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HomeMy WebLinkAbout0065 CRANBERRY LANE - Health 65 Cranberry Lane Centerville A = 246 177 M�.uir ��pEtYC(pp UPC 12543 No.53LOR coNS°��� HASTINGS.61N c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 Cranberry Lane, Barnstable M -234 P-26 CID v Property Address tiw� Katie Van Leeuwen Owner Owners Name " information is 65 Cranberry Lane, Centerville ✓ MA 02632 October 16, 2018 ;= required for every page. City/Town State Zip Code Date of Inspection ; �t 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. Inspector Information on the computer, use only the tab Troy Williams key to move your Name of Inspector cursor-do not Troy Williams Septic Inspections use the return Company Name key. 19 Hummel Drive — r� Company Address South Dennis MA 02660 _ City/Town State Zip Code (508) 385- 1300 S1682 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'We 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 J October 16, 2018 Inspector's Signatur 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 d c Commonwealth of Massachusetts Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 1` 65 Cranberry Lane, Barnstable _ M -234 P-26 _ Property Address Katie Van Leeuwen _ Owner Owners Name information is 65 CranberryLane Centerville MA 02632 October 16 2018 required for every — page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 I Commonwealth of Massachusetts _Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Cranberry Lane, Barnstable M -234 P-26 Property Address Katie Van Leeuwen Owner Owner's Name information is required for every 65 CranberryLane, Centerville MA 02632 October 16, 2018 page. Cityrrown 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 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V � 65 Cranberry Lane, Barnstable M -234 P-26 Property Address Katie Van Leeuwen Owner Owner's Name information is required for every 65 CranberryLane, Centerville MA 02632 October 16, 2018 _ 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 El ® 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 v% 65 Cranberry Lane, Barnstable _ M -234 P -26 Property Address Katie Van Leeuwen Owner Owner's Name information is required for every 65 CranberryLane, Centerville MA 02632 October 16, 2018 page. CityrTown 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/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 c Commonwealth of Massachusetts �� -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 Cranberry Lane, Barnstable M -234 P-26 _ Property Address Katie Van Leeuwen Owner Owner's Name information is 65 Cranberry Lane, Centerville MA 02632 October 16, 2018 required for every ry _ ---- page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to an question in Section C.5 the system is considered a significant Y Y any Y 9 threat, or answered"yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 Cranberry Lane, Barnstable M -234 P -26 Property Address Katie Van Leeuwen --- Owner Owner's Name information is 65 Cranberry Lane, Centerville MA 02632 October 16, 2018 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3- DESIGN flow based on 310 CMR 15.203 (for example: 11.0 gpd x#of bedrooms): 330 gpd Description: 1 Number of current residents: — Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: N/A Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No ,000 gals. Water meter readings, if available (last 2 years usage (gpd)): 17=316=38,000 gals. Detail: Sump pump? ❑ Yes ® No occ Last date of occupancy: oat upied t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official- Mspe,ction For m .. Subsurface Sewage Disposal System Form- Not for Voluntary Assessments (F' 65 Cranberry Lane, Barnstable M -234 P-26 Property Address Katie Van Leeuwen Owner Owner's Name information is required for every 65 Cranberry Lane, Centerville MA_ 02632 October 16, 2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: N/A _ Design flow(based on 310 CMR 15.203): N/A Gaiions per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: N/A Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A Last date of occupancy/use: N/ADate Other(describe below): N/A 3. Pumping Records: Source of information: Last pumped in 2016 per info from owner. _ 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.