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0043 FERNBROOK LANE - Health
43 FERNBROOK -LANE, CENTERVILLE - A=208-085.021 ; f t S/!// J�aEcrc�fo�o Zad, _ ?Z UPC 12543 o &3LOR ttAst�rlbs,n�N TOWN OF`BARNSTABLE LOTION �3 �iG�,�t���®/c� n-- SEWAGE# VILLAGE. ('„ fS�L� 11C_ ASSESSOR'S MAP&PARCELA©Fr—QYY— O?I INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: e ® �• x(typ )� (size) /i o�''i��® 1C Z� NO.OF BEDROOMS `7 OWNER PERMIT DATE: -/J - COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Ceaching 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 fa-cci-liityy)� Feet FURNISHED BY t it i -D o&•o F y3. °, ° r r� i No. Fee ^ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 3L PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSF�TTS Yes 0[pprication for �igo5al *p6tem Comaruction Permit 2000 JUN I I 3: 46 Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑ Complete System Individual Components Location Address or Lot No. CIJ 3 Pj r h /©��� /1! Owner's 1jame, d ess,and I N Assessor'sMap/Parcel ce,v elri Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: P Dwelling No.of Bedrooms Lot Size 1 7 / ° , ft. Garbage Grinder ( Q Other Type of Building r /��. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) /V YjQgpd Design flow provided q57? gpd Plan Date Number of sheets Revision Date Title w ® F rld Size of Septic Tank 0 Type of S.A.S. ©w Description of Soil o 0 o J f qaz ` p ir Nature of Repair4Vbr 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 Environ ental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He It ff Sign Date Application Approved by (2 Date jutV Application Disapproved by: Date for the following reasons Permit No. ")Ck ,���_�� Date Issued No. '�llU -1�Jg `,' , t 1°t Fee THE-COMMONWEALTH OF MASSACHUSETTS . Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for �Digogaf *potent Ungtruction Permit } Application for a Permit to Construct( ) Repair( ) Upgrade ) Abandon( ❑ Complete System Individual Components Location Address or Lot No. [�3 �`19 /G�©�C IJ Owner's ame,Address,and el.N• _ -D S.S;Oz/ / p fvi/�2 a�Ic ��r/ J- r ©fir =�;a Assessor's Map/Parcel (�C:�% Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 2 -7 Type of Building: P 2 Dwelling No.of Bedrooms /����`/,?J p Lot Size 13 7 !!j��Sq, ft. Garbage Grinder Other Type of Building �e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.[[required) gpd Design flow provided qa'? gpd Plan Date 17 7L/01 Number of sheets Revision Date Title 51 M /?&A 3 rAt /V lG w 0 Size of Septic Tank r ,' 9,X>5 Type of S.A.S. c �Iow b&/-1q Description of Soil Nature of Repair 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!/ Sign d �� / Date Application Approved 1. F Date ' r • e Application Disapproved by: Date for the following reasons Permit No. ')(Xi k-.2 Date Issued ---.-------.-------- ------------' ------------- THE COMMONWEALTH OF MASSACHUSETTS r " BARNSTABLE, MASSACHUSETTS , (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded (�) Abandoned( )by l,r h5)/a at d r=Xt /0 0 P has been constructed in accordance / with the provisions of Title 5 and the for/Disposal System Construction Permit No. .took—2 TS'r dated Installer hop Lo o Designer 1,9614J y C_1_1 p � #bedrooms 7 Approved d si n flow ��-� gpd The issuancetof this permit shall not be construed as a guarantee that the systemi:ll uAetioii 411as desi..ned/ G' L Date n (�1 Inspector I/f � No. '1 1�! — 7 Fee � )y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=igpogal *pgtem CongtructionPermit Permission is hereby granted to Construct ( ) Repair ( )/ Upgrade (1//) Abandon System located at q3 14--etAf and as described in the above Application for Disposal System Construction Permit.The app leant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. '" } Provided: Construction ust be completed within three years of the date of th t permit. r 14\' Date q ,/j Approved by f No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entere&incomputer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Migpogal �§pgtem Construction Permit , Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of,Septic Tank Type of S.A.S. 