The URL can be used to link to this page

Home My WebLink About0028 CAPTAIN LUMBERT LANE - Health 2 i CAPTAIN LUMBERT LN Centerville ' A = 147 — O11 —004 I 4 � { UPC 12534 No. 2� 153LOR gPosr.coNSJ� HASTINGS, MN 106 No. � �� Fee �� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4plitation for 30isposal *pstrm ConstCUttion 3pPrmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 07 "L.�etYl {-(� ��Oyywner's Name,Address,and Tel.No. Assessor's Map/Parcel l E/� 1 j_ d 1$ f Installer' Name,Address,and Tel.NoJ`^08-971- 9319 , Designer's e,Address,and Tel.No. SOS—3Co9^ s 0vr+�oie_04n'5�rc,C4440,J nC p0•86X '7 )Sf �oum� 'n�vi�, �r+c- vl D a!o Type of Building: Dwelling No.of Bedrooms Lot Size al Sll — sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3 SI 9 gpd Plan Date 90 i 7 Number of sheets Revision Date Title I�i4 l.0 AL Size of Septic Tank l° S " '10611,J Type of S.A.S. (.9) Y007,lZ Laa Ad p1 lww; acy,lot<$3 Description of Soil,:5p2 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code a place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date l Application Disapproved by Date for the following reasons Permit No. �' '� Date Issued F No. '` Fee `-� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:" PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplication fDr Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade,( ) Abandon( ) ❑Complete System ❑Individual Components :; Location Address or Lot No. O?w Q, 6 L Owner's Name,Address,and Tel.No. g�8(��—0309 C er�i �� rluml�e�' �/v��?�Se CQpone 3NileS • Assessor's Map/Parcel J yh 1 J_ �} y r'r O 1'8ZZ/ Installer's Name Address and Tel.No.•J d 8-r2!)l— 9339 Designer's Name,Address,and Tel.No. 0040Io CGnS�t 1M,1n� f D• Box f7o(l �ow+�Cce�CLe_1�'A 'n�rirrj,�'� , 1 6--)QRL 1 0 '7 Type of Building: Dwelling No.of Bedrooms Lot Size o7/St/ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided -7 V 9 gpd Plan Date MU n e I a, aG 17 Number of sheets /l Revision Date Title I r'd p /i S E, , P� 0 of `t$CaD41In UlYll-,,eMLLA Size of Septic Tank tE)�'SA j q Type of S.A.S. v7� Jc�U9 rnl2 Le Q c��.11w,$ V X I •��3 Description of Soil �jpp Q,e�f�A a-,3— i� �C+c ->�`�''�`T`,Ljd Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and,not-to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. -'' / Signed Date M 1 Application Approved by Date Application Disapproved by ' +Date for the following reasons � � Permit No. fJ' /� Date Issued / -------------------------------------------,------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On n--site Sewage jDisposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by nr 40 i ` ,r?.5 e-, i 40 • at a � �11 (��i�r� f p n J(e- has been constructed in accordance / J with the provisions'of Title 5 and the for Disposal System Construction Permit Nb?''w17 1� ?dated (Q / / 7 Installer Gr ��" �C,r.,fnic i o ra J ne— Designer �#) 0 o � I n � r^ #bedrooms Approved design flo y gpd The issuance o this p �it shall not be construed as a guarantee that the system w' fun•idn as desi d. I` Date (] Inspector Vt,- >, ---------------------------------------------------------------------------------------------------------------------- No. -/ � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( I Upgrade( ) Abandon( ) System located at ^, L[l�7�j r 7t n, (f7 � and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must bd co pleted th h` me years of the date of thisdpermit. Date t(/ � 1 i Approved`b. 1r7- 13 Town ®f Barnstable WE Regulatory SerAces „ Thomas F.Geiler,Director BMIN rABM Public Health Division 1639.prFO�A. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer&Designer Certification Form I I Date: .S Sewage Per;mnit# a0)?'