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official- Inspection Form Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments 65 Cranberry Lane, Barnstable M -234 P-26 _ Property Address Katie Van Leeuwen — Owner Owner's Name information is required for every 65 Cranberry Lane, Centerville MA 02632 October 16, 2018 page. City/Town 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: Tank, d-box and leaching were installed on 8/1/00 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Lines were found clear at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts -- Title 5 Official. Inspection Form- Subsurface Sewage Disposal System Form -Not-for Voluntary Assessments ,V 65 Cranberry Lane, Barnstable _ M -234 P-26 Property Address Katie Van Leeuwen _ Owner Owner's Name information is required for every 65 Cranberry Lane, Centerville _MA 02632 October 16, 2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1' Depth below grade: feet 1 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 i Dimensions: 6'X10.5'X6' 1500 gallon Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 2 8 Scum thickness none Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? probe/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.): Pvc inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. t5insp.doc-rev.71M2018 Title 5 Of dal 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 b� �J� 65 Cranberry Lane, Barnstable M -234 P -26 _ Property Address Katie Van Leeuwen _ _— Owner Owner's Name information is required for every 65 Cranberry Lane, Centerville MA 02632, October 16, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet _ P 9 feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): _ Dimensions: 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 N/A 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.): N/A 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): /A Depth below grade: N -- —� Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A N/A Capacity: gallons N/A Design Flow: gallons per day t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts -- Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 Cranberry Lane, Barnstable M -234 P -26 _ Property Address Katie Van Leeuwen Owner Owner's Name information is required for every 65 Cranberry Lane, Centerville MA 02632 October 16, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: N/A — Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments (condition of alarm and float switches, etc.): N/A *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 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.): D-box was found level and in working order. No evidence of solid carry-over or backup in the past was found at the time of inspection. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 Cranberry Lane, Barnstable M -23.4 P-26 Property Address Katie Van Leeuwen Owner Owner's Name information is required for every 65 CranberryLane, Centerville MA 02632 October 16, 2018 page. Cityrrown 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.): N/A * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: - ❑ leaching chambers number: --- ❑ leaching galleries number: --- ® leaching trenches number, length: 60'X 4'X 2' _ ❑ leaching fields number, dimensions: ❑ overflow cesspool number: -- ❑ innovative/alternative system Type/name of technology: -- t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection,, Form (- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 - 65 C a nb r r Barnstable M -234 P-26 _ e Lane,a e \V� Property Address Katie Van Leeuwen Owner Owner's Name information is required for every 65 CranberryLane, Centerville MA 02632 October 16, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cunt.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil was sandy. Checked stone and found dry and clean. No evidence of hydraulic failure or problems in the past were found at the time of inspection. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection form 11.* � Subsurface Sewage Disposal System Form-Not.for Voluntary Assessments 65 Cranberry Lane, Barnstable M -234 P -26 Property Address Katie Van Leeuwen Owner Owner's Name information is 65 Cranberry Lane, Centerville MA 02632 October 16, 2018 required for every ry page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: N/A _ Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 c Commonwealth of Massachusetts Title 5 O€ficia[ Inspection-form' Subsurface Sewage Disposal System Form Not for Voluntary Assessments 65 Cranberry Lane, Barnstable _ M -234 P -26 Property Address Katie Van Leeuwen _ Owner Owner's Name information is 65 Cranberry Lane, Centerville MA_ 02632 October 16, 2018 required for every ry — page. City/Town 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 � . s- 'A � A le 01 y' .3 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form. 1 Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments. 65 Cranberry Lane, Barnstable M -234 P-26 Property Address Katie Van Leeuwen Owner Owner's Name information is 65 Cranberry Lane, Centerville MA 02632 October 16, 2018 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cone.) 15. Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth 9 9 feet th to high round water: feet _ Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: past inspection _ ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: AIW 247 Zone C 23.0' 3.1' adjustment You must describe how you established the high ground water elevation: USGS map and past inspection show groundwater at approx. 