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HomeMy WebLinkAbout0012 EBENEZER ROAD - Health 4 2 Ebbneze(Read Centerville P r 147 074 4' to 0—"ato 1 u�c 1� sa �W- i . . WAST11406, um f No. Fee /0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYication for Diopont 46p5tem Con0truction Permit Application for a Permit to Construct( ) Repair(0/0u'pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. n�,,' )1�o, Owner's Name,Address, Tel.No. '"C cNTw/ r�l l f� y G" Assessor's MapTarcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size ;24 2, sq.ft. Garbage Grinder ( ) Other Type of Building `26t6 r. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided ;3!f7, 9 gpd Plan Date O " 4 —0 Number of sheets ,, Revision Date Title 07 Size of Septic Tank Type Type of S.A.S. S Description of Soil �cf. 'PtAN Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health.. Signed Date Application Approved by Date 16— 7— Zeo0 S Application Disapproved by: Date for the following reasons Permit No. Date Issued ———---————=1 —————————---————————————————————-- Y S ,mil °''w � •�`' ^y.�� / � No. .� O 6 y V 2. fir."\ TT Fee l o o �! .THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes -- - PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 'FlppYication for Tigpogal �&pgtern Con0truction Permit Application for a Permit to Construct( ) Repair(Upgrade Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. >�, Owner's Name,Address;aiaj Tel.No. v l�f rvl ( A1011 Grp' Assessor's Map/Parcel .. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �,�l�s �B sc�-��os�► Tn�9,Nrc�f 1�7s ks .�a�-r��-��8 _Type of Building: y Dwelling No.of Bedrooms Lot-Size �0T2�a�Y sq.ft. Garbage Grinder ( ) Other Type of Building /�/ Ntofe sons' f .4-- Showers( ) Cafeteria( ) Other Fixtures ' � Design Flow(min.required) + gpd Design flow provided 3!v-7. Q, gpd Plan Date 0A - (p _ Of Number of sheetsRevision Date f , Title r - Size of Septic Tank &M�i ni Type,of S.A.S. t Description of Soil" I Nature of Repairs or Alterations(Answer when applicable) Date last inspected.' Agreement: t 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. Signed /:.-e7_ � Date Application Approved by )K Date 2006. Application Disapproved by: Date for the following reasons Permit No. Dat e Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( graded ( ) Abandoned( )by at Pn/ ` Ad d f,-I dr/ has been constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit No.2 065 - ya 7 dated/ A U /0 ( b Installer j,/t k t 1-01 O Designer rr✓!/p'r'r'/!�° t �Fi/!t #bedrooms Approved design flow )': , /' gpd The issuance of this permit shall not fie coristrued a�a guarantee that the system wil func ion as designed. C G Date (inspector K, -------------------------- No.ZoU F, / Fee /o0-''" THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Tigpogal *pgtem Congtruction Permit Permission is hereby granted to C/onstruct ( ) Rep it ( Upgrade ( ) Abandon ( ) System located at /7Oa !/,"r,,/ ,(7/ 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 ust be completed within three years of the date of this pet�tnit. Date \0 6 f4• Approved by f -IP'J'08/2008 12:22 5084775313 ENGINEERING WORKS PAGE 01 xr: Town of Barnstable I ) Regulatory Services Thomas F.Geller,Dirmtor } Public Health Division _P,. Thomas Mclean,Director 200 Main Street, Hyannis,MA 02601 Office: 509-962- Fox: SM79463,44 t . Date: I91!fi r& OR : ' Fewe MC- ' 0 )Ora Inc.. Designer: Wem LAA IMMUt pro �a x; Addr _ �r Add - P®a ® c A �' 3.�t on Q.A-GrV.0� 0 tee.a was issued a permit to install a i, __r (installer) septic system at n ZC P °I based on a design do mn by f (address) c rgucy) )[ I certify that the septic system refemced above,was inst"ed subsWtiallY accordin9 to the dest a, which may include minor approved changes such as l8kral rcloca&ion of the distribution box and/or septic tank. Stripout (if required) vans iasps and the soils E'. wem found satisfactory. R r i I certify tbaY the septic stoat references above was installed with nn* changes 0.e. greater than 101 la�terul relocation of the SAS or any vertical f any come t off the septic system)but in accordance with State di I,oca1 revision or ceitified as-built by designer to follow. Stripout(if r�qu' d the soils were found satisfit;tory. PETER T,ki CIVIL o McENTEE No 35109 er s t ) tgne r s Signature) (A x signer's Stamp ) TE ASE RETURN-TO J6ABIA F-UBLIC EM1,101 dVo L BE MUED IMU TIE TM FORM d 1 BUK-T C AN WXW-1 r' t F Q:1mfce famd- ?J ° } r�Q:. Town of Barnstable. b e P# ' $ Department of Regulatory Services Public Health Division Date [l 3 6 B 200 Main Street,Hyannis MA 02601 1 1 0✓ Date Scheduled Tlme Fee Pd. Soil Suitability Assessment for Sewage s osal 6 Performed By: / r4-C1r 1 1 VIC&I t-e-C Witnessed By: 1' Location Address LOCATION& GENERAL INFORMATION. `= a 12 �be�e7q r �� N. Owner's Name Co.r'�.ci 1 ,ivy Address 12 � t/vt'Zt�i � Assessor's Map/Parcel: C 7y �r'�-. c 2 Engineer's Name r -P• -k,M-C-cake- NEW CONSTRUCTION REPAIR Telephone# ,j 0Y--?