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0018 GINA COURT - Health
18 Gina Court Centerville A=210— 191 i UPC12b34 � -153L 'fir I I i I I i I I ! I " I i r � I : I i ! : i _ .. . • ! 1 C 1 s : , 1 1 - • f i �F r , .t i • . ._ : W' >✓ - �' 1 A O 1 fl .. : ' . � I 1 1419 /=P Ll co 00 Tw�x DSxb Lug n5w T xs r�� , S dx �a ' X A rr�r�► �r Q I I' s�1 Y 2 J � O �S. tu P-0 3 w Q OV) Tj ,Z) f'- F 6 -1 D 0 w C) 6 L 4� i 6U 2 No. .d=L% - Fee Ito— THE COMMONWEALTH OF MASSACHUSETTS Entered incomp : PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zippricatiou. for Ii.5 ooat i§pgtem Cougtructiou Ver it Application for a Permit to Construct( ) Repair(.. Upgrade( ) Abandon( ) ❑ Complete System Individual Components Location Address or Lot No. / b/l5/W4 Ca.&- Owner's Name,Address,and Tel.No./'�r��^i� `�l - Assessor's Map/Parcel +N/+ Y� 4f✓9 fd T Installer's Name,Address,and Tel.No. /),-#4 T V 6,-071° Designer's Name,Address and Tel.No. eC®" y3Tilt /,r ,".,W,/� Type of Building: Dwelling No.of Bedrooms Lot Size � (�� sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) c2.2-U gpd Design flow provided 3 3f® gpd Plan Date ®G/ /.2-. "e.96 Number of sheets / Revision Date Title 5. ,a`l< .l mo sa4 Sit &. �,► 5'r.vt t x.)AM 1,dI Size of Septic Tank 1,OeO CA, 6A,d tir Type of S.A.S. .2• $)a G[ C •3..-� Description of Soil 5-,, D 1.1 Nature of Repairs or Alterations(Answer when applicable) 9 r-pkre^ Ll-aa 61 Wq Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B lth. Sign;d Date / — ApplicationApprovedby Date ji y 4y Application Disapproved by: Date for the following reasons Permit No. -�°a `��" Date Issued 11 �v No 7 / . `_• t Fee �. computer:in com THE COMMONWEALTH OF MASSACHUSETTS Entered p Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01 pprication for �Bi!gpo!5al-�§p!5tem ,(Eon!5truction Permit Application for a Permit to Construct( ) Repair(,) Upgrade( ) Abandon( ) ❑ Complete System Zindividu'al Components Location Address or Lot No.1'/CJlk/4 4!�� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel "'�'n"/JY �''✓d Installer's Name,Address,and /Tel.No. J�Us/ y��f j�� J� Designer's Name,Address and Tel.No. eec,Tee 4 '93T r Type of Building: Dwelling No.of Bedrooms Lot Size /$ �')� sq.ft. Garbage Grinder 4p.r , Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min,required) c2 ;2 O gpd Design flow provided -3 36. tl gpd Plan Date OG/ /�2, ;iW-6 Number of sheets Revision Date Title S...✓us< Dlwosl. S1f O�A.67 ��a�. A.0lI 1��hL1,fl a i Size of Septic Tank Ct ( &A,)Ayr Type of S.A.S. 3 -_I Description of Soil Nature of Repairs or Alterations(Answer when applicable) 9_1P ,e 61 tic I l 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 Boardf Health. Sig (d Date Application Approved by Date Application Disapproved by: Date for the following reasons14 c Permit No.. 0-19 1 Date Issued N. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the,O-site Sewage.Disposal System Constructed ( ) Repaired ( V Upgraded ( ) Abandoned( )by all,/i/Q) at Glj✓� Cam` f{ C-.w 4'.4 J'(/P has been construct led in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. P©O (c, ' Led 1 dated Installer V - c�'o' l Designer GSLA�K "„o UJ #bedrooms �^ Approved design flow�_4- S � gpd The issuance of this permit shall not be onstrued as a guarantee that the system w\illl fulnctr i6n a designed. Date �, , 30 tc, Inspector ———rvo. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS =i!6po.5ar *pztem Co 5tructton Permit Permission is hereby granted to Construct ( ) Repair ( v) Upgrade ( ) Abandon ( ) System located at 11-e and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construct' Tust be completed within three years of the dae of this pe it. Date l� ' T Approved>b Town of Barnstable Regulatory Services . Thomas F. Geiler, Director BAMSTAOLM "�; P Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: ►N0u 301 2-006 Designer: D010 V 6006OWM-IInstaller: Address: LD 7KI K&6 CIR Address: QS '1'„r�c,,�c sv DWK(J On d&C) rJ n\G'Ml was issued a permit to install a (date) (installer) septic system at l c� &o Coy gr based on a design drawn by (address) NVID D• &VC9(4(��k ;25 dated . OCf Zr W O�; . (designer) 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 OF MASs9 DAVID o�GN o D. (Installer's ignature) COUGHANOWR N No. 1093 OISTER�o LQ �IOW4� Ni TAW PN (Designer'sSignature) (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. TOWN OF BARNSTABLE LOCATION 1:5 G i,-%0. cc2�- SEWAGE# 260t—49-1 VILLAGE CF���,'�� ASSESSORS MAP&PARCEL . 