The URL can be used to link to this page

Home My WebLink About0055 DONEGAL CIRCLE - Health 55 DONEGAL CILC�E, CETR LL A= i e i i! A lll_ J��`Y�O��+ ////n�cuc® UPC 12534 ' No.2153LOR , HASTINGS,UN i r t No. ® Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21pplication for 33i.5pozal i§p$tem Con!5tructiott permit Application for a Permit to Construct( ) Repair%/) Upgrade7 ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No., p ��1 ( vL_ Owner's Name,Address,and Tel.N� (fin Assessor's Map/Parcel �,y Installer's Na r�g Address and Tel.No ��/! "4f D �ner's Na ss a d a e ;el. o.V141 �e� �S' -cv2 Ala V &�� Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other. Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank7 Type of S.A.S. .y Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: �&l vs Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board/ofH h. Signed Date Application Approved by Date —f C) Application Disapproved by: Date for the following reasons Permit No. 90 10 — 3c4 Date Issued l f a ,. No. / f V J `,7 a zgf �� /V V Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(ppIication for � gpozal *pgtem Congtruction Permit Application for a Permit to Construct( ) Repair ta�O Upgrade ) Abandon( ) ❑Complete System ❑individual Components Location Address or Lot No. �D� ��vv� v{� Owner's Name,Address,and Tel.N �/�- /� � Assessor's Map/Parcel (/ Installer's Name Address and Tel No. lhfi / �/ �/ De igner's Name and Tel.No. �MA7% i fC/, fJjt*'�1`��'. 4/,� Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �� gpd Design flow provided " gpd Plan Date Number of sheets Revision Date Title r Size of Septic Tank P � f7_.�� fQ©� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ` �J — j� Date last inspected: j Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Z Z Signed , Date Gam' Application Approved by Date _Application Disapproved by: Date for the following reasons Permit No. 90 l 34 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance + THIS IS TO CERTIFY,that the On-site Sew e Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by / � ` at / a has been constructed in accordance �with the provisions of Title 5 and the for Disposal System Construction Permit No. U t C 7 2!L-(% dated rI 3-f c) Installer4 Designer #bedrooms `� Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will ffu cTton" a�gneyd. Date f f� `/� Inspecto No. 0 to _31 1 _ -- Fee ( THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS 'WigPogal 6pgtem Con!9truction Permit Permission is hereby granted to Cojistruct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at Uijf �� (Z11,2 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. f� Date Approved by /� Town of Barnstable VE'a` .� Regulatory Services Thomas F. Geiler,Director • BARNUABL&. + 9�A1ALAS& ,� Public Health Division ``�► Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form el Date: Sewage Permit# �ksIs sor's Map\Parcel Designer: >v,vYeA Installer: Address: TO R4X vlq Address: 02� � On �, " was issued'a permit to install a ( ate) (in6;t� tall r) se, is system at �� based on a design drawn by (address) G�YY? , VV dated 1Z ;L'I (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the • distribution box and/or septic tank. V 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 State & Local Regulations. Plan revision or certified as-built by designer to follow. 4F Mq DAft qF V Installers Si (Installer's Signature) � No: 1140 RfGIStE�� I l SOITA��t'� Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BA TABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU 0 Q: Heahh/Septic/Designer Certification Form 3-26-04:doc TOWN,OF-BARNSTABLE LOCATION��5—J2��,�� , SEWAGE#JZO/l' " VILLAGE[�rW;e VZZ/EASSESSOR'S MAP&PARCEL,/46/"' � INSTALLER'S NAME&PHONE NO.ZVII1 SEPTIC TANK CAPACITY A,!575 % LEACHING FACILITY:(type)�6� rD.DGr ./5 (size) $� �° 2( � . NO.OF BEDROOMS e_t2 OWNER PERMIT DATE: 0 COMPLIANCE DATE: 9113116 Separation Distance detween 04. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within w 300 feet of leaching facility). �� /V Feet FURNISHED BY u O Sf r �- �/ � � F- � ;:�: �- ... J t.:.` _/ - I • Town of B'r nstable. P# Department of Regulatory Services C . Public jaealt'h Division Date ° sreere. pose. i63q Mee$ 200 Main Street•,Hyannis MA 02601 !fp M12I { 'Time Fee Pd. (y Date Scheduled I i I it Suitability AssessMent for Sewage Di posal � Performed By: vim'r1( �A v �" ` Witnessed By: U LOCATION & GENERAL INFORMATION �f Location Address S S ©N (7�(- U�'( Owner's Name F&f)- i{vME tA•� '"-� co Address suo JbtiEs g cl 0& Assessor's Map/P4rcel: + /624 Engineer's Name Dck- f�NEW CONSIRU(. ION REPAIR j Telephone# Land Use Slopes(%) 4 Surface Stones Distances from: Clpen Water Body ft Possible Wei Area > Ott Drinking Water Well > ft i Drainage Way > n ft Propsrty Lincft Other ft SKETCH:(Street name,dimcnsiods of lot.exact Inentions of test holes&perc tests,locate wetlands in pr�ii ty to holes) N55'10'35"W 137.UU' i \ o LLJ o ��Pyote � 0. ' C ) ' GJG� 9�0;; QP6�Po ao U 11 27.30''; 3 c 1 O a _�� in ! W N N DECK J z ASPHALT DRIVE M Q vj, � GRAVEL 1 2 . a4_9_t— i N55'10'35"W 137.00' Parent material(gecilAgic) (�� '� "' ' "OS� I Depth t0 Bedrock I Weeping from Pit Face Depth to GroundwaWr. Sta ding Water in Hole:'' I l n 1 P g Estimated Seasonal Nigh Groundwater DItT`ERM NATION FOR SEASO!,NAL HIGH WATER T"LE Method Used: I ln. In. Depth td S0II M0ttl9S; 1k Depth (bperved standing in obs.hole: P ient Depth to weeping from side of obs.hole: ! in. O.Actor ntei AdJuBt dj, i ! A .faelor.�.._.r� AdJ.fJrraundwaterlevel.,,,,e. Index Well# Reading Date: Index Well levzl I PERCOLATION TEST . D$te-�— �`4ne Observation - I Time lit 9" ILL ------ Hole# I 1 Time at 6" -- Depth of Pere Time(9"-6" Start Pre-soak Time.@ I I't77— ) — End Pre-soak Rate MinJInch 1 ! X Site Failed;_— Additional Testing Needed(YIN) Site Suitability�Assessment: Site Passed - Original:,Public#lalth Division Observation Hole Data To Be Completed on Back---- ***If percola�ibn test is to be conducted within 100' of wetland,'you must first notify the Barnstable C6 4servation Division at least one (1)wedk prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface from (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel Li Moll &lc 2. c DEEP OBSERVATION HOLE LOG Hole#_Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel) �1 - 21 —..31'l cilvl CW1 c DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEP SERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color $all Other Surface(in.) (USDA) (Munsell) ottling (Structure,Stones,Boulders. Consisten ravel) F Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No 7 Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring per ' material exist_in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification ) I certify that on l (date)I have passed the soil evaluator examination approved by the Department o nvi nmental Protection and that the above analysis was performed by me consistent with the required - ain ,expertise and experience described in 310 CMR 15.01 . Signature �&W, Date L� Q:\SEPTIC\PERCFORM.DOC Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System-Form -Not for Voluntary Assessments 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is Centerville MA 02632 June 30, 2010 required for every,page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Impotent: A. General Information When filling out / forms on the computer,use 1. Inspector: �(J only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co Company Name 189 Cammett Road Company Address Marstons Mllls MA 02648 m City/Town State Zip Code 508.428.1779 S1 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority Li �- June 30, 2010 Job# 10-164 r''3 Vpectorr—'sSig nature Date k c The system inspector shall submit a copy of this inspection report to the Approving Authority(Board rn of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the o CM report to the appropriate regional office of the DEP. The original should be sent to the system owner a I and copies sent to the buyer, if applicable, and the approving authority. 