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0458 ELLIOTT ROAD - Health
458 Elliot Road " Centerville A= 227-125 I No. 4210 1/3 ORA Pendaflex 4 J 1 0% 4! Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 458 ELLIOTT RD Property Address ZDANYS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-7-15 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the _ -- —- computer, use 1. Inspector: only the tab key I i o to move your DOUGLAS A BROWN ' --- -- cursor-do not. Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 Cityrrown State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the 'information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 1-7-15 Inspector' i ature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form.Wrface wage Disposal System•Page 1 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 458 ELLIOTT RD M Property Address P Y ZDANYS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-7-15 every page. City/Town 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: S.A.S WAS INSTALLED IN JAN OF 2013 AND HOUSE HAS BEEN PRETTY MUCH VACANT SINCE THEN. SYSTEM HAS SEEN VERY LITTLE USE B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 1 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 458 ELLIOTT RD Property Address ZDANYS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-7-15 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 458 ELLIOTT RD Property Address ZDANYS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-7-15 every page. City/Town State Zip Code• Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 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 '/Z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 458 ELLIOTT RD Property Address ZDANYS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-7-15 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ,❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® 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- 1 0,000g pd. ❑ ® 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 458 ELLIOTT RD Property Address ZDANYS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-7-15 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information i Residential Flow Conditions: 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M •''� 458 ELLIOTT RD Property Address ZDANYS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-7-15 every page. Citylrown State Zip Code Date of Inspection D. System Information Description: SYSTEM CONSISTS OF A SEPTIC TANK D-BOX AND AN 80 FT TRENCH CONSISTING OF ARC 36 HC CHAMBERS Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes Z No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage HOUSE g ( y g (gpd))' VACANT Detail: HOUSE HAS BEEN VACANT Sump pump? ❑ Yes ❑ No Last date of occupancy: 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: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 458 ELLIOTT RD Property Address ZDANYS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-7-15 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: PUMPED IN 2013 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 458 ELLIOTT RD Property Address ZDANYS Owner Owner's Name information is CENTERVILLE MA 02632 1-7-15 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: S.A.S INSTALLED IN JAN OF 2013 Were sewage odors detected when arriving at the site? ❑ Yes ® No 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: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Sludge depth: LIGHT t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 ELLIOTT RD Property Address ZDANYS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-7-15 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0 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? WOODEN POLE Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK WAS IN PROPER WORKING ORDER AT TIME OF INSPECTION 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 458 ELLIOTT RD Property Address ZDANYS . Owner Owner's Name information is required for CENTERVILLE MA 02632 1-7-15 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 458 ELLIOTT RD Property Address ZDANYS Owner Owners Name information is required for CENTERVILLE' MA 02632 1-7-15 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): BOX LEVEL NO LEAKAGE OR SOLID CARRY OVER Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 458 ELLIOTT RD Property Address ZDANYS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-7-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: arc 36 80ft ❑ 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.): CHAMBERS WERE DRY AT TIME OF INSPECTION Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool i Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments cwM 458 ELLIOTT RD Property Address ZDANYS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-7-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 ELLIOTT RD Property Address ZDANYS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-7-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 458 ELLIOTT RD Property Address ZDANYS Owner Owners Name information is required for CENTERVILLE MA 02632 1-7-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: NONE ENCOUNTERED AT TIME OF PERC TEST 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: 1-2015 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 458 ELLIOTT RD Property Address ZDANYS Owner Owner's Name information is required for CENTERVILLE MA 02632 1-7-15 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 2 TOWN/OF BARNSTABLE 00/ /-a5`A) LOCATION_�/S�C//, �t Cd SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL 2 a-7—i% INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHINGFACIITfY:(type),cfic �c ge N-20 (Size) J �Tir�vt`7 NO.OF BEDROOMS a/ OWNER Z AJ PERMIT DATE: �aLDZ� COMPLIANCE DATE: 3 . Separation Distance Between the: nw,¢cluCvyvdP�rr� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility dgfi-, /c Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 20.0 feet of leaching facility) Feet . Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FuRNimEDBYfQ,,a)c5 R ru.J FRONT 1 i I IN � t3 iR ,)-�c.ry - 3C A Iv— S y -Li A -33.5 IDT30X-3o,S (,-4i.S 1 - 301s .4- 29Ct g-40 L http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=227125&seq=2 1/7/2015 t ii �j � t t No. 1 `�� Fee du THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppliLatIon for Dis' poAAY 6pstem Const union VPrmit Application for a Permit to Construct( ) Repair(V/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or of No. et,615 8 lZd Owner's Name,Address,and Tel.No. G +-e(-v Mr Assessor's Map/Parcel d+ ZD N s Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. ��( — i568-qOO-74� n U)n/k -S 1 Type of Building: Dwelling No.of Bedrooms Lot Size N% 3C, sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank x��} �� Type of S.A.S. A(,- f?,G d c- /#,xa T e,,r- Description of Soil Nature of Repairs or Alterations(Answer when applicable) �I�,�n(cc�•,.P - 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. Si a Date 26 Application Approved by Date /Z o.Z Application Disapproved Date for the following reasons r� Permit No. Z97 Q Z Date Issued IL�ZGI Z�iZ V, No. 4O 12-- H05,O), - Fee t ...a _. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpYication for Dip 1,,h6pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or of No. 4/,f8 9 Hl p/- /2d Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ��� a 2�A N S Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. - 00 /S h n+ [.t/ /G -S Type of Building: Dwelling No.of Bedrooms /1 Lot Size y785[, sq.ft. Garbage Grinder( ) Other Type of Building kpk 2ST_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided yN8 / gpd Plan Date Number of sheets Revision Date Title ' Size of Septic Tank Type of S.A.S. Are- !!3 c, 2=o 7/2,1/-C 1 150 FV Description of Soil Nature of Repairs or Alterations(Answer when applicable) f2 q .S :keo 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. Si e Date ZGh-'— Application Approved by ' Date 2 o iZ Application Disapproved b Date for the following reasons \\ �A 1 Permit No. 7-Ca42. Date Issued�zv/Zo,Z THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(c�Upgraded( ) Abandoned( r)by c12;p,,�r:c A at l�S 1: ;r,> {� �� \� has been constructed in accordap e . with the provisions of Title 5 and the for Disposal System Construction Permit No. aG yDSd (ZU11 2- Installer`"�6,,A_no,—!Z6,r Designer W/45 #.bedrooms 4 f Approved design flow ,0,, / gpd The issuance of thisGpermit shall not be construed as a guarantee that the system I-) fupction as de igned, Date r1 'l Inspector ,r' ��� � y� No. O LZ -- ���� _ / w° THE COMMONWEALTH OF MASSACHUSETTS Fee �Q� PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal *pstrm Coustructiou Permit Permission is hereby granted to Construct( ) Repair( I<"- Upgrade( ) Abandon( ) System located at li;'� ���/p�' Ce,-*1-rV1 J e and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date /1 Zp 1Z c, r-L Approved by Town of Barnstable �Ww Regulatory Services $ Thomas F. Geiler,Director Public Health Division `��': Thomas McKean, Director 1� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: I Sewage Permit# Assessor's Map/Parcel 'Z L 7 - L Installer&Designer Certification Form Designer: 57.,E; n¢,a n', W o r l�5% ]nc . Installer: Address: 12 W. Crb S S ,e ►el TR#• Address: O' X 1 4.S- 4;7� j_d t-� a z y y C�,� -J �l l� M 0—"3 Z On fy-�^ I`-< was issued a permit to install a (date) (installer) septic system at y S$ 1 o t based on a design drawn by (address) . e'L dated (Z , I a 3 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. C=, r j o4,, N I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was ' cted and the soils were found satisfactory. � OF MAssq �y PETER T. N M ENTEE stabler s igna re civet A 9 N0.35109 �O �QeS T E G `<11 (Designer's Signature) (Affix Design re) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. ` THANK YOU. I gAoffice formAdesignercertification fonn.doc s - TOWN OF BARNSTABLE aB (75 CflJ LOCATION ,PJ SEWAGE# VILLAGE 6e of r'r✓;jf ASSESSOR'S MAP&PARCEL 1-.7 7--/7 j� INSTALLER'S NAME&PHONE NO. vQ��S�A:. SEPTIC TANK CAPACITY _F�c/s/ tic LEACHING FACILITY.(type).4/c :!?c l/[ A/> a (size) `TYrvc'Gj NO.OF BEDROOMS OWNER PERMIT DATE: �0�1�(�D/� COMPLIANCE DATE: 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility dui P E-/e Eeet Private Water Supply Well 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 facilityy)1 Feet FURNISHED BY 0,U J r R_O� `zNT r Co r Our , P V)OX tt l 1=5 D.13UX 30 3qo — 3C 71(, o-: J ,-jP ../ ,• �p I Tp� Town of Barnstable Barnstable Regulatory Services Department e;caC f yI � BARNS-TABLE, I}9 MASS. Public Health Division i6gq. ♦� �'AfED f a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3524 7403 October 31, 2012 Jonas & Brone K Zdanys 458 Elliott Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 458 Elliott Road, Centerville,MA was last inspected on 10/18/2012,by James D. Sears, a certified septic inspector for the State of Massachusetts. J The inspection of the septic system showed that the system "Fails"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: . • System is in hydraulic failure. You are ordered to repair/replace the above listed septic system components 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. i PER ORDER OF THE B�QARD OF HEALTH n, , CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\458 Elliott Rd Cent.