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Home My WebLink About0062 GREAT HILL DRIVE - Health 62 GREAT HILL ROAD Centerville A = 174 - 041 No. 42101/3 ORA pion MW (,ff 10 ® ® p p �. _� .� Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 62 GREAT HILL RD - - - Property Address MAKI Owner Owner's Name 02632 10-23-14 7 information is CENTERVILLE MA Date of Inspection required for State Zip Code every page. City/Town :i r� cti inspection results must be . a submitted checklist form. Inspe of he o forms may not be altered in any way. Please see comp) Important- A. General Information When filling out llJ l� forms on the computer,use 1. Inspector. only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return D.A. BROWN INC key. - - - - - --- - - Company Name— -- — -- — --_ _._ �--- - P.O. BOX 145 - - - - - I� Company Address MA 02632 CENTERVILLE State Zip Code ,enm cityrrown SI4297 - 508-420-A534 License Number Telephone Number B. Certification i certify that I have personal a ow is true, accurate and compected the sewage lsposal system at this address and that the ete as of the time of the inspection. The information reported bproper inspection my on was performed based on a training approved system inspector pursua t to and 15 340 ofe sewage disposal systems. m a Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10-23-14 �inn'-gW- ignature 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. TtUe 5 Official Inspection W: surfac.e Sewage Di s sal cyst m•Page 1 or 17 l5ins•3113 4 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 62 GREAT HILL RD Property Address MAKI Owner Owner's Name information is CENTERVILLE MA 02632 10-23-14 required for State Zip Code Date of Inspection every page. CityRown 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: TANK AND D-BOX WERE LOCATED AND AT TIME OF INSPECTION SHOWED-NO-SIGNS OF FAILURE.THERE WAS NO AS-BUILT CARD AVAILABLE SO THE S:A.S WAS NOT LOCATED. THE HOUSE WAS ONLY 2 PEOPLE LIVING THERE FROM 1985-2000 AND ONLY 1 PERSON FROM 2000-2014 SYSTEM IS ORIGINAL FROM 1985, FUTURE PERFORMANCE UNDER THE SAME OR INCREASED USE CAN NOT BE DETERMINED FROM THIS INSPECTION REPORT 13) 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): l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 1 ` Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 62 GREAT HILL RD _. . Property Address MAKI Owner Owners Name information is required for CENTERVILLE MA 02632 10-23-14 every page. City/Town 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 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 62 GREAT HILL RD Property Address MAKI Owner Owner's Name information is CENTERVILLE MA 02632 10-23-14 required for State Zip Code Date of Inspection every page. City/Town 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 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow 15ins•3M3 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 62 GREAT HILL RD Property Address MAKI Owner Owner's Name information is CENTERVILLE MA 02632 10-23-14 required for every page. Citylrown 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. El ® 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 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. I5ins•3113 Title 5 Official Inspection Forth: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 62 GREAT HILL RD Property Address MAKI Owner Owners Name _ information is required for CENTERVILLE MA 02632 10-23-14 every 