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HomeMy WebLinkAbout0044 FERNBROOK LANE - Health 44 Fernbrook Lane Centerville 208-085.012 Slug__ / /11/ . UPC 12534 No.2�153LLO_R �,a�' T4WT 4 ENSTABLE LC)C 'it3N T e A W. `# VTI,I:At CQ Q'i er U Z� ASS SSOWS 7 MAP -OT' 7IJST .LER` NAi c$ HONE I`T4 SEPTIC TANK C:A.FACM- LEACFIING FACILi'FY {typ�j {sue) / S NO OFBEDUdI�iS 3 EUlLDER C}It"OWi�tER ' y PERBd�TDATE CO� CE-7ATE. Separation DIstBII CC"B tureen be Maximum Ad� sted Gioandwater Table to the Boriom of Leachng Fat.{ty FeeR Pn�rate:dilater supplye11 and reaching FacYl�ty {�f any weIIs exist tin site ur wa�un 24Kf feet of IeacEwsg fad} =Feet: Edge v£�letlaad and IeacWti"g#"aa'1}ty(If any wetlaa3s exist; - v�nttt13 300 Feet of teacivagfacilrty}: o � b ¢ r r� Q3 3 a , ,3 _35-'Sl" Q r3_, 33 ` f Commonwealth of Massachusetts Title 5 Official Inspection Form , ! iI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 . a 44 Fernbrook Ln Property Address Christopher Ward r. Owner Owner's Name / z information is required for every Centerville V MA 02632 10-9-19 ^, page. City/Town State Zip Code Date of Inspection w, 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. A. Inspector Information 57#Nc�l4- Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10-9-19 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 f Commonwealth of Massachusetts r� Title 5 Official Inspection Form I� w-� rl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 Fernbrook Ln J" Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes,,. ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 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): t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ICI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � .. ? 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection 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 El ❑ ND (Explain below): ❑ obstruction is removed ❑ Y El ❑ 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 16.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 s Commonwealth of Massachusetts �-r Title 5 Official Inspection Form Ii Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection 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 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. 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 ❑ ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 .� Commonwealth of Massachusetts �- Title 5 Official Inspection Form I t. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOTdue 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form i6i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection 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 ❑ ® 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? ® ❑ Wasthe 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts ,. Title 5 Official Inspection Form C�'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 0 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 10-2019Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form w_� hi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection 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: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts ,w Title 5 Official Inspection Form ICI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments >°` 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) - 4. 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): Approximate age of all components, date installed (if known) and source of information: 2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 24"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.): Good condition. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts a Title 5 official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - T, >�I 44 Fernbrook Ln �, Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 1" 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? Tape 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 is in good condition with baffles installed and no sign of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 .