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Home My WebLink About0033 GOOSE POINT ROAD - Health 33 Goose Point Road Centerville A - 252 - 069 /// S M E A D� No.2453LOR MUM nn @do= 9 wa.in M No. /15 Fee THE COMMONWEALTH OFMASSACHUSETTS Entered in c pater: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS",." Yes 01ppl.tation for Mispo8ar *pstpm Construction 3pPrmit r Application for a Permit to Construct( ) Repair'Upgrade( ) Abandon( ) ❑Complete System Q Individual Components Location Address or Lot No. T5 f cvCC Po,o+ Ip04 wner's Name,Address,and Tel.No. a.�e l 0 J/ Co�� -.vc �Ofs'-77G'4310 Assessor'sMap/Parcel S��/� �6 7 O SAV, 2 2 om Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.'. �Z k�� dad �� rt�� v y: �4hl�s � a �� Pd4 ,S�Ar-a. Type of Building: Dwelling No.of Bedrooms / h,,e Lot Size Q sq. Garbage'ba ge Grinder Other Type of Building No.of Persons Showers( ` ) .Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided l gpd Plan Date I� ®I Number of sheets Revision Date , Title Size of Septic Tank Type of SAS Description of Soil r Nature of Repairs or Alterations(Answer when applicable) If Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the.Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date / /1,1 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. G ��_ Date Issued p' -- s Fee - No. d � � � THE COMMONWEAC�p'OP,FIVIASSACHUSET;TS Entered in cpuler: PUBLIC HEALTH DIVISION - TOWN iOF BARNSTABLE, MASSACHUSETTS Yes %* 01pplltation for Disposal .6pBtem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 6w9c 170+0_' J?64d L 14/ Owner's Name,Address,and Tel.No. ^<< S' 76.090 Assessor's Map/Parcel �(� ,( d Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. R-Kee LcA l ,54.ov l<►a►l V.N• ✓.*XS ,-s 3-70 Cod a fi33• Type of Building: Dwelling No.of Bedrooms T ee g Lot Size sq.ft. Garbage Grinder( ) 10 Other Type of Building No.,of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 6 gpd Design flow provided 39 . gpd ' Plan Date ] 14- bls Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. -Description of Soil 'y Nature of Repairs or Alterations(Answer when applicable) T Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date J, / 0 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued 0- / --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repairg& ) Upgraded( ) Abandoned( )by �;IAA/' Cno �an S' ,C 4, at ;�lo ��„� Rar has been constructed in accordance Q A 5� with the provisions of Title 5 and the for Disposal System Construction Permit No"=' led J 1 p r Installer A Designer it #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a g arantee that the system ' functio de i d. Date Inspector ___-_____ __ ___ ___ _ .. ___v_______ ___ No. f� C� '",\; 8 ') Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Rep air') Upgrade( ) Abandon( ) System located at . UCJGSG �h��7 rl"o 4 I 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 ermit. i, Date Approved by 1 , ' . _ TOWN OF BARNSTABLE a LOCATION 3 Q®.Ak Q� SEWAGE`# VILLAGE ��{,/�o�l� ASSESSOR'S MAP&PARCEL :152 YO INSTALLER'S NAME&PHONE NO. R`,k,�J LZt,0r)L SEPTIC TANK CAPACITY /415'C,o cry LEACHING FACILITY-(type) %^Je\1s 4{ o(size) Cbo SckL. NO.OF BEDROOMS OWNER PERMIT DATE: . !/ COMPLIANCE DATE: I ,� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet` Private Water Supply Well and Leaching Facility(If any wells'exist on site or within 200 feet of leaching facility) Feet Edge.of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 1 W Orr at tir Town of Barnstable Regulatory Services Thomas F.Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-9624644 Fax: 508-790-6304 Installer&Designer Certification Form Date: �'�10'/� Sewage Permit# X/S-c2P Assessor's Map\Parcel S 2 -,-/`(O Desig@er: /¢SS4C WleO.S Installer: Address: 5:7�D 641-f AQal Address: On XiI&V /6,t ;�2�d4as issued a permit to install a (date) (installer) ��4S�° ` septic system at �� /o/�I based on a design drawn by ///, (address) �/!