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HomeMy WebLinkAbout0017 FARM HILL ROAD - Health 17 Farm Hill Road Centerville 1 • I■■ram■■■ram■■��r���������r� _ �r� 1■■■■■■■SEM■■■■■■■��■■ �� ��■ ■■��■ ��■�MEN 1■���■■■�■■�■���■■���■■e��■■■■■��■■■o■�■��■■ems■ MUMMIMEMEMEM 1�■■��■■ ■��■ ■■■■■■■■■■■■■■■■■■■E■E■E■MIM■EME■ NEE EMEN IMEMEM MEN 1■■■■■■■■■■■■■■■■■■■■■■■■■■M■■■■EM■■■M■■ I■ 1■■■M■■■■■■■■■■■■■■■■f:ml�RI■■■M■ME■ENE■Mo M■■EM ■■■■■■■■■m■■■■■■■■■®■■■■■■■■■'■■■■� ■■■■■■■■■■■■■■■■■'■■■■'■■■■■■■■■■■■■I ■■■■■■■■■■■■'■■■■■■■■■■■■■■■■■■■■■■I ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■I ■■■■■■■■■■■■■■■■■■■■■■■■■■■m■■■m■■I ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■I ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■I ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■) '■■■■■■■■■■■■■■■■■' ■■■■■■■■■■■■■■■■I ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■�■■■■■■■■■E■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■M■N■■■■■E ■■■■■■■■■■■■■■■■■■■■■■■■■■■M■■■M ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■s■■■■■■■■■■■■■■■■■■■�■■■■■► : Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -tic:-or Voluntary Assessments / 7 __Farm Op=riy Addrev- ,n ` t ere,�,jpl o(J Owner Jane'sa-e �-F � / ll � � a-nforma5or: s C � ✓ Qd�•,(o 3 02 required for ever, �N — _ Dace. 01ty71 ovm To-Code Date oil spection, Inspection results must be submitted or this town. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Imponant:whan A. Inspector [nf atlon filling out forms on the ccmoL:er, a Y` use only the tab Key to move your `la,-:e cf inspector cursor-do not L-1/0 use he return P IL �O� key. Company Name O m Company Adc-ess M. f') ) 6 � ) .LAGS f yi c. M _ Zip V Code d C: iTown 11 1 /� State ' `O e� - r� I: eiep"r:cn.. .:-be- _icense\umber B. Certification i ceriiry that: 1 am a DEP approved system inspector in full compliance with Section 1�.340 of Title 5 (310 CMR 15.000); i have personally inspected the sewage disposal system at the property address iisted above;the Information reported- below is true. accurate and complete as of she time of my inspection: and the inspection was performed based on my:raining and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection i have determined that thesyr` .:,. 1- Passes 2. L vvnv;LCnatlY 2SSc 3. _ Neecs urther =vaivailc y_ �GC2i Approving ,�uu^vr:Y Fails S a 9' a v nspec c' Sic:ztu:z- Cate The SyStei% SpeCiCi Shci SUCr"t:a CCC �f i a� :.,aue it^v ieuv i C nle.approving Au nority(Board G'Health Or DC'1 - l- r pe . i Lhe system has a design flow of wi1�I in 30 GayS GG D eiinG .i;iS :i,S Ct!G 0:000 Cod o, areater,the inspecvor and-tl:e system owner;i-atl submit.the report to the appropriate regional office of the DEP.The o;pinai fora. shcuid be seat tG the system owner and copies sent to Me buyer; If applicable. and the approving authc: Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. sys.'-Page'.of is JitsP.�OG'Yv.?G4.c�.B Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address / Oct sod Owner Owner's Name / information is G Q M`I'a rf/y/ e �/4 De�.•l'o� S a 9 C�fl required for every page. CitylTown State Zip Code Date of In pectin C. Inspection Summary Inspection Summary: Complete 1, 2: 3, or 5 and all of 4 and 6. 1) System P es: 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: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass' section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes'. "no' or"not determined" (Y, N, ND)for the following statements. If"not determined,° please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal'septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): [Sinsp.tloc•rev.71262018 "me 5 Of—iaai inspeca .c or:sucsur•"ace Sewage D,sposa system•?age 2 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address -1 c; O Al G Owner Owners Name information is � A4 ��� p required for every ree-kv-y-, 7 page. Cityrrown State Zip Code Date of Ins ection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 "times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health: safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/252018 -tue 5 Offidai;nspecon=om:Suosur`ace Sewage Disposal Svsten•Page 3 of 18 Commonwealth of Massachusetts �^ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f � Property Address Owner Owner's Name information is Pi✓�� e A4 oa 6 3�- ,5 a�- a� required for every page. City/Town State Zip Code Date of Inspe tion C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well'. Method used to determine distance: **This system passes if the well water analysis; performed at a DCP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ckup of sewage into facility or system component due to overloaded or El clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or ciogged SAS or cesspool Title 5 Offidai inspec':on Foy—:sunur'ace sewage Disposal System•Page 4 of 18 t5insp.Coc•rev.726/2018 . Commonwealth of Massachusetts I� Title 5 Official Inspection Form Assessments Subsurface Se wa a Disposal System Form Not for Voluntary P Y rY � 7 , l 9) Property Address, 1 Qt ✓''!p w Owner Owner's Name information is �� �a 6 3� C� required for every e h page. City/Town State hzlo Zip Code Date of In ection C. Inspection Summary (cost.