� Commonwealth of Massachusetts 3 Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � r 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Oil Title 5 Official Inspection Form wa ri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection 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: Type: ❑ leaching pits number: ® leaching chambers number: 6-110's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form C�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach chambers in good working order and empty at inspection with no visible stain lines. 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 ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 .� Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts ,. Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection 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 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 A 07 44, A '3 —3y4f</ 3 1 A 38--- rP . i 1 j .. - t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts ri ,w Title 5 Official Inspection Form ! ICI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 11'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 I' s Commonwealth of Massachusetts . r� Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 Fernbrook Ln Property Address Christopher Ward Owner Owner's Name information is required for every Centerville MA 02632 10-9-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE .:LOCATION V` SEWAGE# 2eD?' "VLLAGE eerx f aA&,g 1CR ASSESSOR'S MAP&PARC /Z INSTALLERS NAME&PHONE NO. � p&vIake a4' t SEPTIC TANK CAPACITY i Qo M 1 U LEACHING FACILITY:(type) ((Q) (size) 75S n 3$ NO.OF BEDROOMS ?j 1 OWNER lie Ie n 1-eUAS/d u 2 PERMIT DATE:' 10 ' 1001 COMPLIANCE DATE: g ' Z-0 — 2©0-7 Separation Distance Between the: Maxiroum Adjusted Groundwater Table to the Bottom of Leaching Facility ko // 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 64PoW4 LLC -r AI a�.v 1-3 ag- � wa a?- a as 3b o 3 35,u i33 �3a. )9Lf 38•v G'( 37•0 3 Al S 3-? 3 t.5 TOWN OF BARNSTABLE \ OCATION D.•k SEWAGE # ILEACHING LAGE ASSESSOR'S MAP & LOT NAME&PHONE NO.PTIC TANK CAPACITY FACILITY: (type) �S NO.OF BEDROOMS �eq� `+Y� BUILDER OR OWNER PERMTTDATE: LMLLANCE DATE: Separation Distance Between the: . � �a Maximum Adjusted Groundwater Tale o 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 i No. Q T r � Fee--�� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes appItcatton for �Dtzponl �&pgtem Cori.0truction Vermtt Application for a Permit to Construct( ) Repair W Upgrade( ) Abandon( ) �omplete System ❑Individual Components Location Address or Lot No. k-(%A f'CA 1jt001,6. L o4 vi 2 Owner's Name,Address,and Tel.No. e4r,f Wpat el &AT'Ulik(e 14c-4rs 1%,.� Assessor's Map/Parcel ` —eg /o/Z Installer's Name,Address,and Tel.No.64P60"Wf Designer's Name,Address and Tel.No. bl leo lA✓/a-Y*0 P 6. rjox -?ro3 i c"a /i?&se Type of Building: Dwelling No.of Bedrooms Lot Size 1�i©C�6 f sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures C Design Flow(min.required) 336 gpd Design flow provided 3 '1 3 gpd Plan Date 2` 1 0 — ��t— Number of sheets / Revision Date Title qt( ke', &00" Size of Septic Tank iS goo 4 e''( Type of S.A.S. 6 G & G'�%��Lz'S �•� STlO� Description of Soil 5:1u- ® 4k, G e 6 f Nature of Repairs or Alterations(Answer when applicable) fi)y 2-MA t Tb flfi[w ) 10�k f L r On / 1 o F 5!-y}..e t/�S 17/ne ok-wnd 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 F—/O A UD Application Approved by Date A 116 ©!i' Application Disapproved by: Date for the following reasons Permit No.�� � Date Issued o r. No. 1 r. ' s Fee " THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION= TOWN OF BARNSTABLE, MASSACHUSETTS Yes 't rication for 0*`ogar 6p!gtem Con,5truction Permit Application for a Permit to Construct O Repair(�✓j� Upgrade( ) Abandon O Z�mplete System ❑Individual Components i Location Address or Lot No. q u f{eC A ljrpok. Z+►a 11 C Owner's S Name,Address;and Tel.No. �r9�1 I �eATtrli 0� rGi ri' rs pc f Assessor's Map/Farcel— 2-0,g.. C)T�S /OrLE:zrtier,,'I/c r'l9 Installer's Name,Address,and Tel.No.G</PC l0, F C4��''15"e-S Designer's Name,Address and Tel.No.641eo lx,*vi,af kJW Soy /Z>✓ Nt�zt Ce,.,rE.c r(e ✓Ii�t `l2� 3e6Z ��e�`� 2�E t�-t�rs/�t d�Fr r/f Type of Building: -7 ¢ Dwelling No.of Bedrooms Lot Size I� 00o" sq. ft. Garbage Grinder ( ) j < . Other ' Type of Building No.of Persons Showers( ) Cafeteria( ) . Other Fixtures _ Design Flow(min.required) ~ gpd Design flow provided '1 4 gpd Plan Date '2• f Number of sheets / Revision Date Title Y1( } tem 13✓ao f t (Z o Size of Septic Tank+ 0 jg( Type of S.A.S. �0 , G ;�j s!4 44j Description of Soil n �!