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HomeMy WebLinkAbout0154 FIVE CORNERS ROAD - Health EA 4 Five Corners Roadnterville P= 168 114 1 s i UPC 12534 No.2_ HASTINGS, MN ur,13 14 08:33p p 1 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 154 Five Corners Road Property.Address David Spadafora Owner Owner's Name information is Centerville MA 02632 6-12-14 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information a�intnrrufr filling out forms `�w� iiz�� on the computer, SN ��x OF. 9. *ice use only the tab 1- Inspector: key to move your o: N cursor=do not JAMES James D.Sears use the return Name of Inspector — e key. CapewideEnterprises,LLC •�' �o; Company Name =r .. .. . •••s ��•— Company Addressi� S 1NSP� ����� 153 Commercial Street Mashpee MA 02649 Citylrown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete.as of the time of the inspection-The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 16.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-12-14 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 15ins•3r13 Title 5 Official trts . V' 'U'Urface Sewage Disposal System-Page 1 of 17 f Jun 1314 08:34p p 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 154 Five Corners Road Property Address David Spadafora Owner Owner's Name information Is required for every Centerville MA 02632 6-12-14 page. CityFrown State Zip Code Date of Inspection B. Certification (cunt.) 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. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If".not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3113 - Title 5 Official Inspection Form SubsWace Sewage Disposal System•Page 2 of 17 Jun 13 14 08:34p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 154 Five Comers Road ..Property_Address David Spadafora Owner information is owners Name required for every. Centerville MA 02632 6-12-14 page. Cdyrrown State Zip Code Date of Inspection- -B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 13) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board.of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: l ❑ 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 15ins-3113 Tine 5 Official Inspection Fam:Subsurface Sewage Disposal System•Page 3 of 17 r r Jun 13 14 08:34p p 4 Commonwealth of Massachusetts Title 5 Official Inspection Form r. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 154 Five Corners Road Property Address David Spadafora Owner Owners Name information is required for every Centerville MA 02632 6-12-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2- System will fail unless the Board of Health(and Public Water Supplier,.if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑.The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or I more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or."No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in s less than 6" below invert or available volume is less than Yz day flow ei5r PIVI ,C t5ins•3/13 .. Title 5 Olydal Inspedian form:Subsurface Sewage Disposal System•Page 4 or 17 i Jun 13 14 08:35p p.5 Commonwealth of Massachusetts Title 5 Official,:Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 154 Five Comers Road Property Address David Spadafora Owner Owner's Name iequiredion a Centerville MA 02632 &12-14 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no otherfailure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in$10 CMR 1.5.303, therefore the system fails. The system'owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a,mapped Zone II of a public water supply well If you have answered"yes" to'any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. i t5ins•3113 Title S Olridd Inspedicn Form:Subsurface Sewage Disposal System•Page 5 of 17 t i Jun 13 1408:35p p g Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 154 Five Corners Road P-roperty Address - David Spadafora Owner. owners Name information is Centerville required for every MA 02632 6-12-14 Pap. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"-or"no"as to each of the following: Yes No ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were astuilt plans of the system obtained and examined?(If they were not available note as NIA) ® ❑ Was.the facility or dwelling inspected for signs.of sewage pack up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of-the baffles or tees,material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size.and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(designj: 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 15ine•3/13 Title 5 official hspectron Form subsurface sewage Disposal System•Page 6 of 17 Jun 13 14 08:35p p 7 Commonwealth of Massachusetts We Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 154 Five Corners Road Property Address David Spadafora Owner Owner's(dame information required for every Centerville MA 02632 6-12-14 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. tank D Box and dry well chamber. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2012-129,000Gal g y g (gp )�' 2013-146,0000al's Detail Sump pump? ❑ Yes ® No Last date of occupancy: PresentDate Commercial/industrial Flow Conditions: Type of Establishment: — -- — Design Flow(based on 310 CMR 15.203): Gallons per day(9Pd) Basis of design.flow (seatstpersonslsq.fL, etc.): ---'- --- Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No � r Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins 1'13 Title 5 Official Inspection Fomf:Subsurface Se wage evrage Disposal System•Page 7 of 17 i I S 4 Jun 13 14 08:36p p 8 Commonwealth of Massachusetts _ Title 5 Official ,Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 154 Five Comers Road Property Address David Spadafora Owner Owner's Name information is required for every Centerville MA 02632 6-12-14 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): r 4. General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No e If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance.contract.