (*fer from service iabei) 7 014 1200 0001 0358 4 015 PS Form;3811,July 2013 Domestic Return Receipt I � I UNITED STATES POSTAL SERVICE I First-Class Mail Postage&Fees Paid tl LISPS Permit No.G-10 I • Sender: Please print your name, address, and ZIP±4®in this box* j I I I � I i I Town of Barnstable Public Health Division E 200 Main Street Hyannis, MA 02601 tom. Town Of Barnstable Barnstable �j Regulatory Services Department + 1ARNSTASM + I MAOM �, Public Health Division 200 Main Street, Hyannis MA 02601 200� Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7014 1200 0001 0358 4015 June 15, 2015 SHM LLC %Debora Brodeur 30 Blossom Avenue Osterville, MA. 02655 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,Title 5. The septic system located at 43 Briarcliff Lane, Centerville,MA,was last inspected on 5/27/20159 by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level, <12" below pit (per Town Code 360-9.1) You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in,future enforcement action. PER ORDER OF THE BOARD OF HEALTH e��Fxv Z-L— —._... Thomas McKean, R.S. CHO Agent of the Board of Health • Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\43 Briarcliff Ln Cent Jun 2015.doc COMMONWEALTH OF MASSACHUSETTS LS trz r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS V DEPARTMENT OF ENVIRONMENTAL PROTECTION r 3 TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION operty Address: - 43 BriarchALane Centerville, MA 02632 f Owner's Name: Ed Giovannone Owner's Address: Date of Inspection: __ May 1, 2008 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 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: 4AAW4. Date: May 2, 2008 The system inspector shall subm 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 I Page 2 of 11 a OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 43 BriarcliffLane Centerville,MA Owner's Name: Ed Giovannone Date of Inspection: May 1. 2008 Inspection.Summary: Check A,9,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 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: 43 BriarcliffLane Centerville MA Owner's Name: Ed Giovannone Date of Inspection: May 1. 2008 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 CN M 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 5.0 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 I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 43 BriarcliffLane Centerville, MA Owner's Name: Ed Giovannone Date of Inspection: Ma 1. 2008 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 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 I of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of aprivate 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 DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure.criteria are triggered. A copy of the analysis.must be attached to this form.] No (Yes/No)The system fails. -I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 1I 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 Page 5 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 43 BriarcliffLane Centerville. AM Owner's Name: Ed Giovannone Date of Inspection: Mav 1, 2008 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 I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 43 BriarcliffLane Centerville MA Owner's Name: Ed Giovannone Date of Inspection: Mav 1. 2008 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310(design).: 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current.residents: Does residence have a garbage grinder(yes or no): N/a 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 occu ied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): epd Basis of design flow(seats/persons/sgft,etc.): Grease trap.present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of infonnation: Unknown 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: Date of installation 11119192-per as-built Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 43 Briarcfi fLane Centerville, MA Owner's Name: Ed Giovannone Date of Inspection: May 1, 2008 BUILDING SEWER(locate on site plan) 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: 15". 