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HomeMy WebLinkAbout190-204 CONNERS ROAD - Health 19 )-204 CONNERS RD., CENTERVILLE oo ----- F i t G AN UPC 12534 No.2�OR kr HAOTINGA,Un ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.- Not for Voluntary Assessments 190 Connors Rd. ( Main House ) Properly Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms I r I on the computer, Ills/ use only the tab 1. Inspector: key to move your cursor-do not Robert Paolini use the return key. Name of Inspector Robert Paolini Septic Service a' ,- � Company Name 17 Playground Lane Company Address Yarmouthport MA 026751 City/Town State Zip Code a 508 362-3555 S14454 Telephone Number License Number Qs:-a 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: 0 Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Ev I ation b the Local Approving Authority Aga 5/25/14 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 perfe m in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspectfo o :Subsurface Sewage Disposal System•Page 1 of 17 ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Connors Rd. ( Main House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Il Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. ( Main House) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cunt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance,with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh c t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 X Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 190 Connors Rd. ( Main House ) Property Address Ed Marshall Owner owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: . D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ❑x 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 ❑ ❑x Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 190 Connors Rd. ( Main House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ❑x Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ❑x Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ 0 The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 �l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Connors Rd. ( Main House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 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 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 Were any of the system components pumped out in the previous two weeks? ❑ ❑x Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? 0 ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑x. ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑x ❑ Was the site inspected for signs of break out? ❑x ❑ Were all system components, excluding the SAS, located on site? ❑x ❑ 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? 0 ❑ 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. ❑ 0 Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4. DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 15ins-3113 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. ( Main House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ❑x No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑x Yes ❑ No Seasonal use? ❑ Yes 0 No Water meter readings, if available(last 2 years usage(gpd)): na Detail: Sump pump? ❑ Yes ❑x No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): a Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. ( Main House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Robert Paolini Septic Service Was system pumped as part of the inspection? 2 Yes ❑ No If yes, volume pumped: 1500 gl. gallons How was quantity pumped determined? Measured Reason for pumping: Maintenance Type of System: 1 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/Altemative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and'a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. ( Main House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed(if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes 0 No Building Sewer(locate on site plan): Depth below grade: 3' feet Material of construction: El iron ❑x 40 PVC ❑ other(explain): Distance from private water supply well or suction line: fe e e 1 + t � Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the building vents. Septic Tank(locate on site plan): Depth below grade: 3.5' feet Material of construction: ❑x concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) .k If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gl. Sludge depth: 2" t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Connors Rd. ( Main House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness 61' Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or'baffle 101. How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every 2 years.Inlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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 t5 ns•3/13 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. ( Main House ) Property Address Ed Marshall Owner Owner's Name information is Centerville MA 02632 5125/14 required for 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.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ' ❑ concrete ❑ metal El fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 TNe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,a 190 Connors Rd. ( Main House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town . State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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 is Ievel.Box has three outlet Iateral.No evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 l _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. ( Main House ) Property Address Ed Marshall Owner owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: leaching fields number, dimensions: 20'x 42'x 6" ❑ 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.): Sandy soil.No signs of hydraulic failure. No ponding or damp soil. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer = Depth of scum layer Dimensions of cesspool , Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "< 190 Connors Rd. ( Main House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) , 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.): 3 s t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. ( Main House) Property Address Ed Marshall Owner owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 j` ❑ drawing attached separately . t I T I Title 5 Official Inspection Form:Subsurface sewage Disposal System-Page 15 of 17 t5ins-3113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Connors Rd. ( Main House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑x Check Slope ❑x Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 8' 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: As-Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database'-explain: You must describe how you established the high ground water elevation: USED:USGS observation well data.USED:Technical bulletin 92-0001 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 190 Connors Rd. ( Main House ) Property Address ` Ed Marshall Omer Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist 0 Inspection Summary: A, B, C, D, or E checked ❑x Inspection Summary D (System Failure Criteria Applicable to All Systems) completed System Information—Estimated depth to high groundwater N Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. ( Guest House ) Property Address Ed Marshall . Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, (y/�►�^1 t/J� use only the tab 1. Inspector: key to.move your cursor-do not Robert Paolini use the return key. Name of Inspector Robert Paolini Septic Service �11 Company Name 17 Playground Lane Company Address �� Yarmouthport MA 02675" City/Town State x° Zip Code T 508 362-3555 S 14454 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: ❑x Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further E aluation by the Local Approving Authority 5125/14 'Inspector Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000,gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official I Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 190 Connors Rd. ( Guest House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 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: ❑x 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old" or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Connors Rd. ( Guest House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): } ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. ( Guest House ) Property Address Ed Marshall Owner owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: *' This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ❑x Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ❑x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. ( Guest House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ❑X Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ FX1 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ❑X Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Z Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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.] ❑ ❑x The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ 0 The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 16.303, therefore the system fails. The system owner should contact the Board-of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. ( Guest House ) Property Address Ed Marshall j Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 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 ❑x ❑ Pumping information was provided b the owner, occupant, or Board of Health P 9 P Y P ❑ ❑X Were any of the system components pumped out in the previous two weeks? ❑ Fx� Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? 0 ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) N ❑ Was the facility or dwelling inspected for signs of sewage back up? n ❑ Was the site inspected for signs of break out? ❑X ❑ 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? 0 ❑ 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: ❑ ❑X Existing information. For example, a plan at the Board of Health. ❑ 0 Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5. Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Connors Rd. ( Guest House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. C41rown State Zip Code Date of Inspection D. System Information Description: Number of current residents: _ 0 Does residence have a garbage grinder? ❑ Yes ❑x No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑x -No information in this report.) Laundry system inspected? 0 Yes ❑ No Seasonal use? ❑x Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): na Detail Sump pump? ❑ Yes R No NA 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: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. ( Guest House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: - Robert Paolini Septic Service Was system pumped as part of the inspection? ❑ Yes 0 No If yes, volume pumped: gallons r How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool. ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. ( Guest House ) Property Address Ed Marshall Owner owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ❑x No Building Sewer(locate on site plan): Depth below grade: 2, feet Material of construction: ❑ cast iron ❑x 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the building vents. Septic Tank(locate on site plan): Depth below grade: 21 �• feet Material of construction: ❑x concrete, ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gl. 1 Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts T. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Connors Rd. ( Guest House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3411 Scum thickness Oil i Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every 2 years.Inlet and outlet tees are in place.No evidence of leakage.Tank appears structurally sound. 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 1Sins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Connors Rd. ( Guest House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No 1 Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Connors Rd. ( Guest House ) Property Address Ed Marshall Owner owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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 is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 190 Connors Rd. ( Guest House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑x leaching chambers number: 3 Flowdiffusors ❑ 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.): Sandy soil.No signs of hydraulic failure. No ponding or damp soil. Leaching was dry at time of inspection. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer. Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Connors Rd. ( Guest House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurrace Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. (Guest House ) Property Address Ed Marshall Owner Owner's Name information is Centerville MA 02632 5125/14 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 i \q�n' i 6 ® k �p ` tp 0 Ce js I i 15ins•X13 Title 5 Micial Inspection Form:Subsurface Sewage Disposal 5ysWm•Page 15 or 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 Connors Rd. ( Guest House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: 0 Check Slope ❑x Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 10' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date' ❑ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: As-Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS observation well data.USED:Technical bulletin 92-0001 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Connors Rd. ( Guest House ) Property Address Ed Marshall Owner Owner's Name information is required for every Centerville MA 02632 5/25/14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑x Inspection Summary: A, B, C, D, or E checked ❑O° Inspection Summary D (System Failure Criteria Applicable to All Systems)completed System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r TOWN OF BARNSTABLE LOCAMMON 3y 6001JkKeS /cam" SEWAGE # ODD rl(X/v VILLAGE ASSESSOR' MAP & LOT �DDI INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �Cf�✓ LEACHING FACILITY: (type) +%�t�c % c��- (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 4o 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) I Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 00 (j t R1 AL l y, Ax l r F. THE COMMONWEALTH OF MASSACHUSETTS G BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIEY at a On-site Sewa a sal System Constructed( )Repaired Abandoned( )by C � at - Cow S 'ref, ! P:1 has been constructedt}'W".6-)6 ance with the provisions of Title 5 and the for Disposal System Construction Permaz_it dated L Installer ' Designer ACCoFI�' The issuance of this permit sh 1 t o trued as a guarantee that the s 4e functio a sign Date Inspector CAPE COD ENGINEERING, INC Robert M. Perry, P.E. 50 Leland Road a Brewster,MA 02631 Tel./Fax 508-896-4861 bobperry�a,,capecod.net November 13, 2000 Town of Barnstable Health Department 367 Main Street Hyannis, MA 02601 Re: 190 Connors Road, Centerville, MA 02632 To the Health Department, This office has completed its inspection of the recently completed septic system at the referenced site. Soil removal perimeter excavation was inspected and is in compliance. We hereby certify that the system has been installed in compliance with the approved plan, Title 5, and Town of Barnstable Health code regulations. Thank you for your assistance with the project. Please contact our office should you have questions. Very Truly Yours, Cape neering, Inc. Robe . Perry, J i . f t , I Ik- s CDcn =_ �Xo IFlCD to G� cn cn M. — `'i ? S� I,•.. t». N N - Cn N ,_ r .