(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank..Attach a copy of the DEP approval. ❑ Other(describe): 15ins•,7/13 Tale 5 Oftmal hspecUon Forth Substu%oe Sewage Disposal System•Page 8 of 17 Jun 13 14 08:36p p 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments J 154 Five Corners Road .Property Address David Spadafora Owner Owner's Name information required for every Centerville _MA 02632 6-12-14 page. Cityrrown State Zip Code Date of Inspedion D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: Tank NA-D Box and leaching 2009 permit #2009-039 Were sewage odors detected when arriving at the site? ❑ Yes ®. No Building Sewer(locate on site plan): 20" Depth below grade: feet Material of construction: ❑cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting,evidence of leakage, etc_): Pipeing is 4' PVC SCH 40. ' Septic Tank(locate on site plan): Depth below grade: fees ! Material of construction: ® concrete El 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.Precast Sludge depth: 3„ t5irts•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 i 1 Jun 13 14 08:36p p.10 Commonwealth of Massachusetts Title 5 Official_ Inspection Form " Subsurface Sewag e Disposal System Form Not for Voluntary Assessments 1W154 Five Comers Road i Property.Address David Spadafora Owner Owners Name information is required for every Centerville MA 02632 6-12-14 page. City/Town State Zip Code Date cf,inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27" — Scum thickness 3„ 8„ Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 15" How.were dimensions determined? Asbuilt-Tape- Plan Sludge Judge 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 at working level. Tank and covers at 8"below grade. Inlet baffle, outlet tee. No sign of leakage or over loading. Note: Maint pump after inspection i Grease Trap(locate on site plan): Depth below grade: _ feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene lene y y El 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 t5hs-3/13 � Title 5 Oftidal h5peaian Form Subsurface Sewage Disposal System•Page 10 of 17 i Jun 1314 08:37p p.11 Commonwealth of Massachusetts I WWW'... Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 154 Five Corners Road Property Address David Spadafora Owner owner's Name information is required for every Centerville MA 02632 6-12-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments:(condition of alarm and float switches, etc.): 'Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Oisposa!System•Page 11 of 17 Jun 13 14 08:37p p 12 Commonwealth of Massachusetts Title 5 official_ Inspection Form Subsurface Sewage Disposal System Fomn -Not for Voluntary Assessments G 154 Five Corners Road Property Address David Spadafora Owner Owner's Name information is Centerville _MA 02632 6-12-14 requ ired for every page. dty/Town State Zip Code Date of Inspection D. System Information (cunt.) 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.): D Box is 167x16"-1W below grade. Box is clean and solid,w/one line out. No sign of over loading or solid carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins'3113 Title 5 Official Inspection Fe m:St,bs rrana Sewage Disposal System•page 12 of 17 s Jun 13 14 08:37p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 3i 154 Five Comers Road Property Address David Spadafora Owner Owner's Name information is required ror every Centerville MA 02632 6-12-14 page. City/Town State Zip Code hate of Inspection D. System Information (cont.) Type: ❑ leaching pits number ® leaching chambers number: 1 ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: - ❑ innovative/alternative system Type/name of-technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.). Leaching is.a 500 Gal. dry.well chamber w/46"stone. Chamber is 34" below grade.w/cover.at 6". 8"water in chamber. No higher stain line,wail's clean like new. No sign of over loading or solid carry over. 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 t51n3•3/13 Title 5 Official Inspection Form:Subsurface sewage Disposal system•Page 13 of 17 s r Jun 13 14 08:38p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 154 Five Corners Road Property Address David Spadafora Owner owners Name information is required for every Centerville MA 02632 6-12-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of-vegetation, etc,): F 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_): [Sins•3113 Title 5 Official Inspection Form:Subsu laoe Sewage Dlsposel System-Page 14 of 17 e 1 7 Jun 13 14 08:38p p.15 Commonwealth of Massachusetts s if Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 154 Five Corners Road Property Address David Spadafora Owner Owners Name information required For every Centerville MA 02632 6-12-14 page. city[rown State Zip Code Date of Inspection D. System Information (cunt.) 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= 39 0-3: dIT- - of O ❑3 . ISIns-3113 TRIe 5 Official Inspection Form stbsurfaca sewage Disposal system-Page 15 of 17 i i f Jun 13 1408:38p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 154 Five Corners Road Property Address David Spadafora Owner owner's Name information is required for every Centerville MA 02632_ 6-12-14 page. CRY/Town State Zip Code Date of InspectiDn . D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells i A1Q Estimated depth to igh ground water. 