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: 3" 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: 10" How were dimensions determined: _Measuring stick Connnents(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 anv signs ofleakaQe GREASE TRAP: None (locate on site plan) Depth below grade: I 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: 43 BriareliffLane Centerville, MA Owner's Name: Ed Giovannone Date of Inspection: Mav 1, 2008 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: Qallons Design Flow: gallons/day Alarm present(yes or no): Alarm level Alann 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 clean. No solids were present. PUMP CHAMBER: None (locate on site plan). Pumps in working order(yes or no): Alarns in working order(yes or no) Coni nents(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 i Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 43 Briarcli Lane Centerville MA Owner's Name: Ed Giovannone Date of Inspection: May 1, 2008 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation.not required) If SAS not located explain why: Type ✓ leaching pits,number: 1000 gal. Pit leaching chambers,number: leaching galleries,number: leaching trenches,number, length: . leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Coirunents(note condition of soil;signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The leach Pit had 4'ofwater on the bottom There did not appear to be any si ns of failure. The bottom to grade was 9' The cover was 21"below grade. CESSPOOLS: None (cesspool must be pumped as part of ins pection)(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: 43 BriarcliffLane Centerville, MA Owner's Name: Ed Giovannone Date of Inspection: May]. 2008 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 1� ( , a a9 (� b i 3r,ck f' o 10 Page 11 of I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 43 BriarcliffLane _ _Centerville. MA Owner's Name: Ed Giovannone Date of Inspection: May 1, 2008 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 15 +/- 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 Barnstable topographic and water contours maps the maps were showing garoxiinately 15'+/ to groundwater at this site. This report has been prepared only for the septic system and components described herein. This septic system has been. inspected and passed 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 septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 Town of Barnstable 0p YHF Tp� Regulatory Services BMWSTAEM Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY.PRIVATE CONTRACTORS DISCLAIMER 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 or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations 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 Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Q:\SEPTIC\Disclaimer Private Septic Inspections.DOC TOWN OF BARNSTABLE ..TION / GU �� ��/F� ,�/1*- SEWAGE # VILLAGE e £y 7 ASSESSOR'S MAP & LOT���`��� RF,T S NAME&PHONE NO. 4 46 &i0ti C a'> SEPTIC TANK CAPACITY S ���' Z /zE6EC�f � LEACHING FACU ITY: (type) (size) -NO. BEDROOMS i B3UILDER OR OWNER 016 U/f AIX,1a (/ r `PERMIT DATE: C 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 f't �A� 3�, �� o � � �D` � y ,. � - .3 0 r RECEIVED MAY 3 1 0005 TOWN OF BARNSTABLE 'COMMONWEALTH OF MASSACrIU EALTH DEPT. f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION �'9M c�ey /\ 350 MAIN STREET WEST YARMOUTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 208—PARC 110 Property Address: 43 E-RIAR CLIFF LANE _ CEP i 1 ERVILLE,MA 02632 Owner's Name: GIG\'ANNONE,EDWARD Owner's Address: 43 I.:PIAR CLIFF LANE CEI,-TERVILLE,MA 02632 Date of Inspection APRIL 28,2005 Name of Inspector:(please print) TAMES D.SEARS Company Name: A&B Canco Mailing Address: 350 Maui Street West Yarmouth,MA 02673 Telephone Number: 508 775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this addres, 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 prober T,. ,,; .,n 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 Needs Further Evaluation by the Local Approving Authority _ Fails Inspector's Signature: 40—Dail: The system inspector shall subs,i,.a copy of this inspection report to the Approvinl!..