21® rq INSTALLERS NAME&PHONE NO. ����csti t ci6e�,ci� �S'7`j 1�9 SEPTIC TANK CAPACITY i LEACHING FACILITY:(type)�$Ci� C1, �► ;j(size)1�.. 2LJ V NO. OF BE—DROOMS 3 OWNER }�ce-3,_r;e_k a �J�,.nr Ce�ma j4e r PERMIT DATE: I - I ILI_6L 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 �CG FURNISHED BY Ct� I. ���►cef1�/ll r i LOCATION SEWAGE PERMIT NO. .Z VILLAGEaas. CElt,7-iW 111LLt:- •INSTA LLER'S NAME i ADDRESS BUILDER OR OWNER SAIi /r li DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 1� r,• V •S � t TOWN OF BARNSTABLE LOCATION IS CT SEWAGE # VILLAGE Cawf eir t e ASSESSOR'S MAP & LOT1^10 ' �a INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1000 V11 n, LEACHING FACILITY: (type) Pt F (size) (©00e I NO.OF BEDROOMS Z BUILDER OR OWNER Foe4eri c� Cav I f er PERMITDATE: 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*et of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by R(O ' TeCA , I RSP: 1 a1) I z f > N O ym 1 ~ IC # om xn !� _WATER LINE 2:X �N O m— O 1 ~� r- O �> co _ x ;n Z Z = IC) ! m � 21 W N W N N CD LJI CD O Cf) ,, z m 41 CD CD "�J LD F Ln Ln Ln m m rr r- rr cb L-0 CATION S A G E PERMIT NO. �-0T� /L? LIA/ A Gc.) u,,cr ,VILLAGE J INSTALLER'S NAME i ADDRESS (/ vzI tia Ato 5 BUILDER OR .OWNER J- soi irk DATE PERMIT ISSUED 3 DATE COMPLIANCE ISSUED ��_�� F- C- i s. 14 q © P U � 7 3-0 I Town of Barnstable OF tHE;Tpfy do Regulatory Services Thomas F. Geiler,Director 11 MASS... •�� Public. Health Division AIfD��A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office:. 508-862-4644 Fax:_508-790-6304 Septemberl1, 2006 Mr and Mrs Frederick Coulter 18 Gina Court Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located at 18 Gina Court, Centerville,MA,was last inspected August 30t' 2006 by David D. Coughanowr, R._S., a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Scum staining was observed on inside of cover and on top of inlet pipe indicating previous hydraulic overload. You have 2 years from the date of the of the system failure to bring the system in to compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE DEPARTMENT HEALT c an,R.S., C.H.O. Agent of the Board of Health Postal CERTIFIED MAILT. RECEIPT ry (Domestic a For Relivery information visit our website at www.usps.como rr .: I C I Postage $ 39 CCertified Fee Retum Receipt Fee I O W2 5 2�pg (Endorsement Required) O Restricted Delivery Fee -0 (Endorsement Required) r=1 ASP S e r-q Total Postage&Fees Ln Q Sent T --........ ,Apt N ---------- -------- ........ rti Sreeto.; </ c or PO Box No. City,State,ZlP+4 /� PS Form :r0 June 2002 Certified Mail Provides: A mailing receipt (esianay)ZOOZeunf'008£Wjo�Sd ■ ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years i Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mpil. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. ,grature item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse AO Addressee so that we can return the Card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, ��,, ^Q� or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: if YES,enter delivery address below: ❑No �ou.0-Cw � � �� oA�3a- 3. Service Type ❑Certified Mail ❑Express Mail ❑ Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ,7Op5 1162 t 0200 �2191 1826 (Transfer from service label). j PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 l I • Sender: Please print your name, address, and ZIP+4 in this box' PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE 200 MAIN STREET HYANNIS, MASSACHUSSETS 02601 I I I rr Town of Barnstable ��F1HE ip�� Regulatory Services * AB Thomas F. Geiler,Director MASS.BARNST9A •�� Public Health Division rEp:Nlp•'�A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644. Fax:. 508-790-6304 Septemberl1, 2006 Mr and Mrs Frederick Coulter 18 Gina Court Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located at 18 Gina Court, Centerville,MA,was last inspected August 30th 2006 by David D. Coughanowr, R. S., a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Scum staining was observed on inside of cover and on top of inlet pipe indicating previous hydraulic overload. You have 2 years from the date of the of the system failure.to bring the system in to compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE;n, 7CH. TMENT c Agent of the Board of Health Town of Barnstable " CF tME tp� do Regulatory Services .