Loading...
HomeMy WebLinkAbout0043 COPPER LANE - Health 43 Copper Lane Centerville A=248 037 No. H163OR UPC 10259 smead.com • Made in USA ��c cip 2J COS "oT1' cam, Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M1 43 Copper Ln. ��g Z 1 u r+ti Property Address h Stacy Rotondo Owner Owner's Name -0 information is required for every Centerville Ma 02632 2/11/2019 page. City/Town State Zip Code Date of Inspection �d 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. Inspector Information S 135 filling out forms q� on the computer, use only the tab Raymond Dumas key to move your Name of Inspector cursor-do not Dumas Landscape Const. Inc. use the return Company Name key. 564 Old Stage Rd. r6 Company Address Centerville, Ma. 02632 AA City/Town State Zip Code xenon 508-509-0210 S1437 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 2/11/2019 Ins'pe-Etoest6ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 c Commonwealth of Massachusetts r= :. Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Copper Ln. u- Property Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is.replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Copper Ln. Property Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 16.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Copper Ln. u- Property Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Copper Ln. Property Address Stacy Rotondo Owner Owner's Name information is Centerville Ma 02632 2/11/2019 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. El ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Copper Ln. L� Property Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for an inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® El information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Copper Ln. Property Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: 1500 gallon septic tank, D-Sox and 2 500 gallon chambers with stone Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail 2018 5000gallons, 2017 8000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: 10/18 Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Copper Ln. u- Property Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: no records available at Barnstable Treatment Plant Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts ,@ Title 5 Official Inspection Form I. 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ti 43 Copper Ln. Property Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2006 as per plan on record Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: approx 25 ft. feet Comments (on condition of joints, venting, evidence of leakage, etc.): good t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 cam, Commonwealth of Massachusetts r: Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments emu, 43 Copper Ln. Property Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 as per plan Sludge depth: none all water Distance from top of sludge to bottom of outlet tee or baffle none Scum thickness none Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? removed cover dip tank with stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): not needed at this time t5inWdoo•rev.7/260018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .. 43 Copper Ln. Property Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 98 c Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Copper Ln. Property Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at level 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.): Inspected with camera from outlet tee on septic tank -t5insfs.doa•rev.7/26/2018 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 43 Copper Ln. Property Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: as per plan Type: ❑ leaching pits number: ® leaching chambers number: 2 500 gallon chambers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: pre cast t5insp.doc-rev:7/26/2018 Title 5 Official Inspection Foam Subsurface Sewage Disposal System-Page 13 of f8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Copper Ln. Property Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of pondng,condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official inspection form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Copper Ln. Property Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 45insp.doc'-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page f5 of 18 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Copper Ln. u- Properly Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below drawing attached separately t5insp.doc-rev.7/26/2016 Titter 5(Kfidat Inspection Fmw..SLbsorface Sewage Dispsat System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ISubsurface Sewage Disposal System Form - Not for Voluntary Assessments aa � 43 Copper Ln. Lu, Property Address Stacy Rotondo Owner Owners Name information is required for every Centerville Ma 02632 2/11/2019 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12 ft+ 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: 2/2006 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: no water at 144"as per plan ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file for upgrade 2/2006 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.70612018 Trite 5 Official Inspection Fomr.Subsurface sewage Disposal system•Page 17 of t6 0 Commonwealth of Massachusetts :. Title 5 Official Inspection Form I. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u- 43 Copper Ln. Property Address Stacy Rotondo Owner Owner's Name information is required for every Centerville Ma 02632 2/11/2019 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included 18insg.doc-rev.7/28/2018 Title 5 Official Inspection Form:SubsurfaceSewagaUisposat System-Page 18 of 18 BENCH MARK — CTR OF CATCH BASIN ELEV. = 34.0 oppER LANE 42.3 V + .8 t 5 + 44.5 C� � " 00c2 �+4 � t4r ' �12.41 y �(9 (f? �8�v �+ L 33.0 352 O\Z J -�lfL city 35.1 �L -7 42.2 42 44.6 14" TREE •0 EXIST. DwEu.. a 7 �. o / — \ TOP FNDN M 429' d O +31. LA� Vi ! FULL FNDN INVERT'OUT AT TH �� ELEV. 39.3 44.9 CO ON IERS O M DECK 42£ p� + Z 45.8 61 / + 4 d + g` + 6.8 +` SHED g" TREE al .5 / l9O d' THi c 38 r �} + 46.4 LO 10 ry v, 1 ,69 t SQ. T. y 06 t 44.2 co , 141. 55 NOTE: ONLY 1 CESSPOOL FOUND 1 r + 39.4. (.ANOTHER MAY. EXIST) ' 5' REMOVAL OF UNSUITABLE SOIL REQUIRED AROUND ACHIN FACILITY. DOWN, SUITABLE SOILMETER-OFLLLAYER. REPLACE WITH Z AN MED. SAND. 06--018 t c ri No. { Fee 00 THE COMMONWEALTH OF MASSACHUSETTS Entered inco pater: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for �Mpo5al &pg;tem Con.5tructiou Permit Application for a Permit to Construct(.Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1j13 t civ Owner's Name,Addr s,and Tel. �0 tl V tl j�-)� I � f� Assessor's Map/Parcel 76, Installer's Name,Address,and Tel.No.061 ho/®� 07 J1 ra^-rj✓' Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size d,2-. sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons ^L Showers( C`) Cafeteria( ) Other Fixtures Design Flow(min.required) _gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank , ,�"0,7 0 Type of S.A.S. Description of Soil n kgmz .✓lsll Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thi Boa H . //o /0 / Sign o Date ` ` (� Application Approved by ® Date Application Disapproved by: Date for the following reasons Permit No. Date Issued (4� 4. No. Cl t G Fee ce V r �` .. THE COMMONWEALTH OF MASSACHUSETTS Enteredmcomputer: { PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS. Yes ZippYication for Bigoogal *pgtemc Congtruction Permit Application for a Permit to Construct(p/Repair,( )`Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Ld (� p�,6R ,�an G ZVJ Owner;s Name,Address,and Tel.Np ` Assessor's Map/parcel ' /,/,7 3 6 w Installer's Name,Address,and Tel.No. 4 U /i t,^_j7 Designer's Name,Address and Tel.No. �G t�v�c707 MARfk�r�i �t�/fl���`�t1 �39� t7ryW'VG'AeZ Jew &r,.