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 iystem owner shall submit the report to the appropr:,ate regional office of the DEP. The original should be sent to tl:e system owner and copies sent tot he buyer,if applicable,and the approving authority. Notes and Connnents ****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 1 1 Page 2 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 43 BRIAR CLIFF LANE CENTERVILLE,MA 02632 Owner: GIOVANNONE,EDWARD Date of Inspection: APRIL 28,2005 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 CUR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A 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 extiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 43 BRIAR CLIFF LANE CENTERVILLE,MA 02632 Owner: GIOVANNONE,EDWARD Date of Inspection: APRIL 28,2005 C. Further Evaluation is Required by the Board of Health:N/A 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(i)(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 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 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: Title 5 Inspection Form 6/15/2000 3 R. r Page 4 of 11 OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 43 BRIAR CLIFF LANE CENTERVILLE,MA 02632 Owner: GIOVANNONE,EDWARD Date of Inspection: APRIL 28, 2005 D. System Failure Criteria applicable to all systems: N/A 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 pit 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 N/A Any portion'of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CUR 15.303,therefore the system fails. 'I1ie system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service 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 is 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 CUR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 43 BRIAR CLIFF LANE CENTERVILLE,MA 02632 Owner: GIOVANNONE,EDWARD Date of Inspection: APRIL 28, 2005 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,including 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)has been detennined 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 CNIR 15.302(3Xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 43 BRIAR CLIFF LANE CENTERVILLE,MA 02632 Owner: GIOVANNONE,EDWARD Date of Inspection: APRIL 28,2005 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: 4 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2003—160,000 GAL/2004—176.000 GAL Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): . Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A 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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1992 PERMIT#92-565 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 43 BRIAR CLIFF LANE CENTERVILLE,MA 02632 Owner: GIOVANNONE,EDWARD Date of Inspection: APRIL 28,2005 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 12" 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 onsite plan): ✓ Depth below grade: 14" 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-GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 28" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: ASBUILT&TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT LEVEL,NO SIGN OF OVER LOADING OR LEAKAGE. GREASE TRAP(located on site plan) N/A 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.): Title 5 Inspection Form 6/15/2000 7 i Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 43 BRIAR CLIFF LANE CENTERVILLE,MA 02632 Owner: GIOVANNONE,EDWARD Date of Inspection: APRIL 28, 2005 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: I Alarm in working order(yes or no): Date of last pumping Continents(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: 0 Continents(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): D-BOX IS 16"X 16"—26"BELOW GRADE,ONE LINE IN—ONE LINE OUT.BOX IS CLEAN&SOLID. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. PUMP CHAMBER: N/A (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.): Title 5 Inspection Form 6/15/2000 8 gg' Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 43 BRIAR CLIFF LANE _ CENTERVILLE,MA 02632 Owner: GIOVANNONE,EDWARD Date of Inspection: APRIL 28, 2005 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan;excavation not required) If SAS not located explain why: Type •/ leaching pits,number: 1 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.) LEACHING IS ONE 1000-GALLON PRE CAST PIT,30"TO COVER 24"WATER,STAIN LINE AT 28. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (cesspool must be piunped as part of inspectionxlocate 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: N/A (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.) Title 5 Inspection Form 6/15/2000 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 43 BRIAR CLIFF LANE CENTERVILLE. MA 02632 Owner: GIOVANNONE,EDWARD Date of Inspection: APRIL 28, 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM , Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i 1 Title Inspection Form 6/15/1000 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: 43 BRIAR CLIFF LANE CENTERVILLE.MA 02632 Owner: GIOVANNONE,EDWARD Date of Inspection: APRIL,28. 