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0021 FIVE CORNERS ROAD - Health
21 FIVE CORNERS RD, CENTERVILLE A= Omrford. NO. 1521/3 ORA 10% 4 .-"'^,..d.:.stiSiu�uc�al�cil�:s�:Y11'lacu... .:. �.:. �a__ ::.:.,a r�� ....•.: .. �. � __ � _—_ ~ rf@ Mtrt+ -- �� ..........._�._..__..._�_.._,_ - ....�:w,,-r.-,.-..-.....,...,.-.�....r _ �.._.__.�.�.___...,.,.�...�.,...,��_ r- � Commonwealth of Massachusetts 9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 21 Five Corners Rd. Property Address r , Kennedy Owner information is Owner's Name required for every Centerville J MA 02632 7/7/20 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information 51# 1' URv Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Citylrown State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property 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 7/7/20 Inspect igna u 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. 4//A�r Please notg: 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 toe 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 �. 11 Title 5 Official Inspection Form �e Subsurface Sewage Disposal System Form=Not for Voluntary Assessments 21 Five Corners Rd. Property Address Kennedy Owner information is Owner's Name required for every Centerville MA 02632 7/7/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 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: 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �a 21 Five Corners Rd. Property Address Kennedy Owner information is Owner's Name required for every Centerville MA 02632 7/7/20 page. Cityrrown 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 ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Five Corners Rd. Property Address Kennedy Owner information is Owner's Name required for every Centerville MA 02632 7/7/20 page. Cityrrown 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 (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Five Corners Rd. Property Address Kennedy Owner information is Owner's Name required for every Centerville MA 02632 7/7/20 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 '/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Five Corners Rd. Property Address Kennedy Owner information is Owner's Name required for every Centerville MA 02632 7/7/20 page. Cityrrown 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? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �o 21 Five Corners Rd. Property Address Kennedy Owner Owner's Name information is required for every Centerville MA 02632 7/7/20 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Description: 4 bedroom permit and plan on file at BOH Number of current residents: 2 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 ears usage d 186 GPD 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupiedDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,•�e II 21 Five Corners Rd. Property Address Kennedy Owner information is Owner's Name required for every Centerville MA 02632 7/7/20 page. Cityrrown 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: Pumped 2018 per owner 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 i i c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •t, 21 Five Corners Rd. Property Address Kennedy Owner Owner's Name information is required for every Centerville MA 02632 7/7/20 page. City(rown 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: Existing tank per age of home, new d-box and infiltrators 2010 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): 2'6" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts (e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Five Corners Rd. Property Address Kennedy Owner Owner's Name information is required for every Centerville MA 02632 7/7/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 2' Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 septic tank appears to be structurally sound, cover raised to 6"of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g - Sludge depth: 6, Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2° How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc-rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts (e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Five Corners Rd. Property Address Kennedy Owner information is Owner's Name required for every Centerville MA 02632 7/7/20 page. Cityrrown 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 I - Commonwealth of Massachusetts r_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Five Corners Rd. Property Address Kennedy Owner information is Owner's Name required for every Centerville MA 02632 7/7/20 page. Cityfrown 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.): H-20 d-box is 2'6" below grade, cover