�gfR�.��,�s f� Type of Building: i Dwelling No.of Bedrooms 2.. Lot Size 12..E 6%R' sq.ft. Garbage Grinder( ) Other Type of Building Pl1 No.of Persons , Showers( /) Cafeteria( ) Other Fixtures x Design Flow(min.required) gpd Design flow provided - gpd Plan Date 2_ / / J Number of sheets Revision Date Title Size of Septic Tank 'e2 a Type of S.A.S. Description of Soils Nature of Repairs or Alterations(Answer when applicable) Date last„inspected" Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thi Board of Hea)th!� l© �� / Sign �74�� o Date 11 6 Application Approved by B �l! Date Q Application Disapproved by: Date for the following reasons I } Permit No. Dat ssue&. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS _ Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded Abandoned( )by �ca rp 2;? X©7'/ at -3 efPP L" r chi' has been co structed in ccordance with the provisions itl 5 and the for Di§posal System Construction Permit No. °'' dated 3 Installer � � ' d Designer r" —L )41 #bedrooms Appro d-design flow gpd . The issuance of this perm i sh/�11 not be construed as a guarantee that the sy'tem will fun'o des' ned: Date 9/ Inspector �' , __ No. / / C �!/ Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS %i.5pogat *pgtem Congtruction Permit Permission is hereby granted to, Construct ( ) Repair ( ) Upgrade ( V� Abandon ( ) System located at /_ 'l�f®��!` �h v P Al 7e ryi (" and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be c p&ed wftin three years of the date of thi Date / //) Approved by TOWN OF BARNSTABLE LOCATION 1-13 SEWAGE# VILLAGE �� l±,t, ASSESSOR'S MAP&PARCEL 4 I e) 3 7 INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY I�QOt LEACHING FACILITY: (type) Z-.5 Ste\ C"er.5 (size)`UO ,Z NO. OF BEDROOMS .3 OWNER PERMIT DATE: Z/101a( COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on_site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY I 4 0 g all-Is ,-u- FROM :down cape engineering inc FAX NO. :15083629880 Jun. 12 2006 07:OBAM P1 Town of Barnstable Regulatory Services Thomas F. Geller, Director Public Health Divisic►n Thomas McKean, Director. 200 Main Street,.H,yamis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# .®��a.OY� Assessor's MapTareel d Designer: Installer: d✓� / Address: �3 ���� �� �.�—------ _ --- . Address: on 3 IdA 6.1 was issued a permit to install a (date) , r (installer) septic system at'7',-, a e." ""- based on a design drawn by (address) to, dated (deli I certify that.the septic system referenced a1mve was installed substantially according tir the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e- greater than 10* lateral relocation of the SAS or any vertical relocation of any component of the:septic system) but in accordance with Stale Kc Local Regulations. Plan revision or ce d as-built by designer to follow. V ' a� ARNE H OJALA (Installer's Signature) Civic, No. 30792 &G/$TEtL����r (Desi er's Sign ) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE V/ILL NOT BE ISSUED UNTIL BOTH THI FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNST_ABLE PUBLIC HEALTH DIVISION THANK YOU Q:HealUSeptleJHesigner Certification Fawn 3-26.04.doc COPPER LA NE 112.41, PROPOSED r, ADDITION O Lo 12� 45.1' j EXISTING DWELLING EXISTING ROOFED LOT 10 CONCRETE PORCH o 12,698f SQ. FT. o 0 29.5, DECK 0 EXISTING CESSPOOL SHED W 141.55 DCE #06-014 BUILDING PLOT PLAN PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT, NOT FOR ANY OTHER USE LOCATION : 43 COPPER LANE, CENTERVILLE, MASS. PREPARED FOR: SCALE 1" = 20' DATE FEBRUARY 13, 2006 WILLIAM CAPRA REFERENCE MAP 248 PARCEL 37 PLAN BK 160 PG 89 I HEREBY CERTIFY THAT THE STRUCTURE H OF 