-3-7-- -".(- Land Use s i /L, d Slopes(%) Surface Stones 46 1 Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well _ft Drainage Way ft Property Line ft Other ft SKETCH:(street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ® ; w .l Parent material(geologic) Gf 4 ���+v�`�� Depth to Bedrock Depth to Groundwater. Standing Water in Hole: �� Weeping from Pit Face 111,L Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method-Used: Depth Observed standing in obs.hole: __— In, Depth to soil mottles: In. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.fhetor �...�Adj.Croundwater Level,,,m PERCOLATION TEST Date Time.&!01-, Observation Hole# �_ Tinto at 9" r Depth of Pero I Time at 6" Start Pre-soak Time @ 1 _ 't ime(9"-611) p End Pre-soak , /a Rate Minllnch L Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:1.SEPTICU'ERCFORM.DOC Zoo&- CIO L 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 OBSERVATION HOLE LOG Hole,# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.% A . SL to YIZ c M-C 5r^tom ZSY DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistengy. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Slopes;Boulders. a Flood.Insurance Rate Map: Above 500'year flood boundary No_ Yes Within 500'year boundary No Yes Within 100 year flood boundary No Yes.�. Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the. area proposed for the soil absorption system? y- -- If not,what is the depth of naturally occurring pervious material? Certification I certify that on a ((date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required train' ,expertise and experience described`in.310 CMR 15.017. Date d Signature Q:\SBp'r1C1PERCFORM.DOC �� 0 of Barnstable Barnstable Regulatory Services Department ; j saatvsrast.�. p b� ,�� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO August 5, 2008 Carlos Ramirez 715 S. Metropolitan Oklahoma City, OK 73108-2090 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 12 Ebenezzer Road, Centerville, MA was last inspected on June 17,2008,by Douglas A. Brown, a certified septic inspector for the State of Massachusetts.' The inspection of the septic system showed that the system "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Leach pit failed due to heavy scum build up and stain line at the top of the pit. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Donald R. Desmarais, R.S. Agent of the Board of Health CERTIFIED MAIL#7006 2150 0002 1041 7606 Q:\SEPTIC\Letters Septic Inspection Failures\l2 Ebenezzer Road.doc T� Town of Barnstable Barnstable Regulatory Services Department ;eriea Cft )301RN13fA8LE, MAC Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO July 16, 2008 12 Ebenezzer Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 12 Ebenezzer Road, Centerville, MA was last inspected on June 17, 2008,by Douglas A. Brown, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Leach pit failed due to heavy scum build up and stain line at the top of the pit. You are ordered to repair or replace the septic system within sixty(60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T E BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL#7006 2150 0002 1041 7545 Q:\SEPTIC\Letters Septic Inspection Failures\12 Ebenezzer Road.doc Commonwealth of,Massachusetts Ck //6 Title 5 .Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y0ti'� 1 EBENEZZER RD 5Ma v Prr operty Address Owner Owner's Name information is CENTERVILLE required for MA 02632 6/17/08 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. Important:nfilling out When filling A. General Information W forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A. BROWN cursor-do not use the return Name of Inspector key. D.A. BROWN Company Name Q P.O. BOX 145 Company Address CENTERVILLE MA 02632 rnm Cityrrown State Zip Code 508-420-4534 S 14297 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 maibtenangte]pf on-,site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 111340!0 Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fair _ c� ❑ Needs Further Evaluation by the Local Approving Authority cc CO N r— In or's nn Date The sys 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. Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �< 12 EBENEZZER RD Property Address Owner Owner's Name information is required for CENTERVILLE MA 02632 6/17/08 every page. di mown 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: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the❑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. ND Explain: ❑ 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 Title V Inspection Form.doc•OS/OS Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 f Commonwealth of,Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments II 12 EBENEZZER RD Property Address Owner Owner's Name information is CENTERVILLE required for MA 02632 6/17/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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: ❑ 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 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. Title V Inspection Form.doc-0&06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 i f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M � 12 EBENEZZER RD Property Address Owner Owner's Name information is CENTERVILLE required for MA 02632 6/17/08 every page. Cttyfrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 ® ❑ 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 'h 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. Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 12 EBENEZZER RD Property Address Owner Owner's Name information is CENTERVILLE required for MA 02632 6/17/08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 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. Tide V Inspection Form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments <'< 12 EBENEZZER RD Property Address Owner Owner's Name information is CENTERVILLE required for MA 02632 6/17/08 every page. Cltyrrown State Zip Code Date of Inspection C. Checkfist 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)] Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 6 of 15 I Commonwealth Qf Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 EBENEZZER RD Property Address Owner Owner's Name information is required for CENTERVILLE MA 02632 6/17/08 every page. Cltyrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 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 Water meter readings, if available (last 2 years usage (gpd)): VACANT Sump pump? ❑ Yes ® No Last date of occupancy: VACANT 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: Last date of occupancy/use: Date Other(describe): Title V inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 12 EBENEZZER RD Properly Address Owner Owner's Name information is CENTERVILLE required for MA 02632 6/17108 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: APPEARS TO BE ORIGINAL Were sewage odors detected when arriving at the site? ❑ Yes ® No Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M '^ 12 EBENEZZER RD Property Address Owner Owner's Name information is CENTERVILLE required for MA 02632 6/17/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene El 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Title V Inspection Form.doc-08l06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 12 EBENEZZER RD Property Address Owner Owner's Name information is CENTERVILLE required for MA 02632 6/17/08 every page. Cltyr own 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.): LEACH PIT FAILED DUE TO STAIN LINE AT THE TOP 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): Title V Inspection Form.doc•08/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments '< 12 EBENEZZER RD Property Address Owner Owner's Name information is CENTERVILLE required for MA 02632 6/17/08 ' every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 Tide V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page t t of 15 I Commonwealth.of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 12 EBENEZZER RD Property Address Owner Owner's Name information is CENTERVILLE required for MA 02632 6/17/08 every page. di yrrown State Zip Code Date of Inspection D. System Information (cont.) 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: ® leaching pits number: 1 ❑ 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.): PIT IS FAILED DUE TO HEAVY SCUM BUILD UP AND STAIN LINE AT THE TOP OF PIT Tide V Inspection Form.doc-0&06 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M y` 12 EBENEZZER RD Property Address Owner Ow ner's Name information is CENTERVILLE required for MA 02632 6/17/08 . every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) 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.): �I 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.): Title V Inspection Forrn.