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HomeMy WebLinkAbout0084 DUNASKIN ROAD - Health 84 Dunaskin Road Centerville F/R A = 229 006 01. Ord'�� � N0. 152 1/3 ORA, p. 10%, �.+"_ -.: � - ,,fir•.,, .:..,.fig ..,._. .. C TOWN OF BARNSTABLE 1 LOCATION ��' ��""�'f'F��' SEWAGE # VILLAGE -,y,C`�veL�l ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. `3; * SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 63 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 �e0 within 300 feet of leaching facility) Feet Furnished by Av / 0, �. A,e,26 f1 0 ei 8C, Faec,✓T 4fs �j I � TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE C X 2 r/J L—�f^ ASSESSOR'S MAP & L � �- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 'NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland 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 (CA to C) 4Ajq3 Falb �P a L WZ�7/ No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS 01ppYication for ]igpoeal *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade;�)Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. /�a/i�� i N /'�L�t` Owner's Name,Address and Tel.No. Assessor's Map/Parcel �1 f L<' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. •Type of Building: Dwelling No.of Bedrooms '5e' Lot Size sq.ft. Garbage Grinder( ) Other TI pe of Building 't'Z%r No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �J gallons per day. Calculated daily flow � � gallons. Plan Date �� y `� Number of sheets O Revision Date Title Size of Septic Tank Type of S.A.S. f=� ``� -�3 �•' Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue y this Board of Health. Signed i 1 Date -�- Application Approved by 0 Date Application Disapproved for the following reaso z�7—�r— Permit No. Date Issued r T i Fee 1, THE COMMONWEALTH OF MASSACHUSETTS ,Entered in computer:N, Yes PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE,, MASSACHUSETTS 0[ppYication for �Digpogar *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade)Abandon( ) O Complete System EJ Individual Components Location Address or Lot No. .b!//t/�f'���y /Ql/�' Owner's Name,Address and Tel.No. Assessor's Map/Parcel 9 Installer's.Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �i 1 C•�3cc«i� c��i9 .fi�'�eT��. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building OPO*Lr- No.of Persons 1 Showers( ) Cafeteria( ) Other Fixtures Design Flow y T gallons per day. Calculated daily flow gallons. Plan Date ��-�` V Number of sheets / Revision Date 01 Title Size of Septic Tank Type of S.A.S. f%�`�4 -/3•Y,�3X� Description of Soil - Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersign_ed4ggp:ee .to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue y this Board of Health. Signed `If " Date 6' �OS Application Approved by 8_0c,- f"L ,4 'l O v Date - ,/ Application Disapproved for the following reasons � C/ Permit No. ...- Date Issued ——————————————————---——————-- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded k Abandoned( )by C7�,o" at jo�R AD �y�f�/� ��/ GG`%�I`� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2C63- 24( dated G �- Installer Designer The issuance of thrs pe t shall not be construed as a guarantee that the system wi f ct d� s' es' /K Date Inspector / - f A _ ___ _ � No. .� �—�_���-----------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS wigogar *pgtem Construction Permit Permission is hereby gra ted to nstruc e a,i �)U grade( Ab Edon System located at //V �� r o f , 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:Cons ctio/must b completed within three years of the date of th• •(per/mi Date: � 7 Approved b / . i TOWN OF BARNSTABLE LOCATION SEWAGE# 1Z R— VILLAGE ��'� ASSESSOR'S MAP &LOT INSTALLER'S NAME.