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 wets not available note as NIA) ® ❑ 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): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 62 GREAT HILL RD - Property Address MAKI Owner Owner's Name information is CENTERVILLE MA 02632 10-23-14 required for State Zip Code Date of Inspection every page. Citylrown D. System Information Description: PERMIT SHOWS A 1000 GALLON TANK DESIGN PLAN SHOWS 2000 GALLON TANK IT APPEARED TO BE A 2000 GALLON H-20 TANK, D-BOX,A 6X34 LEACH AREA WITH STONE AND FLOWDIFFUSERS ACCORDING TO ATTACHED DESIGN PLAN 0 Number of current residents: 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 years usage(gpd)): Detail: HOUSE VACANT-MINIMUM WATER USAGE Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Titre 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 7 of V t5irrs-3113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 62 GREAT HILL RD Property Address MAKI Owner Owner's Name information is CENTERVILLE MA 02632 10-23-14 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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-3113 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 hw 62 GREAT HILL RD - - Property Address MAKI Owner Owners Name information is required for CENTERVILLE MA 02632 10-23-14 every 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: 7/26/85 PER PERMIT Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: APPEARS TO BE 2000 H-20 Sludge depth: CLEAN LIQUID AT TIME OF INSP t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of W Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments h 62 GREAT HILL RD Property Address MAKI Owner Owner's Name information is CENTERVILLE MA 02632 10-23-14 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 0 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 How were dimensions determined? 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 LOOKED SUPRISINGLY CLEAN AT TIME OF INSPECTION WITH CLEAR LIQUID AND NO SIGNS OF FAILURE OR SURCHARGE, APPEARED TO BE H-20 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 t5ins•3113 Tithe 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 62 GREAT HILL RD - Property Address MAKI Owner Owner's Name information is CENTERVILLE MA 02632 10-23-14 required for every page. City/Town Site Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: --� Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 62 GREAT HILL RD - Property Address MAKI Owner Owner's Name information is CENTERVILLE MA 02632 10-23-14 required for every page. CiTy(rown 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 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_): BOX WAS VIEWED BY CAMERA WITH NO SIGNS OF FAILURE OR SURCHARGE Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order. ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NO AS -BUILT AVAILABLE t5ins•3I13 , Title 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 g 62 GREAT HILL RD Property Address MAKI Owner Owner's Name information is required for CENTERVILLE MA 02632 10-23-14 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: — ❑ leaching chambers number. ® leaching galleries number. flowdiffusers ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert I Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No isms•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts x Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w - . 