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No i J Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool quid depth in cesspool is less than 6" below invert or available volume is less i j than '/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: y 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. J (LV Any portion of a cesspool or privy is within a Zone 1 of a public water supply — well. ny portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion P ortion 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.] he system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. r- The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes or"no-to each of the following, in addition to the questions in Section 0.4. Yes No n ! 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 iocated in a nitrogen sensitive area (Interim Wellhead Protection -' Area—IWPA)or a mapped Zone It of a public water supply ,da:;nsoecO n=or:SuDsu'a--e Sewage Disoosal Sys.em•Page 5 0`18 t5irtsp.doc•ey.7262018 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address M r � O� fV '0 L/Y Cjl JU Owner Owner's Name C!I►4�,�X 'A information is required for every page. City[Town State Zip Code Date of Inspec n C. Inspection Summary (cont.) If you have answered"yes' to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: Yes No Pumping information was provided by the owner, occupant, or Board of Health ere any of the system components pumped out in the previous two weeks? ❑ s 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)] 7e 5 Ot`cai irspe,30--n=0=11:SuDSCrace sewage Disposal 5ysten•?age 5 of 18 1.5insp.doc•rev.7/2512018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments E� Property Address. Owner Owner's Name information is fX- required for every IL page. CitylTown State Zip Code Date of Ins coon D. System Information .1. Residential Flow Conditions: 23 Number of bedrooms (design): Number of bedrooms (actual): O DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of/bedrooms): Description: / /SOO // N /gS?1 L C 1' v �► I ✓� T�Lr T��"lt� / J) s 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes No If yes: discharges to: Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes No ❑ � Seasonal use? Yes o Water meter readings: if available (last 2 years usage (gpd)): Detail Sump pump? ❑ Yes No Last date of occupancy: tate `Ge 5�"i`da�rspecor,Fcra.St.oau'zce Sewage Discs system•?aye 7 of 18 ;5insp.doc•rev.7126/2018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address / Owner Owners Name information is d required for every a/&r, '�yj Ale, page. Cityi I own State Z p Code Date of Ins ection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: Was system pumped as par of the inspection? ❑ Yes o If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.tloc•rev.71262018 -itle 5 offiaa, nscectior.=om:Suosurfage Sewage Disposal System•?age 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i k Subsurface Sewage Disposal System Form -Not for Voluntary Assessments W. / ? rat K 14 d Property Address Owner Owners Name ✓ /�- ��3� �O information is required for every page. Cit down State Zip Code Date of In ection D. System Information (cont.) 4. Type of S em; Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components; date installed (if kAown).�nd source of information: 0 6 ��S/o J arriving at the site? ❑ Yes Were sewage odors detected when 9 5. Building Sewer(locate on site plan): Depth below grade: feet 1/ 0--- Material of constructio ❑ cast iron n: PVC ❑ other(explain): / _[ Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): -;Ue 9„"�`cai nspacticn Forn.SutSurface Sewage Jisposai System•Page 9 of 1 8 t5insp.doc•rev.7/26/2018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Property Address r � Owner Owner's Name information is _?� required for every �(((o/�N"?TT"Q�{��� Od 6 ) /et O page. City/Town State Zip Code Date of Ins ection D. System Information (cons.) 6. Septic Tank (locate on site plan): Depth below grade: feet 3a ) Material of construction: sjpG� q ( ❑ concrete ❑ metal ❑ fiberglass polyethylene ❑ other(explain) G¢ 111e64 �- C� v44- Q. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certiflc te) ❑/ Yes ❑ No Dimensions: 62 -X vll— Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle /(/10 Scum thickness '�G Distance from top of scum to top of outlet tee or baffle _ Distance from bottom of scum to bottom of outlet tee or baffle - t7 � f How were dimensions 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.): C✓I 00 41 L�� �✓s t5insp.doc•rev.7/26aOl8 ?itle 5 3-1.aai inspecnon Fo-n!Suosuraoe Sewage Disposai System•Page 10 of 78 �°�, Commonwealth of Massachusetts Title 5 Official Inspection Form 13 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address V1tvv� Owner Owner's Name information is e h t / a; �3,)- j oz 9 a,Q required for every C• page. CityfTown State Zip Code Date of Insf ection D. System Information (cost.) 7. 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.): 8. 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 ~low: gallons per day Tile 5 0,pa':rspz.-uon Fon:Sucsujace Sewage Disposal system•Page 11 of I t5inspAOC•rev.71262018 Commonwealth of Massachusetts Title 5 Official Inspection Form W1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 All 9 � Property Address Owner Owner's Name ' ) information is required for every page. City/Town State Zip Code Date of Inspec n D. System Information (cont.) S. Tight or Holding Tank (cont.) 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 9. Distribution Box (if present must be opened) (locate on site plan):.-- Depth of liquid level above outlet invert I---vim 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.): /tib ellj /Vn e 5 Tcal Inspr=uon Foy-,.—uDsjrace sewaoe-Disposal System•?age 12 of 18 c8insp.Coc-rev.7252018 c Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Owl 14,11 9d Property Address Owner Owner's Name information is ei V1 4v,V 1 1 G �i/ (f� (e�p� ,� .2 q c3 O required for every page. Cityi7own State Zip Code Date of Ins ection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: �2 9 ) 3 3 0 �;o Type: leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: lJ leaching trenches number. length: ❑ leaching fields number, dimensions: [) overflow cesspool number: ❑ innovabvelaltemative system Type/name of technology: ----- 0 -,Ue 5 p 5aa tns?�ion=cr:Suas ece Sewage Disposal System•Page 13 of 18 t5insp.doc•rev.'/26120i8 r Commonwealth of Massachusetts Title 5 Official Inspection Form ;- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address 1 aL �"jll rl' p Owner Owner's Name O /_ 7� 5 a 7 a o information is C ` V J required for every page. City/Town State Zip Code Date of Inspectidn D. System Information (cost.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): S4V v,-e yl f p YI �r;,►v 1 L 12. 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 I l Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding; condition of vegetation, etc.): -me 5 `,oai inspec�en=omi.Sucsurace Sewage Disposai System•?age 14 of 18 t5insp.doc•rev.7/76/2018 Commonwealth of Massachusetts iq_ Title 5 Official Inspection Form ' 01 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address > Owner Owners Name information is required for every page. City/Town State Zip Code Date of I spection D. System Information (cons.) 13. 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.): I 'Ine 5 Ctiaa,nscxcon=orm SLDsuCace Sewage Disposal System•?age 15 of 18 5insp.doc•rev.'1262018 I Commonwealth of Massachusetts Ti Sewage tle 5Official Inspection Form Susurface Disposal System Not for voluntary Assessments 9C'j Property Address Owner Owner's Name information is required for ever page. City/Town State Zip Code Date of Inspe ion D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks enchmarks. Locate all wells within 100 feet. Locate where public water supply enters the bui ng. Check one of the boxes below: hand-sketch in the area below 17 drawing attached separately /Sorg Gam,t101 lH i 3a" se6.o,t I i i (�3 3- .7-Y)ft o So S w� S40� i c 49 0 � .I i A3 TYe 5 c final inspection:c—:suCscrtace Sewage Disposai system-Page 16 of 18 t5insp.000•rev.712612018 Commonwealth of Massachusetts �ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address I g IM O✓1 C Owner Ownes Name e r N A o information is 1 /3� � required for every orb O� I' page. CityfTown State Zip Code Date of Ins coon D. System Information (cons.