�97 Assessor's Map\Parcel Designer: �()QWA Ga.o C �11g t lltc�c� Installer: � 0 rlz'(p M and t kc'b e r Address: / 11Q YN / t' Address: 'P,,0- 060x 70Y yQ�Mpu.'t-h. Y �rl ' /(�jYc/�►� �l/N C On �op/ /7 _ r a s r 'was issued a permit to install a (date) (installer) septic system at °� Cap�ec r rn Lt�►� �,'� based on a design drawn by (address) 16L'te, �• d �o� dated J u-.ne l Z ZDI7 / (desi r) V I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the se . m)but in accordance with State&Local Regulations. Plan revision or ce a as- t by designer to follow. Y "dF M1SS�cy DANIELA. �s o OJALA (Installer's Signature) " CIVIL No.46502 �� G/q10, ' C2 ION AL ECG\ (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL. BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc JUL-07-2017 05:24 From: To:15087906304 Pase:1/1 Town of Barnstable Regulatory Services Thomas F.Ceder,Director NASL Public Health Division Thernss McKean,gDirector , 200 Main Street,*%knaia,to 02601 Office: 508-862-4644 Pax: 508-790-6304 f>mstaller&IIDesigger Certification Form Date: Sewage Perm t## l /9 Assessor's MapTarcel 1Y'7 II �f QDesiper: 10!6)A G-Ae ,)j Lntaller: 60v-lWDtn,_ aAdt-kcWo,, ! Address: - o r l�.n �• Address; �°,v_ B x 7a / f L On G artolxg' t. was issued a permit to install a (date) (im-ta]ler) septic system at a� ��a r A L14�b�,e iy based on a#design drawn by (address) —_ Gt 11 te. Q dated IJ k.►te l Z ?s?17 (desiw) •- I certify that the septic system referenced above was installed substantially according to the design,which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. geater than 10' lateral relocation of the SAS or any vertical relocation of any component of the sei ygZm)but in accordance with State&Local Regulations. Plan revision or ee as- , t by designer to follow. ' N Of Mgy. cy. ❑ANIELA. CJALA (Xnstaller's Signature) CIVIL t^ No.4WO2 w FSSr°NAt tiaa� (Designer's Signature) I (Affix Designer's Stamp Here) pligASE PTYlItI"1 TO RARNSTABLE PUBLIC HEALTH Dl[VISION. OY;It,WT TE RJR Cm1V1PL MCE WILL NOT BE M D UNTIL BOTH THIS I?OIRM AND AS-BUILT CARD ARE RECRIV19 D BY THE B E PUBLIC HEALTH DIMIO YOU. Q:1lGdtWSeptim>.4ipu Certification Pomp 3-26-04.doe TOWN OF BARNSTABLE LOCATIONC.txw.��t��Lxi.SEWAGE# —10P� VILLAGE lr t� i�di�� ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. C.` I . %-T/ SEPTIC TANK CAPACITY ezr�CAP (6co 49Mf{.(— /4•/d LEACHING FACILITY.(type) 'fZ1-5UC"J4= (size) NO.OF BEDROOMS 3 - S276-4Al— Ck# OWNERf.�x PERMIT DATE: COMPLIANCE DATE: O 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) /,4-- Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet.of leaching facility) Feet FURNISHED BY ��c.✓ Y��( �s.wa►/s•�sy� lob 3 8� ................ ........... ........... 4061r- - PAU.OK .............. i Town of liar n -able P Department of Health,Safety,and Environmental Services Public Health Division Date� z, 367 Main Street,Hyannis MA 02601 HARN9FASM lUa ALMIL A Date Scheduled Time Fee Pd.- X Soil Suitability Assessment for Sewage Disposal 'M f--x Performed By: Witnessed By: ..... . ......... ..... ........ ....................... Location Address Owner's Name Address Assessor's Map/Parcel: M Engineer's Name U LJ CA-f e NEW CONSTRUCTION REPAIR Telephone tf� 1 Land Use Slopes N Surface Stones Nr I 4k Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way 760 ft Property Line yh ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ?- 6. I�Jc 19F 2. ............................. Parent material(geologic) Depth to Bedrock > Depth to Groundwater: Standing Water In Hole: J Weeping from Pit Face /,k- Estimated Seasonal High Groundwater f ................................... .................. • ....... .. ......................... .......................... ......... .............. .......................... .. .......................... ............................. .. .................. .... ....... . ...... .. . Method.Used:• . ... ......................... Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: In. Groundwater Adjustment ft. Index Well# -Reading Date: Index Well level.