►' N m �t jl r i li is I i �N i t _ S li o j I II I I: iaa M y` � I• .1. - v I� I I � I f u , I e I } IY I P. v v Z N T TOWN OF BARNSTABLE LOCATION 90 SEWAGE # 000 (< D VILLAGE ASSESSOR MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY OU r4�/u✓ LEACHING FACILITY: (type) f-2 c l (size) V22 20l G n NO. OF BEDROOMS BUILDER OR OWNER /,y . PERMITDATE: COMPLIANCE DATE: OrJ i 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 4 1 9 0 0 Oct 27 00 04: 44p Robert .M-ichael Perry 500-096-4861 p. l � I n Q 0 a ' y r a 0 Al 0 � i a � j a / I i c./ A O _ a N4 a 4 U` d �i 4 O�?No Y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migpaal *pgtem Cow6truction Permit Application for a Permit to Construct( )Repair( )Upgrade(Abandon 1 Complete System ❑Individual Components Location Address or Lot No. &A kw d 5 Owner's Name,Address and Tel.No. SjAssessor's Map/Parcel - C er-r, .5 Install j Address,and Tej^ 0�r� Designer's Name,Address and Tel.No. 5 vJ11\�jS 11(/5T, Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures �q / Design Flow �v gallons per day. Calculated daily flow;��0 gallons. Plan Date P:400 1y"h D�000 Number of sheets I Revision Date Title Size of Septic Tank 1<0 Type of S,A.S. Description of Soil L_o" 5 66,0 Me,Q�� Nature of Repairs or Alterations(Answer when applicable) I Date last inspected: x ISS DESIGNING ENGINEER CERTIFY NUW�ING Agreement: INST,",LLATION AN INSTALLED IN STRICT ��i"7 "'Ns EM WAS The undersigned agrees to ensure the construction and maintenance of the�avo � ewage disposal system 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 bee Signed Date Application Approved by Date Application Disapproved for/4 e fo owing reasons Permit No. Date Issued J rlo �D \./ Kyi _ �n ,.Fee 5o: y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH"DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zfppfication for -Mi5ppoaf *pztem Conaruction Permit Application for a Permit to Construct( )Repair-(- )Upgrade(Abandon( ) Complete System ❑Individual Components Location Address or Lot No. D ivy, d 5 Owner's Name,Address and Tel.No. Assessor's Map/Parcel iJ Install N Address,and T Designer's Name,Address and Tel.No. o � all, t. V1.�1'f5 tc)j\ r, si. 4 , Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building oNo.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow �!y gallons. Plan,Date. P::e-b�� ;Xv Number of sheets [ Revision Date g - Size of Septic Tank Type of S.A.S. Sew ✓q Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ' - Agreement: xi The undersigned agreesjo-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 Certifi- cate of Compliance has beer i a y-this-B. Signed A A nVD Date v . z 11 Application Approved by t _ Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTF, that e On-site Sewage-D!nssal�Syysste Constructed( )Repaired( )Upgraded Abandoned( )by c� ` r 1 at , U ow t-_l S ,O_ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer s Designe J, A n The issuance of this permit sha o e onstrued as a guarantee that the s S- ik functio aV design�� Date dnm 0 Inspector �A - --------------- No. Fee�/ Oz�--------- =- - i I i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Miopaai bpotem Conotruction Permit Permission is hereby granted to Construct( )Re�air( Upgrade( )A don( ) System located at �U r 1Yk--',S C4:41.-T. } 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 /st�e co plete within three years of the date of this Date: C/ O� Approved by S e l COMMONWFA.L'11I OF MASSACII(1S.L'I"I'S ExFCUTIVF OFFICE, OF ElNVIRONMEWAL AFFAIRS DFPARTMLNT OF ENV1JtONMF,NTA1, PROTECTION �F ONE WINTER.STREET, BOSTON MA 02108 (617) 292-5500 000'RUDY�;OXE 350 MAIN STREET + Secretary WEST YARMOUTH, MA r'aif �" ARGEO PAUL CELLUCCI 1)AVLD B.',STRUIIS Governor 508-775-2800 /�G��timissioner KIM SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION MAP PAR PROPERTY ADDRESS: 190-204 CONNERS ROAD, CENTERVILLE- ADDRESS OF OWNER: DATE OF INSPECTION: AUGUST 23, 2000 COLDWELL BANKER MURRAY NAME OF INSPECTOR : JAMES D. SEARS I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673 TELEPHONE NUMBER: (508)775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: DATE: SEPTEMBER 1,2000 The system Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. NOTES AND COMMENTS: SYSTEM FOR HOUSE WITH INLET FROM GARAGE, FIRST HOUSE ON LEFT. SITE OVER ALL PASSES,INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM. revised 9/2/98 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIVICATION(continued) Property Address: 190-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23,2000 INSPECTION SUMMARY: Check A,B, C, orD: A] SYSTEM PASSES: X 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B SYSTEM CONDITIONALLY PASSES: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The System,upon completion of the replacement or repair,as approved by the Board of Health will pass. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) _ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate Of Compliance(attached)indicating that the tank was installed within twenty(20) years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pa pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _ The system required pumping more than four 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 revised 9/2/98 2 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 190-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23,2000 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(b)THT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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 and is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 109-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23,2000 D]SYSTEM FAILS: N/A You must indicate either"Yes"or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 16.303. The basis for this determination is identified below. The Board of Health should be contacted to Determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: N/A You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 109-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23,2000 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No N/A Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and the system has not been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. N/A As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,including the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site Has been determined based on: N/A Existing information. Ex.Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)] N/A The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. revised 9/2/98 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 109-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23,2000 FLOW CONDITIONS RESIDENTIAL: Design flow: 440 g.p.d./bedroom for S.A.S. Number of bedrooms(design) 4 Number of bedrooms(actual): 4 Total DESIGN flow Number of current residents: 0 Garbage grinder(yes or no): NO Laundry(separate system) (yes or no): YES If yes,separate inspection required Laundry system inspected(yes or no): Seasonal use(yes or no) N/A Water meter readings,if available(last two(2)year usage(gpd): Sump Pump(yes or no): NO Last date of occupancy: N/A COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: Gpd(Based on 15.203) Basis of design flow Grease trap present:(yes or no): Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N/A System pumped as part of inspection:(yes or no) NO If yes,volume pumped: gallons Reason for pumping TYPE OF SYSTEM X Septic tank/distribution boxisoil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract. Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed (if known)and source of information: UNKNOWN Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 190-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23,2000 BUILDING SEWER: N/A (Locate on site plan) Depth below grade: Material of construction _ cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: X (Locate on site plan) Depth below grade: 24" Material of construction X concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,500 GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How dimensions were determined TAPE Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) MAIN TANK AT WORKING LEVEL,INLET TEE,OUTLET BAFFLE.NOTE:INLET FROM GARAGE BESIDE OUTLET BAFFLE NO TEE. GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) revised 9/2/98 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 190-204 CONNER ROAD,CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23,2000 TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to,or at time,of inspection) (Locate on site plan) Depth below grade: Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Capacity: Gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order Yes; No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) D-BOX IS 30"BELOW GRADE,ONE LINE IN,ONE LINE OUT.BOX IS CLEAN AND SOLID. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 190-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23, 2000 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not located,explain: Type: Leaching pits,number: Leaching chambers,number: X Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number, Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS FLOWS,FLOWS ARE 34"BELOW GRADE,DRY LIKE NEW. CESSPOOLS: N/A (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(cesspool must be pumped as part of inspection) Comments:: (note condition of soil,signs of hydraulic failure,,level of ponding,condition of vegetation,etc.) PRIVY: N/A (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) revised 9/2/98 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 109-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23, 2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100'(locate where public water supply comes into house) I v.5 br I O 3� revised 9/2/98 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 109-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23, 2000 NRCS Rdp ort name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Ground water depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to groundwater 25.3 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(Must be completed) USGS WELL AI W-247 8-3-00 25.3 ZONE C revised 9/2/98 11 1 I .'`rns..u.t annwGn f r I NTH - . - s-- , ram.-• � xcra-- _ � s ;�'"�•� ,mod.. 91 73 tl M O X QJ.=3 CD C�Tco C.71CA � - -�v' y ram :. -rt--` Wchi ��-,L4 Q� 3 i1 t CD CD t --j - I.IS_- - 1I .. I I � i 61I _ i F\ 4 I I I! ;i i; r I II G C, X W=) =s CD Ul P r p r ^pN —4 0) = i �p C,3 p> (v Ntcn CY3 CD cn cn 3 � O CD - e 1 I" - o;o a 9 COMMON WE,ALTII OF MASSACI-IUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS s1, — DEPARTMENT OF ENVJRONMrNTA1., PRUTEC'ITI.ON ONE WiN'PF.R STREET, IIOS'I'ON MA 02108 (617) 292-5500 S EP oo r�l,,; f 8 .2000 TRUDY COXF, Secrets 350 MAIN STREET a'`��... /� `�'� �' ARGEO PAUL CELLUCCI WEST YARMOUTH, MA +�j _ Governor �` 508-775-2800 I IAA ;ID B. STRUIIS Kim Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION MAP PAR PROPERTY ADDRESS: 190-204 CONNERS ROAD, CENTERVILLE ADDRESS OF OWNER: DATE OF INSPECTION: AUGUST 23, 2000 COLDWELL BANKER MURRAY NAME OF INSPECTOR : JAMES D. SEARS I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673 TELEPHONE NUMBER: (508)775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper rtetie d maintenance of on-site sewage disposal systems. The system: PASSES CONDITIONALLY PASSES X FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY SV PEC ORS SIGNATURE: DATE: SEPTEMBER 1,2000 The s stem Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within thirty(30) claws f 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 4(jJ� t owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original sho Id be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. (� (� TES AND COMMENTS: SYSTEM FOR BIG HOUSE END OF DRIVEWAY SITE OVER ALL PASSES,INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM. revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIVICATION(continued) Property Address: 190-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23,2000 INSPECTION SUMMARY: Check A,B, C, orD: A] SYSTEM PASSES: N/A I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B SYSTEM CONDITIONALLY PASSES: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The System,upon completion of the replacement or repair,as approved by the Board of Health will pass. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) _ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate Of Compliance(attached)indicating that the tank was installed within twenty(20) years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pa pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _ The system required pumping more than four 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 revised 9/2/98 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART A CERTIFICATION(continued) Property Address: 190-204 CONNERS ROAD,CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23,2000 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: X Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(b)THT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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 and is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER X PRE CAST SEPTIC TANK,TOP CORNER BROKEN,TANK FILLING WITH DIRT. HEALTH DEPARTMENT MAY REQUIRE NEW LEACHING. D-BOX IS 1,500 GALLON TANK,4-PIT 2'/i STONE. I revised 9/2/98 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 190-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23,2000 D]SYSTEM FAILS: N/A You must indicate either"Yes"or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 16.303. The basis for this determination is identified below. The Board of Health should be contacted to Determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: N/A You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 4 SUBSUR.FACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 190-204 CONENRS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23,2000 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No N/A Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and the system has not been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. N/A As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,including the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site Has been determined based on: N/A Existing information. Ex.Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)] N/A The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. revised 9/2/98 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 190-204 CONENRS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23,2000 FLOW CONDITIONS RESIDENTIAL: Design flow: 440 g.p.d./bedroom for S.A.S. Number of bedrooms(design) 4 Number of bedrooms(actual): 4 Total DESIGN flow "0 Number of current residents: N/A Garbage grinder(yes or no): NO Laundry(separate system) (yes or no): YES If yes,separate inspection required Laundry system inspected(yes or no): N/A Seasonal use(yes or no) N/A Water meter readings,if available(last two(2)year usage(gpd): N/A Sump Pump(yes or no): N/A Last date of occupancy: N/A COM M ERCIAUINDUSTRIAL: Type of establishment: Design flow: Gpd(Based on 16.203) Basis of design flow Grease trap present:(yes or no): Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N/A System pumped as part of inspection:(yes or no) NO If yes,volume pumped: gallons Reason for pumping TYPE OF SYSTEM X Septic tank/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract. Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed (if known)and source of information: UNKNOWN Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 190-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23,2000 BUILDING SEWER: N/A (Locate on site plan) Depth below grade: Material of construction _ cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: X (Locate on site plan) Depth below grade: 4' Material of construction X concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,500 GALLON PRE CAST Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: N/A Scum thickness: N/A Distance from top of scum to top of outlet tee or baffle: N/A Distance from bottom of scum to bottom of outlet tee or baffle: N/A How dimensions were determined TAPE "`NOTE TANK DRY Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) MAIN TANK 4'BELOW GRADE.INLET COVER 12"BELOW GRADE,OUTLET BAFFLE,OUTLET END OF TANK TOP RIGHT CORNER PRE CAST IS BROKEN.TANK FILLING WITH SAND.TANK NEEDS TO BE REPLACED. GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construction _ concrete _ metal Fiberglass _ Polyethylene _ other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) revised 9/2/98 7 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 190-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23,2000 TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to,or at time,of inspection) (Locate on site plan) Depth below grade: Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Capacity: Gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order Yes; No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: N/A (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) PUMP CHAMBER: N/A (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 8 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 190-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23, 2000 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not located, explain: Type: Leaching pits,number: 1 Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number, Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) ONE(1)4'PRE CAST PIT,PIT 6'BELOW GRADE.COVER 32"BELOW GRADE,2'/2 STONE AROUND PIT. PIT IS DRY,WALLS CLEAN AND BOTTOM CLEAN LIKE NEW. CESSPOOLS: N/A (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(cesspool must be pumped as part of inspection) Comments:: (note condition of soil,signs of hydraulic failure,,level of ponding,condition of vegetation,etc.) PRIVY: N/A (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) revised 9/2/98 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 190-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23, 2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100'(locate where public water supply comes into house) 11 � Q' f c ;2516 r lea revised 9/2/98 10 * SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 190-204 CONNERS ROAD, CENTERVILLE Owner: COLDWELL BANKER MURRAY Date of Inspection: AUGUST 23, 2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Ground water depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar = Shallow wells Estimated Depth to groundwater 25.3 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(Must be completed) USGS WELL DATA 8-3-00 AI W-247 25.3 ZONE C revised 9/2/98 11 i 07-12-2000 11:57PM Cr_NT OST FIREDEFT 5067902385 P.02 Make application to local Fire Department I Fire Department retains original application and issues dupficate as Permit cx/25/--M 6 Mai r%�`itL Cnzarrl a v,Ye C YP�wuicea^ �'c7caixcz!a ='��xe t I APPLICATION and PERMIT !Fee:_$25.00 i l for storage tank remcsraJ and transportation to approved tank disposal yard in accordance with the prcvisions of M.G.L. Chapter 1 Section 38A, 527 CMR 9.00, application is hereby nee by: Tank Owner Name(piEar�print) Tom Shane X • a„marwa: a,,h,nd a pen»er Address 190 Connors Road, Centerville, MA I Rrert�- Cry S+ate Z:p i Company Name Advanced Environmental I Co.or'individual-_,advanced Environmental Piirt,••.�••• ! FYmt Address .—_190 Connors Road, Centerville 1{ Address _ - -- Prw7t Pon( Signature(i' p yin �_e r Signatur ,rf apply a'cr er IFC Cerurtec Other ✓ i^ i G{Certified Other . t • I ITankLocation 190 Connors Raod, Centerville sra•r.�atess ^-' Tank Gapaciry(gailcas 1,000 --Substance Lasi Storms #? Fuel ' I Tank O:rnen_;ons(Ci2^titar x length) Remarks: r � Firm transporting waste Advanced Environmental. State Lic.#_—MV5083856100 I Hazzrdous waste rnar:^:sz! E.P.A.# Approved tank J.G. GraEC _Tank yard# 03501 I 1 t Type of inert gas Tank vard address Readville, MA 1 Centerville 01920 4 City or Town _ FDIO;r Permit# _— I Jiily 12, 2000 Dale July 26, 2000 r j Date of Issue - jt 240028077 pig Se+ci ' T umber 800-322-4844 I Dig safe approval nurr�; ._ 20002- — II S;gnature r`Title of Cftc r:tensing permi�-- — 1 Atter rerroval(s)send signed by Local Fire Dept.to UST Regulatory Cempiier °Jolt;One Ashburton Place. Room 13t0,80ston,W :2,)a-1618, Fp•�G�frar�w>r19�1 ' TOTAL P.02 Town of Barnstable P# 1�-J v Department of Health,Safety,and Environmental Services I Public Health Division Date Q, 367 Main Street,Hyannis MA 02601 e,►nxareeM � rfp39. ��� Date Scheduled o �900 Time Fee Pd. �. Soil Suitability Assessment for Sewage Disposal Performed By: ,QO Eze T M, R62e j :,�E Witnessed By: DONNA _. LOCATION& GENERAL INFORMATION Location Address Owner's Name WX/ i S77,�nN,6 4. Address7�D46�I STlolivfR,1L Auc cNq�G��'o GO Assessor's Map/Parcel: 25113 Engineer's Name ,eGaEz rOeRQ7 NEW CONSTRUCTION AIR Telephone# 9'Vf-c?76'*,F6/ Land Use 7Z�S/D,f/*l7/10f Slopes(%) .Z �a 11`7 �� I Surface Stones Distances from: Open Water Body /'lf ft Possible Wet Area /.5-19 R Drinking Water Well /IJ l R Drainage Way It/ A ft Property Line ft Other ft SE.ETCH:(Street name,dimensions of lot,exact locations of test hole kerc tests,locate wetlands in proximity to holes) t�liCQ�Aq-E SD/LT(f1T -OGf}-T/071� s4 20, i o /9v �a Parent material(geologic) 6-1 Depth to Bedrock Depth to Groundwater: Standing Water in Hole: f► Weeping from Pit Face Estimated Seasonal High Groundwater rES7 T I) TE> NA:TYCII'�t 'DRSEA UNAU 6 T.W.'. "E�TA)ILE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well#_ ._._. .Reading Date:.__..