/�.h G r/f+� (�1�✓z y 1 Nature of Repairs or Alterations(Answer when applicable) Xs, SI f7 n, Tim /?z x i t I ! Date last inspected: �4 (`, r Agreement: 1' 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`s 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. - t . i Signed Date Application Approved by > Date f6 0= Application Disapproved by: Date �— i for the following reasons i l ,-'Permit No. % Date Issued THE COMMONWEALTH OF MASSACHUSETTS , ]1641 S T' p�`�`'� BARNSTABLE, MASSACHUSETTS l (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (,,.,0/) Upgraded ( ) Abandoned( )by 67,ft ✓r C (,(, C at �� tl 13/c ak- L � I<- has been constructed in accordance with the pro/visions of Title 5 and thp for Disposal System Construction Permit No. � -T j � dated l.. e ( C g16�f l� + / . S Installer �(ZPi.t)rr &h e,(,0 iS Ct C Desi ner /r Y #bedrooms ✓ Approved design flow 310 gpd The issuance of this penit sha 1 not be construed as a guarantee that the system 'll`func f I as desig ed. _ Date u I'� U� Inspector✓ km ^ () No. q0 Fee = THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS x1i6pogal 6p5tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) System located at � �heoc,` Lo,� //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 th'p Date Approved by I�: t ; Town of Barnstable FIMElp�o Regulatory Services Thomas F. Geiler, Director anxxsrns[.e. Q MASS. Public Health Division vp i639• �0 A Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: FIW67 Sewage Permit# Zoo-7 .3 q(a Assessor's Map\Parcel e o T-OrS-I Z Designer: (�(t Installer: (.,0Z' IrWi 6�Oj i'?V17255 U L Address: o/ G If,dA /Zjc Lh Address: � � t3c>X -7(.3 On g 10 Zoa-7 C, W; e L__7171 1)1, was issued a permit to install a (date) —T (installer) septic system at 4-Z114 1�e7p_hk_M4 Grn , &AV based on a design drawn by (address) dated ZC1e}C, (designer) T I certify that the septic system referenced above was installed substantially accordingto the design, which may include minor approved changes such as lateral relocation of her d y distribution box and/or septic tank: Oc.D T.r. rVlka eotka- C o6s� Cw. f��- %/Vl;y e�oan , / Ja�/. l�'ro�v/% 7 1h,J9440( 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. K OF Mgs9 S GLEN cy� ERIC m, Installer's •gnature) 00 HARRINGTON ; No. 1070 0 s��IS1E�Pr� T:A B (Des i ner's igna ure) (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 3-26-04.doc I iU.S. Postal .� CERTIFIEDRECEIPTT.m (Dorfiestic Mail Only;No Insurance Coverage Provided) for delivery information visit our website at a OFFICIALrr S Postage $ ,3 kv -026 E3 Certified Fee •3 d $/ Return Receipt Fee �- Po M (Endorsement Required) �yS = Q re M Restricted Delivery Fee / `` / _a (Endorsement Required) �c r� l� U5Q J Total Postage&Fees $ 7 Ll E:l Senif To o $ �2L�� p trps u e Iti Utreet,Apt No"or PO Box No. 1--e p n fl o.O k a 0 --------ate- — - -G3 City,State,z, ed e N✓,J_ e God a- Certified Mail Provides:■ A mailing receipt (avanaa)zoos aunr ooeejod sd ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: s Certified Mail may ONLY be combined with First-Class Mail®or.Priority Maile. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery'. ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■'Complete items 1,2,and 3.Also complete A. Signatur item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you.■ Attach this card to the back of the mailpiece; ceiv y(Printed Name) C.ateofDelive6y or on the front if space permits. B. YY//' D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No Ms Helen Levesque 44 Fernbrook Lane 3. Service Type Centerville, MA 02632 ❑Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Art c!e Number ii 7[051{116O : OOOM0191 t13' (Transfer from service laf PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVIC ,,�;;'�� �. - F1rst-Class MaiF~- ,`' Postage&Fees Paid j)SPS Permit No.G-10.. i • Sender: Please print your name, address, and ZIP+4 in this box• PUBLIC, HEALTH DIVISION, --c .`c TOWN OF BARNS TABLE 200 MAIN STREET r� coHYANNIS, MASSA.CHUSETTS 0 601 I I I !!1 ! l !1 !1 !i }}t! t! ! ! 1 !! ► i 1 iil??:sfl?{?II:?II?ff?f=. I?