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Home My WebLink About0013 CONNERS ROAD - Health JF13 Conners 1 1 Centerville �� . ■■N■MOee■ e■■eeeee■■eee■MEN _ .. ._ ., . __�■■■■■■■■■■e■e■eM■■eeeeeEMe®um■e NEE■MENEM■Me■®■■■■■■■■■M■■■■eeeee■■EE■EN■e-0000 ■■■■e■■e MEN NEEMSEMeeeeM■■eeeeeN■eeeeeeeeeMee �e■■■��■■ ■■� ■�� e■�ee■■�■eeeMEeeeeeee■■Eee■ �■■■�eeeee■■eeev�e■■w■■eeee■■■■■ee�e■eev■■®e�■ IMeeMe■e■■Eee■OMEMENe■■■■■eeE� _ ■eeeee MEMEMEME 1■■■■■■■e■■■■■■e■OMMEMEMee■■■■■ eE■eeeMeeMENNEN ■■■ ■■■S■■eee■� ��■ev� �■■e�e■e�■e■eeee� ■e■ 1■■e■■■■■■EEM■■ OR■ee NEE■ee■■■ME■■■ � �ee ■tee■■■ �■ ■eee■■�■�� ■ i■■■■■■e■■�■�■■■■■®■■■■■ewe■■■e■��■��■eeea■ee ■■e■■■■■■■ee■e■ ■■■■■ere■■■eeeeeeM■eeEMM■■e■■■ I■■ee■■■■■eee■e■■■eeee■■■■■■eeee■■eeeee■ee�e ■ 1■e■■■e■■e■■■e■■■eee■■eeee■■■eee■■■eeee■e■ee�e■ �e■■■■eeee■■■■e�■■ee■■eeeeee��eeeve�e■■eeee■ 1■■ MENE■ ■■■e■■eeeeee■eee�e�eee■■�■�e�eeeeeeee��w�e■ �■■■�■■�■■eeee■■e■■�■eeevv�ee��e■eeeee�■��e��e�■ �■■eeeeee■eeee■■■■■■■eeeevee■eee�e■eeve■■tee■■�■ �■■■ee■■■■ee■eee■■e■e■eeeee■e■eee■■e■eeeeeeeee I■■■■■ee■eeee■■eee■■■■■eee eeee®�■■ � eeee� �ee gee■■■■■■■■■■■eee■e■■■eeeeeee■eee■e■e■eeeeee��■ �■ee■ee■eeeeee■eee■eeee��eeeee■ee�■■e■�eee�■ �eeee■e■�eee■■e■eeer• =, ��=�� r=;r�eeeeeeee■e�e�eeew� �■■■■■■eeeeeeeaea■■�`��eeeesee�ee�■®��®ve■■e M■■■■ ■■■■■eeee■■■■■ �e■■■■eeeee■eeeeeeee■eeee■■■eee■eeIIeeeee■e■eMENNEN �eeeeeeeeee■■e■ee■■��ee■_•••eases■■■■e■eeeeeeee I■■eee■e■■eee■■■■■■MOM®eeKOPMeeeee■e■eee■eeeeee mm� ■■■■e■■■■e■■e■e■■■ �■ee■�ee■■■s■e■■■Meeee■ NEW 1■■■�■�■■■ee■fie■■■■�■■■■■■■■■■■■■1 1■■■■■■■■■■■■ems■■■■■■■■■ee■■■■■�� 1�■■■■■�■■■■■■■■■■eye■■■■■■■■■■■■ 1■■■■■■■■e■■■■■e■e■ewe■■■�■■■■■■�■■ 1■■■■■■■■ems■�■■■■■■■■■■■■■�■�■■■e■■1 1■■■■■■■■ee■tee■■■�■■■��■�■�■�■■■■�■t �■■■■■■■■■■■■■■e■■■■■■■vim■■■■■■■■�■t ■■�■■■■■■■■■■e��■�■■■■��■�■ MEMO■ I Commonwealth of Massachusetts :26 -bqg ,t? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments { 1 13 Conners , Property Address 1 Burlingame Owner Owner's Name t information is / required for Centerville ✓ Ma 02632 9-16-19 every page. Cityrrown State Zip Code Date of Inspection c ti 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. 'mP°'l"t A. Inspector Information When filling out p 614 /yI(o.-L., forms on the computer,use Douglas A Brown only the tab key Name of Inspector to move your D.A.Brown Inc cursor-do not Company Name use the return key. P.o Box 145 Company Address Centerville Ma 02632 City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 9-16-19 ec or'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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: At time of inspection this system was only a little over 3 yrs old. This system is in good working order. This system was pumped in the past year. 2) 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form �n Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) t 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 c Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form ISubsurface Sewage Disposal System Form - Not for Voluntary Assessments 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information 1. 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 Description: System consists of a 1500 gallon septic tank d-box and 2 500 gallon leach chambers with 4 ft of stone. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: 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 years usage (gpd)): Detail: 2017--297 2018--138 gpd Property also has a irrigation system. Sump pump? ❑ Yes ❑ No Last date of occupancy: currentlyoccupied t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: Scott Frank Pumping stated he recently pumped the tank Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,• 13 Conners v Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: 8-25-16 per as-built Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 2 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: 1500 Sludge depth: light Distance from top of sludge to bottom of outlet tee or baffle Scum thickness trace Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? 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 had recently been pumped. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 I Commonwealth of Massachusetts �v ,�-p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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.): 8. 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 t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. 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.): Box was functioning properly at time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 13 Conners u- Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: l5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 12. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts ,t? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •� 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .v 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: none encountered at time of perc test feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: no G.W encountered at time of perc test. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts lg Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 13 Conners Property Address Burlingame Owner Owner's Name information is required for Centerville Ma 02632 9-16-19 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Assessing As-Built Cards Page 1 of 2 TOWNOFBARtNSTABLE LOCAEON 13( 4 G —SEWAGE"1p1t�1$1_ Vll,LAGE�mb!,,Jp SSESSOR'SMAP&PARCEL )I' UV$TALLER'SWIE&PHONENO. SEPTICIANKCAPAM 1500 LEACMG FACUM(l pe) NO.OF BEDROOMS OWNER�d mA P PERMDATE: -16 COMLANCEDATE: 2S`I SeysmiooDElaoceBeMeenlhc: "6�it of MarrmmnA3jus�dGr000d�sierTablatothaBaflamafLeulgogFazdiry IC Fsd PmateR�+�rSuPplyR'aBwdLachiogF�lily�fsnyaaBSexEfou sit¢mwP.6iut�fcelaflt�c6oigficdih�) .Fed PEg�o;l4dDadmbiLexhiogFuB�rRfsm,adl��cristarAio iWimoflachmgficBry) Fed F Is DBr 1 I ( . _ . I NT-4'�t� 'I we Vj Hz' I , . r II -3G 16 3f�1=�0'NII o�r.�L�yq �,�ISiI ,air t �.d1t71/ 2 � https://townof bamstable.us/Departments/Assessing/Properry_Values/HMdisplay.asp?mapp... 9/17/2019 Assessing As-Built Cards Page 2 of 2 https://townofbamstable.us/Departments/Assessing/Property_Values/HMdisplay.asp?mapp... 9/17/2019 q No. ` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for -Misposal *pstem Construction joPrmit Application for a Permit to Construct( ) Repair(0--lu'-pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 Cow/��e'f Owner's Name,Address,and Tel.No. A e sor s Map/Parcel 2571 -O`I Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. t'. v�IGS pr 13cawa T-fjc o, U - OCJ y Nc' Pd'�.