3 n tom- c-=-4***This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i Co monwealth of Massachusetts Ti le 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Dyne al Circle Prope y Address Federal Home Loan Mortgage Corp Owner Owner's Name information is required for Centerville MA 02632 June 30, 2010 every page. CitylT(iwn State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: El 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: i i B) System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. Y ❑ N ❑ ND (Explain below): i i i I 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is Centerville MA 02632 June 30, 2010 required for State Zip Code Date of Inspection every page. Citylrown P P B. Certification (cont.) B!) System Conditionally Passes (cont.): Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): i �I ❑1 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): I i C) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board, of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or.a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is required for Centerville MA 02632 June 30, 2010 every page. cityrr6wn State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Ej The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3; Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ' 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is Centerville MA 02632 June 30, 2010 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 well. El ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is Centerville MA 02632 June 30, 2010 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is required for Centerville MA 02632 June 30, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is required for Centerville MA 02632 June 30, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: . Unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared.system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is required for Centerville MA 02632 June 30, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 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.): Septic Tank (locate on site plan): 8° Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 3" t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is required for Centerville MA 02632 June 30, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness 2" 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 12" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level currently at bottom of outlet invert, observed solids on top of outlet baffle indicatinf hydraulic failure. 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 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is required for Centerville MA 02632 June 30, 2010 every page. Citynbwn State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-09l08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is required for Centerville MA 02632 June 30, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Previously full to top. 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.): 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins•09l08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4M 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is required for Centerville MA 02632 June 30, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: One 6x6 pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching pit was half full at time of inspection with staining to top of riser. Pit is in hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 113 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is required for Centerville MA 02632 June 30, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 ` <L\ Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is Centerville MA 02632 _ June 30, 2010 required for ---- -------- --- --- State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) 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 Donegal Circle r r r r r r r r r\ r r\/\r\;\/♦r\;\r\r ♦/\/\/\/♦r\r\r r r r r r r r r r \r\r\r\r♦r\r♦r\r\/\/\r\r\/\r\r♦r\r\/\r\r\r\/\r\r 24 21 r*rd "iz:.l�ty�lt > i. 31 29 ��Yt Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is Centerville MA 02632 June 30, 2010 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high round water: p g g feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Donegal Circle Property Address Federal Home Loan Mortgage Corp Owner Owner's Name information is Centerville MA 02632 June 30, 2010 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable Regulatory Services Thomas F. Geiler, Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 July 16, 2007 Mr Michael Palmer 691 County Street New Bedford, MA 02740 { ORDER TO COMPLY WITH STATE ENVIROMENTAL CODE, TITLE 5 The septic system located at 55 Donegal Circle, Centerville,MA was last inspected on June 18th, 2007,by Jason Burnie, a certified inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: The line between the tank and leaching is orangeburg and has a break in it. A D-box needs to be installed. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HEAL H DEPARTMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of HealthT'` av-/'c-Q- Cfl/o�7�4 stal ServiceTM L . � omestic Mail Only;No Insurance Coverage Provided) � f`' Postage $ - 0 0 In Certified Fee o f � O !O1ark C, p Return Recelpt Fee - 4P H (Endorsement Required) ,. J J �J Restricted Delivery Fee -0 (Endorsement Required) G Total Postage&Fees $ ,0 / u-1 O Sent To O At q r 34ieet,Apt:No.; - -------------------- or PO Box No. 7 Clly,State,ZIP+4 PS Form :00 ie 2002 i Certified Mail Provides:s A mailing receipt fan asiaa)ZOOZ aunt ooee W,o=j sd ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years j Important Reminders: �- ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Mail& ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured orRegistered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. ® For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. ■ Complete items 1,2,and 3.Also complete A Signature Item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Rem 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No W.Michael Palmer 691 County Street 3. Service Type New Bedford, MA 02740 ❑Certified Mail ❑Express Mail ❑Registered 0 Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7 0 0 5 1160 0000 0191 3554 (rn3nsfer from service labeo 1 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE. First-Class Mail Postage&Fees.Paid USPS Permit No.G-10 •Sender Please print your'name, address, and ZIP+4;in this box-* PUBLIC HEALTH DEPARTMENT TOWN OF BARNSTABLE 200 MAIN STREET HYANNIS, MA 02601 ~ THE Tp�O Town of Barnstable - " Public Health Division o�PP eNO 200 Main Street A 4 0"— Hyannis,MA 02601 ` 7005 1160 0000 0191 3554 T . 