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth,of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 12 EBENEZZER RD Property Address Owner Owner's Name information is CENTERVILLE required for MA 02632 6/17/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 — 33,6 A 41,L 13 1 0 7--7 a.— 33 e 9SSa'� L( • � 2 Q3 Title V Inspection Form.doc•08f06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth,of Massachusetts IMMEM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 12 EBENEZZER RD Property Address Owner Owner's Name information is CENTERVILLE required for MA 02632 6/17/08 every page. CItyrrown State Zip Code Date of Inspection D. System Information (cost.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Title V Inspection Foan.doc•006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable z 1HE Tp�� o� Regulatory Services BARNSTABLE. : Thomas F. Geiler,Director MA&s 9E1639. � Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIC\Uisclaimer Private Septic Inspections.l)OC i a t w r'. ST �3Z� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP ;.� RECEIVED PARCEL ;_ Off_q- __ AUG 0 9 2004 t O7 5 �, TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 12 Ebenezer Road 9wer , MA 02655 Owner's Name l Richard& Carol McQuade t ry Owner's Address: r..> Date of Inspection: July 13, 2004 cz Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford ' Mailing Address: P.O. Box 49 _ Osterville,MA 02655-0049 - cpa. � Telephone Number: (508) 862-9400 v� En CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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 Nee Further Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: July 15, 2004 The system inspector shall sub rcopy 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. Notes and Comments ****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 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 12 Ebenezer Road Osterville, MA Owner: Richard& Carol McQuade Date of Inspection: July 13, 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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. Answer yes,no or not determined(Y,N,ND) in the 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 exflltration 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: 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: 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 12 Ebenezer Road Osterville, MA Owner: Richard&Carol McQuade Date of Inspection: July 13, 2004 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 surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 12 Ebenezer Road Osterville, M4 Owner: Richard&Carol McQuade Date of Inspection: July 13, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"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 '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ 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 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.] i No (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. E. Large System:. 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) 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. 4 Page 5 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 12 Ebenezer Road Osterville, AM Owner: Richard&Carol McOuade Date of Inspection: July 13, 2004 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: Yes No ✓ _ 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(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 12 Ebenezer Road Osterville. MA Owner: Richard& Carol McOuade Date of Inspection: July 13, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 3 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [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)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Cast date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped last year-per owner Was system pumped as part of the inspection(yes or no): 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed in 1981 -per owner Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 12 Ebenezer Road Osterville, MA Owner: Richard&Carol McQuade Date of Inspection: July 13, 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 2' Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 3" 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: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 12 Ebenezer Road Osterville, MA Owner: Richard&Carol McQuade Date of Inspection: July 13, 2004 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: -- 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.