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 14 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: �— Observation site(abutting property/observation hole within 150 feet of SAS) Checked %,nth local Board of Health-explain: Checked with local excavators,installers-(attach documentation Accessed USGS database-explain: You must describe how you established the high ground water elevation: TEST HOLE 14 ` NO WATER. BOTTOM OF PIT AT 9'. TEST HOLE S' below TEST HOLE 5'BELOW BOTTOM OF PIT. "D y ,�.. i L '`' Title 5 Inspection Form 6/15/2000 1 1 TOWN OF BARNSTABLE L LOCA'aON 3 ��/�� L' Fi 1Ic J-N SEWAGE # VILLAGE £ivy ASSESSOR'S MAP&LOT 10 INSTALLER'S NAME&PHONE NO. SEPTIC-TANK CAPACITY LEACHING FACII.TfY: (type) ®/T (size) /U� NO.OF BEDROOMS 3 BUILDER OR OWNER- /Q/n ERMTT DATE: 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 faci 'ty) Feet Furnished by /16 — - --;---, i ������ 2� �g o �„ � �� Q o o TOWN OF BARNSTABLE ON 7� � /R� (�/l lQ0. SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY - Il 491/. LEACHING FACILITY:(type � mll&I A(size) 1jOG' MO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 7 ` 7 a- VARIANCE GRANTED: Yes No / } 4 � . t. a,, i Jos - Ire No._f.... _.... Fxs.... :................. THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOARD OF H E A LT FParnstable Conservation OePmunt TOWN OF BARNSTABLE, Appliration for lliipuoal Works Cn���$r�r��� n �e�uti� Date Application is hereby made for a Permit to Construct ( ) or Repair (k/f an Individual Sewage Disposal System at: / C_ E V LLL A! 7. _..._. ��.... ..`.��......�.�.........-•••-•-••- ......•---•••-N.....--�---------------•---...----.....------------.•..................... NL ... �2/Lb d 0�ip�ti ess or Lot No. V T"� Owner Address -I1 . o ......... :.. fa O uq.... Installer Address Type of Building Size Lot...........................Sq. feet Dwelling—No. of Bedrooms..............:.........................Expansion Attic ( ) Garbage Grinder (. ) a Other—T e of Buildin a —Type g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ---------------------------------•----•••-•-•-----•--- W Design Flow:...........................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ �4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-__----____-_-__-----_-. 44 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ a .--------•-•------------••••-•-•-•-••-••-•••-•--•------------•---•-•--•...----•----•...............•-••••--•--••---..........••-•-.......................... 0 Description of Soil...............................................................................----------------------------•-•---•-•-----....................... U ....................... ••-•-----•--••---••---------•-•--------•-•----••--•-••-••-•-•.._...-•••---•-•---•--•-•----•--•------•---•---------••------••-----••--•----•••---•------•-••••---•-••-•--•--••---- W ----------------------- -------•---•---------••---------------------•-••---------.............-•-- --------------------- x U Nature of Repairs or It ation —Ans er whe ap�licabl -___--__..I �_ __________ _ ____ _s._.� • . - '---••`'' --.. .. Q'` -'"`- -`........................................-......................... `o /ego© A Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co p ' c has been issue y the board of health. lk% Signed .. ---. `� ------ .... .................. ..................... .............. lO.- I.7..- �.. Dare Application Approved B — 07 .. - r, pp pp Y - � . ........... ................................. ----- .�� Dace Application Disapproved for the following reasons- ................................................. -------------------------------......................................------------ ------------------------------------------------ -------...----------------------------------------------------- --------------------------------- Permit No. r `� -9 - ..-- -- --- Issued ------------ -- "' Dare / 1 ►, - � v � - IE0E No.21 Fizz.3 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLEZ7/4 Appliration for Bi"mial Works Tnnitrnrtw ramit Application is hereby made for a Permit to Construct ( ) or Repair (V) an Individual Sewage Disposal System at: u� ..... .