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells /Lop Estimated depth to high ground water: feet �v 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 loc ' Board of Health - explain: Checked with local excavators: installers- (attach documentation) ❑l Accessed USGS database-explain: You must describe nowt e lished the high gr and water elevation: /„Sn 0 5 4M /.:�p A 14 1 c7` l /'o 0y Ot ..,n ` A 4a s '"' Before filing this inspection Report, please see Report Completeness Checklist on next page. 5insp.3oc•ray.7I26120 18 'ite 5 J"aa, rsoe=on For l:s D",'aoe sewage Disposal system•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i'4 Subsurface Sewage Disposal System Form -No Voluntary Assessments 4� Property Address Owner Owners Name i information is r required for every vvj�vj / �' ��-� 3� s �� "V page. City/Town State Zip Code Date of Ins ction E. Report Completeness Checklist Complete applicable sections of this form inclusive of: A. Inspector Information. Complete all fields in this section. :/rtification: Signed & Dated and 1, 2, 3, or 4 checked Cinspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (F re Criteria) and 6 (Checklist)completed i D. System Information: For 8-.Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 15 or attached For 15: Explanation of estimated depth to high groundwater included _ T;lle 5 o5aa!nspecuon=o� 5'.:bsurtace Savage Disposal System-?aye�b o`�8 t5insp.doc-rev.7126,2018 j ygtr u[aPEs ARE 1C>es*'stnEane�ao Pv,C, :: SBCT/Olr A A he�m.awik mrA .::::: .:::: ":�:' _:; ..�:: � .:: PRRFIL6'.YIffN�:OP:Ltl'AC7'fIN6 S3518'Y azeri.w. x .. 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SEPT;I:C SYSTCM UPGRADE. l ). .:� ,.` '•'�''� PREPARED B FOR r f FORT atcffr wAry P ii END SECTION :.: .;',i ��:�: :. r.�v1R KENi�IETH MtU H...-: 'PS <.NPICAL`,(tt-LO EDAOtNG} 7.. NIL ROA s 1500 GALLON•SEPTIC TANK: ?' M :; � .ram �"I FARM.; D l � .. c �.:. M�y:.sMbst,tute w'th I�OR aidl0 H-70 Poivetttvlene-Took-GeoraP O'8rien C�i -:�':. � �«os[ wsim,[ae vo.ac RaQ'AIET :' :�� `W. �HYAN.NI.'SPORT;:' MA� ;awn Cak:tat � :'. Nanbp of Bedrban".S EO�nKdm+t.:t 3�!4d.MoY (S30 f.'M.(Oc9 M .pvr rHb'V) .': ':. R»; �.9.R,t�IF1V .�' 'BEERY I I tmdga.g cgxi<,er r+.;;Awed:�.to ca;(oer Min!rnuih:.fM Pa mia vt ... seP;k�raM -a,:t:�aa/1>oy�Beo USE NEW t sag cu.::.sIIfa ra.a. :: "� t &NvIROxXSxtAL',��BxVicBs.,IlVC .:i S�:RBSfMiPYidf AREA. Osing Pbe<omt(pn fok`af�<2, _O.l4;.Optf 0 ft. A'290 b8-R.:.2f e.8 g9lbnv:: � '': :. -:: \ 8 P O,>;BOX 6�7,:,�� I 0 � YG � ... 1 5dbrus ae« ax:;ybL(eR.ft k;tss m.R-.;naat�,a _..:: ':� ::: <;..:: ..�': � L,,.�.�'�" k ,>a�' �.$Y:FALM(}UTfi;;MA 02535 ,: Pretkttl,9 >:S36W gapbne.: ' �.-T ea �f , t ubr :(s)Soso H 2a':irafTnR,AYwi aAMtiE(s.wt.+mw A t EFFEOTfy[pEPTN, p: '. TF.t.FAX 508 539.7958 . SCAI•E::t 2R SCaiI.E,,1_; 2R nRAWN,B! CES RATE. Ff9. 23, 2GO6 '(a W. 7 y TO RE USED VA711 s tffi wA9tE7):STONE fN . ..•of wASIEO-STORE oR THE Erm& .:: -: ::. � P#�WEC°i�SDBSf � f71.$NAA1E !M966PPiDWG;j 5NEET 1 OF t L U&3 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 17 Farm Hill Road Property Address r Joe Dolaher N Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 = 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 forms A. General Information 95-4p on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8-31-16 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Lodged v& Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 17 Farm Hill Road Property Address Joe Dolaher Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System was in working order at time of inspection. 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 17 Farm Hill Road Property Address Joe Dolaher Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 page. City/Town 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 17 Farm Hill Road Property Address Joe Dolaher Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 page. Cityrrown 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 '/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 17 Farm Hill Road M Property Address Joe Dolaher Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® 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. 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 17 Farm Hill Road Property Address Joe Dolaher Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (Actual) _3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 17 Farm Hill Road Property Address Joe Dolaher Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gp ))� Detail: 2014-26,000gallons 2015-35,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: CurrentDate Commercial/Industrial Flow Conditions: Type of Establishment: NA 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 17 Farm Hill Road Property Address Joe Dolaher Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner- last pumped 6 years ago 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 17 Farm Hill Road Property Address Joe Dolaher Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2 Depth below grade: feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain).- Distance from private water supply well or suction line. Town feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1 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: 1500gallons Sludge depth: 7 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 17 Farm Hill Road Property Address Joe Dolaher Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 page. City/Town 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 29 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 15 How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is in need of pumping at this time and should be pumped every two years for maintenance. Grease Trap(locate on site plan): Depth below grade: NAfeet 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 17 Farm Hill Road Property Address Joe Dolaher Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 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: NA 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 17 Farm Hill Road Property Address Joe Dolaher Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 page. CitylTown 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 11 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was in good condition at time of inspection. No sign of back up present. 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.): NA * 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 17 Farm Hill Road Property Address Joe Dolaher Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (3) 3050infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching was in working order at time of inspection. Area of leaching was probed and found to be dry. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA x Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 17 Farm Hill Road Property Address Joe Dolaher Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 page. Citylrown 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: NA 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 ° M 17 Farm Hill Road Property Address Joe Dolaher Owner Owner's Name information is required for every Centerville Ma 02632 8-31-16 page. City/Town 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 A1.0= 537 A -PORT--39.6" 81 24' 82-PORT 2s' "DJ A -Cl- 10' A -C2=15' 8 -C1='21' 132 2=180 FRONT Al B2 GARAGE C2 C1 I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 17 Farm Hill Road Property Address Joe Dolaher Owner Owner's Name information is Centerville Ma 02632 8-31-16 required for every page. City/Town 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: 132" 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: 2006 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: Plan on file with BOH. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 17 Farm Hill Road M Property Address Joe Dolaher Owner Owner's Name information is Centerville Ma 02632 8-31-16 required for every i page. City/Town 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 7 T�O�WN) lOF BARNSTABLE LOCATION 7 t6 2 � /T/// �� SEWAGE # VILLAGE 4f ti 7 t�1,L v i lle ASSESSOR'S MAP & LOTS 0�3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �` 5 O 0 LEACHING FACILITY: (typelL-3)-3em-4)1�'<<1AA9TD�-r(size)%�� ,X 14.1e 0- NO.OF BEDROOMS BUILDER OR OWNER PC- 0-01 9''56 PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by, fGZoN 7- i T n136X /3 � - � Lqa -�oozi- = 026 .S �Al Ti6OL' �s ;r No. C 2 D1 S Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes N r.� flAration for Mispo8AY 6pstPUt Construction 3permit Application for a Permit to Construct( ) Repair( /Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components CD 4r. Location Addressjy Lot No. 1-7 F j L L 1] p Owner's Name,Address,and Tel.No. � (� ar: Assessor's p arcel L' 1r jL ;d 7, LyA2. 92YU801 927- $71�jUS Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. R��oy �zooY��. �►��. � � Type of Building: Kkyl`.J Dwelling No.of Bedrooms riLot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons'. Showers( ) Cafeteria( ) Other Fixtures 'I Design Flow(min.required) N gpd Design flow provided N Q gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Asp C A C S..-i i G�rj Lr o r► 116 VS(r To -f cJi i{ oveto (figPAt2 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 1444Date oe Application Disapproved by Date for the following reasons Permit No. -2 I Date Issued i ,. r-•.... - :ti.•.` -.+`ti;ry4 ., .� .F'� ..^ ,.fit.