� BARNSTABLE ; Thomas F. Geiler, Director 9�A 16 9. ••� Public Health Division TFD MA'S A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 8, 2006 Mr and Mrs Frederick Coulter 18 Gina Court Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located at 18 Gina Court, Centerville,MA,was last inspected August 30th 2006 by David D. Coughanowr, R. S., a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed"under the guidelines of 1995 TITLE 5.(310 CMR 15.00) due to the following: ,Ev' e a e ew PV a -bo e You have 2 years from th�date of the of the system failure to bring the system in to compliance. � If there are any questions.about this reminder,please feel free to contact the Barnstable �� J JJ Health Department. n BARNSTABLE HEALTH DEPARTMENT Thomas A. McKean,R.S., C.H.O. Agent of the Board of Health Commonwealth of Massachusetts o H u Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification Important: When filling out 1. Property Information: forms on the computer,use 18 Gina Court - Centerville only the tab key Property Address to move your Frederick and Elinor Coulter cursor-do not use the return Owner's Name key. 18 Gina Court Owner's Address Q Centerville MA 02632 CA ff City/Town State Zip Code Date of Inspection: August 30, 2006Date 2. Inspector: David D. Coughanowr, R.S. Name of Inspector Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364 0894 Telephone Number Certification Statement: I certify that I have personally inspected the sewage disposal system at this add.ress and that the, information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: - ❑ Passes I ❑ Conditionally Passes ® Fails - A � ❑ Needs Further Evaluation by the Local Approving Authority ( ` )wk 141tv4, R-S August 30, 2006 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5-2435.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments ,M Subsurface Sewage Disposal System Form A. Certification (cont.) 18 Gina Court Property Address Centerville MA 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name Date of Inspection 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: Inspector's Note==> Aseptic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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: t5-2435.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 2 of 16 . V Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form A. Certification (cont.) 18 Gina Court Property Address Centerville MA 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name Date of Inspection B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ 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: 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 t5-2435.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form o Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 18 Gina Court Property Address Centerville MA 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (cont.): 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for 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: t5-2435.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 4of16 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 18 Gina Court Property Address Centerville MA 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name 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 ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/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. ❑ ® 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 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. t5-2435.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form GSM A. Certification (cont.) 18 Gina Court Property Address Centerville MA 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name Date of Inspection 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. t5-2435.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts L Title 5 Official Inspection Form a ° Not for Voluntary Assessments rG^M Subsurface Sewage Disposal System Form B. Checklist 18 Gina Court Property Address Centerville MA 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name Date of Inspection 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? ❑ N/A 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, including 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(3)(b)] t5-2435.doc.11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M C. System Information 18 Gina Court Property Address Centerville MA 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a-no plan Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 233 gpd 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: December, 2006Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other (describe): t5-2435.doc. 