62 GREAT HILL RD Property Address MAKI Owner Owner's Name information is CENTERVILLE MA 02632 10-23-14 required for every page. Citylrown 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.): t5ins•3113 Title 5 Official Inspection Form: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 62 GREAT HILL RD --- Property Address MAKI Owner Owner's Name information is CENTERVILLE MA 02632 10-23-14 required for every page. City/Town State 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 15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, 62 GREAT HILL RD - - -- Property Address MAKI Owner Owner's Name information is required for CENTERVILLE MA 02632 10-23-14 every page. Cityfrown 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: see attached plan ^ 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: attached Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report,please see Report Completeness Checklist on next page. tSins•3113 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 62 GREAT HILL RD Property Address MAK► Owner Owner's Name information is required for CENTERVI LLE MA 02632 10-23-14 every page. CityrTown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 t' �Un3 I 4F- z - 3c 3 - �- z 3I _ SUBJECT TO AaS No.3 rTAB! c'�._-, FEE— r.,Ni , THE COMMONWEALTH OF MA55ACHU5E115 --- BOARD F" H "lH ..............OF.-_ �j�'(n�) N�Iplirafiait fnr Bisposal Warks (�;a�5hM-fWtt VPrmif _ ,_ "� "Application is hereby made for a/Perrmitit to Construct ( or R air ( ) an Individual Sewage Disposal '/ " d L 9ddress , or Lot V.. Address .•; Insaner 9ddress on Type of Budding Size feet Lot �SSq. U Dwelling-No. of Bedrooms_-.-3..—____-------_---Fxpanson Attic (70) Garbage Grinder t7d Other-Type of Building ----- No. of persons___..._.._._____-._____ Showers ( } - Cafeteria ( ) P. Other fixtures --------- -- ---.11C -- --- - -_..__ -- -- -x� W Design Flow___-_---C--I�-----•li_Ons per person per day. Total daily'flow------------ 1_ _gallons. Septic Tank-Liquid'capacityl alIons Length-----_____4V•idt5____--------Diameter---__...__Depth--_•_-------- Disposal Trench-No.—.__--Width_-_---..—Total Length_---___.-_---Total leaching area__-._ sq.ft. Seepage Pit No...-__-__-_ Diameter--_-----____ Depth below inlet___-___.____Total Icaching area -•--------sq.it. Z Other Distribution box( ) Dosing an1t( ) Percolation Test Results Performed by ,� Test Pit No. 1_ ,,5j__minutes per inch Depth of Test Pit �y Y'Dep` ground water------_- Test Pit No��-mutes per inch Depth of Test Pi '`�__ Depth to ground water_._101�_- -- - - Description of Soil-0�s1_---" �,S US�1- -----• ----._..------_-____ --•—�--�-�=--__-1�-L��[.L'Yt:_._�G�1�.Ci=--f�-21�-�--.SS�.�iG._S-f�,�-�-- - �_- - ---- CwJ Nature of Repairs or Alterations-Answer when applicable-__--------______ -------_•----_-•---•-•----•--•---..--.. Agreement:- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T11TIZ 5 of the State Sanitary Code-The undersigned farther agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health / ` Date Application Approved By_—.__-_._-_-- Dam Application Disapproved for the following reasons:--------_--- --------•----•-----•-----...—_._...-----___-- -_--.__-._-----'-----•-•--------- Permit No.__-___—.____ Issued._____-_.___-_-_ D=:• _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH OF. <. -5 - TPrf firat2 if (ff=Vh=r THIS IS TO CERTIFY, That/the Individual Seccage Disposal System constructed - or Repaired' ( ) by_-_Tin ^I�°- -1 t CRt - __ __..._. _---_--- ------ >C.fa.r_...