- r h"w.rrt..,, r ;4. . .: ...,r- o?!5� Fee ��7, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zippftcation for Wposal Opstem Construction Permit Application for a Permit to Construct( ) Repair(/)`Upgrade( ) Abandon( ) ❑Complete System El Individual Components Location Address a Lot No. ' ,Y f 7 (a Ri►1 (a i LL R b> Owner's Name,Address,and Tel.No. Assessors ap ar el _ Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: V 4 vj r) e $ Dwelling No.of Bedrooms Off A- -Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures , Design Flow(min.required) JU 1 A gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil - Nature of Repairs or Alterations(Answer when applicable) R C PG r' �^� (rr ry I�► or, /�0V.rG To -fA„ t .Jim u/t vw 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 He 1th. Signed �� Date Application Approved by V - {A^p Date i Application Disapproved by Date for the following reasons Permit No. Date Issued - - - --- ----- - - -- -- --- -- - - -- -- - -- - ----- -- -- ii THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS I ,� $ f e P Certificate of Compliance „- THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by R L A D y i -at 1-7 FOAM- H'(1 ►2 - has been constructed in accordance -with the provisions of Title 5 and the for Disposal System Construction Permit No. d I -.2 S Ydated Installer 2 L A;D v A 4 t-r e r4. -P-d G Designer #bedrooms Approved desi fl w /l 1 gpd The issuance of this permit.shall not b /construed as a guarantee that the system wi l�fimction d'signeda Date ���/ Inspector --------- ----- 7 ------- - -- -- - -- -- --- - ---------- - --------------------------------------------- -- - --------- ------------ -- - 11 No. 070/ ^ r)r Fee THE COMMONWEALTH OF MASSACHUSETTS �— PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(V Upgrade( ) Abandon( ) System located at I ? rA/G M rL)- r,0 CC IV T(./- d 1l'4' 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. ct / ` Date O ( 1//k Approved by V V `s f 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM ► I,_ �A2►�Et�) E. �►�Nl� ,hereby certify that the engineered plan signed by me dated 2- 22,-()ce .concerning the property located at i 4- 'Fkm \ :\\ tad, . C�� �►\�z meets all of the. following criteria: • This failed system is.connected to a residential dwelling only. There.are.no.commercial or business.uses.associated with the.dwelling. • The soil is.classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to.conclude this fact or.may conduct deep test holes and percolation tests,at the site without a health agent present. • There is no.increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will-be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 44 .00 B) G.W. Elevation ,3 +adjustment for high G.W.2.S = If. 50 DIFFERENCE BETWEEN A and B 2-4•S© SIGNED : . DATE: - 2 6(p NOTICE Based upon the above information;a repair permit will be issued for 3 bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. M 2-q gASeptic\percexemp.doc No. aw `otily �, Fee THE COMMONWEALTH OF MASSACHUSETTS� Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipprication for aigo!gat *pztem Construction 3dermit Application for a Permit to Construct(Repair( ) Upgrade( ) Abandon( ) 0 Complete System ❑Individual Components Location Address or Lot No / CK y% Owner's Name,Address and Tel.No. / Assessor's Map/Parcel [� d &`3 Installer's Name,Address,and Tel.No. Designer's Name,Address a d, el.No. /�2�1i �o.✓sT C � �t �r� Vga� Y 5—4 7 -3 3 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures c� Design Flow(min.required) 3.3 0 gpd Design flow provided 3 j Os ® / gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S.3 3os Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sig Date oZ �6 Application Approved by, Date a U @Application Disapproved by: r� Date o2 y CdIR C�C�for the following reasons -PS v` 'P��t 0�1 f t)^ I 0 V r lI//P i t p J ✓ �r � r^V f P Jr. - d`1� !U V, lNc ermitNo. �_(����p0 _���--- -- -�'r Date Issued a ay No. / 0d( ' 04 Fee/U0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for Migpogal *pgtem Cow5truction Permit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) �"'❑ Complete System ❑Individual Components Location Address or Lot No. �'n/?fir �� � / � C Owner's Name,Address,and Tel.No. 4 Assessor's Map/Parcel i Installer's Name,Address,and Tel.No. Designer's Name,Address and el.No. i �J � t Rr� f.✓ J�AY IV,2G2 "" 5 S D P � aJ- /3L � SOS S J 7 6� Type of Building: I Dwelling No.of Bedrooms Lot Size sq. ft., Garbage Grinder ( ) 1 Other Type of Building No.of Persons Showers'( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 y gpd Design flow provided ds G gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 37 0 Type of S.A.S.