� . eL1.. .F--..... .b.: ......0 �?;E2v��.c_c ' �......---... .......... - - -- ------•.................. N4 jerr,> G 1._6 V A N 1S_1iQ a�C9'ess or Lot No. +.........__............................... .to T'Lt 1,-----•-------•-- ..........--.•.....-•-----•-•-----......--•---------...........•..-----...............---......... Owner Address �R+ �'.� Cn +mod . oc �99 (.v . Up2W�ou-r'!-� ------.. '�' ................••---•--•••......----...._ ........ .. •...........--_... .---•----•--•-----•----------•-.......... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.%;.......................................Expansion Attic ( ) Garbage Grinder (� ) a Other—T e of Building No. of persons............................ Showers a YP g ---------------------------- P ( ) — Cafeteria ( ) dOther fixtures ---------------------------------------------------......-•-•----------------•-•--•--------••--•--------------•----•-------........•--•--....---•---- ' W Design Fl6w............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fTq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -----••-•••--------------------------------•••----•------•-•---....----••---._..........••----............................................................... 0 Description of Soil........................................................................................................................................................................ "W U ...........................................................----------------------••----------------------•-----------------------•-•------------•----------.........----...._..-•--•---....-•---•...... W ---•----------------------------------------------------------------------------------••-•--•-----••--- ---- " ....... ----------•= = x � U Nature of Repairs or OAlterations—Answer when applica�bllei: .--------. pro??.. ... � v 1._:__ ' ............... ..........'.av-r-rx-=-----I . Agreement: j The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issuelby the board of health. Signed.. .............. Dace Application Approved BY /'' .........`-- - Date Application Disapproved for the following reasons: ........................-- at e Permit No. � ----.- Issued ..-......... - - . .................... Date ,THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ger#ifirate of Contylian e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (✓ ) by---------- ` .......... ..j..C..(—D................------........ --------------------------------------------- ------------------------------------------------------- .. �- Installer atQ-/A C. .. -r...-- .-a------------- ......................----------------------------- has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......��... -�,�..- dated .&"" ./ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................... `----------------------------------- Inspector ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN'OF BARNSTABLE No........................ FEE.3 ............... Disposal Worko Contrur#ion Fermi# Permission is hereby granted•--�- - ...... -------------------------------------------------------------•-•••.......-•-.....--------- to Construct ( ) or Repair (j,-� an Individual Sewage Disposal System atNo....... 1.F1 .... I .. . ' P77:RV_l C..............................................................! Street as shown on the application for Disposal Works Construction Permit .___.� :.Dated.._........_`..../�"...�... s/`!? 5 o'au�d%ofJHealt�i DATE / / - :� FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS r Cop SEPTIC PUMPING AND INSTALLATION 350 Main St. • W. Yarmouth, MA 02673 • 775-2800 Heating&Plumbing,Fire Sprinklers SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property �3 QaP�i9R C',LIfF ,tN08. Owner's name An+� MAFS� Date of Inspection PAR# �4 s=i3-?s' PART A CHECKLIST Check if the following have been donee v Pumping information was requested of the owner, occupant, and Board of ~~• Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal .flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ZAs built plans have been obtained and examined. Note if they are not ' available with N/A The facility or dwelling was inspected for signs of sewage back-up. V The site was inspected for signs of breakout. ;..,, ll. system components, excluding the SAS, haye ;Peen,,located`.on the : { site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined based on existing information or approximated. by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. �` ♦. 