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 12 Ebenezer Road Osterville, MA Owner: Richard&Carol McQuade Date of Inspection: July 13, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000ga1.) 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.): The pit had]'of water on the bottom. The scum line was approximately Y up from the bottom. There did not appear to be any signs of failure. The bottom to grade was 9'. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 12 Ebenezer Road Osterville, MA Owner: Richard&Carol McQuade Date of Inspection: July 13, 2004 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. A �AVk g I � Q 23(. a� a T) 33 y 3 �b y 3� ya 10 i Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION continued Property Address: 12 Ebenezer Road Osterville, MA Owner: Richard&Carol McQuade Date of Inspection: July 13, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 + feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic maps and water contours maps the maps were showing approximately 25'+ to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ;>> ; PART C SYSTEM INFORMATION (continued) roperty Address: �t '0' "� a`i`(I- 4 Owner: " Date of Inspection: NRCS Report name '�V -- — --- Soil Type_ — -- _ Typical depth to groundwater____-_ _ ___ USGS Date website visited "Wit) Observation Wells checked Deep Groundwater depth: Shallow Moderate SITE EXAM Slope �j Surface waterf-5'�% • Check Cellar 4 � Shallow wellsY-AL ; t Estimated Depth to Groundwater_ Feet Please Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers ':::' Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) s - revised 9/2/98 Page 11of11 r!� TOWN OF BARNSTABLE LOCATION ' C. I�C�C�ZZe� R SEWAGE # _ VILLAGE PM ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY CUD LEACHING FACIL=: (type) PiT x (size) NO.OF BEDROOMS-2 BUILDER OR OWNER /�^^.IG9VA�L PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leachin facility) _ / Feet Furnished by TOn SAGUIIh Z)f �k _ � Q aQLIlit, a� 11) 113 3 �Ib 3�6 3 y 3� �►C .. N6. J _................ - Fes$..-&.................._ Li� THE COMMONWEALTH OF MASSACHUSETTS V"'e' BOAR® QF H EA H _ 6 lVulirtt#iivin for Disposal Works Tonstrnrtion rrrmit Application is hereby made for a Permit to Construct o e air Individual Sewage Disposal � System aT��� I, aI' n-Address .._...... - _..... ... .. .. -- --- --------- ----�....----- _..�_.. � /p.-or�No. - j- Owner Address aJ._... 11..7�r/1.. ----------•-•......--•------• •d .........................•------....------....---•-•-._......-------• Installer Address U Type of Building Size Lot }_ t.....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -•----------------------------------•--------•---------------------•--------------------- W Design Flow.................,;, ................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacit}/p .gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... AAidth.................... Total Length.....................Total leaching area... .. _.sq. ft. Seepage Pit No................ ... Diameter...._.............. Depth below inlet.................... Total leaching area.._ 1 __sq. ft. Z Other Distribution box ) Dosing tank ) '-' Percolation Test Res Its erformed by-____� li :... _ Date.... ____,��..__-. ,� _. •-----------•.... ,l Test Pit No. 1 ! .minutes per inch Depth of Test Pit...... 2....---- Depth to ground water...... minu Lt, Test Pit No. 2____.__._�/ ' tes per inch Depth of Test Pit____________________ Depth to ground water.__.�.�!!G�' Description of Soil-•-------------0-•-•----1_..._._... ? .. ---------� �� J>G -----: ..................... ----------------- UNature of Repairs or Alterations—Answer when applicable............................................................................................... ..--------•----------•-----------•-••-------------•------•-•---•---•--------••-------•--•----------------•-------------------------------------......-•---------------------------......--------••_---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL LE 5 of the State Sanitary Code— The undersigned further agrees not to place the syst in operation until a Certificate of Compliance hAbDeissued by the b and of health. � Yf •-Sign '' .L� � t`!- /' ate Application Approved By.......... Date Application Disapproved for the following reasons:----•-----------------•----........-----------•-----•---------------------------•-------------------------_...