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HomeMy WebLinkAbout0034 COLLINS AVENUE - Health 34 COLLINS AVE. , CENTE,RVILI.E A = 190173 LOT 9 a — u aJ�IECYCfFOCop UPC 12534 ' HASTIN3i.YN Commonwealth of Massachusetts_ _-- Title 5 Official Inspection Form h — Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4\\ 34 COLLINS AVE Cr `�O - Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, Owner Owner's Name information is CEN_TERVILLE MA 02632 9/9/07 _ required for —.- - every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. i Important: A. General Information =° When filling out y forms the `r!�►' /„� computer, r,use 1. Inspector: only the tab key --y to move your Michael DeDecko =F --- cursor-do not Name of Inspector use the return i key. Compass Realty Develo ment Corparationi Company Name .r reb P.O. Box 2384 Company Address Mashpee Ma _ 0264_9 em City/Town State Zip Code 508 -221- 5003 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 M- 9/9/07 _.------- -------- 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. 34 COLLINS•08106 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts _- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 , 34 COLLINS AVE \ Property Address C/O DAVID HOLT_ , TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 9/9/07 - every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 34 COLLINS•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 � Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 COLLINS AVE Property Address C/O DAVID_HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 9/9/07 _ _____--._.___�__-___ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 34 COLLINS•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 COLLINS AVE Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 _ Owner Owner's Name information is required for CENTERVILLE MA 02632 9/9/07 - every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *" This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/Z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 34 COLLINS•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^ 34 COLLINS AVE _ Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is CENTERVILLE MA 02632 9/9/07 required for — every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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. 34 COLLINS•013106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts -- -- -_ Title 5 Official Inspection Form �R Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 't 34 COLLINS AVE Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 9/9/07 — every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of ❑ ® this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® El 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)] 34 COLLINS-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts -_-_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 COLLINS AVE — — Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 _ Owner Owner's Name information is CENTERVILLE MA 02632 9/9/07 _— required for every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 0 Number of current residents: -- Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): N/A— Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): — --- Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: — --- Last date of occupancy/use: Date Other(describe): — 34 COLLINS-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System"Page 7 of 15 Commonwealth of Massachusetts _ Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 COLLINS AVE Property Address C/O DA_VID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is required for -__CENTERVILLE MA 02632 9/9/07 -- -- --- every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: N/A - - ---------- Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 34 COLLINS•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 34 COLLINS AVE — Property Address _C/O D_A_VID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is required for CE_N_TERVILLE MA 02632 9/9/07 — -- — ------- — every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): JOINTS TIGHT,YES VENTED,NO LEAKAGE. Septic Tank (locate on site plan): 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 ---------------------------------------------------------------------------------------------------- 1500 GAL. Dimensions: Sludge depth: — Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 11" _ Distance from top of scum to top of outlet tee or baffle 14" _ Distance from bottom of scum to bottom of outlet tee or baffle MEASURED _ How were dimensions determined? 34 COLLINS•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 COLLINS AVE Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUT_H RD, MA, 02632 _ Owner Owner's Name information is required for CENTERVILLE MA 02632 9/9/07 _ _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): NO NEED TO PUMP, TEE'S INTACT,STRUCTALLY SOUND, LIQUID LEVEL EQUAL WITH OUTLET INVERT, NO 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 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): 34 COLLINS-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Com monwealth of Massachusetts f4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - /a - - --- ----- 34 COLLINS AVE Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 9/9/07 — _— — - --------- every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: ---"— Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert EQUAL WITH 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 IS LEVEL AND DISTRIBUTION EQUAL, NO SOLID CARRYOVER, NO.LEAKAGE_ Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 34 COLLINS•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 COLLINS AVE -- - Property Address C/O DAVID HO_LT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 9/9/07 _ ---- - - every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: -- - ® leaching chambers number: 3 ❑ 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.): SOIL-GRAVEL/SAND, NO SIGNS OF HYDRAULIC FAILURE, PONDING- DRY,NO DAMP SOIL, VEGETATION - NORMAL. 