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. Signed Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTI hat0n-si eSe g 9D isosa Syst Cotutdo Repaired Upgraded, e Abandoned by at ��ha been constructed in accordance with the provisions o ide 5 a d,t4,elifor ispgsal stem Construction Permit No. _ dated Installer ,/y'( /P'j�UE esigner v #bedrooms Approved design flow gpd i The,issuan/ce Jo�'this @rmit shall not be construed as a guarantee that the system will functionaJs d�e(sign/d. O o Date /�J ��t Inspector ///��// I v v , l I �l -----—==--=====----- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION--BARNSTABLE;MASSACHUSETTS 3"nipigpont 6pgtem Congtruction permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( �) System located at r 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 must be completed within three years of the date of this permit. Date Approved by Town of Barnstable 'ME' ,,� Regulatory Services Thomas F. Geiler,Director * 9ARNSTABIX M^� Public Health Division gyp► " Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: $ Sewage Permit# 2,00r'"2-153Assessor's Map\Parcel a011� 0�b 'i�%)� Designer: p w v\ / e cn at Installer: /10 r- /o lJn.o n'Lt CSC I p Address: <� �ct � p Address: On �� �D`� LOP10� a� was issued a permit to install a (date) (installer) septic system at W� ��o� �-� based on a design drawn by (address) / D dated ( signer) 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. 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. h of r,�Ass9c ARNE H yes (Installer's Signature) �IVI A No. 30792 fox, GISTER�O��� ass/oNA (Design is 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-BUH T CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc ,Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "< 43 Fernbrook Lane Centerville Q Property Address ' Debora Dolan Sb cb Owner Owner's Name V information is m 5636 Lon required for Longmont Drive, Houston TX 77056 May 22, 2008 every page. Cltyrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. ImpoWhen filling A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 rim City/Town State Zip Code 508-428-1779 SI 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: to ® Passes ❑ Conditional) 'y Passes Falls ❑ Needs Further Evaluation by the Local Approving Authority , May 22, 2008 � � ..�- In pector's Signatur Date The system inspector.shall submit a copy of this inspection report to the Approving uthoritC�boalf` of Health or DEP)within 30 days of completing this inspection. If the system is a sh red system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shal :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. 08-124 Dolan2.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'f 43 Fernbrook Lane, Centerville Property Address Debora Dolan Owner Owner's Name information is 5636 Longmont Drive Houston TX 77056 May required for 9 � y 22, 2008 every page. Citylrown 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: Tank is not in need of pumping at this time, leaching chambers were empty at time of inspection. Current system was designed and permitted to accommodate a three bedroom house B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the❑ for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 08-124 Dolan2.doe-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Fernbrook Lane, Centerville Property Address Debora Dolan Owner Owner's Name information is m 5636 Lon required for Longmont Drive, Houston TX 77056 May 22, 2008 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain:, ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, • safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 08.124 Dolan2.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 6 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Fernbrook Lane, Centerville Property Address Debora Dolan Owner Owner's Name information is requred for 5636 Longmont Drive, Houston TX 77056 May 22, 2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 08.124 Dolan2.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 .Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "( 43 Fernbrook Lane, Centerville Property Address Debora Dolan Owner Owner's Name information is g required for 5636 Lon mont Drive Houston TX 77056 May 22, 2008 every page. Cltylrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed y , p ed 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. 08-124 Dolan2.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Fernbrook Lane, Centerville Property Address Debora Dolan Owner Owner's Name information is 9 required for 5636 Longmont Drive, Houston TX 77056 May 22, 2008 ' every page. Citylrown 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 to ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 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. ® ❑ r 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)] V 08-124 Dolan2.doc-08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 or 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "t 43 Fernbrook Lane, Centerville Property Address Debora Dolan Owner Owner's Name information is 5636 Longmont Drive, Houston TX 77056 May 22, 2008 required for 9 y every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No t Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 197,000 gal. _ g ( Y 9 (gpd)): 269 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: One year ago. Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 06-124 Dolan2.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments .•'' 43 Fernbrook Lane, Centerville Property Address Debora Dolan Owner Owner's Name information is 9 required for 5636 Longmont Drive Houston TX 77056 May 22, 2008 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Leaching system installed in 1998 Were sewage odors detected when arriving at the site? ❑ Yes ® No I I 08-124 Dolan2.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °t 43 Fernbrook Lane, Centerville Property Address Debora Dolan Owner Owner's Name information is m 5636 Lon required for Longmont Drive, Houston TX 77056 May 22, 2008 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2'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: 2'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: 10.5'long x 5.8'wide- 1500 gal. -Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Trace 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? Measured L08MDolan2.doc•08= Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y- 43 Fernbrook Lane, Centerville Property Address Debora Dolan Owner Owner's Name information is 5636 Longmont Drive Houston TX 77056 May required for 9 y 22, 2008 every page. Citylrown 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.): Liquid level is 3-4" below outlet invert due to vacancy and evaporation. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): 08-124 Dolan2.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "f 43 Fernbrook Lane, Centerville Property Address Debora Dolan Owner Owner's Name information is 5636 Longmont required for g ont Drive Houston TX 77056 May 22, 2008 every page. Cltylrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day , Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 08-124 Dolan2.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 43 Fernbrook Lane, Centerville Property Address Debora Dolan Owner owner's Name information is m 5636 Lon required for Longmont Drive, Houston TX 77056 May 22, 2008 every page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: Three 500 galdrywells. ❑ 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 chambers were empty at time of inspection with a high stain line indicating chambers have never had more than 4"of standing water. Size of leaching system is 10'x 30'x 2'designed to handle 345 gallons per day. 08-124 Dolan2.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Fernbrook Lane, Centerville Property Address Debora Dolan Owner Owner's Name information is 5636 Longmont required for g ont Drive, Houston TX 77056 May 22, 2008 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) .Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): 08-124 Dolan2.