02 1A $ 05.210 141 -_ _ _ _- w ----- - - --w— 0004606238 JUL 1 7 2007 MAILED FROM ZIP CODE 02601 C't $ en Mr Michael Palmer 691 County Street ' New Bedford, MA 02740 } N. q W 1 UNCL-ATMED me: 02601400.200 *0969 1111,I6,111,11)t1I M 11 111111,11111111111111111111)1►111�1�1�1 e k 1 v \ i I d i a � C } lrF � ~ f f Y ' f y 41 Town of Barnstable Regulatory Services Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 16, 2007 Mr Michael Palmer 691 County Street New Bedford, MA 02740 ORDER TO COMPLY WITH STATE ENVIROMENTAL CODE, TITLE 5 The septic system located at 55 Donegal Circle, Centerville,MA was last inspected on June 18th, 2007,by Jason Burnie, a certified inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passed" under the guidelines of 1995'-TITLE 5 (310 CMR 15.00) due to the following: ]i r The line between the tank and leaching is orangeburg and has a break in it. A D-box needs to be installed. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. --- — - - -- - BARNSTABLE HEAL H DEPARTMENT Thomas A. McKean, R.S., C.H.O. Agenf of the Board 6flHealth ` � ' ' Commonwealth of Massachusetts Q -- Title 5 Official Inspection Form _ S Not for Voluntary Assessments y Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information Important: When filling out 1. Property information: forms on the �/,3,3 computer, use 55 DONE GAL CIRCLE CENTERVILLE MA 02632 only the tab key Property Address ® r to move your MICHAEL PALMER ---- cursor-do not use the return Owner's Name key. 691 COUNTY ST Owner's Address cn N) tab NEW BEDFORD MA -,____,..-__._,__ 740__ � -- _.._. -.------ --_. ._...-- ------- - -.__. K.._ City/Town State Z p Code _1: rf) 6-18-07 , Date of Inspection: Date cr3 .P- M 2. Inspector: JASON BURNIE Name of Inspector D.J BURNIE & SONS bluewater holding corp_ _ ------- --- Company Name 105 FERNDOC ST UNIT A Company Address HYANNIS MA 02601_ _ City/Town State Zip Code 508-775-0139 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-18-07 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. title5 2006 blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System — Page 1 of 16 & ^ Commonwealth of Massachusetts � ��N�� ^��~°��0 0��N��^�^°�� NrN��| Title �� 0 Nmm��r��0��mm Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form � B. Certification (cont.) 55DONEGAL CIRCLE _ CENTERVLLE.MA 02832 _....Property Address CENTERV|LLE yWA _ 02632 —'— --- - -'---- - -- -------- - -- Zip Code ------ City/Town yW|CHAELPALyWER G-18'O7_______________----____--________ -----�'------ --'-- ----- Date o[|nspw�mn Owner's Name Inspection Summary� Check A.B.C.OnrE/always complete all of Section D � A) System Passes: �� | have not found any inforn�adon.which indicates that any of the failure cr�ehadescribed ^� in310CK8R153O3nrin31UCK8R15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be ^~ replaced or repaired. The system, upon completion of the replacement or repair, ao approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the [_1 for the following statements. If"not datarmined.'' please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits aubstunde| infi|tradnnoroxfi|tnodonor tank taUuna \simminanL System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board ofHealth. ° A metal septic tank will pooa inspection if it is structurally sound, not leaking and if Certificate of Compliance indicating that the tank is less than 20 years old isavailable. NDExp|aini � uno^on/2oo6 Title o Official Inspection Form:Subsurface Sewage Disposal ^ Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 55 DONEGAL CIRCLE CENTERVILLE,MA 02632.- Property Address CE-NT.E.R.Y.ILLE ......- MA 02632 City/Town State Zip Code MICHAEL PALMER 6-18-07 Owner's Name Date of Inspection B) System Conditionally Passes (cont.): F] 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 F] obstruction is removed ❑ distribution box is leveled or replaced ND Explain: THE LINE BETWEEN THE TANK AND LEACHING IS ORANGEBURG AND HAS A BREAK IN IT. ...........----------------- ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: F1 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: El Cesspool or privy is within 50 feet of a surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh title5 2006 blank.doc-03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 55 DONEGAL CIRCLE CENTERVILLE,MA 02632 Property Address CENTERVILLE MA 02632 City/Town State Zip Code MI-CHAEL--PA-L.-MER...-.---.---., - - 6-18-07 --------- Owner's Name Date of inspection C) Further Evaluation is Required by the Board of Health (cont.): 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. n The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. n 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other'. titles—2OO6—blank.doc-03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form �= Not for Voluntary s ments -- — ,' Assessments Subsurface Sewage Disposal System Form B. Certification (cost.) 55 DONEGAL CIRCLE CENTERVILLE,MA 02632 Property Address CENTERVILLE MA 02632 City/Town State ZipCode MICHAEL PALMER 6718-07 _ Owner's Name Date of Inspection D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than M,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 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 of chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. Yes No ❑ ® 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. titles 2006_blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 . . Commonwealth of Massachusetts ` ��'��N�� =��=��~�� "=�'�� e��°NM�� N�� ~�0NN��N�m� @mm��N��mm Form Not for Voluntary Assessments Subsurface Sewage Disposal System FO[nn B. Certification (cont.) 55DONE8ALQRCLE CENTERV�LE`K4AO2832 __ Property Address CENTERV|LLE _ MA____�___ ______ �O2832 City/Townm� -- ------- - '-- -- --' -- - State Zip NUCHAELpALMER _ 6-18-07' -_-___- '__-------'--------------- Owner's Name Date nfInspection E) Large Systems: Tmbu considered a large system the system must serve m facility with o design flow mf1O.QODgpdto 15,000gpd. For large ayntemo, you must indicate either"yes" or"no" to each of the foUuwing, in addition to the questions in Section D. YES NO F] [l the system is within 400 feet ofa surface drinking water supply 0 F-1 the system is within 200 feet ofa tributary to a surface drinking water supply F-1 �� the system is located ina nitrogen sensitive area (Interim VVe||headPnotaodon �� Area- |VVPA) ora mapped Zone || ofa public water supply well If you have answered ''yea" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section O shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. nueu_aouo_u/onx.uoc^ou000s Title n Official Inspection Form:Subsurface Sewage Disposal ^ Page am1s Commonwealth of Massachusetts - - Title 5 Official Inspection Form Not for Voluntary Assessments - Y Subsurface Sewage Disposal System Form C. Checklist 55 DONEGAL CIRCLE CENTERVILLE,MA 02632 Property Address CENTERVILLE MA 02632 City/Town State Zip Code MICHAEL PALMER 6-18 07 Owner's Name Date of Inspection Check if the following have been done. You must indicate"yes" or"no" as to each of the following: YES NO ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,411ilft 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)] title5 2006 blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Y Assessments A, Subsurface Sewage Disposal System Form D. System Information 55 DONEGAL CIRCLE CENTERVILLE,MA 02632 Property Address CENTERVILLE MA 02632 City/Town State Zip Code MICHAEL PALMER 6718-07 Owner's Name Date of Inspection Residential Flow Conditions: unknown 2 Number of bedrooms(design): - - Number of bedrooms (actual): - — — unknown DESIGN flow based on 310 CM u R 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No 05= 96gpd Water meter readings, if available (last 2 years usage (gpd)): 06=82gpd___ -_ Sump pump? ❑ Yes ® No CURRENT _ — Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: —.-- -- ._...-_---._.-------- -------- based on flow Design 310 CM : Gallons 15.203 9 ( ) per day(gpd) Basis of design flow(seats/persons/sq.ft., etc-): - Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: — - - --" -- Last date of occupancy/use: Date Other(describe): ---_--._-_. _ __ __._..._._---__-___-------_---.----------- -- titles 2006 blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 C Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 55 DONEGAL CIRCLE CEENTERVILLEWA 02632 Property Address CENTERVILLE MA 02632 City/Town St.ate- Zip Code MICHAEL PALMER 6-18-07 Owner's Name Date of Inspection General Information Pumping Records: barnstable boh pumped in 1999 and 2003 also Source of information: system pumped 1 month-prior0 t inspection Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool F] Overflow cesspool ❑ Privy El Shared system (yes or no) (if yes, attach previous inspection records, if any) El Innovative/Alternative technology. Attach a copy of the current operation and .maintenance contract (to be obtained from system owner) El Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: qppx 1976 per info from the barnstable boh Were sewage odors detected when arriving at the site? El Yes 0 No title5 2006 blank.doc-03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 9 of 16 Commonwealth of Massachusetts ____ Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 55 DONEGAL CIRCLE CENTERVILLEWA 02632 Property Address CENTERVILLE MA 02632 City/Town State Zip Code .MICHAEL PALMER ------- 6-..18-.07._____ Owner's Name Date of Inspection Building Sewer(locate on site plan): 13" Depth below grade: feet Material of construction: ORANGEBURG F] cast iron El 40 PVC other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): 8" Depth below grade: feet Material of construction: 0 concrete EJ metal E] fiberglass El polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of El Yes F1 No certificate) ------------------------------------------------------ Dimensions: 1000 Sludge depth: -0-1 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 were dimensions determined? sludge judge- titles_2006—blank.doc-03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 10 of 16 Commonwealth of Massachusetts a� W Title 5 Official Inspection Form Not for Voluntary Assessments ¢^ Subsurface Sewage Disposal System Form �0 D. System Information (coat.) 55 DONEGAL CIRCLE CENTERVILLE,MA 02632 Property Address CENTERVILLE MA 02632 City/Town State Zip Code MICHAEL PALMER 6-18-07 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: -- ---- Scum thickness Distance from top of scum to top of outlet tee or baffle -- -- -- --"-- Distance from bottom of scum to bottom of outlet tee or baffle - -- — - Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: -- Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): titles 2006 blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 ' �c\ Commonwealth of Massachusetts � ��N�� Official 0 G��=^�^�� N�NMk� Title �� nNNN��N��N �mm��N��mm Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 55 DONEGAL [1RCLE CENTERV LLE MA O2032______ ____ _ Property Address CENTERV|LLE MA ._ 02632 �-------'--�---------- --' ---� State Zip Code City/Town W4|CHAELPALMER _ _ 6'18_07 Owner's Name Date wInspection Tight or Holding Tank (cont-) � Oimenamnsi Capacity: a-- -------------------------'--'-- g�|mns Design Flow: gallons per da --- --'--- ---'------------- Alannpresent 0 Yes Fl No Alarm level: --� ��- ---- - - Alarm in working order: 0 Yen El No Date of last pumping: lDate-- --�' ------- Comments (condition of alarm and float switches, atcj: ------------ Attach copy of current pumping contract(required). Is copy attached? El Yes || No Distribution Box (if present must be opened) (locate nn site p|an), Depth ofliquid level above outlet invert — '--- ---'-- ----- Comment (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence nf leakage into or out of box, etc.): THERE IS NO DISTRIBUTION BOX_ Pmmnp Chamber(locate on site p|an)� Pumps in working order: �l Yes No Alarms in working order: El Yes | | No uue5_2ODs_u|anxumc^oaonom noeomnc/a/inspection runn�au�oux�coo�wuyo Disposal ^ � Page 12o,10 Commonwealth of Massachusetts ---_ Title 5 Official Inspection Form - Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (coat.) 55 DONEGAL CIRCLE CENTERVILLE,MA 02632 Property Address CENTERVILLE MA 02632 City/Town State Zip Code MICHAEL PALMER 6-18707 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: 1- 6X6 . ® leaching pits number: -- --— ❑ leaching chambers number: — -- — ❑ leaching galleries number: -- ❑ leaching trenches number, length: ---------------- ❑ leaching fields number, dimensions: — ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: --... _._..... 11_..... . —.. ... - - --- ---- —..--- - - Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): THE PIT WAS 1'8" DEEP AND IT HAD TY OF STANDING WATER AT TIME OF INSPECTION _ title5 2006 blank.