30.0'. Groundwater adjustment at the time of inspection was 3.1'. Bottom of leaching at 4.0'was found not to be located in the high groundwater elevation at the time of inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts Title 5 Official. Inspection., Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 Cranberry Lane, Barnstable M -234 P-26 Property Address Katie Van Leeuwen Owner Owner's Name information is ry required for every 65 Cranber Lane, Centerville MA 02632 October 16, 2018 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 MAY-14-2004 01 : 14 PM JCENGINEERING 508 273 0367 P. 01 - - FACSIMILE COVER SHEET '�:�;I�:j rx�j�n : i I �I� I•�III rt i �, r .. ..I�: I pit I I I .,..,i...r rli ri �•n :...,,I,L.�pI ...,.,.•411 II ... I �� .. r ... .�rv�ld•�ih il,l��l!h fb ill I. r i II IiiGlliili iir;ii !r lili,li li il�' 'i�i�li�ili•i?Pi•fiP;��IIIiI ,iql igi��i•II III 149' II i i I!,I�!�li!1,Ilil.11l�l�I!fl ,II���I�ly,Iq'�>,I�,!.lylll,,,, ,� t •I. I � ���I�I�Id ,II,�hI�, d�•„ �1,I,,i,l�l,i�,i�i1il�i:'�!tll�lil4 illil, i Ilili ,,I,�i II I I I I I , II I.I.�����I���I><�0�1�!�,,,ul�il,Illd,91rL4LL..J�,III.,lllllllllf.1.16uIV!Iillu.IL�I�1i.,:L��LI�•::.hh,III,IIIVhIIV�lllidllll6JICI!,.I>I,.,,C,J,.,I.LI�LL�L,11.11VV����,I,JI,���IGIV.LLII,IuFIILi,I�Lu�ILV��u11411�111!�U11�IlII�IIhI��IHlllllll�lllldlpld JC Engineering, Inc. Civil&Environmental Services Telephone:508.273-0377 2854 Cranberry Highway Facsimile:508-271.0167 East Wareham, MA 02538 ..........I I � i9I C:J}ji�:::i'S::. .::.i::i:;i iri p{i::i.,� II FI UI!@Ir IV '....:::::I.:Jl:gi ill I i' L�,dul> I,LI.0 I IIL....La.:::uW;l><1 .,»::e,;,.11.11 I:.:.:::�.�,...... ...........,�. .:<..:.:,:.::.,:, .P� ....:::L. . ,li:f lllbll 11 111 L III. .�..! I:.,: : :... ..�,o:,:,.:,::: .I .I �,e.,,..��..�a.,��II:II:II�II�IIILQIIIi��llll,lirl I��h���IlyIItlI,II�in�ew.III►IIIIIIIIIIIIII�IpIIIINLfIIPllfih�ll�IlldiIIiFI��.;�.� L.IPIIIIIIILL .... ,,,�,..Ill�lllll,llli�llnllhllllll IIII,':I::.!.II IIII►.I III.:: IIBII�IIIL�IN��IChl�ll�l�l��II����,�,u��lup�i:I�I�L:Ii.11.11,.'�,..,'.,�'..,I,,.I,,�,��Ilf'IJJII.LL LLNLLILI�,.,I�aN,lll.11 IIIII I>Illli TO: Barnstable Board of Health FAX #: 508-790-6304 FROM: Rebecca R. Figueroa DATE: May 14,2004 PAGES (including Cover): 2 RE: 65 Cranberry Lane, Hyannisport,MA Attached, please find a copy of the Installer&Designer Certification form for 65 Cranberry Lane, Hyannisport,MA. It is my understanding that Bob from Macomber's will sign this form at your office. If you have any questions,please contact our office. Thank you, Rebecca f i stein intormetlon that is privileged, I which it to addressed,and may w or tot the use 01 the Individual or entity a i�not the(stand°d r°elpienl,or tn°emPloYBe or 11ceb10 la-- If lha reader of this mesae4 teiaPhone,and This message is intended only p notified that mile uinimm immediately by le ocPy to the intended WOO you are hereby lease nollry uB immediately by agent Ntial and e pans b e%to deUyenng the message to V'Ove received this community 13 In error,p this commuNGetion i8 5tricdy prohibited, IF y return the original'ellmessy®e to us at the above address vie the U.S,PO6tBi SeN Ce' MAY-14-2004 01 : 14 PM JCENGINEERING 508 273 0367 P_ 02 Town of Barnstable Regulatory Services I Thomas F.Getter,Director Public Health Division Thomas Mdtasn,Director 200 Main strut,x7aaata,MA 02601 OtHa: 502-IM 46" Fax: 505-790-6304 Installer&Deaiffier Cameatlon Form Dz tet c r Jgngroccclio�,, nc. Installer: MacoMbcr Address: a Cr0v4XVr 4'0 Address: P $ox 6� �ja rr Km a53� OW; on i 3 /0 �' was issued a permit to install a ate er jj septic system at &a n be r r L a t c,n r4 based on a design drawn by s . dated Jan d d&03 - Reoed Jan 301 ;00.3 I certify that the septic system referenced above was installed substantially according to The de�' , which may include minor approved changes such as lateral relocation of the dis�tribudon box and/or septic teak. I certify that the septic em nferoaced above wee installed with mayor changes (i.e, slo of the SAS or an vertical relocation of any component greater than 10 )eterel relooation Y ' of the septic ) but in accordance with"Ate &Local Regulattens. Plan revision or oaread is-built by designer to follow. C JOHN L.. 8 1 CHUKCiiILL m JK. CN;l. No n1F.'17 P s ll� s foie Tom Q;Be� TOWN OF BARNSTABLE �. ' F G LOCATION Cf C L< SEWAGE # VILLAGE ASSESSOR'S MAP & LOT-2-qJ:-1 7Z i INSTALLER'S NAME&PHONE NO. T-A ZM A C O Z? de X -t so,1 SEPTIC TANK CAPACITY AS b D - l• 0®D - ,O fl4�P C#A M $e A. LEACHING FACILITY: (type) L e A C /0 6 �e/eL L7lsize) NO. OF,BEDROOMS 3 BUILDER OR OWNER A S � v . PERMITDATE: 11 COMPLIANCE DATE. L • Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply�We-11-apd 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 9 � /6 saq ,fJ AP, �2�r LAAVe 6 ,5 . e�ZANaeRRy _ SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3. A. Signatur ■ Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B ecelved by(Printed ame) C. ate of Delivery or on the front if space permits. 