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Home My WebLink About0147 GLENEAGLE DRIVE - Health JCIA DRIVE Centerville • I ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■ ■■■■■■■■■■■r ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■RN;M■■■■ ■o■m■■■■■■m ■■ ■■■O No. 0 l Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS RpPlitation for Mispo8al *pstpm Construction permit Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 14-1 OR, Owner's Name,Address,and Tel.No. �'vtt.e� L-O A15 VAN,LARE Assessor's Map/Parcel (q( 7 P-0-lap 911 W.Ca4TOAAA Installer's Name,Address,and Tel.No. , (�$ -�f'1Z-2%71 Designer's Name,Address,and Tel.No. 5'08-A'73 6-5�7 <°AAEw i D G G&) &U&1SZ?S L,G T"ivG c1 S aSCY G " , E. fit/ Type of Building: (N d%J 3 PER T rrCbV) Dwelling No.of Bedrooms Lot Size 54 Q sq.ft. Garbage Grinder( ) Other Type of Building ICES jD&V7!14-L- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) o2 M-0 gpd Design flow provided gpd Plan Date 9-30 Number of sheets Revision Date Title 14-7 CG.&AJEAC-L& j)W u& Size of Septic Tank 1 .O 00 GACL4W Type of S.A.S.�a� �o� *AAL,Q?j C46kaagvS Description of Soil wt Eb COAR.S, S AL,tj tt 1 .SEC pc o / Nature of Repairs or Alterations(Answer when applicable) VsC- E)OS-ri&J& i,000 G s�$ G.�/�✓ !y Faeff-- o 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 Board of He lth. Signed CXVDate !q- 's�-®`k Application Approved by Date Application Disapproved by Date for the following reasons Permit No.�-®t 3 t 5 Date Issued No. 4o{ ..• (� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplication for Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(N Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 141 Op, Owner's Name,Address,and Tel.No. C'vr L-ORis VAr4447LE' Assessor's Map/Parcel P.o.J10 91-7 W-<ZJ44 '[{AaA Installer's Name,Address,and Tel.No. 7n Designer's Name,Address,and Tel.No. S09-X7 3-6377 G4DEw t D E Gci t aU&ISz?s L<,C. 3L E1vCztly .cx ='NC. c+J ST S �c� v�sSµ G N f+i✓Y E. Gu�QEEE.4/Lt Type of Building: (M i v 3 i>E R 7 tits v) Dwelling No.of Bedrooms aZ Lot Size ( 0 sq.ft. Garbage Grinder( ) Other Type of Building k ES[DFVT(4c 4 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .Z ZO gpd Design flow provided 3 q% gpd Plan Date 0 l(„ Number of sheets Revision Date �r Title 14? Size of Septic Tank 1 ,000 Gw4td_&N Type of S.A.S. (;Z) 500 �si4L1.DlU C ��c s Description of Soil [tit(�7b —COAP.S.6 :SAL.)!)�. 36 SELL Nature of Repairs or Alterations(Answer when applicable) 05C- 15AsS- l rJ& ((OOC> G..4444C�f) ' /,.k I)"boy- ?'4 t a) 500 U& CL�6�1e 7Q.S crt,CT16�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 Health. ti Signed Date 9• •cad-D1)6 Application Approved by Clr� Date - 1 f(a Application Disapproved by 0 Date for the following reasons Permit No. �?-OI g, 3%5 Date Issued ---------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( x) Upgraded( ) Abandoned( )bye^_ amr---G i D a E_Q r EP_P L1S� �-� at I y-7 G(61y6—/ GL6 D(Z has been constructed in accordance � ' with the provisions of Title 5 and the for Disposal System Construction Permit No. o��'3 � dated 9 _ Installer (!24GGcv(_6 &—rF_kPQ16ggLl-C. Designer SG ENG-4U 2WN)G. XM C•• #bedrooms A Approved design flow n ;k 1,0 gpd The issuance of this`e it shall not be construed as a guarantee that the system will �ctio �(as)deesigned �r Date 1 1(/ Inspector It w I --------------------------------------------------------------------------------------------------------------------------------------- No. ( 6 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Vsposal 6pstem Construction prrmlt Permission is hereby granted to Construct( ) Repair O0 Upgrade( ) Abandon( ) System located at 14 '-'LElV E/4C(-E b u V G d E A.1-ir 9&Y(Lcc- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date / Approved by L Town Of Harnst016 Regulatory Services i Richard V.Scali,Interim Director E anBNBTWta IMAM A�� Public Health Division s6lso Thomas McKean,Director t 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: $08-190-6304 Installer&Designer Certification:Form Date: Sewage Permit# _,;tGd d 5 Assessor's Map\Parcel l q ( /I Y 5 Designer: 5G n 5 10eutn ' C. Installer: CaP,.wiJe- �,�kec�crs Address: 285Y CrAnVexu � ig way Address:;; 143 Ct f ife5: arelr«A 6253 Hashp�e, H� 02 On Ci' 1 40 Capewirle. E0+4erlsg-s was issued a permit to install a (date) (Installer) r. fi septic system at i 7 l4tl ect e. D C U based on a design drawn by (address dated 1110�� (desig er I ✓ [ certify that he septic system referenced above was in substantially according to the design, w iich may include minor approved changes such as lateral relocation of the distribution b x and/or septic tank. Strip out (if required) was inspected and the soils were found s isfactory. !! I certify that a septic system referenced above was ainstalle d with major changes (i.e. greater than I ' lateral relocation of the SAS or any vertical relocation of any component of the septic stem) but in accordance with State & Local Regulations. Plan revision or certified as-bi ilt by designer to follow. Strip out(if required)was inspected and the soils were founds isfactory. I certify that he system referenced above was construe s ' nce with the terms of he AA ap o,al letters (IfApplicable) a JOHN { CHUA (I stalle ' Signat e) iN .411 � PLAsigner's Signa (Affix I' ignie s St mp Here) ASE T TO BARNSTAlB1LE PUBLIC FIE ID , S N. CERTIF CATS OF COMPLIANCE WILL NOT BE ISSUED UNTIL OT I IS FORM AND AS- BUILT CARD RECEIVED BY THE BAD2NS ABLEi lU C HEALTH DIVISION. THANK YOU. !! ! QAScp6d\Designer Certification Form Rev 8-14-13.doe !j L TOWN OF BARNSTABLE LOCATION �� L"64G4,e ba SEWAGE# �ZOl 2 .b VILLAGE QNI't,64VI t;4,47, ASSESSOR'S MAP&PARCEL 19 INSTALLER'S NAME&PHONE NO.�A Q �a� iL=-Ri>Q191K C.C,� cyti 0 11 SEPTIC TANK CAPACITY ,ODD (2ZA-L a M(: LEACHING FACILITY.(type)(A)SUCH C-i1L (size) FS NO.OF BEDROOMS / OWNER LoaiS VAw.AizC PERMIT DATE: CJ I -aO C(A COMPLIANCE DATE: q"(p v2C�l fp Separation Distance Between the:Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility A Feet Private Water Supply Well and Leaching Facility(If any wells exist on AA 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 l APC-W t L)E &Tee . A+ A -2. 38.2° e A-3 - 56.2° A-9- GS.3 a o i r 21.9 ° ✓ [3-3 = 4395 ° 2 ® 4 ^5 � 51 ° ® 5 Town of Barnstable P# f a g Department of Regulatory Services i nenr,erAet�4 ]i Public Health Division Date g (p a MAIM �A reap. 200 Main Street,Hyannis MA 02601 • lflt Mutt A � Date Scheduled Time , - h M Fee Pd._ d vMi Soil Suitability Assessment for Sewage D'*1 4spos Z W . Performed By: M;CA ae/ Pimet al �l'+� /= Witnessed By !�f LOCATION&.GENERAL INFORMATION Location Address Owner's Name 4.0 P_IS VQ MLAiZe- Address 1 613OX 1?(7 W•(:�6e4-(0 Assessor's Map/Parcel ` % / r✓ Engineer's Name 1G GW4;et 1 NEW CONSTRUCTION 111 REPAIR )C Telephone 14`j —SS 51 . S08-273-v377 Land Use S+174/C . {Am, pwelfin�uef Slopes(%) / Y Surface Stones N Distancea from: Open Water Body —' ft Possiblc Wet•Area ft Drinking Water Well ft Dralhage Way i ft Property Line 7 � � ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of teat holes&Para tests,locate wetlands in proximity to holes) See- Parent material(geologic)__.9MC;01 Ot/�WAsh Depth to Bedrock Depth to Groundwater. Standing Water in Hole: 7 [2611. Weeping$oltt Pit FoCa Bsdmnted Seasonal High Groundwater 7126 + DETERMINATION FOR SEASON•ALUIGH WATER TABLE Method Used: Di 1 ec f Obseryo f1 on „ � Depth Observed standing in obs.hole: 71 Z6 in. Depth to soil mottles., Z6 In.' Deilth to weeping from aide of obs.hole: 7/Z 6 ' lit. Oroundwater Adjustment N46ft. lndex Well•# Reading Dato: Index Well loyal.* Adj.,hetor, ,_. Adj.Groundwater.Laval- PERCOLATION TEST Dote -16-i6Time ►0��0OA A Observation Hole# t Time At 9" Fr Depth of Pero 3 6--$'1 Time At 6" Start Pro-soak Time @ 10,0 O Time(9"-611) End Pro-soak Rate Mlh./Inch 2 Mr; Site Sultabtllty Assessment: Site Passed CS 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 100 of wetland,you must first notify the Barnstable Conselrvation Division at least one(1)week prior to beginning. Q:ISEPTICIPBRCFORM.DOC �on�Us DEEP.OBSERVATION HOLE LOG Hole# Depth from Soli Horizon Sail Texture Shcl Color Sol]. Other Surface(in.) (USDA) (Munsell) Mottling (Stnucturo,Stonei;Boulders. tslstency.%'t3raval) o-y„ A L6-o SAod l onr 3 Z y-36R Q (-0-aml Sa..oa 10'r S 6 Med-coo rs{SA"e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Sail Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. r R DEEP OBSERVATION HOLE LOG Hole# Depth from Sol Horizon Soil Texture Sall Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders., DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Sail Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structura,SSopes;Boulders,. 5 Flood Insurance Rate Map: Above 500 year Mood boundary No— Yes Within 500 year boundary No ✓, Yes 7 Within 100 year flood boundary No. Yea Depth of Naturally Occurring Peryioiss Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorptibn system? yes If not,what is the depth of naturally occurring pervious material? .. . Cer'tiffcation I certify that on `??' 9 9 (date)I have passed the soil evaluator examination approved by this Department of Environmental Protectlo that the above analysis was performed by me consistent with . the required training a arose nd a eri ce described in 410 CMR 15.017. 840 44 Signature ` Datts Q;15flPTIC\PERCFORM.DOC � 1 i Town of Barnstable Barnstable THE T Regulatory Services Department 1 B" r Public Health Division ' I I � ' �EC 319.