1 � RECEIVED ' AUG 3 1 1995 � r F= '41ep SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B S' SYSTEM INFORMATION rr - "° FLOW CONDITIONS If residential number of bedrooms number of current residents H {5y x garbage grinder, yes or no laundry connected to s stem, yes or no .•. seasonal use yes or If nonresidential , calculated flow: �Q� Scrul'c C Water meter readings, if available: P cgs£N7— Last date of occupancy GENERAL INFORMATION Pumping records and source of information: b ' s r,*r/c-< : /VdA• System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Jv TypB�0f system Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspodl w Privy Shared system (yes or no) ( if yes, attach previous inspection` '"�z -�records, if- any) Other (explain) Approximate age of all components. Date installed, if known. Source of information: pry ��� A&ST�E-�--/�-/l-!`� �'a v�ecr Q���- Bo9 of / �r�lr. � ,�� f Sewage odors detected when arriving at the site, yes or s, ,s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORN PART B ' SYSTEM INFORMATION continued SEPTIC TANK: - (locate on site plan) depth below grade: material of construction: concrete metal FRP other(explain) dimensions: /Oao GWJ- ' sludge depth distance from top of sludge to bottom of outlet tee or baffle Ij 0` scum thickness r7- distance from top of scum to top of outlet _tee or baffle distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) �F �tyh-�tGE ac �irviJi£N� �0 6PtP 1,es A,rL-ash DISTRIBUTION BOX: s (locate on site plan) m depth of liquid level above outlet invert Comments: (note if level and distribution is equal , evidence of solids, carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) QOX /S £✓£L., No So �/7, CA�PP�'oyr2 PUMP CHAMBER: &O IV F (locate on site plan) pumps in working order, yes or no { Comments: (note condition of pump .chamber, of pumps and appurtenances, , recommendations for maintenance or repairs, etc. ) i; ?` . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS).: (locate on site plan, if possible: excavation not required, but may be approximated by non-intrusive- methods) If not determined . to be present , explain: r' Type leaching pits and number L. ° 3#a leaching chambers and number leaching g galleries and number s ;. Teaching trenches, number , length leaching fields , number, dimensions k, overflow cesspool , number Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) . 7- CESSPOOLS (locate on site plan) : number and configuration depth-top of liquid to inlet invert depth of solids layer k* dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) - PRIVY: A locate on site plan) 43 materials of construction dimensions depth of. solids Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs , etc.. ) 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARfi B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 o� VJ) r)91�tH TO GROUNDWATER 4. depth to groundwater method of determination of approximation: env ,4WA-1 r SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes , no, or not determined (Y, N, or ND) . Describe basis of determination "in all instances . If "not determined" , explain why not _ / Backup of sewage into facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <6" below invert or available volumec. 1/2 da- flow? Al Required pumping 4 times or more in the last year? number of times pumped N Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is -any.portion of the SAS, cesspool or privy: } (� below the high groundwater elevation? within 50 feet of a surface water? within 100 feet- of a surface water supply or tributary to a surface . water supply? within a zone I of a public well? . within 50 feet of a private water supply well? N less than 100 feet but greater the 50 feet from a private water suppl: well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. F z. f SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector � £AjeS Company Name A & B Canco Company Address 350 Main Street, West Yarmouth MA 02673 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. Check one: 171 have not found any information which indicates that the system fail to adequately protect public health or the environment as defined in 310 CMR 15 . 