__. � y L•��'_�-l-l-�---' '--�-----LPn �Lr✓k'...L - C`S -'•-•___._•_--- has been installed in accordance with the provisions of TITTF_-S of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. _= THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL�FUNgTION SATISFACTORY. 1 DATE----?- ._ ' - inspector- "Of-) THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA T)_i 1- /J D _ �is�r»stti �r�s �mt� /i>a� ��r�il • Permission is hereby granted- _:5 f1'_l /��!_ -•------------------------------------ -------- to Construct �)�or Repair, ( ) aq dual Sewage Disposal System at No !/ streetas shown on the application for Disposal Works Construct t-No__'i_____ __- _• Board of Health FORM IZ55 A.M.SULKIN. INC..BOSTON , TE 1 F THe �5EP Tl C TAX/< /.T 20 FTM.LN_ N� TWA Al /2 INCHES 8E�4L`/ GiqAoE, A 24 '- �Zei .IO FT M/N. .1NCH D/AMETE-jl? CONC/?ETE COV..=R SWA L L 76 4"Ave P/P� $E�$ROUGHT To �,p�AD� (AN .�1<7 f1�AYY CON-CRETE MIN. 'PITGW CAST /RdN COYEl3S',1-1ALL BZ-�: USED IN �; CDY�R.s �",o,ER FT. /�RIYC,WAY �----X FLOIrYD/F�U.sOR O oFr yl�2 Ml/Y. GRADE EOU/Y.9LENT,G,gLC'&R%ES L/QUIo LL`VL _., S--- CL.EA N SAND 4 PIA '4 SCHEDULE 4a 4 i_' -! rs ct o to PTO 9 P_V-G. RIPE ZpDo GAL ct Q n �] fit.: O/SGf!A RGE L/NE /''I//V.PI TCK SEPTIC TA NK d/ST. ,`c`•:ti � J.,4 tsr z_ � : �#O/ 69,E B OtC CQa ;h �edn�ER FT. �DESiG.✓ �'Tn? !�y_rfv><t �_ G �iFr, 49" aF /4u.. 2 „ I j a� Solt� f� LEACf�!!1!G GAL LEde% 8 WASNE�.s74N.E a raa.�j,,� �rl ��* .,. :. r .r==,-M,=• _ �/M�m �i�L G,G✓; GR-cc�5 ; :� 7+� WA I E- SECTfON OF GROUNO dYATER7"A ZL(O GAD' SEWAI6E VISPOS'AL SYSTEM T.A-BVL-A?I0H BoT1"arH: ZOYx 7-erst` CAPAGJT�� yb9 GAD. . x L�IMEN,SIoK A 3^S PT. . f,S'CALE : Y4'1 DIMENSION C a= FT 4 Fr SOIL LUG DATE OF Sall. TEST � ,S`p/L TE'S'T #1 S014 7AFFST#2 _- REsULTS '6 r J, Gorfcon� ��X.EY r3,y ELL�V. Pg2CCLAT/D/Y RATE #j 2•S P MfK�IiYCK . �RY]CL.4 T/ON RATE�2 M/N. /iYew ,,, o- 2' ccm I 5 ur35 orL CL ERN L.�YE.�of .¢/vac OAS/GN Gle/TE/e1A SA/vo POLY'-TyYLEN,s NUIS40ER OF ®EPMOOM5 _ v ",ff)? Z`LA Yf)C GARGA,qE DISPOSAL UNIT y bCM3r,';• pF �pp N p ((y '^�iTI1 5am6 / "StDE •' O c] '' ; A.Sf 9 STOwE ESTI/yATED -46W �� G.a LIDAY� cvAy r6•wLks ,�ttr4[NnvG ':r S/OELEACH/N4 AREA SP.FT, . BOTTOM/.'&ACHING ARZA 26, 7a T.4 L AREA3 Y_ SO.FT SE C Tl D N .X—?G w RZSERVE AREA �� -54•�'. SCALE: �14�= /r--OCl NO GROUND WATEK ENCOVNT,ERED ` /MV�RT ELC-VAr)ONS .Q 4',eou^(P JVA7 R .nT Et Ev. �f %Nt/F�PT AT L�U/LDJNCr .� FT. 2•�- y�, �: .a../'" ;•y w �p�Y1 SS v!n ALBERT �` 1tV4ETSE.DTJC TANK FT, F- y ROBERT ��- 72.0 ` S F A. rn' Y t',� � E, OUTLET SEo77C TANIK FT. •yam Mor, �, ELDREE)CE =; INL�7"D/STR1aUT/ONDoX 7f,s. PT ELDREDGE GINE�R/NG CO.,INC. o pN�o.•l1�51�0�, No. 13"s67 �" ` aU L ,o�ts77�/BUTloXQ4X 71.'3 FT 7/2-M'AINST., NYANN/S /SASS•. po�� STE `,r �`ssy�f�l$TEitEC.°y IN LFLDyYbiFFU3oR y/. cL/�ivI-! rr�rai- oAr.. z 8 f e'1db JQ.e_No, .8 3 zo. Completed by ; HIGH GROUND.-WATLR t_f.U1 L COMPU.TAT10W 1 y l r a (Site .Location_ �.�;:'�...i t`:�.:• -----Lot No. -- E --- -� --- - Y ----- Owner: Address: _ Contractor: -----_---- - +--Address: --- ----- - ---� — lNotes: STEP 1 : Measure depth . to water table .