-3//3c's 61 `6- Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: w 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 / / O Application Approved by r k7.,5. Date''�2 -.2 c/f U b rApplication Disapproved by: �• is ^ Date 02 - C Jt� for the following reasons ,�,� T-f 14- I-�e v� Q �P�h ���5 �C t ��I P d Un $` (orb v, wr r �' ruaf .:�rIJ f orb M eo-717 � /9vr+ 1jP/', �' j Ak4 �v' 7W krmit No. a 60V1 -0 6 f Date Issued ——————————————— —— — ————=——------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ()() Upgraded ( ) Abandoned( )by ')1Le A,` c° �j at 'k ' �f F ti l� has been constructed in accordance 4,� with the provisions of Title 5 and the for Disposal System Construction Permit No. a®06dated / p Installer � �"` Designer �f� n #bedrooms 3 Approve design flow 3 0 gpd The issuance of this permit shall not be construed as a guarantee that the sy tem will cti n signed. Date Inspecto ---No. a606 —yhY Fee t()0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1 0igpogal;*pgtem ComStruction Permit Permission is hereby granted toConstruct ( /)' Repair ( ) Upgrade ( ) Abandon S ) V. System located at t _ Y ti i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction ust be completed within three years of the date of this^pe it. Date � N rn Approved by W✓ , Town of Barnstable F tHE tp� o Regulatory Services Thomas F. Geiler, Director • BAMSTABLE, 9�A 1639.MASS. 10� Public Health Division °i Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: Shay Environmental Services, Inc: Installer: e.C4 Address:. _ P.O. Box 627 Address: r QIV _East Falmouth, MA 02536 Arv� 1 _ On J� was issued a permit to install a ( ate) (installer) septic system at V;�V•4 4111 r based on a design drawn by (address) Shay Environmental Services, Inc. dated (designer) X_XI 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. 1 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. OF o CARMEN E. \'. (Installer's Signature SHAY N No. 11$1 � 0 ��GISTER� SANITAR\Pa (Designer's Signature) (Affix Designer's Stamp Here) 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. Q:Health/Septic/Designer Certification Form *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. SECTION A -A 61RAN0!eftSALLY 10' min. from All OUTLET PIPES FROM THE t' "°sO Existing Foundation �h.use e' x cover must he FILE VIEW OF LEACHING SYSTEM �l�FOR AT iEA`ASST 2 FT. 12' CONCRETE COVER A = L BE TOPOF FOUNDATION ELEV. 100.00S(Assumed) Septic took KbVer9 must be within 6 in. of finished grade tic tank PRO Not to Scale within 6 in. of finished rode -• Grade over Septic Tank- 99.00 Grade over D-Box- 99.00 over SAS- 99.00 3- 5.OUTLET ..• v 2 e a a' of 1/d'.- f/t" it u,Peadonr `w,-• KNOCKOUTS - t�. �""1`.-.- -„_,/ ^", Farris N"°4i, ���j f /I' to ,f/l lLeAed GYweAei Boone 5.5' �.v 12' MLET ` ni r//N • S 0.02 4'PVC(CAPPED)INSPECTION PORT TO BE t 6' irJ' 3 HOLE H-10 - J `. 3' Maximum Cover .INSTALLED AND TO BE MITHN 6'OF GRADE - ` ST. BOX -.._� 0 20 NEW Greater - am°r LILT , S-0.O1 or ' 2' KaV Jr � 3 17 f01M llRt Its a;l EXIST. PIPE 0 1,500 GAL 0.01' Top of SAS-Dev. 96,25 155' 4" SCH. 40 T ~L FROM EXIST. FC1l1NDATION rn SEPTIC TANK r a0 Per foot ( -;,-;--,Effective - -�4H /r eo•.rp.,ry� r n 01 s Ette�o'. Depth z4" E active PLAN SECTION CROSS-SECTION Ile H-10 CONCRETE FULL FouNOA dII uri m _1 SidewaLL / I .( o / 3 Units e15 SYSTEM PROFILE 6 in.of 3/4--1 1/2- ' 1- - 3 HOLE H-10 DISTRIBUTION BOX u 3' 4 3' , Not to Scale C compacted stone c o u R NOT TO SCALE - > 1O' gr S kaed NAVACoMany@'M!NAUEn > Effective Vklth c - 5 6 in.of 3/4'-1 1/2' m Effective Length GENERAL NOTES compacted stone . SOIL ABSORPTION SYSTEM (SAS) NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE m 1. Contractor is responsible for Digsafe notification, Verification of Utilities INFILTRATOR MODEL 3050 (H-20 LOADING)/ SUMNER & DUNBAR and protection of all underground utilities and pipes. V� Bottom of Test Hole 1 Elev.=88.00 (OR EQUIVALENT) 2. The septic tank and distribution box shall be set Groundwater Observed - NONE OBSERVED level on 6" of 3/4"-1 1/2" stone. p 2 nj NOTE: OVERALL HEIGHT OF INFILTRATOR IS 30" /EFFECTIVE HEIGHT IS 24' 3. Backfill should be clean sand or gravel with no stones over 3" in size. C OI ^TI0N TEST ` ' d� i l,r 4. This system is subject to inspection during installation PERCOLATION 1 I I I ��� �d J b Carmen E. Shay - Environmental Services, Inc. N Q, , - (' �' Bath 5. The contractor shall install this system in accordance Date of Percolation Test: FEBRUARY 21, 2006 with Title V of the Massachusetts state code, the approved plan Test Performed By. CARMEN E. SHAY, R.S., C.S.E. ; 1 and Local Regulations. Results Witnessed By WAIVER ( per BARNSTABLE B.O.H.) Vf CLOSED Kitchen 6. If, during installation the contractor encounters ony Bath Bedroom soil conditions or site conditions that are different EXCAVATOR: Shay Env. `Svcs. PORCH /Dining Percolation Rate: Less Than 2 MPI ® 32" from those shown on the soil log or in our design E installation must halt & immediate notification be Test Hole Test Hole ° made to Carmen E. Shay Environmental Services, Inc. No. 1 No. 2 Living Room Bedroom 7. No vehicle or heavy machinery shall drive over the DEPTH SOILS ELEV. DEPTH SOILS EV. m septic system unless noted as H-20 septic components. 