The URL can be used to link to this page

Home My WebLink About0006 CHAPPAQUIDDICK ROAD - Health 6 Chappaquiddick Centerville A= 170—053 kF/ 5 M E A D Na 63LOR UPC 12543 smead.com • Made in USA Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 6 Chappaquiddick Way Z Property Address W Ellen Woodfin Owner O wner's Name information is required for every Centerville ✓ Ma 02632 1-9-17 page. City/Town State Zip Code Date of Inspection G7 Cr.7 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:out When fillip out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return key. Name of Inspector B&B Excavation „b Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 1-9-17 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 4off'ot�S Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is required for every Centerville Ma 02632 1-9-17 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System was in working order at time of inspection. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is required for every Centerville Ma 02632 1-9-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is required for every Centerville Ma 02632 1-9-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is Centerville Ma 02632 1-9-17 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 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is required for every Centerville Ma 02632 1-9-17 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? ❑ ® 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): 331.5 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is required for every Centerville Ma 02632 1-9-17 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gP ))� Detail: 2015- 125,000gallons 2016-95,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: NA 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is required for every Centerville Ma 02632 1-9-17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner- last pumped 2012 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is required for every Centerville Ma 02632 1-9-17 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: 2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 8 feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): 1'8" Depth below grade: 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: 1500gallons Sludge depth: 6 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is required for every Centerville Ma 02632 1-9-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness 4 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 13" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank should be pumped and zable filter should be cleaned. Grease Trap (locate on site plan): Depth below grade: NA 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is required for every Centerville Ma 02632 1-9-17 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: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is required for every Centerville Ma 02632 1-9-17 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 was in working order at time of inspection. 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.): NA * 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 I� Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �M 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is required for every Centerville Ma 02632 1-9-17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (2) 500gallons ❑ 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 was in working order at time of inspection. Area around chambers was probed and found to be dry. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA 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 I Commonwealth of Massachusetts _ Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is required for every Centerville Ma 02632 1-9-17 page. CitylTown 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: NA 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is required for every Centerville Ma 02632 1-9-17 page. CitylFown 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 REAR Al-310 81-4 ' A2.3 S B2*s31'1' p 75 A4-Vi ' i4'3s5' A -70S 85-AT 4 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is required for every Centerville Ma 02632 1-9-17 page. CitylFown 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: No GW 128" 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: June 18 2008 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: Plan on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 6 Chappaquiddick Way Property Address Ellen Woodfin Owner Owner's Name information is Centerville Ma 02632 1-9-17 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Road Property Address Mary H. Conlon - Owner Owner's Name information is Centerville MA 02632 September 28 2012 required for every p page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your a ��o cursor-do not David D. Coughanowr, R.S. use the return Name of Inspector key. Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364-0894 1328 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 ( 10 CMR 15.000). The system: (V ® asses El Passes ElFails ElP, ds Further Evaluation by the Local Approving Authority c� c.l P 2S September 28, 2012 Inspe t 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•11/10 Title 5 Official Inspe n m:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts - W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is p required for every Centerville MA 02632 September 28, 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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. - ;'µ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is stru4rally ' 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is P required for every Centerville MA 02632 September 28, 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): - ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N , ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is p required for every Centerville MA 02632 September 28, 2012 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ti Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is Centerville MA 02632 September 28 2012 required for every p page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is p required for every Centerville MA 02632 September 28, 2012 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is p required for every Centerville MA 02632 September 28, 2012 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 242 gpd 9 ( Y 9 (gP ))� Detail 2010, 2011, and first half of 2012 Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment. Design flow(based on 310 CMR 15.203): Gallons per day(gPd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts L w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is p required for every Centerville MA 02632 September 28, 2012 page. CityTTown 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: owner 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is Centerville MA 02632 September 28 2012 required for every P 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: Age: 4+ years. Certificate of compliance was issued 6/27/08 (Permit#08-267 at Health Dept). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5 x 5 x 6- 1500 gallon tank Sludge depth: 4 in t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is P required for every Centerville MA 02632 September 28, 2012 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 30 in Scum thickness 1 in Distance from top of scum to top of outlet tee or baffle 9 in Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? Design plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is not required at this time, but maintenance pumping is recommended within 2-4 years. Tank and tees appear structurally sound and functioning as intended. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is required for every Centerville MA 02632 September 28, 2012 _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is p required for every Centerville MA 02632 September 28, 2012 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 at outlet invert 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 appears structurally sound with no evidence of leakage in or out. Few solids in sump. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain,why: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is P required for every Centerville MA 02632 September 28 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ 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.): Soils above leaching gallery appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. An observation hole was dug into leaching gallery stone and no effluent contact staining was observed in the stone or overlying soils. No standing effluent was observed to a depth of 1 feet below the top of the peastone layer. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is p required for every Centerville MA 02632 September 28, 2012 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.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts t=� Ties 5 Official Mspec ions Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �•:- 6 Chappaaquiddick Road Property Address Ma!y H. Conlon Owner Owner's Name information is Centerville MA 02632 September 28 2012. required for every —P page. Cityfrown 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 4 � 1 . /c- �a v �cT (ACE ,t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage.Disposal System-,Page 15of17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is Centerville MA 02632 September 28 2012 required for every p 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: 10+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 6/23/2008 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: Approved design plan on file with the Board of Health shows bottom of system to be over 5 feet above the bottom of a witnessed test pit in which no groundwater mottling was noted. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 6 Chappaquiddick Road Property Address Mary H. Conlon Owner Owner's Name information is p required for every Centerville MA 02632 September 28, 2012 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. ,. Fee ve r7 _. THE COMMONWEALTH OF MASSACHUSET'TS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 3pplicatton for �Bi5pagaY 6potem Con5trUCtion Permit Application for a Permit to Construct( ) Repair(<) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. f0 C AfPAj1'J1Lk RID Owner's Name,Address,and Tel.No. Pu i/l� Assessor's Map/Parcel + �� S 3 r!e A11W Installer's Name,Address,and Tel.No. (� aerr.((a �h•>�i�O�Scs Designer's Name,Address and Tel.No. ghee w-i / "30' _7 to3 309. 2 73 -03`7-1 �G.�rc �, Type of Building: DwellingNo.of Bedrooms r sq.ft. Garbage Grinder ( ) Lot Size ' S?J Other Type of Building 5ihfly 4~114t No.of Persons Showers( ) Cafeteriaif ( ) Other Fixtures Design Flow(min.required) -7 3 0 gpd Design flow provided 3 3 1 5— gpd Plan Date (4 1 8-' Z-0&c Number of sheets Revision Date Title G�te1�► Size of Septic Tank 15-OO c,At Type of S.A.S. (7, So v S iq L C- c�,�S?ti►.. Description of Soil 9Qe n n4-, Nature of Repairs or Alterations(Answer when applicable) A!e Twit, i ao 9,Olc 710 f),30.t 0 C. Date last inspected: 2,00 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 f Health. Signed Date (0 " 3 — 26o Application Approved by Date Application Disapproved by: - Date for the following reasons cc, Permit No. `�-�c Date Issued co 0 3 ee I F + # i Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes. PUBLIC HIALA DIVISION- TOWN OF BARNSTABLE', MASSACHUSETTS Zipplicatton for Mtzp gal 6V4tem Cow6truction-permit t Application for a Permit to Construct O Repair) Upgrade O Abandon O ❑Complete System ❑Individual Components Location Address or Lot No. to 661ePAf,,d 4 c,k 1�b Owner's Name,Address,and Tel.No. Assessor's Map/Parcel "� 1 3 : �G«f r C v• r l` /yYl•,i L \ , Installer's Name,Address,and Tel.No. 41 f&u.c.