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System. Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'GSM C. System Information (cont.) 18 Gina Court Property Address Centerville MA 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name Date of Inspection General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age unknown—system is assumed to have been installed at time of dwelling's construction in 1981 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2435.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 9of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 18 Gina Court Property Address Centerville MA 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer appears structurally sound with no evidence of backup or leakage into dwelling Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No certificate) Dimensions: 8.5 ft x 5 ft x 5 ft (1000 gallon) Sludge depth: 8 inches Distance from top of sludge to bottom of outlet tee or baffle 26 inches Scum thickness none Distance from top of scum to top of outlet tee or baffle 10 inches Distance from bottom of scum to bottom of outlet tee or baffle 24 inches How were dimensions determined? Probe to top of tank t5-2435.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 18 Gina Court Property Address Centerville Ma 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name Date of Inspection 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 appears structurally sound. Tank should be pumped dry at time of repair and examined for structural integrity and water tightness. A new PVC tee with a gas baffle should be installed Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): t5-2435.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 18 Gina Court Property Address Centerville MA 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name Date of Inspection Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Not determined Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-Box was opened and found to be crumbling.A new D-box should be installed at time of repair Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2435.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 18 Gina Court Property Address Centerville MA 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: ❑ leaching chambers number: ❑ 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.): Soils above leaching pits appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Pit was uncovered and a scum staining was observed on inside of cover and on top of inlet pipe indicating previous hydraulic overload. t5-2435.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts • Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form /GSM C. System Information (cont.) 18 Gina Court Property Address Centerville MA 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5-2435.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 14 of 16 i Commonwealth of Massachusetts • Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.)_ 18 Gina Court Property Address Centerville MA 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name 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 supply enters the building. LEACO PIT 4 LOCATIONS A B 3 1 25.5 FE 45.5 FE 0 0-e0X 2 29.5 FE 47.5 FE 2 3 31.5 FE 46.5 FE SEPTIC TANK 4 41 FE 48 FE a A B EXISTING DWELLING # 18 W _Z J Ui W H 3 G I N A COURT NOT TO SCALE t5-2435.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 i Commonwealth of Massachusetts • Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'LAM C. System Information (cont.) 18 Gina Court Property Address Centerville MA 02632 City/Town State Zip Code Frederick and Elinor Coulter August 30, 2006 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: Not Determined Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Groundwater elevation to be determined during soil testing required for system repair. t5-2435.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 No THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...---........ ."^.............OF.... Appliration for Disposal Forks Tonstrudion rumit Application is hereby made for a Permit to Construct (i/f or Repair ( ) an Individual Sewage Disposal System at: .............gin_ ......'C- .. ....................... .... �-:� .