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Fernbrook Lane, Centerville Property Address Debora Dolan Owner Owner's Name inforrnation is 5636 required for Longmont Drive Houston TX 77056 May 22, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Fernbrook Lane Water Service J,J`/`J`J`J\ \ ,J\ ♦ ♦/\%/ % % % % % % % % % `/`r`/`/`/`/`/`/`/`/♦/♦/♦J♦J♦/\/♦i i r♦/\/\/\e f e 11 11 .1 .1 11 /\/♦J♦J♦/♦/♦J♦/♦/\/♦/ /\/\/`/♦/♦J♦/♦J\J\/\/ 35 1 60 57 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '• 43 Fernbrook Lane, Centerville Property Address Debora Dolan Owner Owner's Name information is 5636 required for Longmont Drive Houston TX 77056 May 22, 2008 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check'cellar ® Shallow wells Estimated depth to ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el 25 and topo map shows property at el 50 08-124 Dolan2.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 tHa of ro Town of Barnstabile P� regulatory Services o� BARNSTABLE, : Thomas F. Geiler, Director AIEo �a Public- Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable, Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact- the certified Septic System Inspector who conducted the inspection. Q:ISEPTIMisclaimer Private Septic Inspections.DOC ® l c • Ca 4' kN�4 c /q TOWN OF BARNSTABLE n LOCATION 3 r�r�br k (�/1. SEWAGE#�,,% VILLAGE &r-Qf U` - ASSESSOR'S MAP&PARCEL �riLIGLJ��VVFW�� I]V�S NAME&PHONE NO. SEPTIC TANK CAPACITY 1-600 LEACHING FACILITY:(type) �ho "►bA (3 (size) 16 K 3© yc ca NO,OF BEDROOMS OWNER PERMIT DATE: DATE`— 5 c�a Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility.(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Fernbrook Lane Water Service ...Gaza 5-4 r 16 35 60 57 Ilk r { t,� azy Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYtcation for �Digo!5a[ *p!tem Construction i3ermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner'sNa�m ,AddressPand 9Tel.No. ,� / Assessor's Map/Parcel Gem•���J�]� Installer's Name,Address,and Tel.No. 7 Designer's Name,Address and Tel.No. &ttelellj eelfo 7.71 P3'e Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder�to Other Type of Building " h',*—No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow `/0 gallons per day. Calculated daily flower gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �.� �� �" D Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �✓Ile. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this B d Health. Signed Date Application Approved by Date Application Disapproved forte fol owing reasons Permit No.—� � Date Issued No. Fee d / ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓/ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIPPrication for 3Mgo0ar *pMern Conotruction Vertu Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. y3 /— Owner's Name,Address and Tel.No. �1��/DDjL� L Assessor's Map/Parcel Cee I-er'v/ le 7`/'/CC'Q' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 T/ Type of Building: Dwelling_,.--No:of Bedrooms Lot Size �`s sq.ft. Garbage Grinder(le/W Other Type of Building e o-of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //d gallons per day. Calculated daily flow gallons. Plan Date >> Number of sheets Revision Date 'Title Size of Septic Tank ,Y%57')rimy dl� a T/ype of S.A.S. 3 — Dd ,`40�14�'I Ze4 Description of Soil' —� cla�l+�r s f i` 1 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this Bd o Health. Signed �/ Date /a1za�91 Application Approved by __� �\ Date �T Application Disapproved for Re foll6wing reasons Permit No. 7Z —6.9/ Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS f Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(o,- )Upgraded( ) Abandoned( )by O/ J DNS at eV& e lel l/ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. — RG dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date , - U - 9 Inspector Q\ _1 i —————————————————— No. Fee THE COMMONWEALTH OF MASSACHUSETTS �-48', d 5S.d Z� PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS �Di5po.5ar *pOtem onttruction Vermit Permission is hereby granted to Construct( )Repair Upgrade( )Abandon( ) System located at A,07 6 DD 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 must be completed within three years of the date of this permit. Date: //1 '7_Z .g Approved by C7 � y. os 1� e �- Q � � C� 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) 1, R©/Ir/- AV-IV�lel,$ereby certify that