-- A(Ij.factor Adj.Groundwater Level Observation Hole 9 Time at 9" Depth of Pere Time at 6" Start Pre-soak Time @ 05 Time(9"-6") End Pre-soak I Rate Min./inch . I ===u Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back Copy: Applicant ............ ............... ................. ...................... ........ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Grn�el) Ib A- V I oIfi, 1 ........... '-Riii PEI, .............. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel) 'Ilb0"I— '0 It4 nN .................... ............. ................ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Monsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel) ...... ..... ........ ...... Soil Color Soil Other Surface(in.) (Munsell) Mottling (Structure,Stones,Boulderes. Depth from Soil Horizon Soil Texture (USDA) Consistency.%Gravel) Flood Insurance Rate Map: 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 Does at least four feet of naturally occurring pervious tmqateriOtxist 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 <) (date)I have passed the soil evaluator examination approved by the Department of Envirdnmental Protection and that the above analysis was performed by me consistent with the required trainpig,expertise d experience described in 310 CMR 15.017. Signature Date! / 1�' ------------------------------- ofIKEr� Town of.Barnstable Barnstable .�~ Regulatory Services Department 1 C6c'c j SARNSfA$I E '6 9 Public Health Division rfD" a 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012 1010 0000 2847 8650 April 14, 2017 PLUMMER, RICHARD C &HELEN T 28 CAPTAIN LUMBERT LANE .CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 28 Captain Lumbert Lane, Centerville,MA was inspected on 04/06/2017 by.Shawn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days 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 mas c ean, .S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\28 Captain Lumbert Lane Centerville.doc Town of Barn stable �Rrrs-reac.E, Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-8624644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5111116 DEADLINES TO'REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15,000) _ An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground Y ' ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe. Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: 0 WSEPTIMDEADLINES TO REPAIR FAILED SYSTEMS. f , r Commonwealth of Massachusetts 2-oz.- oll- o a=1 fz Title 5 Official Inspection Form r. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v% 28 Captain Lumbert Ln r k Property Address Richard Plummer Owner Owner's Name information is o required for every Centerville MA 02632 4-6-17 page. City/Town State Zip Code Date of Inspection a.„k Inspection results must be submitted on this form. Inspection forms may not be altered rn any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluao by the Local Approving Authority 4-6-17 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 lanKw tls + t Commonwealth of Massachusetts ^+ , Title 5 Official Inspection Form � I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Captain Lumbert Ln Property Address Richard Plummer Owner Owner's Name information is required for every Centerville MA 02632 4-6-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found any information,which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts �al Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •,,,a_JS!y 28 Captain Lumbert Ln Property Address Richard Plummer Owner Owner's Name r information is required for every Centerville MA 02632 4-6-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): i C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts la�l Title 5 Official Inspection Form ' 'I., Subsurface Sewage Disposal System Form Not for Voluntary Assessments 28 Captain Lumbert Ln Property Address Richard Plummer Owner Owner's Name information is required for every Centerville MA 02632 4-6-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts :a= Title 5 Official Inspection Form �R+ fps � I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 28 Captain Lumbert Ln Property Address Richard Plummer Owner Owner's Name information is required for every Centerville MA 02632 4-6-17 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 groundwater elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts R Title 5 Official Inspection Form J. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Captain Lumbert Ln Property Address Richard Plummer Owner Owner's Name information is required for every Centerville MA 02632 4-6-17 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? El 0 Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330._ v t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts I , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Captain Lumbert Ln _ Property Address Richard Plummer Owner Owner's Name information is required for every Centerville MA 02632 4-6-17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2017 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? . . . ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form �0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _ !a 28 Captain Lumbert Ln l J Property Address Richard Plummer Owner Owner's Name information is required for every Centerville MA 02632 4-6-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form e.� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Captain Lumbert Ln Property Address Richard Plummer Owner Owner's Name information is required for every Centerville MA 02632 4-6-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1983 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 17 , Commonwealth of Massachusetts laa Title 5 Official Inspection Form �1�,-I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Captain Lumbert Ln Property Address Richard Plummer Owner Owner's Name information is required for every Centerville MA 02632 4-6-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Captain Lumbert Ln Property Address Richard Plummer Owner Owner's Name information is required for every Centerville MA 02632 4-6-17 page. Cityrfown 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 I 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 Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts 1a=1 Title 5 Official Inspection Form f ' �I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 28 Captain Lumbert Ln Property Address Richard Plummer Owner Owner's Name information is required for every Centerville MA 02632 4-6-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box had water at working level with stain lines above inlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Captain Lumbert Ln Property Address Richard Plummer Owner Owner's Name information is required for every Centerville MA 02632 4-6-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,,dimensions: a ❑ 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.): Leach pit was holding water at 12" below inlet invert with stain lines above inlet invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts lal Title 5 Official Inspection Form ;}t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments as' 28 Captain Lumbert Ln Property Address Richard Plummer Owner Owner's Name information is required for every Centerville MA 02632 4-6-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Gw Title 5 Official Inspection Form ;A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Captain Lumbert Ln Property Address Richard Plummer Owner Owner's Name information is required for every Centerville MA 02632 4-6-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately f d r E1 .3 o � Ard drVr / rr . r■ r �. 