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetaii.aspx?ID=15913 /j7't a Logged In As: Parcel Detail Wednesday,October 31 2012 Parcel Lookup Parcellnfo Parcel ID 227-125 Developer LOT 25 Lo Location 458 ELLIOTT ROAD I Pri Frontage 133 Sec Road SEA MARSH ROAD I Sec 285 Frontage village CENTERVILLE I Fire District C-O-MM Town sewer exists at this address No I Road Index 0492 Asbuilt Septic Scan: Interactive — -T 227125 1 Map _-- { _ Owner Info Owner ZDANYS,JONAS& BRONE K I Co-Owner Streetl 458 ELLIOTT RD I Street2 City CENTERVILLE I State MA zip 02632 Country Land Info Acres 1.06 use Single Fam MDL-01 I zoning RC Nghbd 0108 Topography Level I Road Paved utilities Public Water,Gas,Septic I Location Construction Info Building 1 of 1 Year 1984 I Roof Gable/Hip I Ext Wood Shingle Built Struct Wall Living 2186 I Roof Wood Shingle I AC None I of 15 Area Cover Type -11 5 1 F 7 p 1' 4 Style Cape Cod I Int Plastered I Bed 4 Bedrooms I 'S Z: �. = 11 Wall Rooms 34: M R GAR a- Int Bath 3' 1. Model Residential I Hardwood J 2 Full I FHS 17 Floor_ Rooms BAS' 1 2 BMT 7 -4 Grade Average Plus ( Heat Type Hot Air I Rooms Total 8 Rooms stories 1 1/2 Stories I Heat Gas I Found- Poured Conc. Fuel ation Gross 5293 Area - Permit History i http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=15913 10/31/2012 � a ` � ������ �; �� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Elliott Rd Property Address Brone Zdan s Owner Owner's Name ca .�. information is Centerville ' MA 02632 10-8 2 required for every n page. Cityfrown State Zip Code Date(oE,l spedion IU Inspection results must be submitted on this form. Inspection forms may no be alters in al way. Please see completeness checklist at the end of the form. t Important:When "► filling out forms A. General Information ��,�,����+ ��� N OF y� on the computer, I. �'�� �.�� A`S.Qy'y71 use onlythe tab I � �' 1. I nspector. o, c key to move your =�: JAMES cursor-do not James D. Sears '"� use the return Name of Inspector = o key. Ca ewide Enterprises, LLC %�' �' o Company Name 1,ti,S,P�G;\\```�� 153 Commercial St. u>` Company Address reaa, Mashpee — MA 02649 CitytTown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails Q Needs Further Evaluation by the Local Approving Authority 1t�-y�J1 10-18-12 Jspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 0Sns-11110 Tdle 5 Official Inspection orm:Subsurface Sewage Disposal System•Page 1 of 17 cal rlVU i Oct 191212:12p p.2 g Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° 458 Elliott Rd Property Address Brone Zdanys Owner Owner's Name information is Centerville MA 02632 10-18-12 required for every State Zip Code Date of inspectionpage. City/Town B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 16.303 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_ Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain_ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): 15ins•11I10 Title 5 QtF.dal Inspection Form:Subsurface Sewage Disposal System.Page 2 d 17 Oct 19 12 12:13p p,3 Commonweal th of Massachusetts Official Inspection Form Tale 5 o p t� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 458 Elliott Rd Property Address Brone Zdanys Owner Owner's Name information is Centerville MA 02632 10-18-12 required for every page CdylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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 t5pns,11110 Title 5 official Inspection Form:Sibsurfaco Sewage Diaposal System•Page 3 M.17 Oct 19 12 12:13p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Elliott Rd Property Address Brone Zdanys Owner Owner's Name information is required for every Centerville MA 02632 10-18-12 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 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 Is less than 6" below invert or available volume is less than day flow /"lT t5ins•11110 Title 5 Official Inspection Farts:Subsurface Sewage Disposal System.Page 4 d 17 Oct 19 12 12:13p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .r 458 Elliott Rd Property Address . Brone Zdanys Owner Owner's Name information is required for every Centerville MA 02632 10-18-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 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 ri# butary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this forma ® 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—1WPA) 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. `Mans-11110' Title 5 Official Inspection Form:Subsurface Sewage disposal System•Page 5 of 17 Oct 19 12 12:14p p.6 Commonwealth of Massachusetts • . ..--ems,-��.— T:.�.�r . � ^Si" - � w. .., ..•, Subsurface Sewage Disposal System Form- Not for Voluntary Assessments Property Address Brone Zdanys required for every Centerville 1QtA 1fzVJ2 1 U-12i-'I Z page. Cityfrown State Zip Code Date of Inspection Check if the following have been done.You must indicate"yes"or"no"as to each of the following: ® ❑ Pumping-information was provided by the owner, occupant, or Board of Health ® ❑ Has the system received normal flows in the previous two week period? 