-- ......................................................•-----•----------.....-------•---.._..-------••••-.....-----•-•---------------------------------------------------------------------------•----••- Date PermitNo......................................................... Issued....................................................... Date � 9 N .. -- ....... F>�s.. ................. THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH ..............0F ` � .....Z...........''_.__....--•-••...........-••••- Appliratinn for Bigtao tl Works Tonarurtion tirrutit Application is hereby made for a Permit to Construct .(1") or Repair ( ) an Individual Sewage Disposal f' •••• Location•Address or Lot No. .... - -- -• •• �-------------------------------- ....... .---•-•-- Owner Address Installer Address U Type of Building Size Lot s.!?"I...�..._..Sq. feet .., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures -•••••-••.................•----......-- . w Design Flow..................U4_...............gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity'_Q99%.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area......._g..�_. ..sq. ft. Seepage Pit No____________________ Diameter.................... Depth below inlet.................... Total leaching area...s...A.......sq. ft. Z Other Distribution box.O Dosing tank,( ) '-' Percolation Test Results Performed by._---����!''...�:_._..�`..`...._ Date.... l ati Test Pit No. 1 A �I�r_/_'minutes per inch Depth of Test Pit........ =.f_._ Depth to ground water....... - ,.- GL, Test Pit No. 2.........�22�nminutes per inch Depth of Test Pit____________________ Depth to ground water.... R+' .................... •------t......_------•---........ .. / _ r F r O Description of Soil........... - `.l d? `__.i_J�- , x ....----•--- --.......... .......... .dc�J .Jf� '�� ................... U -----------------------------------------------------•-------------------------------_--__..------------•• y� = --�- 1_ --------------------------- ------------------------------------------------------ ------------------------------------------------------------------- r1_ .....--•-='"i/'% ' .�li� U Nature of Repairs or Alterations—Answer when applicable.................................................................................._.._.......__. •--•----------------••----._...._____...•--_---_....._......_.......--------•-------•---•-........••_...___._....-----------.......----_.._.--•------•------•----_..._----•-.....------•-------......_.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT12 5 of*the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has begn issued by the board of health. Z. / mate --- Application Approved By- -- --- .. Y-I' 1 � •----- Date Application Disapproved for the following reasons:-----•-•--•-•----••••-•-------•••-•------•••----•-••-•--••-•-••-------•--•-"--••--_.._..--••--------------•••-•- ...................••••--•••-----------•-------------------._-___.....--•---•---------._...._._-----------•-__._..•--------•---•--•-------••---••---------------------••---------------•---•--....-•--- Date PermitNo......................................................... Issued......................•............................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, �✓�./.,./ OF.....rf-:''.......� ..?`:!...:`r.✓....'., �rr#ifirtt#ie of f�uutixlittnr�e THIS IS-TO CERTIF�' That the Individual Sewage Disposal S,stem constructed- or Repaired ( ) by.................-�.. `--••• `' .. �""d .... ................•••- - ----- -------- - ------ -=- at.._..._... has been installed in accordance with the provisions ofLr ` of The State Sanitary Code as described in the application for Disposal Works Construction Permit N ! _: I.................. dated.........................._..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATES.... ..- �•----••--------•-----------. ......................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N ____•___l..... FEE.J-d..:.r' ... Disposal Works Tnno#ru lion, thrutit Permission is hereby granted.......... .......:4)/'/-/-K.ti.f ------•--••........•-•---•••••.......•---••....................... to Construct _O or Repair ) an Individual Sewage Disposal System atNo...................... .................................................. `9treet as shown on the application for Disposal Works Construction Permit No........'o.......... Dated.......................................... •--- - -- -------------------••----_-_--•----_._-_ l DATE................................................................................