� A-� dated -7-/�; '/5 Gila) 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. lers (mil ' Signature) #906d w� At IT A0 (Designer's Signature) (Affix Designer's Stamp Here) ff&M RETM 10 RAR&U6M fUBUC WULTR D N. C R OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FOI3Ai FAND AS-BUILT CARD ARE RECEIVED$X THE BARIVSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Certificatkm Farm 3-26-04.doe 4 Town of Barnstable. P# /�/7 2- °t Department of Regulatory Services AKA Public Heal: Division Dace -s ,L 200 Main Street.H�nnis MA 02601 A. Date Scheduled i Time. l DZ11, Fee Soil Suitability �lssessmenl for Sewage 'sposal ri Perfornted'Br Witnessed By: ` tA,- n �C i LOCATION&GENERAL INFORMATION / IA=Uon Address'. �� L° /�� /�„� Owner's Name Jew?5 Address • - � I _ d/psi Assessors Map/Pvcci: 4�Z/�0 / ( Englaftes Twine 1//� NBW CONSTRH�InON REPAIR r I Telephone# Land Use S/ Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Arm ft Viking Water Well ft Drainage Way A7 ft. Properly Line --25—ft Other ft SKETCH:0treet name,dimensiods'of lot,exact locations of telkt holes ac perc tests locate wetlands in proximity to holes) 12 iz 10 V 00 a a s.D /Ve Depth to Bedrock Parent material(gedlegic) Depth to Groundwater: Standing Water in Hole: `f Weeping from Pit Pace Estimated Scasonalhigh Groundwater !D!tT�- FItMN, N FORSEASON GH WATER TALE Method used: !7v/ �tfy/ th to Sell mottles: Depth (lbperved standinglin obs.hole: in• Dep g, Depth tolweeping from side of obs.hot& I in, uroundwn�r Ad)u Adj.t Index Well level,.,.......... Adj.Actor.,..,..r,..�►all�C1t+vttndwateri eval.,,,_, Index Well#_� Reading Date: I . PERCOLATION TEST Daiaxim /D�'�Q Observation I Tiete at 9,, =— Hole# . 49. Depth of Perk ,may Start Pre-soak'[Sme.0 • �:.y r' _ - •� 'Iitna(9"-6") _�._•-- -- End Pre-soak RtiteM'mAnch Site Suitability Asscpsment: Site Passed Sitc Failed; _ Additional Testing Needed(YIN) thi 'naL:Public He�ith Division Observatiod Hole Data To Be Completed on Back---- ***If pergola 'bn testis to be conducted within 100' of wetland,you must ffrst notify the Barnstable C4#servation Division at least one(1)week prior to beginning- JCS 5 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil ' Other Surface CIO.) (USDA) (MUMC11) Mottling (SUMM;%0ACS,Boulders, • 6 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsostencX. 13 G 7 6 46 DEEP OBSERVATION HOLE LOG Hole# Depth from' Soil Horizon Soil Texture Soil Color Soil • Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color $oil Other Surface(in.) (USDA) (MUNWI) Mottling (Structure,Stones,Boulders. consistencilomyell Flood Insurance Rate May: Above 500 year flood boundary No= 'Yes f Within 500 year boundary No_sZ Yes Within loo year flood boundary No Yes Death of Naturally Occurring Pervious Material Does at least four feet of Dattually occturing pervigtp material exist.in all area observed throughout the area proposed for the soil absorption system? VM If not,what is the depth of naturally occurring pe 'ous material? Certification , I certify that on/�'� Z (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expe ' e and experience described in 3.10 CMR 15.017. Signature Date 7� Postal CERTIFIED MAILT. RECEIPT tti (Domestic Er For delivery information visit our website at www.usps.come Ln MPostage $ M'q O� Certified Fee S rq Postmark O. p ReturnReceipt Fee fIM -' 0 th1(Endorsement Required) �',� 21g 0 Restricted Delivery Fee Q (Endorsement Required) rU fiJ Total Postage&Fees $ 1 S Q 5 ra rq 0 o James E. Colegrove M1 418 Long Plain Road -••••••----------•----•- Leverett, MA 01054-9764 Certified Mail Provides: r A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years - Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mails. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.,To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for; a duplicate return receipt,a 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. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 Postal CERTIFIED MAIL-Nr. RECEIPT ru (Domestic Mail Only;No Insurance Coverage Provided) p For delivery information visit our Website at www.usps.come mPostage $ _ piq Certified Fee ostm C3 rkY� p Return Receipt Fee � Here S p (Endorsement Required) p Restdcted Delivery Fee C . a p (Endorsement Required) o rpU Total Postage&Fees s James E Colegrove �� 33 Goose Point Road Centerville, MA 02632-1912 Certified Mail Provides: . ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Pdstal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. is t ■ 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. j PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 1 COMPLETE •N COMPLETE THIS SECTIONON DELIVERYD ■ Complete items 1,2,and 3.Also complete X Signature1 ❑Agent `� C `�O item 4 if Restricted Delivery is desired. i ■ Print your name and address on the reverse ❑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, or on the front if space permits. t D. Is deliv Ladd e�r�it, o item 1? ❑Yes 1. Article Addressed to: If, nter d21i'a ddress below: ❑No y 7 r"q� _ tV James.E. Colegrove 31 418 Long Plain Road 3. servioeType / Leverett, MA 01054-9764 O certified Mall® ❑Pri ty Ma -Express'" ❑'Registe ed--, .. 032etum Receipt for Merchandise ❑Insured Mail Ek C.64cto,n Delivery 4. Restricted Delivery-(Eiit�ra Fee) ❑Yes 2. Article Number tt=ti ttii?It t`:it Mlili (� (Transfer from service labeq 7 014 12 0 0 0 0 01 0 3 5 8' 4 9 4 7 M PS Form 3811,July 2013 Domestic Return Receipt k UNITED STATES' `Fi�t � �1fE� First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address„and ZIP+4®in this box* Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 TM pp�ME Tpw Town of Barnstable U.S.POSTAGE)>Pirr;�v eowEse, Public Health Division AS 200 Main Street MS. pTFD MP'tP•� Hyannis,MA 02601 „ '� OZ2 Ory601 $ 006.48� x �. 0001383424JUL. 07. 2015 T x 7014 1200 0001 0358� 4022 James E Colegrove 33 Goose Point Road Centerville, MA_02632_1.912 i X € 15 lU7'E 1��3 '14 .07/07 /15 II FORWARD TIME EXP RTN TO. SEND COLEGROVE '3AMES E 418 LONG PLAIN RD LEVERET MA 054 9764 ..... .... .»r,'s:w'.:1:..:' .t....i....�... .. 1 pr`n.F i 1.1 R. 14 �2_ 0 2 0'1A4 WO 2 I { SENDER: COMPLETE THIS SECTION COMPLETE THIS.SECTION ON DELIVk,�Y ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we Can return the card to you. B. Received by(Printed Name) C. Date of Delivery f ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Item 1? ❑Yes i 1. Article Addressed to: If YES,enter delivery address below: ❑No I � I i James E G-olegrove 33 GooseM- aint Road Centerville,'•_MA 02632-1912 3. Service Type \� ❑Certified Mall® ❑Priority Mail Express'" i ' ❑Registered ❑Return Receipt for Merchandise i ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra fee) ❑Yes \ J 2. Article Number + 7 014 12 0 0 0 0 01 0 3 5 8 4 0 2 2 ✓'� (Transfer from service labeq MM 3 C Ps Form 3811,July 2013 Domestic Return Receipt 1 Town of Barnstable Barnstable Regulatory Services Department �`�j Y I ' Public Health DivisionMAM m .19. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL.# 7014 1200 0001 0358 4022 July 7, 2015 James E. Colegrove 33 Goose Point Road Centerville, MA 02632-1912 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at,33 Goose Point Road, Centerville,MA. was last inspected on 6/17/2015 by Troy Williams, certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines Of 1995 TITLE 5 (310cmr 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 may result in future enforcement action PER ORDER OF THE BOARD OF HEALTH hods McKean, rS--, CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\33 Goose Point Rd Cent Jun 2015.doc Q.� G I I e C . Town of Barnstable Barnstable Regulatory Services DepartmentBARM ft"s"B'E Q�' Public Health Division. I I 639. `$o 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Riochard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7014 1200 0001 0358 4022 July 6, 2015 James E Colegrove 33 Goose Point Road Centerville, MA 02632-1912 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 33 Goose Point Road, Centerville, MA was last inspected on 6/17/2015 by Troy Williams, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" un the guidelines of 1995 TITLE 5 (310 CMR 15.0) due to the following: p In . • Leaching pit or cesspool with high liquid level, <12" belo pit r 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. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\33 Goose Point Rd Cent Jun 2015.doc 6/30/2015 Parcel Detail Q ,x r - }.l fi,ULASCAOL.k_ Logged In As: �� Detail Tuosday, .Ijne. 30 20,15 Parcel Lookuo Parcel Info _ Parcel ID 252-040-T00 Developer Lot LOT4 1 Location 33 GOOSE POINT ROAD Pri Frontage 70 Sec Road , Sec Frontage Village CENTERVILLE Fire District'C-O-MM Town sewer exists at this address No ' Road Index 0614 rw. Interactive Map f • Owner Info Owner COLEGROVE, JAMES E owner V � �y Streetl Street2 city state MA Zip 02632 Country Land Info Acres 0.46 use Single Fam MDL-01 Zoning SPLT Nghbd 0105 v Topography Level Road Payed utilities Public Water,Gas,Septic Location Construction Info Building 1 of 1 Year 1970 Roof Gable/Hip Wall Wood Shingle Built struct AC Living 1184 Roof Asph/F GIs/Cmp p None Area Cover Type style Ranch EE Int wall Drywall Ro Bed oms 33BBedroomsF In Bath Model Residential ! Floor Typical Rooms .1 Full-1 Half Grade Average Type Hot Water Rooms Total '5 Rooms Heat Found Stories 1 Story Fuel C'aS ation Typical Gross 3 Area178 Permit History Issue Date Purpose Permit# I Amount I Insp Date Comments Visit History Date Who Purpose i http://i ssq 12rntranettpropdata/Parcel Detai I.aspx?ID=18643 1/2 I - Town of Barnstable. Regulatory Services Department. 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. 4/28/15 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) X Leaching pit or cesspool with high liquid level, <1.2"below pit(per Town Code §360-9.1) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments rY 33 Goose Point Road, Centerville M-252 P-40-T00 Property Address Bruce Colegrove Owner owners Name information is required for every P.O. Box 282, Montague MA 01351 June 17 2015 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information 5 ' � y on the computer, use only the tab 1. Inspector: key to move your cursor-do not Troy Williams use the return Name of Inspector key. Troy Williams Septic Inspections ap Company Name 19 Hummel Drive Company Address South Dennis MA 02660 Citylrown State Zip Code (508) 385- 1300 S1682 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 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority f June 17, 2015 Inspectors 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. 10��1" t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 T I . Commonwealth of Massachusetts Title 5 Official Inspection Form BMW Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "< 33 Goose Point Road, Centerville M-252 P-40-T00 Property Address Bruce Colegrove Owner Owner's Name information is p O. Box 282, Montague MA 01351 June 17, 2015 required for every q page. Cityrrown 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-3113 Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 33 Goose Point Road, Centerville M -252 P-40-T00 Property Address Bruce Colegrove Owner Owners Name on requiredlforl every eve P.O. Box 282, Montague MA 01351 June 17, 2015 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 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �Y 33 Goose Point Road, Centerville M-252 P-40-T00 Property Address Bruce Colegrove Owner Owner's Name information is required for every P.O. Box 282, Montague MA 01351 June 17, 2015 page. Citylrown State Zip Code Date of Inspection .B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 m, provided that no other failure criteria are triggered. A co of the analysis must PP P 99 PY Y be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all Inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-3113 Title 5 Official Inspection Form:Subsurfaos Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 33 Goose Point Road, Centerville M-252 P-40-T00 Property Address Bruce Colegrove Owner Owner's Name information is required for every p O. Box 282, Montague MA 01351 June 17 2015 page. Cityrrown 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Tide 5 Official insp ection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "l 33 Goose Point Road, Centerville M-252 P-40-T00 Property Address Bruce Colegrove Owner Owner's Name information is P.O. Box 282, Montague MA 01351 June 17 2015 required for every , page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were 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): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurraee Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "f 33 Goose Point Road, Centerville M-252 P-40-T00 Property Address Bruce Colegrove Owner Owner's Name information is required for every P.O. Box 282, Montague MA 01351 June 17, 2015 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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 14=26,000 gals. g ( y g (gp ))' 13=42,000 gals. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Aug. 2014Date CommerciaUlndustrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/AGallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A 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: N/A t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "< 33 Goose Point Road, Centerville M-252 P-40-T00 Property Address Bruce Colegrove Owner Owner's Name information is p O. Box 282 Montague MA 01351 June 17 2015 required for every � , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/A Date Other(describe below): NIA General Information Pumping Records: Source of information: No pumping info was available. 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)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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r� 33 Goose Point Road, Centerville M-252 P-40-T00 Property Address Bruce Colegrove Owner Owner's Name information is required for every P.O. Box 282, Montague MA 01351 June 17,2015 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: Cesspools are original to home built approx. 1970. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"+feet Material of construction: ® cast iron ❑40 PVC sch 20 pvc ® other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): Lines were found clear at the time of inspection. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) N/A If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: N/A Sludge depth: N/A t5ins-3/13 Title 5 Official Inspection forth:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w .•�'< 33 Goose Point Road, Centerville M-252 P-40-T00 Property Address Bruce Colegrove Owner Owner's Name information isequired or every P.O. Box 282 Mo ntague MA 01351 June 17, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (coot.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? N/A Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A Grease Trap(locate on site plan): Depth below grade: N/A feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 33 Goose Point Road, Centerville M-252 P-40-T00 Property Address Bruce Colegrove Owner Owners Name information isequired or every P.O. Box Montague MA 01351 June 17, 2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Capacity: N/A gallons Design Flow: N/Agallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments(condition of alarm and float switches, etc.): N/A "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Goose Point Road, Centerville M -252 P-40-T00 Property Address Bruce Colegrove Owner Owner's Name information is required for every P.O. Box 282, Montague MA 01351 June 17, 2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A 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.): N/A Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 33 Goose Point Road, Centerville M -252 P-40-T00 Property Address Bruce Colegrove Owner Owner's Name information is required for every P.O. Box 282, Montague MA 01351 June 17, 2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 -6'X6' ❑ 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.): Precast cesspool was found dry on inspection with walls found stained up to inlet line. This is evidence of leaching being full when home was occupied. Cesspools do not have a minimum 1/2 day flow available at this time. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration main cesspool Depth—top of liquid to inlet invert 6'dry Depth of solids layer 2" Depth of scum layer none Dimensions of cesspool 6'X 5' Materials of construction precast Indication of groundwater inflow ❑ Yes ® No t5ins•3/13 Title 5 Official Inspection forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 33 Goose Point Road, Centerville M-252 P-40-T00 Property Address Bruce Colegrove Owner owner's Name information isequired for every P.O. Box 282 Mo ntague MA 01351 June 17, 2015 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.): Cesspool was dry on inspection due to vacancy. Privy(locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y rY p� 33 Goose Point Road, Centerville M-252 P-40-T00 Property Address Bruce Colegrove Owner Owner's Name information is required for every P.O. Box 282, Montague MA 01351 June 17, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) j 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 '3 -�- l� 33 � I I I + i z - 50,L t5ins-3113 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a( 33 Goose Point Road, Centerville M-252 P-40-T00 Property Address Bruce Colegrove Owner Owners Name information is p O. Box 282 Montague MA 01351 June 17 2015 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 15.0'+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: AIW 247 Zone C 22.8' 2.8'adjustment You must describe how you established the high ground water elevation: Hand augered 3.6' below bottom of cesspools with no water found at 11.0'. Groundwater adjustment in area at the time of inspection was 2.8'. Bottom of cesspool at 7.4'was found not to be located in the high groundwater elevation at the time of inspection. USGS estimates water at approx. 49.9'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 33 Goose Point Road, Centerville M-252 P-40-T00 Property Address Bruce Colegrove Owner Owner's Name information is every P O. Box 282 required for eve Montague MA 01351 June 17, 2015 page. Cityrrown 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 ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 17 of 17 101,05 LO 1 o ASSESSOR'S MAP: 252 GENER+AL NOTES: °' PARCEL: 40 I100 90 os� o Q REFERENCE: PL. BK. 198 PG. 151 AND O 1. VERTICAL DATUM: Assumed_________ 2. MUNICIPAL WATER IS AVAILABLE. FLOOD ZONE: X Town of Barnstable 100,- 3 BASIN 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT �� 25001 C0562J 07 16 14 SYSTEM UNLESS OTHERWISE NOTED. o # / / J 100 02 MAG�E0,00 00 4. ALL PRECAST UNITS TO CONFORM TO M� �� \ � AASHTO: H-1 0 & H_20 A . \ � 5. PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. O 6 ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE r rocs 97 Lot 4 0 0 WITH MA ENVIR. CODE (TITLE 5) AND LOCAL \ .� REGULATIONS. LOCUS MAP N.T.S. NA115$� 1'9 7± S.F. 7• CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES Benchmark set: �o�n.. 1p C 102,91 Map\ 2�52 -10 PRIOR TO CONSTRUCTION. Right corner Bulkhead 6IN TO6.. arcei �0 U, 920.58 LEGEND: E EL.= 104.09 (Assumed) �.. / 10215 OL y x \ �� io ss—/- PROPOSED CONTOUR o{ 101,43/ 10 ,76 102,43 \ ?r 0 1 \ /�� ss PROPOSED SPOT GRADE OAK 53' #33. \\ NUS O, l/ — 40 - EXISTING CONTOUR Eag 12?� 10 8 98 TOF_104 09 103,00 . cr G/ X 30.23 EXISTING SPOT GRADE 004'� 4' 16IN\OAK x (ASsurned) G SERVI2E N 01,12E TEST PIT ti. 2 TH 2 5�� 52 102 , 102 65 ® EXISTING WATER SERVICE La r e �c7k ��- g *Upgrade Exist. ( �� 101 24 0 o X o WORK LIMIT LINE 100, 0 5 Cast Iron Pipe I 68 1 0,9 281N1, 0 �J - exiting foundation O with Sch. 40 PVC Deck 1'a, ..: <. OF OF x 10 Shed O �, Patio ck_Pipe. 4 ` 101, HUTOEF �Q�� Mgf � Mgf�9° 3 10p 7 O 4 o AMY L. ti� TERRY yG� 102 9 VON HONE 7, 10 :... ANN 0 2,57 1 �..0 ti o WARNER ., 103,02 :. #= No. 1068 No, 38721 coPaved `: . 1: 262 :.:. ,: `..... 101.61 FGISTER�� GIS[E` x 102,93 Drive,: .:; ' l ? � 101.00 100,71 102.4 8 -.''�.::.. .:.: ;:::.': :`t o LA �,, 0 241N OAK :. :'. :`:.. ro ✓(� o, Garage 100,99 TH-1 102,47 x 102,95 / NOTE: This plan is to be used for septic 102,76 system purposes only and is not to be 10 65onsidered a property line survey. 100 .. ... .c^ / 0 102,64 t x : : : ::. 0,7p 44 o� v`.;.::::>: A. 102.56 �o..... . �� 33 GOOSE POINT ROAD 102,39 V H CENTERVILLE, MA tioZ 101,82 20 x 1p o0� S 6p:1N U) PREPARED Estate of James E. _ 1 associates NOTE: Pump and Backfill �c � 1i 0.81 10 In EMc srs, OE! FOR: Colegrove Failed Cesspools. Any o� jOO� 0,89 a 320 Cotuit Rood C�O Bruce D. COlegrove contaminated soils H ti0 f° / Fence ` Co Sandwich, MA 0 563 within 5' of proposed �' 10 P.C.BOX 282 Leach Facility to be Xi�9.7 d e °'0p m Montagne, MA 01351 removed and replaced oc } J Terry A.SurWarne P.L.S. with clean fill per Title 0=.