raised to 12"of grade, no adverse conditions t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Five Corners Rd. Property Address Kennedy inform Owneration is Owner's Name required for every Centerville MA 02632 7/7/20 page. Cityrrown 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: 5 infiltrators ❑ 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 f c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Five Corners Rd. Property Address Kennedy Owner Owner's Name information is required for every Centerville MA 02632 7/7/20 page. Cityrrown 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.): Infiltrators were video inspected and are damp at this time, no indication of past hydraulic failure 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Five Corners Rd. Property Address Kennedy Owner information is Owner's Name required for every Centerville MA 02632 7/7/20 page. Cityrrown 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 18 c� Commonwealth of Massachusetts ,F Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Five Corners Rd. Property Address Kennedy Owner information is Owner's Name required for every Centerville MA 02632 7/7/20 page. Cityrrown 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 18 TOWN OF BARNSTABLE f LOCATION p7I F�c C/aa.-� RQ SEWAGE#g 010-f/ ( VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY oou C.Lu}iar LEACHING FACILITY:(type)lc�/— .7-- �s (size) /y.7f X y/.1' X-/ NO.OF BEDROOMS r OWNER �,+q PERMITDATE: COMPLIANCEDATE: 1 i Separation Distance Between the: _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S f 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 arty wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Awn, i r B9 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Five Corners Rd. Property Address Kennedy Owner information is Owner's Name required for every Centerville MA 02632 717/20 page. Cityrrown 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: >120" 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: 2010 NGW 120" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: 5'+ seperation per 2010 compliance on file ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping shows the site at 30'msl and nearby surface water at 2'msl You must describe how you established the high ground water elevation: see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 16 i Commonwealth of Massachusetts �s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �e 21 Five Corners Rd. Property Address Kennedy Owner information is Owner's Name required for every Centerville MA 02632 7/7/20 page. Cityfrown 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 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: TighVHolding 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 No- U 0 -2k Fee /Uv THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIMON ' TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitatioii for Misposal *psteia Construction Vermit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No.O?/ Frye-dorAVIS �, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel �(� ,i O R -. I/n�staller' Ny e,Address,and el.No. v�-� $- Designer's Name,Address,and Tel.No. :�$-33 a -V-15-W f�c��ffl�� e0Y1�1�UG�`0 "�1 � t aGYc911 � :ip✓i'vs ��nO- Type of Building: �/ r Dwelling No.of Bedrooms J Lot Size 'y��6-A sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Y y� gpd Design flow provided gpd Plan Date �'JC_66e�-- , ac O Number �S of sheets t Revision Date Title 1 X n j ke_ 5 S`k ��a aZ l RVe ro ►—, 0en 4X1fj/t// ,9_ Size of Septic Tank P_Vjuilm Type of S.A.S. s- 3e��'��j��,j.�w.y rs, Description of Soil p 0G IN Nature of Repairs or Alterations(Answer when applicable) tan Date last inspected: /j 40 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 th>Healt ronme Co and not to place the system in operation until a Certificate of Compliance has been issued by this Board of S' d Date lQ �� Application Approved by Date -1 v Application Disapproved by Date for the following reasons Permit No. `oZ 0�) Date Issued o a No. d�(J/U t Fee (JU THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 60< - _ t PUBBLIC HEALTH DIVISION-f TOWN OF BARNSTABLE, MASSACHUSETTS Yes 1 application, -or 1 Iisposat 6pstrui,Cone.trUction Vertu + i Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) «'Complete System ndividual Components Location Address or Lot No.J//4 F1'✓e-(2orner s Ad- Owner's Name,Address,and Tel.No. S 0'i Ce.q ui I,�" /ho F 1AennecQ11 a I r V-E dornerg /V Assessor's Ma arce UQ Installer's Name,Address,and Tel.No. 520$ X` Designer's Name,Address,and Tel.No. ..Sw$-36.2 - V5W 12�0( 011411 z6jn Cure rstNwli'rs,?,,)C. y OJ" fs ;I1 oatgg WA ac Type of Building: Dwelling No.of Bedrooms Lot Size / /li oZ '�sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures /t, Design Flow(min.required) gpd Design flow provided �f$� gpd Plan Date Oc-�AeT- (T_ as! Q Number of sheets Revision Date Title 1���� 'S .l�t Ole,n cz :R t Rye Cocnecs aj 0en 4 rlyd4 Size of Septic Tank p i roc OGtrj AA- Type of S.A.S. S<� �nTt 1� r Description of Soil Tp [ ��_ ! m Nature of Repairs or Alterations(Answer when applicable) .