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System — / Page 13 of 16 CJ'. . G Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 55 DONEGAL CIRCLE CENTERVILLE,MA 02632 ------------- Property Address CENTERVILLE MA .026321 State Zip Code MICHAEL PALMER 6-18-07 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth -top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ----------- Privy (locate on site plan): Materials of construction: Dimensions Depth of solids ------ Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): title5 2006 blank.doc•03/2006 Title 5 Official inspection Form:Subsurface Sewage Disposal System- Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 55 DONEGAL CIRCLE CENTERVILLE,MA 02632 .......... Property Address CENTERVILLE MA 02632 City/Town ........... State Zip Code MICHAEL PALMER 6-18-07 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. r D Ri C-- titles—2OO6—blank.doc-03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 15 of 16 � � - ' Commonwealth of Massachusetts ° ��"��N�� m��"��"��0 N��°��°�� ~�� Title �� ~�NNN��0�m� �mm�� Q-��mmmm ~ - Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 55DONEGALCIRCLE _CENTERV|LLEjNA02832___________________________________ Property Address CENTERV|LLE yW/\ 02632 City/Town -'--��-'- --'-- ' ---- - State Zip Code K8ICHAELPALMER_ _ 6�18-07 Owner's Name Date ofInspection Site Exam: Slope �' � Surface �v� r^/`�'/' Check cellar Shallow wells Estimated depth bo ground water: Please indicate all methods used to determine the high ground water elevation: [1 Obtained from system design plans onrecord If checked, date - '--- - -- ----------''--------- ' uom El Observed site (abutting property/observation hole within 15O feet ofSAS) � z Checked with local Board of Health -exp|ain: WE USED 8ARNSTABLE TOPO MAPS DATED 2004 AVAILABLE AT THE BARNSTABLE BOARD (JF,HEALTH.____ El Checked with local excavators, installers (attach documentation) Accessed USGSdatabase exp|aim SDVV'252 ZONE O4'5 WATER LEVEL 4G5 �5X 12= �"_ADJUSTKAENT You must describe how you established the high ground water elevation: WE USED 8ARNSTABLETOPO MAPS DATED 2004AND FOUND A CRANBERRY BOG THAT WAS LISTED AT 164 THE PROPERTY THAT WAS WORKED ON WAS LISTED AT48 WE ARE ABOVE GROUNDWATER BY 2O AT LEAST ' _-__- _-- -_- - -�� _ �-' __' ' due5_2005_ulanx.uoo^08/2006 Title official inspection pnnn:Subsurface Sewage Disposal ^ Page 16 of 16 `__~ UA QFl- o• Fee 'l.d./-� / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for dig ont *pztem Con5trurtton Verna Application for a Permit to Construct( ) Repair mellupgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. joy,)t)),A�,c...t Owner's Name,Address,and Tel.No. Assessor's Map/Parcel r�l - � r/ / ' ` n rcLL 1 . Installer's Name,Address,and Tel.No. :/IA4A esigner's Name,Address and Tel.No. l•� Type of Building: O;;'h�Qi Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 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(Answ w licahLe) 40 �L\J Date last inspected: Agreement: The undersigned agrees to ensure t construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title o the Environment and not ce he system in operation until a Certificate of Compliance has been issued by thi&Bar of th. Signed Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued ,o, '`1 o.I Av)) �W "� �l� i y ` Fee olo •tD t ' THE COMMONWEALTH,OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for 3 gtlo5al 6pgtem Cottgtruction Permit Application for a Permit to Construct O Repair(Upgrade`( ) Abandon( Complete System kindividual Components Location Address or Lot No. /,LL Owner's Name,Address,and Tel.No Assessor's Map/Parcel (-mot Cl UI�lk d (7 f' Ic rw# +"d E q IJ Installer's Name,Address,and Tel.No. 941CIVIJW vj iAXA Vesigner's Name,Address and Tel.No. Type of+Building: ,f'. ,,, )�Lj Dwelling No.of Bedrooms 4 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures x Design Flow(min.required) gpd Design flow provided gpd 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(Answ w lica e Of Date,last inspected: rN Agreement: `- . __j The undersigned agrees to ensure t e construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title o the Environmenta and not .p4aChe system in operation until a Certificate of Compliance has been issued by this B ar of e t He th. - Signed Date t f .� Application Approved by flit Date l U Application Disapproved by: Date for the following reasons Permit No. oo 6 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS ` BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site/Sewage isposal System Constructed ( ) Repaired ( L_�Upgraded ( ) Abandoned( )by (.uu f l��v/ i )'C- at. U 4 e; c has been constructed in accordance with the provisions of Title 5 a9d the for Disposal System Construction Permit No. — 276 dated G� Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall no be construed as a guarantee that the sy em will f o s designed. Date �/ Inspe or ———————————————————————————————————————————— No. DL(-0 7—2 7� Fee` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS a lwigomt *p!gtem Construction Permit Permission is hereby granted to Construct ( )nnRepairr (✓I Upgrade ( ) Abandon ( ) System located at. /�/ ec_—.l C�_�Z�C.. (_ -7440_ -1h_4� 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:Const 'ction dust be completed within three years of the date of thi permit. Date /Q Approved by �- r rLOCATION TOWN OFBARNSTABLE�.?� +JO1�� SEWAGE# '' VILLAGEC04 11Api L.LG ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY �L ``-- LEACHING FACILITY:(type) P (size) IfJX NO. OF BEDROOMS OWNER (� PERMIT DATE: lD COMPLIANCE DATE: r 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) 0 Feet FURNISHED B ^ facility) l uo v < _ C- _D > _ asp 7,Uu � - 29 . ti y COMMONWEALTH OF M ASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DzPARTMENT OF EKmtoN'MENTAL P'IiOTECTIONT ONE WINTER STREET, BOSTON MA 02109 (617)992-6600 Tfff!ff COXE f>tr�;t+starq APrGSO PAUL CELI.UCCI D.l VID B.91 RIM 00"Wntor SUNURFACE SEWAGE OMPOOAL SVSTEM 001PEIC ION FORf)IB Com of reioner PART A CEfI'T>PICATIe1N PraPsrty Address: fS D D rE�G A.I C f rz l e Noma of O+ww de r'ife r`v+1�, �11�,ss. Address of coons&:_, Dowe�f Ir.pseM.rr: l a t \cao G�i v;&, /71 a s5 Nadia of hapsaw. PAnt1.�[j E..l��.Q 1 K� t4 , 1 ate►a OEf• a l:"sa w o$rsnartt 10$ nae�donfj16.340 of Two i(310 CNIR 15.0001 cM"Palay Nearer: Gt , U Y1..! ttobL MaMsp Adlbaar: 4s •tS3.�Z6 S// Tebt --74 20. MWAIM BMW I cerTify that I have personsity inspected the sewage disposal system at this address end that the information reported bNsM-is trn.a.aoarsi e and complete so of the time of inspection. The inspection was performed band on my training and experience In the proper furor ion+sM maintenance of on-site&swage disposal systems, The system: Passes Conditionally Passe$ Needs Further Eralustion Illy the Local Approving Audw tky Fab Ytspealar'a ligrtaArra: % �a s Dow. a� The llystem inspector shall submit a oozy of this inspection report to the Approving Authority(lord of Health at OEP)wiftfr fti ,(30)riayll of contptedng this IMpecdon. If the system is a shared system or has a design flow of 10,000 gpd or greeter,the inspector w+d the system:a+rnw shall submit the report to the appropriate.regional office of the Osps►emem of E.mironmantal Protection. The origirwl should Ise&s•it to thu system owner and copies sent to the bu rer,ff applicable,and the approving eu+dtwity. N0T1It A140 C0MMENTS 143 ate,` � 01 s °apt, �O V ` revksed 9/2/98 etagrtofta to Printed en secydsd Paper / SUBSURFACE SMA®E DISPOSAL SYSTRA NS►ECTIOM FORM PART A COTtfq{;AT10N lasntlrtetadi ftopar+ty Addmes: ar'a. "E6 (a4 eot� Inap.at�ato: b bits pn o VJMMARY: Cheek A At C. of 0: A. SYSTM►ABM- e I have not found any informailon which Indicelos that any of the faRuro conditions described in 310 CMR 16.303 eniot Any 14dure oriterla not evaluated are Ind hated below. �I arts s rr� k 0.0 l� b.e 1Pv r►►�• d� r�1 i mac. l{ �,; 4u- s. SYSTM COMMtN)NALLY PAWS: One or more system eomponunts as described In the "Conditional paces"section need to seed or repaired. Tho i-stem,upon completion of the replecemead or repair,as approved by the board oil Health, will ps Indbaste yes, no,or not determined(Y.N, or NO). Describe basis of dounninution in natences. If "not determined", exlAsin !