1.J•v....n.Jnn"n..nle..rr,:."r".ni ul.r�n►,Hn�n i%.�Tn�r.rnnl'J fn f+,n r1ji-Jom 7.%e-o f1%o nr A,%r);40(%# U)is 111DpewuislI I ® ElWere as built plans of the system obtained and examined?(if they were not N U Was fhe facility or dwelling inspecfed for signs of sewage back up:? M ..n ® ❑ Were all system components, excluding the SAS, located on site? 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 land'occupants tt diiterent 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 .,.;��,-vuufG'eti7lir+,.r ciciSCEFQ1i(: . M ❑ Existing information. For example, a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part Cis at issue ® ❑ approximation of distance is unacceptable)(310 CMR 15.302(5)1 D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 4 DESIGN now based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 1 Mrs•11110 Tile 5 Otriaal Inspect on Form Subsurface Sewage Disposal System•Pegs 6 of V Oct 19 12 12:14p p.7 Com-ironwealth o1 Massachusetts Title 5 Official Inspection Form Subsurface Sewage T2tspiraa9 System.ri?iwt -Not ,c'3`i f;3tctnYcair rGacao<<cc<<is 458 Elliott Rd Property Address Brone Zdanys Owner Owner's Name regrtired for every formation Centerville MA 02632 10-18-12 re per• City/Town state Zip Code Date of inspection D. System Information DeCrription: The system is a 1000 Gal Precast tank 0 Box and 4'pit Number of current residents: 2 Does residence have a garbage grinder? 1A Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required) ❑ Yes 0 No Laundry system inspected? ❑ Yes IS No Seasonal use? ❑ Yet 0 NO Water meter readings, if avatlat>le(last 2 years 2010-111,00OGM usage(gPd)} 2011-111,000Gal Detail: Sump pump? C] Yes 0 No Last state of occupancy: Present Dale Commercialtindustrial Flow Conditions: Type of Estabfishment: Design flow(based on 310 CMR 15.203): Genons per day(gpM Basis of design flow(seatsfpersonslsq.ft.,eta): - --T.-- --- Grease trap present? ❑ Yes ❑ No industrial waste holding ink present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available- — tans•I Vle Tine 5 01Fde1 Ampeciian Feim:3vbaurroae Sewgpe Disposal 9yalem•Pepe 7 or/7 Oct 19 12 12:15p p.8 Commonwealth of Massachusetts Tale 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 458 Elliott Rd Property Addmas Brone Zdanys 0WTW C%Twes Name information is regsied for e"ery Centerville MA 02632 10-18-12 Page• cityrrown state Zip Code Date of inspection D. System information (cons.) Last Aare of a=upant yluse: Date _ Other(describe below). General Information PLarnpin9 Reco'�: Source o97f information: 2008 th'as system pumped as part of the inspection? ❑ Yes If yes,volume pumped: Note: system pumped after�tspection gabons How was quantity pumped determined? Reason for pumping: Type of System: z Septic tank,distribution box,soil absorption systern ❑ Single cesspool ❑ OverfivN cesspool ❑ Privy ❑ St eared system(yes or no) (if yes,attach previous inspection records,if any) ❑ Innovative[Altemative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): ,5•�v�o 7AM 6 Omdet MWee6on Form:9ubx,eface SewnOe Disposd Syetmn•pop 5 d 11 Oct 19 12 12:15p p.9 C..O mloriirllealth of MaSsachusef Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary mess ants 458 Elliott Rd Property Address Brone Zdanys Owner Owner's Name information is Centerville MA 02632 10-18-12 w_ required for ery State Zip Code Date of trtspection Pale- CilylTown D. System information (cant.) Approximate age of all components,slate installed(if known)and sour^..e of information: 1983 Permit 83-1142 Were sc?-mge odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site{plan): 26" 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.): Pipeing is 4" PVC SCH 20 Septa Tank(locate on site plan): 18' Depth below grade: feet Material of c onst uction: ®concrete ❑metal ❑fiberglass ❑polyethylene other(explain) If tank is metal, list age: Is age m-ifirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ .'es ❑ No Dimensions: 1000 Gal Precast _ 4° Sludge depth: t5ers•'.1110 Title 5 Ofbtiel lnspecdcm Ferran 9%.tSurtem Sewage Disposal System Pea 9 yr 17 Oct 19 1212:15p p.10 Commonwealth of Massachuseft Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 458 Elliott Rd . Pn34erty Address Brone Zdanys Owrtsl Owner's Name infemlalion isre Centerville NIA 02632 10-18-12 mquiredfor every (WTown state zip Lode Date of Mspectrort D. System Information (cont.) Sepfti Tank(cor:t) Distance from top of sludge to bottom of outlet tee or baffle ' Scum thickness 3" Distance from top of scum to top of outlet tee or baffle OvER Distance from bottom of scum to bottom of outlet tee or baffle NA s P,,vw were dimensions ASBUILT PLAN tape determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank and covers at 18"below grade, Tank full over outlet tee Grease Trap(locate on site plan): Depth below grate: rem Material of construction: D concrete D metal D fibergl-ass D polyetl;y;ene D ottm(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 Mo.7 7I70 Title 5 Mdal Inspection Form:Subsu.Face Sewage Disposal System•Page 10,of 17 t Oct 19 12 12:16p p.11 :onrtllonweaCth of Massachusetts Title 5 Official Inspection Form Sn:bra acs Sewage Dlsposai System For-Not for Voluntary Assessments 458 Elliott Rd 7Vj Property Address Brone Zdanys Owner Owners Marne information is Centerville MA 02632 10-18-12. -quired for_very CWTown suit zap coda Date of tnsp on D. System Information (cont.) Comments(on pumping