= 99 66 a 22 Long Road 5 specifications. ^, do Norwich. MA WS) 432'c830 07 DATE REVISED SCALE SHEET N0. 1" = 2 0' 1 of 2 4. n Provide Riser over D-box 4 NOTE: All components to be marked-with NOTE: To prevent breakout, final T.O.F. (Full) to within 6" of final grade magnetic tape or similar prior to final cover. t' grade of EL. 98.4 to be carried EL. 104.09 (Cover to be watertight) out a minimum 15' beyond edge F.G. EL: 102.5-103.24 F.G., EL: 100.5 F.G. EL: 100.5 Maintain Min. 2% slope over leach facility to F.G. EL: 100.5 of leach facility. Existin revent 2onding Install risers w/covers over inlet and Min. 2" of 1/8" - 3/4" Washed Stone or In ection Port within 6" to grade Exist. Invert outlet to within 6" of final grade Geotextile Fabric EL. 101.59 L=50 (Access Covers min. 20" di m. per Code) 5, 3/4" - 1 1/2" Double Washed Stone 4" SCH 40 P . L=25' 4 SCH 40 PVC �* Top of Peastone or Geotextile Fabric EL. 98.4 ®S=6.6% 2� _ 4 SCH 40 PVC *Upgrade Exist. 10• 14• CAS-5% 19oM1 s ®®a24" EffDepth P9 @S=2.5% 0.5%.MINaCast Iron Pipe EL. 98.05 EL. 97:63 95.2 ... Install fflEL. 97.8exitin ... Gas Ba e9 '` EL. 98.3 EL. 97.2 OU6393, se 2 - 00 Gallon Precast Chambers foundation with � PROPOSED DB-3 on w t Sch. 40 PVC H-20 DISTRIBUTION BOX (H-10) with Double Washed Stone 5.5' Pipe due to Watertest for levelness 4 Ends, 4' Sides (Install PVC Inlet & Outlet Tees) (25 x ,2.83' x 2') SEPTIC SYSTEM PROFILE negative pitch PROPOSED 1500 GALLON if more than oneEL. 89.7 per Home H-10 SEPTIC TANK outlet Inspection N.T.S. Bottom of TH-2 Report. ADDITIONAL NOTES DESIGN CRITERIA SOIL LOG 1. Contractor to confim soil suitability prior to installation. Contact Number of Bedrooms: SOIL EVALUATOR: AMY VON HONE, R.S. S.E. #2517 BOH and Design Sanitarian in the event of varying soils from original Existing 3 Bedrooms INSPECTOR: DAVID STANTON, R.S., BOH soil test. DATE: JULY 15, 2015 10:00 AM Soil Type: Class I<2 m PERMIT: 1 1 Percolation Rate: in Inch # 2 Pump and remove/backfill Failed Cesspools. Any contaminated / PERCOLATION RATE:<2 MIN/INCH IN C1 materials within 5' of proposed Leach Facility to be removed. P P Y Daily Flow: 110 G.P.D./Bedrm x 3 =330G.P.D. TH - 1 TH - 2 3 Water line to be sleeved at any sewerline crossings and .within 10 Design Flow: 330 G.P.D. (Min. Required) EL. 100.3 EL. 100.7 of any septic components, as needed, per Water Department Garbage Grinder: requirements. Contractor to verify location of water line prior to Not Allowed (Remove Existing) A A construction. Sandy Loam Sandy Loam Leaching Area 10YR3/2 10YR3/2 Required: (330)/0.74 = 445.9 S.F. 7" 99.72 8" 100.03 4 Septic Tank and Distribution Box to be placed on 6" crushed stone or compacted, level base. Septic Tank Required: 330 G.P.D. x 200% = 660 G.P.D Sandy Loam Sandy Loam Minimum 1500 Gallon (Proposed) 10YR4/6 7.5YR4/6 5 Upgrade existing Cast Iron 4" pipe exiting foundation with Sch. 40 Use 2 - 500 Gallon Precast Chambers H-10 with 37" 97.2 27" 98.45 4" PVC Pie per Plumbing Code. C1 C1 P P 9 Double Washed Stone: 25' x 12.83' x 2' Medium Sand Coarse Sand Perc FLOOR PLAN 10YR5/3 2.5Y6/6 �148" Bottom 2(25' + 12.83' 2= 151.32 S.F. N.T.S. Sidewall Area: ) 10-15% 10-15% Bottom Area: 25' x 12.83'= 321.25 S.F. Cobbles Cobbles Total Area: 472.57 S.F. Desi n Flow Provided: 0.74 472.57 S.F.)= 349.7 G.P.D. 33 GOOSE POINT ROAD CBed V H CEN TER VI LLE, MA Garage °o [M�' orc Kitchen o 1 associates PREPARED Estate of James E. 120" 90.3 132" 89.7 SEanc SYSnM DESIGNS FOR: C o l e g r o ve No Groundwater Observed No Groundwater Observed Living Bed Bed Sandwich, Cotult Road c/o Bruce D. Colegrove MA 02563 25 gallons in 11: 43 minutes PERC RATE: <2 MIN/INCH C1 Horizon Room 3 2 508.833.0041 P.O.Box 282 I, Am L. von Hone, R.S., hereby certify that I am current) approved b M on tagn e, MA 01 351 Y Y Y Y PP Y Surveying by: the DEP pursuant to 310 CMR 15.017 to conduct soil evaluations and Terry A. Warner.P.L.S. that the above analysis has been performed by me consistent with the 1 st Floor 22 Long Road requirements of 310 CMR 15.017. 1 further certify that I have N(508) 83sas DATE REVISED SCALE SHEET NO. S08) 432-83os 2015 1" = 20' 2 of 215 successfully passed the Soil Evaluator's Exam on November, 1994. 07/ /