-!hy nat. The aeptk tank is n cal,unless the owner of operator Ms pro the eyatem Mepectof with a Copy O'I a C't tlffcats o+l Compliance lsttecMi4)indicating that the tank was IFthrTistino ithin twenty(20)Vows prior to the date oil vim :upoction: w the sspde tank, whnrther or not motel,is cracked,st unsound,shows substantial infntration or ttxiiiViitimi, or sank failure is Imminent. The system win pass inspeeti septic tank Is rwpiseed with a complying. septc tai*iss approved by floe boircd of Health. s SawsQs backup or breakout or ' stack water level observed In the distribution box Is due to broken ar obstructed pi;ie(s) or due to a broken, ��ettled or van distribution box. The system will pass inspection if lwith approval of th: Board of Health). I1rok pipets)are replaced on is remeve0 ben is levelled or replaced The system re ss'pumping more than four times a year,dw to broken or obstructed pipe(s). The syrten+ weal pass Inspection if Ith al:groval of the beard of Health): broken pipets)we replaced obstruction is removed revised 9/2/98 Pop 2of12 *USSURFAC6 SEWAGE DISMAL SYIET9N WSPECTION FORM PART A CEIITN}CATION toe drm di Oaiwar: a ke r �1aea wf 6!a r/W C. IRAITHER EVALUATION M f1Es3tMRiID BY THE BOARD OF HEALTH: _ Conditions exist which require lorther evaluation by the Board of Health In order to datermirw systsn9 is feilirNl to 1pi stoc:t%,4v pFW hadth,safety and the environment. 11 SYSTM WILL PASS I N&=$BOARD OF HEALTH OETSI MES N A 210 CUR 15.202 f I KM,I*HAt' rHi:B f11,11 M IS NOT 6UNCTIO�IG N A WINNER t1 Hr_N V LLL PROTECT THE KeLiC TH AND SAFETY AND T11E EMVMt,00184!;NT: Coaapeo0 or privy is w4thin 60 foot of surface water Cesspool or privy Is r/HEALTM bordering Wand or s ash marsh. 21 SYSTEM tWIS.L FAN.UNLIESS TILTH(AND PU11M%WATER SUPPLE R.IF ANY'DET61p OU TH ITTl-li;SYSTEM IS FUN N A MAIIBiNR TTHE PUSILIC HEALTH MD SAFETY AND THE ElIVE%ONMIENT: The eyatern has a aspbsorptoon system(&AS)and the SAS Is within 100 feet of a surf&:&twa;Far supply xtributary to a surface The system has s be tank and salt absorption system and the SAS is within a Zone I of a public water sulalol,r we0. The system has a septic tank and sail absorption system and the SAS is within 60 feet of a private water soagppi-f wall. The eyetem has sop tk:tank and Boll absorptlon system and the SAS is less then 100 feet but 60 foot at moan from a private water .ply e10o11,urtbess a wep water analysis for eallform booterla and volatile organic compounds ilndl mos Viom the wap Is tree polkr4on from that facility,and the presence of ammonia nitrogen and nitrate nitrogen is*qual to or Isieu then 6 Method used to determine distance _(eWaximation not vaW. 2) OTHER revised 9/2/98 PW3ofit SUBSURFACE SEWAGE DIiPOM rr$Tem NSPECTfION FORM PART A CdMWATM loeatdno" Oweer. D. BYSTf6M FALB: You must indicate either"Yea"or"No" to each of the following: I have determined that one or more of tit fogowing failure conditions exist as described in 310 CMR 15.303. The Dash for-this deterrtdnadon is Identified below. The Board of Heahh should be contacted to determine what will be necessary ic,cori is et the t'al are. Yen No ,q Backup of sewage into facility or system component due to an overloaded o ogged SAS or cesspool. Discharge w pondinp of effluent to the surface of the ground or au a waters due to an overloaded at cicglp o,d SAS,w cesspool. Static liquid level In the distribution box above outlet inv due to on overloaded or clogged SAS or casopool. Liquid depth in ceserool la less than 6"below in or available volume is less than 112 day flow. Required pumping mere then 4 times in th at year JW duo to clogged a obstructad pips(a). Number of dmos punnpsd Any poAion of the Said Absorptl ystam, cesspool or prhry is below the high groundwater elevation. Any portion of a cmt jipool privy Is within 100 feet of a su face water supply or tributary to a surface a ier upp;y. Any poAlon of e e pod or privy b within •ions I of a public wog. o, Any portion a eelupool or privy is within t30 feet o4 a prlvete water supply well. Any on of a cos�ipooi or privy is less•than 100 feet but:greats than 50 feet from a private water supply n all with ria water quedity analysis. If the wag has been analyzed to be sceepttilMe,attach Dopy of well w ater ndysis hor rm becteria,Watlie organic compounds,ammonia nitrogen and nitrate nkrogen. E LAMM SYSTUA PANS: You anuat indicate either"Yes"or"No" to loch of the following: The following crkwla apply to large systems in addlOon to the criterit jabove. The system serves a facility with a design Now of 10,000 or greater(Large System) and the system is a signifiawr throat tak public health end safety and the environment because one air a of the hollowing oondkions exist: Yes No the system Is within 400 of a surface drinking wetw auppty the system la 200 feet of a tdbutwy to a surface drinking water supply the system located In a nitrogen sensitive was(interim Nfeghead Protection Area=1WPA)a a mapped 2omAi II of a INjf:.lic wow won) The owner or operator f any such systion shall upgrade the system In accordance with 310 CMR 16.304(2). Please consull 1ths iocei regional otMtee of the i3epa for flrrtliar info riiatton. relrised 9/2/98 Fsgr4of11 SUOSURFACE SEWAGE OMM>sAL S'VSTW I ancTION FORM PART• tr �ety AdAreea: 5"S� f7on G�GcI C %rat e tsar: , f- ®abr of inrpostltah: 6 ! a `o Chaak if tM fallowing have boon done: fou swat lndioaa either 'Yp"or'No" as to each of the following. Yes No Jt _ Pumping Informisdon was provided by the owner,oecupent.or Board of Health. • _ None of the system,sonWnoms have been pumped for at least two weeks and the system has been recntNnnt,:rmmsl flow rates during that period. large volumes of water have not been introduced into the system recently or•es gNsr of thin krapeotkm- _ As built plans have Irsen obtained and examined. Note if they are not available with N/A. _ The feciiity or dwel0ing was inspected for signs of sewage back-up. _ The system does nest race"non•senhary or industrial waste now. The site was Inepeotew,l for signs of breakout. s All system comperterts, exek,ding the SON Absorption system, have been located on the oft. _ The septic tank meni,ides were uneovaed,openad, end the interior of the septic tank was inspected for rorncb-ion of bullies or toes,material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. This size and location of the$all Absorption System on the site has been determined based on: _ Existing information. For exempla,Plan at I.O.H. , Determined In the fled Qf any of the fieiiure criteria related to Part C is at issue,approximation of dlotanw,is urutcc(1ptrbd,r) l9 6.S®ElSl(bi) _ 'rho facility,owner lmtd occupants,If efferent from owner)+were provided with information on the proper mnlnl�ntareo of Subsurface Disposal 3"toms. revised .9/2/99 Per 5ofIll SUSSURPACE SEWAGE DOPOSAL SYSTUA NSPECTION FORM PAST C SYSTEM S>l}'+OMkTm Atrsrar: b4 4�e/�s �on eta C ,rcGC tom'.e rti.p..aa" 6 (a I !cam PLOW CON91TMM CDool a [!l�s p.d.rood►oom. !Number of bod►ooms;dsslgn): S hilimber of bedrooms(actual):� Tout DESION flow -T-30 Number of ourront real a -.9Z Gabege rindw(yes or no):-(—VD A Laundry(aaparaft system) tyse or no):, If yes,separate Inspection►eWired d�(��1• r Laundry syatam I apeolod (Y-"or no) Sesamw use IV"or noi:=S1 a Water motor►east tps,If available Mast two year's usage(Spol: Sump Pump(yM or no): Lost data of occupancy: Urreo I Type of oetabltshment: DeA;n tow: and (Based o .203) Sash,of design fievr .