(y rrT!kyr-1.5e Designer's Name,Address_ and Tel.No. Pv. 3Jy 7C,3 �•- T+61�`� GiA��iti/� 47 ,� C�rrit-,-te .tiW ot63� /O�• 1 �� —03'7"� G'rss� w.o�Ckr�.� Type of Building: ^� J S-' s S Dwelling No.of Bedrooms ,7 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building 51 r(/Y A+r L No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ' 3 C gpd Design flow provided 3 , $r gpd Plan Date �+ r ' Load Number of sheets Revision Date Title CG,a p Size of Septic Tank 1!F00 4A(- Type of S.A.S. rrZ S Ju C��q C 1,-C. r�SRi•.. Description of Soil dui- (2)/An r C,Ito (Q 3 Zr Nature.of Repairs or Alterations(Answer when applicable) New fq-rik 1 Soo 9 ot. P /)-•3„ < (b \2:) 1 0a S I/ylt Date last inspected: ?i00 ` 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.. j Signed Date 3 - -Zoo F Application Approved by Date Application Disapproved'by: Date for the following reasons Nf Permit No. —4 c -.. Date Issued 6 ,t)3/v F— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ,( ) Upgraded ( ) Abandoned( )by ,/l/2e. i lU &'l� al i)2,S (. L C 9 at (aO ,/a C v• J d•� �� (f�111 t I'`' has been constructed in accordanceh_3/�� with the r;j9&41d, sions of Title 5 and the for Disposal System Construction Permit No. dated b Installer CA Designer �.• �.�'I r t} e�. #bedrooms Approved design,flow �j � �/ gpd The issuance of this permit hal not e cdnstrued as a guarantee that the system w/fu ction as designed. C a Date Inspector /f (i f/.1,L . 4 �fY 116 /' r �- ( No. lJ ^9 Fee ———— l THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS (,,1i.5po!5al 6p5tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( ) U grade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be ted within three years of the da-e of this pe,Zit. Date &7M,M Approved b: TOWN OF BARNSTABLE LOCATION (p CGtan c��lC ►Ld SEWAGE# 09 " of VILLAGE ASSESSOR'S MAP&PARCEL 170 S3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /S-60 1f/d LEACHING FACILITY:(type). (,t)a 0 l.c L11 O (size) \Z X IS" NO.OF BEDROOMS 3 OWNER 6,e r+r.,-d $l�st2 Miry. PERMIT DATE: d 1S COMPLIANCE DATE: Separation Distance Between the: _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility l'o /V feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY A/ 31,0 '?2 3b,S A A3 Aff ,A f -70.S R(o 70.7 31 Y3.2 �S2 �•S , S3 Qlo 3Z•2 J.Owfi of bamtgble Regulatory Services 1 hiimus F.Geiler,Director Public,Health D'ivasion Thomas McKean,Dir etor 200 Maltz Street,Flyanit s,;MA 02601 Clftics! R�08-862-4644 Fax, 508.790.6304 Installer & Designer Corti cation Forni' '1 1 Date: i �jC- (�cj„�tr�':Ctr1J _Sv�C ; 11 E3ta11er C ofe t(��.; n�eC�rtS�s F r`{ ( 1\P Address: _ _ �' �.w- �w Address.; ..` :... 2)z�xZMlo3...�__T. {' i C)xtc4i was issued a �ernnit to install a (date; (installer) ; } ' I septic system at _ (n based ca"n a design drawn by l _ Co c i r� ,�)G datedur�� ---- ----- V 1 certif� that the septic s st6m referenced above' ' : ..._._,..._ Y 1� Y was 'installEd substantially according to r the design, which triay include minor approved changes such as lateral relocation of the distribution box and/or septic tarLk. ; _y I certify that the septic system',referenect3 shave was instal;l�ed with zriajor changes (i.e; greater than 10' lateral relocation of the SAS or ally vertical relocation of any component of the septic system)abut in accbraance withi States Localegulatiuns. Plan revision or certified as-built by designer to follow.; + r nstaller�s Si ature) ;t }` , -- (Y�esigrt.er's St e.} (Affi esigner'- .unpHere) c' i PLEASE RE r T4 BARNS' ' ' ,PUB C HE T DIVISION. CERT CAT F. Of CUMPCE IL N AS- t BUILT ED BY AB L -HEALTH DIVISION. Q: Realtlt/septiOnesignei'Certificatiort Form 1 0 'd L920 £ZZ 809 !)N I d33N I'DN3:3t Wd SR= 20 800Z-L 1:-inn op� Town of Barnstable P# JI� S� Departitnent of Regulatory Services MUMaz,BL& t Public Health Division Date 200 Main Street,Hyannis MA 02601 6 ) � Date Scheduled U Time—'-1_ Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: MKHgE��ml tEa-�E.I.T, Witnessed By:-1 Q"AJ4 M#or2Rnioj LOCATION& GENERAL INFORMATION Location Address (o CnArpR (&mot nt n_ ,,,_p Owner's Name cJt 1'�u�� Address(p C�.��4��' C/'wcl'cu�c'te ✓"I��ti•IG� Assessor's Map/Parcel: l 7b/o S-3 Engineer's Name J-L X91Si112eil a'Z/�G NEW CONSTRUCTION REPAIR Telephone# 50� LM E402t Land Use -"'510ENnAL- LAwN Slopes(4b) x-5"lo Surface Stones NONE Distances from: Open Water Body >i5o ft Possible Wet Area 150 ft Drinking Water Well >�`JO ft Drainage Way 3.10 ft Property Line >10 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands Sn proximity to holes) see abtc;he.d ekao daF`d .5uvie, i B l 2vo8 e,fq aced �oy �G Crbtnee`inS iYic: , CA+-tied SgAtc sys lem uey tJe_ Pert o - S �7 k 'F.w. CIO Parent material(geologic) OU WASH Depth to Bedrock , Depth to Groundwater. Standing Water in Hole: > R$ S.C. .S• Weeping from Pit Face tom. G•s• Estimated Seasonal High Groundwater > Qee>. 'R.G.5. DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: r 0195EQUAnom Depth Observed standing in obs.hole: _ ?� � __— __in. Depth to soil mottles: 912$ in. Depth to weeping from side of obs.hole: 1 W in, Groundwater Adjustment IN 1 A ft. Index Well# - Reading Date: Index Well level =— Adj.thctor• - Adj.Groundwater Level•R_ PERCOLATION TEST We (41210$ Thne tt:zs Am Observation Hole# , Time at 9" Depth of Perc 2 -50" Time at 6" Start Pre-soak Time @ tt•.t9gaq Time(9"-6") End Pre-soak o� 3i AM Rate MinJlnch 42 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) N 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 beginning. Q:\SEPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# .a Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistencv. ravel O-Af, A L 6AM'f 'SAND IOYQ 311 LOAMY *5j}nr0 f0YR gZ-t>a a mep-eoaast 5ano 2.5`(°1� 5-l0`lo Gaav DEEP OBSERVATION HOLE LOG Hole# �- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistency.% `I"-3L". 6 tonMty canto �uYR S16 7,i-- Mee-COARSE 3An►0 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from '5"' Soil Horizon Soil Texture Soil Color Soil Other �► , Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. • Consi n •r Flood Insurance Rate Mau: 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 material exist in all areas observed throughout the area proposed for the soil absorption system? YES If not,what is the depth of naturally occurring pervious material? Certification I certify that on 0-21.- 11 (date)I have passed the soil evaluator examination approved by the Protection and that the above analysis was performed by me consistent with . Department of En vironmental Prot the required training,exper' e and erience described in 310 CMR 15.017. Date Signature Q:\SEPTIC�?ERCFORM.DOC M . • O M ir For delivery information visit our website at www.usps.come E3 Postage $ , q j 0260� Certified Fee CO p Return Receipt Fee P p (Endorsement Required) S re 0 Restricted Delivery Fee (Endorsement Required) M ul rg Total Postage&Fees ru Sent o�� -----*------- ?C�� Street,Apt.No.;-^-�-�-'----�,y�// ,� �� -- MR or PO Sox No.-Oj- _ ' �O C , --to ZIPf4 M(..�_.c.'. Va 'La :00 August 2006 See Reverse for Instructions Certified Mail Prpides: > ■ 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 Mails or Priority Mails. ® Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a 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 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 USPS®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". a 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 mop WEraw Town of Barnstable . Barnstable /h- Regulatory Services Department A*A"Mcacft" 1 . RARNS-rABLE. "Ass01 i639• Public Health Division �e Alf°Mai a, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F..Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO May 2, 2008 Gertrude Sheehan c/o Mary.Conlon 21 Westerly Street#10 Wellesley, MA 02482 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 6 Chappaquiddick, Centerville, MA was last inspected on April 4, 2008 by Mark Polselli, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Backup of sewage into facility or system component due to 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 B RD OF HEALTH oe ` o as McKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL #7006 2150 0002 1041 9303 Q:\SEPTIC\Letters Septic Inspection Failures\6 Chappaquiddick.doc r I lr4 � •%� E+x�;C`u TVT n Tyr, 0 � .0—Ni ,rn^i�'I_ L r� _^�T S +�J DEPARTMENT 0y _1_NV1RONN 4F JTAL ARC)r_CT10? L4 611 ce N IE T 0 W [E B MAY 0 2 2008 TITLE 5 HEALTH DEPT. O-F'S?C IA'AAL INSPECC 1 g'idN FORN —NOT FOs'@.VOLUNTARY i_H9.Y_ SS SSI-1 .1`T'+J' SUBSURFACE SEWAGE DISPOS— l- SYSTENI FORM CE RT? 1(_7 A T 10 N Pronert&Address: `r✓ Gi Ot ��rd�tc6✓ RCi Ctrs Yv/ �— OoZ G.�.Z 0-i-mer's Name: Go �aH4, Owner's Address: �� uQ�cr �✓ � / /Jp 907( /�So Date of lnspeetiors: _61 /_/ Q i .-gip. h' Name of n.srector lease pi int G7Y D SP i Company Name:� V/O %�G Mailine,Address:' O 0 OoZ6�o� Telephone Number: D �f CEI T IYTCA TIE ON S E. I cer iff %that 1 ha, personall-'inmected the.sewage disposal system,at`;is add.:_ess and-that;he ion;,^-,� _te,_ d below is tr-ae accurate and co=,ete as of the time of the Lnspection. ts. �, 1 e _spe c ioL^ -as, erf,wed based o.: _ trainin-and experience in the proper function and maintenance cf on site sewage dis^osal syster I ears a LA P approved syrstPrn inspector pursua t to Section 15.340 of Title -(310 LAIR 1.5.000). The t�s_vs s Passes Con' :.tall:-Passes 2 eel F u-tj'.=r E p aluatsey�y e Local r. Dro'� ,' utho�t' F t iJ Fails , Inspector's Signature: �" Date; OF The system inspector shall submit a copy of this inspection repot`to the Appro,:-sng Authority-(Board of Realm or DEM within 30 days of completing this inspection.if the system is a shared system or has a desin fflo-,;of?t;,1r_1n gpd or greater,he inspectcr and the sySter?GW e'sl all S It 2t`h repot in-�e appropriate:e_g oT 31 O Ce of--he DEP. The o-im:al s oiild be sent to the system mwner and copies sent to the'bLver, if apDlicabl-, and the a*,• cvi-,)r authority. - Notes and Comments ****This report only describes conditions at the thane of inspection and under the conditions of use at that time.This inspection does not address how the sF stem will perform in the future under the same or different conditions of use. Title 5 Inspection Four_ 6/15/2000 pace Page 2 of i i 0 F F1 C 1 A L S P:1']C TI 0 IN F 0 R- M—N 0 T FOR V 0 L ITINNIT APY-4-1 S S E S S-Alf E-N-1 T S SUBSURFACE SEWAGF T)TSPOSAL FORNT FART A CERTIFICATION(continued) Property;Address: WC/ 7 Owner: Date,ifInnspectlior,: 5t Inspection Summary: Cheell, A,B,C,D er E!ALINIAYS.complete all of Section T-) A. System Passes: /f have not found.any in fb 7.---,ation :ndic a-ie s that a!-,.,.,of tl;e fall-tr,e,=fteria&s cri-bcd in-7 10 C-1,11-R-1 15303 or in 3 10 CTIR 15.304 exist.Ary fail-are criteria no- are iEdicafed belo-iv. Comments: B. System Con0ition-aily Passes: eOne or more system,corqponents as described in th-2"'Conditional Pass"section.n2ed to be r-.placed or repaired.The system, upon,co=,l r -etion -of I tb e replacenrenT or re? as approved by W Board of Health: A!pass, Answer no or not deterfined(Y,NN, -D)in the--fcr the following statements. If"rot deter fined"please explain. -he t�—znk(w et-her mnet2l Cr-,not) is stmaLL-nally I he sepnic is metal, and over 20 years W or 0, lwh unsound,exhibits substantial infiltration or Wltration or tank failure is immJulent.System-Mij pass inspechon if the existing tank is replaced-writh a complying septic tank as approved by the Board of Hlcalfh. *A metal septic tank Mi pass inspection Uit is structrally soun.d,notlealimig and if a Certificate ofCo=. �-'!ian.ce indicating that the tank is less than 20 years old is available. ND explain: Obser-,--ation of s�!