1. Article Addressed to: - D. Is delivery address different from item 1.? ❑Yes If YES,enter delivery address below: ❑No rt II I'III'I IIII I�I I I I I I I II II IIII I I II I I II I I I)I II I 3.'Service Type ❑Priority Mail Express® ❑Adult Signature ❑Registered MajlTM ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted ❑Certified Mail® Delivery 9590 9403 0922 5223 8275 33 ❑Certified Mail Restricted Delivery ❑Return Receipt for ❑Collect on Delivery Merchandise — ---- —7 Collect on Delivery Restricted Delivery ❑Signature ConfinnationTM 7 D Z 4 Z 2 D D D D D Z D 3 5 8 4 2 9 9 -3 Insured Mail ❑Signature Confirmation D Insured Mail Restricted Delivery Restricted Delivery (over$500) PS Form 3811,July 2015 PSN 7530-02-000-9053 1® Domestic Return.Receipt I USPS TRACKING# First-Class Mail Postage&Fees Paid I USPS I Permit No.G-10 9590 9403 0922 5223 8275 33 United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service. Town of Barnstable M j Health Division 200 Main Street ` Hyannis,MA 62601 I I I1�'11-1i�1'�13ii�'llrli�itii.11llil�lll�illl�itia,�tj}ltlil'I'11i' Certified Mail#7014 1200 0001 0358 4299 ,oFTMf lati� Town of Barnstable Regulatory Services BAMSTAB9 `erg Richard Scali, Director 1639. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Kurt Linden 17 Keith Road Wayland,MA 01778 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 65 Cranberry Lane, Centerville MA was inspected on September 19, 2016 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of The Town of Barnstable Rental Ordinance. The following violation(s) of the State Sanitary Code were observed: 105 CMR 410.300 and 310 CMR 15.00: Sanitary Drainage System There were a total of five (5) bedrooms observed on this property; three (3) on the main floor and two (2) within the walkout basement level of the home. One of the rooms within the basement did not have proper egress. The existing septic system (Permit# 2003-548)was designed for three (3)bedrooms not five (5) You are ordered to correct the 105 CMR 410.300 and 310 CMR 15.00 violations listed above within six(6) months of your receipt of this notice by pulling the required building permits. You are ordered to remove two bedrooms from this dwelling by removing entrance door(s) and by opening the door-way entrance to a minimum opening of four feet. This will bring the total bedroom count down from five (5) to the appropriate three (3). You are ordered to cease and desist within (24) hours of your receipt of this letter the use of the rooms within the basement as bedrooms due to the lack of.proper egress and insufficient septic capacity. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. QAOrder letters\Housing-Motel Violations\65 cranberry.doc9-16-16.docx Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH as A. cKean, R.S., CHO Director of Public Health Town of Barnstable Q:\Order letterMousing-Motel Violations\65 cranberry.doc9-16-16.docx TOWN OF BARNSTABLE BOARD OF HEALTH r ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date L Time: In Out Owner J Tenant Address Address Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal . 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here �.'.� TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION l , i; Date Time: In Out Owner �tAA.1� Tenant fAddress �7�L " Address � 5 � Y Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation .r 9.Installation,and Maintenance-of-Facilities___ 10. Curtailment of Service e 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposalj`. 16. Sewage Disposal 17.Temporary Housing ; 18. Driveway Width ' 19. Number,of Tenants Observed r PART II "'�'�''* 37. Placard ing'of Condemned Dwelling; Removal�of Occupants; Demolition I • Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) _ Person(s) Interviewed Inspector If.Public Building such as Store or Hotel/Motel specify here r No.�l)0�r=� Fee $5 0. 0 0 e. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS application for Mitpogal *pgtem Cou!5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No.6 5 C z a n t 2 z y a n e Owner's Name,Address and Tel.No.K u z.t Linden GJ -, � Ku2t Linden 17 Ke.i.th Road Assessor's ap/Parcel a 6s Oay.Land, Na3,3. 01778 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—2 7 3—0 3 7 7 a. %. Nacomgea 9 Son Inc. 5 Roundh.iii BLVD Eazt ldalzeham, 17azz. Box 66 Cen.tezv.i.eie, Na.6h. 02632 02538 Type of Building: Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other TI pe of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 0m.i;Y.ing ce'"120 o.P' . In't a"'ng 9- 1500 gaeion ze/2.t.ic .tank. 1- 7000 gaiion 12um/? cham9e2. 1-di-6bzigu.t-ion ox. - eac .cng )tieid =333. 7 gPDDESIGNING ST �`,7 E Date last inspected: THE SYSTEM WAS INSTALLED IN F,,:3-i Agreement: ACCO DKA ,('E TO PLAN. 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 Certifi- cate of Compliance has been iss ed by h' BHealth Signed Date 11112103 Application Approved by Date Application Disapproved for the following reasons Permit No. 2 00 -tY Date Issued 11 -Fee $5 0. 