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: 1-13-09 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: i You must-describe how you.established the high ground water elevation: T.H_on design plan 1-13-09,no G.W.at 11'. Bottom of chamber at 5' below grade. Bottom of chamber at 6'above T.H.depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 9 15ins•31.13 Title 5 Officiai Inspection ram:Subsurface Sewage Disposal System•page 16 of 17 f t a I i Jun 13 14 08:39p p 17 -Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'r r 154 Five Comers Road Property Address David Spadafora Owner Owners Name information is required for every Centerville MA 02632 6-12-14 _ page. cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist 1 Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i [Sins•3/13 , Tide 5 Official Iropeclion Form:Subsurface Serage Disposal System-Page 17 of 17 No. D Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Ye ZipphrAtion for Mispo8AY *pBtrm ConstCUction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑ stem Complete Sy stem y ❑Individual Components Location Address or Lot No. /y'y ev e CQ"r-A i�d Owner's Name,Address,and Tel.No. Assessor's Map/Parcel - C&jtr-eru tdr G1o�tos; Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. d�.a�l�5 /� �vrescA►� �o���Cv-7/S� Ica jt,ch �dg -3�N -UgYN Type of Building: Dwelling No.of Bedrooms 'L Lot Size I 157&`L. sq.ft. Garbage Grinder( ) Other Type of Building h pv5 No.of Persons 2- Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 21-0 gpd Design flow provided 2 31. 3 G gpd Plan Date i S'IOy Number of sheets Revision Date r Title Size of Septic Tank I013n E IC'}IN) Type of S.A.S. 500 Description of Soil Nature of Repairs or Alterations(Answer when applicable) I J L� 11 Joe w I b C tf pd M 'j. s�. S 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 ign d Date Application Approved bye' Date Application Disapproved by Date for the following reasons IPermit No. Date Issued ^r -..R.-r-:nril-,ry�o. :".r•r.-+✓.+.`.-^...�m,.w.'•+"'-.nle-.w...-+.l '.,.. ^'•rM`.+.+x• -. ;y... f' '6 •' .-•r.-...-..,- ov No. O D Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1 PUBLIC HEALTH DIVISION:-TOWN OF BARNSTABLE, MASSACHUSETTS Ye _ 1 application for Zispo8al 6pBtem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /�L/ �y�, <�✓NtWS l�J Owner's Name,Address,and Tel.No. <Paa-PieV I Color ios - Assessor''s Map/Parcel e _ j 1- Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. aoslo5 f4 �-o8 _o0q / 'lope of Building: Dwelling No.of Bedrooms `L Lot Size 1 y SL sq.ft. Garbage Grinder( ) Other Type of Building h oy,, No.of Persons Z. Showers( ) Cafeteria( ) Other Fixtures r Design Flow(min.required) 2 2 gpd Design flow provided 2-3 2. 3 G gpd Plan Date 1�);/05 Number of sheets Revision Date Title Size of Septic Tank 1()nn F Xr4 t IN Type of S.A.S. SU O Description of Soil t Nature of Repairs or Alterations(Answer when applicable) to L f-cA uJ 1) 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 11palth. Sign d 9 // Date 9 6 _,� Application Approved by !/ _a17M ✓� <f' , i Date Application Disapproved by Date for the following reasons i / ^n Permit No. ( �v Date Issued V i ------------------- -- - - - -- ------------------- - - ---- -- = - -=------= --------==- THE COMMONWEALTH OF MASSACHUSETTS 9_1L BARNSTABLE,MASSACHUSETTS , Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(��Upgraded( ) Abandoned( )by at Y/S rd 6YME r✓t/i& has been con"cteindance with the provisions of Title 5 and the for Disposal System Construction Permit Nodated Installer )Jc�C,5 A 1 i(C ,s-� Designer f �� ��A� #bedrooms Approved design flow A/ _gpd The issuance of this permit shal no be construed as a guarantee that the system w%Mnct�ion , Date �� /f 1 Inspector ./✓�� r'/1 i S -- ------------------- -------- Fee - / -- - - - No. A X V, r _0 THE COMMONWEALTH OF MASSACHUSETTS `r PUBLIC HEALTH DIVISION= BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit r Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at fvY elleyr il; Rd �PN/Y/✓i��t 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:Constru tion must be completed within three years of the date of this permit. Date � lI Approved b pl � PP Y �� �� Town of Barnstable Regulatory Services • Thomas F. Geiler,Director • &UWSPABL& • MAS& Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Designer: �4v'D (,ou�,rii}Wt,WR , IZ� Installer• (%fir/ �i/<✓ Address: 43 ) Ic i P yc?L,L Address: a l y C,,�QP wIC-11, >M 4 D 40 On f was issued a permit to install a (date) (installer septic system at F I V L Co Z c.�12.S based on a design drawn by (address) WS dated 1(15101 , QLV 1/1Oloq / (designer) t/ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. �N S,q 4F DAVID �yGN o D. a staller's Signature) 0 COUGHANOWR co No. 9 093 G1STEa�O (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. NOW, THEREFORE,icSe��,� �Pcl .C &6 s hereby place the ` (owner's name) following restriction on his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: a���� may have constructed (address) upon the lot a house containing no more than _ )o (a.) bedrooms. (r���r - so agrees that this shall be permanent deed (owner's name) is q . F i v-?