-,.--.,agee backup or break out or high-,-at-.;c water level in the cEstibution box due to 1wolven or obstructed pipc(s) or due to a broken,settled or une-,en dismbution box. System will pass inspection V(Q-01 approval of Board of Healfhi): broken pipe(s',are replaced obstnacti,on is rern-o-v_d disc butior box is levzled or--e lacod IND explain: .e system-,quired piunping more than.4 Mms a ITar the to broken or obstruicted..pipe(s). j�b- owl pass inspection if(with approval of the Board of Health): broken pipe(s)are mpkwd' obstnunion is removed POD explain: Page 31 of! I 0MCIAL INSPECTION FORM--P�O'TFOR VOUTNT-AMY ASSESSNFENTTS STUB- SUIRFACE SEVVAGE DISPOSAY, SYSTEM LN'SPECTION -FORAM FART A CF,RTI F' Propei-tv Address, C,4, oQ Ov"r-er:.-.qeWa,.,j Date of lnspe&Jon: -fl A C. Further Evaluation is.Required by the Board of Health: ter, - - r,-qu:- further-va"ua!4.on-,nv �,p Board o'-1!eat in or er to def --,�ne the syst,--,n r, Itions exist wilich 1-1 e d is failfing to 7orotect public ealth. safety or the en-'-i-iorc-nant, 1. Svstem wlfll Dass unless Board Of_711,ealth dellcrrnines in accordance with 3-10 OVER 153-03"W))that the I k . , , Svs+lem is not funeflrarfruff in a marner whic.,thi N-%Tl,protect public-health.s2fetv and the emi-on M. ent: Cesspool or privy is-,;;-rithin 50 Let ofla surface water Cesspool or 50 feet of a bordering vegetated wetland or a salt rnarsh 2. System Nill fail unless the Board of Health(and Pub',.te'Water Supplier. if any.",determines that the system is functioning in a manner that protects the pub!!-,health,safety-and environment: The system has a septic tank and soil abso7ption system(SAS)and the SAS is 100 feet of a surface-water sumply or tributary to a surface-,varl-r su-col-v. SAS-S he system has a sep-Ec tank and SAS and tl,-.e a Zone I of a putfic water su-,I)IV met t o a pm. -a t a t e-s-a r.—o 1-v e Ilie system has a septic tank and SAS and the S AS is ,vith-liz. 5, T The s-vstem has a seYtic tank and SAS and the SAS is less than 100 feet bait 50 feet or more r'=a private w..ater surmv vve.`�**. N-lethod used to detemnine qSLjac,- supply "This s-,."s+Lem gasses-.I*f the Welt water analysis. bactenia a vala le organic co—imo, ds indicat.-s the-wt-U! s'—rep L-on-po,11-1-tion m tha t fa c i!i an4 the presence of a,--.-,=,.-oTna nutroger and nitrate nitog--n is ear-la-1 to oT-less t-Shan 5 m7n prn-17ded that T,,o other failure cnitetia are miagered.A copy of the anal-vsis irnus:be attached to this fc, 3. Other: Paee 4 of 11 OFFICIAL INSPECTION FORM—NO T FOR VOLUNTARY A:SSE SSINTE TS StJ U7k.A€'E SE"AGE DISPOSAL SY'ST M I SPECTIO-N FORN1 yam, PART ACER>" S"CAT`O (coritinued) ?ropei-ty.Address; Owner: � �,.✓1 -- Date of Inspection: D. Svstem Failure Criteria applicable to all systems- You must indicate "yes"Or"nC"to each of the fOiiOv:ing for ai➢.iIlzmectons: Yes o _ _:1 :Oi S?'✓,%a e _1i1;Or Svc;e C Y c^e ,t sue tC.Cter GO c� d n Ss r -- tC .et-i lOa d GT 0` 8 $n O_ ^eS '1^<nt Disaar�e or of-effluent to'he surface Oi the gound Or surface;n.°a`iers due To an over],-ailed or �2Qed SAS or cesspocl C�.Icu:d level in the diSt^l ati.Cn k a;^,C'>'c outlet in i-e..C d is t0 a OT%erlo?did Or ICaaed C e nr G;iid Qet'_^_in CeSSpOCl is less than „'re;C invert or%.`-zcil_h3F =0l'?r'?e_S ie5,+i,g- dgv>l(.w ReT1ireG P`?2�ip1nQ more than C tines in t11'13St Ve 7 !.'O rat?t0 r'_nooe OZ OhS c' i T)inei S). \T ?A- p�'times pumped �!/ v portion of the SAS_cesspool or pr-y i vs Belo�,-bi6h ground water elevation'. Y portion Cf cesspool or privy is within 1 00 feet Of a-s! e-rat, r supply f-t l3Cc rtaC„ e_ Or trl_ti_ar�'to, a ci,�_ eater su:;ph,. L/�ta-,v`�omon of a c SSnool or^.;-i��;is r, thii' _. e ? of p h; c -,Cn a. u.,=1 - Portion of a ces-zpool or privy i5 wri ill 51C feet Of a private vfater supply v7ZI. Any por ton Cf a cesspool Or privy is less than 100-eet but greater than. 5O feet`rorn a private-,,vater supply well with no acceptable water cuali`✓ai alvsis. (This sdstein passes if the-well water 2nalvsis, performed at a DES- certified laboratory,for coliform bacteria and volatile organic compounds indicates that the weil is free fr orp poPurinn,from that facility and the presence of ammonia Iiitrouen and nitrate rnitraaea is equal to Or Less tb2.n 5 ppin.pl!)-Oded that no other failure criteria are -rigger?d.fix.copy'Of the analysis nn3stbie attached to th!5 for`i.] vYPS^vn}'T'ha system fa ids.:have detei_i Iled it .`.Onc Jrr^^re ai' e al r;e failureaterna Cam`:=as described in 310 C?z c 1 303,therefore&e s:-Ste,._LG31s.the s-y Ste^I ovvpier S?io:Tid Contact the 111-3Ga`d of Health to detei?nine vhai v711 be necessar J to correct f-he failure. E. (large Systems: To be considered a iarge system the system must serve a facility with a design floe o`1f_.000 gpd to 15.000 grid. You must indicate either"ves"or"no"to each ofthe foil^ _:n�• llie fL OC«in4 Crite.;H app1�tC !arse systems in addition to _he Criteria abov>\ yes no tr.e syste.., «it?i.is - n 400-,-,et of a surface drn?