° 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2848 2190 August 1, 2016 Loris G. Vanlare P.O. BOX 817 West Chatham, MA 02669 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 147 Gleneagle Drive, Centerville, MA was last inspected on 07/21/2016, by James D. Sears, a certified septic inspector for the state of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level, <12" below inlet (per Town Code 360-9.1) You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. E� RDE F THE BOARD OF HEALTH omas McKean, R.S. CHO Agent of the Board of Health CC: Barnstable Department of Health and Environment Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\147 Gleneagle Drive Centerville.doc Town of Barnstable r r • HARNSi'AHI.E, 'Regulatory Services Department ,orfa�� Public Health Division 200 Main Street, Hyannis MA'02601 Office: 508-862-4644 Richard Scali;Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15,000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) Leaching pit or cesspool with high liquid level, <12" below inlet(per Town Code 360-9.1) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc 0 %I 24 2016 13:14 Jim The Inspector Man 5085349919 page 1 :i MEN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - I— ' 147 Gleneagle Drive _ Property Address !-+ Loris Van'lare Owner Owner's Name F-+ information is Centerville ✓ MA 02632 7-21-16 required for every _ page. City/Town State Zip Code Date of Inspection i" 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 filling out forms �I# �1'7(��. ��►tttluuiH�p on the computer, I 't'T ��SN DF A4�� use only the tab 1. Inspector: .��'' '`•.'C4'% key to move your per •.'S% cursor-do not =�: JAMES James D.Sears =�� 4 use the return — '—+ key. Name of Inspector =* ' o parry Na Enterprises, LLC .c+ o :4 Company Name 5'.Z,5� ??. .... r 153 Commercial Street "41, �rr� 1Nsut��\` Company Address �« Mashpee MA 02649 City/Town 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. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 16.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 9,-i7wtl�' 7-21-16 pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate q 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. t5ins.doc•rev.6116 Title 5 Official lispection Form:Subsurface Sewage Disposal System•Page t of 17 Jul 24 '2016 13:14 Jim The Inspector Man 5085349919 page 2 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 147 Gleneagle Drive Property Address Loris Vanlare Owner Owner's Name information is Centerville MA 02632 7-21-16 required for every page. Cityrl-own state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 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: Failed system - leaching pit. The system is a 1000 Gal. Tank and pit R 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Jul 24 *2016 13:14 Jim The Inspector Man 5085349919 page 3 - Commonwealth of Massachusetts TIPTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 147 Gleneagle Drive _ Property Address Loris Vanlare _ Owner Owner's Name information is required for every Centerville MA 02632 7-21-16 page. Cityfrown 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. 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 ❑ 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: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if i 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 t5lns.doc-rev.&16 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 3 of 17 Jul 24 '2016 13:14 Jim The Inspector Man 5085349919 page 4 Commonwealth of Massachusetts .. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments W 147 Gleneagle Drive Property Address Loris Vanlare Owner Owner's Name information is required for every Centerville MA 02632 7-21-16 page. City/Town State Zip Code Date of Inspection B. Certification (cost.) 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 welly". 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 NA ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in I is less than 6" below invert or available volume is less than %day flow /Pry" t5ins.tloc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Jul 24 '2016 13:14 Jim The Inspector Man 5085349919 page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 147 Gleneagle Drive Property Address Loris Vanlare Owner Owner's Name information is required for every Centerville MA 02632 7-21-16 page. CityfTown 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 other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Sectiori D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 16ins.doc-•ev.6116 Title 5 Official Inspection Form:Subsurlace Sewage Disposal System•Page 5 of 17 Jul 24 2016 13:14 Jim The Inspector Man 5085349919 page 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments , 147 Gleneagle Drive Property Address Loris Vanlare Owner Owner's Name Information Is required for every Centerville MA 02632 7-21-16 page. City/Town 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 