the application for disposal works construction permit signed by me dated 49/ZZ l P!5" , concerning the property located at � ��� � `G c G&�e/i* '/44eets all of the following criteria: L/There are no wetlands located within 100 feet of the proposed leaching facility V There are no private wells within 150 feet of the proposed septic system Y There is no increase in flow and/or change in use proposed ✓ There are no variances requested or needed. /if the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will=be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) ` B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert TOWN OF BARNSTABLE 41-1 1 v�z / / LOc;knON 7✓ fer,1 J/'®®�� �1, SEWAGE # vrLLAGE GPn}:jfrl/ `1t�. ASSESSOR'S MAP& LOT Zd6--Or3,�/ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY l3-010 16d, LEACHING FACILITY: (type)6DO414vri C :-3 �3� (size) /d X)a �xv � 'NO.OF BEDROOMS BUILDER O OWNER rT� 4'ERMTTDATE: /0�-7 Z -00 COMPLIANCE DATE: U Separation Distance Between the: KaMaximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private.Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) # Feet Furnished by ifG �� 576r. No..gS FEs..............�o.--- O THE COMMONWEALTH OF MASSACHUSETTS �-� BOARD" OF HEALTH , OF..............................mot-�...ls'rj.............-.......---------.. Appliration for Ui.ipn,s.al Wrkg Tv�iitrurtiutn Permit Application is hereby made for a Permit to Construct (�) or Repair- ( ) an Individual Sewage Disposal System at �, oa Lo ' ddress �' or No� T -, e C GG�... v r u X-._. .:�5.. ..... -r.I ._C !�.r l..(�'y � 1126" n C ( Owner Address a ... _ .............•-•----......-------••--•----•-•-•.-................---- .........---........---...•.....-•---•---------...........---•--•---••........................••. Installer Address . . M + Type of Building `C a Size-Lot-..'S U Dwelling—No. of Bedrooms.... ------------------............Expansion Attic ( ) Garbage Grinder pa, Other—Type of Building ............................ No. of persons............................ Showers ( ),— Cafeteria ( ) a' Other fixtures ........................................................... W Design Flow................�-�.`7.......__..........gallons per person per day.- Total daily flow............. ...............gallons. WSeptic Tank—Liquid capacity! .gallons Length :.5._. Width: (-1.. Diameter................ Depth. §'9� x Disposal Trench—No..................... Width ................ Total Length.................... Total leaching area.:.................sq. ft. 3 Seepage Pit No....>--- Diameter.8.. F��Depth below inletG._ F Total leaching area4d.!...A...sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed b .._ vTy1�9 Date._. '�1 ..21' t4ES W, Y - --- ,�.. 1 Test Pit No. I..C. ...minutes per inch Depth of Test Pit.... 4........ Depth to ground water.... fz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•--_---•--------•-----------------•-•-•---•---•-------•---•----•----•-----•----•---•--••--..-- •---- O Description of Soil...... -- . . . ' 4al®' o :l - !.I - V -- gas. !hla 1 -.------•---------•---•---------*--- . fr V-_ _. . nC -J--- ----- `zf -O---'--�---•`-G-•-,-----------n----c-!�-W U Nature of Repairs or Alterations Answer when applicable..........jl ..?NG--.-�r� ?...VJ1 .. ... �.. a t Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:IT?• 5 of the State Sanitary Code— The undersigned further agrees not to place the system in om 'a e issued by the board of health: P operation until a Certiti��f C / ... .. .!,-----1--�-, ......... -�/ �/.1�--��C to Application Approved By.. �•••• •.. 5...... ate Application Disapproved for th ollowing reasons:.......................................................................................... .................. r ................................•-•-•-------•--...................------......---•--....---......---......--•.......----•------------------=-----•------------.......---•--•--...-•-....:...---......... Date Permit No.......... S� b Issued................. ' ate. "Ae V No..... ....... .......................'_ T1t,.IE COMMONWEALTH Of MASSACHUSETTS BOARD OF HEALTH ................ ........... OF:......................................................................................... �- Appfiratiiit=-Ior Uhipaaal Workii Tonstrurtion Permit e �y made for a Permit to Construct Application is hereby.;e or Repair an Individual Sewage Disposal System at: ..... .......................................................................... ................................................Lo . .(.....AA.. ddress . ........................... f X ........... Address Owner ................................................................................................. ............................................... ................................................ Installer Address ..... ...........Type of Building Size Lot....I ...Sq. feet Dwelling—No. of Bedroqms.-------------------------------------------Expansion Attic Garbage Grinder Other—Type of Building.: -------------------------- No. of persons......_.............._._..._ Showers Cafeteria P4 Other fixtures ................................WW ..................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow........... 6- .........gallons. .............-�!?�S!.gallons LengthA2_-.:q... Width.45��71_ Diameter .............D Septic Tank—Liquid capacity.!-'r ame ep Disposal Trench—No. ..................... Width............_..__.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit Diameter..�.&-�_-F_—Depth: below inleV�.'.' Total leaching areaf_+�'!..-A...sq. ft. Z Other Distribution box ()Q _Dosing tank Percolation Test Results Performed by.____._.......I_- .............. ........... Date....M..................... ......... .. Test Pit No. ...minutes per inch Depth of[Test Pit..._.1.4........ Depth to ground water.... j 44 Test Pit No. 2................minutes per inch Depth, o�' f�&es_? Pit.................... Depth to ground water........................ 04 .............. ......................................................................................1;..................................................... 0 1-�- �r_' Description of Soil........ ......5.�.... . .. f......... Eg -5 ...................................... U T---------------------------).......... .............................. ............................................. ..................... ............................................................................................ ......... ....................... U Nature of Repairs or Alterations—Answer when applicAble......... lAt-CE..... I. ':�& K ty.. ...................................... ........................................................................................... .................................................................................... ................ Agreement: The undersigned agrees to instg.11jthe aforedescribed./Individual Sewage Disposal System in accordance with the provisions of TITLE 1 5.of�the State Sanita 'Cqde&— The undersigned further agrees not to place the,system in operation until a Certifjca*t f Com e issued by the board of health. ......... ..... ............................ e Application Approved By------.... ......... .... ... ... .............. ......... J.... ..... . ...... ate Application Disapproved for th Rowing reasons:....................................................................................... ...... '4 7, 0( R/at ............................. I...................................................................I.......................................................(......... ......... ... .. 11 1 .B�a`te 7....... icr Permit No......---....................`a.......LZ-------- Issued................. ........... ate i A - ---------- a ...................... THE COMMONWEALTH.OF MASSACHU;ET'T'S-------- ------ BOARD" OF ;-HEALTH ..........................................0 F........-n................... ............................................. ...... Trrtifirate ,of (0muttiatta THIS IS TO CERTIFY, That the Individud'Sewage Disposal System constructed (>(11) or Repaired by..... ........... . . ............ ........*'-'***-"*---------------------------------------------- ........... ....... . ............. Installe at.. ........ ;....... .......... has been installed in accordance with the provisions of TITLE, 5 of The State Sanitary Code as described in the application for Di.,spos,A, Works,Construction Permit ........... dated....................... ........................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... ....................................... Inspector......Lkv.. ................................. ................... ........... THE COMMONWEALTH OF MASSACHUSETTEP;' BOARD OF HEALTH 0 F'.'........................ ............................................................ FEE.......................... n Permission is hereby granted.......AR J ............................ ............................ ............... to Construc; ( )4r Re *r )—an Individual Disposal Svidual Sewage"Di sal sit y (.I�T .. ...........n-t----- ------ ......... ..... ... at No.......... ... . r.. Street Ts —'sar as shown on the applica?on for. Disposal Works Construction Permit No.................... Dated..__-------- -------- ......... ...... ............................... ..................B Calth ..........................V D, A................ ........... ................ "T ------ - 00 C A ' ION SEWAGE PERMIT NO. VILLACE �.c"s✓rEsz yr //� INST-A LLER'S, NAME i ADDRESS Z -Z / - 6 ,e U I L `D E R OR OWN ER DATE PERMIT ISSUED R'.10 -�s DATE COMPLIANCE ISSUED q_ ��_ �S 1 z 9 ` s ��:.2lYdy�c�o.� SECTO E t H WAGE S . 1.r. a. .... ... - -.- .: - .. •' .. ..: :. ... ., ...-. .. �d - -. r . : ,�� �k ; � / V - fin• J l S -SEPTIC TANK- -.-,.p.,BOX- ) i:_';�> -LEACH 1 TOP OF ON 4- .c (MSLI* ..2..OF 4aTO Vh" -� T�3`� Gz�Tt .�►� �T"tYaC WASHED STONE T1 M tr b e'a Cz> .tJZ'Jts JLT1 O. tN• OUT. IN• ,c, ' CL a i(fj ,C(� . OUT• IN• �•S.FX� SEPTIC t I�1 G� PB rr 7 TANK r. ELEV. -ELEV. ELEV. ELEV. _ i TKO ELEV. ELEV. ,.� r .WASHED STONE. :TEST HOLE LOG TEST BY T Tjc�MAS G o�J I�p�J Taal-F 5 `�`' r.ica,Z ,'L-1 TEST DATE �—F'��� WITNESS DESIGN � BEDROOM HOUSE ' ._-� —� .e' .�•-�'� '- / �� Z T.H. 1 T.H. * 2 p4'—_W ELEV.1jC7.\ ELEV. NO eJ'P f-' L�!'. ZMIN/IN.' DISPOSER DISPOSER • 1 / PERC RATE FLOW RATE F 3.6 (GAL./DAY) 3'0 a SEPTIC TANK 33 0 (i•�= -. r � \ � � ._ _ _ I b od _. ` REO'D SEPTIC TANK SIZE � Y LEACH FACILITY SIDE WALL Gb�Lo� ►gg,(Z.�) _ �"�('Z' G/D. , �I �� ✓�- (08" Y /� LIP BOTTOM Io'z-?��h =--.a s (l,0 1 ` 8. G/D. 9I / \ (/ ,c�-�r s q ante TOTAL ' USE: �(`=1 � LEACHING �"�� WATER ENCOUNTERED NOTES (UNLESS OTHERWISE,NOTED) 1.DATUM(MSL) TAKEN FROM__�•}'�_Y_y �5_.._.QUAORANGLE MAP ' `� O \t�F 4 ��� OF II9q�S9 2.MUNICIPAL WATER 3.PIPE PITCH:V4^PER FOOT O ARNE G c0 ARNE H. 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- -44 H• oil S.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1) FT. ccJ OJALA PI DISTANCE AS CERTIFIED 6.PIPE JOINTS SHALL BE MADE WATER TIGHT y No.130792 �- _7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. g2634II STATE ENVIRONMENTAL CODE TITLES \�F 9ECISTER�O ,� Q .' SITE PLAN �HAL L Fss� �;+`•� LOCUS: REG.PROFESSIONAL ENGINEERV11 REF: LLoT ZS L .L �. ;�4�"72- y,:2 / down cape engineering' PREPARED FOR: CIVIL ENGINEERS #% ------------ BOARD OF HEALTH LAND SURVEYORS s REG.LAND SURVEYOR. -CONTOURS (EXISTING)------- �{sTAT,L� r 9� w� SCALE I 3 S g5 (PROPOSED)—O-0—O-0— APPROVED DATE MA Ya ..W. DATE 8�-dPjSO �p j I SHALL SYSTEM PROFILE MARKEALL D WITHCOMPONENTS MAGNETIC TAPE OR BE NOTES i (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1• DATUM IS APPROXIMATE NGVD ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE ADD 6.17' OF 1/8" TO 1/2" PEASTONE 2. MUNICIPAL WATER IS EXISTING TOP FOUND. EL. 54.0' PROP. TOP SYS. EL. 51.0't 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. I \ 49.0' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 54.0' 'I PRECAST H-�o BLOCKS OR UNITS4. SIGN TO BE AAING SHO HR ALL PROPOSED PRECAST Y EL. 51.0't PRECA T RISERS PR P TOP S. -29 TYP. " . . . . . Q \ ' RISERS ( ) 4 0SCH40 PVC :: 2'0 45.73'f ,• •. 0 H-20 EXISTING TOP §YS. EL'!;.83��'" ';-'; 5. PIPE JOINTS TO BE MADE WATERTIGHT. �P •9 '•` PIPES LEVEL 1ST 2' MORTAf� ALL 3 SNP)NENTS : EXISTING INV'S EL. 43.75't ' SIDES 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE SOp * EXISTING FENDS 10" " ' EXISTING 1500 GAL H-10 14 >``oe•oo•o o` °°0°0°°0°° WITH LOCUS EXISTING' TEE TEE .