_. o r n e r s 4-A,restriction affecting ��. located on ('Pr,-ecr-uc.1 • and being shown on the plan recorded in Plan Book ?A a , Paged Or on Land Court Plan For title of see the following deed: Book q� , Page Or L nd ou Ce ' icate of Title Number . Executed as a sealed instrument day of � er's ignatu e r` i Owner's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS � �,•, �-�Q _ , ss Then personally appeared the above-named known to met be the person who executed the foregoing instrument and acknowledged the same to be �e e- free act and deed, before me, u� t ; NotaryH 14 J2 o� ,; My commission expires: y, gym:o 2_rj 14 - Y P+ab�c (date) ° ° E1L18ETH M.M P U \ �:OI<l1110111�Of 6z�.�f� BARNSTABLE REGISTRY OF DEEDS Bk 23441 Pa213 -NIF702H 02-12-2009 a 14 = 24at DEED RESTRICTION WHEREAS, las�c�� `A ncLr �. �9 �o��aSd of (owner's name) � EIALc�rr\e� t2Qac� �'P ��� r ti�.Il2 MA (add ss) is the owner of i s =Fw e Lmer PAAoieru'Lie located (address) u at t S(A e C Ca MA (hereinafter referred to as e_r� and being shown on a plan entitled "Subdivision of Land in e kec:uk .tU MA, Property of kS �ruS-4 , et al, duly recorded in Barnstable County Registry of Deeds in Plan Book Page 5 ; Or on Land Court Plan Number WHEREAS, Tc)&e ri. � �den vane It)(- I p-so as the owner of said lot has (owner's name) agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said Iot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compiance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring•that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with t Barnstable County Registry of Deeds by recording tment, I , If j ti �VIE Town of Barnstable P# 791 Department of Regulatory Services ' Public l Health Division Date / O 16 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By:�!� l D 1 J- U/(��o N Il'�. � lL Witnessed By: 7,1 f/i LOCATION& GENERAL INFORMATION I Location Address S Ve &rner-S ;?4 Owner's Name-T6S Ph l-frk-4hOr 6-*'JerlO,�C Vl l \ Address t54- Ft tre e!�qf he15' p_•q Assessor's Map/Parcel: Engineer's Name NVId NEW CONSTRUCTION !`0 REPAIR V Telephone# ��YI 3�'� ofq+. Land Use Slopes 'Yo P ( ) 0 Surface Stones ND�� Distances from: Open Water Body bDV ft Possible Wet Area/n1 DD+ ft Drinking Water Well 0_0 ft `o Drainage Way 50+ ft Property Line t ft Other ft SI ETCI3:1Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands In proximity to holes) W �4 GROUNDWATER ADJUSTMENT ZI EXISTING GROUNDWATER LEVEL BASED N TOWN OF BARNSTABLE ® , DEPARTMENT RECORDS. I U INDICATED GW 13.00 ®, k' INDEX WELL MIW-29 f D `'+ ) READING DATE DEC. 2009 READING 8.0 I ADJUSTMENT 3.8 ADJUSTED GW 16.8 �, `�� \� LUMBERT MILL - ROAD ti Parent material(geologic) P r�1 GG1 UI 1 (0VWa5� Depth to Bedrock N O P1 e— Depth to Groundwater. Standing Water in Hole: r��� `\wi�_t P Weeping from Pit Pace Estimated Seasonal High Groundwater �e , �0ou e DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: SC-,-_ raj(00V('. Depth Observed standing in obs.hole: in, Depth to soil mottles: jfl, Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# _ Reading Date: -_ Index welt tPvel _ edt,f, yr��� Adj. 4U hya zr oval - —Observation PERCOLATION TEST bate ; i. 09 Time IHole# Time at 9" 7 � Depth of Perc /i i�h Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak to Rate Min./Inch Site Suitability Assessment: Site Passed ` Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 1001 of wetland,you must first notify the, Barnstable Conservation Division at least one(1) week prior to beginning. Q:\.SEI-"I'IC�PERCFORM.DOC ATE OF TEST: JANUAR 13, SOIL TEST L O G D PROVED SOIL EVALUATOR: DAV D DY COUG0H0ANOWR. #461 WITNESSED BY: DONNA MIORANDI. HEALTH DEPT. PERC NUMBER: 12456 ; TEST PIT I NO GROUNDWATER ENCOUNTERED PARENT MATERIAL: PROGLACIAL OUTWASH PERC AT 62 in - 2 MIN/INCH;IN C SOILS '. ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 49.50 0-5 FILL , k 5-6 O SANDY LOAM 10 YR 2/2 NONE FRIABLE . 8-12 A LOAMY SAND 10 YR 3/3 NONE FRIABLE s 46.67 12-34 B LOAMY SAND 10 YR 4/6 NONE FRIABLE , 34-132 C MEDIUM SAND -10 YR 5/4 1 NONE ILOOSE E 36.50 TEST PIT 2 NO GROUNDWATER PARENT MAATERIA EN COUNTERED L OUTWASH i 2 MIN/INCH IN C SOILS i ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER j 49.20 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 0-4 O SANDY LOAM 10 YR 2/2 NONE FRIABLE - 4-8 A LOAMY SAND 10 YR 3/4 NONE FRIABLE i 46.53 8-32 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 38.20 32-132 C MEDIUM SAND 10 YR 6/4 NONE LOOSE DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten Flood Insurance Rate Map: Above 500 year flood boundary No— Yes .✓___ Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring 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 pervious material? - Certification Nbv ��G�S 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 . the required training,expertise a d experience �-described �in 310 CMR 15.0�1 1^7. 2 Signature L/rye✓ . �7l'. `t(o Date � -1 h t 1 2M Q:\SBPTIC�PERCFORM.DOC TOWN OF BARNSTABLE LOCATION /T4/ !Sr foRtjeeS -917 SEWAGE# A 00`Y-011 :VILLAGE J�myh„Jl e, ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. "Doody A Fknw o . Lj[_ SEPTIC TANK CAPACITY JCW F_X 1 SnNC& LEACHING FACILITY.(type) s(kj��� &ftt (size). I t.S X 1 G X-L- NO.OF BEDROOMS I - OWNER G t O✓1 oSv PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility'(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Q4c�i .of l�ov5r 02- 2--36' 4 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PRO TEC�TIION iVED 4 l.