as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of,scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): NA Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 f Jul 24 '2016 13:14 Jim The Inspector Man 5085349919 page 7 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form - Not for Voluntary Assessments 147 Gleneagle Drive - Property Address Loris Vanlare Owner Owners Name information is required for every Centerville MA 02632 7-21-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank and pit. Number of current residents: 3 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 2014-107,000Gal g ( y g (gp )) 2016-95,000 Gal's Detail: Sump pump? ❑ Yes ® No i Last date of occupancy: Present Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis'of design flow (seats/personslsq.ft., etc.).- Grease trap present? ❑ Yes ❑ No E Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins.doc• ev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Jul 24 '2016 13:15 Jim The Inspector Man 5085349919 page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 147 Gleneagle Drive Property Address Loris Vanlare Owner Owner's Name information is Centerville MA 02632 7-21-16 required for every — _. _— page. Cityrrown State Zip Code Date of Inspection D. System Information (coot.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA 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, 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): t5ins.doc•rev.6116 Thle 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 0 of 17 Jul 24 '2016 13:15 Jim The Inspector Man 5085349919 page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 147 Gleneagle Drive Property Address Loris Van lare Owner Owner's Name information is required for every Centerville MA 02632 7-21-16 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1976 Permit # 76-405 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank (locate on site plan): - Depth below grade: 14 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) i 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 H-10 Sludge depth: 3„ t5lns.doc•rev.6/16 Tille 5 Official Inspection Form.subsurface Sewage Disposal System-Page 9 of 17 Jul 24 2016 13:15 Jim The Inspector Man 5085349919 page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 147 Gleneagle Drive Property Address ------ --__..- --.---___-- Loris Vanlare Owner Owner's Name information is required for every Centerville MA 02632 7-21-16 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 2 Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Asbuilt-TapeSludge 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 14" below grade. Inlet old wall type Baffl., Outlet baffle. No sign of leakage. 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 151ns.cloc•rw.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 e Jul 24' 2016 13:15 Jim The Inspector Man 5085349919 page 11 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 147 Gleneagle Drive _ Property Address Loris Vanlare Owner Owner's Name information is required for every Centerville MA 02632 7-21-16 page. CityfTown State Zip Code Date of Inspection D. System Information (cunt.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc_): t 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.): I 'Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.&16 Title 6 Official Inspaction Form:Subsurface Sewage Disposal System-Page 11 of 17 Jul 24' 2016 13:15 Jim The Inspector Man 5085349919 page 12 Commonwealth of Massachusetts a = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 147 Gleneagle Drive Property Address Loris Vanlare Owner Owner's Name information is Centerville MA 02632 7-21-16 required for every page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) E Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Box Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No` F Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): i ' 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: F t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurlace Sewage Disposal System•Page 12 of 17 i Jul 24' 2016 13:15 Jim The Inspector Man 5085349919 page 13 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 147 Gleneagle Drive Property Address Loris Vanlare Owner Owner's Name information is Centerville MA 02632 7-21-16 required for every - page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativelalternative 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 1000 Gal, Precast Pit. Pit at 27" below grade w/cover at 9". Pit is full to top. Pit not leaching. Need to replace leachin�c.. _ 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 15ins.tloc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i f Jul 24•.2016 13:15 Jim The Inspector Man 5085349919 page 14 Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments A 147 Gleneagle Drive Property Address Loris Vanlare Owner Owner's Name information is required For every Centerville MA 02632 7-21-16 - - 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.)