•-•• rd of th FIea FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS y r 4� z 1 3 a 't a : • t'r .:: irk'i"`atr-.,.�� f' A mi l 7 ,7717- CA ru • 1' F I t is N4, :-E_ � � �-f cI v^•-.�•i�} '.�7''.R': .�,.�' - ,� A I.A /r�. r lti y He r 4 9 44 1 1- p ' j OF if L r I f 1 A; ro, OE-RTROBERT A. `� $ ORUCE -4i 'fit w Ant+rSE ;`t}tEOG V H ni15TE�.yQR-t x � 4 <'i 1 k LEGEND EirSTING 'SPOT. ELEVATION ` O,cO CERT'IFIEa PLOT . 0 -A EXISYING CONTOUR - 0 - �nr-: zs a4s FINISHED SPOT ELEVATION 10.0 e+ r � r d 1NI,SHED 'CONTOUR 0 .�,`•_.. ;AIR®V,ED: BO n w, ARD ' OF HEALTH w, DATE AGENT SCALE.= i y,o ' DATE { r . , L D RED GE ENGINEERIwIG CO. IN CLIENT 32tF R ' Vic` "'� I CERTIFY THAT THE # � EGI3TERE REGISTERED JOB N0. � ° BUILDING SHOWN ON 'THI {f #: 5 CIVIL LAND (��, CONFORMS, TO. THE ZONING `�► ` ENGINEER SURVEYOR DR•BY _ OF BARNSTABLE , MA4Z8. h1« CH. BY t 2 -MAIN ST HYA NI a ?�:. y a w . N S, M SS. SHEETS OF L°— ATE Ed. LAND ,, s `777 VC 'r�AVA, 71H A�v Oel 0-p I v P7. m IAI. SNA 4 4 80_,9 R004Sq 7-:-ro 4,TA Z�,e.(AY WA CONCRErR _X7 ve* pipr, /A-,4 V Y CA S 7- 01V CO -/-,V 0RIVFWAY' co YZRv.:t :.!/e co k-11,Fllcr C Z A AV -S*A N 0 LIQUID LIEVel- . . .. . . . .... . . .. ..... 2 LAYER -0' CAST IRON P/ S/a t v 0 MJ Al.JPJrCW GAL. A • 0 0 WASHAF0 5701VAE SEPTIC TANK0 0 a I ir (app,611AZ", - f 'ecrIve 40 0 9 0 0 PZP7" & 0 v 1 0 • WA5NFZ> STONE pi Its 0 0 * 0 1 's 4, 0 o 0 PRECo 4 5 r SAS EPA a E' 0,0 P170R E0411V. A-r azllj-Dl)vcy IN YER 7 97-15 FT 0 F7 VIA M. C(5--&7ABVI-A 77)OA�) INLET SEPTIC r,4,V/< 5�6..5, Fr, 96.3 Fr ou'ri-er szp7vc -r,4,v.A< 6. GROUND WATER TABLE 0 0 rLZ7D1 5Tqfa&-rio N BOX F-_ SECT/ON aF -rA&414AT140tV CA4LE : =/VS/ LEACH11V6 PIT DIM- ON A DESISV CRITERIA FT. NUMBER 0,4r AFJ>Roo^fS FT. Awl. ��IC,4AUSAGZ,015,POSA.Z. aw"r 1laJr SOIL Z-00 7 rO 77A 4 e3TIAIA /-eD - a*V. 33 Ga,4i../a4v, SOIL 7 7 SOIL __l=S7-**2 S01.4 TEST ANUM8Ee OF 404CROVa .40/rS 97.0 Ael OA7e 0.0' SOIL 7,E.Sr SIOR 4A54CHIM6 PlEA:t PIlr. Z L�S9 -4-7- WESS.El> q, JRL-lu'-rS AV17 4gy�3,,,�v m t AWN CO,4 A AF At/ ,7'IOJV RATE J*NCOJ_A7�/40N,RA r0rA4 LEACHING'AqeA r. RRAER VS 4 P54 CNI N6 AREA =L SQ. =;r leg P� Z 7- R R OBER �fj4R CIE.-"' u kl v'S E LOREOU F7 SW --A 4 -.._sr4 4, t ' ` N LOCUS D BENCHMARK: EXISTING SEPTIC TANK CORNER OF BU TOP OF TANK EL LKHEAD aQ ELEVATION = 99.72 .97.50 INV.(OUT)=96''17t �• 1. ""� ` LUMBERT�� o (ASSUMED DATUM) Q POND EXISTING LE:;. I TO BE PUMPED, FILLED WIT N le I �� SAND AND ABANDONED N 80'04'05" E } Qv m 0 Gu nbe ° j r o¢ Rebecc° Ln r Mli Ry ? c Rd OO 202.39' VENT oN ro 8) To amo 100.40 } Pic°sso �r� .. .. ,.• /V ¢ pl V m 5'— 99.95 x ��9 ' f — 28 r� 100 ;_.. _ .. M` I—_ — r__� e a down ' f """, Route S. LOCUS MAP NOT TO SCALE LA ( SHED ` f l . . . .. . .. . . . . 00 f 30 ' 98.15 :x 99 �.<�i4y 2� t f ` —__ _ . x 99.31 �x , .ram �'� � � GENERAL NOTES: ¢ a g9'08 f DECK r �TP-1 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL ISTP-2 i m O BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULA7IONS EXCEPT AS REQUESTED BELOW: 'HOUSE (#12)'l `%/ 98.85 x 1) 2' variance th i i /� �, 1) A 2' variance to the 3' maximum cover requirement, for no greater # i ,T O.F. 99.72/ GARAGE = \ than 5' of cover. S.A.S. shall be vented and H-20 Rated. x 97.00 G i ' 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR / TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 897.43 / /' !! �'//f i LOT 25 DESIGN ENGINEER. i i 98.60 x L._ f /f 1 d7 "~d 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING o APN 1 4r/ • 074 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 98.95 x x 8,45 1 2,0;218f ENGINEER BEFORE CONSTRUCTION CONTINUES. 1 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. — 95.. WALK a ��/ O 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF `' .. --. 1�� � O' HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. X`w,� .58 98,45 x a '9 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. Qy" -- .°ate o f 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. , g6✓" 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS ':Zj _._ _.-- '` - - AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE gad DIRECTED BY THE APPROVING AUTHOR UP � '` ••�- "••- - � .