�� i. Date last inspected: /v///f/O Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in i accordance with the provisions of Title 5 of the Environmental CodeJand not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healtl3.! ° S. d A Date Application Approved by /►h/;- Date Application Disapproved by Date for the following reasons Permit No. a 01 d yZ Date Issued o THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by�1-f0 77t c at o21 F✓& oornpls ( 1 ,on 1�rt/i [� has been constructed in accordance with the provisions of Title 5 and rrd the for Disposal System Construction Permit No. 0 � �dated � �'7 � -l d �I Installer j lo` �w��t Ctz a'gy, ,r1nC Designer rlllw� �! o Eq i nice ri �T #bedrooms Approved design flow gpd The issuance of is p it shall not be construed as a guarantee that the system iPfun tiq as designe . Date l ) Inspector --- No. u— (0 Fee /0y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Disposal 6pstetn Construction 3dermit Permission is hereby granted to Construct( ) 'Repair(,J� Upgrade( ) Abandon( ) System located at c9 1 Rik ` n r o rs, 04 - 0& o 4 rX/Ae and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with < Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date U - a a '�© Approved byri - A ?, TOWN OF BARNSTABLE LOCATION p��/Fro �ar J /?-),J SEWAGE VILLAGE ASSESSOR'S MAP&PARCEL `T INSTALLER'S NAME&PHONE NO. �o.- /o���' Ca✓��`�o� �/�8 $�16 SEPTIC TANK CAPACITY / o0o Co L C,1�ibr LEACHING FACILITY: (type) Yew (size) /0.-If 'X i//•) X.2 / NO.OF BEDROOMS OWNER �yda d PERMIT DATE: /0-A2-/D COMPLIANCE DATE: I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f 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 ! /✓ ��t ��9f�V:rai r1 t 3� p Y -1 0 gq FROM :down cape engineering inc FAX NO. :15083629880 Nov. 22 2010 12:33PM P2 II/i�1�--- 1�. - 'f'6�FQi3IIIltt� 4�a:4:aE11fcCk". o411'�ti.l'oyg•, 1 �I ri4acniti�•�,FfLF/� .. p t g pp..yyfL, pg p� u \\�� MRAP,. /� ADHKN}�)t4:, 69�rt�L'U.Hl •IlJ�Q4flI�J�.�13PJE. `•�:P6��sAq :'/ 'Y'6r�at'�a.aas N7I�.l�a°a�ul,i�ii>rcrlta�a- -- T-00 14 anilio Street,Hynmtmi.w,,Fir A 02IT01 Ofriaa: 8-790-00/1 1n0afler Nskuoer C rdift€ufio n LFoin',�tl. 1TL. atc: / a` ! s4".'�'uUr��' .�DS?.@.11Rilllt'` �(V JV •+ �3d+;Rsnr':A iU D�a�1C�'.'t}:�._ /� / '•-tJ^- � 4 j /} I:1rn�tafltn 0=�L0 l ft 1(A Addiress: Al ro taa/U was '<9xl_ .. � �� 1ssi7nCl to PerrniL Lit ixlstaL!s septic sy.tom at V t Co r,,y..r.1 /`z+- based on a.f-iesi.(m dra-kAm..by (acldxe,ss) _— sigua::t "Iej—o - T curtifv fbaf. I-be septic, systPm..refere:aced above tivm i.uslalkd siz.hst�m:tia'ly _ccordinp, to the, d.sign, which may 1-DURK1.0 r dL0r alaproVCd changes ,Tucli as lateral Aalocation of tie dirmibu'Liuubox.and/0T septic; L<ailk. I c(Zt.ify tlud thf; scpfic system v2fe.t•eazced above lwui irtstcahcd with .mAjnr ch�.l.ngts' (i.r,, pgeacuy than 10' latel-al rE;locallon ol: tho SAS or any Vertical reloutilou Uf auy cd'mponeTiL Of the Septic :ayStcm) bT.rt iu a.CGOTdance wi L1i StaLr&. Local Ris u.lati-tnx. Plan ruvisiou or. ctrd--od.as-hunt by d sigzacr to folluW. �z Z1a.Of MA q. r\ 4 0V OJACJ t� "1 (lnsta.ilel"s siKil Wo.46502 Sr fYAL dG tc `r�k:i93*Fa6a- .IavncaturE) (At11Jt l]C:ulul[!P'.-l''S '.1t711111 t��i'b'} i _i-ue"IT.T.RK TO ._tfiAX:t�t:;T..�ar��,F �TJE�H�r� .�VJLt�L'4'�A 1.is.V.9��.aD1�..-----Z'A�:i.'93�'Ta_A_AF ..r�]U' C(D1YIfi'a,IANCE yd.U., NCPT tsE..ii56 hF.'V T14— , 30TH T HS D'ORM .&NO AS.-BUD.BJ:I'.Clt.L D ARE R E4'JLYORIb BY TIJUL',B.A.RF.dti`D AULLL 1'1LTBl(,]C BTH AT.T.j5 T)TV]fSIU.N:. .Il7CJLA_W..YOU. C?:J 1ca1th/S:;pfic1Desi-,,aor Cnrli&..;,ricm.Pn,ITI I26()4.doc y Town of Barnsta We 3b6 )Depa➢'time➢➢t of Regulatory Services DA RTAa Public Health Divisi®In D s' 200 Main Street,Hyannis MA 02601 0 (r 0 Tinie flee d. Date Scheduled_ . Foil Suitability Asses,snient for Sewage �isposa Pcrfonned Dy: �/ Witnessed By: °9 V 1 - LOCATION& GE1 L I1V][+ORNIATION Localion Address ve—( Owner's Name ` ✓1�'Q Address Assessor's Map/Parcel: �� Engineer's Name Telephone It NEW CONSTRUCTION REPAIR Tele p L D- Surface Stones Land Use•��'�—�' Slopes(%) '►C��✓"^'vd Distance's from: Open Water Body ft Possible Wet Area eft Drinking Water Well ft Drainage Way ft Property Line _ ft Other Yt G f SKC'TCH, (Street name,dimensions of lot,exact locations of test holes&pert tests,locale wetlands'm proxindly to hales) 1 SEP :1 7 REC D i 4�,Y�.r- _ ParenCmaterial(geologic)' Depiit Lq Bee rock Depth to Groundwater: Standing Water in Hole: / _ Weeping I'ranl Pit Ptlee Estimated Seasonal High Groundwater A_,_;,A= rr DICI TE NA ION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Depth to 3Q11 IT101.9,1: lu, Depth to weeping from side of obs.hole: -__ In. Orouudwnler Adjustment„e. ft. Index Well## Reading Date: Index Well level Adj,fllethr _ Adj.