--•--`` - .....---..........------..........------. .......Location-Address Ow �p oA Lddtr - ------ ....... ....................................................... .s.s........---...............................-- Installer Address d Type of Building Size Lot..1 2..........Sq. feet Dwelling—No. of Bedrooms............-3...........................Expansion Attic ( ) Garbage Grinder Other—Type of Buildin a g --------••------------------ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------------------------------------=--------------------------- W Design Flow..........U0........................gallons per person per day. Total daily flow........... �.�....._______..__._gallons. WSeptic Tank—Liquid capacityWOO.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►-' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----- ---------minutes per inch Depth of Test iPit.................... Depth to ground water........................ ls., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------------------ -------------------------•-----------...---------••--------•------- O Description x Descri tion of Soil.......!C_-)=.;;L........... � n� ----•--------------------•--------••------.. ----------- •-----------------•------------------.----- x --------------------------------------------------------------------------------------------------------------- ------------------------------------••-------------------------------- ................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .-----------•----•---•-•--•..............•---------------------------------------------------------------------...----------•-..----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. #�� Date Application Approved BY---.-- p •----- Date Application Disapproved for the following reasons------------------------------------------------------•------------------------•----------...--•------••-. ............................................•---....---------.._..---------------.....--•--•-•------•-••---------•---------------------------------.................................................... Date PermitNo......................................................... Issued........................................................ Date 35, .. No... Fss....., , ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ^ OF. C Appfiration for Uhipos al Workii Tonstro.rtion Prrutit Application is hereby made for a Permit to Construct (,.-*) or Repair ( ) an Individual Sewage Disposal System at: ...............? rl_A..... G 1 ---•••--•-••................. ..... .`...�....... ..................•....................... ^� Location-Address --1 or Lot No. J £ (Y�C� Y\1 .._. ....- .... — ..................•••......_......._.... _ } Owner �` ress v r\ ! t3 S .................... ....... .. ....••--------•---.......---•--...........................••. --•-•-••.........------...................•••......... -----•--•---............................ Installer Address dType of Building Size Lot_ k: ,v-:; ......Sq. feet ---------------------------Ex Garbage Expansion Attic a a Grinder N Dwelling—No. of Bedrooms............:� p ( ) ( a 914 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .------••--•----•---•--•-------. - W Design Flow...........\-.0........................gallons per person per day. Total daily flow................=f.........................gallons. WSeptic Tank—Liquid capacity\00agallons Length................ Width--..__-________- Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...............-....sq. ft. Seepage Pit No-------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..............................................................•._......... Date........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit-_-____-----__.._--- Depth to ground water........................ a' ----------------------------------------------•------••--- •---•----•-•••••----•-----------•-•-..........••-••-••-•-•-•-•------------•••.....---•--....... O Description of Soil...._..:�D_-.;;�-..........�..��_..O-�" t. = �' W ------------------- --------------------------••--•--•-•--------------------------------•-•----••------•-----------------------------------------•-•-------•--•.......---_.._..------------------------ U Nature of Repairs or Alterations—Answer when applicable.