00 t No. -I' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t� Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Mi4pozar 6potem Con.5truction perinit Application for a Permit to Construct( . )Repair(a )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.6 5 C2 a n a e 2 R y a ripe Owner's Name,Address and Tel.No.K u a t Linden Gl��s - +runih/s.o2t, Nahh. ,f�� Kuat Linden 17 Keith Road Assessor's ap/Pazcel a b f !Jayiand, Nahh. 07778 J. Installer's Name,Address,and Tel.No.5 0 8—7 7 5— 3 38 , Designer's Name,Address and Tel.No.5 0 8 8 2 7 3—0 3 7 7 ;. lPNacomae2 & Son Inc. 5 Roundh.i2i /3LVD -Eaht Valteham, lYahh. Pox 66 Centenv.ille, Nahh. 02 32 02538 Type of Building: Dwelling XX No.of Bedrooms 33 Lot Size sq.ft. Garbage Grinder( ) Other - Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r Design Flow M'galMns per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil .s Nature of Repairs or Alterations(Answer when a plicable) Om.i.t t.i n g c e h h R o o.e h. I n h t a e e i n g 1-,1500 gaiion he/2t.ic .tank. 1-�000 gaiion 12um%2 chameea. 1-d ih n��u ion ox. - eac ing Aietd - % I 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 Certifi- cate of Compliance has been issued Vbyth' Boat f Health. Signed / Date 11112103 Application- Arr Y roved b 1/ w:�y�1_ 25 Date l! 10 rr Application Disapproved for the following reasons Permit No. ?U 03-fVao Date Issued I f. D --------------------------------------- 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 ,7. P. Nacomgen R Son Inc. at 6 5 CaanI e,,z/tu Lane 0P_.6 yuann.i.62o2t. P7ahh. has been constructed i accordance with the provisions of Title/5 and-the for Disposal System Construction Permit No. .0 bu 3— dated l t i a U Installer .7. %. r"laeomgen & Son Inc. Designer K Cn .ine Ittnq . ' The issuance of tpis pM-/.. t shall not be construed as a guarantee that the sys a ill oon as de gned. Date w 4 j 11 Inspector f c �. I----------------------------------------- No. 0 0 3 ' slit Fee $5 0. 00 THE COMMONWEALTH OF MASSACIUSETTS t f�, PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS =izpozal bpoterr Co 5truction Permit Permission is hereby granted to Construct 4)Repair( ')Upgrade( )Abandon( ) Systemlocatedat 65 C2ange2ay Lane Veht flyann.ih/ao.at, Nahh. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of thi eJit. Date:_ I I U Approved by ��• r r. TOWN OF BARNSTABLE . LOCATION S C L "SEWAGE # ut)3'J y4 VILLAGE .� e ,_ l ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. A 10 A C U Al fS eX f So,t/ SEPTIC TANK CAPACITY f 4_ d 0 A 0 0 0 ,o t1AA j G `AACHIIVG FACILITY: (type) L e A C H 1,A0 6 r/,eL b(size) NO. OF BEDROOMS .3 " - BUILDER OR OWNER iJR.A PERMITDATE: 1 3 COMPLIANCE DATE: s /=OL-/ 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)' r. Feet Edge of.Wetland and Leaching Facility (If any wetlands exist within 300 feet-of leaching facility) Feet Furnished by . y 6S c�pA�✓ B c'�R y �AAle COMMONAVEALTH OF MASSAC14USETTS y EXECUTIVE OFFICE,OF ENVIRONMENTAL AFFAIRS ' DEPARTMENT OF ENVIRONMENTAL PROTECTIO,- $ 9 ONE WINTER STREET. BOSTON. MA 02108 61 292-5500 A WILLIA�7F.l�ELD A UG TRUDY C Govcmu! 350 MAIN STREET 3 199�ecr ARGEO PAUL CELLUCCI WEST YARMOUTH, MA TO E0�gq g11D B.ST Lt.Governor 508-775-2800 H�fPT. FComm r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM A ~ PART A g '� CERTIFICATION t eMr,Aut tte, PROPERTY ADDRESS: 65 Cranberry Lane,W. Ilya i9ped ADDRESS OF OWNER: DATE OF INSPECTION: August 7, 1997 Jason Wiseman NAME OF INSPECTOR : James D. Sears 421 Waverly Ave, Newton, MA 1 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: August 7, 1997 The system Inspector shall submit a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: X 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 b the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or NO). 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. Page 1 of 10 (revised 04/25/97) DEP on the World Wide Web:http://www.magnet.state.ma.un/d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (.CONTINUED) Property Address: 65 Cranberry Lane,West Hyannisport Owner: Weisman,Jason Date of Inspection: August 7, 1997 B] SYSTEM CONDITIONALLY PASSES(continued) 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 pass inspection if(with approval of the Board of Health). Describe observations: 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 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 envirogmeot. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT 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 APPROPRIATE) 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 to 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 nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation no$t valid). 3) OTHER (revised 04/25/97) Page 2 of 10 i a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 65 Cranberry Lane,West Hyannisport Owner: Weisman,Jason Date of Inspection: August 7, 1997 D] SYSTEM FAILS: You must indicate either"Yes" or"No" as to each of the following: N/A 1 have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.