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Home My WebLink About0028 GREAT MARSH ROAD - Health Y:�at Mai-sh Road 9;:�nterv; le . f Commonwealth of Massachusetts o7ab 009,_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a -� 28 Great Marsh Road Property Address ' E Katherine O'Hara& Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 ' page. Cityrrown 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 filling out forms A. Inspector Information 51W /50y9 on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane VQ Company Address Centerville Ma 02632 Cityfrown State Zip Code 774-248-4850 smjonestitle5@gmail.com, S14522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation;3711/16/2020 hority 4. ❑ Fails Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Great Marsh Road Property Address Katherine O'Hara& Kenneth McCray Owner Owner's Name information is Centerville Ma 02632 11/16/2020 required for every page. Citylrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: The property located at 28 Great Marsh Rd Centerville is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 20 Bio Diffusers in a 25'x11.5'field. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Great Marsh Road Property Address Katherine O'Hara & Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. System will pass unless Board of Health determines in accordance with 310 CMR 16.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Great Marsh Road Property Address Katherine O'Hara & Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 car Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -� � 28 Great Marsh Road u Property Address Katherine O'Hara & Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® cesspool Liquid depth in is less than 6 below invert or available volume is less q P than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Great Marsh Road Property Address Katherine O'Hara& Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes" to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: 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)] l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts rP Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 28 Great Marsh Road Property Address Katherine O'Hara& Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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): 355.2 gpd provided Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes E No If yes, discharges to: 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: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Great Marsh Road Property Address Katherine O'Hara& Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposals System Form-Not for Voluntary Assessments 28 Great Marsh Road Property Address Katherine O'Hara & Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: system repaired 12/17/09, tank was existing Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.5feet 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.): Joints in good condition, no leakage, vented through roof. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 I Commonwealth of Massachusetts @ Title 5 Official Inspection Form I,- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Great Marsh Road Property Address Katherine O'Hara& Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. 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: 1000 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Outlet tee has filter installed, filter nees to be cleaned every 6 months to prevent clogging. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 i c Commonwealth of Massachusetts Title 5 Official Inspection Form I.- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Great Marsh Road v Property Address Katherine O'Hara& Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. Cityn"own State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 i Commonwealth of Massachusetts - Title 5 Official Inspection Form I." Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Great Marsh Road Property Address Katherine O'Hara & Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. Cover is on a riser t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 F Commonwealth of Massachusetts Title 5 Official Inspection Form 1" Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Great Marsh Road Property Address Katherine O'Hara& Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 20 Bio Diffusers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Great Marsh Road Property Address Katherine O'Hara& Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): s.a.s. consists of 20 Biodiffusers in a 25'x11.5'field: No signs of past hydraulic overloading. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Great Marsh Road Property Address Katherine O'Hara& Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 great Marsh Road Property Address Katherine O'Hara&Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 ui tro.a at 2t•s Cz w.o ab as.o A 3 55.0 44 aa•o AS Ab 3Z.0 y ii7 3z•5. ® Jrr Mw t5hsp.doc•rev.7r2WO18 rdle 5 Official Inspection form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I." Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Great Marsh Road Property Address Katherine O'Hara & Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to 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: 12/4/09 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Design plan dated 12/4/09 indicates that no groundwater was encountered at 128"and system is designed to have 5' seperation between bottom of s.a.s. and adjusted high groundwater elevation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/2 612 01 8 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form je Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Great Marsh Road Property Address Katherine O'Hara & Kenneth McCray Owner Owner's Name information is required for every Centerville Ma 02632 11/16/2020 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .X' 28 Great Marsh Road Property Address Tracy Field Owner Owner's Name r�9 information is required for every Centerville Ma 02632 10/27/2015 r- page. City/Town State Zip Code Date of Inspection :s¢ r; 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 on the computer, / 117 use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection 2y Company Name 74 Beldan Ln. Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com S14522 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 16.340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10/27/2015 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 official Inspection Form:Subsurface a Sewa es-alm•Page 1 of 17 P 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Great Marsh Road Property Address Tracy Field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 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: The dwelling located at 28 Great Marsh Rd Centerville is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 20 Biodiffusers in a 25'xl 1.5' field. The system was found to be in proper working condition at the time of inspection. 