recommendations,Inlet and outlet tee or bale condiflon, shtr'tt:rai 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 Elmetal Elp'� fiberglass ❑ polyethylene 0 other(e) a;•,): Dimensions: Capacity: gallons Design Flow: gallons pet day - Alarm present ❑ Yes ❑ No Alarm levek Alarm in L;;,Wng order © Yes ❑ ,140 Date of last pumping: Date Comments(condition of alarm and float switches,etc.): Attach copy of current pumping contract(required). is copy attacFred? ❑ Yes 0 No t51ns•t 177 0 ' Tft 5 OBoai Inspection Form:sWbaufaw 9wow Divosm System-Pepe 17 of V Oct 19 12 12:16p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 458 Elliott Rd Property Address Brone Zdanys Owner Owner's Name regWrefor a Centerville MA 02632 I -18-12 required for eYery page. CKyffawn stew zip Code Date of homed m Q. System information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert over Comments(rote if box Is level and disftution to otMets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D Box is 16"x WAS" Below grade w/one fine out, wales are gone, D B ox is full to cover. Pump Chamber(locate on site plan): Pumps in working order. Q Yes Q No Alarms in working order: 0 Yes Q No Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS rot located, explain why: R5eu�•t 1l10 Tile 5 OfFedef yuacfion Form$ubvAsm sewn a 1);%md syg m•Page 12 or v Oct 191212:16p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments 458 Elliott Rd Property Address Bran Zdanys _ Owner Owner's blame informatregWred fofa isr every Centerville MA 026M 10-18-12 m cityrrown State Zip Code Qaba of a D. System information (cont.) 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 Typefname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp sail,condition of vegetation,ate.): Leaching is one 4' precast pit w f 31stonee pit,at 38"below grade w/cover at 14% Pit is full, Not leaching, need to replace leaching 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 t5ina•11110 Title 5 ol6del InsvecEoa+won:3ti�rfece serege 4ispoaei aye em•Pepe r s cd 1T Oct 19 12 12:17p p.14 Commonwealth of Massachuseft Title 5 Official Inspection Form SubsurtFace Sewage Disposal System Form-Not for Voluntary Assessments 458 Elliott Rd Property Address Brone Zdanys Owner owners Nerve informad for every on is mquired Centerville MA 02632 10-18-12 lequu page- City(rown State Zip Code Dole of frApection D. system information (cunt.) Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Matertais of construction: Dimensions Depth of solids --------- Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): Lane-t Ind Tft 5 O>cW farm:3ubwfaw 9eaMe D*csd System-Pepe 14 a117 Oct 19 12 12:17p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments E io Y 458 Elliott Rd ProQerty Address Brone Zdanys Owner Owners Name —— — —- require for Centerville MA 02632 10-18-12 required fior every. o .^ _ ... _.�..._w_,.�....�...�__.... �. Cftyffofwt gate Zip Code f?aile at p¢ tior� D. System information (cant.) Sketch Of Sewage Dispose(System.: Provide a View of the age disposal system— inci rdrng*es to at least two permanent re`erence landmarks or henchmafs. Low aN was wit,,r 3 0*feet-Locate where public water supply enters the bL,,KTn^_Check-v* o`the boxes bey hand-sketch in the area tmlow ara*ng attached se rateiy .r f1 fL ��V 1 1 Sins-111to Tdle 5 Oficial 4upec6on Form Subsurface Sewage Disposal SysWrn-Page t5 or 17 Oct 19 12 12:17p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 458 Elliott Rd Property Address Brone Zdanys Owrtes Qwners Nameirlformetion is Centerville required far every _-- - MA 02632 page. Cltyrrown state Zip Code Dena of heron D. System Information (Cont.) Site Exam: ❑ Check Slope ❑ Surface water Check cellar ❑ Shallow wells Estimated depth to high ground water: 43+' feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record tf checked,date of design plan reviewed: g-19-83 Date Q Observed site(abutting property/observation hole within 150 feet of SAS) Q Chec:ked with kxml Board of Health-explain: Q Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H.on Design plan 9-19-83, 13'no G.W. Before filing this Inspectlon Report,please see Report Complatonasa Cheeldict on t7axt page. Mns-11110 Title 5 Official bwpeftan Form:Subusfece Sewage Disposal System-Pepe I B of 17 Oct 19 12 12:18p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 458 Elliott Rd Property Address Brone Zdanys Owner Owner's Name information isrequ Centerville page- foreva cityrrawn tm zip codde �of 32 tiWecdon P89Q• E. Report Completeness Checklist ® Inspection Summary:A, 8,C. D. or E checked ® inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached In separate file l5ns=71J10 TWO 50t5dal InWcfion Form SubsMam 8ft"s Dhposat System-Pete 17 cP 17 Town oaxntst bye P# l 3 q ' Department::-of Regulatory Services F P>txblc Iealth D><vYson Date 1� j 2 tb3!► ♦ 200 Mam Street,Hyannis'MA 02601 Date Scheduled 11 r a A 1- ,...., Time Fee Pd. Soil Su�ablilty Assessment for Sewage Disposal Perforated-By. p -�"� �5 '#1�yZ Witnessed By:, n LOCATIO INFORNIAThON Location Address. 4,5 £1 R v4t, Owner's Name' ' t✓-en�•Q✓1/i I�-1 Address �g ((i 0 3^Z Assessor's Map/Parcel: 2Z7" 12 5 Engineer's Name f jje/t,C£n j-� tYL0,tl �n q NEW CONSTR!jcnION REPAIR � Telephone# J�+O" �7�. ���, s AA Land Use ! +o6y+z�a k Slopes(%) 2'"S' Surface Stones Distances from: Open Water Body O V ft Possible' Wet Area 1W ft Drinking Water Weil�d_ft Drainage Way.