34 COLLINS•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts -- = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 COLLINS AVE Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is required for _CENTERVILLE MA 02632 9/9/07 - -- every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration - - -- -- Depth -top of liquid to inlet invert --- --- Depth of solids layer --- --- — Depth of scum layer ------- Dimensions of cesspool ---- - Materials of construction --- - Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: -- -- ---- Dimensions - Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 34 COLLINS•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form IT - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l� 34 COLLINS AVE -- Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is CENTERVILLE MA 02632 9/9/07 required for - — --- every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. G Z a V-=- L\ bill �� t 3:, U2- 3 52 63� 3 34 COLLINS"08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts _ Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 COLLINS AVE --------------- Property Address C/O DAVID HOLT, TODAY REAL ESTATE,1533 FALMOUTH RD, MA, 02632 Owner Owner's Name information is CE_NTERVILLE MA 02632 9/9/07 required for every page. City/Town Satet Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 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: USGS ELEVATION LOOK UP You must describe how you established the high ground water elevation: USGS TOPO MAP - - 34 COLLINS•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 DATE : 3/13/0 APR 2 7 Z003 PROPERTY ADDRESS34 Collins Ave TOWN OF BAR_ T. HEALTH DE T. ABLE _ Centerville,Mass. ---------- ------------ ice•-/77j 02632 ------------------------ On the above date, I inspected the septic system at the above address, This system consists of the following: 1 . 1 -1500 gallon septic tank. 2. 1 -Distribution box. FAILED-INSPECTION 3. 2-500 gallon leaching chambers. ( 24 'X13 'X2 ' ) Based on my inspection, I certify the following conditions: 4 . This is a septic system. ( 95 Cdde ) 5 . The septic system is in hydraulic failure. 6. A new leaching area needs to be installed. 7 . There is heavy 'water useage here.They use over 500 gallons per day.The system in stalled in 2000 is for a three bedroom. Which is 330 gallons per day. Present useage is 200 gallons per day over 33 . House is in need of a largerleaching area.Water being se t �timequals a five bedroom design. SIG N ATUR _ This is the reason why the septic system gone into hydraulic failure. Name : _ J ._ P . _Macomber_Jr . ---- \ ;/Company :19aP- h'_pJ_ M_�94mt t 8_ Son, Inc . A00rdss : aQ;i A6 -------- - __C-12-nS2rY_iLLe,_Da::_Q.2-632-0066 Pn one : _-508- 775_ 3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks•Cesspools•Leachf lelds Pumped & Installed Town Sewer Connections P.0 Box 66 Centerville, MA 02632.0066 775-3338 775.6412 COMMONWEALTH OF MASSACHUSETTS = EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION i TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 34 Collins Ave Centerville,Mass. Owner's Name:Barbara Benoit Owner's Address: 16ifiaRol ling ng Hitch Road 32 Date of Inspection:3 1 3 03 Name of Inspector: (please print) Jose .Macomber Jr. Company Name: J.P.Macomber & Son Inc. Mailing Address: Box 66 Centervi1le,Mass. 02632 Telephone Number: rnp-7771718 CERTIFICATION STATEMENT 1 certify that 1 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 traiping 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 eeds Further Evaluation by the Local Approving Authority ails Inspector's Signature: Date: �. "!3✓7 The system inspector shall Lit 77pyof this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different, conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address34 Collins Ave Centervi e, ass. Owner: Rarhara Benoit Date of inspection: .1 1 -f 01 Inspection Summary: Check A,B,C,D or E/ALWA_yS complete all of Section D A. System Passesk� I have not found any information which indicates that any of the failure criteria described in 310 ChJR 15.303 or in 10 C`FIff'I5.304 exist. Any failure criteria not evaluated are indicated below. Comments: The leaching area is in hydraulic failure. A new leaching area nees to be ins a e Heavy wa er useagehe cause of the system failure.System is designe or per day. J.h gashas been using over 500 gallons per day. One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined(Y,N,ND) in the for the following statemen explain. Es. If"not determined"please 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 existi4 tank is replaced with a complying septic tank as approved by the Board of Health. 