&PHONE N0. SEPTIC TANK CAPACITY �G�4 LEACHING FACILITY: (type) .(size) NO.OF BEDROOMS BUILDER OR OWNER i PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table tothe Bottom of Leaching Facility - Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 309 feet of leaching facility) Furnished by 6 ,fJ o r OF a ,2 4 LFX( J lb COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS F DEPARTMENT OF ENVIRONMENTAL PROTECTION r � } d a TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 84 DUNASKIN AVE CENTERVILLE, MA 02632 '0�1I boa p Owner's Name: MRS. HINCKLEY Owner's Address: 84 DUNASKIN AVE CENTERVILLE,MA 02632 Date of Inspection: 9/10/01 Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA. 02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT 1 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 X Conditionally Passes _ Needs Further a ation by the Local Approving Authority Fails Inspector's Signature: Date: 9/10/01 n. If the system is a shared system or h The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspect oas 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. Notes and Comments THE SYSTEM IS A CONDITIONAL PASSES AS PER THOMAS MCKEAN-HEALTH AGENT-MAIN CESSPOOL IS 5 PTO A BODY OF WATER-FOR SYSTEM TO PASS-CESSPOOL NEEDS TO BE REPLACED WITH SEPTIC TANK.RECOMMEND RAISING COVER TO LEACH PIT-DEPTH TO GRADE APPROXIMATELY 6' ****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. Title'; Incnvrtinn Fnrm twi rs/innn Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 84 DUNASKIN AVE CENTERVILLE,MA 02632 Owner: MRS.HINCKLEY Date of Inspection: 9/10/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: c _ 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: THE SYSTEM IS A CONDITIONAL PASSES AS PER THOMAS MCKEAN-HEALTH AGENT-MAIN CESSPOOL IS 51' TO A BODY OF WATER-FOR SYSTEM TO PASS-CESSPOOL NEEDS TO BE REPLACED WITH SEPTIC TANK. B. System Conditionally Passes: X 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. n/a 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. ND explain: n/a n/a 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 _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a 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: n/a `t Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 84 DUNASKIN AVE CENTERVILLE,MA 02632 Owner: MRS.HINCKLEY Date of Inspection: 9/10/01 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 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 surfa&water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen 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: n/a ;,. Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 84 DUNASKIN AVE CENTERVILLE,MA 02632 Owner: MRS.HINCKLEY Date of Inspection: 9/10/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n/a. _ X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply.well. X 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen 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.] (Yes/No)The system fails. l 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. You must indicate either"yes"or'".no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 31, yes no _ X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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. A Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE-.