% /10G ft Property Line �a -- ft .Other ft SKETCH::(Sweet name,dimensions of lot,:exacclocations of test-holes&perc tests,locate wetlands in proximity to holes)" _T. �1 Y�;�,► 07 Parent material(geologic) Depth to Sedrock. DepthtoGroundwater. Stand'in Water:in Hole: ✓�� - Weeping.from @It Face Nl Estimated -High Groundwater ( /-^- DETERNUNATION FOR SEASONAL HIGH WATER TAB S Method Used: Depth Observed standing in obs.hole: in. Depth to s411 mOttlOtlt' InG Depth to weeping from side of obs.hole: in. Oroundwater,AdJu8tment fC. Index.Wei;.# Reading Date: Index Well level„ Adj.factor A4J` tlroundwaterLevel.,,. PERCOLATION TEST Data;— Thu Observation Hole# y Time at 91, -,_, Depth of Perc ?1 3 6 Time;at 6" 24 Start Pre-soak Time® Time(9"0611) End Pre-soak Rate MinJlncti L-.2 l S M•r+ 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:VSEPTICIPERCFORM.DOC • DEEP:OBSERVATION HOLE L"OG Hole# _ Depth from Soil Horizon Soil Texture. Soi]Color : Soil Other Surface(in.) (USDA) (Munsell) Mottling (S,tructure,Stones;Boulders: y 4 _ ` _T �S a'Irz-��� DE1✓ OBSERVATION`EOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) ,: , (USDA) (Munsell) Mottling., (Structure,Stones,Boulders. s r �S 10 y(Z SSG DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil.Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:!Boulders. Consistano. F DEEP OBSERVATION HOLE LOG H61e# Depth.from Soil Horizon Soil Texture Soil Color Soil Other Surface e(in.) (USDA) (Munsell) ,Mottling (Structure,CM Orave Stones $oulders. s , Flood`•hnat><rance Rate,Mao:. Aboue 500 year flood'boundary' No_' Yes YVtthtn S00 year`boundary, No _ Yes Within 100 year flood boundary No ,. Yes Death of Naturally Occurring Pervious 1Glaterlai Does tit igxst fiur ft et of naturally occurrtn=rervious in ter! exist in all areas observed throughaut.the area.proposed for the soil absorption system? ' ` -- If not,.what is the depth of naturally occurring pervious matieriai? Cecatson' I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistehrwith the required'trairiing;expertise andrexperience described"-in' lU CIvIIt 15.017. Date Q:1SBp'CIC�PBRCFORM:DOC T' l , No.�J�........ .v Figs::..... V................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------ .--- ..... ......:................ .OF................................................................ =........ .............. r Appliration for Disposal Works Toustrnrtinn tirrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal :System ............. ..... ...... ...;®r ..1 , ........---------------.............-- -----------.............------....--- as-.-----------....------......----------... 9'' �(f — L on-q1 less or Lot No. �C.Y� i/. �Z� ...................... ...... ...............•-•--•--................---•---•--..............----•-............................. caner Address W a -.. .... ........................................... Installer Address Type ofBuilding No. of Bedrooms.._._._. ..............................Ex Expansion Attic Size Lot._.___..__......__._....._._Sq. feet �+ g— p ( ) Garbage Grinder ( ) aOther—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 capacity............gallons Length................ Width................ Diameter.---..--........ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------------_-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a a Test Pit No. l................minutes per inch Depth of Test Pit.......:............ Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R; ----------------------------•------•-------•------••-•---.........................--•--•......------........--•--............------.....-----------:....----.. ODescription of Soil.........................................................................................................................-------------------•-------------....._.------ U ------------------------•--------------•--------------•----------------------------------------------------------------------------•----------.....----------•--•----.....------...---------..._......-- W . UNature of Repairs or Alterations—Answer when applicable.......................................................... ................._............. •-- ------------------------------•-------•-------••-----------------------................................----•---------------------------...-.------•---------•--.------------------------ Agreement: The undersigned agrees to install the aforedescribed. Individual Sewage Disposal S stem in accordance with the provisions of TITLE 5 of.the State Sanitary Code—jhe unders'gned f rtl ag s of to place the system in operation until a Certificate of Compliance been is he b of gned �._ZA, �}.. r Application Approve ...... --•---------- ------------------------------------------------------------------:.. l`�� --- ......... Date '--- Application Disapprove or a following reasons-------------•-------•-•----...........---•--•----------------••-------------•-•-----------:..------------------ ...... ...................................................................------•-•---..................................... .....---.... ............- Date PermitNo......................................................... Issued....................................................... Date No.��..... .. Fps... l.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................... ............OF......................................... Appliratiou for Diipo.g al Works Toatfitrortiou Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: � � ��t 0 �' .... ................ .-. �,.. t L ion- dress or Lot No. ......--•-- l r_C� � .... :. c.c ............................. -•------•-----••-•--•----•-•-•-----•-•----............---..............---••-•-•--•............... Owner Address W Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling-No. of Bedrooms..........`.�...............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons........... ----------- Showers ( 'Z) — Cafeteria ( ) dOther fixtures ...................................................................................................... W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Al ......................................-••.................................................................................................................... 0 Description of Soil...................................................................................................................................-..............0........•............ x W 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 TITLdj 5 of the State Sanitary Code— The undersigned f rtlr gr 's not to place the system in operation until a Certificate of Compliance has been iss d y,he bo r of Y l Signed ._......... �/.... . . ... . .....--•---... ....�. ..`. ... Application A roved,` _:��°_� PP PP ,,. ... _.. ......................... Date Application Disappd Z e f ollowing reasons:.-----•------------------------•----•-----------------••---•--------------•------••------. •--....._..---••••. -•----.....---•------------------ -----••---------.....------.....---------.......------.......---.......--------------•--------------•-----•------------------------•. ...................... Date PermitNo......................................................... Issued........-.....................................0........ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... C9rdif iratr of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (— or Repaired ( ) by.......... a t` A ia....i�-••-------••-•---...._..•..................•-•--•--••-•-•......•--.-.-----....----•.....--••-- has been installed in accordance with the provisions of T F 5�of The State Sanitary Code,a de� ` A in the application for Disposal Works Construction Permit No.._����1�!�X ............ dated_.----- .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................................... Q..Q� -.(.$ ,D. ..........-• Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... ............. '`✓� - ..........................................OF................... .. . ..............--------.....•................... N ......................... FEE................................ fork �oo,��rion �rruti# Permission hereby granter ' ' -------------------------------•....... ... to Construct )yr Repat ('"` an I iv'. a Sewage Disposal System atNo. `"= ...:..L.e�. �k ----.r`t.+G'.......-•-•---••---....----------------------------=''..................................... Street � � as shown on thVlicati,,.�Ifor Disposal Vl�orks Construction Permit . .................. Datd. ____.__._.._!, ..... ------•-••-•...... ........... -t'"':." ------......-----•--•------..............---Board of Health DATE.'.. ./ --- ----•-----••-------•-•-------------••--- FORM 12.55 A. M. S LKIN. INC.. BOSTON Lb CATION � SEWAGE PERMIT NO. VILLAGE _ 14c) ii _ � sy MISNTE#,)S NAME ADDRESS A . � 1 OR OWNER DATE PERMIT ISSUED C ' DATE COMPLIANCE ISSUED Sr� N�y Ld ..r 5 t i 1' a ! (0: It 0 IJ LU cla ' tr' ire I Gm , i od \\ - - ti _ I\ter i -� AA) i � i .i ��eI I - III API ` F III t V fit+ •f� � � tF� �i ill BI AN I 1 -r I all l i Al rCC � 5 r� :u ,EXISTING LEGEND HOUSE(#458) -- 1 g -- EXISTING CONTOUR /� Elliott Rd TOF=18.3t x 16.82 EXISTING SPOT GRADE GARAGE -Wy EXISTING WATER SERVICE -G EXISTING GAS SERVICE li N � oD -U OVERHEAD WIRES TEST PIT BENCHMARK 6> ------6 V�I( Se, 04a ' �I f ------------4 LOCUS SIDEPORT COUPLER LOCUS MAP S.A.S. LAYOUT NOT TO SCALE QG / .001 LOT 25 i M BL 227-125 47,836±S.F. Z tr 1.02 (::::_ OVERGROWN `° 1 10.33 i �\ `�� \�� \`� d) N CRAIVBBRRY BOG rn -- i ' b xX4\25 `� 1.22 �' ,� x,35410.68 x 9.00 ��\ `' WETLANDS �• ' �N 'p 20 4x 4.28 ,, ' y0 n i� \98 x 6.86 �- x 4.51 �' / �0 // :1� x 13.03 v ' _ _ 9,70 le 10.06 \ -------10.89 13.10 T /V`•� lij.82 11.4��_------- DECK x 15.01 11.21 ` i z 21, ,15.38 x .EXISTING PATIO , P X n.o1 N 9X% HOUSE(#458) d9e 0'`•i. do �A ZONE 8 W - off...,...of 0 FE r x.) ._ catchbasin �• `'^ •• -w 16.L4 TOF=18 J± .62i, �Zo C(°Qp ° EXISTING SEPTIC TANK 11.43 l) GARAGE i2 AMA ZONE TOP OF TANK, EL.=16.09 09 17 9e � .. INV. OUT=14.76-± oa a3 i+ .aa� ;' .. :r i 0.31 1 i 7 1 �0 -'�. `16.54 ® 17. 4.01, •� �••.• . . l 7.9x 17.36°._... 17.7� r_ 18.48 Ji 13.18t i 3 r i �x 0.84 TP,-2 + . �i 14.00 0 Z�\ 17.12. '17.36 K SFF •` `twf - I P13.SO�T `\, .3J 4• i _11 14.07 20 �OCE OF 15. bo ' I EXISTING LEACH PIT ' Pq�'b1EiVT 3T 1 11 61 TO BE COMPLETEL Y OR BENCHMARK NO. 1 / �� �' .'.::. PARTIALLY REMOVED X7M1 Outside Cor. Bott. Step ` qs"'F..:". 16.E (SEE NOTE 11-SHEET 2) EL.=17.98 (Assumed tss7 -` 18.53 PK SET O�L O 15.98 SI P A COUPLER O 16zo OF M gs�q�ti� BENCHMARK N0.2 o PETER T. Magnetic Nail Set McENTEE CIVIL "' EL.