'A meal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: XIAO 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, sertled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: Nb The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I 1 OFFICIAL INSPECTION FORM • NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 34 Collins Ave C n rvi11P'MasG _ Owoer: Barbara Benoit Date of lospectioo: 3/1 3/03 C. Further Evaluatioo is Required by the Board of Health: ,0 Conditions exist which require Nnher evaluation by the Board of Health in order to determine if the system , is fa,ltng to protect public health, safety or-the environment. I. S,,stem will pass unless Board of Health determloes In accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a maooer wblch will protect public bealib, safety and the environment: Nb Cesspool or privy is within SO feet of a surface water Cesspool or privy is within SO feet of a bordering vegetated wetland or a salt marsh 01 2. S,,stem will fail unless the Board of Health (and Public Water Supplier, if any)determines that the s,,stem is functioning in a manner that protects the public health, safety and environment: ,t10 The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or rributary to a surface water supply. ,jk The system has a septic tank and SAS and the SAS is within a Zone I ore public water supply �.26 The system has a septic tank and SAS and the SAS is within 50 feet ore private water supply well. The system has a septic tank and SAS and the SAS is less than 10Q feet but 0 feet or more from a private eater supple well'' Method used to determine distance 'This system passes if the well water analysis,performed at a DEP certified laboratory, for eoliform bacteria and volatile organic compounds indicates that the well is bee from pollution from that facility and the presence of ammonia nitrogen and nirrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are rriggered. A copy of the analysis must be anaehed to this form. 3. Other: 3 Page 4 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 34 Collins Ave Centerville,Mass. Owner:Rarbara Benoit Date of Inspection: 'i 1 1/p D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yeses No ackup 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 v _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 'e-3-M,f � v��xI 1t ?I _ iquid depth in cesspeel is less than 6"below invert or available volume is less than h day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number / of times pumped i �pc� 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. d�,Any portion of a cesspool or privy is within a Zone 1 of a public well. _ s/Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] e-� (Yes/No)The system fails. 1 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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no e system is within 400 feet of a surface drinking water supply 4 he system is within 200 feet of a tributary to a surface drinking water supply � he system is located in a nitrogen sensitive area(I.nterim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department: 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 34 Collins Ave Centerville,Mass. Owner:Barbara Benoit Date of Inspection: 3/1 3/0 3 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? Z—! H 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,19kluding the SAS, located on site? Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no r/ Existing information.For example, a plan at the Board of Health. 6/ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)J 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 34 Collins Ave Centerville,Mass. Owner:Barbara Benoit Benoit Date of Inspection: 3/1 3/0 3 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_ Number of bedrooms(actual): J DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Ve Is laundry on a separate sewage system (yes or no): ,e& [if yes separate inspection required) Laundry system inspected(yes or no): Seasonal use: (yes or no):N� Water meter readings, if available(last 2 years usage(gpd)):2 0 01 -21 4, 0 0 0 ga 1 Ions=5 8 6. 31 G P D Sump pump(yes or no):A)C' 2002-193, 000 gallons=528. 77=GPD Last date of occupancy: a Present system is designed to handle T 330 gallons per day. ( 3 Bedrooms) COMMERCIAL/INDUSTRIAL This house has a very large water Type of establishment: -04 useage.This is probably why the Design flow(based on 310 CMR 15.203): gpd system has failed. in such a Basis of design flow(seats/persons/sgft,etc.): IVO short time. r Grease trap present(yes or no):/ i Industrial waste holding tank present(yes or no);if/,!I Non-sanitary waste discharged to the Title 5 system(yes or no):'em Water meter readings, if available: Last date of occupancy/use: 4)X OTHER(describe): GENERAL INFORMATION Pumping Records Source of in formation: Pumped at time of inspection. Was system pumped as part of the inspection(yes or no):�� If yes, volume pumped: /d gallons--How was quantity pumped determined? �i4Sr Reason for pumping: System filled to capacity. TY,POF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool 4)4 Overflow cesspool N� Privy lVe Shared system(yes or no)(if yes,attach previous inspection records, if any) 11V Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 4e Tight tank ,6# Attach a copy of the DEP approval 4 Other(describe): ,tO Appr ximate aye of all components,date inst fled(if own'and sour of information: ��.s 714 �s� — .4 Were sewage odors detected when arriving at the site(yes or no):'do 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 Collins Ave Centerville,Mass . Owner-Barbara Benoit Date of Inspection: 3/13/03 BUILDING SEWER(locate on site plan) Depth below grade: -7 W Materials of construction: cast iron 240 PVCVh other(explain): .r-bd- Distance from private water supply well or suction line: 0".