0 99.00 0 99.50 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. ��dy Sand 9. All Distribution Lines shall be 4' diameter Schedule 40 NSF PVC pipes. Loam 10. All solid piping, tees & fittings shall be 4" diameter 10 YR 3/2 10 YR 3/2 3 BE HOUSE FLOOR SCHEMATIC 0"-6" A, sB.50 0"-6" A Schedule 40 NSF PVC pipes with water tight joints. , 99.00 +1 11. Municipal Water is Connected to ALL OF The Residence and Abutting Loamy Sand Loamy Sand Properties Within 150 Feet. 10 YR s/s 10 YR s/s �,� THE PROPERTY LINES ARE APPROXIMATE AND 6'- 30" Br 96.50 6" 32- gw COMPILED FROM THE SURVEY PLAN GENERATED BY MED MED BEARSE & KELLOG OF HYANNIS, MA Sand Sand ENTITLED "SUBDIVISION PLAN OF CRAIGVILLE BEACH ESTATES, HYANNIS, MA, 2.5 Y 7/4 2.5 Y 7/4 DATED DEC. 14, 1964, PLAN BOOK 118, PAGE 133 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 30"- 132 C, 88.00 32"- 132 C, 88.50 ____----_-- 98---------------- 98 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN LOT #3 115' She THE SEPTIC SYSTEM INSTALLATION. Square Feet 7.500 S + Failed DECK q /- Cesspool EXISTING CESSPOOL TO BE PUMPED OUT& REMOVED. NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE EXISTING NEW 1500 GAL FROM THE EXISTING CESSPOOL TO BE DISPOSED GARAGE SEPTIC TANK TEST HOLE #2 OF AS PER BOARD OF HEALTH SPECIFICATIONS. _._._PROJECT_BENCH MARK EL_El�s= _gq.50 TOP OF FOUNDATION THERE ARE NO WETLANDS ARE PRESENT WITHIN 200 Or THE PROPERTY Pere #1 Depth to Pere: 32" to 50" ELEV. 100.00 (Assumed) I CONCRETE Pere Rate= 2 MPI i �- TIO ASSESSORS MAP 247 PARCEL 063 Groundwater Not Observed I LEGEND No Observed ESH WT r I ADJUSTED H2O Elev. = None CLOSED Full oI PORCH #f7 Foundation . I `-------- 104X1 DENOTES PROPOSED 3-24•a�M. ACCESS MANHOLES LOT #2 I 3B EDR O.lt O SPOT GRADE SOUSE ,o -6• i o DENOTES EXISTING - - .- I _ CRAWL SPACE FOUNDATION) LOT #4 X SPOT GRADE •.._ems .�-.�._,�:.. � ` .. 99----------- ----i--�� -'-�--==-- ----------- -- --- ------------- 99 pL PROPERTY LINE I a / = w INLET e i�� ou Qo t PROPOSED CONTOUR INLET �,_./ `,/ -�_ I ` - _ THE ACCESS COVERS FOR THE SEPTIC TANK, f DISTRIBUTION BOX AND LEACHING COMPONENT I z9' -- - - -97 EXISTING CONTOUR SHALL BE RAISED TO WITHIN 6" OF I + -•S_s ' 'i_�C�i'-i't _•_;,_.t-� ...:fix �: :��:��.• I a FINISHED GRADE. STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-T1TE GAS BAFFLES OR EQUALS DEEP TEST HOLE & M} PERCOLATION TEST LOCATION fo.5 ON ALL OUTLET TEE ENDS PLAN VIEW FZ-� - -.:. r .t - ;.• �. I 3-24'REMOVABLE COVERS6 FOOT STOCKADE FENCE 1 75.00 o f 0' TEST HOLE #1 .---• - -- � ► � ELEV._ 99.00 3'min. clearance INLET I S" mtn.T12- min. Inlet to outlet C mFr. �. tY wwEi. I I 1D _ _ INLE Llqukl level OUTLET 98-------------- ��-----rt� --- ---------------------------- 98 mIrL -----' --=\- -.---._..._------------.----------- ' E$• ' 4'-0'min. P LOT P LA o o.ma. b � r +o FARM r�rLL R oAr OF PROPOSED SEPTIC SYSTEM UPGRADE J i `..'�-�±-�•C-c-ems!.!'-_`_ .�_:•'�- V_„ �.�____-�. •:..:...:f -. 10'-0- 5'-e' (40 FOOT RIGHT OF WAY) PREPARED FOR CROSS SECTION END-SECTION MR . K E N N ETH B. M U R P HY TYPICAL (H-10 LOADING) 1500 GALLON SEPTIC TANK # 17 FARM ATHILL ROAD NOT TO SCALE May Substitute with 1500 gallon H-10 Polyethylene Tank-George O'Brien Co. NOTE: WATER LINE TO BE RELOCATED AS-SHOWN W. HYAN N I S PO RT, MA Design Calculations OF ASs901 PREPARED BY: Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V)Garbage Grinder. No CL-1 R Il E 1' E. S 11`1u/� Y .Leaching Capacity.Proposed. 330 Gal./Day Minimum (Min. Per. Title V) 'H � i Septic Tank - 2 x 330 Gal./Day.= 660 USE NEW 1,500 GAL Septic Tank. . A 0. 1 ENVIRONMENTAL SERVICES, INC. SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch 0 20 4.0 50 O Bottom Area: _0.74 gal/sq. ft. x 290 sq. ft. = 214.6 gallons GISTS P.O. BOX 627 Sidewall Area: 0.74 gal./sq. ft. x 156 sq. ft. = 115.44 gallons SgNITAROP� EAST FALMOUTH, MA 02536 Providing: = 330.04 gallonsr TEL/FAX : 508-539-7966 Use: (3) 3050 H-20 INFILTRATOR CHAMBERS, HAVING A 2' EFFECTIVE DEPTH, „ , "-2O_ ' (4' W x 7' L) To,BE USED WITH 3' OF WASHED STONE ON THE SIDES AND SCALE: 1 =2O SCALE. 1 DRAWN BY. CES DATE. FEB. 23, 2006 4' OF WASHED STONE ON THE ENDS. PROJECT#SD866 FILENAME: SD866PP.DWG SHEET 1 OF 1