3o ' g-2 33 '6;, re 3 w ter_ t5ins-3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form f ' W., Subsurface Sewage Disposal System Form Not for Voluntary Assessments 28 Captain Lumbert Ln Property Address Richard Plummer Owner Owner's Name information is Centerville MA 02632 4-6-17 required for every page, City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 7 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Captain Lumbert Ln Property Address Richard Plummer Owner Owner's Name information is Centerville MA 02632 4-6-17 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 T+DV Gi~EA STABLE f 7 1 7 "� QN .: p�� u �e U,}►= 1�✓t? 1 SZ;WAGE# ...., : LOCA�'i'i VdLLAGE &:LOT STP .E `S NAME 8t FIC)1+iE NQ S] C'I'A Y`Tt CAPACifiY scze) Cf LII1PiG 1� ,CIIrI'PY (ttypa) t I�IP�QR(�WI�TIait ' I)ii seanra 3atv�e n e �� poet Maxiztwm A justed Geautadv'�ti6OWiib the Battam a xachm� suiUty °�..----- �- Pily Be 1�i�=r Supply Vf4i1 Wid i,. twin �'ac ty f any f<t9s cxisi' cat s9ta feat `or.with,t< 00 o le iW4 fAGib y�) ,. �ca9•. EcIL�';c)��►l�ta�d spit l�.eacdup�r Pactlis y array v�etlancl5 axist fee tiv1�131)d�1Q{1�LCt of bappWgia a 10. �urnt3hrid'by ', D � s 0 a Z'3 - 30 '�H 3-33'& _. A-L{-5Ll' 9 6 L /Ll`� opt �- vU� i LO CATION �� ►�, SEWAGE PERMIT NO. C.. r O VILLAGE I N S T LLA.R'S NA i A0DRESS it 4r. BUILDER OR OWNER N (- DATE PERMIT ISSUED _ DATE COMPLIANCE ISSUED �� I� � �` � r } 3t s �� - -_ Or .................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® F• H TH ................OF...... . �/. ..! ..................................................... Appliration for Disposal Works ntrnrtiun rrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: I ................_........_...................................................................... ----------------- Location-Address or Lot No. W ......................_ ......................................................................... ................... ---......--•---•----.......-........--•...------ wner sk.X�� res ............... - -.. .:� ---------•-•--•-------------- .-_-__-_0 ------. ., ......-.---...... .------------------------- Installer Address Type of Building Size Lot... fa.j....Sq. feet �.. Dwelling—No. of Bedrooms............. � 41 ___-----._----_-•-__-___-Expansion/�ttic ( ) Garbage Grinder Q� Other—T e of Building No. of ersons___.._.�e4 .............. Showers Cafeteria Other fixt es - ._... --------•---------------------------------- ----------- --- ------ W Design Flow.................. ..�-..__.._...-_gallons per person per day. Total daily flow....... .-;C2.---___._--.-------_-•gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................. x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing t ( ) Percolation Test Results Performed b -------------- .................. Date_... ,a Test Pit No. 1................minutes per inch Depth of Tes Pit..../... ...... Depth to ground ater.. ............ ._ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Zoe •-------•----------•--------••-----•-------•----••-•---------------- 0 Description of Soil.___.._..__ .........� J' _ ___.__ .-�,� ----------- x -----------------------------------------/•`/&- ..� :- , - -:.._..- U J` W ..................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------•--•--•--•••-••-••••--•-•----•-•-------------•-•--•--•-•--------......-•••••....----------•----•--•...-•-------------••----•-----•••-------•--•-••----. ••--••-••••••--•................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITA t; 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is, �ddd by the boa o health. sig -- -=- ------------ Date Application Approved By ..... --- -----•••.....----•-----••-•------------••-------------•----........._.... ........................................-? Date Application Disapproved fllowing reasons--------------------------------•-----------------------•-----------------------•------------------.........--- --•-•••-•.....................................•------•----•-••------------•••-------------•--•----------------------•-------•-----•-••-•--•-•-•--...----------•----•-••--•-------•••••----••------------ Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD - F Al"T hy:,J� ----...