- Comments(on condition of joints, venting,evidence of leakage, etc.): Joints appear tight No evidence of leakage The system is vented through the house vents. SEPTIC TANK: locate on site plan) Depth below grade: AIA Material of construction:,e4concretex,//ImetalAOfiberglass.t/4polyethylene ,�<4ther(explain) AAA If tank is metal list age: tO Is age confirmed by a Certificate of Compliance(yes or no):,&(attach a copy of certificate) Dimensions:/eXN 6-1149, !•j�F"U, , Sludge depth: l Distance from top of sludlge to bottom of outlet tee or baffle: Al Scum thickness: le' Distance from top of scum to top of outlet tee or baffle: ` Distance from bottom of scum to bottom of outlet tee or baffle: eC How were dimensions determined:11� 9u✓ 'c� Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of.leakage,etc.): Qnr•e is nperra(JPA /Ptimn t-hP c;Ppti c- tank Pver)z 1 )zPar- Lnl et k mill et tees are Ni n nl act The czez)tic tank is stri ri-iira 1 ly sound and shows no evidence of leakage.The liquid level at the oG$VA� T�t�N�l L14lo is on site plan) Depth below grade: Material of construction:d&4 concrete jametal,U4 fiberglassepolyethyleneAO other (explain): AA Dimensions: AJ4 Scum thickness: 1�014 Distance from top of scum to top of outlet tee or baffle: 4,0 Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping:_ J4 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Grea-se trap is—not present 7 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 Collins Ave Cente Owner: Barbara Benoit Mass. Date of Inspection: ' TIGHT or HOLDING TANK4AZL(tank must be pumped at time of inspect ion)(locate on site plan) Depth below grade: Material of construction: eA_concrete 11A metal d4 fiberglass polyethylene&0other(explain): Dimensions: Capacity: A2,4 gallons Design Flow: -4111 gallons/day Alarm present(yes or no):_,V,4 Alarm level: e,4 Alarm in working order(yes or no);/(>i� Date of last pumping: AIN Comments(condition of alarm and float switches,etc.): Sight or holding tanks are not present DISTRIBUTION BOX:_Z(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Cis Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box has one lateral.There is evidence of solids carry ny�rN_Pvi r1PncP of leakage i ntn nr ntit of the bnx R _j�1 aced broken box cover. PUMP CHAMBE ,(locate on site plan) Pumps in working order(yes or no): 10 Alarms in working order(yes or no): �l%'.� Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Pump chamber is not present. 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: _34 Collins Ave rpntPrvi l iel maGG , Owner: _Barbara Benoit Date of Inspection:I/1 1/n i SOIL ABSORPTION SYSTEM (SAS): Zlocate on site plan,excavation not required) 2-900 n 1pachinu rhambPrc ( 24 ' X1 1X L1 ChPmhinrz Prim in d auotlloicate d s failur explain w�y:System installed 7/12/00 ( Early failure) 1ySArS n T,r)natPrl! SPP naQP 10 Type leaching pits, number: 0 S leaching chambers, number:/(& dAAN1k(llwg oft/ly4X"? , P leaching galleries,number:_0 leaching trenches,number, length: O ,47b leaching fields,number,dimensions: .Ub overflow cesspool, number: 0 ,-2p innovative/alternative system Type/name of technology: ""i'e Gv� Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): T.namy Gana to medium Gang mho leaching are is in hydraulic f�l_1 nrP GlactP avatar nvcr the invert pi pe Soils are damp Vegetation is normal. A new leaching area needs to be installed. Check so ' 1 conditions and put in a larger system. 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: A Depth of scum layer: Dimensions of cesspool: A Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): CPS—Pools are not present PRIVY���(locate on site plan) Materials of construction: Dimensions: A�,9 Depth of solids: _ W2,�i Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): _Privy is not nrespnt _ 9 Page 10 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 Collins Ave Centerville,Mass . Owner:Barhara Benr)i t Date of Inspection: -1 f 1 3_/0 3__ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Q,,/3 ox. L-i:!7j 10 r , r No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Migpogal *psstem Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) E)Complete System O Individual Components Location Address or Lot No. 3 ��T Owner's Name,Address and Tel.No. MT Assessor's Map/Parcel D - L0 3C Installer's Name,Address,and Tel.No. 13 RI AYorTL- Designer's Name,Address and Tel.No. ao 7RE�70P u& mr�c5 0- Type of Building: Dwelling No. of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Z?D gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank_456- a Type of S.A.S. a- W Z e6-5'k WS Description of Soil 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 Env' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i ed b s Boazd eal Signed 0 Date ' Application Approved by Date Application Disapproved fo a following reasons Permit No Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE that On-site Sewage Disposal System Constructed ( ) Repaired ( v) / ' Upgraded ( ) ;'/ O E Aban d ( )by 77 at � C01-47//5 G- constructed in accordance with the proviSi�,I} /�e and he for Disposal System Construction Permit No dated Installer ,1[, f/Si Designer The issuan this etmit shall n ed s a guarantee that the it on s g Date Inspector ------------- No. ---� ---------------- Fee ,� Tut= Pn0ARAnA1WRA1 TN nG MACCArHIIRFTTS TOWN OF BARNSTABLE LOCATION 3�- L4(-GTN5 Qb16. SEWAGE # q-0-6 VILLAGE ASSESSOR'S MAP &LOT INSTALLER'S NANM &PHONE NO. AkZW ,4c10 )?F �4aO—q-S4A SEPTIC TANK CAPACITY 1 S00 LEACHING FACM=: (type)-a-5-00 L�4y e/ t ) 13 • NO. OF BEDROOMS BUILDER OR 0 F�T AO�iAP0. 