(71'l?n11dwatdr UVeI ]PERCOLATI.ON ` ESrA -- tlatm. Tim Observation Holt## '['intent 9" Depth of Perc TIInQ at 6" Statt Pre-soak Time @ Time(9"-6") End Pre-soakIV (f� Rate Min./Inch Site Suitability Assessment: Site Passed Sit..r'-Faited: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back--- *-**If percolation test is to be conducted Witi➢in 100' of Weiland,you must first Uotify the Barnstable Conservation Division at least one (1) Wee]( prior to beglhlui➢Og. Q:\SCPTIC\PERCF0RM.DOC t ON HOLE' LOG Depth from Soil Horizon Hole # � � .� � Soil Texture Soil Color Soil Surface(in.) Other '(USDA).. Wunsell) Moltlin g (structure,Stones;boulders, Co istenc % ravel DR)CP Depth from G-BS-ERVATI®I�I- O LOG Soil horizon Flo,lo Surface(in.) Soil Texture Soil Color (USDA) Soil Other (Mansell) Mottling (Structure,Stones, Boulders. !Z /Lz Consis e c %U aver Z _� . DEEP OBSERVATION I-TOLE,Depth from Soil Horizon ®� Hole# Surface(in.) Soil Texture Soil Color (USDA) soil Other (Mansell) Mottling (Structure,Stones,Boulders. Consiste_ncy,%(i vell__ ------------ ------------ Depth from D�C'.IIC+H OBSERVATION HOLE' LOG HOI�# Y Horizon Soil Texture Surface(in.) Soil Color Sofl Other (USDA) ,. (Mansell) Mottling (Structure,Stones;Boulders, Consi ten vk Oray� eh^_�^ e Flood]insurance Rate Myp. Above 500 year flood boundary No yes Within 500 year boundary No yes,_ Within 100 year flood boundary No Yes . DeRt➢>I of Nflturally Occurrin Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring )ervi us matoriall Ceitification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with Ole required training. exnerti.cP and exper;en ce de.,_criuzd-its.10 Civuc 15.017. /1 Signature Date Q:\SBPTfCU'ERCFOafvf.DOC . � " fin a /a panngwr�y � y, _a x a p yr, FmdMapParcel 167055 �ndOwer r Paicel Id 167055 Del D y V Account No 003723 prent'r�0094221 Neig, borhood p 38AC � / / De�iel loot 'LOT 4B 1.10Ak acres s Curr Ownf _WYNNE EDWARD C f S to C lass 101 a %KENNEDY ROBERT E N Bitlgs 1 Ada 00000000 t �q k 574 MAIN ST ear A e ., 87 �� r /r / HYANNIS ' `' ,v G% r MA i 02601 °� ,f sewerOF- acc D ed Date 000000 2926 2 " Reference / �% Conda,Complex Buii mg _ ... 7y� � .January 1st WYNNE, EDWARD C Deed MYY: 0000 � D,eecf ei �2926/2 ' Values Land 000066600 Bwid�ngs 000119400 i °Extra Features °0000000000 Location 21 FIVE CORNERS ROAD Rop Lin exs 0545 Frntg OOOOj , Fire Dist CO. SeC,ln ex 0000 Frn g 0000 l rF /yMF i y� /ice r GM±10 wee. PSI / <� COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION a TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: Owner's Name y0 z, 4,/ Owner's Address: RECEIVE® Date of.Inspection: Name of Inspector: (please riot) , (26rk/oat FEB 2 0 2001 Company Nam > TOWN OF BARNSTABLE Mailing Address: s �� �`� HEALTH DEPT. Telephone Number: CERTIFICATION STATEMENT I:certify that I.have personally inspected the sewage disposal system at this address and.that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am u DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Xasses Conditionally Passes Need Further Evaluation by the Local Approving Authority, Fail Inspector's Signature: Date: / elf 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 ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I . Page of l l + OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner Date of Inspection(/=/,:A q 0/ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I Dave 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A --� CERTIFICATION(continued) Property Address:' / Owner: Date of Inspection. C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the.Board of Health in-order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass.unless Board of Health determines in accordance with�310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment:. Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of.a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic_tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 r, Page 4 of 11 y OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: P Y Owner: Date of Inspection. D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Z/Discharge Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool or ponding of effluent to the surface of the ground or surface waters due to an overloaded or / clogged SAS or cesspool V Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or 1Icesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow _ Required pumping more,than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. V Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 80 Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50'feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than.50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a.DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free.from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to.this form.] (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 II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant.threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304..The system owner should contact the appropriate regional office of the Department. 4 t. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS .SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:pJf 4JA/ l Owner: Date of Inspection. ,L'42 1214/ Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _t,,-"_ Pumping information was provided by the owner,occupant,or Board of Health V--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? `f — 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 constriction,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: s Yes no r✓Existing information.For example, a plan at the Board of Health.. Az_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15:302(3)(b)] 5 J Page 6 of 11 OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: / D Owner: (d!�r L- 4 i Date of Inspection: /� O 0 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design); Number of bedrooms(actual): DESIGN flow based on 310 CM 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder"yes or no): /J� g krAw-- 1. . . , . Is laundry on a separate sewage system(yes or no), ', [if yes separate inspection required] Laundry system inspected(yes or no):Akf- Seasonal use: (yes or no): � Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): �0- . Last date of occupancy - COMMERCIAL/INDUSTRIAL/94��_ Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,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: (describe ): ) GENERAL INFORMATION Pumping Records - Source of information:,W Was system pumped as part of the i specti (yes or 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 nn ! "Other(describe)Qwh"--7ua V, Approximate age of all components,date installed(if known)and source of information: Were:sewage odors detected when arriving at the site(yes or no).�Z� 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: a .� 4 94 Owner: Date of Inspection: ZZ:29 p/ BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast.iron _40 PVC other(explain): Distance from private water supply well or.suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) r e Depth below grade: k Material of construction: ncrete_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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: —� — Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee o�baffle: How were dimensions determined: � �2�'�� ��� Comments(on pumping recommendations, i let and outlet tee or baffle.condition,structural integrity, liquid levels related to outlet invert,evidence of leakage,etc.): a f/ ` 7L,O,W G f A air av 4yQ GREASE TRAPPILLJ-(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping:. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of I I OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: / 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/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/2LI-(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 or no): _ Alarms in working order(yes-,or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: " / g � Owner:— p Date of Inspection. .1 e,A _ SOIL ABSORPTION SYSTEM (SAS): locate on site plan,excavation not required) If SAS not located explain why: Type Teaching pits,number:_ 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, lc.): 14JI cv- go6,0 . 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 or no):._. Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of'vegetation,etc.): PRIVYI//2ate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C, SYSTEM INFORMATION(continued) Property Address:,—,?) Owner: Date of Inspection. 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 sn,pply enters the building. . . i' t G r f l 1 ' 9° 10 10 i f Page 11 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspectio SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water �J feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevatio: /j 11 < ASSESSORS MAP NO: No59.]'Ca:-_—00 'ARCEL NO.: 9 Fizz. • cL.. THE COMMONWEALTH S�F�MASSA-CHUSE'TTS BOARD OF HEALTH Tovtt. 