--- Index Well level. Adi.factor Adj.Groundwater Level PER+G A:TION TEST'; hate rime Observation Hole# Time at 9" Depth of Perc 71 C� • Time at 6" Start Pre-soak Time @ © D Time(9"-611) End Pre-soak D 00 Rate Min./Inch LESS 7f/,4ry rrt�/� / Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant ' I ..- ... .. DEEP OB1Z�A1'tON HOE LC ;C Isle#, l . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,% ravel 9 2G 13 aia . SANo �.sy e 44 44" -0 " �"� C L Sit r L0,9^A (,4 /3L C --IzAvell 3 LoA�,.SAND DI/D (ice vN,O Gv�9T�'/2 �GO!//vTFldtsO , DEEP OBSERVATION HOLE LOG .........H Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel) .. BEEP O8SEIZA�`I01�t MOLE .....L Ilole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. C nsistenc % ravel DEEP OBSERVATION HOLE LCG Hiiile# Depth from Soil Horizon Soil Texture ..Soil Color. Soil Other Surface(in.) (USDA) r (Munsell) ' Mottling (Structure,Stones,Boulderes. Consistency,% ravel) Flood Insurance Rate Man: ivaT� CLvrE CGt+���.ye r Above 500 year flood boundary No Yes /Les?xlcTEO /7loA/T�dr�L 7 71lvF, /Woolle r Within 500 year boundary No_ Yes liF.2/'--/Ga'—/&-/ 4�90.v /N S7-4 LLA%% .4 f A Within 100 year flood boundary No_ Yes v.. Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? yes If not,what is the depth of naturally occurring pervious material? Certification I certify that on WA Y /975—(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature Date o0 The Town of Barnstable Conservation Department i639. 367 Main Street; Hyannis, MA 02601 Office 508-790-6245 FAX 508-775-3344 Robert W. Gatewood Conservation Administrator TO: Joseph Daluz, Building Commissioner ' FROM: Robert Gatewood RE: Occupancy Permit/Final inspection DATE: � Cl The following project has been granted an Order of Conditions b the Commission. Y Conservation Applicant: U)�-AAI'o.AL W- Project: Location: Map/Parcel: aS — Our Permit #: SE 3- "a3Ot 6 We would kindly ask that no AG@!aP3N0Y ; ft_.., p Final Inspection (as may apply) be granted b y Your de department until a Certificate of Compliance for the project has issued from the Conservation Commission. Your assistance is very much appreciated. �4 , M�rp ZS l No.._./.. mil--- Fizs..../42-0....._ THE COMMONWEALTH OF MASSACHUSETTS IC�0 BOARD OF HEALTH COD oS TOWN OF BARNSTABLE Appliration for 14sposal Works Tonstrnrtion thrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 1 / f61�`ocation-Address OYL S 9-P r 1- - -- -- - -----•- M r Lot t.1 t..i�lTE i Lb Owner Address a --•.............................................•-••-........._._._...................... ••----••-••--•-•---.....•-----........-•-•--..._._.........---•---••--------....•-•-•--••-•-••---- Installer Address Type of Building + Size Lot___............................ Dwelling—No. of Bedrooms_______.....________________________________Expansion Attic (fjgl Garbage Grinder 96 Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures _________________________________ W Design Flow.........26_..........................gallons per person per day. Total daily flow........z�......................gallons. WSeptic Tank—Liquid capacity_IDOO--.gallons Length__ "lvo____ Width._A-15.__ Diameter._. ---z___ Depth_ x Disposal Trench—No............I------- Width__:_$............ Total Length...'........ Total leaching area____ _________sq. ft. " Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (Y Do ng,tank (�(�� , '~ Percolation Test Results Performed b ..__ _A?C_. _____________________ Date___....... ............. aTest, Pit No. I___2.......minutes per inch Depth of Test Pit------1_Z......... Depth to ground water.AoikCoVM%SESc) Test"Pit No. 2................minutes per inch Depth of:Test Pit.................... Depth to ground water________________________ P4 •--•---•--•----•••--•-------•-•-••-••-••- -•-•--••--------•---•----------------•--•-•-......._..._..........-••-••--•------••••---•••---••••••-...---------- O Description of Soil-_-- .......................................................... t C�- U W ••-•---------------•...-----•----._...•-•----------------------------------•-----------••---------------••-•-----------------•-•------------------•••----•---•-•-----•-•-••••--•--------•-------•---•--- UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------•---...--------•-------•--------------•-----•-•--•-••••----------•-•-•••-------•--•--•-•••-----------•-•-•------•--------•---••••-••--•------•-•--•-•----•-••------•--••---- Agreement: The undersigned agrees to install the aforedescribed,Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Cbde—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce en K!,isq;��oardalth. Signed --------------- ...............................-------- Date Application Approved By -------------` .� ..................... ------ v1. .. -�.9/... Date Application Disapproved for the following reasons- ...........................................----------------------------------------------- ----------------------------------- ------------------- ------------------- -----...-----------------------------------------------------------------------.............................................................. --------- ----------------- Permit No. -------- pri �. /�— ----- D -------------------- . Issued --------------------------- ........... rv' are FEB y ( - THE COMMONWEALTH OF MASSACHUSETTS ; / J BOARD OF HEALTH �'S TOWN OF BARNSTABLE �� pphratiou for Di-gVasal Warkii Tonstrur#iou thruti# Application is hereby made for a Permit to Construct ( lC) or Repair ( ) an Individual Sewage Disposal System at: ���� Iv► 12S CEhIT�t�VIL( �..._.... ......................................... Location-Address or Lot Nob owner Address Installer Address Type of Building Size Lot....1:2-------------S Dwelling—No. of Bedrooms----- ---------------------------------Expansion Attic Garbage Grinder (�6 '4 Other—T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures = •------------------•••---------- W Design Flow...........5�..........................gallons per person per day. Total daily flow.........ZZQ........._..........gallons. x Septic Tank—Liquid capacity__kO-t ..gallons Length..`�n6-... Width...471.5 Diameter____ _________ Depth_A-Z----- Disposal Trench—No.............1....... Width.....15--_-___-__-- Total Length___- Total leaching area_3 -------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area.....¢...........sq. ft. Z Other Distribution box (V85 Dosing tank (�b Percolation Test Results Performed by.._BA_X-_TmP.4--!-(alwC.,------------------_ Date---- _____ Test Pit No. 1____!2........minutes per inch Depth of Test Pit-------IZ........ Depth to ground water_A 6 _ i£eSC:) fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................._...... 9 ............................................................................................................................................................ 0 Description of Soil.....Q-3'.I-CA!_'LA--5u65O1L___-V� 12�.-_1AYG2SC�FME�__ W L V Nature of Repairs or Alterations—Answer when applicable___________________________•_--__--______-.-------•____-_---_--___-_•_--_---____•--•--------__. . .-••-•••-------------•---•••---•-•--••---•••----•••-•••••-••----•--•-------•--••••-•-•-•............-•-•••••--•---•-------•------•--._...........---•.................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia\s-b en iss } the board of health. Signed------------------- -------------- --------- —' --------------- \ .— -------------- .__..---'----'-- -------------- Date ApplicationApproved BY � ...Q�c�,, . ---------------------------------------------------------------------- --- .