� o JAN 2 12003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: #154 Five Corners Road MAP Centerville,MA PARCEL Owner's Name: Barbara Trainor LOT Owner's Address: 154 Five Corners Road - - - Centerville,MA 02632 Date of Inspections 12/21/02. Name of Inspector: (please print) Mr.Carmen E.Shay Company Name: Shay Environmental Services,Inc. Mailing Address: 34 Thatchers Lane East Falmouth,MA 02536 Telephone Number: (508)-548-0796 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 a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: XX Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority � Fails o Inspector's Signature: Date: 12/21/02 CAE. o H The system inspector shall submit a copy of this inspection report t the Approving Authority(Board e DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flo gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office 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 4" Liquid noted in Leach Pit. (3' Stain Line) ****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 i Page 2 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: #154 Five Corners Road Centerville, MA Owner: Barbara Trainor Date of Inspection: 12/21/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: XX 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 exftltration 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. c 1—.,o,.t;— Pr,,, 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: #154 Five Corners Road Centerville,MA Owner: Barbara Trainor Date of Inspection: 12/21/02 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 I 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: 'T':t1A ; [--ti- P..r.., 3 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: #154 Five Corners Road Centerville,MA Owner: Barbara Trainor Date of Inspection: 12/21/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No XX Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool XX Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool XX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool XX Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped XX Any portion of the SAS,cesspool or privy is below high ground water elevation. XX Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. XX Any portion of a cesspool or privy is within a Zone I of a public well. XX Any portion of a cesspool or privy is within 50 feet of a private water supply well. XX 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.] NO (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—IWPA)or a mapped Zone 11 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. T41. c 1--t;- P,.r.., 411 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: #154 Five Corners Road Centerville,MA Owner: Barbara Trainor Date of Inspection: 12/21/02 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No XX Pumping information was provided by the owner,occupant,or Board of Health XX Were any of the system components pumped out in the previous two weeks'? XX _ Has the system received normal flows in the previous two week period? XX Have large volumes of water been introduced to the system recently or as part of this inspection ? XX Were as built plans of the system obtained and examined?(If they were not available note as N/A) XX _ Was the facility or dwelling inspected for signs of sewage back up? XX _ Was the site inspected for signs of break out'? XX _ Were all system components,excluding the SAS, located on site? XX _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of t he baffles or tees, material of construction,dimensions, depth of liquid,depth of sludge and depth of scum `' XX _ 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 XX _ Existing information. For example,a plan at the Board of Health. XX _ 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)] T;t1. c 1 -,,t;- r•— All<nnnn 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: #154 Five Corners Road Centerville,MA Owner: Barbara Trainor Date of Inspection: 12/21/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes 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): Sump pump(yes or no): No Last date of occupancy: Currently Unoccupied 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 Source of information: None on File Was system pumped as part of the inspection(yes or no):_ If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM XX 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: 1977- per Board of Health & Owner Records Were sewage odors detected when arriving at the site(yes or no): No Tit). c 1nc t;n V,,.,,, All ri)nnn 6 i Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #154 Five Corners Road Centerville,MA Owner: Barbara Trainor Date of Inspection: 12/21/02 BUILDING SEWER(locate on site plan) Depth below grade: 16" Materials of construction: XX cast iron XX 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: 9" Material of construction: XX 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: 5' deep x 5'wide by 8' long (1,000 gallon) Sludge depth: 4. 75' Distance from top of sludge to bottom of outlet tee or baffle: 3.00' Scum thickness: No Significant Scum Laver Noted 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: 14" 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.): Structural integrity of tank was ok.No evidence of cracks,leaks,or water infiltration/exfiltration. PVC Inlet Tee present and in good condition. Outlet Baffle also in good condition. Liquid level equal with outlet invert. GREASE TRAP:_(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.): Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #154 Five Corners Road Centerville,MA Owner: Barbara Trainor Date of Inspection: 12/21/02 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: (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, etc1_ T;tlA r, inon ti— P..,-.,,411�,nnnn 8 Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #154 Five Corners Road Centerville,MA Owner: Barbara Trainor Date of Inspection: 12/21/02 SOIL ABSORPTION SYSTEM (SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type XX_leaching pits, number: 1 6' x 6' diam. 