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 84 DUNASKIN AVE CENTERVILLE,MA 02632 Owner: MRS.HINCKLEY Date of Inspection: 9/10/01 Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period 9 X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site'? _ X Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ 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: Yes no X Existing information. For example,a plan at the Board of Health. X _ 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(3)(b)) ,y+ li Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 84 DUNASKIN AVE CENTERVILLE,MA 02632 Owner: MRS. HINCKLEY Date of Inspection: 9/10/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use:(yes or no): NO Water meter readings, if available.(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a . TYPE OF SYSTEM X 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) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: ORIGINAL 40 YEARS Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 DUNASKIN AVE CENTERVILLE,MA 02632 Owner: MRS.HINCKLEY Date of Inspection: 9/10/01 BUILDING SEWER(locate on site plan) Depth below grade: 48" Materials of construction:_cast iron _40 PVC Xother(explain): ORANGEBURG Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 3" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 6' X 6' BLOCK CESSPOOL" Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle:36" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom.of outlet tee or baffle: n/a How 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.): MAIN CESSPOOL IS 51' TO BODY OF WATER AND NEEDS TO BE REPLACED WITH SEPTIC TANK FOR SYSTEM TO PASSES TITLE V INSPECTION. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 Page 8 of 11 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 DUNASKIN AVE CENTERVILLE,MA 02632 Owner: MRS.HINCKLEY Date of Inspection: 9/10/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: _(if present,must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): NO-BOX PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a i , f 41> u Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 DUNASKIN AVE CENTERVILLE,MA 02632 Owner: MRS.HINCKLEY Date of Inspection: 9/10/01 SOIL ABSORPTION SYSTEMJSAS): X (locate on site plan,excavation not required) If SAS not located explain why. n/a Type 1000 GAL 6' X 4' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: nla n/a leaching trenches, number, length: nla n/a leaching fields, number: nla n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: nla Comments(note condition of soil,+signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE PIT HAS NOT HAD MORE THAN I'OF WATER IN IT. ESTIMATE T OF STONE.BOTTOM AT 10' CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a f.a yk Page 10 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 DUNASKIN AVE CENTERVILLE,MA 02632 Owner: MRS.HINCKLEY Date of Inspection: 9/10/01 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. I � P'Ji6 05 Oec� AA )y3 lot in Page I 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 84 DUNASKIN AVE CENTERVILLE,MA 02632 Owner: MRS. HINCKLEY Date of Inspection: 9/10/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12 feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: GROUNDWATER DETERMINED AT IT FROM HAND AUGER ON SITE. BOTTOM OF PIT AT 10" II -__ _ _ --- __ -- -- - - -- ______ __ __ _ _______ ____ _ _ _ _ M r' ro lo c' , - - - - . . .HI Cll SOIL TEST TOP'OF FOUNDATION 20 FT: MINIMUM FROM CELLAR DATE OF SOIL TEST _j / l 8 a 2 ..,�.:i.I�I II.