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 '/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped Any portion of the 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: 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: N/A 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 bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 65 Cranberry Lane,West Hyannisport Owner: Weisman,Jason Date of Inspection: August 7, 1997 Check if the following have been done: You must indicate either"Yes" or"No" as to each of the following: Yes No X 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 manholes were uncovered, opened, and the interior was inspected for condition of 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: X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. X Existing information. Ex. Plan at B.O.H. N/A 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)] (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 65 Cranberry Lane,West Hyannisport Owner: Weisman,Jason Date of Inspection: August 7, 1997 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g.p.d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 2 Garbage grinder(yes or no): YES Laundry connected to system es or no): YES Seasonal use(yes or no) YES Water meter readings, if available(last two (2)year usage(gpd): 94-5 119,000/95-96 90,000 Sump Pump(yes or no): NO COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gallons/day 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: 5-93 System pumped as part of inspection:(yes or no) YES If yes, volume pumped: 1,500 gallons Reason for pumping PART OF INSPECTION, CHECK FOR GROUND WATER TYPE OF SYSTEM Septic tank/distribution box/soil absorption system X cesspool X Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? 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 04/25/97) Page 5 of 10 n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 65 Cranberry Lane,West Hyannisport Owner: Weisman, Jason Date of Inspection: August 7, 1997 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: N/A (Locate on site plan) Depth below grade: Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) If tank is metal, list age Is age confirmed by Certificate of Con9pliance (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How dimensions were determined 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.) 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 04/25/97) Page 6 of 10 e h SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 65 Cranberry Lane,West Hyannisport Owner: Weisman,Jason Date of Inspection: August 7, 1997 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: Design flow: gallons/day 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: J 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 04/25/97) Page 7 of 10 n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 65 Cranberry Lane, West Hyannisport Owner: Weisman, Jason Date of Inspection: August 7, 1997 SOIL ABSORPTION SYSTEM (SAS):X (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: BLOCK C-POOL, 8' DEEP, 20"WATER, NO HIGHER WATER MARK, COVER TO GRADE ONE LINE IN, NO TEE Type: leaching pits, number: 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, condition of vegetation, etc.) MAIN CESSPOOLS: X (locate on site plan) Number and configuration.- Depth-top of liquid to inlet invert: 8" Depth of solids layer: 6" Depth of scum layer: 1" Dimensions of cesspool: 8'DEEP Materials of construction: BLOCK Indication of groundwater: NO 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.) BLOCK POOL COVER TO GRADE ONE LINE IN, NO TEE, ONE LINE OUT, OUTLET HAS TEE MAIN POOL AT WORKING LEVEL. NOTE: BROKEN COVER SHOULD BE REPLACED. 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 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 Cranberry Lane, West Hyannisport Owner: Weisman, Jason Date of Inspection: August 7, 1997 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) R a7� 0 doi.f- 0 Q 7 0 (revised 04/25/97) Page 9 of 10 'i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 Cranberry Lane, West Hyannisport Owner: Weisman, Jason Date of Inspection: August 7, 1997 Depth to groundwater 9 feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained fro Design Plans on record X 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 Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) HAND DUG TEST HOLE. BOTTOM OF POOLS 1'ABOVE GROUND WATER. (revised 04/25/97) Page 10 of 10 h - TOWN OF BARNSTABLE LOCATION �-� C� AAol,6£'ki(',�' Z.,v SEWAGE # VILLAGE bd —/ $ePT ASSESSOR'S MAP & LOT S�(� " 0 7 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY d` ,Lae�c (' Pools LEACHING FACILITY:(type) (size) NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER LV iE 15 12 41v DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No .' .11117/3 d4o I - 6 y• 0 s TOP OF FOUNDATION = 1 01 .20' 2" PVC TEE FINISHED GRADE OVER 4" SCHEDULE 40 PVC MIN. SLOPE 1% FINISH GRADE OVER LEACHING FIELD= 1 00.00' - 99.75' i GENERAL NOTES PROVIDE PRECAST CONCRETE EXTENSION PROVIDE PRECAST CONCRETE EXTENSION D-BOX = 1 00.00' RISER WITH CONCRETE COVER TO WITHIN 3/4" TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE SLOPE @ 2% MIN. OVER SYSTEM RISER WITH CONCRETE COVER TO WITHIN REMOVABLE COVER 6" OF FINISH GRADE OVER OUTLET COVER 6" OF FINISH GRADE OVER OUTLET COVER 2" SCH. 40 5" DIA. OUTLET(S) 2" OF 1/8" TO 1/2" DOUBLE WASHED STONE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION IFINISH GRADE @ FND. EL.