----... Oresse trap present:(yes er no) ind�►t►alal Waste floldMtg Tank sort:l res or not_ Non-somtsry waste&"her to tfa Tide 6 system: (yes or no),.,,_. Wow stater reed n",M .— Lost deft of oaaupane . OTMER:(DoseAbe —» '.at date of psncy:,o GSMIAL SIP01 RTM PUMMO 11 WOMS Sind !pol inf:jrinotlon: system pumped do part of lnsPeetlon:(Vat or no) V if yea, volume pumped: ._@Wom Reason for p rnpkq: TV";of srSTlMlI . Septic tatki 9eo14 absorptlon system _r singb cesspool Overflow assapool Shared system(yes or not (If res, attach previous Inspection records.If any) HA Technology ote. Attach colty of up to date operation and wAnt rtance contract Tight tank Copy of CEP Approval OOa? APNIOSiN)ATIE AGE of all corttpenonts, date Installed Of known)ate source of Infomttetb0: y Seemtne wire dsteoted when arriving sI the she: (yes or no) revised 9/2/98 PWS*fll SUUiJRFACE UWA®E OitlPOSAL SYSTW MPECT)ON FORM PART C SYSTM 994f1MATXHO ferns ra.ee) D.uof b to t 100 WRONG Otl11M1t: (leerete on oft plan) Doom Dabs wed.:!Vic. Material of construction:„—oost iron.,K+A PVC_ other(explain) Diatoms f►ent� yoft wetsr supply well or auction line •""" darnater.,S'` � Cornments: (condition of joints,venting,evidence of IOaksge.etc.) >sWM TAMK: (bane an site pbe} Depth beloar wade: 0 2" Material of construction:_eonoratemeo al_,Fiberglas _Polyatbvien*, other{axplainl Of task is metal,pat age,_ Is age care-limed by Certificate of Comp{ience_—lyee/No) Dlrniemelona: OQO Q, . Sktdp Dismiss,frro „ om top of aludos to bottom cot outlet tee or baffle. oZ-6 � Sewn ihkalenose: 014:1100 a from top at Bourn to top of oullat We or baffle._ defense from bettrrm of scum to baqWri of outlet�a or befpe:� `iow dkrearesiona wera determined: _` s�,rrX Carw+motts: IrsccrrMondst)on for pumping,condition,of Not and outiat toss or bsffies.depth of Squid level In rotation to outlet invert,ssnxitmj!l imtegrhh,, evidence of age etc �.P fa !c &. C a 2 r C ...�c� '� r ) ' /9. oiliG fllow:e an site plan) Dop"I babes red*:,o Mstarid of construction:_eonereta„,motat,_Fberglaes _p One+othWoxpkdn) 01"M ra}oeea: Seum Vftkness• Dista ve from top of scum to top of"did we or Distance from bottom of scum to bottom of or baffle. Dote of but pungft: Cemmsreq: {ratortrnandatloa for purreping, oo Iaaitaoa of ,atr.} Of Inlet and outlet toss or befWes,deptlh of Squid level In relation tO outlet k'nOn.atn,etrrr;' Int egov.1f, widsraoa rev:Loed 9/2/98 Pgataftl SUUURFACE SEWAGE SYSTEM MPECTION FOM PART C sYSTMi M�OAfMATtOItt faantlnwdl Ptep.w SS To Coast' b (g.l 100 Tl W OR MOLL MQ TANK:_(Tarr(must be pump te pion) ed prior or et time of,inspoedoni noests on aft DeVO below fits:_..__ Nlaterlel of corrstruoelon:_concrete-motel E roles*—Polyethyleneother(explain) capoc#y swam Dealon flown O"'doritil Alarm preserrt Alain IevN: order:Yea No — OWN of previous p .- ConrmisrIll . icom*don of inlet te!XtA1wmwork1rq �and Host switches,etc,) fMZliltd><W*10N SOM -, (fonts on aft plan) Dslrl h of liquid level above outlet kwent:, Comments: (note if level WW die i r+is equal, o0dence of solids carryover,avid*ne*of i*akaoa into or out of boat,etc.) '7 !ice D b,`Frs �.,-Fco� ,�Uk _ ...,.� P&Mp : (Weros on eta plan ",a In waking order:(Yes or Nol__ Alamos In was Int;order iY*s at No)__ Comrnarts. $none condition of pump chamber,condMi o4 pumps end sppurtenances,etc.) revised 9/2/98 >a�reofrt I IVBSURFACE"WAGE DW O"L EYSTW WSPECTION FORM PART C A t�Y�TIIIIIj M�OIfiMAT1ON QOMI'rY16Md1 over: -SSct(cis S 17®^ IT Cc Ct�2 rAw.sae Aa�eoatloa � (aZ f L vo IIIO< Itdltf�IDN sYaT�lo ISAsI nooses on aim perm.If possible:excavadan not►agWrod,loaedon may be,aWaxenmstad by nanantmeivs mmmathods) 11 not",aafa C amain: Typ•. lamold ng offs,nwmIlw.--L lasehkm®Marhba►a,numbe►:_ is Wng gelled".n untbw:_ latmalo Del moha,numbs►, k"th;�_ Ia-so A 9 006,enerfmbw,dfmonalens: ovwAow oaaaposl,rWA*M:�. Alwo ve syatonm: bens of Technology: Canmrm�anp: from emondiden of nail, of"auk failure.level of pending, dam all, cw4von of vagauden, ate. ` � N Pic 9 zh Jc�E� A A h �i/ - Cell: (ieaefs on oft plan) NWWWK end eon"pravon: —l'apth;tep of 44M to inlet kmve►t: opth of sends Ism: a epth of scum Is":. Ole►snamiorts of Cesspool: Mafa►tads of conslewatlon: kmdkstion of gfoundwafa►: inflow foasapool must be pu d as pert of inspection)_ Camnrmm+mnfs: (note,condition of soil,si of hydrau(k Ialkws,level of pondWq,aondidon of vagatatlon, ate.) P1fIfN►:,_ flsoase an sits owl mat"Ods of eorsauotion: Dimensions: Oaph/mf scolds: Canum wft: Incur oondtion of soil,signs of hydrsuba fAme,levN ponding, Comoom of vopstatlon,aft,) . revised 9/2/98 ho9of11 .SUBSURFACE SEWAGE DWOSAL S1rSTEM W SPECTHM FORM PART C SYSTM NICRMATMOI(cam+dm" �+rt9r 53 De•�Q FQ' C �wc.(2 Om bnfaafioa: 6 r'oZ ( too I 8MFCH OF SEWAGE DISPOSAL SYSTIM: Includo ties to at least two permanent reforenes landmarks or benchmarks locate all wells whMn 100' (lucato where puble *star supply comas into house) I ear revised 9/2/98 lspftoof13 811 1111SURFACE SEWAGE o1SFOSAI SYSTM 011SPECTION FORM PART C SYS't1EM1 SiM'011MAf101W(�teuetMsuedl tiapael�oR• b ja r(oo NRCs Report nano Solt Type— Tyo"depth to groundwater-- USGS Delo web"v Wted Observation Weds chocked Oroundwasir depth: Shallow Modsrate _Deep SITE.EXAM SWpe Swrfaee wow Chock Colic Shallow wells Estirnstsd Dept to Oroundweter Wrest Noaso indicate MI the methods used to dcisermine Migh groundwater Elevation: 1Mbtained from Design Plans on reesrd Observed Site(Abutting property,ek,servetion hole.basement sump etc:.) iietorrnined from local conditions (Chocked wit Weal Board of health (Chocked FEMA Maps Chocked pumping rsoords Chocked local eneavators, ln*W*rs 'Vaud us"Data Describe hair You es6MWhod the too CIroundwater Elevation. (Sal be completed) nn clsere� Tv (0'2 -Qez o hcQ ��v v ^o 1 revised 9/2/98 !ap it or it .LOC&LT10 5EW&C-4E PERMIT UO. JAM- S J:) 1,�9U��, 1t�JSTQLLERS ►J� tiEfT�ADDRESSAMEs gQL�,kwA 1082 Old Stage Road —, CONTRACTOR OR �';nterwilleTlass. 