11............oF......... AFZ► `' ,m'-+.. .......................... Appliration for 11iopoottl Workii Tonotrurtion Prrutit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at: 0A...rmaV .. �. . of _45.._ --------------------- --------------•---= ....4 -------------------.......----•-•-------•....-•---....... Location-Address or Lot No. ......•-• --•- .....C:....\. 1Y......6..1...14r.................. . ?... 1C? 1�A 1t�.1. C.....GLA.51C.?IL&UP`4c, Owner n ress W ..........................• � Inst er Address� ® / 1 1�9 Type of Building Size Lot___'�._..,�..............Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic (NJA) Garbage Grinder (NIA) � A_.......... No. of persons �A.A Showers — Cafeteria (WA) p-, Other—Type of Building __.._.___.__l_ p _�___._.__..._ (�q) (u Other fixtures ....................'`--f....---•----•-- . W Design Flow..............1.10..................... per person per day. Total daily flow...............ZZ.-C................. WSeptic Tank—Liquid capacity.1 --gallons Length, -Co-'s-.. Width�L16.".. Diameter-►-±_ b..... Depth._.5.t" ". x Disposal Trench-No. ..t40......... Width_._._+_�-.+_A........ Total Length_.t:a.!_A.�_..... Total leaching area.... J.t'!.......sq. ft. 3 Seepage Pit No........j........... Diameter.......1Q._._..__ Depth below inlet......J4.......... Total leaching area..ZOy....sq. ft. Z Other Distribution box (w Dosing tank (Nl�) '-' Percolation Test Results Performed by.-_ ,�_. ,rCd4l.nl.../ C!d.3 / A Date..W1. _._ �_�� _.. Test Pit No. 1_.L.Z'.....minutes per inch Depth of Test Pit..... °....... Depth to ground water..? _ (Tq Test Pit No. 2................minutes per inch Depth of Test Pit.... Depth to ground water_)s 3 Hc�,o a O Description of Soil--- - �-•- _ ge U W ---••••------------------------•------------.....------------......---•--•-------------.............----•------•--------.......... -•---------------•----------•-•---•--......------•-••......•••...... UNature of Repairs or Alterations—Answer when applicable._...j-AIIA................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of:ITT.% 5 of the State Sanitary Code—.The undersigned further agreed not to place the system in operation until a Certificate of Compliance has bee ssue y boar f health. / Signed------. ... •...................... -O�.� 'e ...... Application Approved By .. . - i. ....... ..:...•• :...... ......... Application Disapproved for the following reasons:.............................................................................................................. -•---------------•--........-------•-•----...........-•----•-•---••-•----------------•---..............--••---•--•..._......-••-•---•--••••-----•••--•-••--•--•----•-•-- ............................... Date vec> PermitNo....................................................... Issued_-------•------------------••-•-•---•---........._...... Date Nog.-Ca 7700 P't OF P«o 9� F$$........::...�.... THE COMMONWEALTWOF MASSACHUSETTS BOARD OF HEALTH TP1..�1-...........OF.........- ? •! .? `�zT'/ P..��-- -...._....••••••--•••••_•_- Appliratinn,fur Disposal Works, Tonstrurtiun Fkrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. W .� -• ...... r.._...... - .s1 .. h�. t:_d r.eG lT� ST ne ........................W V:f 4;t ......... lost Address Type ding'. Size Lot...4'1,91�...Sq. feet 0-4 Dwelling—No. of 'Bedrooms...............�'4__e........................Expansion Attic (MIA) Garbage Grinder (WA) a a Other—Type f Building ........t-_IA........... No. of persons......... w (+lA) — Cafeteria (+/A)o kOther fi 't1 Design Flow---•••--•--•�-l Q......... G W gn gallons per person per day. Total daily ............... ........................gallons. WSeptic Tank—Liquid capacitylCCOgallons Length 8_7GP ___ Width�_=IO____• Diameter.�-'/.A______ Depth._r-___�7__-- x Disposal Trench—No. 1A_.......... Width_...+r+rA........ Total Length_.!:+l_A......... Total leaching area_.__!�!eA.......sq. ft. 3 Seepage Pit No.........l-.:----.... Diameter.......1.0"._..... Depth below inlet.._.._.4 l........ Total leaching area..zG?_'_y_...sq. ft. Z Other Distribution box (w*) Dosing tank (i4o) ' '-' Percolation Test Results Performed by...aLA.,S._r,_�PI.W-:i-N__.1.4 �N���Test Pit No. 1__ _Z.___.minutes per inch Depth of Test Pit__.__13^_!.__. Depth to ground water...'_:K Fnw' fl GL, Test Pit No. 2................minutes per inch Depth of Test Pit....jzi-5..... Depth to ground water._� I!!cS!?-O W __________________ •••••#•----------........._.._......--\--•••-•--....................-----_............. ;- 'O Description of Soil....T _ _.,.. ?F..Le'. ,1�_. .._ U.� Q1 --17, Q..F•MC-0...`4A[J'>: W UNature of Repairs or Alterations—Answer when applicable____�r-!_/A............................................................................... ............................-........................