�I..1-I.NI�I..1�I.I I.I.,.II.I��I�� .:P�,I.1 I.�..II II�:l 1.k-.-�-I..,II 1.,.­�.�-1.I�I-.M.I.-I I.�..I.1.-,,,I I.".�.I I�I,I.I D I II"I-I.I�.,�I,�­l.I 1 II.�­.II�.-II�.�,�I-�,I-.I.II�..I.:I 1 E I­,_1",�;I�--I�I.II.�.III-�._I1��I II_1�-III�I 1-�I�,I.�PI 1 II..�II I;�..-I-1-.I1I.-,I�1�,-...1...,,�-..1 T�,1 1-I�,._,�.1I-I�,....�I.�.I,I.I,.-RH",.��I\I.;I,�.-...!�II I.1.�1 1.I,1.I.�..,...�I...-,1 I�,.�.II1,.I�.,,I.,�I�,..I.-.�I I I��II J1�...I.�I,II I,.�,�.,I-.I I.,�.II I.��.I I,�.�.I-l 1.I'.I..I I 1.'..I'I.:..��,�I.-I.1',�,�I:�.�....II�:�I-I'I.1.7.III­I­.�.I I%.�..1mI,I,I-II I­.�I1,;I I,,I�.�_,,I,l..ILI Il I�..-I.._­,:.I�,I.'.��II�'_-���,,I.­,�-�_II-�I���.-,I I-".,:I,:I1..v.I"�II�I���I.I 1 II I."--�,.--II I:4.,",..I-,II.�,1�..I-1/.�r�I��,�1-:II�,j�.I�_I­I..I-�.:I II"...,,..",�.I I,�.1�(1'.I,�T.,,-�%1Ir�.­.-.1,....I I.I.-."IE.I/1'��-II�_.1'.1.-1.'.I_:�.1�I I1..II EII..'I I..1I;-�:.IIII...I1..I/'.I-"I 1I I.1..../.11.I.�...I­,-'.1 a..I-.��.I.,�.I.�.�I�1,-I II�1I I:.�-�,I:,I'�.,I..r I�-.II-I-II.III�.I._1��.��I�I1..I,.I,1 I,/I II�.�I.���I,I I.�.t. -.-I II 1 I;-I"I.I._��Ir1 5-,�f...1,��II I�.*II��I II��..,I­Ii..�I��.I,..4 I11,11*.�.i,-�,I I1�.�.I�..I-1,III- .,�._­11-II-�.�I�I.I�-.1:�,?,�."-I1��I_�1I.I,.1....;��,.I..I.,1��.,A�-�l_�.�.,I��I�.;1o.a�I�I.I�,.;.1."I�5�...,..r,.,-L,.-..-i,w.-),.�I-,<1-��..�,-I�_...��.-I�,II I I./iI_.�-�.lI 4A.I.I.�I I�I t��..-.;��1I I..I..III I I I.�IIIII I I;I,I I�I t1I%_I�I I�i...��II I.1 I[ l 20.Q ld FT. MINIMUM` 10 F.T. MINIMUM FROM SLAB OR CRAWL SPACE SOIL TEST DONE BY 0, .-t.,'#W pl ELEV. ___. CLEAN SAND WITNESSED BY /,',,t -_4 a v f1'3�vraC :--,.-"-..,1I�N.,1,.'1I,-,_,1 I,111,"�1_n.I-­-1z",�_,­,�.:-�,,"'--- III (ASSUME(7) CONCRETE . . COVERS t oaM ANa sEEa - OBSERVATION HOLE 1 ELEV.=w.9"0 4" SCHEDULE 40 PVC PIPE PERCOLATION RATE �_�� MIN.jINGH AT �t INCHES O- MIN: PITCH 1/8" PER T. TEXTURE COLOR M TT, OTHER . 2" LAYER OF DEPTH HORIZ 46 ExJsr le;_I 1/s" To 1 jr' LEGEND: 0 � ...,,r ,o " ?*. WASHED STONE. VENT I -S EXISTING SPOT ELEVATION 00,0 !Z AP ran+e� f ?- 4" CAST IRON PIPE " t` 9 L';7.fJ,, REGUII 1:J . ''8 (OR EQUAL) MINIMUM - EXISTING CONTOUR ----00---- #I / 40YA PITCH 1/4 PER FT. e,'",r5✓d , fA.AV ! /F A-1 C70I4r FINAL:SPOT ELEVATION ? f a ..-I& .St+ vt I0r= i THAa1 3 FINAL CONTOUR . i C p ��" SOIL TEST LOCATION & 5a. 1d4' ` lQY2 t.�: Awz FLOW LINE t 9W 7'f " _" _J ©v�r� 3.A .s. UTILITY POLE -0- B, C� c.•. � ' y 9 ,,c7 C 10 f TOWN WATER -�W W _... *$ PLuk0NG ELEV. - '" MIN. ❑ O 0 C] O 0 C3 ❑ C3 ❑.❑ .. / � "`"� ,. ------�' o 0 0 o CATCH BASIN GG�u� (,'BENS 8Y ELEV. = q•� .'- LE EL a ^ 0.-° 0 p 0 C] C3 © 0 0 O I]0 o °o GAS LINE C.O: '� d'4'r`1 / tD A ELEV. =t�f 7� ELEV. = 95:33 6 SUMP ELEV. _ ,J,l? o o CLEAN OUT GAS ❑ C] OODC 00000 o 2'' o CI SGQ/+d I/O BAFFLE - o o CESSPOOL C.P. l'J . . DISTRIBUTION ; ° o 0 ° G ° 4►rAk ell . ELE�L = OOO © ❑ C 0000 ❑ q� 0'; 3sOla o o° o ° ° ELEV. _ _/-'___ LIQUID OUTLET )32 4 FEET 14 ,INCHES (TO BE PLACED ON FIRM BASE) TO BE WATER TESTED 3 - 500 GALLON NE IN N WITH . STONE IN AN 5 FEET 19 INCHES '� 00 GALLON IF MORE THAN ONE OUTLET i f# I IVG WATER ENCOUNTERED AT ._J_ , ELEV.'_ ' '*O J 6 FEET,, 24 INCHES /3 x ,;3,3 .O 2 TRENCH FORMATION t WELL "°-7 7 FEET , 29 INCHES (TO BE PLACED ON FIRM BASE) ZONE / 8 FEET 34 INCHES . SEPTIC TANK _J ,5' 3/4" TO i 1 j2" CLEAN SOIL ABSORPTION : INDEX -�_...._ DOUBLE WASHED STONE ADJUST�--_._- - FREE OF FINES & SILT , SYSTEM {SAS). , DESIGN CALCULATIONS . - NUMBER OF BEDROOMS ,. . T� Ct1 C USGS. PROBABLE WATER TABLE ELEV.