-. 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.): 15ins.doc•rev.6/16 Title 5 Officiei Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Jul 24'.2016 13:16 Jim The inspector Man 5085349919 page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments A 147 Gleneagle Drive Property Address Loris Vanlare Owner Owner's Name requir reqtionuired is Centerville MA 02632 7-21-16 required for every page. Cityrrown Stale Zip Code Date of Inspection D. System Information (cont.) 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 OARAa E �= ;L8 Li a .41 0 r o � t r t t5ins.doc•rev.6/16 Title 5 Official Inspection Form;SuWur/ace Sewage Disposal System-Page 15 of 17 Jul 24`-2016 13:16 Jim The Inspector Man 5085349919 page 16 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 147 Gleneagle Drive Property Address Loris Vanlare Owner Owner's Name information is required for every Centerville MA 02632 7-21-16 page. Cityrrown Stale Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N� Estimated depth t high ground water: 12'-+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting propertylobservation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: T.H. at house on RD. ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. at 167 Glenea le (1977) no G.W. at 12'+. Before filing this Inspection Report, please see Report Completeness Checklist on next page. i t5ins.doc•rev.6116 Title 5 Official Inspadion Form:Subsurface Sewage Disposal System•Page 16 of 17 Jul 24. 2016 13:16 Jim The Inspector Man 5085349919 page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for VoluntaryAssessments ents . 147 Gleneagle Drive Property Address Loris Vanlare i Owner Owner's Name information is required for every Centerville MA 02632 7-21-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® 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 t ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t51ns.doc•rev.6116 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 N . � ... Fine .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _......... .... __ ...-. ..........OF..............................-.--.......-..-...-.-.-....---------------...----------- Apphratiun -fur ]i.ipuuttl Vorko Tunutrnrtiun Prrntit Appli, tion is hereby m e for a Perm//it to Construct ) or Repair ( ) an Individual Sewage Disposal System a �G�� Locati�o -Address t^� or Lot Nof/l i,wow � Installer N Address�� Q Type/of Building Size Lo _ dL'--"___Sq. feet U Dwelling Edo. of Bedrooms _ -!_!d_____________________Expansion Attic ( ) Garbage Grinder t7L)b a Other—Type of Building -_ ___ �L! ��-.No. of persons____________________________ Showers ( ) — Cafeteria ( ) Oti r fixtures .................... -------- W Design Flow:.W' ________________________________gallons per person per day. Total daily flow._:__0 W Septic Tank—Liquid capacity j _gallons Length---------------- Width................ Diameter................ Depth_._--____-___-.. Disposal Trench—No..........._......... Wid h_.__..•._.._.___.-__ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.611---— Diameter_ r��__ Depth below inlet___________________ Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank j'-11' 74• aPercolation Test Results Performed by------ ----------------------•---------._.._.__....--•--••-•-•--•••----- Date-•---•------------------------••------.. Test Pit No. I......_---------minutes per inch Depth of Test Pit.................... Depth to ground water-..___-__-__-_-_---- f Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water_..__-._.______-__-_.--. �+ �� =�! Description of Soil------- (® ._..- •-• •---•-•--• •• t/ __.12 x ---------- ---------_--------- --------------------------------------------------------------------------------------------------------------------- ............... --------------------------------- U Nature of Repairs or Alterations—Answer when applicable...........................................__________________________........_.................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Dii posal System in accordance with the provisions of Article XI of the State Sani ary Co e— The undersigned fur , f agrees not to place the system in operation until a Certificate of Compliance ha e ssued byte 'oa ,of health. � -- -----„---------' L-- Date / Application Approved By--------• •-- ------ --•••-�----- l �74..•-- -- -- --------- -- ---- - Date Application Disapproved for the following reasons_________________________________________________________________________________________________________________ •----••-•---•-------------•-•-------•-----------------------•-•-•-----•-------------•-----•--------------I--------------------------•---------------------------•------•---•-----------•------•-•--_----- Date PermitNo......................................................... Issued........................................................ Date ----------------- — --------------------------- �_ No. (J .. F�a...... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. .. _. ---------------OF...........................I............ .. . ...-.........•.................. Applirtttion -for Disposal Works Tonntrnrtion Puniit Applicaion is hereby ma e for a Permit t�C nstruct�( )fo%�Repair ( ) an Individual Sewage Disposal System atk I(� f { f -�k--Location Address Ad / . � f Installer Address // ,i I U Type-of Building Size Lott.,:--.7 __QL.�":Sq. feet Dwelling-4-11o. of Bedrooms.d ?1..(!`/'1 ---------------------Expansion Attic ( ) Garbage Grinder Other—Type of Building ... 3".-No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures . ' ---------------------------•---........-..-------------------------------------------- Desi n Flow_: ---------------------------------- Mons' r person per day. Total daily flow......: 0------------------------- allons. W g g� P- P P Y• Y g� W Septic Tank—Liquid capacitv.J.l gallons Length---------------- Width........ Diameter------------ --- Depth.............._. x Disposal Trench—No. .................... Width.................... Total Length..----..-..--.------ Total leaching area--------------------sq. ft. 3 Seepage Pit No.. �---- Diameter... 6 Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) M-"";"'1h,- . J�"-//- 74 aPercolation Test Results Performed by........................................................... ... Date...........................------....... Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water........................ �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........--.------------ r,r i----------- •-•• .... ..:................•-•---••-•--;; ----------, - •----1`---•---•------------------------------- O Description of Soil--------- {��....G-_.-.._Gt l(�! ! ` / x ---------------• -- / yc�t'1�v W ------------- -----• x ---------=f---------------------•-•----• ----..---- - -----...-------------------•------------•-•----•---..-..-----------------------------------------------------------------------•---------------- U Nature of Repairs or Alterations—Answer when applicable...................................................................................------------ Agreement: The undersigned agrees to install. the afoo described Individual Sewage Dpyosal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned fur ,ll�rfagrees..not to place the system in operation until a Certificate of Compliance has�ee issued by the loa of heal't ig �j� C ate Application Approved BY---.----- /_LfiL� ��!'f 1 �1 / - � Date Application Disapproved for the following reasons:---•---•------•--•-----------------------------•-------•-----------•----.....-.........---•-----------------•--• ............................................................................•-•-----.....---•-----------------......----•-------------•-------•------------------------------.........-....---------.--- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��-... . .. .. OF......... .'?................................................. T.rrtif irtttr of f�onmplittnrr THIS T CERTI,E Tha tlh dividual Sewage Disposal System constructed ( or Repaired ( ) by = f - , staller has been installed in accordance with the provisions of Ar rcieLX/I of The State Sanitary Code as described in the application for Disposal Works Construction Permit No... .............. dated....... ............... THE THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------- .T 7• .......................... Inspector.-------- \ ........... THE COMMONWEALTH OF MASSACHUSETTS 571 BOARD O HEALTH `�/� .............`..........................OF...... .... N .----•-------•-----•----• FEE... .......... i�V1Itt ork.� - n rtio$trrntit Permission i eb granted...... 1� A.....•.----- L ........I-------•--•------------------------Yg to Constr � or epair �n Individual S age isposal S at No. -�'= y Street as shown on the application for Disposal Works Construction Permit 1�/�T}o��./.-- .- ---/. D//J//a//tP,d...�.-- ---7`------------- ------------------ / ^ l .C.�A� Board of Health 7 DATE.................-.............................................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS LOCL.TIOKI : 5E\N6,C,E PERMIT UO, I IW5T&LLER S W&ME 4� ADDRESS - - - - a0 li-'� /So 1,vulh N f�T lU�adH s7u�/.� — BUILDER 5 Q [ MF— ADDRE 55 DQ"TE PER"VT ISSUED DATE COMPLIW-dCE ISSUED : — �. i� ,�. ._ , .a8 ,; �� L'/ s_, ,� �:� .�y� ��, LOC&T10N ' 5EW8,C4E PERMIT VJO- VILLAGE _ -C2,v�� eLA- — — — IMSTaLLER S VI&ME ADDRESS - BUILDER5 1.1 &"F- l.�DDRESS Dt-\TE PERMIT 1SSUED '— _ _ =3_l=7&5- 7 D ATE COMPLI &KICE ISSUED : _ =� --Al -_- .-,-....,..