✓SLJl�c/I( Type of Building: Dwelling No.of Bedrooms 3 Lot Size /l��J`/ sq.ft. Garbage Grinder( ) Other Type of Building re Sid-eV",c, , No.of Persons 12_ Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ';3 gpd Design flow provided : y,0 , '7 gpd Plan Date - [d Number of sheets 2 Revision Date Title l Size of Septic Tank LSO 0 Type of S.A.S. 2 SOG G 1 fo,j <-L C t bWS W 1 t N If'S bAC Description of Soil Nature of Repairs or Alterations(Answer when applicable) (A.)5 fiG 1 C.c 1 S CJo f(,nJIc O-TjOX' tvyy 5-00 qe., I(cs,y C L cr2 h`a°r S w t F I-I t4 , 51 o ry n. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 2 2.- f C, Application Approved by Date Application Disapproved by Date for the following reasons Permit No. -2-1 Date Issued -------------------------------- ___ ____--_ ----- _-- _ .__ - - _ _-- - -- _ ---- - oi6 — acl7� c _ No Fee THE COMMONWEALTH OF MASSACHUSETTS Entered incomputer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes a �pfication for Misp4al 6pstem Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( )_ Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. aj Cor✓�'�✓3 Owner's Name,Address,and Tel.No. C qv, -e r t/1WC l-jv/��/ Givr t Assessors Map/Parcel 2 S 1 -0L/F3 ' Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. A 13(a w nJ S rJC. l'ni .✓r I ,-.-r N f vim✓ 1 '�. -0 -L/av- 7/5- s 5 Type of Building: Dwelling No.of Bedrooms ' 3 Lot Size // ,7/o/ sq.ft. Garbage Grinder( ) Other Type of Building rY'S No.of Persons 2._ Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '3-3 C) gpd Design flow provided :?00 , 'Z ' gpd Plan Date ' I - i G Number of sheets Revision Date Title Size of Septic Tank I SC)C) Type of S.A.S. 2 SPC-) r-iG e-Lr an�^e-'S l ty1 Description of Soil i? Nature of Repairs orAlterationsr(Answer when applicable) ►,v»;G I t S C1C� U/wN -/G,JIc O-Pe))r ayc) ( 2 oo G I IC,N CGc✓L f S w L7 El 5 GN LQ. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of CompliaEce has been issued by this Board of Health. Signed Date Application Approved by 3. Date Application Disapproved by / Date for the following reasons Permit No. G ( Date Issued 3 ` fo --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(W Upgraded( ) Abandoned( )by '�J G 5 A I'2j(c.)w�-j T- /y C at /3 Q e) re-titrP lV X, 1 e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.020/6;1""'dated i 'd-3 Installers,,� G c (cam`.�..1 T7 NC Designer #bedrooms Approved design flow gpd The issuance of this ermit'hall not be construed as a guarantee that the system will nc' n designedl Date �� Inspector ---- -l�-� �-- (- ---------------------------------------------------------------------------- --- --------- No. �b ( � Fee `� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Misposal �6pstem onstruction Ermit Permission is hereby granted to Construct( ) Repair( Upgrade( )f/ Abandon( ) System located at 1 C OrV N C C/ �-ry Ae.'y, / / r- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. I Provided:Construction must be completedwithin three years of the date of this permit. Date 3 fo Approved by v Town of Barnstable a}} Richard V. Scan, IaileK1m Iffireeiar �oi sn8nslast,e, MAss Public Health :Divisiolii t63q• v� Fnt�u*s° Thomas.McKean, Director 200 Main Street,Hyannis,_NLN 02601 Office: 508-862-4644 Rix: 501-790-033i) Installer& Designer C:er ificatia>ti Form Date: �F 2S� l�Sewage Permit#€ 201&—2,!�7 rtkssessOlr s i.NapTarcel Designer: Instafler: _Pc a c'R Address. 1'Z 1�?, Cti�s c�'��c�i Address: l"d', %3" 1 -15 Ce n t� ✓� i I� r� aZ�3Z On_C'`2 3�-1 (. '_ A �`� �.�t•� 1 t.