- = ,,^^ " 'g!" 9 G/`,,i - SEWAGE DISPOSAL SYS 1 EM PROF ILO pa 4D OBSERVED WATER TABLE ( j ,/ ) ELEV = _-9!7 Z"A^'p GARBAGE DISPOSAL UNIT rJo NOT TO SCALE BOTTOM OF TEST HOLE ELEV = TOTAL ESTIMATED FLOW 44f0 caca GAL./DAY REQUIRED SEPTIC TANK CAPACITY GAL. �a.g_ " ACTUAL SIZE.OF SEPTIC TANK / GAL. SOIL CLASSIFICATION DESIGN PERCOLATION RATE < MiN./IN. . EFFLUENT LOADING RATE GAL./DAY,/S.F. -LEACHING AREA 13,X 3',3 ++ 9 Z.K,2' SQ. FT. I LEACHING CAPACITY (AREA X RATE) !E,3 GAL./DAY RESERVE LEACHING CAPACITY LrL -GAL,/DAY . NOTES: . 1. ALL WORKMANSHIP AND MATERIALS SHALL `CONFORM -TO .D,E.P. I '• TITLE 5 AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. . 2. ALL.COVERS TO SANITARY UNITS SHALL BE BROUGHT TO . WITHIN 6" OF FINISHED GRADE. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN - '10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL CE " cc = : USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING ARFAS. 4. ANY MASONRY UNITS USED TO BRINCO COVERS TO GRADE SHALL ., . 1 <. __,. _ .:.. ESQ. MORTARED �N PLACE. . T'A . 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR :ZONING REGULATIONS. OWNER j APPLICANT 1S TO . �_5 8 n 7-/ s`G E S � 3 Q I-✓ /ZA=a-U 4:,17-,`el,tJ t/•'3fZ-'.n A/e-,*- OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY: . . 6. UTILITIES SHOWN ARE APPROXIMATE ONLY,.EXCAVATION CONTRACTOR LONG POND .o . r ,�,, IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS -. ' : / R S.=" -7""!©,N.r / .,. 2 " l7 t Z 74� � `9-,7-teV.e`A -nT . ' _ ' PRIOR TO COMMENCING WORK ON SITE. . II�.-.I.1...-,�..I...-IT,I I'�:..I�.,),.II�...�:..1 I._/III',.,II,.�II../-�II.I.I I.i�1....I:-%�I­, I�1 M..I.�..II�,.."�,-�I1�I1�IA.II lI�II.�.%1...-�-X��I,I I:,I 1.-...�I.��,I.I.��1,..�I.II,.I�.I I/\.I�I/:-I�/",�,�­ r . ';)1j 5w 4. ;, f �, Sri 7" - , ,t, �,, 'A- /q•,e�r QU'/r�7. CONTRACTOR ,IS TO VERIFY GRADES AND ELEVATIONS -AS WELL AS . 7 SITE CflNDiT101JS PRIOR TO .COMMENCING WORK ON SITE. ANY .VARtATINt . � Z + V.#j fz r�Al ,C 4E n,w'0 4a)+ F,,5 T' 1 w hS TO:E BROUGHT TO.THE ATTENTION 01` THE DESIGN ENGtNEER <<, �I g7.3 -, ,2 �. , 87.E D►ATELY, �,, .. IMME . I ' /< : 8. PARCEL IS IN FLOOD ZONE. •:82.2 ` t _ 5. COT IS SHOWN''ON'`ASSESSORS'MAP 2-2_? AS PARCEL ,. . 0s P f _- rS.,• 10. ALL UNSUITABLE MATERIAL SHALL. BE REiuIOVEp FROM UNDER, RNLI , f , f , /. / � z� . ,/ _� / FOR ,A MINIMUM OF 5'FEET FROM AROUND.THE SOIL tABSORPTION SYSTEM, '. �t.2 . - I AND BE REPLACED WITH '.SAND:AS SPECIFIED IN;310.CMR 15.255, :(3) ' - $6.5 / __,- (LE. TITLE 0 IF ENCOUNTERED BELOW S.A.S.;.:PtPE INVERT.'• ;/ BEACH �6.7 . . - 0F0, . .11. EXISTING CC SS P00 r,TO BE PUMPED AND FILLED :WITH SAND i M 4 �/ f . ,/' / .l / 9 2..5 : Av9'q�' p =L I / --' 0 9 3.0 : `P�' s rn G ■-96. ORAIG �•� WI .;i : a /// y,.. :' / _47.2 .. - ;g k SHORT a 4i i' } . I -: b� . PP'ROVED, BOARD 0F : HEAL`TH 82 3 ___ 8�:9 . , c' A v, � ! : IL , / ,. x 3 w " _ � NC. PAD t NO. 274. 6 .3 � /I../.III.I..I.1�-1III.I�-I*.,IIII �I.,i Iz I I�,rI I I I I.:.I�.I I.�I I�.I.I.II 1�N�.II,II I_.I. . ., A LDTB f � - 'a,9 .8 , p To 4� _ . 'l i -_ AREA ,14,368� S.F. p.,,.,,/ F . , / i s , � r ; , -. 9 . �. - w. 'DECK r 1. II $ _ SATE AGENT . 7.0 ., _,,.; , v ._. .". EXI s ,.,. /'� .,, ..� f STING TJWELLiNG � _ . . -,. ,,: 1 : /. . _p . �' 1 / _ {J/ .,� - .. / �. 0 0 D EP c ;D ; G z / P P E T I F( R _ _ ,- . -.. . .. . Y / o �_ ., 1 c� /_ c : x 974 l.. - 1 .. _ o . SHED 4 K BIT DR/t�E . =' l a 7.8 3 � 9 , ,, - ' . ,r, , v ti ,, t F Ja: 1 / /3 . .,.. .. . 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