-_.....-----......_......-......_ Appliratiun for DiupuuFal Works unstrurtiun ramit Application is.hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: 1 ...................................... L....................................................... ....................... ocation-Address or Lot No. W ............... .... '..... --•• --------------•----•---•---------- ----•-•--•- Owner Addres •---- -- ................. ............... Installer Address /� � UType of Building Size Lot.__�^+__3_6. ....Sq. fe 1-1 Dwelling—No. of Bedrooms............._ ____.___.._________._.__._Expansion Attic ( ) Garbage Grinder Other—T e of Building _.____. No. of ersons.......�j---------------- Showers (� - Cafeteria ( ) a Other g-•-•-•••-••-••••-------•-•----•-•--•.----•-P � Other fixt res , ,_ ----••----------------------------------------•---------------------.....---•----............---• WDesign Flow............... __.......__._,gallons per person per day. Total daily flow........ .747......................gallons. W Septic 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 �k ) aPercolation Test Results Performed by ___�� .:....:.. .....: { _.__...____._.____ Date.._. Test Pit No. I________________minutes per inch Depth of Tes Pit._.!p p _ ______ Depth to ground ater_ ___.��✓_C,.c___. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f O Description of Soil......_ 4 _ ! G ----------------------•---•--------------------------•--••-•-._.....-•---• x i� f r V .....-•-••-••-••---••••--•---•-•••--•--- J • ' { %.S ............. -------•------------•-------...----------._..._...._._......---••---••-------------- W U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ----------------------------•------------------------------•---------------------------...._....------•-•-----•-------------...---------•-•-•--------•••••••----------------------------........_..----- Agreement: The undersigned agrees .to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI,,=, 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is d by the boa o health. } � Sig . d ------ -------••--•------.._...... ........... Date Application Approved By_...••••. •----- --•-•-••---•-•--•-----------------•.....-----•-•--••---••---=------.._..-- ....................................... ,Y _ Date Application Disapproved f r e following reasons----------------------------------------------------------------------------------------••-•••-•-•-•--------•---- ....................•---........-.---•--...-•------•--------•--------•---------------.....--•------------'--•-----.-..------------------------------------------------------------------------•-••-•---•- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOAR HE��'�'� ..............O F...... ... ::�/✓.. . ......... ....--------------........_•---•-__... Trrtgfgratr of TumpliFanrr THIS IS RT Y, That the I dividua Sewag Disposal System constructed or Repaired ( ) b ----------------------... .. ._�� ... lr ------•. --•------- - ,,, ,, l /� j Installers, at............ •/1' ....... L :4.► s• ' /L � y! v► ...._ ... "> t � •--------- has been installed in accordance with the provisions of T T L. ` of The State Sanitary Cod s d cribed in the application for Disposal Works Construction Permit No.U.-=/J .................... dated__, _ S_ _._ ................... THE ISS CE F THIS CERTIFICATE SMALL NOT BE CONSTRUE® S A GUARANTEE THAT THE SSYSTEM _dll1 U FU ION SATISFACTORY. 5 AV DATE.----- _.. ............................................................... Inspector... •- ------••-•-------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BQARD F HEA T ....r204 ..................OF..-. 1�`..... ------ ............................ Nc ...... ........ FEE........................ i �ru �a1 dun flution rrmtt Permission is ereby granted..........._____. `? to Construct„f/ ) or Rep r ( ) a Indivi ual ewag Disposal Syst , at No. ;, LJ--... /� l�fk�._._ 1 ..... ''+ P�Z.