�c was issued a pel-rnit to install a. (date) (iiista[Iel-f septic system at_.1 C_0YNnew^s ? ��•► based ana desion drawn by (address) McCq l e e dated t r f (designer) I certify that the septic system referenced above was iiistalled stlhstantially According to the design, which may 'include minor approved. changes such as, lateral relocation o17 the distribution box and/oi- :peptic tank Str'Ip OUT (if re(iidred) tvas inspected all rile soils were found satisfactory. l certify that tl?e septic ,ysteni r-ef0j.et?cedabove was itT5tallt€f with maim t i,at?,13 es ;i. . r7reater than 101 lateral relocation of the SAS or any verUcal relocation d' ails, eo�nponent of the septic system) "Nit in accordance v ith State Local Regtilation:s. Plat?.revisiun ar cer-tl.fi.ed as built by designer to'follot.-. Strip ow (If required) was inspectedand the soil; Were'fOUnd satisfactory, .1 oerti - that the sysl:ena referenced above was constructed. 1'll (oi11:.lIcll?C( tVl:tt3. 'ttlt tE I7.-r1S of the RA approval letters (if applicable) J� . PETER T ( nstailS McENIEE e u _. (Designer's Sigslai�a�e i:' fx De51 Il.erej--- .EASE RETURN TO 4z�_R iST PAli L.E: PUBLIC; H1G:A.L.TI-1. DIVISION. C;ERTIF C ATF OF COMPLIANCE WILL KNOT BE ISSUED UNTYL 'BOTH THIS FORM ,k D S- :B]U1:L"C CARD ARE. RECEIVED BY THUBA RNSTABLE PUBLIC HEALTH iDIVISfON. THANK YOU. QASeFGc;Dcsi`ncr Ceriili cat ion Forth Rev 8-14- No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in ck Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS fipfication for 30isposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. C Owner's Name,Address,and Tel.No. J3ses%r's M1 JArcel ��C'�` � SCO Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. SCC V- Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank k�zo Description of Soil Nature of Repairs or Alterations(Answer when applicable) C b r, .0 ctl\ A7 Al 1 V Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board�pfHealth. dZ1, Date / iC7 Application Approved by / Date Application Disapproved by Date for the following reasons Permit No. "r �2 Date Issued r No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS. Yes` 21pptitation for ]Di8aposaf 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. �� Owner's Name,Address,and Tel.No. J&e� r'sMa %reel �'� � l �"cA5 �SCO Fr , v installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 5co V- S'0 �A Od�o.q 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(min.required) gpd Design flow provided gpd A Plan Date Number of sheets Revision Date Title AA 1 Size of Septic Tank 1�V ` C oM Wll l-A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ( '^ �c V Date last inspected: ". re Agreement: M 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. _ Sign Date Application Approved byX:r2ff-11ZAp Date Application Disapproved by o Date for the following reasons Permit No. Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS ` BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired lV 1 Upgraded( ) Abandoned( )by scpm. M �- at `�P -, C.Q/� Cf- \�� has been cons cte i acco ce with the provisions of Title 5 and the for Disposal System Construction Permit No. led Installer SCs-) Designer #bedrooms ARA Approved design flow gpd The issuance of thi pe it shall not be construed as a guarantee that the system wig' chon as desi e . Date (�► / Inspector tj -= -------------------- - ---------------------------------------------------" ------------------ --- No.— Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoSal6pste/m Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons tion ust a completed within three years of the date of this permit. Date Approved by _ gg�A ofAw Town of]Barnstable P# Department.of Regulatory Services ' BARNSTAELM Public Health Di ( i V1SiQI1 Date � 1 630. 200 Main Street,Hyannis MA 02601 Z ArfO MAt Fa► Date Scheduled Time lM Fee Pd, G r U �` ' 6 � Soil Suitability Asps-essment for Sewage Disposal Performed B �� G2 t " l c-��l l-Cc S L-iJ (S� — Y: Witnessed By _ ✓<� G✓� ;/I s! S LOCATION & GENERAL INFORMATION Location Address 1 Owner's Name + &J..(. t 1 C°C.�t .✓+� 1 Address is Cc, l✓tp�—j' Rq Assessor's Map/Parcel: Engineer's Name NEW CONSTRUCTION REPAIR Telephone# 5 d 9 Land Use ��S' \� t'` 4 Slopes(%) 2Surface iyo r ?, Distances from: Open Water Body 111J A ft Possible Wet Area /\.)`X ft Drinking Water Well>is y ft r Drainage Way rlj /Q" ft Property Line T /S ft Other ft SKETCH: (Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) 7 Parent material(geologic) ." `� 1 Depth to Bedrock. Ivar� Depth to Groundwater. Standing Water in Hole:— AJ/ Weeping froin Pit Nce Ai C, ^ Estimated Seasonal High Groundwater —/ �2U DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to Solt mottles; Depth to weeping from side of obs.bole: in, oroundwater Adjustment--_fr. Index Well# Reading Date: Index Well level,..,,� �.,w„ Adi,factor _ Adj.Groundwater level PERCOLATION TEST Date Time Observation Hole# `time at 9" Depth of Perc 3�l _ 2 �{ R& a Tlme at 6" Start Pre-soak Time @ _ __ ___ 1 I``, Time(9"-6") End Pre-soak Rate Min,/Inch. G Z Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Dita 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:\SEPTfC\PERCFORM.DOC � ldu� DEEP.OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling '(Structure,Stones;Boulders, Consisteogy.%anyell 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 Z� _gt, C ,mot-L S..,. d DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. 0 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consiste FY anyell Flood Insurance Rate MaZ. Above 500 year flood boundary No— Yes - -_ Within 500 year boundary No K Yes Within 100 year flood boundary No' Yes Depth of Naturafly Occurring Pervious Mater'al Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification (�94'r(date)I certify that on I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 310 CMR 15.00. C . Signature` � ..........._.�.—"_..-... Date� I Q;\S Bp'i'1(.vE4,RCF0RM.DOC 13 TOWN OF BARNSTABLE ` LOCATION CATION . �rl. SE AGE # V1 t:AGE ASSESSOR'S MAP & LOT Z's/ O S'P INSTALLER'S NAME&PHONE NO. : SEPTIC TANK CAPACITY oo LEACHING FACII.TTY: (type) / OV t1 � ��Z� (size) NO.OF BEDROOMS — BUELDER OR OWNER_ % �"U n PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist onsite or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist 7 within 300 feettof leaching f lity) v -Feet Furnished by /ti-� J� N a Ir N J TOWN OF BARNSTABLE f wLOCATION 1`2 C ON rigg� SEWAGE# 2.01(2 2 7 T VILLAGE C41� .t� �-P�t�a��•Ey ASSESSOR'S MAP&PARCEL S t/ INSTALLER'S NAME&PHONE NO. �uNw� 7( 7(5 SEPTIC TANK CAPACITY 5ZDC) / 1r_ \- LEACHING FACILITY:(type).;z MZACA) C GYJN er (size) 12, BB _�� 2- NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: / L Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 0Ca(C 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 2C�`all 1 � 32� J �'�lt •�'a •ra sA �lapa��o 60, J �� J bP� �o��o •?tJl'y�8'�jjl,��j�� lsJ �Yo IQp a?,o �aa � Jro�a T o Vo a� lop J Ab 71 a o s�ssd i / s ` �SlPa j t�? f o? vb ,o J �J 11)10 � Q, 014 y � -0110 r�N r ' r i. --101— EXISTING CONTOUR e x 100.98 EXISTING SPOT GRADE - S�e Lakeview Ave EXISTING CESSPOOLS W-EXISTING WATER SVC. 1 a CafPa REMOVE-SEE NOTE 11 G EXISTING GAS SERVICE Hott Lakeside Dr 0 o6Cp �o 99.20 -9.H.