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIS 5 of the State Sanitary Code=`r The undersigned further agrees,not to place the-system in operation until a Certificate of Compliance has bee sue y boar f health. 3 9- ._.. Signed.......---- y �.. .. .....-•-•--......,.- aje Application Approved BY. C .. ... ............ ............ Date Application Disapproved for the following reasons:--••--•-----....-•-------•-•----•--•---------------•--...-----•---------------•-----------••-------------....._ -••-•...............•---.r---...-----............-------•----•----........._....-----------------------....-•---•------.......---•---•-•----...._.......-----------•--.....•-----------....--••--.------ �e�. � Permit No.... �...... �_..... ---...v -._--_ Issued Date -----------------•---------•----..........Date .---... Date THE COMMONWEALTH OF MASSACHUSETTS _--- BOARD F- EALTH ..........................................OF..................................................................................... Tntif iratr of Tompliana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( Repaired ( ) Y ----•--------•-_.... ......................... .....-----•---................••---...-----.... ........ n InstaJ Pl� at �- L�lz •........ Vic._...( __�.!'_?_C"`._..---•-------•--------•--•----••-•---•-----•---- ---..•..--•-------- has been installed in accordance with the provisions of TITJF, 5 off Th�State Sanitary Code s desh in the application for Disposal Works Construction Permit No.____._�'-_�_�_______________Q._. dated......... 7_- I_-:_.____._.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNC nN SATISFACTORY. .. ., DATE...........................z•.....-----... ----.................------------ Inspector--•----••-,-•=-•---•---------------------•--••--•-----••----.....----......-----.... w THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' ..:......OF.......•-LG, (V .,h.� zr No.. . r ......... FEE........................ Disposal arks Tunstrurtiun Vvirmit Permission is hereby granted.- '- L..:---�"��._....._....-•---•........................................................__•-_ to Construct ( or Repair ( ) an Individual SewagerD.i Sys ( �. at No............j..4--p............--- �-4!�...� ..�+....._�'�� .J+.R............. ----•---.._. street as shown on the application for Disposal Works Construction Perm+:* -___.___= ated..... . ..........�..� ......... -•--•...................•-•---•••...... •. -•---•-••--•---...-----••-------._...._ Board of Health DATE......_.__ �,. �..5'�. � •---•----•- FORM 1255 A. M. LKI NC., BOSTON TOWN OF BARNSTABLE 0 AD LOCATION z 6T SEWAGE # P6 - 7 e O VILLAGE �'�,� u t `1'P ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. Pere P aAn,l�m,4, dap- P'If' SEPTIC TANK CAPACITY �4 BOG LEACHING FACILITY:(type) Pn e eA-1 T (size) 7Y-S- /o6a NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER /,w.9q,,` BUILDER OR OWNER C X ,A A DATE PERMIT ISSUED: ` DATE . COMPLIANCE ISSUED: 2 VARIANCE GRANTED: Yes No a� b b 3 � � 30 1 } a DESIGN DATA t w'. i a OE Mqs STRUCTURE SIN,GI-C DESIGN FLOW.,- _t' SIN 7� 98744 SEPTIC TANK 1-1-FEE: 100c2 G/,L-.1-7. 4K __ \ / 'V J l 0 s EGISTER��JQ, LEACHING RATES SIDE AREA 2•S GPD/SF Ll��Q BOTTOM AREA 1.0GPD/SF LO 3a C000� ...:. \\ ~ N.. / ' ` LEACHING FACILITY , T ---_ —� , / / a !o'dP X�-+ L_-R, w /Z s-Enlam, f�Tp V l t=r , l \ ?X- �-i 1 Z Co 5, Z-- - 'l f3 S.i7-=, r78 e--P-C!> Sy I \ c _ \; yJS�G• 9 t nn Ill PLAN REFERENCE, • � 1 _ ! _ � �_ , - ( I _ Pt 4 r-, .=71 c �-- ` \ ^�� Tdc�. , i h n ii S .. •ram --r�t� r ; U -D PP,OFD..ih1V. WHEI�I GC>IV�S ASSESSORS LOT NO. lfaf3i � "'4 T E�EC•T4V E. DE.Prr-� y ` ' lJ � ; � N N��.� �y 0 �O��t.^.OR LF •sN� �-ls.c � v - NOTE, I 17- i A 3.ti i J �S�E._ 3g,cJ \ - L ALL MATERIALS AND CONSTRUCTION METHODS S, 1, \Iy -TO CONFORM WITH COMM. OF MASS. TITLE SC -_ D ENVIRONMENTAL CODE `�o ' 1Z' Z. L_o-rs �s d }44 AL �� ,44g 2L F .d ME \ \ i t: / �• �S�ppE G \y, \ o x 1 cp>� ''`` L ��► 1�.n S�� >_��d'�� G..SSW t1hl�-. N 3��2 \ I 1►- 1 O �, I_-nT LI R 4 P C!�. L©T �\ II J Q 1-I.Towt�J wa-r�a -Z\v4j 3 O TNIs L_v-r, Z-S OO so -- 110�P� F Mqs� �`� `\iD yy 1 o T ' n Z ...—�10 -` 4 1V G T ULIN TO w .J1' � N ,299_6 � k•��.T ER ' �FZQR��7C� r'��� ...--{.c•10}-- � cis �`� PLAN - p SC LE 1"=tio' TEST PIT NO. \ TEST PIT .NO. Z 1 IA.'"CE2ELEV -- I 55 ; Is TOP A TLpNK `-- ;k.• • F>va= So.3 9,1SEF�5 �. j o SOIL OBSERVATION PITS 'R-S7SS 55.5 c 50.5 y 9 �I .S -- EUP Solt.. . C or�t.� £ DATE OF TEST Z.� ENGINEER �g I �� f� -1 ?-ILJ l_i f� 1�So« a cpx LA L,.P 50 z� EXCAVATOR r , L_' /�P./�'C� 1- _ ��. So-I' 2.' S-i'ot�1� _ S ri4' PERC RATE IN T.P. NO. ATS.SFT.-G. MIN./IN. p S.5 ' �Ort: E.D�sSiZv G.