�f?ill?ifli?????i?I�j?f811f???I?�?I r Town of Barnstable . �FtME 1p� o Regulatory Services * sAtuvsrABLE, » Thomas F. Geiler, Director 039.MASS. •0� Public Health Division rED MA'S A, Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 28, 2006 Ms Helen Levesque 44 Fernbrook Lane Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 44 Fernbrook Lane, Centerville, MA,was last inspected on December 151h 2005, by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following. System is in hydraulic failure. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH DEPARTMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health COMMONWEALTH OF MASSACHUSETTS y EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS,;,, ,rl.. i F li J i `.L d DEPARTMENT OF ENVIRONMENTAL PROTECTION O,,M Sv9 V W...,..�w�)VISION ~TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 44 Fernbrook Lane Centerville MA 02632 Owner's Name: Helen Levesque , Owner's Address: Same Date of Inspection: December 15,2005 Job P 05-384 Name of Inspector: PATRICK M. O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported /11. below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my l training and experience in the proper function and maintenance of on site sewage disposal systems. I am a D,EP approved system inspector pursuant to Section 15.340 of Title 5(310 CM 15.000). The system: \y `Fttiii����i Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority _ PATRC ,' - _X_ Fa� o r` t �^ —i ��� L Inspector's Signature: M Date: 12/15/05 �'rr,�% [I•FtiE�' Q�O� INSPE�'ww�`• ft11111111��� 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. Notes and Comments: Leaching pit full to top,in hydraulic failure. Tank is structurally sound and can continue to be used with a new leaching system. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 44 Fernbrook Lane,Centerville Owner: Helen Levesque Date of Inspection: December 15,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed 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: T41. G 1—nartinn Fnr 2 Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 44 Fernbrook Lane,Centerville Owner: Helen Levesque Date of Inspection: December 15,2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. — The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Titles C Tncnnrtinn G•nrm r�ii�mnnn Page 4 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 44 Fernbrook Lane,Centerville Owner: Helen Levesque Date of Inspection: December 15,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No —X— _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X_ _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool —X— Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped — —X— Any portion of the SAS,cesspool or privy is below high ground water elevation. —X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. —X— Any portion of a cesspool or privy is within a Zone I of a public well. —X— Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma _Yes_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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— I WPA)or a mapped Zone Il 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. Title S Inc-P tin" PA—ri1;/Innn 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 44 Fernbrook Lane,Centerville Owner: Helen Levesque Date of Inspection: December 15,2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant, or Board of Health _X_ Were any of the system components pumped out in the previous two weeks'? _X_ _ Has the system received normal flows in the previous two week period `' _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components, excluding the SAS, located on site? _X_ _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid, depth of sludge and depth of scum? _X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems`? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no _X_ _ Existing information. For example, a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)J Titles C )nenortinn Fnrm ail snnnn 5 f Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 44 Fernbrook Lane,Centerville Owner: Helen Levesque Date of Inspection: December 15,2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2003+2004 90,000 gal.