1,f4ss SHOWN ON THIS PLAN IS LOCATED ON THE ARNE q�yG GROUND AS SHOWN HEREON. �� o H. � off 508-362-4541 " OJAL.A ai fax 508 362-9880 80 No.26348 down cape engineering, inc. ( o �aQ' CIVIL ENGINEERS ' 01� 9N LAND SURVEYORS DATE REG� SURVEYOR s39 main st. yarmouth, ma TOP FNDN. AT EL. 42.9' SYSTEM PRDEILE TEST HOLE LEGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN 6" OF FINISH GRADE DAVID FLAHERTY, RS PINE ACCESS COVER (WATERTIGHT) To ENGINEER: /42.5- -4 ,0' MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 33.0' WITNESS: DON DESMARAIS, RS RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE\ DATE: 2/23/06 J 39.3' FOR FIRST 2'EXIST. PROPOSED 1500 3' MAX. PERC. RATE _ < 2 MIN/INCH GALLON SEPTIC t38.25,GAS I TEE 30.0' CLASS I SOILS P# 11228 0 38.5' TANK (H- 10 ) BAFFLE �� 29.31 ' o O 0 O o W 0 29.17' 0 0 0 0 0 0 [] o COPPER ( 2 % SLOPE) �6' CRUSHED STONE OR MECHANICAL go , COMPACTION. (15.221 [2]) MIN. �90 2 DODO 0 0 0 0 0� 27.17 Q ELEV. Q LOCUS af DEPTH OF FLOW = 4 ( 1 2 % SLOPE) ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE ��� 34.5' 0" 32.8 3 TEE SIZES: A FILL INLET DEPTH = 10" LS 24" OUTLET DEPTH = 14" 12 lOYR 3/3 q LOCATION MAP NTS FOUNDATION- 36' SEPTIC TANK 71 ' D' BOX 16' LEACHING B LS ASSESSORS MAP 248 PARCEL 37 FACIL iY 6 37' 44" 10YR 3/3 *THE INSTALLER SHALL VERIFY THE LS LOCATIONS OF ALL UTILITIES AND ALL B BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF 7.5YR 5/8 LS SEPTIC SYSTEM 32" 31 .8' 7.5YR 5/8 BOTTOM TH 2 ELEV. 20.8' 64" C 27.5' PERC MS C PERC 10YR 5/6 MS 10YR 5/6 144" 22.5' 144" 20.8' NGWE NGWE NOTES__ BENCH MARK - CTR OF CATCH BASIN ELEV. = 34.0 �,pNE 1 . DATUM IS APPROX. NGVD (FROM GIS SPOT ELEV.) � ER +� PP a2.3 SEPTIC DESIGN: (GARBAGE DISPOSER Is NOT ALLOWED ) EXISTING _ UE51UN FLOW: 3 BEURUOMS ( '1 _GNU) _ 330 VNU 2. iViUiViCIPAL WATE` ;3 + + 44.5 USE A 330 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. ��° S� 112.41 ' + 4 SEPTIC TANK: 330 GPD (2 660 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 •� ' ) =->J p z 9-61 �� v 5. PIPE JOINTS TO BE MADE WATERTIGHT. 33.0 USE A 1500 GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. LEACHING: ENVIRONMENTAL CODE TITLE V. u, 35.2 2(30 + 9.83) 2 (.74) = 118 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT 35.1 �z o� SIDES: TO BE USED FOR ANY OTHER PURPOSE. 42.2 42 BOTTOM: 30 x 9.83 (.74) = 218 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 44.6 14" TREE 0 TOTAL: 454 S F 336 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT EXIST. DWELL. 4 •7 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED _ USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. + 31.3 / 2� TOP FNDN = o EQUAL) WISH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING SEPTIC SYSTEM �I QI o BETWEEN UNITS 11 . ALL WORK TO OCCUR > 200' FROM STREAM TH "� FULL FNDN INVERT OUT AT I ELEV. 39.3' 44.9 r- I 3 DECK ON IERS 42 LEGEND TITLE 5 SITE PLAN + 2 y 100.0 PROPOSED SPOT ELEVATION OF 16' C Z + 45.8 43 COPPER LANE + / + 4m 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: 3 8" TREE + 6.8 SHED 100 PROPOSED CONTOUR (CENTERVILLE) BARN STABLE 41.0 5 �N TIS 0 ( 100 EXISTING CONTOUR PREPARED FOR: BORTOLOTTI CONSTRUCTION/ROTONDO + 38 LO 10 ,� d + 46.4 20 0 20 40 60 1 ,69 f SO. T. �`� 1 op 0k + 44.2 BOARD OF HEALTH VL 141.55' , MA SCALE: 1 " = 20' DATE: FEBRUARY 26, 2006 M NOTE: ONLY 1 CESSPOOL FOUND APPROVED DATE + 39.4 (ANOTHER MAY EXIST) off 508-362-4541 fox 508 362-9880 OF,p(�S C 5' REMOVAL OF UNSUITABLE SOIL REQUIRED I ,�� ARNE H. �����kOFA14S� AROUND PERIMETER OF LEACHING FACILITY, o OJALA ARNE c�G DOWN TO SUITABLE SOIL LAYER. REPLACE down cape engineering, Inc. " CIVIL ti �'� H. WITH CLEAN MED. SAND. N0. 3O79Z OJALA y CIVIL ENGINEERS �p�F`�c,srE�� `�``� No,26348 LAND SURVEYORSss/0 L ENS E N- qN f c+4�v& 06-018 939 vain st. yarmouth, mo. 02675 AI>ANE H. OJALA, P.E., P.L.S. DATE