�in_tooter sp^v _ r• the s-,ste.m is within 200 feet of a tributary to a surface drinidrg water si pp? the s<sten, Is located in a rii Toger:Seri 3 c T. to Z77v1? ead G�Ct C _. e—1. �� or 2 --'-D� C SIr ie re i_; ? _r _ d i 7 one. U o`a rlublic,;voter supply we" if you have ans-:vered" es`'to any question is1 Section E f 11c S %Stela is cOnS-idereu a ei?n Cast `'2"T Or 3?S r yes"in Section_D a00-e the la ,ge system has failed. The caner Or Operator of a7c larce sygiem eo-e�._tz 2 siQnificart threat under Section i or lolled under Section.fJ sletaij'-ii �Tade the system�n y� P: m:_ Lrordance i C_—, 15.304. The system o�s.ner S`iould contact the appropriate r�0-enal office O tl e Depar.-,-= E. Pate 5 of i' OFFICIAL B_Na3?ECT1tON 41'O�A-��i � O.= FCJ.E'L VO.itfiJ iW ,4'LiR3 _=ASSl:SSA3E ty SUBSURFSCE. SE',N`AGE DISPOSAL SYSTEM INSPEC"3`UO ORN'I H E-C KI iS T Propert�T Address: !/�g Gl Q��Gr C � S`(I, / lam(// ®a-611 owner: Bate of inspection. Check if We_fn ipw_nv_have been done.You IFPIPSt indicate"yeS OZ"no""3S t0 each 0f`-he fO1iQ,�v:^-q�: - Yes No Pumping inforimation was provided by the o-7e_,occ�u ant or BOard of Heaiu ' �kT _"ti-o .he system.corilponen`•S 7i!Si1?eG C T' L p Lv1'V we kpanod Has system rece '` iQrialQLT the�rEviJiS Hove i g.-volumes of dater been introduced to the system recen t1y OJT as part of this:nspection? We.--,as built plans of the system Obtained and examined?(if t1tie,-were not available note as ti-A) � ki ,V S ti �. '?: d .ell T__stect d fO= - .__� ._ ewage bac CP a- --- i-''` I-`-Y Ot - r was the site inSDECted for signs of break out . Were all system coil.ponents,excluding the SAS,located on s.te? !/ Were the sF, tic tan::rnan oles uncovered,opened;and the interior of the tack inspected for the condition _ r`-` Of the tiieS or tees, tiatE lal Of Oilsti LiC:iOn;di Tlen5i0P,s. depth.of liquid,depth of sludge and depth Of Scurn r r` Cc- nts dime^t u v, ?T'.=,7Tni%d�^: nth SifO?'i'_7�.tl-on.ter tlle proper _ ',Was the raciaiy o� e: (and,Q . 1Da._` i. t_._ O11 O— rlaintenance of subsurface sevjage disposal.systenis? Re size and location of the SO Absorphon System(SAS)on the site has been detc-mined based on: Yes no r.QS rig infoi�atiOn.for e a-iple,n Man at the Beard O'i?ealth. - _ _ - i r C_s 7ssut me*�iii-naf on of anCe� DEteriT'.ciTiEd'u`:the�Lli.(3I aiiy'of the is 11�':.:e�Ciieia'e;2.ted t�I'aai -2i_ a ai. is unacceptable) 1310 CNIR 15.302(3)(b) Pace 6 of i S BSUR CE SEWAGE DISPOEAVL SYSTEM U�'�SPEC `IOIN f t RA! Dropert 62"t Date of Irspeetion: �$ NN, C()NISI TION S RESIDENTIAL �tl7i�`'ei. Of'ned:oOms 1CieSi�r;).� �:�ribe'Ori. (t orY-:C ra^,iun�' �� DESIGN, _qo--i% astd o'n 7 0{ _`� t�.2� 'fore:aIri�' . ;i!^!_-T d K Oi^edroor �.uIni'?'of C u-._.. Does residence ina-ve a garbage gri-rde-(yes or no):-P'o Is launidj7,, on a system( � +a eua,.a.t�sew°a� _,s`er yes or net- F: �,.ec seParate;ns?_•sectio required Lanadnr sVStern.ins.u? Md'VeS OF ito'-/�� Seasonal use: 'veS or n ,zlater mac;. read-i cs. if availa 1p-Mast!,years usarse(zpd)): Last date of occu_nancy: T:_e of estabiisinment: Design flow(based on_.i.�,Cv R I5.20 ): —gpd Basis of d,-sl f_mo T fceat !rr,..c-c^r_g/s; ^.tc.1 Grease'ra,,P_reser_ (ves o-no? _ in dusty al waste hold-ing tarS present(yes or no): Non-sanitary v ae , a to th,- '- = to dISC_ar-e -I I . "Sidi:_ Water meter_e'adirl.—z if availaJie last Crate.37F c:u�a C "/-d — - -- OTHER'describe" PlimpinQ Records Source of mifori nation: Was sys`.-- purnmeu as part of he i;�Spectim i yeS r ioi: _ If yes. Vo3Ume vumoed: 'aailons--low i%as GZ 2_i.' '-_ul'I'M"d Bete- li-necd? Reason for piarni,ing: TYTE OF Sept; tare; cis,.,ib;:tion bo•�, so;l absorption sysicr: _S ?'. c-Ssnoof ., Y —P.-•<_ Sl<a_p-d.-- te? (Ves or no) (if yes. attailn pre rloIIs Ir_s ec-'on rec?rds. if an-r) IrLnO,%a Vei 41terT_atIVe technology. rA tacin a ci: "O r Lr=nt Opera lOr anC ma* 'zr-ron r'' :rteriz_--, ect,(to be obtained fl"orm s-ystem, ov:per) �igbtt t- nk _�. ace a copy of the D E?approval �tHer lCescri"be': App'C; r at aa ofallQ..nn TtS. Cate in$ialiea(;rimer,_ a^ A - -- 'n?rCe ifCi� iVere set-a^e etec odlrS C ter wlne arr Vi_r,.o at tn. slt !;"_ Fare , of 11 OFFICIAL INNSPE8.=,TIO FORM—NOT FOR VOLT>�T_.A SS S I �__.TS SUBSURFACE SELVAGE D.SPOSAL SYSTEM 1NN'SPE T1071"T'OR'Nf PART C SYS T -k�, N."F` / IATIO (contirruled; Prope,rty^ddrzss. G Owner: 1v Date of Inspect;or.: BUILDING sENVER(locate cr.site plan) l/ Depth below grade: -- Materials of constnactiors: ast iron c :✓C__o`.`_er(explain):--_ -- — Distance from private water supply well or suction line: Cor=ents(on.con^ition or J?ir tS; %enLSrla, evidence 0±'eakage;et..): SEPTIC`F�'dF5: �" %!oCate on site plarr) Depth below Grade: Mate ial of construct-ion:_co-nerete_metal_.fiberglass polyethylene other(explain) If tank is metal ligt ac,e _ IS 8.ae COri LTYiler by 3 Ce:- irCate of Lorl?P1ia1'.te Nej{r O j:_(at a lb a co-o of certificate) v Dimensions Sludge de th _ Distance from ton_ of sludge to bottom of outlet tee or baf e: Scu_r?thickness: Distance from top of scum to top of outlet tee or barle: Distance orn bottom of scu�':-i to bottom of outlet tee erf zffle: How;were dimensions deten-nihied: co=nents (Ori pu=inc;reco ; 'iendations,inlet and outlet tee or affae cot^d-itioa,structural integ-irv— hQuid'eevcls as related to Cutlet is Vert; evidence of leakage;etc.): GREASE TRAP—_t,lecate on site plan) Depth be'o v grade:_ Matenia of co'smactiori:_concrete_nnetal tiber?t ss__polyeth._%lene other (explain): Dimensions: Sci m thickness: Distance iiom toll of sciuD.to top of outlet tee or baffle: Distance-from bottom of scum-to bottorn of ou let tee baffle: Date of:ast m' Ji Comme-i is (on gimp? reco=tndations izLe`i and o'uttiet e of baffle on `� r r 1 � - r, d rc idi�.o..y suu.,rkra_ rt�« �, li.,��i- els as related to outlet inert, evidence of leakage; Page 8 of, a UBSURIFACE :S °PAGE DISPOSAL ORM PART C Y S 1 EM INFORMATION(coniir_aed; Proper`-Address= a� �wr,e-- Bate of Inspections: TIGHT or HOLDING TANIK& (tank must I e penned at tur_e Gf inspectien)(locate on site plan) Dentl 1-heiow grade: T aterlat Of CGnSt ucilon: concrete metal____bersdass r'olvet.hyiene otl,er(e_z'plaln): Dimensions: Capacity: gallons Design Flo ga=?o_Es/day Alarm present(yes or no): A±arm te vet: A_arm ,wor-king order(yes m n0): Date of last puln pil Corrune is(condition O-alarir_and float sy atC 1es.etc. DID+l I;TIG°+BOX: O nreseni must be opeinccd Jocaie on site plan) Depth of liquid level_above Gutlet invtzt: Comments(note if box is level and dis nbu`ort tc outlets equal;any el dence of solids cmz 'yoven any evidence of leakage.nto or out of box, etc.)' PTUNIP CHAMBER:j (locate on site plan, Pairrps it :working cider(-Ps or no):-- Alarms in,:-Ors: e,rde_`( es or nc F: Comments(note condition ofpu mpchamber, condition of purms and a 7_iLi eranC's,etc.i;- Page 9 of l l OFFrC!AL INSPECTION FOR --OT FOR V0UL-IIN-7-41RE YASSESSM-T,N S F Rg C' SYSTEM ti'F EMAT iA (GGnhn=ueQ) Property,.