--- -- .--_9/ Date Application Disapproved for the following reasons• - ------- ------------------------------------ ---------------------------..------.------. '--------------- ---- fl ---------------------.......................................------------------------------------------------------------------------------------------------- ------------................................ -------------I--. --------------------- p. Date / Permit No. --......../... .- j ---------------------------- Issued ------------�^---- Vz.-.__ n...�J Date n THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (�Ex#ifi ate,of (nomlaliartre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( k ) or Repaired ( ) by -.............. / `' °�s"o......... /-�--�------------------------------.......----------------------------------------------------------------------- /+ Installer _ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ___...... PP P �1 J`�-1- dated _, - ._�?. �'/. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE "" r.....----- --/------------------------------------ Inspector - ------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �� -� TOWN OF BARNSTABLE No... .....'.- FEE..... ..4.....r Disposal Varkii TIMMItrurtV t frrutit Permission is hereby granted----------- . . ... c, 1 ........................................................ to Construct (KC) or Repair ( ) an Individual Sewage Disposal System at No........................ QX!�1f9`?....?a_D....... '4�ds!.t Yt = ........................ Street 9 as shown on the application for'Disposal Works Construction Permit No/1.51__- Dated.... ................................ Board of Zalth DATE............-----=�/�-----•� �. FORM 36508 HOBBS If WARREN.'INC..PUBLISHERS b t , DESIGN DATA �, GT 1 �14:7 2 SINGLE_fAMILY -.-?-,'-BEDROOM NO,..GARBAGE DISPOSAL DAIL-.Y.FLOW = 110�x z = 220 G.P.D. SEPTIC"TANK = 22o x 150%0 = 33o G.P.D. USE 1000 GAL, TANK ... ,., DIS.FQSAL'/�RE,{iFl.�w'D�FF•_'�ris w n-H ZFlr�uOD SIDEWALL AREA = 14.4 S.F: ..S.F. x 2.5 = 3%oo G.P.D.. BOTTOM AREA = Z24-S.F, x 1.0 = 224 G.P.D. u o q u'✓ TOTAL DESIGN =5_84• G.P.D. z ' TOTAL DAILY FLOW = 220 G.P.D. 00 N-RATE : I' IN 'MIN. OR LESS - -- �---_ {.. . ... .PETER --�--- J.. .;.-.SULLIVAN ....RICHARD . tea:. . q � No. 29733 " BAz EReo N c �ClS i E`' a �3, xS 1-(o�J D�FFvso2: w�TFI Z'oF3/y'-��L wA_SHLT' o�J Fc-ITb 14l o F 1/sTc . TEST HOLE # : P- 76.8 �.7 l j9 / wrrur�st-o BY � Paul la►�opzs,. E� 3a2>zY., Bawl, -:.o.H. NJ Bq�-roz4�Yt,-�,.yc.. � . • �1. L L. 4-7. 4� F.G. _ ¢4- 4- 'F.G _ 44 �•'' 'TOP FND.= 44 4 �,• .r4.4 ;4 e'Z''C45�..�Eo�+7A� ¢¢ SCHED: 40 P.V.C. - `• ' INV. ..4-I' Irv. :.- DIST, INV. GAL. INV. LAY S 90' BOX 4d,6 SEPTIC o. OF TANK h-I�-v• I INV. IN SgrJA Qo71"oN tl. 38/, . qo,2 4n.4-' --T i &IZAVEl. PROFILE. NO SCALE...., CERTIFIED. PLOT, PLAN CONTKotQ> I44MR LGVCL WCquAcpvC- LAY-e LOCATION I CERTIFY THAT THE PROPOSED FOUNDATION SHOWN HEREON COMPLYS WITH SCALE 1 'I=moo' DATE ITHE SIDELINE AND SETBACK �tB, �7t 19�i REQUIREMENTS OF THE TOWN ,OF PLAN REFERENCE R9nsTAE AND IS NOT LOCATED WITHIN THE:FLOODPLAIN.- DATE : FKK7 BAXTER a NYE, INC, THIS PLAN IS NOT BASED ON, AN REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND .THE OFFSETS $ SHOWN .SHOULD NOT. BE USED TO CIVIL ENGINEERS OSTERVILLE, MASS. DLTERMINE LOT LINES, APPLICANT Lo i 'F-0 ^° PETER No ,� } l `,�pi? W/gD57-tAU_t> L/M,T r-, SULLIVAN y % / FC No. 733 ` �"+sT VA� ti4�r • P cg BAXTEA . r M No.24048 �,0D 44- _\_ 3 \� -7 �e v - r TH 1 , 39 t 44- 6cAt.c �u. 301 "�o /ao. oG ' �c ev471 G. V. D. ,. TOWN OF BARNSTABLE LOCATION 0A4t4z.S _ SEWAGE # ILVVILLAGE C E'�TU 111� IS ESS R L � INSTALLER'S NAME & PHONE NO. 4%10c� ckyaba SEPTIC TANK CAPACITY ( ©6 -0 LEACHING FACILITY:(type) (sue) -3 NO. OF BEDROOMS - PRIVATE WE OR PUBLIC WATER �U16E R OWNER .� "iZw.°u� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ( VARIANCE GRANTED: Yes No x._ • v 5s kt f : -,.. DESIGN DATA , . e .,5..IN_GLE_.FAMILY Z.'. BEDROOM N0,,GARBAGE DISPOSAL DAILY FLOW = I10 x-z 220 G.P.D.jCC Sy� J- SEPTIC`TANK .2Z0.x J.50%* USE 1000 GAL. TANK DISPOSAL FFA1 u5E (3) *'K6' FC.ow._lxFFo �oaS w rrH 2!AI?-obti1D SIDEWALL :AREA x 2.5 = 36o G.P.D.. t ls-FLSAL BOTTOM AREA ='ZZ�S.F, scAuE F, x I,0 = Z? G.P.D. TOTAL DESIGN =$s4 G.P.D. 7�i3 TOTAL DAILY FLOW = 22o G.P.D. N RATE : I" IN MIN. OR LESS - .. — .. PETER - .. STl ULLIVAN � . ..RtCHARo " ",` ¢ 19, .✓.PP. No. 29733 ti eAz r'ISTE� / +' `f'1S':r`� 4! F"FLV,0 D,FF S,r. wfCFI Z�oF3/y"-J�z vrASHEP uAsHt. TEST HOLE # :`P-.7 Ft-z:7 Iqq / s(ot,E oaJ Pc fTo�t4 �F S�sTe►�. wrrucsst-n BY PauL(AUoau., r ED B R-F-Y Baws,. o.H. 44 1+ 4 F.G = TOP FND.= 4 ' =S:�. / i //t /ice _ '�/ �'. / /f /•t. /I .. / ///r /i= i/c// .ussoi$ugSoir �� P.V.C. . ,`, 4 �ZAC4s7NEoNro�.-x_ �_4-... ..,. SC.H..ED-. 40 �bUo INV. 41 .J .DIST, INV. GAL. . INV, '•:: LAYc-z 4.' BOX 4,6' SEPTIC 40,s °F I TANK Q--o• d INV, INV. Qo7t"oM 1E.L. 3S 4o,2 4,4- PROFILE. .. .. NO SCALE:.,'; _. CERTIFIED PLOT, PLAN 4C0+VTX0L&7; 1"4MR LLVEL WGQUAgQR LAY-E _ LOCATION (2E>vT I CERTIFY THAT THE PROPOSED FOUNDATION e(LvtLLL- ) rlA_ SS SHOWN HEREON COMPLYS WITH SCALE THE SIDELINE AND SETBACK 30� DATE }=t� 71 1�j�j' 1 REQUIREMENTS'OF THE TOWN OF PLAN REFERENCE P4 PW STAWE7 AND IS NOT LOCATED' �,,�� WITHIN THE FLOODP(LAIN. DATE : BE 7 I I 1 ' G '� BAXTER a NYE, INC. THIS PLAN BASED ON. AN REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE OFFSETS a SHOWN `SHOULD N_OT BE USED .T0 CIVIL ENGINEERS DETERMINE LOT LINES, OSTERVILLE, MASS. APPLICANT �n/1NDsT2a�+u 1 PATER �yc�• 1 ,z OF vv01 W�^/�sTltA�1D L-�MITc_ wr SULLIVAN No. 2,9733 JvAk OF job, 40 RICHARD BAXTEA No.24048 �- J S1 L0 '•. i � - ` 44- - IV, \ �\ �4%. x /w 6 i 11 I .� a r r, .• � �. E A/�V q rill qj TH i l _ �oZ 3q'f 4-4 t { 6CgL.0 0 - 30 o ELX-VA7/oN'::, LY1Stz) tJ,G. V. T�). 241 ko t 41 o - r _ t ✓� AS S M aYP' > '0 � 'as r"c��, s",�f}Y a yi+.� S "e t et�•a p /y,h t� . AJ 4r sr s N! y 7 - Fv ar L Y q J. it� I 5 '`°fiS4U- 1J'k i, k•7r .3 ,3�aa4yy*4� f`!y aY�y m.s.� 2t"u{ f -a . �. + i /� ,t !i 1T s r• r F yn �'''1 r..t�^r :.yY.fS9�' 4 1�i L:.:-�..,�.j: 69, i �, s Y � h• 5 ,'� ' .'`1 `3P ,.�^,"� WIy,ta �'4},. a'lt t„ :4.X %i+,,•K�a� 3 {,. '�w�'iM q ^�i' :I3'. r J ) � :'rTr•" ft�T :,l t� "F:J '.�^sl � .y"X!• -�j�" A �.. 9^9-� 6.i� ....,t. .. W ,�� ��� �rt'r., e ,:e�Y� Ni•:° ira� !" ���A .r 1" "�.�a�S•..'�is. 4} z `, '. N �\I ! ?r.. � - 7l�!�� Y�r.�Y��9!)��• � �1F1 ; Ii� S��t:N:s.� ��,,,:, r:;_t � 4. t0 .1 :y t ?r. y f' \ .F' M %� (�y.!4a �+ta . .r...ut.,a,... ':s a ot.r s• 1 a r � .� .! -' �Lt�,i '� ! x�s.T3� l+ K C6 J[�d^+ ��`{ F-"'lt�r, �•f .,{ .. ~ aJ .. .. �aIII.�I� ." ��" �;�. 'Jk��� rytk� gf$xr! x�r o,� t•ayfC��.�3 t' '` ' 5 k1,.. ! '' ``. 5 d ^'F7�•J w I.I a ly #) y \ .. r DESIGN DATA �,� ,- l o1= SINGLE FAMILY - 2 BEDROOM NO GARBAGE DISPOSAL DAILY FLOW = 110 x z = 220 G.P.D. SEPTIC TANK = 220 x 150% = 330� G.P.D. USE 1000 GAL. TANK _.:___.__. __. . . . _ Pb4 U DISPOSAL A?,F-A — u5E (3) 4"x6' FL-w�1FFvSoRS w rrH ZAR-0u�D SIDEWALL AREA = 144 S.F.. S.F. x 2.5 = 31oo G.P.D.. BOTTOM AREA = 224-S.F. 1.0 := ZZ¢G.P:D. Cuo TOTAL DESIGN =584 G.P.D. ?$ ' TOTAL DAILY FLOW 220 G.P.D. , N RATE : I" IN MIN. OR LESS Z -g-2¢ ^� PETER - -SULLIVAN `ti A ''HARo 1:. No. 29133 - � aNCT� No.2 Qr ^QrstEa �+�4, `�F e.00 'IV �3' ¢'x� Zo�J biFtv5o2> wtTFl Z'oF3/Y -IV, wASHe�.� STo'ut.: At2ouQD A�t� I' oF a�-�+/i UAiHt� .:., �, ��;:;• ST'otil-E o rl Bc�TT'o It'l or- S YS'J'L.►j. TEST HOLE # : P- 7�S Fes.? lq9 / wmu(ESst-0 BY PAuL(AUbMs:¢E BARMY- Bates. B,u.H. QA rATz-4►)Y-z,Yc . ,4 i _e•o.p TOP FND.= 4¢FG EL. 4-7.