�_1yfJ1�lE. I3.I S ELLIS & THULIN, INC. IZ, LAND SURVEYORS AND CIVIL ENGINEERS INo_\c.J EAST SANDWICH, MASS. SCALE\\ocz: 1"_10 vFQ;V_sr SECTION THRU SEPTIC SYSTEM U Lam/ 3 190(o aY tcL ---- -- ---------- - ' i 1 SYSTEM r ROI ILE ALL SYSTEM COMPONENTS TAPE OR NT BE PROP. VENT NOTES LEGEND SYSTEM DESIGN: COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) 1. DATUM IS APPROX. NGVD 99 - EXISTING CONTOUR GARBAGE DISPOSER IS NOT ALLOWED FIRST FLOOR EL. 37.3' ACCESS COVERS TO WITHIN 6 OF FIN. GRADE ` 2. MUNICIPAL WATER IS EXISTING R°°te 28 X 99•1 PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE EXIST. SPOT ELEV. 'DESIGN FLOW: 4 BEDROOMS ® 110 GPD = 440 GPD \ 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 99 PROPOSED CONTOUR USE A 44O GPD DESIGN FLOW MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED 'VER SYSTEM 31.0 - 31 '.5 Q 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS Locus [98.4] PROPOSED SPOT EL TO BE AASHO H-10 1� gym a Road 32.38 4"0SCH40 PVC e� TH1 SEPTIC TANK: 440 GPD (2) = 880 11 PIPES LEVEL 1ST 2' 5. PIPE JOINTS TO BE MADE WATERTIGHT. ti RE-USE EXISTING SEPTIC TANK** 2" DOUB�� WASHED PEASTONE R TEST HOLE OR GEOT TILE FABRIC 28 5' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITHloll 14" 2% SLOPE OF GROUND TEE EXISTING TEE 310 CMR 15.000 (TITLE V.) LEACHING: SEPTIC TANK** 30.9$ f** s UTILITY POLE SIDES: 2 (41.5 + 1-0.25) 1.85 (.74) = 141 GPD GAS BAFFLE ° °o°o°o°o°o°o o� o� 28 p' 0 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO °0 0 0°o°o°o BE USED FOR LOT LINE STAKING OR ANY OTHER FIRE HYDRANT BOTTOM 41.5 x 10.25(.74) = 314 GPD 28.19' 28.02' o PURPOSE. 2' o y NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING I E� 6" MIN. SUMP o000 �o0 26.0' a TOTAL: 615 S.F. 455 GPD 12" MIN. INT. DIM. ��� 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. H-20 3050 INFILTRATORS o 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED - 'ds USE (5) INFILTRATOR 3050'S WITH 3' STONE 6" CRUSHED STONE OR MECHANICAL 3/4" TO 1 1/2" DOUBLE WASHED STONE WITHOUT INSPECTION BY BOARD OF HEALTH AND 0o� LPL ALL AROUND COMPACTION. (15.221 [21) PERMISSION OBTAINED FROM BOARD OF HEALTH. *THE INSTALLER SHALL VERIFY THE OVERALL DIMENSIONS TO OUTSIDE OF STONE: 41.5' X 10.25' 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING M° LOCATIONS OF ALL UTILITIES AND ALL 4' DIGSAFE (1-888-344-7233) AND VERIFYING THE BUILDING SEWER OUTLETS AND 18't LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 5 4 PRIOR TO COMMENCEMENT OF WORK. LOCUS MAP D ( SLOPE) ( 1 SLOPE) 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE LOCUS 'y1^1 MA EXIST. 52' LEACHING REMOVED 5` BENEATH AND AROUND THE PROPOSED NOT TO SCALE APPROVED DATE BOARD OF HEALTH FOUNDATION SEPTIC TANK D BOX 4 BOTTOM TH-1 & TH-2 22 0' LEACHING FACILITY. FACILITY NO GROUNDWATER FOUND ASSESSORS MAP 167 PARCEL 55 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND G-W ESTIMATED AT EL. 8't REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. "INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT • AS PER TOWN MAP 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE (OR H-20 SEPTIC TANK IF IT WILL BE SUBJECT TO VEHICLE LOADING). TEST HOLE LOGS ENGINEER: ARNE H. OJALA, PE, SE 324 �3 WITNESS: DAVID W. STANTON, IRS 25.0 DATE: 10/14/10 GARAGE 22.03 i \ PERC. RATE _ < 2 MIN/INCH NOTE: POOL, SHEDS, ETC. NOT SHOWN IN THIS AREA x 20.32 j CLASS I SOILS P# 13063 6 � � 33.97 ELEV. ELEV. 34.��N'CRETE 0„ 4 32.0' off32.2' X EXISTING DWELLING DRIVE 33. 7 X 6. 7 .- . FIRST FL = 37.3' BENCH MARK - SLAB AT A A 3 .99 33 C7�� �� �x 23.79 GARAGE ELEV. = 34.1 LS LS 10YR •1 1 10 R 3 / Y 2 .1 -- - _..._ _._ _ _.__- / !� ,,, x -� 3 ( x 2�jg �6 4 I � 3 . E STx 33.82 1� CAJ X 6.25 LS LS CHERRY / v .5 33.97� 3 x 32.8 2. 4 30 29.5 2 LEACH PIT „ 10YR 5/6 30" 10YR 5/6 29.7' 33.83�x 33.64 ` " 28 / 6 s C C o CHERR -9 x 27.69 / } 344L�w� ti PERC ^� �33.7/* 33 �j MS MS X 33.57 1 x 29.6 32.75 / 32. 2.5 7 4 2.5 7 4 x 3223 o x 27.88 32 / 2?, LOT 4B x 2 .1 47,962 f SF �1 x 29.79 �o / 120" 22.0' 120" 22.2' CO QQ 30.2 0.75 30.85 30 ! � v'2 PIOP. VENT WITH CHARCOAL FILTER ^ NO GROUNDWATER ENCOUNTERED \ sop .16 J x 27.9 AID BUGSCREEN (FINAL PLACEMENT BY ^0 0 9.21 29.95 CINTRACTOR WITH HOMEOWNER q 29 ti CINSULTATION) / 29.36 Gip n \ 28 28.86 27.91 x 27.23 O,%' ^ \ 27 27 `� x?6.5TITLE 5 SITE PLAN NOTE: POSSIBLE UNDERGROUND ELECTRIC IN AREA \ / OF PROPOSED LEACHING FACILITY 262 �2 I O / V of 6.00 2530 / \ � . I,IAw J 21 FIVE CORNERS ROAD \ it x 2 5.8 / 24.85 �` \ CENTERVILLE I x 25.3 PREPARED FOR BORTOLOTTI CONSTRUCTIONXENNEDY x 26.4 OCTOBER 18, 2010 / Scale: 1"= 20' / 0 10 20 30 40 50 FEET . -----.` N OF of ygs off 508-362-4541 o sycy fax 508-362-9880 o ; <� DANIELA. downca e.com DANIEL �'GU o OJA �, I P o A. CIVIL tl Cn No.46502 down C1p a eng ineerin inc. / N°.40.8a a �. 8' civil engineers land surveyors f 939 Main Street ( R to 6A) "k DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 > 0-218 ,I