____........................................................................................... ----------------------------•---------------------------------------------------------•-•-•--•-•--•-----••-------------•-•----•-------•----•••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITILE 5 of the State Sanitary Code-The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.....C��- �W\.s+ �C' ' ` t n' c�C� ,�f Da t e Application Approved By----- !le ------G', 19 '�� ....... Date Application Disapproved for the following reasons:................................................................................................................ ....------•---•-•-•-•--------••-•----•.....•------•----------••----••-•-....•--•-••---•-....----•------_.........................•-•---------•----•-•--•------•---•--••--••.............................. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... �'......... OF........J.0—k.................................................................. (9rdifirtt#r of Tooapliaatrr THIS IS T_O_ C��RTIFY, That the Individual Sewage Disposal System constructed (✓) or Repaired ( ) by.............•-_..V..{:,,41d ?. &9�uo............... ---------•-------•------..-� ----------- -------...--------------- --------- Z- Innstaller ,,�� at...........Z-�___1.2.......... � �'•�" 2------.... -•-------------C 111-12 ....---------.......................--•------------------•- has been installed in accordance with the provisions of 'IT—7 ` of The State Sanitary Code as described in the application for Disposal Works Construction Permit No __ :. 3sG_ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........0..................� --e Inspector..........-• ----•-...................---•--•---.....----------•-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N010 ........... ...............OF....... •-� 1� Dispo,o al Work. �oo,�#rt iou amit Permission 's hereby granted----••-----.. 12-.:� r+�ra---.---•-•-----•-------•-•-------•-----•-------•--•--•--------•----....--••................... .. to Construct._(�'j`or R�e)air ( ) an Individual Sewage Disposal System � atNo �7 -----------....2. .............................................. s- Street as shown on the application for Disposal Works Construction Permit No................ ... Da d.......................................... -------------------------------- Boa Health DATE.................... �� FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �..1 L.Lr..I..C= YG'AM►L-14 - ?> T5E')•r:IZOC�NA, uv IIQ 4 -S? s 330 &Ptz [•,''� 3 �E_Ff� �c -rt�.1►c = 33n.r Ir�c % • 4�jS 6.�n. (2 orST 1 loci% / PG4 C,L P1T :.. uS;E lco0 M Gni... 5�K� � � w` 'N �c�waLl. Ae�a. - t5o sue. g• T,y• �C�;� SF,: .c. 2.S + 3'7$ G.P.Q. G-��UC• f] s. GC> �O U U D TOT'A L .426 yi ToTQ L t;�,ti1 L%( FLiDV./ = 33D 6.PD. V Oe ` s G•'Et1GDl.&TiOLl owr !"K;2MIiJ 0¢ r rio Vt , j V' c a e � :� � g ' 7777 .. i ��P lac: (�.•` - f�l ��/min ��`/✓� ..— ��-r-'. Qp ♦ i��� ' �-------•tea f:J1�`-101 LOd rY1 S urL 'Sox `t 1•$ Sepnc Z , iuv : l T,NK o00 `t'7.0 wv jW GAL. � �,t q7,3 d i ,• 1T E; %VAIW v. ip :r �D LV 4 rb7lL - t GGIZTI�=`l TkAT' T14r-_ ���C. fou► D StAOW�.! R���� ►��� W►'ic'1••i T4Z: 51 DE.t..1 ice � p� .. i / WL,> 5C1 L'�AGt, C.'CQJ1�:CrtitG�iTS OF TNC T •�a w w c = C-3 P.��..�>�A.(3 t1=. i �� . �rL 2z k ••` ''('t-115 t7I..At+t !!� UOT L�A;G-?'� UM-t A�.1 05TE(L�/1l-lL- 0 1�rlrLS • ' � 11JSC�:JI,.�l J i ��I_�/�_�{ •,�T��E� a�F�;�Y�i �I�GWI� AI�P:'t_t C_b.t-.lT' `l (( . LoT LI W`>;, r- . - ^ GREAT MARSH ROAD r 24 FL X12.5fL X2 FL o CONTOURS I, LEACHING GALLERY EXISTING - - - - - - - 50 :FALMOUTH RALDINE W0 MINIMAL GRADING PROPOSED __�--� uRr N o<w _�� _, 44 INA C;OS CURT __ o OOP m(n m m _����-- ROAD ROUTE 28 + m CENTERVILLE. MA CD o�W 0 0 LOCUS MAP II--zo \ / TP 1 TP-2 za-O NOT TO SCALE m ` w owo / z ❑wa� / O w \\ � m � c� �� �Jz � ^ W LOT 12 6D w= �� �--� � w � � A RED = 15PJ26 s f-' BENCH MARK u 3 Z W - o 44 �\ i TOP OF FOUNDATION \ Pi ELEVATION = 46.29 Z m x Of QO < z I N / (-XIS TING I- BARNSTABLE GIS DATUM z w m mz W o `` 2 BEDROOM � � ' `� ui lu ❑ w / � � Lo ` DWELLING z ❑p TOP OF FNDN % W zl z_ LEGEND \ / EL = 46.29+- I U W w ff X �' EXISTINGLd Li `` l o ° �,m 1000 GALLON 45 ` I l m G� W 0� I SEPTIC TANK \ ; _j w v as \ Z U co} Li D-BOX ❑ �A \ I � CONVERSION l INCHES TO O V Z W / DECIMAL FEET LIJ>� X OJ ro��czo_o TEST PIT ® to ft J~ z um EXISTING \ �� I , 08 �o DAVID �yG� �o�� DAVID bj O z wwz LEACH PIT • \ �70 O I , 2 .17 o D. o D. 3 z \\ ~ I / 5 .3 CONo.H1093 R N U COUGHANOWR W o ,, UTILITY POLE 1 Z It w w m \ Z� m , 6 .50 9F �o s 4ic E10 Q J o of + c, N uo EDGE OF \ W l 8 .67 O/STEM o�4 EVALU �0 e W w � F N CLEARING � � \ I 9 .F5 IT o X TREE /� `�\ I / / 10 .83 W U W -NUMBER REFERS TO V ` 11 92 ��b w DIAMETER IN INCHES. \ / 12 1.0 oG-0ber 1 � LETTER DENOTES TYPE. 18 O-OAK M-MAPLE P-PINE \ -- - SEWAGE DISPOSAL SYSTEM PLAN z J O ` �� A 45 0.