¢ F.G. ¢4- ± / / i.///r / :i//: //cf , f - /ice7:i / f /•' ' L + /G T777727 177 ..o. + P.V.C. �• Su85 t..=14.4I Z/oEAsT.NEo� 75.P -„ l� SCHED. 40 bUG INV. .4 i trly. DIST. INV. GAL. - INV. •' LAYcZS 40' BOX 40,6' SEPTIC 40.s + TANK hIt_O• x INV. INV. sArJD Cio1T'oM EL. 38' +o,2 4o,4-' STo 0 &aAV6L PROFILE. � 3.sa' 4 NO SCALE.,.,, Ec 3� y CERTIFIED. PLOT T. PL A N CcWrXoLG) 1"4 a LEVCt- wGQu,4„cr LAY..E LOCATION I CERTIFY THAT THE PRO DOSED.. FOUNDATION SHOWN HEREON COMPLYS WITH SCALE I ''= 30, DATE THE SIDELINE AND SETBACK REQUIREMENTS OF THE TOWN OF PLAN REFERENCE ssras3t� AND IS NOT LOCATED ,,a WITHIN THE FLOODPLAIN. �.�, c�- DATE : F�7 I I � G. � BAXTER & NYE, INC. I THIS PLAN IS NOT BASED ON. AN REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE OFFSETS CIVIL ENGINEERS SHOWN SHOULD NOT. BE USED. TO OSTERVILLE, MASS. DETERMINE LOT LINES. APPLICANT ��l,N pS7-,2,�,� LI�� 7-�-p TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION V MAP NO. PARCEL NO. ADDRESS OF TANK: I/ JV/V �� $ VILLAGE: .I Number Otr�wmt A :;MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : 0s �C)� 'y ll�) OWNER NAME: _ f(p4 � f� ' 1 PHONE: INSTALLATION DATE: z BY: �� fC f INSTALLER ADDRESS: CERT.NO. *TANK LOCATION: ``nn (DtQCR�-I�t TANK LOCAT I W ITN PIK "7cT TO HU I L I Nm CAPACITY 10(- TYPE OF TANK C 6F,1, AGE' 1 YRS. FUEL/CHEMICAL l� TESTING CERTIFICATION C I PASS [ I FAIL DATE LEAK DETECTION C I CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION 06 YES CSC NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ I YES [ I NO DATE CONSERVATION EX CHECK IF "N/A DATE BOARD OF HEALTH TAG NO. C �; I DATE 3 * PLEASE PROVIDE A ,SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD ( n` ri V' �� �r�' � � �� �� "// f � y� � � - _` i i� t � �����/ •� �,r�l1 DUARTE & PERRY PLUMBING & HEATING, INC. BOX 226•MARSTONS MILLS, MASSACHUSETTS 02648.OFFICE(617) 428-3500 (#9236) December 19 , 1988 To Whom It May Concern: On or about August 1981 Duarte & Perry Plumbing & Heating,Inc. installed a 1 , 000 gallon underground oil tank at the residence of Dr.Robert Freedman located at 190 Conners Road,Centerville, Massachusetts . Installer was Joseph Duarte , Jr. Very truly yours , Clinton Perry Jr. President CP/ssp cc: Dr.Robert Freedman file I ------------- sy � co „36 FN D. tis �0 0 93 6 9• C.B. F FN D. BARNSTABLE PLANNING BOARD APPROVAL UNDER THE SUBDIVISION CONTROL LAW NOT REQUIRED. DATE: I ® 1 T 1. 87,948 S.F. k � t 5x1 2.02 Ac. 20.05 x j 4 k � t � t ��,=t j z � v l ±sue j. `• am SMM te, 44 7 � f too1 � 3j O�G 70 tK a,q mom� C.�j v k \ 7` t� DRIVEWAY O00 t a ♦ \ ,0 r XK C.B. FND. s PIA - - ;£ #, -s r Y T Y O�-.(� o Q �z N r W ox Now 4 f S t sw- M. { ra 1 Aug MW Omni FND. 700 ��6 # . 9�, _ LOCUS MAP DEEP OBSERVATION HOLE 0 1 Tat Date:Fs 7,2000; Witness:Doane Miorandi,RS,Barnstable health Dept. j �,-- 0 brasr3' � f 10 .+. I &two depth(in.) horizon texture color I Mottling other 44.4-43.9 0-6 A loam.sand 7.SY f RIM 43.9-43.6 6-9 E med.sand .SYR 641 yt 43.6-42.2 9-26 B loam.sand 7.SYR4A6 42.2-40.2 26-SO C1 med.sand 10YR6/4 �.L 0 h Y` 40.2-39.1 50-64 C2 silt loam 2.SY6/4 r 39.1-33.4 f<-132 C3 loam.sand Parent material:Glacial ontwash - U _ Depth to Groundwater: not encountered -- SC4I0: It1.+ ft. Pere.test data: tested 8 U"depth;24 gal.Passed through test hok in 10 min. L\ `� Perc.Rate=less than 5 MPI L E G E [V Nxx vy 2 �., - P2oPos6p cvnnbvQ UN@ CA 3 R>21 SO /ae5t:Rva AcsEA 3 > - r x - Exi�71 Net; eoNTt�u t2, xxet IMNO S Lr r_Lff 0AZCN5 P ran RDS� I C•o4 s e v Tc.pw I�P1W Y U N t� / Al U 5D 1 ``r�ti o Sis %Tin A( BAXFROSaD / \' �3'OFt7Ea!D SAS v_ uNCMQA;Z0UNAM LML.TV N (` 0 I I GENERAL,NOTES 1. ELEVATIONS REFER TO NGVD. ELEVATION BENCHMARK IS T11E �_115� + LEFT SIWf OUTSIDE EDGE OF THE EXISTING GARAGE SLAB. 2. ALL CONSTRUCTION MATERIALS SHALL.CONFORM TO THE. STATE SANITARY CODE,TITLE 5 AND OF BARNSTABLE: ' ! '`� `• HEALTH DEPT.REGULATIONS. 3. ANY'CHANGES TO THIS PLAN MUST IWAAPPROVED BY THE HEALTH DEPT. 4. NO PERMANENT STRUCTURES ARE P'ERMFTTED OVER THE IOA% RESERVE AREA. 5. EXISTING SEIrnC SYSTEM COMPONENTS AND DEGRADED SOIL SHALL BE REMOVED AND VOIDS FELLED W/CLEAN SAND. COMPACT AND RETURN DISTURBED AREA A NATURAL ! �4 CONTOUR LANDSCAPE AS PER OTHERS'DIRECTIVES. 6. INSTALLATION CONTRACTOR SHALL VERIFY ALL 8011.PIPE%' Ile 44 ('\ CONDITION PRIOR 1'0 MAKV#G COPtittlOC"ITON. Tf WILL BE NECESSARY TO CONNECT RL rLACE&WVT 4"!'VC,30U.PIPE AT J" THE FOUNDATION. EXISTING SURVI1S:IN TRENCH AREA SHALI. 8E SALVAGED IF POSSIBLE FOR IMMEDIATE REPLACEMENT. 7. UTILIZE DIGSAFE AND ANY OTHER NECESSARY UTILITY r7\ M.ARKOUT SERVICE TO LOCATE AND PROTECT ALL UNDERGROUND UTILITIES. (` 8. .A 5F'I. PERIMETER EXCAVATION IS REQtTIRED TO REMOVE.ALL UNSV17ALi"80111. SOIL TXST INDICATES THAT THE -f, ! EXCAVATION 15 ltiTENDED TO REMOVE T H E A A ND B SOI I" 1 HORl7:f"W&AND THE SOIL LAYERS DOWN TO AND INCLUDING THE C2 LATER AT APPROX.65"DEPTH. PROTECT GARAGE FOt!NDATlON AS NEEDED AGAINST SETTLEMENT.REPLACE EXCAVATED", L WITH CLEAN SAND CONSISTENT WITH TITLE. 5 \ F11 L.SPFC/FICATION.CONSTRUCT THE SAS IN THE NEW 9. INSTALLER SHALL rONTA(T ENGINEER Al +b0 8'16-4ift AT•Tlvtl. OF EXCAVATION TO VERIFY SOIL CONDITIONS ENCOUNTERED AND ALSO AT COMPLETION FOR SYSTEM CERTIFICATION. 10.CONTACT ENGINEER IF ANY QUESTIONS OR DOUBTS ARISE: REGARDING SOIL CONDITIONS ENCOUNTERED DURING CONSTRUCTION. 11. NO KNOWN WELLS EXIST WITHIN 200 FT.OF THE PROPOSED �. Fq ,� \i SEPTIC SYSTEM. t. �9.' _] If a � \ \.:. 12. PLAN REFERENCE: "PLAN OF LAND"BY BAXTER AND NYE,INC. `�� \ �\ J AN 31, 1994, ASSESSORS' MAP 251,PARCEL 3 DESIGN DATA III'DRAULIC LOADING - 4 BEDROOMS 03 110 GPD/BEDROOM X 4 BEDROOMS =440.0 GPD SEPTIC TASK SITE-440.0GPD X 200•h=aaoGAl PROVIDE 1500 GAL TANK. C! 1 v - ~` -------, PERCOLATION RATE-LESS THAN 5 MPI BOTTOM AND SIDEWALL LOAD RATE=0.74 GPD/S.F. SIDE.AREA:NOT APPLICABLE W1 BED-TYPE SAS - BOTTOM AREA:49' X 15.25'=747.3 S.F. CAPAC1TV: 747.3S.F.X 0.74GAL/S.F.=553 GPD . .� < F�. _., � ---- --- ---------- ------ - ------ PLAN SHOWING PROPOSED �- �-.� , .�Af _ •� ,�. �.s" s E P r k c s Y sT c- n/t p 1;->0 F 1 L E SUBSURFACE SEWAGE DISPOSAL SYSTEM NO xAL�- 0AN"O LE COVE R- MIN.01A-Z4' FOR AN EXISTING SINGLE FAMILY RESIDENCE E;w>uz.Wr UP TO WIn4iN 6" 01= 20 LAYF- Z �•-�' -� AT t=1N15HeD GRADE WYAS"eDl STONL /ri c;1. h:♦?DE 190 CONNERS ROAD, CENTERVILLE, NIA V IWO . . - --------- i LN"= 4' ��.' ' ASSESSORS' MAP 251; PARCEL 3 I OUTLt:T --_� On. PREPARED FOR .► 1// --- Rai - - --- 7 K I. c.q i� r .qr t ✓ t ns S T �''' t' `��I D .. S,� 3 >4 / L- °° f'' :' � K, RAND LTD. t 1--N Q ST INV., a , + T - _._ _: THOMAS SHANE (� _ ,,,,�,.- oy 9200 FAST MINERAL LANE, SUITE 200 s ♦ �., w �� C*, �'• 4 x b r G w n 4 4a Fc i w - �� rrs T-E..� 3 "'- r ¢�` ENGLEWOOD,CO$0112-3414 d-o BAF FLa ��N- 4 Z Vic, ._ _.� ...__ �9q'._..-__.__ - --i� Ft t v - 3 7'} 303-789-3311 < LIQUID : 0.5, or 3i'4 � 1 LEVEL "Y. _ `� 6 .. I'YZ•0 srt7NL� �i6Tt71t3uTioat Tex Z., ..:..._ _ _ -_-____._ . S' ._ .._._, ss� �/.,t 1'�! l� .Jr9vGrLE" -rvAli�c�G BELOW TANK FEBRUARY 7, 2000 SCALE - 1" =20' v - .,� _ zriv��r eLev�T�or�s 4 CY1^ d ? PREPARED BY �s r e v ' • r° + ' r ,° • (MF ALL OUTLETS Tb b.. L" -T- 0, • 0 ` • 8E TwLr �.ME 0R •T ,� r o s !, .' Ao � ° usE 2o-raTiNcT w,eR ___. � _ , .L� ' g, ` __ � { CAPE COD ENGINEERING, INC: ALL Pcrc Tp ec ROBERT M. PERRY,PE 4•c* PV.0 .TIGHT Snp'T lC_ TAnIIL OUTLETS rid we W � � d _ ���3:. 50 LELAND ROAD -TO INT csar><,ct� ____LIONS OUTLET PtPEssHaLL BB /iY✓ELL -°h'G � ..5/i , BREWSTER,MA 02631 pRGCA.ST•T2C1►yFo¢�eD �rucczETe LeVEL F2�)R AT LMAsT 7wc)k Fe.e T TEL- 509-896-4861