• ° ° ®®®® �m®� ni�®® ��®® >°°°°°°°° 310 CMR 15.000 (TITLE V.) SEPTIC TANK 44.33 f �000,0000000 00000000 ° ° ° ° i!>°O°O°O° ®®®®®®®L��®� ®®®®®®®®®® )000000�0 GAS BAFFLE 00000000000 0 b ° ° ° ° ° OR +_0 0 0 0 0_ 0°g°g°g° ®®®®®®®�L �t� ��®®®®®®®®® ;°o°g0000 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND SF 0 0_ '°°°°°°°° ®®®®®®��®®I� ®.�®®®®®®®®® '°°°°°°°° NOT TO BE USED FOR LOT LINE STAKING OR ANY 43.98't 43.81'f °0°0°0°0 00000000 •,a :: °°°°°°°° OTHER PURPOSE. EL 41,64L LH-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 8• PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. DEPTH OF FLOW = 40 3/4"-1-1/2" DOUBLE WASHED STONE (1) ADDITIONAL UNIT-REQUIRED TEE SIZES: 6" CRUSHED STONE OR MECHANICAL MATCH TO EXISTING 9. COMPONENTS NOT TO BE BACKFILLED OR LOCUS MAP CONCEALED WITHOUT INSPECTION BY BOARD OF INLET DEPTH = 10„ COMPACTION. (15.221 (21) HEALTH AND PERMISSION OBTAINED FROM BOARD NOT TO SCALE OF HEALTH. OUTLET DEPTH = 1 4 10. CONTRACTOR SHALL BE RESPONSIBLE FOR ASSESSORS MAP 208 PARCEL 85-21 a CALLING DIGSAFE (1-888-344-7233) AND 36.5' BOTTOM TH-3 VERIFYING THE LOCATION OF ALL UNDERGROUND & ( 1 % SLOPE) ( 1 % SLOPE) NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF LOCUS IS WITHIN AP OVERLAY DISTRICT LEACHING WORK. FOUNDATION EXISTING SEPTIC TANK 35't DBOX g'f FACILITY 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL SAS DETAIL PROPOSED LEACHING FACILITY. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM VE DRIFIED LOCATION APPROXIMATE, TO VERIFIED AND REPLACED IF NECESSARY.. FIELD .. TEST HOLE LOGS �o ENGINEER: DAVID FLAHERTY, R.S., SE2755" SYSTEM DESIGN" }t' 1 � WITNESS: DON DESMARAIS, R.S.(0-/�Zp�f its 31 �J ,gyp• �iR. GARBAGE DISPOSER IS NOT ALLOWED DATE: DUNE 6, 2008 `p�f3�G� Apo �'6� _ _ < 2 MIN/INCH DESIGN FLOW: 4 BEDROOMS 0110 GPD = 440 GPD PERC. RATE - O LOT 25 'A���`��96, USE A 440 GPD DESIGN FLOW �3 15,931f SF �� 61�• 6 12258 SOILS P 0.4f AC. - CLASS # 0 t SEPTIC TANK: 440 GPD (2) - 880 **RE-USE EXISTING 1500 GAL. SEPTIC TANK ELEV. ELEV. ,1�T • Q Q 54.0' g � 54.0' � EXISTING.: LEACHING: _ A A / SIDES: 2 (30 4- 10) 2 (.74) = 118 GPD LS LS n Aj 10YR 3/2 10YR 3/2 �1 BOTTOM 30 X 10 (.74) = 222 GPD s" B 8" B �8 'A EXISTING 4 BR TOTAL: 459 S.F. 340 GPD DWELLING / Ls Ls TOP FNDN = 54.0' (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) y� 27" 10YR 5/8 51 7• 28" 10YR 5/8 51.7 +513 < / WITH 3' STONE ALL AROUND (PER AS BUILT FROM B.C.) Nn + I / PROPOSED TOTAL LEACHING: C C �� 51 47 PAVED DRIVE / ��- SIDES: (103 FT) 2 (.74) = 152 GPD / 48 MCS MCS 09 / BOTTOM 415 SF (.74) = 307 GPD TOTAL: 620 S.F. 459 GPD 2.5Y 7/3 2.5Y 7/3 O / 5% GRAVEL 5% GRAVEL + 53 SO / USE (4) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) 53 /+ `7 WITH 3' STONE ALL AROUND AS SHOWN PER PLAN 156" 36.5' 144" 36.5' � SHED T�H� � /� DECK � MANO GROUNDWATER ENCOUNTERED } TH 4 �JF. APPROVED DATE BOARD OF HEALTH ' ELEV. ELEV 5 o"" 4 54.0' o• 4 54.0' >djo�� / T. TITLE 5 SITE PLAN A A � / TH OO H 1 EX T STEM °F LS LS I�V ®A.o. Q� 6" tOYR 3/2 8" 1oYR 3/2 43 FERNBROOK LANE B B LS LS s6)0, PR P. (CENTERVILLE) BARNSTABLE, MA AD 27" 1OYR 5/8 51. 1 28" 1OYR 5/8 51.7 \� �� ' �� - PREPARED FOR BENCH MARK CORNER OF BORTOLOTTI CONSTJ PAVED DRIVE ELEV. = 52.7 MICHAEL DOLAN C C DESIGN ENGINEER TO PERc VERIFY SOILS AT TIME DATE: JUNE 9, Zoos REV. DATE: JUNE 13. 2008 (RAISE TOP OF SYSTEM. ADDN. DEEP HOLES) MCS MCS LEGEND OF INSTALLATION �\sa- EXISTING off 508-362-4541 EXISTING CONTOUR � fax 508-362-9880 2.5Y 7/3 2.5Y 7/3 x �/ EXIST. SPOT Ems. EXIST. VENT PIPE ENOFMASsq ����CNOFMgSS9 dOWflCdpe.COm 5% GRAVEL 5% GRAVEL -CM- PROPOSED CONTOUR \� � 5� °z� cyG �° DANIEL yGN /� •/� •p •/� 198.4] PROPOSED SPOT EL ! DANIELA. dOWII C41pe �I/�blee II,f ift. \ � OJALA � � A• � � THE CIVIL m OJALA 210" 36.5' 210" 36.5' TEST HOLE No.46502 q No.40980 civil engineers a o� �P land surveyors NO GROUNDWATER ENCOUNTERED 2� s�oPE of cRouND P �STE q �o 0 UTILITY POLE Scale: 1 = 20 ssc ` NO RVE� = 939 Main Street ( Rte 6A) w�13JD�" RRE HYDRANT YARMOUTHPORT MA 02675 NM.X ,,�,AIL SV MBMWA N o„0111,„, DATE DANIEL A. OJALA, P.E., P.L.S. LICE #08- '36 0 10 20 30 40 50 FEET 08-136 BORTOLOTTI_DOLAN-FROM-ASL.DWG (DDF)