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.): No evidence of hydraulic failure, pondine damp soil or stressed vegetation. Probes stone with 6' bar with no evidence of liquid(Stone Dry). Excavated cover and noted 4"water in pit(3' stain line). 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.): 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.): Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #154 Five Corners Road Centerville,MA Owner: Barbara Trainor Date of Inspection: 12/21/02 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. Swine Ties• A- Tank In—23' B- Tank In—35' A—Tank Out—28' B—Tank Out—36.5' A—Leach Pit Cover—43' Leach Pit B—Leach Trench Cover—30' O 1,000 Gal Tank O Deck A B Exist House Garage FIVE CORNERS ROAD T:t1. c 1 o,.t;. P..r,,, All�nnnn 10 Page 1 1 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #154 Five Corners Road Centerville,MA Owner: Barbara Trainor Date of Inspection: 12/21/02 SITE EXAM Slope Surface water - None Check cellar - Yes Shallow wells—None Estimated depth to ground water 20 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: XX 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) XX Accessed USGS database-explain: You must describe how you established the high ground water elevation: Checked with Ouadrande of USGS Map. Per Barnstable GIS: Elev.of Ground =51.2Feet Elev. Of Groundwater= 15 Feet Elev. Of Bottom of Leach Pit=43.2Feet Therefore: 43.2—15 =28.20 feet separation between Bottom of Leach Pit and Groundwater. Groundwater Adjustment using Index Well MIW29: 8.8 feet Adjusted Groundwater Separation= 15' +5.8=20.8' feet (Refer to attached work sheet) Grade=Elev. 51.2 feet Leach Pit Bottom of Leach Pit=Elev.43.2 feet 1,000 gallon Tank Adj. Groundwater=Elev.20.8 Feet rtiP G 1--t;n Pn An r,nnnn 11 I i . Permit Number: Date: Completed by: HIGH GROUNDWATER LEVEL COMPUTATION I Site Location: SILA S �V('{7Q�'� o� l��_ot No. Owner: �'{ •� `Address: Conlractor: �� �l Q M%J 7�lddress: Notes. I r � STEP 1 Measure depth to water table to nearest 1/10 h. .............................................................................. Date O 15 month/tlsy/Ye r I I I I i STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: sv� i OA Appropriate index well.................................................... OWater level range zone I STEP 3 Using monthly report "Current I jWater Resources Conditions" j ' determine current depth to I water level for index well ........................... mont Year I I I STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water level adjustment .......................................................................................... I STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) I from measured depth to water p levelat site (STEP 1) ............................................................................................................. •9 I I I i LO C T ION E A G'E PERMIT NO. VlL G �,t-,tt,. -�� , L IN.STA LLER'S NAME ADDRESS B U I*L D R OR OWNER DATE PERMIT ISSUED l� DATE COMPLIANCE ISSUED �� � � 0 'f �a �r CJo us a C41XAc No....... 1FEE.... 1 � . r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA T .! ................OF.... ........ -----.................................... Appliration. fur lliopasa1 Works Tnnotrnrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: , ZuAvi .._. _ .... ------•• ....--- ------- --- - Locat ddres or Lot Owner ` Addr s W _--•---------•--•--•---------------- ..._.. ! ......:..'f/..r'�!!1:. a ...__--•----••-- Installer Address Type of Building Size Lot._ 7/.—9 mASq. feet Dwelling—No. of Bedrooms............. ......................._...Expansion Attic g) ' Garbage Grinder kVc) Other—T e of Building No. of persons a YP g ---------------------------- P ---: Showers ;(_�)�— Cafeteria . r Other fixtures .................. = '=------ '. _ ..._.... W Design Flow_.._..___......................gallons per person per day. Total dairy;flow t__ "_0 Bons., " Hpl, Septic Tank—Liquid'capacity/gallons Length4l�.'1�_____ Width___��___ ._t Diameter._ _.:_ Depth... .......... + - Disposal Trench—No_ ____________________ Width_.__I.__._._____._ Total Length.............T.c'_ Total leach ng area.....................sq. ft. `t 11 Seepage Pit No......I__.__._____ Diameter....46---_______-Depthh below;inlet _._?_._.._...._ Total leaching area2.0_2.__sq. ft. Z Other Distribution box (!) Dosing_ta�nk p / ; '-' Percolation Test Result Performed-by:,__.! erv_ r1 __.:_ _ ______________«.Date_. 7 4 as Test Pit No. l.__ _______minutes per inch- Depth of Test rt__._�® __ __. Depth to ground'water_ YR!-�,.�_ ' (1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground,water............_...... a,ra O Description of Soil - d! 7® d�?.. ` 2 e f 1t" G'®d YS � -�------'------ - -• -------- .................................. U Nature�of Repairs or Alterations—Answer when applicable____________________.* -' ------------- ---- , ------................... 1 3 • +a t Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systemz in a ccordance with 4 the provisions of'IT 5 bf the State Sanitary Code—The undersigned furtli&agrees not to place the system in operation until a Certificate of Compliance has be issued by t oard of health. Si d. - ............. �- - of ate Application Approved By- --- ;✓ ..... -- � � ' - y- --•-•------------ 7_7-- Date Application Disapproved for the following reasons_____________________________ } ..............................•-----------•-----.....