= 123 gpd. Sump pump(yes or no): No **water usage for 2005 higher due to new irrigation system and lawn** Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank pumped within the past year. Source of information: Owner Was system pumped as part of the inspection(yes or no): No If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components, date installed(if known)and source of information: Compliance date: 8/21/84 Were sewage odors detected when arriving at the site(yes or no): No Tula C (nc—tinn Fnrm Oil;ionnn 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Fernbrook Lane,Centerville Owner: Helen Levesque Date of Inspection: December 15,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: 4' Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 2' Material of construction:_X_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 8.5' long x 5.2' wide— 1000 gal. Sludge depth: 0" 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: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined: STICK WITH HINGE FLAP. 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 at bottom of outlet invert tank is structurally sound and can be used with a new leaching system. GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): T410 C Tncnar4inn P: —4/1;i,)nnn 7 Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Fernbrook Lane,Centerville Owner: Helen Levesque Date of Inspection: December 15,2005 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Box is deteriorated and leaking and shows evidence of backup from leaching pit PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Titla f fncnantinn Pn _<n snnnn 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Fernbrook Lane,Centerville Owner: Helen Levesque Date of Inspection: December 15,2005 SOIL ABSORPTION SYSTEM (SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 6x6 pit. leaching chambers, number: leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Liquid level at top of structure with staining to top of risers Pit is in hydraulic failure CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY: No (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.): Titles 1; inonartinn Rnrm Aii cnnnn 9 r Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTA RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Fernbrook Lane,Centerville Owner: Helen Levesque Date of Inspection: December 15,2005 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 Driveway 28 40 34 29 29 22 Garage #44 Titla 1� fncnanfinn Gnr All CI,)nnn 10 • Page 1 I of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Fernbrook Lane,Centerville Owner: Helen Levesque Date of Inspection: December 15,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: N/A Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: A perc test will be performed prior to repair to determine groundwater elevation. Titla lnenantinn Fnrm A/i,;i,)nnn 1 1 e No........... .�.. FF-ic ... 6............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ( ' t 0...................OF..........3..LkA.A�-S-.l.. b4- . for Uiupuutti Workii Tomitrurttun ramit Application is hereby made for a Permit to Construct (V/ or Repair ( ) an Individual Sewage Disposal System at: e2� 11if ._eil.� r�N...... •••• W J�s. ....:..... Locati Addr ss or t No. ... ....1`3..4 fS.4.*Ale. .�1......�`..... ... �....... ................................ .------ .....................------- O er �� Address a •---••--•••••••••••-••-••••.........- --•• ���. ..._. ��. ........... .................... Installer Address dType of Building Size Lot............................Sq. feet UU Dwelling—No. of Bedrooms......... ...... Expansion Attic (�1()j Garbage Grinder (1!D) .................. - '4 04 Other—Type of BuildingI� ........... No. of ersons.......c. Showers Cafeteria Q' Other fixtures ................................. . W Design Flow......... ............................gallons per person per day. Total daily flow........... ...................gallons. WSeptic Tank—Liquid capacity:l0.0d.gallons Length---10....... Width......(L...... Diameter-------4--_•... Depth....8........ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....A4.j....sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (VII, Dosing tank ( ) f `" Percolation Test Results^ Performed by.....43/fk.T--CA....�....