� to nearest 1/1.0 ft. . . . . . . . . . date STEP 2 Using Water-Level Range Zone and Index Well Map locate site and _determine: eO A) Appropriate index well . . . . C3 B) Water-level range zone STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to water level for index well . . . . . / mo yr STEP Using Table of Water-level Adjustments. for index well TSTEP 2A , current d&pth to water level for index well (STEP 3) , and water-level zone (STEP 2B) determine water-level adjustment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .t STEP 5 Estimate depth to high water by subtracting the water 00 - level- adjustment (STEP 4)from measured- depth to water , level at site (STEP 1) . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . C c,rni�1 c t e d by - -- —•--_-.. __�_._-- IiI (;II GROUND-WATER LLVI I. LUM('U:IATION 09 . - — Lot Site Locat ion: .tr ---- - -- -Owner: -- Addles!': —_.--- _ _ _ ---- - ---- C o n t r a c t — ,-rA d d r e,s s -- Notes. -- STEP 1 Measure depth to water table to nearest 1/ date STEP 2 Using Water-Level Range Zone and Index Well Hap locate site and- detarmine:- - _SD uJ ZS3 A) Appropriate index well . . . . . . . B) Water-level range zone . . . . • . • . . . . . [� STEP 3 Using monthly report"Current Water Resources Conditions" In determinecurrent depth to water level for index we] 1 / /U= mo yr STEP 4 Using Table of Water-lr'vel Adjustments for index well `-- STEP 2AI , cur[-cnt depth to water level for index we] 1 (STEP 3) , and water-level 1 zone (STEP 2B) determine -�• � water-li.-vel odjustmcnt . . . . . . . . . . . . . . . . . . . . . - - - - - - - - - - STEP 5 Estimate depth to high water by subtracting the water- — level adjustment (STEP 4) from measured depth to water f 7`� level at site (STEP 1 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ° Member Of, Piesident: 'R0lIERT BRUCE ELDREDGE.R.L-S. E GINEERS AND LAND SURVEYORS CAPE COD SOCIETY OF PROFESSIONAL ELDREDGEENGINEERING MASS.ASSOC.OF LAND SURVEYORS AND CIVIL ENGINEERS Associates: COMPANY INC. ALBERT A MORSE.P.E..R.LS. ' AMERICAN CONGRESS ON SURVEYING AND MAPPING PHILIP WEINBERG.P.E.,R.LS. - - AMERICAN SOCIETY FOR L'1:E4Ed TESTING AND MATERIALS eREg��tetsd• - �=g - -- 712 MAIN STREET.-- £ r HYANNIS,MASS.02601 1Su.¢vEyo¢< CngLr e:< TEL.(617)775-2244 July 25, 1985 Board of Health Town Office 367 Main Street Hyannis, Massachusetts 02601 RE: Greenbrier Development Corp. — Lot .34 Great Hill Drive, Centerville, MA. Job No. 83209 Gentlemen: A final inspection was made on July 25, 1985 and the results are as follows: DESIGN AS—BUILT Inv. at foundation Elevation 74.2 Elevation 72.5 Inv. at Septic Tank Inlet " 73.5 " 72.2 Inv, at Septic Tank Outlet " 73.1 72.0 Inv, at Dist. Box Inlet " 72.9 71.5 Inv, at Dist. Box Outlet " 72. 7 71.3 Inv. at Flow Diffusal Inlet " 72.6 71.1 Bottom of Flow Diffusors 71.6 " 70.1 The system appears to have been installed substantially in conformance to the minimum design standards specified in our sewerage plans dated April 24, 1985. Sincerely, ELDREDGE ENGINEERING COMPANY, INC. Robert B. Eldredge, R. L. S. President cc: Greenbrier Development RBE/etb c.. LOAM Ar1r, jut✓Sur� .r�Qow �zEV -�l,l r'jj _ .rs•;� �'j�.: �7,(GJ'YIAJL�� JO Fi;�"T fl2ndNn. . P(n D Fr rau 7)r 7-F�/scve iZESL, 2E� Fcow ��FFu s urz.s -E ✓t1 7 fa Pk1 V Sv of �� zap vo: /✓4 CA 7 q A 51Ac�F±{ 7 3 (rj CJ 3 II �. �? G SUKYL-Y 0 _ Al 1�7r HAY n� �e� V1 33 07- 35 z�/V" �y , t ` \ . \ C ✓/F7)awl 5 A'Ge--S r \ M . i, .�l L T�'L. y:�:: . . �A s✓l� L - ' N'ci cA✓-r i r''`': 1 CERTIFIED PLOT PLAN rt.r., qif Cf FIC'L•TER AL f3ERT �C'�+cam- G�P�AT �i�c.L. n��-�7� I/// ♦ _ L0CAT10N G SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME i ADDRESS S U I L D E R OR OWNER 6 "t tA�� C-ev, cv� , DATE PERMIT ISSUED 7 DAT E COMPLIANCE ISSUED -16 � �C)+ r i