- - s- .�.-_.�..........-+,•mow.-•.�..-r.•r _ �_...� ....yw.....�.,..-..u.. -+-0.-- « _ -i .. t-•"..�+.. ry._- �- -7. I il -� , ; -_+ - r ` + • +-,' :, r rL ",. ` M`•*•- y-' - r" ..' c3"., . rT;• . . ! w•,~T , " .., "L'- ` .3 r .T , � --.a s,'k •.'.1 y I - 'i- r,J" f • e - .t .- - . •�,.. t 11 ! ' K j" , f♦ , i „X;Y kl Vl.,'�„1"n, l-w. s,.�r'Y ��,rtL.,r r s. -^-!Fti"-- 1--'--r--r-"' -�`,3 'I�. I , -, �j - _ Y - s•- _ L'1'Ea5 r0^.E LOAM H'r•L[. •`2'""M'Ai-T -.. '/�IDaD LORM 4• .'ti �`• + • •I � . - :�., D s .s '" ,.�u , ,tea i ,� •^,�, y I �+`•I•. ,f� °t 2�'� ` �1S + )- 4'IG.;I t :� I. i3[d�tst. ' � t ' .. e i - ..: it 1. .t . . !i ! I . ,C e `! [ ADX t. I.i°�� v 'r t x - . T h '0• a' I -!OdO,.' s 2y �`' a`, o' �W !000^ GAL_ + a y, o�, .., .. _ a -'''�,f_ y'9t{' + /�.- ,.,.. i l .GAL,' I �_ --I ' I*� I �I PRECAST • OR , 'I' .+ t ;r � .3�� , t �� -1r', t[ . SER?71C !• _ .�. :6 �'o' ,;- 6LOCK , e I r � - , i , - rs y :TANK' ' _ • ` e! SEEPAGE _ PIT iM1.,. �'_ `1 .Y 'r ,,'' . .i !, I fjrr} �, U .. # I. 'III - i _ - y.a` 1 9� • o o t �• r.. ,, F "} :tia �r r �� 20' ,MINIMUM` Ii{"�.T- s f �'�T I�i . . I - 4 <-.� �:-" ' 4.° �h'a P- a. .V-..,SO o D o r r . _ r-.i { r I- '� _-.1� �; - r . * 2 . +" ! Y= WASHED �STO,NE �� - �} � , . .a - .. . 2`o ° �• a< -�,v ., �! -" e ., % i SCALE x' I`• 4` � ..' i�) '. n ..�.• • , • 1. _ ,!y �L. ..... s. . - Y ,s/� . "' W /. is t1 . i[`Y e. 1' _ �' _ :� .€, ` _ - }�•+•-�. 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Li m. --I y'i €= , � a ,1 ' -4 J ! 4 _ - r _--= --xi-fir _ -. - sr_• - �.,--I!=, ' _ 1 to c , , r i .. I - r I - _ T.O.F. EL.- 61 .1�t r--FINISH GRADE OVER D-BOX = 59.8'f FINISH GRADE OVER CHAMBERS = 59.8 - 59.5' 3/4" TO 1-1/2" DOUBLE WASHED SLOPE @ 2% MIN. OVER SYSTEM STONE TO CROWN OF PIPE - PROVIDE EXTENSION RISER �REMOVABLE WATER-TIGHT COVER OVER i. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION /// WITH COVER OVER INLET & RISER TO WITHIN 6" OF FINISHED GRADE 4" SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL OUTLET TO WITHIN 6" OF F.G. 0 2" OF 1/8"TO 1/2" DOUBLE WASHED FINISH GRADE , 5" DIA. OUTLET(S) MIN SLOPE 1 /a BOX TO F.G. (SEE NOTE 21) STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES. @ FND. EL.= 59.2 F.G. OVER TANK EL. = 59,2 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE tPLACE RISERS ON ALL DESIGN ENGINEER. 9" MIN. TOP OF SAS= 56.$3' CHAMBERS WITH 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PROPOSED 4" 9' MIN. - � OF SCH 40 PVC , 36" MAX i � jQj,QQ� 36"MAX. i BREAKOUT EL = 56,501 INLET PIPES TO 6" DE SYSTEM UNLESS OTHERWISE NOTED. J FINISHED GRADE-= SEWER PIPE 4 TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6" 3" 3"; DROP MAX 3„ 9°, i L=21"± PROVIDE WATERTIGHT i o o ELEVATION = 56.50' FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE SAS UNLESS A 2 DROP MIN MIN SLOPE,*t , o 0 i f -JOINTS (TYP.) �w 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 4'" PVC IN FROM 4 (--1 O Q o �1 13 4" PVC OUT TO L-i j-' 4c;: THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 14" SEPTIC TANK LEACHING FACILI� Y \j oo I --, --, r--� r - -� r- - - r--�n c c r--- r--, ?-- 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. o CONTRACTOR TO PROVIDE o eo SPECIFIED DROP BETWEEN 12 6°° ( oQ 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL OUTLET TEE 56.37 MIN. 56.20 0 0 0 0 o 0 0 0 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK SHALL VERIFY SIZE 48" VERIFY CONDITION OF \ AND CONDITION OF EXISTING TEES GAS BAFFLE i 6" CRUSHED STONE o o 0 00 o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY o _ NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE !! ii f AND DESIGN ENGINEER. f 4.0'_ T 1 4.0' T ! 5 -8.5 (�YP) i 4.0` 4 83' 4.0' i OUTLET DISTRIBUTION BOX I 8. ELEVATIONS BASED ON APPROXIMATE ti1.S.L DATUM. BENCHMARK ELEVATION OF 60.00' 1 TO BE INSTALLED ON A LEVEL STABLE --25.0' (TYP ) ESTABLISHED ON THE CORNER OF THE BULKHEAD, AS SHOWN ON PLAN. i BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 49.00' ! 12.83' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL 54.00, 2 - 500 GALLON CHAMBERS THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT s MIN. ,HAA/IRF�? END VItW EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES 33�� +ppi ``� TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. E P U S T R I Q $ t t1I) 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM PERC NO. 15128 APPROPRIATE AUTHORITY. • ` r INSPECTOR: David W. Stanton R.S. 12 ALL SEPTIC SYSTEM COMPONENTS SHALL.WITHSTAND H-10 LOADING UNLESS LOCATED EVALUATOR: Michael Pimentel, EIT, CSE UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT. DRIVES, OR • • TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. C S.E. APPROVAL DATE: Oct 1999 .» c�. • '» '4' + '' DATE:. August 16, 2016 13 DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. �� ; • _ TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE t� w MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY • =' 'h * 'ELEV TOP = 59.50 REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). ELEV WATER < 49.00' = » 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN _ MAP 191 , x PERC RATE _ < 2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. > +. '-;i• PARCEL 146 `i DEPTH OF PERC = 36"- 54" 16. PROPOSED PROJECT IS LOCATED WITHIN: • » TEXTURAL CLASS 1 ASSESSOR'S MAP 191 PARCEL 145 + » - • OWNER OF RECORD: LORIS_G. VANLARE _ ` , r ♦ > t • • :• > > _ r • Si N7$= 28, 2pr.tAl \� .