� Ci................... Date......,�._�:.3�� . Test Pit No. 1..�. ._..minutes per inch Depth of Test Pit.......... ..... Depth to ground water..... ....___....... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----•---•-------------------------•-----•------------------•-------•-t•-•-•-............................ •..... • ........ ----••-•-•-------••--.-- O Description of Soil••®--�•••-•.` ; IMt - _c� �.44..----•-----f..,_J.�......... S�l-i�- G'vt.% -�tl�Z ••-' •" x �Q{:--.1 `----••------------------------------•---------.......--••-------..., W •--•-----------------------•-------•--•---------•-----•--•-•--.....-------•••-------•--••-•••--•-•••---••••-•--•------•--•------•-•-••••----••----•-•••••••••-•--•----••---•••-•--••----......--•-.••••. UNature of Repairs or Alterations—Answer when applicable............................................................................................._.. Agreement: The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of ealth. Sied-- . . ................ Application Approved By.....-~`" ../•......-------. .. . •. --•--------•-•-•--••--••--•---... ... // Date Application Disapproved for the following reasons---------------••----...------------------------.........--------------------•-------------....-•••---•••-••-•-•- ----------•---•--------••---------------•--•-----------------........----........-•---•---•------------.._..................-----•----------------------------------------------------------............ Date PermitNo......................................................... Issued........................................................ Date No...........6.Y......y6l FEs...... �..r.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L. . ..............OF . ................. .....-..-...... -..-..-...-.-._.. Appliratiou for Bi-tipooul Work.i Ton,itrur#inn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: r•" •-•--•--•...............................••-•--•---•-••--....._. Location-Address or Lot No. ................................................................................................. .................••............................................................................... W Owner Address a ....... Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons........................... Showers ( ) — Cafeteria ( ) d Other fixtures W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter---------------- Depth_.............. x Disposal Trench—No- -------------------- Width.................... Total Length.................... Total leaching area........_...........sq. ft. ?� Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by......................................................................... Date..................... .................. Test Pit No. 1---.-------_-.-minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4. Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-.-____------___-----._- 04 --------------- --------- ................................................. •-•-----------.--------------- ---------------- ----------- -............. .... •..... O Description of Soil---------------------------- ----•------------•-------------••---------------------------------------------------------------•-----------------------••......••-••-.... x (> W --------------------------------------------------------------------•--•-•---•-----•---------•-•------------•---•••---------••............-_._...---•--••••......-•-----•-••-•-•.....•-- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------------•--•----------•-•-•-----••----•-•-••••-•-•-•--------••••••-•••••••••-••-•--••-•••-••---------••---••-••----•-•••••••----.......-•••--••--••-----•-•-•••................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the pro�-isions of TITLT, 5 of the State Sanitary Code — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sied._... ----------- •. Date Application Approved By..... �.._, c '_ „J'� ff `�......------•-- ate ------- Application Disapproved for ;;::Tol�lowing reasons:.... •----- ------------- --•.............t................ Date PermitNo................................................