=15.98 (Assumed) No. 35109 R£USA PROPOSED SEPTIC SYSTEM UPGRADE PLAN �oF S 0 ENS OWNER OF RECORD ZDANYS, JONAS & BRONE K 458 ELLIOTT ROAD, CENTERVILLE, MA 458 ELLIOT ROAD Prepared for: D.A. Brown, Inc., P.O. Box 125, Centerville, MA 02632 CENTERVILLE, MA 02632 _ Engineering by: SCALE DRAWN JOB. N0. FLOOD PLAIN DESIGNATION Engineering Works, Inc. 1"=30' P.T.M. 280-12 FIRM COMMUNITY PANEL NO. 250001 0008 D 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. MAP REVISED: JULY 2, 1992 ZONEC A10 (EL 11), B, C. (508) 477-5313 12/18/12 P.T.M. 1 Of 2 3 i Y NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL.14.83 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT INSTALL INSPECTION PORT OVER END UNIT T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE EXISTING F.G. EL.=17.2t F.G. EL: 16.4t F.G. EL: 17.8(MAX.) MAINTAIN 2% GRADE (MIN.) OVER S.A.S. INSPECTION PORT L = 14' L = 3'(MAX) EACH TRENCH S=1% (MIN.) ® S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 6' tD"I 14" 6 10.38" TO INVERT EXISTING as' UQULEVEL INV.=14.40 LEVEL ADD TRENCH 1: 12 UNITS + 1 COUPLER = 61.2' GAS BAFFLE INV.=14.60 PROPOSED INV.=14.43 TRENCH 2: 4 UNITS = 20.0' INV.=14.76t D BOX TOTAL EFFECTIVE LENGTH = 61.2' + 20.0' = 81.2' ED EXISTTNG SEPTIC TANK SOIL ABSORPTION SYSTEM (PROFILE) UNITS MUST BE STAMPED H-20 ESTABLISH VEGETATIVE COVER NOTES: BACKFILL WITH CLEAN NATIVE OR PERC SAND TO TOP OF CHAMBERS 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS, PRIOR TO INSTALLATION. 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX TOP ELEV.=14.83 INCH CRUSHED STONE BASE, AS SPECIFIED IN INV. ELEV.=14.40 310 CMR 15.221(2). BOTTOM ELEV.=13.50 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 2.83' 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 4' MIN. SUITABLE SOILS AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 5' MIN. ABOVE BOTTOM OF T.P. EXCAVATION OR G.W. EXISTING SUITABLE NO G.W., EL=6.7 - MATERIAL Arc 36HC UNITS TO BE SEPTIC SYSTEM PROFILE ADS TRENCH CONFIGURATION WTHNSTALLED NO STONEN N.T.S. TYPICAL SECTION SOIL LOG GENERAL NOTES: DATE: NOVEMBER 16, 2012 (REF#13,796) SOIL EVALUATOR: PETER McENTEE (SE#1542) 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL WITNESS: DONALD DESMARAIS R.S. BOARD OF HEALTH AND THE DESIGN ENGINEER. HEALTH AGENT 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS ELEv. TP-1 DEPTH ELEv. TP-2 DEPTH OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. 16.8 A LOAMY SAND O 16.7 A LOAMY SAND 0" 3. THE,SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 16.5 B 10YR 4/2 4» 16.4. B 1OYR'4/2 4„ _TO_INSPECTION_AND_AP_PROVAL:BY THE-BOARD OF HEALTH AND THE = DESIGN ENGINEER. Y 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING LOAMY SAND LOAMY SAND FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 10YR 5/6 10YR 5/6 14 ENGINEER BEFORE CONSTRUCTION CONTINUES. .8 24" 14.7 24" C C PERC 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. 24"/36" 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. MED. SAND MED. SAND 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 2.5Y 6/4 2.5Y 6/4 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE .CONTRACTOR TO VERIFY 6.8 120" 6.7 120" THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING PERC RATE <2 MIN/IN.("C" HORIZON) CONSTRUCTION. NO GROUNDWATER ENCOUNTERED 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). Note'• Arc 36HC SIDE PORT (H-20) COUPLERS ARE TO BE 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. ALSO USED WITH THIS DESIGN. UNITS MUST BE STAMPED H-20 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 63.25" IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED PIPES OR SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THIS PLAN. 16' F - 34.5" DESIGN CRITERIA NUMBER OF BEDROOMS: 4 BEDROOMS TOP VIEW SOIL TEXTURAL CLASS: CLASS 1 60" DESIGN PERCOLATION RATE: <2 MIN/IN END CAP SIDE VIEW DAILY FLOW: 440 GPD END CAP DESIGN FLOW: 440 GPD REAR/TOP VIEW GARBAGE GRINDER: NO NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. .74 GPD/SF 4640 TRUEMAN BLVD EXISTING SEPTIC TANK: 1000 GALLON CAPACITY S. HILLIARD, OHIO 43026 Arc 36HC DETAIL PROPOSED D-BOX: 1 INLET, 3 OUTLETS, H-10 RATED ADVANCED DRAINAGE SYSTEMS.INC. PROPOSED SEPTIC SYSTEM UPGRADE PLAN SOIL ABSORPTION SYSTEM 458 ELLIOTT ROAD, CENTERVILLE, MA USE ADS Arc 36HC UNITS IN STONELESS TRENCH CONFIGURATION (GENERAL USE APPROVAL FOR 7.79 SF/LF IN TRENCH CONFIGURATION) Prepared for: D.A. Brown, Inc., P.O. Box 125, Centerville, MA 02632 16 94 UNITS + 1 COUPLERS = 81.2 FT Engineering by: SCALE DRAWN JOB. NO. 81.2' x 7.79 SF/LF = 632.5 SF Engineering Works, Inc. N.T.S. P.T.M. 280-12 DESIGN FLOW PROVIDED: 0.74(632.5 S.F.) = 468.1 GPD 12 West Crossfield Road, Forestdole, MA 02.644 DATE CHECKED SHEET NO. (508) 477-5313 12/18/12 P.T.M. 2 Of 2 �D --�--- -ro , tt, 1 / . T_ TQ -i SEC !� � a ./�f _._____...___ li E- �? T" �S �C .mil L E• : / � � ��� �.l C T�-�'� f-�L L._ f=i � Pnavoscd c�ravnd Pr'of1 /e NO �'r� SCALE / = ,' �' -- f-/E-D, 4 0 F' 'v' C. c7,Q —-- -- IC 1 O L✓ - - --- ___.__,,. � � f-ri r r�r rnvrn f4 fir -�a ra�'� `-••_...._. 1� /ti1 a . --j" 77 / s 11 / !• 8 U}S f 3 '/ SEPTIC 7-AAJ K F71 -74 r2 0 �? - r, r`t ' `~ r" w•S I L� ?R tt ; v �''3 `` �^,r .__ T ' t ! 'aJ _ . �. . 0L_ G. (� • fro 'w b.! K eL Y — ,. 7 _ �--^" 4_- t-✓ / 9 it ,.cJ r - � 1"JC. , - ` ; 7 �1 C S „ ._� S, )�. �`` , \ z n 3 3 6 T 3 3 0 ��A[ s. r,09 Tv,,r 3.3 r -,-?A,',- 33 0_ x ST Npe / 7' ��.c�•p,Q oo. / •, ? ,, 2 ..�� ,� USE /moo o c Afi, go T/ l 7'ES HOLD �rl LOT 24 �.. I ! `H L O G. -N-n �L O^'�• E L"c 6W N ' 3 1 �_= $. Z, S Q 9 2,8 G rG? D 3 U - --- E L t Ei a Ito D --� 3.47 1uv Y; A2,_ .. � c,+ goo �8,5 TCJT,/�L.. �!- $,� C P. Z:7. ! F � �-, �• f / T Vr i4 USA. �/4CtJ Fes! "T' 47, , p - .�)o T 0 Cl r \• ' ;2 C.M.p M ed :U tTti i t3 `� mac!•-. 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