---------------------•--••-••-----•------._...-•-....--------------------------------------------------------------------------------- ----•-•- 1 '� .Date qO ___0_K______________•------------I------- Ssue&.....f'....-'----------. •----- _ 1 Date r NO......�2.. ...» F�s..�l - s'.. ... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL 1Apptiration for Dispuiitt1 VorkA. L�onitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemecrx a �fLoca � f . ddre t..... { �•' w, Owner dress W a 'c - _____________ ---------•---------___..... _------•----__---- Installer Address fj y Q Type of Building Size Lot__�f__a______-----_t__'_"_._Sq. f t U Dwelling—No. of Bedrooms____________________________________________Expansion Attic ) Garbage Grinder �) �-, v Other—Type of Building ____________________________ No. of persons__..--_____;._._._.._....._ .Showers ( ) — Cafeteria ( ) QOther fi tures -•-•-••••-----••-------•-••••-•---•---••------------••----•---- -------------------------- wt� Design Flow......... ._..._ �0pgallons per perso 'per Jay. Total.dill fl ................ pns. D h.. __.__.. Diameter ---_Se tic ank—Liquid ca acit �----------gallons Len h ! r _.__ Wid De ____._.. % Disposal'Trench—No..................... Widt .-y............._ Total Length........ ..... Total leaching area..- sq. ft. Seepage Pit No-_-_.1............ Diameter... -____-_-_- Deptl below inlet..... Total leaching area.__._....sq. ft. Z Other Dis ibution box (� ) Dosing t^, �D �r Percolation Test Resull�i Performed by.. .__ take/' ___. ................. Date_._ Test Pit No. I-_I'---+----_-__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........................ . -- D Description of Soil___- d 'Y0 ) C a�I lit 44 i` S C �3'Q7 v ---------------------------------- ` s - ' = - C4 w ----------•- ........................................ .r�--�-------------------------------------- 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 df TITI1 5 of the State Sanitary Code— The undersigned further agrees not to place.the system in operation until a Certificate of Compliance has be n issued by the board of health. .y t �} ���Sjgned., . . ---- ....„................................ ' Date Application Approved By. r --•-- -----------• .... - ��- 7 yy Application Disapproved for the following reasons:..............n ............ ........................................................................%......-------•----...------•-•---------------------------------------------------------------------------.......-- 4, Date r Permit No............:. .....--=•' _ Issued- .......................................................Date t THE;COMMONWEALTH OF MASSACHUSETTS as;. - � BOARD�FH t c .................OF.... ...........:.......... ......................................................... (Irrtifiratr of Toutpfidnrr j7 IS ERT That the Individual Sewage Disposal System constructed or Repaired ( ) b , .taller....... ...... ... ....... has been installed in accordance with the provisions of j ` o he State Sanitary Code as,�describej in the applicatio n;for Disposal Works Construction Permit N / .............. da.ted-../�G1. °_.:._..'`------ . .....•... 1 THEASSUANCE OF THIS, CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL FUNCTION SATISFACTORY DATE........�.......___. Y 8 t...........7..I........................ Inspector-- - ------•------- THE COMMONWEALTH OF MASSACHUSETTS :BQARD HEALTH J, W PermiSs>o is hereby granted . .-r----- ------•............ ............................ - ---•-------••-------------- to Con )�i Re ( ) a In id 1 a e' i al System ) 1 at No... --.. Q .... .. Q+l' " F� ........ > j Street `3 as shown on the application'] r Disposal Works.Construction r it No_�. . _._ at .�....................................... ---- • /// Board of Health DATE------. ---•------••--------•--•---------------------•-------••- ;016RM 1255 ji HOBBS & WARREN, INC.PITH ,JSHERS �. CONTOURS - FALMOUTH ROAD GARBAGE GRINDER ROUTE 2B BENCH MARK / _ _ _ _ _ / �� IS NOT ALLOWED EXISTING - - 50 WESTMINSTER ROAD TOP A DRAIN GRATE ® \ WITH THIS DESIGN. MINIMAL GRADING PROPOSED ELEVATION = 46.45 / �� <<4� � O BARNSTABLE GIS DATUM NOTE / � � T �� \ 50 � �- °Z� </ O A DEED RESTRICTION LIMITING THE 3< Locus O DWELLING'S BEDROOM CAPACITY iN �v �uJ G % `�� TO TWO BEDROOMS IS TO BE �ti� gyp '' m° RECORDED AT THE BARNSTABLE m_j� G cn l T �`>nt COUNTY REGISTRY OF DEEDS, CENTERVILLE. MA G / U �In /,�� LOCUS MAP u / T \ wa< J 0h/ ti �� NOT TO SCALE _2fzw Ln w :y : 7� N 3 0 , LEGEND c� ,.,.,.:.,.:.,., w O� aW° w m°°z Off/ / j I LOT S EXISTING ~o _j u° U~l� z 3 �O / A EA = 19552 s f SEPTIC TAN1000 K r <cn<� <w W � cn° / wU W 3 U _j > O `` �L � _jw } _j m ❑ D / EXISTING LEACH Z <U) Q <_ , O < = 1 / PIT/CESSPOOL • CDz � `' < aOLIJ < w � O � � ~ zX / e of m ` w / \ //^^ j W w °cn —� CD ° / G'9S E vJ / TEST PIT ® D-BOX 0 W Z (h U w u, ;;_ ,;,:: m / \ /y, �V O / DECIDUOUS CONIFEROUS �- ° <o m "SSs r \ `VO� Q It / TREE o0o TREE '% w< v v±>;::i:: i .:.:::r:::>:: n , p Q��]2-M 12-P m U �//''II Z (Y ` W l -NUMBER REFERS TO DIAMETER IN w W O-I X 50 ` I INCHES. LETTER DENOTES TYPE. �LL O �LL Z Q ` O-OAK M-MAPLE P-PINE C-CEDAR . Ln In r17 \ ` / ~I W W w I v Ln Li l S� fN OF MgSl y �yIH OF MgSS ccZnn z o wO_LL X I \ W t f / DADV ID em = P DAVID vrcc)c�_nLm< Ul o u D. w? 000UGHNOWR 9°tic o W T_ 0- No. 1093 CQUGHANOWR W Z O Zz \\\ O �� TeVL `p 41f TP-2 ENSE� oQ- W O ~ Z Ln m R� W U) 0 3 i L6 �` I Q AL i LLJ u / q >O z 1 J X U W \ 1 *AZALEA 16 f f, x 12.5 f t x 2 FL e W w \ J(+ 49 LEACHING GALLERY < + o AZALEA LiI \ oQ i SEWAGE DISPOSAL SYSTEM PLAN Z d 12-0 O ® T� w J Z 49 X� � _l �� ��y -TO SERVE EXISTING DWELLING J � Z J \ �D 6-0 / JOSEPH & ELEANOR GLORIOSO 3 f— / / EST. 0 p LD m �- U \ \�� . l OWNERS OF RECORD 0 Z o w ~'\� O j �48 154 FIVE CORNERS ROAD o ii. � X ry p W IS) \` / ��® 1JJ5 ���- CENTERVILLE. MA f 1 z + \ 48--��� l ®��� PROPERTY ADDRESS LL '�� 16-P z3 � m '—' col / ASSESSORS MAP 16 B PARCEL 114 / 43 TRIANGLE CIRCLE &�9 Z Z ( //�j� ' \ SANDWICH MA 02563 PLAN BOOK 312 PAGE 56 0 LL.0 FLAN �.1j _/B \, ��, 508 364-0894 DATE. JANIJARY 15. 