-------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................................OF...................................... Tatif iratr of Toutplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------------------------------------------------------------------------------------------------ --------•--•------------.--------•----------.-----•------.-•-------------------------•------- Instal ler at.------•-•-•---------------------------••--•--•---------•----•----•---------------------------•----•-•---•---------------------•---------- has been installed in accordance with the provisions of TIT The State Sanitary Code as described in the application for Disposal Works Construction Permit No_-��-ff--''--��---------------i__------------- dated---.-,-.............---------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 6 .0 J gq n DATE. Inspector........---``,� ......................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH dd ..........................................OF...................................•....... ....._........-----•---......._ D No...�7..9. �.... . ..l FEE....,. ............. lkip at Vork.5 Toniattrtion "P.erntit Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo...........................................................•--•••-------•-••------•-•---•---•••------------------------------••-----••--------...-•---.......-----•---....----••••......•..... Street as shown on the application for Disposal Works Construction Permit No_____________ _____ Dated-----------.._............................ 00, oard of Health DATE...........................................(' .................. FORM 1255 A. M. SULKIN, INC., BOSTON y�.3 �a1►.IGLC_ FAM►LY - ':� BGOR0oM 4 / u0 GA¢<OAGE (jW►.1DE2 / D�1Ls{ FLow pq SEPT►G TP►vK = 330x15o% �t9iG.P. o : . U51<- \000 GAL. yz 3 .. _• .'•w"J'4 o►5Po5AL P►T �5E Ivoo GAL. �G y ,Zo 7-/S !j�pC•H/p,lL AQ6A - I JO s.F � , , 150 5.P. X 2.5 BOTTOM A2CA= 50 'T oT A I-. p E S I G N = 2 5 G.P. D. Q -TOTAL DA►'LY FL0V4 330G.Po � `�. of .9 f�EtZ•GOLATION RATES I'IIN ZMIN ot`L�55 _y • � .{ �_ INS �°`-+.'e-fit � -38'Sc � / ' •� I �� ' +?;�,;• CF Alas �� l �ZH 0 F M4, ,*'... RICHARD A. DAVID S y 3 �( ✓�1 m! C1AATER H C. THULIN W.2.10� v No. 299.76 '`• CST � \\'` ' TOP FNu 1000 lN�• aeO Soi� D 1ST. G A L. BUX � SEPTIC 3G f3 (DOO INS( TANK C GAI-.. 3�.d LEAC. SANo PIT INV. INV. G,QQ►/�� WIT" WASMGD 670 µE 30,Q 3 Wei I CE2TtF1Cp PLOT PLA►J /Z ZGo P R.O F I L 4-T 10 N C�it/TE�y/G d� NO SCALE 'ScAI.E. � ,._� • � AT �c .��Zy,�'f ,� 2E N GE FI' CQEoPI GOMPL`(5 lnl TN I►Ef S 1 o�1 ESN _ NE �G71 ,auP SET5.GK 26CgU►R.EM1✓NT� oF 'CN� .CCC . /�9 � Z D 'fp w rJ o� .BA2tJ 5��'�•-� a N� I s �.lo`� �k r LOGPT D WITN11.1 •TNE GLOoD PLAIN I D AT>✓S l C.c c..•� . .. B A xT E Q e ti Y E INC. REG 15Z�26�'►.AN o s u Z-.V EYoeS T►t15 PL&ti 15 NET 4n5c r-) ow AN C�STERVILL� - MA55 I. IN.jT2UMaWT QVeY � -rNE 0►=F,SE`r5 Suou� N o T C� U 5 E O T o D ET E ft!^I► ►E L�T -I N E.�j A P P L I C L .. L-'O C A T ION S E AGE PE RNIIT NQ. ff� VILLAGE V I N S T L L S NAME E -AADDRESS B U I L D E R OR OWNER ram}- i f1 DATE PERMIT ISSUED l 'AD AT COMPLIANCE ISSUED 1 I � j b Z� c,� r r i0CAT10Nk`1V rSE AGE PERMIT NO. G '_4 I s_ -F>2N i2iK�� La�� L� ' Iry ! - VILLAGE I_NST LLE 'S NAME i ADDRESS ' MA R<� �R UILDER OR OWNER G�0ATE PERMIT ISSUED 1pDAT E COMPLIANCE ISSUED ! , -. . �� � 'f " 4`.���`-r � � tI • �� + .�� 1� �� (� � - :, � . n;.: s. +.��� BENCH MARK ON SE CORNER OF CONCRETE APRON Design , Calculations ROUTE 28 AT FRONT GARAGE DOOR, ELEV.-100.00* (ASSUMED) Number of Bedrooms: 3 Existing Garbage Grinder: NO, GRINDER NOT ALLOWED WITH THIS DESIGN 0 20 40 50 Septic Tank Capacity Required: 330 gpd X 200% = 660 gpd I-------J Septic Tank Provided: 1,500 gallon Ex,lstirrg- Nerd Leaching Leaching Capacity Required: 330 Gal./Day Leaching Area Required: 330 Gal./(0.74 Gal./Sq.Ft.)