�?• * .. ,r.,,, '1G' ► • • t` •,. • ktiJ f " P.O. BOX 817 m yVV a �; 1> s r , • Z '9 0, 59.50' ADDRESS: MAP 191 ^` • • • Loamy Sand _ WEST C_HATHAM, MA 02669 PARCEL 145 LOCUS • ZONE X r . '� ! I > 4" 59.17' FEMA FLOOD 15,620 S.F.± -� • COMMUNITY PANEL# 25001 CO561 J Loamy Sand �80 • w/G *. ` Ir f ` ' :` B 10Yr 5/6 17. DEED REFERENCE: DEED BOOK 29065, PAGE 159 fw f .• I �Q 1 i , • . • 18. PLAN REFERENCE: PLAN BOOK 260. PAGE 71 'CF'� \ �/ M «. • ';=.` '� �1. �`` *; 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY Benchmark GARAGE •" •�, r +` , t - . "` • ; *••' , "r + FOR SEPTIC SYSTEM UPGRADE. JC ENG�iVEERING WILL NOT ASSUME ANY LIABILITY MAP 191 a o Corner of Bulk Head • > • ♦ IJ�f ry ,� +_ Y r > C Med -Coarse Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. PARCEL 59 ` Elev. =60.00' HC-2 - s, - •_Jogs v� Approx. M.S.L. \ / 21. A 4" PERFORATED SCH. 40 PV0 PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A �x�: DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3" OF FINISH GRADE. A / REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. P LAN 22. OWNER/APPLICANT/ CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL Locus REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. SCALE: 1" = 1000' 126" 49.00' �• I�t�� / No Mottling, Standing or Weeping Observed PROPOSED 2-500 GALLL \ON LEACHING } gULK \ � GHI1y HEAD � �\. GAS -_ GAS -__ CHAMBERS W/AGGREGATE \� \ wq �__ GAS - GAS DESIGN DATA PR. D-BOX 59 2 ROX, WATERLI Ewe V GAS GAS PERC NO. David W.1Sta non. R.S. EXISTING SPOT GRADE \ (4) 60.5 k` GAS GAS NUMBER OF BEDROOMS (EXISTING) 2 INSPECTOR: _ EXISTING CONTOUR - NUMBER OF BEDROOMS (DESIGN) 3 (MIN PER TITLE 5) EVALUATOR: Michael Pimentel, EIT, CSE / #14/ / ✓ C.S.E. APPROVAL DATE: Oct. 1999 r"50 PROPOSED CONTOUR R. INSPECTION PORT -� coo (1� EXISTING \ W� / DESIGN FLOW 110 GAL/DAY/BEDROOM DATE: MAP 191 ;� : 2-BEDROOM +✓ August 16, 2016 PARCEL 48 / TP 1 �' DWELLING / TOTAL DESIGN FLOW 330 GAL/DAY 50 PROPOSED SPOT GRADE TP 1 3 DWELLING - TEST PIT#� 2 Zz \ h� LU DESIGN FLOW x 200 070 660 GAL/DAY _- EXISTING GAS LINE �-- 31 1V S ELEV TOP - 60.00' - ° �.._ 0 �"�'- p USE EXISTING 1,000 _ GALLON SEPTIC TANK ELEV WATER =_ < 49 50' EXISTING OVERHEAD WIRES TP 2 b _ (3) wq{ " (2) o L PERC RATE - EXISTING WATER LINE �,, .._j INSTALL 2 - 500 GALLON CHAMBERS 60.5 2S_°' "-` / / " W wl AGGREGATE DEPTH OF PERC = EXISTING TELEPHONE LINE Q W ll,J � TEXTURAL CLASS: 1 HG-1 Q Z U SIDEWALL CAPACITY - '� TEST PIT LOCATION a LU (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) - GAL/DAY ! % � ' EXISTING 1,000 GALLON SEPTIC TANK (25.0 + 12.83') ( 2 ) ( 2' ) ( 0.74 GPD/S.F.) = 112.0 GAL/DAY 011 60,00' rn Loamy Sand PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE v w BOTTOM CAPACITY A 10Yr 3/2 �„•, 4i ' (LENGTH x WIDTH) (0.74 GPD/S F.) = GAL/DAY 4" 59.67' PROPOSED DISTRIBUTION BOX 1�-�~y"'�--•. (25.0' x 12.83') (0.74 GPD/S.F.) = 237.4 GALDAY B Loamy Sand PROPOSED 500 GALLON LEACHING CHAMBER TOTALS: 36" 57 00' REV. DATE BY APP'D. DESCRIPTION _�-�'"`-•. TOTAL NUMBER OF CHAMBERS 2 _ TOTAL LEACHING AREA 472.2 SQ.FT. PROPOSED SEPTIC SYSTEM UPGRADE 15; 56° TOTAL LEACHING CAPACITY 349.4 GAL./DAY PREPARED FOR: MAP 191 N78 28 .20,w CAPEWIDE ENTERPRISES � I! Med.-Coarse Sand PARCEL 144 I! C 2.5Y 6/6 ILOCATED AT l 147 GLENEAGLE DRIVE CENTERVILLE, MA 02632 NOTES: TAPE SHALL BE PLACED ALONG THE TOP EDGE OF SWING-TIES -� j SCALE 1 INCH = 10 FT. DATE: AUGUST 30, 2016 1.) MAGNETIC MARKING 126 EACH SEPTIC SYSTEM COMPONENT. 49.50' c e io zo ao FEET DESCRIPTION HC-1 HC-2 o No Mottling, Standing or Weeping Observed It .J SHALL VERIFY SOIL CONDITIONS !N THE LOCATION OF - PREPARED BY: 2.) CONTRACTORCORNER OF STONE (1) 35.2' 48.2' Jo""�• - JC ENGINEERING, INC. THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST RESERVED FOR BOARD OF HEALTH USE - CHURCHf L JR. PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL CORNER OF STONE (2) 32.7' 58.6' �' bw 2854 CRANBERRY HIGHWAY BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. No aiao7 EAST WAREHAM MA 02538 CORNER OF STONE (3) 57.T 74.9' ! i R - G r ' 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS- , r i SITE PLAN CORNER OF STONE (4) 59.2' 67 1' � (� /,�J�1� 50$.273.0377 SCALE: 1" - 10� I _ Drawn By. JC designed By JC Checked By MCP JOB No 3575