2009 J x x _ �� Y�/ v JOB #E T E-3 0 6 5 PAGE 1 OF 2 ' VERSION: g ' p W N W W SCALE. 1 In - 20 f L T LL ~ w 20 0 20 40 �O ! \ THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED AO / SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM mmmmoli / I [\ -_ DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING 0 10 20 PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER DRAIN SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. SOIL TEST LOG' DATE OF TEST: DAIVIDD. C . GHA DESIGN CA ��LI__;1LATIONS� APPROVED SOIL EVALUATOR: DAVID D. COUGHANOWR. #461 WITNESSED BY: DONNA MIORANDI. HEALTH DEPT. PERC NUMBER: 12456 DESIGN FLOW: 2 BEDROOMS X 110 GPD = 220 GPD TEST PIT 1 NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 220 GPD X 2 DAYS = 440 GALLONS PARENT MATERIAL: PROGLACIAL •OUTWASH USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL PERC AT 62 in - 2 MIN/INCH IN C SOILS CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) ELEVATION DISTRIBUTION BOX: USE 3 OUTLET D-BOX. DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING SOIL ABSORBTION SYSTEM: A 16 ft. x 12.5 Ft x 2 ft LEACHING GALLERY CAN LEACH 49.50 Abot_ = ( 16 x 12.5 ) = 200 sf 0-5 FILL Asdw = ( 16 + 16 + 12.5 + 12.5 ) x 2 = 114 sf 5-8 O SANDY LOAM 10 YR 2/2 NONE FRIABLE At.ot. = 314 sf Vt 0.74 x 314 = 232.36 GPD -8-12 —A _LOAMY SAND _10 YR 3/3 NONE FRIABLE USE A—i-6—ft x 12.5 ft x 2 ft GALLERY. Vt = 232.36 GPD > 220 GPD REQUIRED 46.67 12-34 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 36.50 34-132 C MEDIUM SAND 10 YR 5/4 NONE LOOSE NO GROUNDWATER ENCOUNTERED L EA CHING GA L L ER Y TEST PIT 2 PARENT MATERIAL: PROGLACIAL OUTWASH USE SHOREY PRECAST 500 GALLON NOT TO 1000 GALLON SEPTIC TAW 2 MIN/INCH IN C SOILS LEACHING DRYWELL (H-10 LOADING) SCALE DIMENSIONS AND DETAIL NOT TO ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER CONSTRUCTION DETAIL USE EXIsrrNc H-10 UNIT SCALE (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 49.20 DRYWELL UNIT SEPTIC TANK IS TO BE PUMPED DRY 0-4 O SANDY LOAM 10 YR 2/2 NONE FRIABLE STONE AT TIME OF INSTALLATION AND IS TO 16.0 f t F BE EXAMINED FOR STRUCTURAL 4-8 A LOAMY SAND 10 YR 3/4 NONE FRIABLE INTEGRITY. INSTALL NEW PVC OUTLET m,, TEE EOUIPPED WITH A GAS BAFFLE. 46.53 B-32 B LOAMY SAND 10 YR 4/6 NONE FRIABLE (0, +� 32-132 C MEDIUM SAND 10 YR 6/4 NONE LOOSE Q_ m, TAPER 3B.20 Lo co _ N m o OJ U 3.75 Ft E3.5 FL 1.3.75 f 16.0Lo f t ;- �,, ` r (v.: . GROUNDWATER ADJUSTMENT f r . .,. . ,_ ; ,+ EXISTING GROUNDWATER LEVEL 500 GALLON DRYWELL B f. W r 1) � (< ;. BASED ON TOWN OF BARNSTABLE DIMENSIONS AND DETAIL E GIS DEPARTMENT RECORDS. USE H-10 UNIT INLET OUTLET INDICATED GW 13.00 INSTALL ONE INSPECTION COVER COVER i4` RISER TO WITHIN THREE f1 , l sa , r .t+` ZONEINDE WELL MD1W-29 INCHES OF FINAL GRADE .•:_.,...... s; .•:•.• •.•,•.,•.•.•:.•._.• ,•._... AND INDICATE LOCATION 3 IN DROP READING DATE DEC. 2009 ON AS-BUILT PLAN --sm. I� FLOW LINE READING 6.0 FROM ' - —� ADJUSTMENT 3.6 BUILDING 10 in 14 TO NOTES ADJUSTED GW 16.6 in D-Box 4s in 0 33 LIQUID GAS pc::D�,O 0�0 1n LEVEL BAFFLE 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 0000a000000 p�Cpp aoCD c:j 000 O�p 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. CROSS SECTION VIEW 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS 1021n OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 41 INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES CROSS SECTION ° VIEW BEFORE EXCAVATING FOR SYSTEM. SEWAGE DISPOSAL SYSTEM PLAN 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED. 2 in PEASTONE 2 in PEASTONE 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON, FINES AND DUST IN PLACE. O o -TO SERVE EXISTING DWELLING 7) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES 28 314, To 2�CTIVE 4u ro 26 AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. 1. -�'^�" DEPTH I- ���VEL In JOSEPH & ELEANOR GLORIOSO 6) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT 154 FIVE CORNERS ROAD CENTERVILLE. MA PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. 46 in 58 1n 46 1n 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL 150 to EEO-TECH ENVIRONMENTAL STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH INSTALLER MAY SUBSTITUTE AN APPROVED GEOTEXTILE 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. FABRIC IN PLACE OF THE 2 1n PEASTONE LAYER SPECIFIED. ETE-30651 JANUARY 15. 2009 1 1212 on Yv o v.co� As ,54dwn Jr aib 14:) o T a 4" p! f /Za 14Pc fa „ad 017 #4 ,s/c,fc. O c60 CX t � s Pvco�o2�iv �cst -,.�e.ss � 3/ to ¢ i // N J }- -T 1 VT � � C � b / c" 3 z 5 b 77 c3/.Z.�/T] � .9//Sf T 7 \ . 40 � CANS T/E' (/e_ 7— -~ � � � To /% Ss. ,�ri vir•ori me *�aL L�[��c, Tiz`/c i 9 p'l _ .3,30 X O. /< `J v A / 0 9 . a PLAN ©F LAND /C / VE (fo �c'. iY6t' . l IN CeN rE e ///t 4 E MASS. p / OWNEt) //BY I,� �A OF #4'- CH DrM © S� x►1� dry z"�* I CERTIFY THAT THIS PLAN SHOWS �� '�*cy ���` '��, � THE ACTUAL LOCATION OF THE, FRANK I2 ti� FRANK CONEfiT 5 TRENT(311I �• STRUCTURE ON THE LAND AND �. FRANK �. 0m1 o CONERY " C ONERY - HYANNIS, MASS. THAT IT CONFORMS WITH THE No. 6232 No 6,�73 wrcl"imlo uRv.vo BY-LAWS OF THE TOWN ,f1 t`�rsTEV`yo♦/ STE rGALE t IN *0?0 w=t. /0AV7-7 �cr n