=446 Sq.Ft. Pine reet Existing Leaching Structure: EX. LEACH PIT TO BE REMOVED SITE PLAN 0 Proposed Leaching Area Provided:SW =90.5' x 2' = 181 sq. ft. SCALE: 1 ' Bottom = 25.5' x 7 5' = 191.25 sq. ft. A Bottom 12.25' x,7.5' = 91.875 so. ft. 01 Total Leaching Capacity 464 sq. ft. > 446 sq. ft. req'd. Total Leaching Capacity = 343 gpd. > 330 gpd., req d. "CENTERVILLE" 9%W Y: GENERAL NOTES LOCUS 99.57 1. ADDRESS: #44 FERNBROOK LANE NO SCALE 2. ASSESSORS NUMBER: 208-085-012 TH #2 3. DEVELOPER'S LOT: LOT 24 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN tcl E GROUND INSTRUMENT SURVEY. PERK TEST & SOIL EVALUATIONS ON TH 5. TOWN WATER IS PROVIDED TO SITE & SURROUNDING PROPERTIES. DATE OF PERK TESTS & EVALUATIONS. FEBRUARY 2, 2006 6 REFERENCE PLAN: L.C. PLAN 14972E TEST PERFORMED BY;Glen E. Harrington, R.S. sF 7. NO WETLANDS ARE LOCATED WITHIN 200 FEET OF SAS. WITNESSED BY Donald Desmarais, R S Barnstable Board of Health Inspector 8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS. EXCAVATED BY: JOEYS SEPTIC SER'�Et 9. THIS PLAN WAS PREPARED FOR THE SEPTIC INSTALLATION ONLY. PERK NO. P11218 An irrigation system Is installed in the entire lawn area. 10. THE SITE IS NOT LOCATED WITHIN A ZONE OF CONTRIBUTION. PERK RATE LESS THAN 2 MPI (ASSUMED) Test Hole Test Hole 218 P#1 1 LOT 15 CONSTRUCTION NOTES No. 1 Na. 2 AREA 17,000± SO-FT. SOILS_JELEV. DEPn SOLS 0", PEST 0 T.H. 41 1. Contractor is responsible for Digsafe notification . RKTEWAIVED BY HEALTH INSPECTOR DUE TO and protection of all underground utilities and pipes. rO 99Je FILL ggcr .5: SAFETY CONCERNS. 2, The septic tank o7l distribution box shall be set A level on 6 of 3 41 -11/2* stone, 3. Backfill should be clean sand or gravel with no Z= RK TEST 0 T.H. #2 6 LC-6 PRECAST CHAMBERS VATH 12* X 103W stones over 3" in size. Bwb �=B* PERK DEPTH-48-es" (CI) _W BEG. SOAK 0 11:24 AM OF STONE UNDER. SEE DETAIL FOR 4. This system is subject to inspection during installation as* W 1 .1. 196.42� END SOAK 0 11:33 AM HORIZONTAL LAYOUT by Glen E. Harrington, R.S. CI 24 GALS. APPLIED, UNABLE TO SOAK C1 5. The contractor shall install this system in accordance M M--oamd W PERK RATE- <2 MPi FOR DESIGN PURPOSES with Title V of the Massachusetts Environmental Code 87," _W_ A 93.08' and the Regulations of the Town of Barnstable. C2 C2 -Box and six MBO Precast LC-6 medim=14 M-C sww 6. Provide one H-110 DB-5 D 10"/4 IOM/4 ..... ............ chambers or equal. 84.7 _89,251 7. No vehicle or heavy machinery shall drive over the NO GROUNDWATER ENCOUNTERED septic system unless noted as H-20 septic components. ....... ........ e 8. Install gas baffle or equal on septic tank outlet tee end. 9. AJI existing inverts and site conditions shall be verified by contractor. END VZRW Of LEACHING SYSTEM =44 10. The existing leaching pit shall be pumped and removed. 11. Remove soil horizontally for five feet around SAS and vertically to Tr mCl (approx. 68 ) and replace with soil meeting 310 CMR 15.255 specifications. r A- 2.25� T14# x MW 5' STRIPOUT ALL AROUNC TO C1 (ELEV. 91.33 tv_$ 94W M. ABSORPTION SYSTEM QEIAIL SECTION A -A 10 SOIL M 7.5 PROPROFILEUNIF OF LRACHZAVG SYSTEM ' NOT TO SCALE I'& rem"ftwo"Almw 4V W-W Falb"F*06ww LEGEND 25.5' EXISTING LEACH PIT ------- ..... ....... . . ...................... • TO BE PUMPED & REMOVED C3 ... ....... ti Foo EXISTING 1500 GAL 12.25' �o H-10 SEPTIC TANK it 7.5' 6 tk*ts DENOTES EXISTING X 104.46 SPOT GRADE .................. .............. effec=L-4th EXISTING CONTOUR S" SAS Det" la�4 DEEP TEST HOLE 33' IL ABSORPTION SYSTEM (SAS) W1 MODEL LC-6 LEACHINGmBa PRECAST OR EGIVALENT 97.W miaTs ,% ___Jo _ APPROX. LOCATION EXISTING WATER SERVICE at to Scale APPROX. LOCATION PROPOSED SEPTIC SYSTEM UPGRADE 6 EXISTING GAS SERVICE OF A PWAM FOR 10' min. from *NOTE. ALL PIPES ARE TO BE 4" DIA. SCHEDULE 40 P.V.C. E HELEN P. LEVESQUE house to septic tank 0, H To 1: AT Finished grade over system=2% slope away 0. 070 #44 FERNBROOK LANE Existing House 5 HOLE H-10 T.O.F. ELEY.=101.02, 0- EXISTING GRADE DIST. BOX Existing Grade Elev.=95-96'± BARNSTABLE (CENTERVILLE), MA PQ Ld Provide riser to within 6" of grade Min. 2'-1/8*-1/2" Provide riser to 2" min. 02, 6' max,S 0. double�-w7 stone Within of grade PREPARED BY: f U f S-,01 Level for 2' 12' 0 S_.OJ OD Peastone Elev.=94,50' GLEN E. HARRINGTON, R.S. cel a r 2; i�r) _f50O GAL. .2 17' Invert Elev.=19_4.00' 03 (o 9 LEDA ROSE LAN E ;i SEPTIC TA 4 4 &.A 0) C;!-=-x;p3 1. * MIN. ottorn of Leach H-10 C3 C=_ 0 to I V.= 92:00' MARSTONS MILLS, MA 02648 GAS B See Detoll 9 QR EQUAL_ I/ 7± provided (5! min. req'd.) TEL: 508-428-3862 6' OF 3/4--11/2- STONE JA LEACH TRENCH FAX: 508-428-3862 3/4to 1 1/2" crushed do ®Bottom of T.H. #1 elev.=84.75' double-washed stone SCALE: 1"=20' DRAWN BY: GEH FEB. 10, 2006 SYSTEM PROFILE 6- OF 3/4--11/2- STONE Not to Scale DATUM: ASSUMED FILE: LEVESQUE SHEET 1 OF 1