--- -.----- ............ Street � as shown on the application for Disposal Works Construction Permit No_________________ �, ted _.` ___ . _________________________ .......... ___ -__-_... ._____e_____..... .------- ....------------------- .. ...............•--•-------.... d of Halth DATE------------.�.�--••--:�.� �.._. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS _. ------� �N OP y 000. (� N 49 N V� <,4 00. 6 SMOFM « x �L PHI IP �+°. vY lb , .1 W61 N' NA4 'r l IZZQ 40 40 G 0 '� ` f+ r� �*,y�I 00o S.F F, S.B. y, ++�T"�.:`ALL U A'RJQ11-L bQOWT1-► � Q..I=MA n.J �� I f G U►.►4lSltJf2$E� loo'. F�av► EA:.H of uPLAwD uJu=SS, A. wo'ncE of iu7F_Q-r I S Pi�A pE-P- N� I 714E-1_n�i E w1=rLAW DS A=x 1 , Go,o A-AFw FALLS WIT VA i u .►=coon 7ca.�h I3 LEGEND `!�, CE.RTIFIED PLOT PLAN EXISTING SPOT ELEVATION 0u0 EXISTING CONTOUR --- 0 — Lr�T;;3c�_: - 'C Pr��► 1 LkJ J:MBET LA,_.IE FINISHED SPOT ELEVATION FINISHED CONTOUR 0 IN . z APPROVED , BOARD OF HEALTH �� .��, � + DATE AGENT ,4 s SCALES, I " Llo' DATE, 03-01 -B L REDGE E-Ni /l VEERING CGt We? CLIENT q ~ I CERTIFY THAT fTHE PROPOSED EGISTERE REOISTE'RED JO0 .N0, i�I 3; ,_ BUI,LDIN(3 .SHOWN ON THIS PLAN CIVIL LAND k CONFORMS: .TO THE ZONING LAWS ENGINEER RV DR'BY�, � �- '- OF, BARNSTABLE ASS. 7I2 MAIN STREET.' ,: CN.`81f#..'"P .,,. ` HYANNI S, .MA3$...'�' SHEET.,,L;,'OF. 'DATE GLAND SURVEYOR !VOTE !F E/TNeR THE.SE PT/C TANK OR ?O FT M/N. LF'ACK/NG PIT .4. E !''JOKE TNA:•/ IZ"49ELOW IO PT. MIN 1RAOE, 24.D/.l.yJET.ER CONCRET, COs Ze SWALL B.E B•40U9S Y7 TOG ,�4 D.E.��+N EXTRA CONCReTt, P/PZ �yEAVY CAST /RO/v CoVZ=,T Sf�.41 Z_ 3E USEO M/N. P/TCM /j= DR/VEWAY E L= 100•S COYZA5 FT. A . 6AOB co ✓E'`t CLEAN SAND rrr=, * 43A C k L L _ L®!!ID LEVEL .. •._ �•-1- _ . .. ,'� . .._ !ROW PIPE'• _ l 00 0 v •. o v1 QF ��8 -'T�®" MIN.P/Tt�f GitL SEPTIC TAN t o • s . • A, o DI SF> s s • •. • • t-• a s.i WA Sh'FO S7nNE Lr /q�PE�s rT K t • _ _ BQX' _ a � s st 8 • � sss � .s• • " -�• .t, t t OF '=cr/lie • 4 - �2., -: s e:• 02PTX'. •.� • a v 1VA3XED STONE I o t.f s • op • • •:se rev • it 4? l !� /D e a t -. : s`r . o s e PRECAS SEEP,4GE • •;.X B,.G/D • }. r i s s_ a".• e t rt a o �� L�4U/V �. . �LEN�4T/v/vs �8._5. 0 7 . °` —,EL°=. °4 fT D/AM `10. INVERT,AT ffq L D/N!s; q7. FT. p i r cAPAc i•f,`1 549 v !NL ET .S4EhT/G T.4NPC 9�•3 FT ` 1 0 7 O/. C�SFE rAeULATIONJ { �y 4M OUTLET SEPTIC 7-ANK:': �►�1_fT. a►(a.9 Fr (yrQOLNO .ytrgTER TABLE "' INLET DISTR/DUTIOJV 801r` SEG'T/ON F' 9 0dTlt?DI3TI�0®l/Y/ON d9QX INLFTLEACH/NG PIT 9Co•5 fT. SEyVAG� GI�S'/'4�i4 SirSTit�/►! - r M {,^ L ACf�//VG Ai/ 11 . .-- WON SCALE, . •� DIMENSION A. FT _ ` t D0516M CA1TER/A DL�f.F/vs/ON _fT f j Di�9EN5lCN , C T �Nt`t N� t UMBER OF®EDRGOMS - • .- K ARSAGE D/SR05AL UNIT L L.OG• ,. o�, SOIL, 33o G.4L. .So/1. 'TESL TaTA` ESTtl4A 'EO FLAN/ �OAY SOIL TEST / SOIL TFST,lit2, 4MBER 4F 4-.ACMlIV6r PITS_ "r Lev 9a.5 �-ELFY, DATE' OF SOIL TF_ST 03�1-1 � SIDEL.G`ACNIIVG PERP/T 18% Sa PT. CoAAA �_ RESCIL.TS ivIrIVESSED By iPe br�D ®orroAf L94CN/NG PER PIT 78 ". ,An - r �PSo�L PERCOlA7-/ON RATE I : �5'� MIIKIINCN TaTAL LEACH/NG AREA 2�� SO FT. I�IERCOL.4T'/GN RATF2 � /ylN:�INCH . ,Q�sicRi�ELEAC'HING,4RE�► 2�,� $Q. FT. � nn �• a tN Of M �ZH OF �r (i!-12 Squp LOT 30 - C�PrAs" Lu M bE-LT LA,.►E cp PH 1 s E . ' ESL.DRIE'DGE ENCrI m"RINCY CO,I NG. c�BSIONAI 7/2 MAIN ST. *l YA.VxHS. MASS. ND SUR��'y [�ND GROV/V� yrATER ENCDlJNTER�L? CLlEAIT: 2viysr DE' DRTF dL.1 .63 GM0U/VD yvA7 AT 6LEl/ .IOB No! 51223 SHEET�OF Z J ALL LL SYSTEM STEM PROFILE MARL EDS WITHCMAGNETICTTAPEAOR BE NOTES 1V C PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS NAVD 88 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE F CONCRETE COVERS TO WITHIN 3" GRADE 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING \ TOP FOUND. EL. 39.8' FILTER FABRIC OVER STONE 2% SLOPE REQUIRED OVER SYSTEM 38.0' - 39.0' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. _ MINIMUM .75' OF COVER OVER PRECAST � NOTE: 2" MIN. WALL PRECAST H-10 4. DESIGN LOADING FOR ALL PROPOSED PRECAST THICKNESS REQUIRED BLOCKS OR RISERS (TYP.) UNITS TO BE AASHO H-10 �. 