•W.---OVERHEAD WIRES Pont Rd -/�ae° c�ooa EXISTING CESSPOOL � TEST PIT -=-7/ m Ga�tia PUMP, FILL WITH /� SAND & ABANDON .off � BENCHMARK \ _J °' LOCUS CB 0 100,06 S 38°31'00" E 'AR LEGEND de Dr We I e4r�, 150.00' y C B ,s /ter- o y ,, 98,84 (� C- Cents a .c a> . . . . . . +.9.9.35. . . . �98,95 j Lo 99.95- 00.00 o TP-1 �98 8-7� \ r H LYTREE TP-2 SHED 949 98 59 Wequaquet Lake J x I� 99.79 �y*,519`95 PROPOSED SEPTIC TANK_ _-- ,-• .O� LOCUS MAP FL•� � ,19 99,g A NOT TO SCALE x 100 ` :. •` p �� GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL cn �j 00.2 � .';:.••:'.:`-jI BOARD OF HEALTH AND THE DESIGN ENGINEER. 100,68 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS bh ` V°%78 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE ENCLOSED 00.53 100,36 x�N Z LOCAL RULES AND REGULATIONS. p Cn 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR o G EXISTING PORCH PATIO 100,31 �,a TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE ' ___X_f3 79 fv I DESIGN ENGINEER. 101,03 HOLISE( 13) o v +I 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING =102.3t 100,72 x 100.17 O FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 100.34 / ENGINEER BEFORE CONSTRUCTION CONTINUES. I� 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF GARAGE o THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 01,06 100.85 i HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 101.52 10�8 100.50 x 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 101,19,:_ BENCHMARK 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. PARCEL ID• 251 -048 "'' ' N PATIO CORNER 9• ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS EL. 100.72 ,... .,,: : , . = 01.22 .'• ; •.• :;%:_:, ..• . :.:...:.... � AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 16,791 ±SF 100.63 DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY x 101,84 �f'AVED. .".:1` , . .:';.• THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 101,68 + 10190 3 1 99.14 ORlVEWAY ;: .y: ` CONSTRUCTION. 100,51 / 100,89 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS x ` IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 99.45 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). %. 150.00 S0.•'•'` ' CB 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE ,4V 38°31 00 W' / 99,86 INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 101,38 edge of pavement 100,20 99,65 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND r--4P gss99.43 NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. �y14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC R T. SYSTEM COMPONENTS NOT SHOWN ON THE PLAN TEE CONNERS R0AD • VIL NPROPOSED SEPTIC SYSTEM UPGRADE PLAN . 51o9 13 CONNERS ROAD, CENTERVILLE, MA E Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. l 13 CONNERS RD NOMINEE TRUST 1"=20' P.T.M. 176-16 Engineering Works, Inc. I BURLINGAME, DAVID B TR' 13 CONNERS ROAD 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. ICENTERVILLE, MA 02632 (508) 477-5313 8/11/16 P.T.M. 1 Of 2 NOTE: TO PREVENT BREAKOUT, FINAL GRADE SEPTIC TANK SHALL NOT BE AT, OR BELOW, EL.