0202d2 1082 Old Stage Roaa ;,i luT,s. 026$2 BUILDER 5 1.J &IkAE 4DORE55 DINE PERWT ISSUED DATE COMPLI &MCE ISSUED : — — — r T�� /JP�v� ,� t _.. X SST/y � .. �` ) c�j� ♦ .ra V R' �x/STiivf,'i a s rsTF� � � � Q y /9��oN PN ^O �\ � 4��. � �J�h�P�s�,rl �t TOWN OF BARNSTABLE S C5rx e 0A �`�c�; _ SEWAGE # 'WV .L -QV`` y t ��74e- ASSESSOR'S MAP & LOT LOT163 026 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY (CSC)F3 LEACHING FACILITY: (type) T (size) NO.OF BEDROOMS BUILDER OR OWNER 621�c't�� ii PERIv:ITDATE: COMPLIANCE DATE: 1 [ cy _r Separation Distance Between the: -Maximum Adjusted Groundwater Table and Bottom'of Leachuig Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 7T -, �-`�� ? I �� e�,�` _. ` CENTERVILLE �O 9 LOCUS z N C NS PARCEL ID: 169/027 0 ,/ ��l PMAC S•� O SPRO . M PARCEL ID: M 146/010-008 ,�'�� ^� �•// �E Z$ N It 10"TREE Existing Leach Pit I� 7.3j LOCUS MAP. ii 6"SPR. (Note 10) EX15T. I ,OCOG �O• Q%utSEPTIC TANK LOCUS INFORMATION PLAN REF: 223/139 ' TITLE REF: 22157/189 Gj \ PARCEL ID: MAP 169 PAR. 26 IN ZONE II FLOOD ZONE: "C" pp �� •�i '; COMMUNITY PANEL: 250001-001 5-C DATED:08/19/85 .� 3p ' ';,�'/ - LE - (ELEC) - �;O! SEPTIC SYSTEM TBM: UNDERGROUND (TEL.) / "SPR. COR BLHD i „ ;; REPAIR PLAN V^t o ELEV.=38.5 �y ;� TOF=39.50 „' � LOCATED AT: clsf / 55 DONEGAL CIRCLE Nlb \ ��H-1 TH-2 '. PARCEL ID \ ---------- ---� CENTERVILLE, MA. GENERAL NOTES: �- �� 169/026 \ MIKE D E D E C K 0 PREPARED FOR 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL �\ ' `` AREA= `� OO f BOARD OF HEALTH AND THE DESIGN ENGINEER. �• / 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS �� ., `��,� W �'� OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE AUGUST 12, 2010 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: S� \�� SSA \� \ SCALE:, 1" = 20 ft. — 310 CMR 15.4.05 (1) (8): 1) A 1.11 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING TO BE 4.11 FT BELOW GRADE VS REQ'D 3 FT. (H20/VENT PROVIDED) `�. `R�l� �`�� W �/ Q 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR ``��` C ,' /� �� OF sS TO INSPECTION AND APPROVAL BY-THE BOARD OF HEALTH AND THE �� DESIGN ENGINEER. �\ ` ,� pq ; E,{� yG 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING I R FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN `� �`�IN ```,�� , No: 1140 ENGINEER BEFORE CONSTRUCTION CONTINUES. PARCEL ID: 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 169 025 �3�\\� / oR \� 10L O 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF �� E�/s( . THE CONTRACTOR OR OWNER.TO NOTIFY THE LOCAL BOARD OF / �0' `�` ��< <'7�� f NITAR\P� HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. \� Q 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. - f, �, u `y w 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 0 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. x, 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY / O THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING — CONSTRUCTION. D A R R E N M. MEYER, R.S. 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND FILLED PER TITLE V. i I 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION � P.O. B 0 X 981 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING 1 EAST. SANDWICH, M A. 02537 , 14. ALL 15. THE OIPING ESIGNTOFBTHIS"SYSTEM DOES NOT (UNLESS SPEC. OTHERWISE) N T ALLOW (5 O Q FOR THE USE OF A GARBAGE GRINDER 13 6 2—2 9 2 2 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING SHEET 1 OF 2 J 1266 r NOTE: TO PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:32.89 _ FOR!A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S: T.O.F. EL.=39.50 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER OF OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. F.G. EL.=38.50E G F.G. EL.=38.Ot F.G. EL: 37.0t F.G. EL: 37.0(MAX.) - DOR M. J' VENT l No. 1140 L 1O'f ' 9" MIN COVER/ , BOX= 0 ® S=1% (MIN.) 36" MAX COVER L = 25' L - 1O'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) ® SCH4 (MIN.) O SCH4 (MIN.) '�NIT000 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC -Poll17 u e 11.3" TO � � 10 \IN = 36.15 48"UQUID INVERT LEVEL INV.=35.90 GAS BAFFLE PROPOSED INV.=33.30 3 ROWS OF 5 UNITS AT 6.25'/UNIT + 0.75' WEDGE = 32.0'/ROW in M D13-S(H-20) INV.=32.50 SOIL ABSORPTION SYSTEM (PROFILE EXISTING 1.000 GALLON SEPTIC TANK RESTORE VEGETATIVE COVER EXISTING SEWER OUTLET BACKFILL WITH CLEAN PERC SAND 75" TO TOP OF CHAMBERS NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING z: .:':_::.: . ,: •• .• PIPE INVERTS PRIOR TO CONSTRUCTION BREAKOUT=TOP ELEV.=32.89 2) D-BOX SHALL'13E SET. LEVEL AND TRUE TO INV. ELEV.= 32.50 GRADE ON A MECHANICALL COMPACTED SIX BOTTOM ELEV.= 31.56 INCH CRUSHED STONE BASE, AS SPECIFIED IN EXISTING SUITABLE WN M INN 310 CMR 15.221(2) 2.83' MATERIAL 5' MIN. ABOVE BOTTOM OF EFFECTIVE WIDTH = 3 x 2.83' = 8.49' r 3) REPLACE EXISTING 1,00 76" GALLON SEPTIC T.P. EXCAVATION OR G.W. TANK WITH 1500 GALLONN SEPTIC TANK (7.46' PROVIDED) USE 3 ROWS OF 5-HIGH CAPACITY IF FAILED, DAMAGED, OR UNDERSIZED. BOTTOM OF TESTHOLE EL.=24.10 - ADS 160OBD .BIODIFFUSER UNITS-NO STONE 4) INSTALL INLET & OUTLET TEES AS REQUIRED _ W/ CONTOURED WEDGE 5) PLACE SANITARY TEE IN D-BOX: SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S. KTs � 16" 11.2" l #:LOG P _1 DESIGN CRITERIA. SOIL 13033 , �-- -� NUMBER OF BEDROOMS: EXIST. 28R DWELLING/38R DESIGN (PROP IS IN ZONE II) DATE: AUGUST 12 2010 34" SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 SECTION AND CAP SOIL TEXTURAL CLASS: CLASS I WITNESS: DAVE STANTON, BARNS. BOH DESIGN PERCOLATION RATE: <2 MIN/IN Elev. h TP-1 De Elev. TP-2 Depth De 16'"' HIGH CAPACITY 160OBD H-20 BIODIFFUSER UNIT -� _� DAILY FLOW: 110 G.P.D/BR. 37.10 0" 37.30 0" DESIGN FLOW: 330 G.P.D. FILL GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 35.10 24" FILL MODEL 16" HICAP A _ 35.55 q 21" LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT PROPOSED SEPTIC TANK: 200% X 330gpd = 660GPD (USE EXISTING 1,000 GAL CAPACITY) LOAMY SAND F EFFECTIVE LENGTH 75" TO CHANGE V41THOUT FROM ACTS. PRODUCT PRODUCT APPEARANCE. MAY LOAMY SAND LEACHING AREA REQUIRED: (330) = 445.94 S.F. 10YR 5/1 IOYR 5/1 SIDE WALL HEIGHT 11.2" 74 34.52 B 31" 34.72 B 31" OVERALL HEIGHT 16" DISTRIBUTION BOX: 3 OUTLETS MINIMUM 'LOAMY SAND ( ) LOAMY 6/6 D 10YR 6/6 OVERALL WIDTH 34" 46 UARDU OMO 4 L VD PRIMARY S.A.S. 33.10 C1 48" 33.55 Ci 45 13.6 CF USE 3 ROWS OF 5 - 16" ADS 1600BD BIODIFFUSER H-20 UNITS-NO STONE CAPACITY 177 (101.7 GAL) ADVANCED DRAINAGE SYSr>MS, INC. AND EXTENDED 0.75' WZ CONTOURED WEDGES MED.SAND MED. SAND PROPOSED SEPTIC SYSTEM SITE PLAN BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF LF OF BIODUFUSER 2.5Y 6/4 2.5Y 6/4 31. 4 (BIOOIFFUSERS) 15 UNIT x 6.25 F x = PERC ® 9 S L 4.70 SF LF 440.63 SF / (CONTOURED WEDGE) 3 ROWS x 0.75' x 4.70 SF/LF = 10.58 SF 24.10 1 156-" '24.30 156" 5"5 DONEGAL CIRCLE CENTERVILLE MA TOTAL AREA = 451.21 SF PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Mike Dedecko DESIGN FLOW PROVIDED: 0.74GPD/SF(451.21 SF) = 333,89 GPD > 330 GPD req'd NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN DARRENM.MEYER,R.S. AfaoDougam Survey NTS D.M.M. • 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pOBOX98f to conduct soil evaluations and that the above analysis has been;psrformsd by me consistent with the (508) 419-1086 DATE: CHECKED EAST SANDWICH,MA 02537 SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. 1 2 08 I 5082s22s22 / /10 D.M.M. 2 of 2