1 PERMITDATE: f COMPLIANCE DATE: Separation Distance etween the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by FTT Xn9IG • � U6i99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERNn-r riI'I'HOUT DESIGYED PLAYS) _1�`tC1J1�1Y�1 �orr� hereby certify that the application for disposal wo rks orl.s construction permit siped by me dated -30 Da conclrnunsz the property located at --�'�� �� � meets all of the following criteria: { �• The failed system is coane^ed to a residential dwelling only. T'ne:e are no commercial or business uses associated with the dwelling. V The soil is classified as CLASS I and the pe.coladon rate is less than or equal to 5 minutes per inch. v There are no wetlands within 100 feet of the orowsed septic system If- T'nerc are no private wets within 150 feet of the proposed septic system v There is no increase in flow and/or change in Use oroposed V. There are no variances regueaced or needed. V• The bottom of the proposed leaching facility will not be located less than Five fee;above the tna durum adjusted groundwater table elcvadon. (Adjust the groundwater table using the Frimotor method when applicablel V• If the S.A.S. will be located with '_50 feet of any ve;etated -eslands. the bottom of the proposed leaching facility will not be loca(ed less than oureen(I,,) feet above the minimum adjusted ;ourtdwate.table 'Ie•/auon, Please complete the followiaa: A) Too of Ground Surface _levaaon(us-no GIS inrormadon) B) G.W. Elevation -the High G.W. Adjustment . D(F'cRENCE B A and 3 SIGN-ED : DATE. -Cao (Si:e:ch proposed plan of svrem pn bacic�. 8� a:ti�u,(bider zzn Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:34 Collins Ave Centerville,Mass . Owner: Barbara Benoit Date of Inspection: 3/1 3/0 3 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 3A feet Please indicate(check)all methods used to determine the high ground water elevation: =Obtained from system design plans on record-If checked,date of design plan reviewed:3/13/0 3 YES Observed site(abutting property/observation hole within 150 feet of SAS) T ye ,5Checked with local Board of Health-explain:Picked up as built card. (copy) UCL Checked with local excavators, installers-(attach documentation) yFSAccessed USGS database-explain: http: //town.barnstable.ma.us. You must describe how you established the high ground water elevation: Used: GahQrty & Miller Model 12/16/94 Ground water elevations above sea level . Used: USrS-Qhcarvaf-inn wal l data Tune 1 997 Used: USGS. -Te,.t,.,; hlletin 92 000 1 Plate 09 January 1992 Anni,al ranges elevations . Lr 7 ;eet Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the botto of the leaching pit and the adjusted groundwater table is feet. 11 , >•rrnr+.—n.•rrr-•n— rnr mr•nsPrrrnn rs.rmm:-.•t-+••+Tr1TRs*rrAssrn`Y 1Ta'7rrartlT �' TOWN OF Barnstable BOARD OF HEALTH 1 SUDSHFACF SEWWAGF DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I -TYPE OR PRINT CI.EARLI'- PROPERTY INSPECTED STREET ADDRESS 34 Collins Ave Centerville,Mass. ' ASSESSORS MAP, BLOCK AND PARCEL # �l�d✓l✓� OWNER' s NAME Barbara Benoit PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J P Macomber & Soa Inc?'.` COMPANY ADDRESSBox 66 Centerville Mass. 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 -1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and omplete as of the time of ,inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. :� System FAILED* The inspection wtlicli I have con tcted has found that the system fails to Protect the ptiblic health and the environment in accordance with Title .5 , 310 CMR 15 , 303 , and _as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature 1 'd - Date a(re copy of this c tification must be provided to the OWNER, the BUYER here applicable ) and the BOARD OF HBALTit. * If the inspection FAILED, the owner or"" perator shall u pgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 C�JR 16 . 305 . partd .doc T No. C) ^� Fee 5 0. 0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1Z Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYication for ;igpozar 6pgtem Conotruction Permit Application for a Permit to Construct( )RepairXXXUpgrade( )Abandon( ) D Complete System ❑Individual Components Location Address or Lot No.3 4 Collins Ave Owner's Name,Address and Tel.No. David Benoit Centerville,Mass.02632 166 Rolloing Hitch Road Assessor'sMap/Parcel lip -i73 Centerville Mass. 02632 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—2 7 3-0 3 7 7 J.P.Macomber & Son inc. JC,Engineering Inc. 5 Round Hill BL D Box 66 Centerville,Mass'.'02632 East. Wareham,Mass. 02538 Type of Building: Dwelling XXNo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons. Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title ' Size of Septic Tank Existing 1 500 Type of S.A.S. Existing 2-500 ' s Description of Soil Loamy sand to sandy loam to medium fine sand Nature of Repairs or Alterations(Answer when applicable) Add in g 3—5 0 0 gallon leaching chambers to the existing septic system. ( 33. 51x131X21 ) Date last inspected: y 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 nvironmental Code nd not to place the system in operation until a Certifi- cate of Compliance has been iss ed by this oar Signed Date 4/2 4/03 10 Application Approved MI 2 S Date , U Application Disapproved for the following reasons ------ Permit No. �>xo 3 — 7,6 Date Issued % d3 Fee 50.00 / ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ ; Yes ' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS rication for 30ig ozal .5tem Construction Permit Application fora Permit to Construct( )Repair'((X)(Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.3 4 Collins Ave Owner's Name,Address and Tel.No. David 13e no i t Centerville,Mass.02632 166 Rolloing Hitch Road Assessor's Map/Pareel 0 2 6 3 2 1-73 Centerville,Mass. Installer's Name,Address,and ITel. No. 5 0 8-7 7 5.13338 Designer's Name,Address and Tel.No. 5 0 8—2 7 3—0 3 7 7 J.PMacomber�� & Son inc. JC,Engineering Inc. 5 .Round Hill BL7D --Box 66 Centerville,Mass.02632 East Wareham,Mass.02538 Type of Building: Dwelling XXNo.of Bedrooms 3 Lot Size r: .,r.' sq.ft. Garbage Grinder( ) Other\ Type of Building No.of Persons 1 , Showers( ) Cafeteria'( ) Other Fixtures Design Flow 1 gallons per day. Calculated daily flow gallons. Plan`Date Number of sheets Revision Date ` ' Title Size of Septic Tank Eg:tj;tin 1 500 ---Type of S.A.S. Existing 2-5.00's yr Description of Soil LOamy sand to sandy login to medium fine sand 1 Nature of Repairs or Alterations(Answer when applicable) Adding 3—5 0 0 cra1lon leach inq chambers to the existing septic system. (.33.5'X13'X2' ) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system ,1\ in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by this Poar, If ea h. Signed Date 4/2 4//0 3 Application Approved b t j, 2,f- Date lb �Y/a 3 Application Disapproved for the following reasons Permit No. )-V o Date Issued' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired Upgraded( ) Abandoned--(---.-)by J.P.Macomber & Son Inc. at 34 Collins Ave Centerville,Mass. has been constructed ' accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ;�00 ?-1 6 dated t/ Installer J.P.Macomber & Son Inc. Designer JC,Engineering INC The issuance of thi permit all not be construed as a guarantee that th sys tin tion as designed. Date t1/ -P''/e "i Inspector No. Uo -3-/7f, Fee$50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC_HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS 'if;pogar *p5tem ConotructionPermit Permission is hereby granted to Construct( )Repair(XX)Up rade( )Abandon( ) Systemlocatedat 34 Collins Ave Centervilfe,Mass. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thi ` rmit. J S. Date: t/ !,�'/��i' Approved"by , �` / ` f •TWw1 OF BARNSTABLE LOCATION 3 �. G Q I N j V d SEWAGE #X Q®3 ' 74� VELLAGE C eAl-re A I L L 62 ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. J , 44.4 C 0/'1 SEPTIC TANK CAPACITY l �'o LEACHING FACILITY: (type) " /)R Y UJ&/_L (size) NO.OF BEDROOMS BUILDER OR OWNER P£RMITDATE. COMPLIANCE DATE: i Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility. Feet Private Water S.upply"Well and Leaching Facility (If any wells exist on site or within:200 feet of leaching facility) Feet Edge of Wetland:aid Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i i ` . \ 9 TOWN OF BARNSTABLE I:oCr�►1 o 3 4 C Q� �IAI S' A Lf SEWAGE #�o 02 " /y 70 VILLAGE C e Al-re A VIZ ASSESSOR'S MAP & LOT r INSTALLER'S NAME&PHONE NO._J ' If AM A C O A 8, 0,0C s' a Al SEPTIC TANK CAPACITY SCJ O LEACHING FACILITY: (type) -3 W&I Z (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE _: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland:and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r Town of Barnstable ptHE 1°� Regulatory Services anruvsrnare Thomas F. Geiler, Director 9$A �9 •0� Public Health Division rED Mph A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. No. �r//��(vv�l»�q�• Fee�— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprtcation for Migpogar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. [. Owner's Name,Address and Tel.No. 7-j ,5 Assessor's Map/Parcel MT 0'"fi4q D - Co Installer's Name,Address,and Tel.No. �i2f�hi 1911a•'r6— Designer's Name,Address and Tel.No. alO TR64VP CK mh&Jn� m la Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ►cam 7 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank_ �(o Type of S.A.S. Q-N22 O9' Description of Soil 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 Env' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has bejen )ed by s Board ealt Signe Date (5 �' Application Approved by Date Application Disapproved a following reasons Permit No f Date Issued �� may` ,J -.�,.._- _._. _• �/� � . ��� .� ,. .. _.. No. '.,� �" Fee �Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC-HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for ]Dtopo$al *p$tem Congtructton Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 Own s t rnAO s��ncj �.No. 5 — Assessor's Map/Parcel Installer's Name,Address,and Tel.No. 19 Designer's Name,Address and Tel.No. ao Tt�ECwP Glut Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow DO gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank .�6o Type of S.A.S. e G// Description of Soil 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 e in accordance with the provisions of Title 5 of the Env' onmei ,Code and not to place the system in operation until a Certifi- cate of Compliance has been ' ed bis Boaz eal Si ned Q o � g Date 6'-�� y Application Approved by / ® Date 01 Application Disapproved for the following reasons Permit No4 Date Issued Xllu ------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE /Y�that a On-site Sewage Disposal System Constructed( )Repaired( U)Upgraded( ) Aban n�e``d( )by %J�rYd�C at LG constructed in accordance with the prov ns Title and the for Disposal System Construction Permit No dated r Installer /�21' T7G Designer The issuan - o this ermit shall no�yonstrue I � d_s a guarantee that the s sfp di unct'•on a ,fles'gned.Date 1'h 00 Inspector 1 V � — ———— '———————————————————————————— No. " Fee l 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS �Digozal *pgtem Con6truction Permit Permission is hereby ted to Construct( Repair(k/ deg )A a System located at COLGIr/5G� and as described in the above Application for Disposal System Construction Permit. The applicant recognizes`his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction u5t c plete ithin three years of the date of t ' pe Date: Approved by 0 r 1i6i99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH A-ND APPLICATION FORA DISPOSAL WORKS CONSTRUCTION PEPN[IT (WITHOUT DESIGNED PLANS) L BRFA II VOTTK- hereby c-rufy that the application for disposal Works construction permit signed by me dated !!�-3o o— concertina the property located at ®/l 66 meets all of the following criteria: �• The failed system is connected to a residential dwellina only. There are no commercial or business uses associated with the dwelling. - V• The soil is classified as CUSS I and the percolation rate is less than or equal co 5 minutes per inch. ill• Tizere are no wetlands within 100 feet of the proposed septic sysem �• There are no private wells within 1:0 feet of the proposed septic s✓ste n v There is no increase in flow and/or change in use proposed �• There are no variances requested or needed_ v i fie bonotn of the proposed leaching faclity•xill not be located less than five feet above the ma..amum adjusted groundwater table elevation. (?adjust the groundwater table usina the rrimntor method when applicable] �• if the S.A.S. will be located wi[h 2-50 f--t of anv vegetated wetlands. the bouorn of the proposed leaching facility will net be located less than foureen(14) fee;above the ma.-cimum adjured z-oundwater table e1e•/adon, Please complete the following: A) Too of Ground Surface (using GIS information) B) G.W. Elevation _the'vL-a:(. =:igh G.W. a.djus,,tnent DCT:E-RENCE 8ET WEE- ,'A and 3 I SIGNED : DATE: (Sketch proposed plan of s✓stein on backj. q:i= h ioldcr..ct . '; q BACK /500 4� ® ® CS 0 0 -�OG G/IGGdh/L "?,<14 C-1-14A �y eS TOWN OF BA.RNSTA.BLE LOCATION 3�- C.©L XN5 .,qU6• SEWAGE # I VILLAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. Ak0:/q Aclo—ZFF 'LZO—4-54�42 SEPTIC TANK CAPACITY /. 0 LEACHING FACILITY: (type).;L' NO. OF BEDROOMS BUILDER OR OWNERPSToN PERMITDATE: COMPLIANCE DATE: Separation Distance etween the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i w ! d �/ Off.. TOWN OF BARNSTABLE E° e L-.' -A nON 3tl- eouxht5 Ay6-. SEWAGE # '7Q�' VILLAGE (Z--&7'6VrL.Z& ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. A PMLA,45/tai-27F %20-45'46-9 SEPTIC TANK CAPACITY f�o� LEACHING FACILITY: (type) NO.OF BEDROOMS 3 f. r BUILDER OR 0 � ® " PERMTTDATE: COMPLIANCE DATE: Separation Distance etween the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by, f f ' ax P Liu¢ is �cr- 'sT F 5" DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS = 49.00' - 50.00' GENERAL NOTES TOP OF FOUNDATION = 54.22� REMOVABLE COVER SLOPE @ 2% MIN. OVER SYSTEM 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION 4" SCHEDULE 40 PVC MIN SLOPE 1% 3/4" TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE FINISH GRADE OVER D-BOX= 49.5 � FINISH GRADE @ FND. EL.= 51 .72 FINISH GRADE OVER TANK EL.= 50.15 2" OF 1/8" TO 1/2" DOUBLE WASHED STONE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD - OF HEALTH AND THE DESIGN ENGINEER. 20" MIN. ACCESS COVER TOP OF SAS= 47.08' TO 6" OPLACE RFISERS FINISHON ALL CHAMBERS FINISHED GRADE 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL (TYPICAL FOR 3) 36"MAX. 9" MIN. BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. EXISTING 4" //f _ 46.251 36" MAX. BREAKOUT EL = 46.75' PIPE _ � �� _ \ 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN 2" DROP MIN. '� PROVIDE WATERTIGHT ELEVATION = 46.75' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS 6"� 3" 3" DROP MAX. 3„ 9„ TJOINTS (TYP.) A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 00 0000 000 000 �� , PVC IN o O oo I THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 0 14" �. 