=97.0 INSTALL RISERS & COVERS OVER INLET & FOR A DISTANCE OF 15' FROM THE EDGE OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D-BOX OF THE PROPOSED S.A.S. GA i INSTALL RISER & COVER PROPOSED S.A.S. SET TO 6" OF GRADE INSTALL RISER & COVER OVER EACH CHAMBER AND T.O.F=102.3f(MAIN HOUSE) SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT F.G. EL.=101.5t F.G. EL.=100.Of F.G. EL.=100.0f F.G. EL.=100.3 (MAX.) PO.RC fMAINTAIN 2% SLOPE OVER S.A.S. L = 10' S(mox.) L = 10' _ io (MIN.) ® S=1%5(MIN.) 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2" M 6" w DOUBLE WASHED STONE N 101 6- aaaSaaa (OR APPROVED FILTER FABRIC) ( Cp It 4" aaaa a as INV.=97.12 48" LIQUID BaaaaBa -^-3/4" TO 1-1/2" DOUBLE �P LEVEL ADD PROPOSED 4' 4.8' 4' WASHED STONE 43 �'- p �81 SHED GAS BAFFLE INV.=96.77 INV.=96.60 ------}, INV.=96.87 D BOX EFFECTIVE WIDTH = 12.8' T Am 3 OUTLETS INV.= 96.50 N I tit PROPOSED SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS ao I PROP. S.A.S. SURROUNDED WITH STONE AS SHOWN CONNECT TO NEW SEWER PIPE AT -�- HOUSE, AT OR ABOVE, INV.=97.30 H-10 RATED I----25' =i TOP CONC. ELEV.= 97.3f NOTES: BREAKOUT ELEV.= 97.00 ease SEPTIC LAYOUT INV. ELEV.= 96.50 eases 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & COMMUNISM aaaaaaaBaaa BOTTOM ELEV.= 94.50 INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' 2 x 8.5' = 17.0' 4' TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' SIX INCH CRUSHED STONE BASE, AS SPECIFIED PERVIOUS MATERIAL IN 310 CMR 15.221(2). 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION CE3 ®® , 0 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=89.0 = ®®®® ® ®®®® 334) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE DESIGN ENGINEER SHALL VERIFY - 0' AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. SOILS AT TIME OF INSTALLATION N > ®®®® ® ®®®Z ®®®® ® ® ®®® SEPTIC SYSTEM PROFILE 102" DESIGN CRITERIA SOIL LOG 4" KNOCKOUT NUMBER OF BEDROOMS: 3 BEDROOMS DATE: JULY 5, 2016 (REF#15,093) 20" DIA. COVER SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) SOIL EVALUATOR: PETER McENTEE PE(SE#1542)WITNESS: DAVID STANTON R.S.HEALTH AGENT 4" KNOCKOUT 4" KNOCKOUT 58" DESIGN PERCOLATION RATE: <2 MIN/IN ELEv. TP-1 DEPTH ELEV. TP-2 DEPTH DAILY FLOW: 330 GPD 99.2 A 0" 99.0 A 0" 0 DESIGN FLOW: 330 GPD LOAMY SAND LOAMY SAND GARBAGE GRINDER: NO-not allowed with design 98 10YR 4/2 6„ 984 10YR 4/2 B e 7" 4" KNOCKOUT ' LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF LOAMY SAND LOAMY SAND .74 GPD/SF 96.7 10YR 5/6 10YR 5/6 500 GALLON CAPACITY, H-10 LOADING PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY C1 30" 96.6 PERC cl 29" PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED M-C SAND M-C SAND 30'/48" N.T.S. USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 2.5Y 6/4 2.5Y 6/4 $°" 92.2 C2 s4" 92.3 C2 PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. MED. SAND MED. SAND 13 CONNERS ROAD, CENTERVILLE, MA 2.5Y 6/6 2.5Y 6/6 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Pre pared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 TOTAL AREA:........................ . . ......... 471.2 S.F. Engineering by: SCALE DRAWN JOB. NO. ' ' """"""""'�""' � 89.2 120' 89.0 120" Engineering Works, Inc. N.T.S. P.T.M. 176-16 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD PERC RATE <2 MIN/IN. I"C" HORIZON DATE NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdale, MA 02644 CHECKED SHEET NO. (508) 477-5313 8/11/16 P.T.M. 2 Of 2