••-•- " - TIES I . IT SHALL BE CONTRACTOR TO L=172.00' _ �- " � - E '= HYD• 10 THE LOCATIIONTOF ALLPUUNDERGROUONDTHE UTILITIES, PRIOR TO BEGIINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS it DGE i IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND C� OF PgVEMENT " REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). tn� 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE LEGEND �L' q'� { INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. EBENEZE 13, THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND yg --- -- EXISTING CONTOUR R bF MASS9� IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. x 100.98 EXISTING SPOT GRADE ROAD �G PROPOSED SEPTIC SYSTEM UPGRADE PLAN 99 PROPOSED CONTOUR o PETER T. J' g9 cIV PROPOSED SPOT GRADE g McTEE lL 12 EBENEZER ROAD, OSTERVILLE, MA ',/�/ EXISTING WATER SERVICE o, 35105 I� SZE��`O '�Q Prepared for: Douglas A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 G EXISTING GAS SERVICE OWNER OF RECORD F / N E Engineering by: SCALE DRAWN JOB. No. —pHIN — OVERHEAD WIRES RAMIREZ, CARLOS R En ineedn WOT'ks 1"=20' P.T.M. 210-08 TEST PIT %CIT GROUP/CONSUMER FINANCE, INC. DATE ��� 9 g 715 S METROPOLITAN - 12 West Crossfield Road, Forestdole, MA 02644 CHECKED SHEET NO. BENCHMARK OAKLAHOMA CITY, OK 73108-2090 (508) 477-5313 9/6/08 P.T.M. 1 of 2 E� NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:95.93 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. PROPOSED D-BOX1" 5-4SEAL SEPTIC TANK PROPOSED S.A.S.SAS 2" t INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL INSPECTION PART OVER END UNIT CHARCOAL 2" OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE I ' T.O.F. VENT EXISTING F.G. EL: 1100.9(MAX.) i F.G. EL.=99.4t F.G. EL: 99.6t MAINTAIN 2% GRADE (MIN.) OVER S.A.S. el N INSPECTION L = 29' L = 7'(MAX) PORT @ S=1% (MIN.) © S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC s i�l Top View Section 14" IN VER T EXISTING 48" LIQUIDI _I LEVEL GAS ABAFFLE INV.=95.87 PROPOSED INV,=95.70 r4 ROWS OF 4 UNITS AT 6.25'/UNIT = 25.0' INV.=96.17t D-BOX INV.=95.54 EXISTING 4 OUTLETS (MIN.) SOIL ABSORPTION 'STEM (PROFILE) EXISTING 1000 GALLON—SEPTIC TANK ESTABLISH VEGETATIVE COVER j BACKFILL WITH"-ftEAN NATIVE OR —" 75' PERCISAND TO TOP OF CHAMBERS NOTES: 1) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED BREAKOUT=TOP STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). TOP ELEV.=95.93 2) INSTALL INLET & OUTLET TEES AS REQUIRED. INV. ELEV.=95.54 3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE BOTTOM ELEV.=94.60 IIIIIMII AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 2.83' r 76 —� 4) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE 5' MIN. ABOVE BOTTOM OF INVERTS PRIOR TO CONSTRUCTION. T.P. EXCAVATION .OR G.W. EFFECTIVE WIDTH11.3' PROFILE EXISTING SUITABLE NO G.W., EL=87.0 = MATERIAL 4 ROWS OF 4 - 16" (H-20) ADS BIODIFFUSER UNITS SEPTIC SYSTEM PROFILE WITH NO SEPARATION BETWEEN EACH ROW & NO STONE TYPICAL SECTION 16 N.T.S. ".rs ; 11,2" - _ SOIL LOG ;-. 34" --►� DESIGN CRITERIA T� e DATE: SEPTEMBER 4, 2008 (REF#12,340) SECTION END CAP OPOSED S. SOIL EVALUATOR: PETER McENTEE PE .3 WITNESS: DONNA MIORANDI R.S. NUMBER OF BEDROOMS: 3 BEDROOMS �� 9) HEALTH AGENT 16"" HIGH CAPACITY (H-20� BIODIFFUSER UNIT SOIL TEXTURAL CLASS: CLASS 1 8Q FELEV. TP-1 DEPTH ELEV. TP-2 DEPTH DESIGN PERCOLATION RATE: <2 MIN/IN 3 ��, ' 0" 0' MODEL 16" HICAP J 98.5 A 1 98.5 DAILY FLOW: 330 G.P.D. SANDY LOAM SANDY LOAM LENGTH 76„ NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT . f 10YR 4/2 10YR 4/2 EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DESIGN FLOW: 330 G.P.D. g f r 98.2 4" 98•2 4" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. ,f B B SIDE WALL HEIGHT 11.2" GARBAGE GRINDER: NO SANDY LOAM SANDY LOAM LEACHING AREA REQUIRED: (330) = 445.9 S.F. E, EXISTING, %I 1o'YR 5/8 10YR 5/8 OVERALL HEIGHT 16" 96.5 1 24 96.3 C1 26 OVERALL WIDTH 34" 4640 TRUEMAN BLVD C1 HI 026 HILLIARD, 0 0 43 74 'HOUSE (#12)f � 38" "13.6 CF EXISTING SEPTIC TANK: 1000 GALLON CAPACITY -'T.O.F.=99.72E CAPACITY PROPOSED D-BOX:: 1 INLET, 4 OUTLET (MINIMUM), H-10 RATED -''t %r f` PERC (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. 50" PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 4 ROWS OF 4 — 16" (H-20) ADS BIODIFFUSER UNITS M-C SAND M-C SAND W/ NO STONE FOR AN S.A.S. WITH DIMENSIONS 1 1 .3' x 25.0' 2.5Y 6/4 2.5Y 6/4 12 EBENEZER ROAD, OSTERVILLE, MA (HIGH CAPACITY INFILTRATORS MAY BE SUBSTITUTED) Prepared for: Douglas A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 SIDEWALL AREA: NOT APPLICABLE Engineering by: SCALE DRAWN JOB. NO. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.7 SF/LF OF BIODIFFUSER) S.A.S. LAYOUT I Engineering Works NTS P.T.M. 210-08 87.0 138" 87.0 138' 16 UNITS x 6.26 LF x 4.7 SF/LF = 470.0 SF PERC RATE <2 MIN/IN. ("Cl" HORIZON) 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET N0. NO GROUNDWATER ENCOUNTERED DESIGN FLOW PROVIDED: 0.74 x 470.0 = 347.8 GPD (508) 477-5313 9/6/0$ P.T.M. 2 Of 2