47.30 SEPTIC TANK FROM 4' PVC OUT TO o O o0CD 00 00 5. SLOPE ALL SOLID PIPE AT 1.0 % MINIMUM. o 0 1 LEACHING FACILITY 000 i 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. + �� + 2� oo � � � � � � � � � o0 0 � � � � � oo j 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN 12" J OUTLET TEE 46.67 MIN. j 46.50 I SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT TO CONTRACTOR TO VERIFY 48 ? o o oo BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH. CONDITION OF EXISTING TEES GAS BAFFLE n '- �-_..-- �`--_._, __..� 0 6" CRUSHED STONE o 0 00 0 14.6' z5�OVER MECHANICALLY o 0 8. ELEVATIONS BASED ON ASSUMED DATUM OF 50.00' MSL OBTAINED AND SIZE OF TANK COMPACTED BASE 4' 8 5' - 4' 4, FROM NAIL IN TREE AS SHOWN ON PLAN. 4' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION 5 OUTLET DISTRIBUTION BOX 33.5' (TYP.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE TO BE INSTALLED ON A LEVEL STABLE < ' - AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY BASE. FIRST TWO FEET OF OUTLET 44.25' GROUND WATER ELEV.= 38.59 12.9' DISCREPANCIES TO THE DESIGN ENGINEER. EXISTING 1000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 3 - 500 GAL. CHAMBERS 5' MIN. 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE LENGTH 8'6" WIDTH 4'10" DEPTH 5'7" CROSS SECTION VIEW STRUCTURES SHALL BE MADE WATERTIGHT. SEPTIC TANK PROFILE DISTRIiU� l I ON X DETAIL TYPICAL CHAMBER PROFILE CHAMBER DETAILS CHAMBER END VIEW 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR NOT TO SCALE NOT TO SCALE NOT TO SCALE ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS TEST PIT DATA LOCATED UNDER PAVEMENT. DRIVES OR TRAVELED WAYS IN WHICH CASE .. r THEY SHALL WITHSTAND H-20 LOADING. INSPECTOR: 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT. DUST AND f"1a f ,k,. � w w p • SOIL EVALUATOR: Samuel Philos Jensen FINES. " .. DATE: April 22, 2003 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF ago � 1 i rFf TEST PIT#: 1 LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN ELEV TOP = 49.59' COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN U, * fir= )}'€�� „t ACCORDANCE WITH 310 CMR 15.255(3). � � ELEV WATER = >1 V BGS CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN "S PERC RATE _ < 2Min/In SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. �i ,' DEPTH OF PERC = 45"-63" 16. PROPOSED PROJECT IS LOCATED WITHIN. '� 91b ���� Aft � � a ` TEXTURAL CLASS: 1 ASSESSORS MAP 190 PARCEL 173 17. OWNER OF RECORD: BARBARA A. BENOIT 4' 49 59' ADDRESS: 166 ROLLING HITCH ROAD a,? „ � � �. �' 'q� , ' �. 0 FILL CENTERVILLE, MA02632 14" 18. PLAN REFERENCE: w co „ yam 48.42' w MAP 211 ' ��4 r Sandy Loam 1. PLAN ENTITLED " PLAN OF LOTS IN CENTERVILLE, BARNSTABLE COUNTY, BELONGING TO ;W � d B 10YR 6/8 CHESTER C. WILCOX, SCALE 1 INCH= 50 FEET, MARCH 19, 1957, NELSON, BEARSE, PARCEL 034 r" �� � i� � 3 �� O 00 MAP 191 (� + r `''" Fn '' 5-10% Gravel RICHARD LAW, SURVEYORS", LOCATED IN BARNSTABLE COUNTY PLAN BOOK 137 PAGE 89. PARCEL039 °44'35'E 4f Tom' C-1 Loamy Coarse N8 � � rf rt' "tat • - ¢ �� r,,m. »� Sand 19. DEED REFERENCE: 112.00' , r "� .,� +,� � fr 45" o 0 45.84' E 1. BOOK 13159 PAGE 254 EXISTING CHAMBER , ,,-FF� . �� 10/0-20/o j �% WNW d ' SFr �, { -�" TO BE PUMPED AND FILLED Perc Gravel and w-- ,., n 20. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. auk - 4r v n� w.._ ' w ,br �f _,. 63" �9 Cobbles . � v � �� xr �f 44.34' _ , �' �fd � 21. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLYWITH CLEAN SAND 30" PINE ��.y � � , �.<: 10YR 5/4 { FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY 12• I. 1s` FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. PROPOSED O O B.M. ` 41.5 Nail In Tree �� � �, �?d% M-C Sand DISTRIBUTION BOX p _ TP >-- I IN Elev. - 50.00' ,., �„ # - �__ Assumed 5-10% Gravel PROPOSED 3-500 GALLON w _ LEACHING CHAMBERS O NO GROUNDWATER ` EXISTING 1000-GALLON LOCUS PLAN 132" 38.59' SEPTIC TANK P _-- SCALE: 1" = 1000' DECK MAP 210 16.0' z �24.2, 9 0 PARCEL 007 N - #34 _ . m DESIGN DATA �^+ „.- EXISTING c. , LEGEND 00 MAP 190 a 3-BEDROOM DWELLING x 50 EXISTING SPOT GRADES "S MAP 190 PARCEL 086 bp "YY �. 50 EXISTING CONTOUR PARCEL 173 TOF = 54.22' 12,768 ± SQ.FT. NUMBER OF BEDROOMS (ASSESSORS) 3 50 PROPOSED SPOT GRADES NUMBER OF BEDROOMS (DESIGN) 4 �50 PROPOSED CONTOUR •;xt t t �� ..� NUMBER OF PERSONS 5 DESIGN FLOW 110 GAL/DAY/BEDROOM E/T/C ---- EXISTING ELECTRICAL UTILITIES ! TOTAL DESIGN FLOW 440 GAL/DAY GAS EXISTING GAS LINE DESIGN FLOW X 200 % = 880 GAL/DAY i � 1 ......-...---w-_-.. w .._-_.............. EXISTING WATER LINE USE EXISTING 1000 GALLON SEPTIC TANK _ � I` S84°44'35"W TEST PIT LOCATION INSTALL 3- 500 GAL. CHAMBERS 112.00' I. _ (� EXISTING 1000 GALLON SEPTIC TANK SIDEWALL CAPACITY EDGE OF PAVEMENT - ���� - SCHEDULE 40 PVC PIPE V (L+W) (2 SIDES) (2' HIGH) (.74 GPD/S.F.) = GAL/DAY COL-LI ,C (33.5' + 12.9') (2 ) (2' ) ( .74 GPD/S.F.) = 137.3 GAL/DAY (� DISTRIBUTION BOX 1v�7 500 GAL. LEACHING CHAMBER BOTTOM CAPACITY (LENGTH x WIDTH) (.74 GPD/S.F.) = GAL/DAY (33.5'x 12.9') (.74 GPD/S.F.) = 319.8 GAL/DAY REV. DATE BY APP'D. DESCRIPTION TOTALS: _--.. ____..____.____ ._ _ _. __._._.__-__ _ TOTAL NUMBER OF CHAMBERS 3 PROPOSED SEPTIC SYSTEM UPGRADE TOTAL LEACHING AREA 617.7 SQ. FT. PREPARED FOR: TOTAL LEACHING CAPACITY 457.1 GAL./DAY BARBARA BENOIT LOCATED AT 34 COLLINS AVENUE CENTERVILLE, MA 02632 SCALE: 1 INCH = 20 FT. DATE: APRIL 23, 2003 SHOF 0 to 20 40 80 FEET 1 JOHN L yodm _v- g CHURCHILL PREPARED BY: CML JC ENGINEERING, INC. No 41807 1 5 ROUNDHILL BLVD. EAST WAREHAM, MA 02538 SITE PLAN 5_08.273.0_3_77_ _ SCALE: 1"=20' 23/03 Drawn By: JLC Designed By: JLC Checked By: JLC JOB ND.433