303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15 . 303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. NOTE: A .& B Canco has had no control over the use and/or routine maintenance of the septic system. Circumstances such as a recent pumping will significantly alter evaluation results . No guarantee or warranty is hereby given, express or implied, as to the evaluation. THE ISSUANCE OF THIS INSPECTION FORM SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY If you have any questions; please call me at 508-775-2800 between 8:30 am and 4:30 pm, Monday through Friday. F Inspector's Signature J�'` Date Original to system owner Copies to: Buyer (if applicable) j Approving authority 7 i :i t i EXISTING 29.24 ABM- FF HOUSE(#33) OUTSIDE BULKHEAD CORNER TOF=30.47 EL.=33.20 ( E NOTE 6-SH _ _�` x 30.19 S 33.92 x31.44 30.91 X 1 n \ 31.0, .; \ --3-2 + y •\30.30 0.20 32.51 + O + _-j 31.92 ' + r -12.30 32.27 29.85 \ I I32.39 31.6 ;� jTP-1 32.2 31.99.:, 1 !! "o. L� ! \ 32,21 EX/STING BH �` 1 I ,0 ctl, HOUSE(#43) _: l :: , ` . 31, �, ENT Y..:'-.:�..`.:.::� 0 28.69 TOF=3J 32:�4: 3 (^\ I 132.18 TN I SF R 32.39 \ I ) X O v,30 �5 GARAGE X , 2.37 31�4b O 0 I / SHAD �5 O 10 + 33r35 / 31.15 31.99 32,38 + 32.59 -. . - ) EXISTING SEPTIC TANK l O ry� 1O BE PUMPED AND FILLED PROPOSED PLASTIC 3 .2 / WITH SAND// SEPTIC + ANK I O 32.15 PAnq �/ J0/ >� 32.19 + 3 .53 28.47 / EXIS77NG SEPTIC TANK 31.739� � -1� / +/ TO BE PUMPED, RUPTURED ,.,--&_FILLED-FILLED SAND__ 31.37." 31.35 / FIREPLACE 3�1.9 OF M ;o' "� / OWNER OF RECORD ASS,ye- ^ �h dge /of low. 31.97 /� / SHM LLC o PETER T. 2 31,70 / %HORTON, LEWE,LYN & / CAMPBELL, BONNIE CDMcENTEE 43 BRIARCLIFF LANE CIVIL "' / / CENTERVILLE, MA 02632 No. 35109 1 / ��oF 31.10 x-/ /// ^.o° LEGEND I'N r Zb -- 32-- EXISTING CONTOUR V ) 27.96 / / / x 31.25 EXISTING SPOT GRADE G EXISTING GAS SERVICE 1 / // W EXISTING WATER SERVICE LOT/ICH.i - OVERHEAD WIRES 7BM-2 MBL/22'08-110 ORANGE PAINT MARK ON SLATE -18,200t SF // TEST PIT EL.=32.35 BENCHMARK SOIL LOG cP0 //// Pos`Ra �y c N DATE: AUGUST 18, 2015 (REF P#14,785) p, SOIL EVALUATOR: PETER McENTEE PE(SE#1542) / a WITNESS: DAVID STANTON RS HEALTH AGENT O: ELEv. TP-1 DEPTH a". TP-2 DEPTH 40''s 32.3 q 0" 32.3 q 0" LOAMY SAND LOAMY SAND 10YR 4/2 10YR 4/2 31.8 B 6" 31.8 B 6" / o LOAMY SAND LOAMY SAND 10YR 5/4 10YR 5/4 0 29.3 36' 29.4 35" C 1 C 1 PERC `Ppie P,g Ceti LOCUS MED. SAND MED. SAND 36"/54" o o f 2.5Y 6/6 2.5Y 6/6 26.3 72" 26.3 72" LOCUS MAP C2 M-C SAND C2 M-C SAND NOT TO SCALE 2.5Y 2.5Y G.W. - 7/4 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 24.55 ADJ. G.W. - 24.55 ADJ. G.W. 21.1 STG. G.W. Q 134" 21.1 STG.G.W. _ 134" 43 BRIARCLIFF LANE, CENTERVILLE, MA 20.8 138" 20.8 138" STANDING G.W. AT EL.=21.1, USE INDEX WELL MIW-29, ZONE D Prepared for: D. A. Brown, Inc., P.O. BOX 145, Centerville, MA 02632 WATER LEVEL=8.8 (JULY 2015), ADJUSTMENT=5.2' Engineering by: SCALE DRAWN JOB. NO. ESTIMATED HIGH G.W., EL.=26.3 (USE 24.55x)*HIGH GROUNDWATER REFERENCED, EL.=24.55, IS TAKEN t] nAr Engineering Works, Inc. 1"=20' P.T.M. 196-15 FROM THE PLAN REFERENCED IN NOTE 5, SHEET 2. AND I IS CONSISTENT WITH OTHER AREA OBSERVATIONS. 12 West Crosstield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. PERC RATE 2 MIN/IN. ("C" HORIZON) (508) 477-5313 9/4/15 P.T.M. 1 Of 2 r NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL: 30.22 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. FF SEPTIC TANK PROPOSED D-BOX INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE INSTALL ONE INSPECTION PORT (MIN.) T.O.F.=33.08t F.G. EL.=32.4t F.G. EL.=32.3t F.G. EL.=32.1 t F.G. EL=32.0t EXISTING L = 12' INSPECTION PORT S=l% (MIN.) L = 30 L = 8' SET 3" TO F.G. WITH 4"SCH40 PVC TOP OF TANK=31.42 ® S=l% (MIN.} ® S=l%VC (MIN.) PROTECTIVE FRAME & 4"SCH40 P 4" MIN.SCH40 PVC COVER 3" lo` I. . ` 44" LIQUID LEVEL 14" a 3" TO . . . . . . . . . . . . . " . . 2 INV.=30.05 INVERT 16 GAS BAFFLE PROPOSED INV'=29'88 2'I -29'80 5 UNITS ® 8' UNIT BOTT. OF TANK=26.88 INV.=30.35 D-BOSS NV' LENGTH=40' GEOGRID PROPOSED 1500 GALLON SEPTIC TANK SPLASH PAD RECOMMENDED INFILTRATOR IM1530 GALLON PLASTIC TANK LAY FILTER FABRIC UNDER AT SOIL ABSORPTION SYSTEM (PROFILE) INV.=30.60 EXTENDING 16" IN FROM INLET CONNECT TO EXISTING SEWER AT HOUSE, INV.=30.75 4" 6" OF LOAM & SEED OR AS INDICATED IN NOTE 4. F.G., ELEV.=32.0t APPROVED FILTER FABRIC COMMON BACKFTLL 8"MIN. TOP OF STONE ELEV.