= 99.80' FINISH GRADE OVER TANKS EL.= 98•5' TO 99.1' - - -"- METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE TO D-BOX ------------ - --------- - -`� -- ---------- --- - ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. 20" MIN. ACCESS COVER 4" PVC OUT TO 4" PVC PERFORATED PIPE T (TYPICAL FOR 3) 36"MAx. 36"MAX. LEACHING FACILITY ° TOP OF S.A.S. = 98.98'- 98.87' SLOPE AT .5 /° 9" MIN. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD EXISTING 4" C I PIPE j 98 37' 36" MAX. OF HEALTH AND THE DESIGN ENGINEER. 4"scH. END CAPS 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL 6" 3" 2" DROP MIN. 3„ 4o Pvc SLOPE 2/o min. T 9" BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. PROPOSED 3" DROP MAX. SLOPE 1%min. 4" SCH. 40 PVC 11 SLOPE ® 1� min. 4 10" 1 I L=3' O O L = 10' (MAX) ---- ------- ----- ------- -- --- -, �., - -- Y. - POSED FINISH GRADE SHALL NOT BE LESS THAN EX. INV. e. T 6' � rri � 1.: ; � 48 14 ALARM ON ,� I:.: ... i ------------------------------------------------------------ =;-=�----�- � y`• •'-==- - �'�- �-� ' ELEVATION = 98.87' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS i LIQUID ! _-' (/ -0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 �clx, r3 �•Y 1 96.7 \\ �� __� I t {: � �;. t- - Y; r A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF LEVEL R PUMP ON ! 98 58 i THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 96.7 INLET TEE -� o o I r r., I j � � r y I E�.,EFFECTIVE 98.75 � i rr •:- - I ,' r'}: r ,�Yr i l DEPTH 5 SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 97.00 /PUMP - If BAFFLE 6" CRUSHED STONE , BOTTOM OF FIELD TO BE LEVEL OUTLET OVER MECHANICALLY 98.48 4' 6' 6' 4' 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. TEE 96.70' COMPACTED BASE VARIES GAS BAFFLE 20. 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED \_6" CRUSHED STONE 5 OUTLET DISTRIBUTION BOX PRIOR TO BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND LENGTH 10'-6" WIDTH 5'-8" DEPTH 5'-7" OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE 97 87' READY FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED COMPACTED BASE BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= 92.87' WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH. 15 ] OOO GALLON PUMP CHAMBER PIPES TO BE LAID LEVEL. 5' MIN. TANKS SHALL BE INSTALLED ON A LEVEL STABLE BASE CROSS SECTION VIEW TYPICAL FIELD PROFILE FIELD DETAILS FIELD END VIEW 8. ELEVATIONS BASED ON ASSUMED DATUM OF 100.0' MSL OBTAINED 1500 GALLON SEPTIC TANK 1000 GALLON PUMP CHAMBER DISTRIBUTION BOX DETAIL FROM NAIL IN RETAINING WALLAS SHOWN ON PLAN. NOT TO SCALE I 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION NOT TO SCALE NOT TO SCALE THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE _-_.____ - ---- ------- - ------ - AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY �+ DISCREPANCIES S TO THE DESIGN ENGINEER. / ABANDONDED CRANBERRY m. �: - TEST PIT DATA 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE CB/FND // ^ "� -. BSC2 BOG CHANNELS � � �' � r / B9�4 � � ��` STRUCTURES SHALL BE MADE WATERTIGHT. cfl BSC8 BSC7 �..- ��. r,. �,I;" I � � ! PERC. NO.: P10,348 4 § w E - €3 „Aa { � .,, fi y � f INSPECTOR: David W. Stanton, R.S. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR 3 : {� u Y PROPOSED SILT FENCE/HAYBALES / ,� V /- BSC1 '1 I� at ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN O / BSC9 .,, ._ SOIL EVALUATOR: Samuel Philc,s Jensen SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. y� m:, EE ... DATE: October 17. 2002 z 7t s .._. m �15 S'6 o� �.�� `�.... ��. + �' � � '' �� � ;.. ;� ,.,:; TEST PIT#: 1 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS Q BSC10 20� _... y��" BSC110 I p + , J N/F HOUGHTON .� 7S 4F ' 0` LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH A 0' .....\ �; , , � � , ELEV TOP = 98.37' a', CASE THEY SHALL WITHSTAND H-20 LOADING. 14 o WF13 I ELEV WATER= 92.87' PROPOSED \ 7I 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND o �. r , I - I 11 - � k�; FINES. S. y° o .x €r � 1I PERC RATE = < 2 Min/In (Assumed) "' ! DISPOSAL '�r REMOVE AND REPLACE UNSUITABLE MATERIAL FIEL cn BSC109 OF N/F FLETCHER DEPTH OF PERC - N.A. 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND 5'AROUND AND BENEATH LEACHING FACILITY / ,��M. - 4T.:; I`v, UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES WF12" R �i �. . , µw . �� i �; , , TO ELEV. 94.79'WITH CLEAN, COARSE SAND / F '� OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN 6� TEXTURAL CLASS: 1 MAP 246 , V r, BSC107 �,., � " I at '� COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN PARCEL 177 - \ \ } 1 0 98 37 ACCORDANCE WITH 310 CMR 15.255(3). 