^address: L4 I J, Owner: a"a Date of Inspection: SOII.ABSORPTION S x'S E"Wk(SAS,: (locate or> sate plau.excavatiop not required; If SAS net 1oca`ed exr,lain, -why: Tape leaching pits. nitrnber:_ leacl2g chambers_number: leaching galleries,number: leach_ng trenches_number. length: --lead:;,-i�fields,numb-er, di-3_nensiaas: overflow cesspool,number: ir�lGvati�e/a.lte native syste- Tyae/name oftecino ogy: CO:itr ent5 (note CO GitiOr Gf SOiI, S1GnS of�tidraTliie.{ail irP level Ot pG1 d?n6, ramp SO 1, cOndiiiOIl Gf tie3etar0 L etc. : CESSPOOLS. CeSS'00i-must be purrcped as par: i LTs'C 0nl<1GCate on Site lan) _zz-,,-rber a-d conficliration: C/o t Depth—top of liquid tG inlet irn er O 30 2 Depth of solids 'aver. Deutli of scum laver: v ` X Dimensions o�cesspcol: 6 Materials of construiction: p L indication of_�:-ro- dv ater n 1G.;-(yes or- / - 'Tliii nts mole c0.nditl0]jof soil, sig:m T hvd aulic%all•,,' ,level of pon."' 7, t, nd'` i of"'ecetatlorl, ctc.j: e n40 m✓e /oe i,c /G G / Al/^el PRIVY: /[/ (locate on Site plan) Materia's of conssuction: D:lnersions: Dept~o scuds Co=ertS mote condition of s^ll,si74m of hydraulic failure, ey'el Of vOnCinc Condkion G'vege`'t`lon. etc.'): pace ?? of 1 D OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY A.SSES.S�T.lTS SUBSU ACE SEW- AGE DISPOSAL SY.STENT TNISREC'IION PART C (/ SYSTEM I�FORAgATTO�v(continued) Proper-yftdreSS' lJ l� �ii �s lo/rG / Otvnes: Rate of Inspection: AY SITE EX-AIM Slope Surface water Check cellar Shallo,,v :ells Estimated depth to ground water feet Please indicate(check) all methods Used to deterr-?ine-he ig,Lioe-nd neater, elevation: Obtained f om system design plans on record-if cl?ecked,date o design plan re iev:ed: Observed site(abiatdna proper-/observation-bole x tl-nl 150 feet of SAS) Checked wi+h local Board of Health-explain: Checked«Mth Iocai excavators,installers-(attach documentation) Accessed USGS database-ex-olain: You rrtu d s ibe ho 4you es'-blish--the high�cand w a o2e'e a oq: — �C�, r � S � /Y�1 c.t✓t Town of Barnstable �p THE Z Regulatory Services BA"SrAB[.E, Thomas F. Geiler,Director au&& g i639. Public.Health .Division pTEp Mp'l p Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts,Department of.Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future not does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. i PROVIDE PRECAST CONCRETE EXTENSION FINISH GRADE OVER D-BOX= 48.0'± TOP OF FOUNDATION = 48.2 ± RISER WITH CONCRETE COVER TO WITHIN FINISH GRADE OVER CHAMBERS= 47.$� - 4•8,2� GENERAL NOTE S � SLOPE 2% MIN. OVER SYSTEM 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION- 6"OF F.G. OVER INLET AND OUTLET COVER REMOVABLE CONCRETE COVER @ TO WITHIN 6"OF FINISHED GRADE 3/4"TO 1-1/2"DOUBLE WASHED STONE TO 4"SCHEDULE 40 PVC MIN SLOPE 1% INSPECTION PORT w/ACCESS BOX w/ CROWN OF PIPE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE @ FOUNDATION = 47.5'± FINISH GRADE OVER TANK EL.= 47,2 ± 5" DIA. OUTLET(S) COVER TO GRADE (SEE NOTE#22) 2"OF 1/8"TO 1/2"DOUBLE WASHED STONE FINISHED GRADE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. 20" MIN. ACCESS COVER � PLACE RISERS ON ALL 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD 9"MIN. i OF HEALTH AND THE DESIGN ENGINEER. ATYPICAL FOR 3 " I TOP OF SAS = 45.23 CHAMBERS WITH ( ) 36 MAX. 9"MIN. INLET PIPES TO 6"OF 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL PROPOSED 4" �_ 36 MAX. 44.40� 36" MAX. BREAKOUT EL = 44.90' FINISHED GRADE BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. SCHEDULE 40 PVC - 2"DROP MIN. r PROVIDE WATERTIGHT i 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS MIN.SLOPE@ 1% 6" 3" 3" DROP MAX. 3" 9" j JOINTS (TYP.) o THAN ELEVATION =44.90' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. z� + 0 14 4"PVC IN FROM I " I� 0 0 0 0�0 O oo TOP OF THE LUNLESS A 40 InNER S NOTIL MBESS THAN HNE LINER IS PLACE AT LEAST FIVE E BREAKOUT ELEVATION.FEET FROM S.A.S.AND THE L-� 45.00' SEPTIC TANK 4 PVC OUT TO LEACHING FACILITY oo op 00 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 45.25' 12" o0 0 0 6. THIS SYSTEM IS NOT DESIGNED FOR AR 48„ OUTLET TEE 44.70 MIN. 44.53 2 o o GQ o0p GARBAGE DISPOSAL. 6"CRUSHED STONE o 0 6 0 00 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED 18.9'to fnd. 22"ZABEL FILTER tw OVER MECHANICALLY I oo 0 00 _ o 0 o PRIOR TO BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND (pipe length = 17'±) MODEL#Al801-4x22 (GAS COMPACTED BASE I 4 0 READY FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED BAFFLE ON BOTTOM) 8 5' (TYP) 4.0 3.55, 4 9' 3.55' WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 6" CRUSHED STONE 5 OUTLET DISTRIBUTION BOX 25 0' (TYP.) AND DESIGN ENGINEER. OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= V 12.0 < 37.33' COMPACTED BASE BASE. FIRST TWO FEET OF OUTLET Z42.40' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L DATUM OF 48.62' ESTABLISHED ON PROPOSED 1500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. A SPIKE SET IN U.P. 1093/2T. 2 - 500 GALLON CHAMBERS 5'MIN. CHAMBER END VIEW LENGTH 10.5 6 WIDTH 55. DEPTH 5�`8 CROSS SECTION VIEW 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE CHAMBER DETAILS THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE NOT TO SCALE NOT TO SCALE AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY NOT TO SCALE _ _ __- - _ DISCREPANCIES TO THE DESIGN ENGINEER. TEST PIT DATA 10 ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE a • a a , a * • STRUCTURES SHALL BE MADE WATERTIGHT. �i, ' r •� " • • ' * + a INSPECTOR: Donna Miorandi 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR \ ,, ,' a a • � • SOIL EVALUATOR: Michael Pimentel, E.LT. ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN / / � , • ' +� , • • * DATE: June 12, 2008 SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. MAP 170 MAP 170 • •r • `'"* ' ' ; TEST PIT#: 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOT 51 LOT 50 • , ,'f / ' • • r LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH • ELEV TOP= 48.00' CASE THEY SHALL WITHSTAND H-20 LOADING. / 1� �, LOCUS OC S � • • ' • • * • p ELEV WATER= <37.33' 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT DUST AND / g 1p20� / L v V v + * PERC RATE _ <2 MIN/IN FINES. ' co r` ` • ' •' . . • ' DEPTH OF PERC= 32"-50" 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND BRUSH &TREES- I •_ • * s r UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES PROPOSED 1500 GALLON SEPTIC TANK * • • TEXTURAL CLASS: 1 OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN / +r , r • _ COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN C14 / / *s • • •� ,;ra ACCORDANCE WITH 310 CMR 15.255(3). CV MAP 170 I � r * '++`# a • • • • 0" Loam Sand 48.00' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES C4 LOT 52 / / i ,i / / 1 a'rr �' �,• + a r A 4" 10Yr 3/1 FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. ., r • •* •r 47.67 16. PROPOSED PROJECT IS LOCATED WITHIN: EXISTING CESSPOOLS TO BE PUMPED AND • + . r •*r • ' Loamy Sand ASSESSORS MAP 170 PARCEL 53 B l� *• . • , f7j -'` FILLED WITH CLEAN, COARSE SAND (TYP) + - 10Yr 5/6 FEMA FLOOD ZONE C / �� •+ • �` , •a• 32" _ y 45.33' AS SHOWN ON COMMUNITY PANEL# 255001 0015 C NO ' !t � � t3 Perc =��= ' * • •• v oyJ / / / •, * i Ohl ISI"! s�, •, �• " 50" 43.83' 17. OWNER OF RECORD: GERTRUDE C. SHEEHAN+ • Hatc � • ` ADDRESS: 6 CHAPPAQUIDDICK ROAD PROPOSED DISTRIBU-ION BOX ' • 11 �'� ��/ O / (4) •• CENTERVILLE, MA 02362 Medium-Coarse Sand 18. PLAN REFERENCE: PLAN BOOK 224, PAGE 87 • (3 C 2.5Y 6/6 19. DEED REFERENCE: BOOK 1506, PAGE 745 (2) PROPOSED 2-500 GALLON LEACHING CHAMBERS � • • (5-10%Gravel) P r 20. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. Q� - -- 21. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY 1 CP _- = ROPOSED INSPECTION PORT FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. LOCUS PLAN 128" 37.33' 22. A 4"PERFORATED SCH.40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A BH TP 1 _ DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A / HC 1 \ 48.0 _ :` _ _- = o Standing, r Mottling serve REMOVABLE THREADED CAP SHALL B PLACED N TOP TO ALLOW FOR INSPECTIONS. O SCALE: 1" 1000' N St d�ng, Weeping, O M ttl�ng Observed E LACED O THE 4 DESIGN DATA TEST PIT DATA LEGEND \ INSPECTOR: EXISTING CONTOURS (6)s-_--- - Donna Miorandi -- ---- 50 -- ---- MAP 170 NUMBER OF BEDROOMS(DESIGN) 3 SOIL EVALUATOR: Michael Pimentel, E.I.T. LOT 54 DESIGN FLOW 110 GAUDAY/BEDROOM DATE: June 12, 2008 50 PROPOSED CONTOURS TOTAL DESIGN FLOW 330 GAUDAY TEST PIT#: 2 # l z 2 y \ \ � EXISTING / s"' \ � � - - . - - EXISTING WATERLINE 3-BEDROOM / \ i DESIGN FLOW X 200 % = 660 GAUDAY ELEV TOP= 48.20' y� \ I; DWELLING HC / \ -- -- -�. EXISTING OVERHEAD UTILITIES 4 �j TOF -48.2' ± ! USE PROPOSED 1500 GALLON SEPTIC TANK ELEV WATER= <37.53' EXISTING GASLINE PERC RATE 115roIQ / \ \ r i DEPTH OF PERC= ■ GARAGE �' � \ ■ TEST PIT LOCATION (SLAB) / \ TEXTURAL CLASS: 1 O/� oG�/f'Q ��F O� INSTALL 2 - 500 GALLON CHAMBERS _ O O o PROPOSED 1500 GALLON SEPTIC TANK O p� J \ \ r3 NG / J l \ SIDEWALL CAPACITY 0" 48.20' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE o O / /\ 3 3 ' \\ (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GPD A Loamy 10Yr 3/1 d ) ( ) (2' ) (0.74 GPD/S.F.) 109.5 GPD 4" 47.87' p PROPOSED DISTRIBUTION BOX APPROXIMATE LOCATION OF \ �� MAP 170 f7l � Loamy Sand WATERLINE; CONTRACTOR TO VERIFY---,,, BOTTOM CAPACITY B Q ? LOT 53 10Yr 5/6 PROPOSED 500 GALLON LEACHING CHAMBER I \ (LENGTH x WIDTH) (0.74 GPD/S.F.) = GPD 32" 2/ \ 15,575 S.F.± (25'x 12') (0.74 GPD/S.F.) = 222.0 GPD 45.53' \ C TOTALS: \ BIT. DRIVE \ NOTE: MAGNETIC MARKING TAPE SHALL BE PLACED / TOTAL NUMBER OF CHAMBERS 2 REV. DATE BY APP'D. DESCRIPTION ALONG THE TOP EDGES OF ALL SEPTIC SYSTEM ti o \ TOTAL LEACHING AREA 448.0 SQ.FT. Medium-Coarse Sand SEPTIC SYSTEM UPGRADE PLAN COMPONENTS. \ / I ^48`_ ,\ TOTAL LEACHING CAPACITY 331.5 GPD C 2.5Y 6/6 \ \ L_76 239 (5-10%Gravel) PREPARED FOR: / R_249 CAPEWIDE ENTERPRISES 40 SWING-TIES MEASUREMENTS LOCATED AT ti C? �� - - -- 128" 37.53' 6 CHAPPAQUIDDICK ROAD DESCRIPTION HC 1 HC2 \ 44,36, 4 1 CENTERVILLE, MA SEPTIC COVER IN (1) 33.6' 46.2' \ _ \8.55 ' _ No Standing, Weeping, Or Mottling Observed -� -- NAUSET LANE _ � - SEPTIC COVER OUT(2) 39.3' 39.8' � Benchmark RESERVED FOR BOARD OF HEALTH USE SCALE: 1 INCH = 10 FT. DATE: JUNE 18, 2008 3 Spike in U.P. 1093/2T (4y WIDE LAYOUT) 0 5 10 20 ao FEET CORNER STONE (3) 62.7' 33.3' Elev. =48.62 CORNER STONE(4) 74.6' 40.5' Approx. M.S.L. ` �°2� �oHN L. y° PREPARED BY: o CHURCHILL JC ENGINEERING INC. CORNER STONE(5) s1.8' 28.4' U LVIL 2854 CRANBERRY HIGHWAY No 41607 CORNER STONE(6) 71.1' 16.6' EAST WAREHAM, MA 02538 SITE PLAN 508.273.0377 SCALE: 1"= 10' Drawn By: BSM Designed By:MCP Checked By:JLC JOB No.1429