=30.72 NOTES: BREAKOUT=TOP OF UNIT 6" IN. 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP OF CHAMBER ELEV.=30.22 INVERTS, PRIOR TO INSTALLATION. INV.ELEV.=29.80 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND BOTTOM ELEV.=29.55 IIIMIIIIIMIIIIIEAII TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' OF NATURALLY OCCURRING 48" (TYPICAL) EXISTING SUITABLE SOILS 2' SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN PERVIOUS MATERIAL 3 ROWS @ V/ROW=EFFECTI WIDTH=12' 310 CMR 15.221(2). 5' (MIN.) ABOVE G.W. 3) INSTALL INLET & OUTLET TEES AS REQUIRED. q ;J�(r 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE ADJUSTED G.W., EL=24.55 = 1 WASHED STONE PLACED TO li' AB E SEE SOIL LOG & NOTE 6 FIELD DRAIN UNITS - EXTEND STONE FOR AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. �1' OUTSIDE S.A.S. FOOTPRINT BIAXIAL GEOGRID / BX1100 SEPTIC SYSTEM PROFILE S.A.S. (SECTION) PRODUCED BY TENSOR CORP. ATLANTA GEORGIA OR EQUAL EXTEND GEOGRID FOR 2' N.T.S. OUTSIDE S.A.S. FOOTPRINT GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL .RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: - - - -- ---- ---- -310 CMR 15.405(1)(b): CONTENTS OF LOCAL UPGRADE APPROVAL MODEL FD C-4 R STARTER „ 1) An 8' variance, S.A.S. to cellar wall, for a 12' setback. SMALL RIB LARGE RIB 4 DIA. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 3" TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 8 rJ" 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING MODEL FD C-4 E MIDDLE/END FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN SMALL RIB LARGE RIB ENGINEER BEFORE CONSTRUCTION CONTINUES. ,,�/ 5. ELEVATION DATUM IS TAKEN FROM PLAN ENTITLED "PROPOSED SEPTIC 4_` SYSTEM UPGRADE PLAN, 33 BRIARCLIFF LANE, CENTERVILLE, MA", BY^' ;C�l" nAAA fv %A MEYER & SONS, INC, SANDWICH, MA, DATED 2/2/12. Q 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 4" DMA. INSPECTION PORT HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN 'WATER SERVICE. o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o u n o 0 0 8. THERE ARE NO ABUTTING WELLS WITHIN 150' OF THE PROPOSED S.A.S.. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. ° 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY01 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 48" CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS ° ° ° ° IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). -7 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 12"INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. ° ° ° ° ° ° ° ° ° ° ° ° ° , 13. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED EXISTING SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. 14. CONTRACTOR SHALL TAKE ALL NECESSARY PRECAUTIONS TO MAINTAIN THE 8,5' THE STABILITY OF ADJACENT STRUCTURES AND RETAINING, WALLS. 15. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 8.0' IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. ° 0 0 0 ° ° DESIGN CRITERIA 8. ° ° ° ° NUMBER OF BEDROOMS: 3 BEDROOMS SMALL RIB LARGE RI SOIL TEXTURAL CLASS: CLASS I CULTEC CONTACTOR FIELD DRAIN C-4 CHAMBER STORAGE = 1.692 CF/FT DESIGN PERCOLATION RATE: 2 MIN/IN ALL CONTACTOR FIELD DRAIN C-4HD HEAVY DUTY UNITS ARE MARKED WITH A COLOR DAILY FLOW: 330 GPD STRIPE FORMED INTO THE PART ALONG THE LENGTH OF THE CHAMBER. DESIGN FLOW: 330 GPD CULTEC CONTACTOR FIELD DRAIN C-4HD GARBAGE GRINDER: NO PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY-PLASTIC CULTEC,Inc pH_ (IMO) 7"75-44164-WLTEC z TM' P.O.Box z8o PH: (800) 4-WLTEC CULTEC Contactor®and Recharger® INFILTRATOR 1 M-1530 878 Federal Road FX: (203) 775-1462 Plastic Septic and Stormwater Chambers Brookfield,CT 06804 USA Www.cultec.Com CULTEC LEACHING AREA REQUIRED: (330 GPD) = 445.94 GPD .74 GPD/SF PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 3 ROWS OF 4 CULTEC C-41-ID UNITS AS SHOWN 43 BRIARCLIFF LANE, CENTERVILLE, MA FOR AN S.A.S. HAVING THE DIMENSIONS: 12.0' x 40.0'. BOTTOM AREA: (GENERAL USE APPROVAL FOR 6.7 SF/LF) Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 5 UNITS/ROW x 8.0'/UNIT = 40.0 FT Engineering by: SCALE DRAWN JOB. NO. 3 ROWS x 40.0' x 6.7 SF/LF = 804.0 SF Engineering Works, Inc. N.T.S. P.T.M. 196-15 n DESIGN FLOW PROVIDED: 9 g 0.74(804.0 SF) = 594.6 GPD (W/CREDITIED AREA) 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. 0.74(480.0 SF) = 355.2 GPD (W/ NOMINAL AREA) (508) 477-5313 9/4/15 P.T.M. 2 Of Ij