5074 S.F._ / I / �h �� fyo / BSC106 ''« Fill 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES IS IBUTION X �h � � FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. ' } `I� fs° ��� 1 q } i / EO-L ER �' a ,I 4 26" 96.20' 16. PROPOSED PROJECT IS LOCATED WITHIN: / TOP ELEV�tON 99.Q0 _� I � Loamy Sand N/F SNIESKA / WF10 BOTTOM ELE tON 95.50' .,u. �, A ,'' �� ) j ` 10YR 4/2 ASSESSORS MAP 246 PARCEL 177 ; . !1 r PF C I OSEL KEYS NE: �RETAINING ff�}t�@ �, I ���� .. � � � ����"���� ��. � 33" 95.62' EXISTING CESSPOOLS TO BE ] WALL T, TOP ELEVA ION OF 99.50 ���� .• �` _ [ I� .,, �����s��, � ;�� � �� - I �, , � Loamy Sand 17. OWNER OF RECORD: LINDEN, KURT J & SUSAN M TRS PUMPED AND FILLED WITH - / INSTALLED AS PER C�1A UFACTURER� �f;�� ;:9l� �� � t �f�� �.i sk r.F "mow:.>,, ,,,,., f ...- I k CLEAN SAND I `�21 SPECIFICATIONS ,' (1 ] '1 ( k _. t { - B 10Yk 5/8 `r ADDRESS. 17 KEITH RD IF9 r 95.6 � �0� I (�� �yi 43" 94.79' WAYLAND MA 01778 N/F TYLER C Medium Sand I / 2.5Y 6/4 I / 118. PLAN REFERENCE: BOOK 76 PAGE 1 f LOCUS PLAN _ -vn-.. ., --~'� Soil Mottling .r _ 66" - 92.87' ] / \ 2.5Y6/6 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. W�8 cP SCALE. 1 = 1000 108 Ob ____d 89.37 20 L s0� - _.._ ._... �, __.______._____. _ __ .__.. __ ____.___.__.-. __.._ ro Observed ! PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY Groundwater i - - o 120" 88 3T i FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY ] _ ,' .9 INSTALL 1 PVC CONDUIT TO HOUSE FOR WIRING FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. WITH WATERTIGHT JOINTS. WIRE HIGH WATER ALARM TO B.M. ] .. I FLOAT TO GP 2000 HIGH WATER ALARM PANEL. Nail in Top of Wall I 65 CRANBERRY \ Elev. = 100.00' I EXI TING 3-BDRM DWELLING \ NEMA 4 JUNCTION BOX CORROSION RESISTANT HOISTING CABLE 7 x 19 STAINLESS STEEL Assumed / T.O.F. = 101.20' j 7 ROPOSED PUMP \ & LIQUID-TIGHT CABLE CONNECTORS SUPPORTED 1/8" DIA. / 1,760 LB. STRENGTH LEGEND / _ 1 CHAMBER CONNECTORS SUPPORTED BY 1-1/4" PVC ' f CONDUIT, JOINTS TO BE MADE WATERTIGHT 2"BALL VALVE w/UNIONS SCH. 80 PVC EXISTING SPOT GRADES ROPOSED 1500-GAL x 50 \ GEORGE FISHER CO. MODEL NO. 560 50 EXISTING CONTOUR SEPTIC TANK \ 6" 3" 2"SCH. 40 TO D-BOX WF6 `"' 7,' 50 PROPOSED SPOT GRADES f ] _ "SCH. 40 TEE w/ CLEAN-OUT CAP ALARM ON E PROPOSED CONTOUR PUMP ON 'yan ;` % o - E/T/C - EXISTING ELECTRICAL UTILITIES c\vWFS ;' ; uMP N 2" BALL CHECK VALVE SCH. 80 PVC �� CO 100 P.S.I. FLOWMATIC MODEL No. 208S I z h CD - (-I(�j EXISTING GAS LINE \ t �? ----•---•-••--- EXISTING WATER LINE PROVIDE 2 -WIDE ANGLE FLOATS: o „ f 1/4 WEEP HOLE IN DISCHARGE PIPE / FLOAT NO. 1: PUMP ON/OFF (BARNES 073618) TEST PIT LOCATION ` FLOAT NO. 2: ALARM ACTIVATION (BARNES 073612) 2°' SCH. 40 PVC DISCHARGE PIPE WF4 r' tf ,� BARNES SE411 PUMP A H.P. 115 V PROPOSED SEPTIC TANK t Q d 2" DISCHARGE PASSING 1-1/2"SOLIDS STAKED AND PUMP CHAMBER, PUMP&ACCESSSORIES AVAILABLE AS A UNIT OR EQUAL 4" SOLID SCHEDULE 40 PVC PIPE 1 k ENTRENCHED SILT FENCE THROUGH WIGGEN PRECAST CORP., BOURNE MA. (800)564-6774 �, / 0 DISTRIBUTION BOX WF3 / / STRAW BALE PUMP &ACCESSORIES AVAILABLE THROUGH WILLIAMSON ELECTRIC (781)444-6800 � �/`�' ROSION/ j ------ -- 4" PERFORATED SCHEDULE 40 PVC PIPE 4 lu ;1f / 1" X 2" X T OAK '5'- SILTATION I 1000 GALLON PUMP CHAMBER� �cf � � FENCE TO BE PROPOSED SILT FENCE/HAYBALES 7 p.. BEANPOLES, /\ / �,' 2 PER BALE INSTALLED --__....__-.__..___ _..._... _........ .._- kill/ I I- y BINDING WIRE DESIGN DATA \ / N/F WHITAKER SEDIMENT OR TWINE LADEN 1 JANUARY 30, 2003 SPJ JC CONNECT HAYBALES ,. / RUNOFF USE NEW 1500-GALLON SEPTIC TANK DOSING & STORAGE REQUIREMENTS ._ REV. DATE BY APP'D. DESCRIPTION WF1s- p� FILTERED (!( /I l r� WF1A f� � ©` Ilk RUNOFF / !( NUMBER OF BEDROOMS 3 (ASSESSORS) DESIGN FLOW: 330 GPD PROPOSED SEPTIC SYSTEM UPGRADE � PREPARE _A NUMBER OF PERSONS 3 DOSING REQUIRED: 4 CYCLES / DAY ZHColj D FOR: DESIGN FLOW 110 GAL/DAY/BEDROOM 330 GPD/4 = 82.5 GAL/CYCLE a JOHN \ � KURT LINDEN 7� TOTAL DESIGN FLOW 330 GAL/DAY CHURCHIt.L --- - - G� `"y ="J CROSS SECTION OF SILT FENCE DISTANCE REQUIRED BETWEEN PUMP crviL LOCATED AT J - N.T.S. DESIGN FLOW X 200 % = 660 GAL/DAY I ON AND PUMP OFF FLOATS: 41e07 65 CRANBERRY LANE 82.5 GAL/CYCLE =250 GAL/FT = .33 FT/CYCLE (USE .50' TO PROVIDE FOR BACKFLOW) HYANNISPORT 8.2' INSTALL DISPOSAL FIELD STORAGE REQUIRED ABOVE WORKING LEVEL: 330 GAL. 30103 STORAGE PROVIDED ABOVE WORKING LEVEL: 625 GAL. SCALE: 1 INCH = 30 FT. DATE: JANUARY 2, 2003 FEET O N622� <'; ,? 'sj o BOTTOM CAPACITY o 1s 3o so 1zo 6 600„ [( LENGTH x WIDTH ) -VOID] x (.74 GPD/S.F.) = GAL/DAY BUOYANCY CALCULATIONS ---- �'- �- -� 500, 4' [ (29.4' x 20.0') - (0.5 x 13.0 x 21.2)] x (.74 GPD/S.F.) = 333.1 GAL/DAY PREPARED BY: 29 4' PUMP CHAMBER: N/F MAROTTA TOTAL LEACHING AREA = 450.2 S.F. HIGH GROUNDWATER EL=92.87' JC ENGINEERING, INC. SITE PLAN BOTTOM OF PUMP CHAMBER EL. =92.20' 5 ROUNDHILL BLVD. DISPOSAL FIELD DETAIL WATER DISPLACED=(92.87'-92.40')X 4.8 X 8.5=27.3 C.F. SCALE:1"=30' WEIGHT OF DISPLACED WATER=27.3 C.F.X 62.4 LB/C.F.=1704 LBS. EAST WAREHAM, MA 02538 0 15 30 60 120 FEET WEIGHT OF H-10 1000 GAL. PUMP CHAMBER=8,300 LBS. 508.273.0377 N/F QUINTILIANI ( 8,300 LBS.> 1704 LBS_ (ACCEPTABLE) ____ i - - II Also,chamber will maintain a 1'septage level below pump off float. Drawn By: SPJ Designed By: SPJ Checked By: JLC JOB No.266