� {t �®� ��� -TO SERVE EXISTING DWELLING Qz J [ DIS T�1 NCES PLAN � WATER EST. FREDERICK & ELINOR COULTER 0 m o CD TO LEACHING GALLERY GATE O U ALL DISTANCES ARE IN DECIMAL J CD �. OWNERS OF RECORD F—+ FEET NOT IN FEET AND INCHES. o 0 W ��, n X F- SCALE. 1 in = 20;' �t d 16 GINA COURT 0 - W 1 44.3 336 3 ��� 1995 ��� CENTERVILLE. MA Z + 2 66.5 20.2 2= 20, _.-- 40 �ON PROPERTY ADDRESS .--i 3 71.3 32.7 1 2 0 O N m D ID 20 EO(jEMENT ASSESSORS MAP 21 PARCEL 191 0 43 TRIANGLE CIRCLE A s r PPvE SANDWICH MA 02563 PLAN BOOK 290 PAGE 57 GINA N X x 508 364-0894 DATE: OCTOBER 12. 2006 O z F N t N JOB #E T E 2 4 4 4 PAGE I OF 2 VERSION: F} L L_ O w W w THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED � COURT SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING 1 PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER J SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. SOIL TEST LOG � ( 5 DESIGN CA � �JLATIONS _ . p DESIGN FLOW: 2 BEDROOMS X 110 GPD = 220 GPD DATE OF TEST: OCTOBER 12. 2006 SEPTIC TANK: 220 GPD X 2 DAYS = 440 GALLONS SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL WITNESSED BY: DAVID STANTON. HEALTH DEPT. CONDITION. IF NOT, INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) NO GROUNDWATER ENCOUNTERED DISTRIBUTION BOX: USE 3 OUTLET D-BOX. TEST PIT 1 PARENT MATERIAL: PROGLACIAL OUTWASH SOIL ABSORBTION SYSTEM: A 24 Ft. x 12.5 ft x 2 ft LEACHING GALLERY CAN LEACH ELEVATION = 45.00 +- PERC AT 70 in : 2 MIN/INCH IN C SOILS Abot = ( 24 x 12.5 ) = 300 sf A s d w = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 sf At ot. = 446 sf DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER Vt 0.74 x 446 = 330.04 GPD (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING USE A 24 FL x 12.5 ft x 2 Ft GALLERY. Vt. = 330.04 GPD > 220 GPD REOUIRED 45.00 0-12 FILL 12-16 Ap SANDY LOAM 10 YR 3/1 NONE FRIABLE LEACHING GALLERY NOT 16-36 B LOAMY SAND 10 YR 5/6 NONE FRIABLE USE SHOREY PRECAST 500 GALLON LEACHING DRYWELL (H-10 LOADING) 41133 34.33 3B-12B C MEDIUM SAND 10 YR 6/3 NONE LOOSE CONSTRUCTION DETAIL EOO GALLON DRYWELL DIMENSIONS AND DETAIL NO GROUNDWATER ENCOUNTERED DRYWELL UNIT STON USE H-10 UNIT TEST PIT 2 PARENT MATERIAL: PROGLACIAL OUTWASH INSTALL ONE INSPECTION 2 MIN/INCH IN C SOILS RISER TO WITHIN SIX +- 24 0 Ft Q AND HINDICATE LOCATION ES OF FINAL GRADE ELEVATION = 44.90 m m ON AS-BUILT PLAN a� 4 DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER Lo O��O m N N �0 33 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING N n o0o O00 In 44.90 oa0000c 0C: 0 0-6 Ap SANDY LOAM 10 YR 3/2 NONE FRIABLE s.s Ft e.s Ft e.s Ft s Ft �0000000 6-36 B LOAMY SAND 10 YR 5/6 NONE FRIABLE 24.0 Ft G�0 41.90 102 1� 36-120 C MEDIUM SAND 10 YR 6/4 NONE LOOSE 34.90 CROSS SECTION VIEW Wr 2 In PEASTONE NOTES 24 in o 28EFFECTIVE 3/4 In TO 26 InDEPTH 1-1/2 0.n GRAVEL In R 1) GARBA.GE-.GRINDER NO,T• ALLOWED WITH THIS DESIGN 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/6 INCH PER FOOT MINIMUM. 46 In 56 In 46 In 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 150 In 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0" BEFORE PITCHING DOWN B) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES GROUNDWATER ADJUSTMENT SEWAGE DISPOSAL SYSTEM PLAN AND APPLIANCES. AND BIANNUAL PUMPING OF' THE SEPTIC TANK EXISTING GROUNDWATER LEVEL 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT BASED ON TOWN OF BARNSTABLE -TO SERVE EXISTING DWELLING PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. GIS DEPARTMENT RECORDS. 10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. INDICATED GW 30.50 FREDERICK & ELINOR COULTER INDEX WELL M1W-29 18 GINA COURT CENTERVILLE. MA 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL ZONE D .STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH READING DATE SEPT. 2006 EEO-TECH ENVIRONMENTAL SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING READING 8.1 12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED ADJUSTMENT 4. FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. ADJUSTED GW 34.5 43 TRIANGLE CIRCLE SANDWICH MA 02563 ETE-2444 OCTOBER 12. 2006 2/2