4"OSCH40 PVC PRECAST RISERS 2 m 40.2' MORTAR ALL _ ` PROP. TEE PIPES LEVEL 1ST 2' 4' COMPONENTS H-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. 5e 6" MIN. SUMP (TYP.) 7' 4 , o 12" MIN. INT. DIM. ENDS SIDES 36.0 �0.� .EXISTING 14" ��_�_��> oo°°°°°°°o 0 0 0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 0 . .. TEE SEPTIC TANK** TEE ° ° ° ° * ° ° ° ° a�oa o .. ooa ooao -oaoo WITH 310 CMR 15.000 (TITLE 5.) Locu �88 �o�o�o�00000 WATERTEHT D'BOX o°o°o°a° �m�00�0��0� ��0�� >oo 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND GAS BAFFLE :• o 0 0 0 0 0 'O°°°O°O° . ��000��0�� 0��MMM��0�0 ;°°O°O°O° ° ° NOT TO BE USED FOR LOT LINE STAKING OR ANY Carlisle 0 0 0„0„0_ FOR LEVELNESS cv o 0 0 0 00 � 0000000 � oo � 000000 � o °�°�°�°� > o 0 0 0 �0��0�0�0 ��0�(�� ° ° ° ° OTHER PURPOSE. 36.17' 36.0' °°°°° °°°°°°°° 33.17'°°°°°°°° °°°°°°°° 8. PIPE FOR SEPTIC SYSTEM TO SCH 40-4" PVC. LH-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. r 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR Route 28 ALL AROUND PRECAST STRUCTURES CONCEALED WITHOUT INSPECTION BY BOARD OF 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' HEALTH AND PERMISSION OBTAINED FROM BOARD d COMPACTION. (15.221 [2]) OF HEALTH. �� Q (32 % SLOPE) ( 1 +% SLOPE) Ln 10. CONTRACTOR SHALL BE RESPONSIBLE FOR �e EXIST** LEACHING CALLING DIGSAFE (1-888-344-7233) AND FOUNDATION- SEPTIC TANK 8 D' BOX 12' VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP FACILITY 27.7' BOTTOM TH-1 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL NO GROUNDWATER FOUND WORK. SCALE ,1"=2000'f UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM -BE REMOVED BENEATH AND 5' AROUND THE ASSESSORS MAP 147 PARCEL 11-4 PROPOSED LEACHING FACILITY. **INSTALLER SHALL CONFIRM MINIMUM SEPTIC 12. EXISTING LEACHING FACILITY SHALL BE PUMPED TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY AND REMOVED OR FILLED WITH SAND FOR RE-USE. REPLACE WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF NOT SUITABLE NO MINOR RE-GRADING NEEDED TO ET BREAK-OUT NOTE: POSSIBLE 5' REMOVAL OF UNSUITABLE SOIL AT DOWNSLOPE END OF SAS. REPLACE WITH CLEAN MED. SYSTEM STEM DESIGN: SAND TO MEET SPECIFICATIONS OF 310 cMR 15.255(3) o GARBAGE DISPOSER IS NOT ALLOWED DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD / BENCH MARK - TOP OF,BOT. STEP USE A 330 GPD DESIGN FLOW AT BRICK LANDING. ELEVATION =39.6 36 SEPTIC TANK: 330 GPD (2) = 660 **RE-USE EXISTING SEPTIC TANK LEACHING: ° 0. SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD � / J�` 40 3 ,� ; BOTTOM 25 x 12.83 (.74) = 237 GPD V / 0 TOTAL: 472 S.F. 349 GPD 35 TEST HOLE LOGS Q4 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) V TH 2 XISTINc o WITH 4' STONE ALL AROUND CRAIG J. FERRARI, SE 13871 \ ENGINEER: I TOFLLIN 9. LOT8 3, WITNESS: D. DESMARAIS, IRSe TM I� / 21,511 s �6 DATE: 6/8/17 1 DRAN. PAVED ' 3 PERC. RATE _ < 2 MIN/INCH - _LG �c�R vE ° i 10 •0' o IVIL CLASS I SOILS P# 15361 MA a ELEV. ELEV. � APPROVED DATE BOARD OF HEALTH t 0 4 38.7' 011 38.9' �5 �� 5 m Z 41 TITLE 5 SITE PLAN FILL FILL 26 05 OF m A A 28 CAPTAIN LUMBERT LN. SL SL CENTERVILLE 18" 10YR 2/1 20„ 10YR 2/1 PREPARED FOR B B SL SL BORTOLOTTI CONSTRUCTION/ ,____-G_- �--�-� „ 10YR 4/6 10YR 4 6 ) H. PLUMMER 36 35.7 36 35.9 h � v , - F � � s � JUNE 12, 2017 c c OF 'I"OF � Ni DANIELA.��y �� DANIELA. � �1 A A. `� off 508-362-4541 5a MS MS �� ( 'I {V!OJA� ° o.4J 0 f o OJALA " 1L n I fax 508-362-9880 CIVIL ? downca e.com No,46502 � of uac� P O No.46502 • • 10YR 7/4 10YR 7/4 P°�F`�c�sreR``� �` �`� 'sT�N�� ' � down cape en iveefi,7 �/Ic. 132" 27.7 120 28.9 SS/OVAL ENG � �� civil engineers Scale: 1"= 30' ( - .4. -� land surveyors NO GROUNDWATER ENCOUNTERED 939 Main Street ( Rte 6A) > 7- > 33 a 5 30 45 60 75 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675