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•3/13 Title 5 Official Inspection 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 28 Great Marsh Road Property Address Tracy Field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 page. Citylrown 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 Tide 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 M 28 Great Marsh Road Property Address Tracy Field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or 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 Y day flow t5ins•3113 Title 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 28 Great Marsh Road Property Address Tracy Field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no 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. t5ins-3/13 Title 5 Official Inspection 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 M 28 Great Marsh Road Property Address Tracy Field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 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 ❑ Z Were any of the system components pumped out-in-theprevious-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): 355.2 gpd provided t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 28 Great Marsh Road Property Address Tracy Field Owner Owners Name information is required for every Centerville Ma 02632 10/27/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 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 Z -No Water meter readings, if available(last 2 years usage (gpd)): Detail: 2014= 52,000 total = 142 gpd 2013= 59,000 total= 162 gpd Sump pump? ❑ Yes ® No Last date of occupancy: current 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: 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 M 28 Great Marsh Road Property Address Tracy Field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 page. City/Town State Zip Code Date of Inspection 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•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 M 28 Great Marsh Road Property Address Tracy-Field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 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: system repaired 12/17/09, tank was existing Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5feet 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.): Joint were ok, no leaks, vented-through the roof Septic Tank(locate on site plan): Depth below grade: 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: 1000 gallons Sludge depth: 6" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M , 28 Great Marsh Road Property Address Tracy'Field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Outlet tee has filter installed, filter nees to be cleaned every 6 months to prevent clogging. 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•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 M 28 Great Marsh Road Property Address -Tracy Field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 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: 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-3/13 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 28 Great Marsh Road Property Address Tracy Field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 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 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was in good condition, no rot, water level was even with outlet invert.Cover on riser. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Forth: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 M 28 Great Marsh Road Property Address Tracy-Field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 20 Biodiffusers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: -❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): s.a.s. consists of 20 Biodiffusers in a 25'xl 1.5'field. No signs of past hydraulic overloading. 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Great Marsh Road Property Address Tracy-Field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 page. Cityrrown 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 28 Great Marsh Road Property Address Tracy Field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 page. Cityfrown 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 Q drawing attached separately ct 1m•� at 2z'S - cz Ummuz � 33 gy � t•� A6 a.S.a j A 3 5SW Nam( 44 AS 30,5 I Ab .3 O y ft� 3�•s � t 6 7 6. t5ins•3113 Title 5 Ofaal Ir=o�_ ion Fur.,:Su7--sace S---*zga Di:•,o5al System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 28 Great Marsh Road Property Address Tracy field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 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: 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. 12/04/09Date ❑ 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-bow you established'the-high ground water elevation: Design plan dated 12/4/09 indicates that no groundwater was encountered at 128"and system is designed to have 5'seperation between bottom of s.a.s. and adjusted high groundwater elevation. 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,. 28 Great Marsh Road Property Address Tracy Field Owner Owner's Name information is required for every Centerville Ma 02632 10/27/2015 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 Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE O LOCATION J t, bI rk-n i Mc� y—j:" 12 e1 SEWAGE# A 0 0 ` t;3 VILLAGE (9/1 h4 1/1�� ASSESSOR'S MAP&PARCEL 93 0 " 5 INSTALLER'S NAME&PHONE NO. �ci/Je�✓tl�(+ H VZ 4%U Z . SEPTIC TANK CAPACITY /lid® LEACHING FACILITY.(type) hQ) /3 1( 13,v��' (size) %/•S Y Is- NO.OF BEDROOMS. _ 3 OWNER �Q ne* vi,e ueti-9 i PERMIT DATE: i a. COMPLIANCE DATE: .a 109 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 4ZO el 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) f\ . _ Feet FURNISHED BY '� T�-4` 4l).e S L� -c '0i ot 81 22•�� ,, •. ez w. - t�3 QS 3.o 7 .o No. ._ / 0 3 Fee c�C/ THE COMMONWEALTH OF MASSACHUSET.TS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes r ftPIication for Misposar 6pstem Construction permit Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Z$ Gre-ar MiArSM flond Owner's Name,Address,and Tel.No. Q v evE Ce.+fu�;�fe Assessor's Map/Parcel `Z /3 O/ j 54vn6 Installer's Name,Address,and Tel.No.L'Qp#W,de Designer's Name,Address,and Tel.No. SG ass o,W';,i� 6 2� twu'c:Ct 2 SS-it SG& `2--7 3 0 3 -7 Type of Building: �+ Dwelling No.of Bedrooms 3 Lot Size b O Z 5 i— sq.ft. Garbage Grinder( ) Other Type of Building S tit !n No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '3 3 p gpd Design flow provided :3 J 5—. Z0 gpd Plan Date j 9 pL( 20 Z Number of sheets Revision Date Title L& Size of Septic Tank Oo® Type of S.A.S. SCoyLe gbG Q� Description of Soil 5-2— Nature of Repairs or Alterations(Answer when applicable) rya tcv- 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 Hea Date 2 '�6 Zao Application Approved Date %c� ,&�/ Application Disapproved by Date for the following reasons Permit No. �-� d 3 Date Issued a d �— r-..-v-n.r:...+..�y��: .6 __ Y,.r. �_�.r.__ ..ti..n.-.:.--.n.-......-....:-....+...:.-....-'vr--.,.... yi."�-.— ..�-.--....-..--. 4...,'gi'RlTk.•-...r`n...'ice' !l' i No. _ / 3 Fee /yL/ THE COMMONWEALTH OF MASSACHUSETiTS, Entered;ncomputer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpYication for Misposai 6pstem Construction Permit Application for a Permit to Construct( ) Repair'( f Upgrade( ) Abandon( ") ❑Complete System ❑Individual Components Location Address or Lot No. 78 6 r e ra- m to r5 ki 2a n d Owner's Name,Address,and Tel.No.(;--o e i E'V i At,-e.S Assessor's Map/Parcel `x.3 O/Jf I Installer's Name,Address,and Tel.No.C , Fkj�,:�j Designer's Name,Address,and Tel.No. 3"C G",} y1U Z� �G 3c< )b3 2zS"v Lrr�r, riy / La�� w!� [.I1-Y�✓v. C G��rrt ✓h� 5-01i 273 0377 Type of Building: Dwelling No.of Bedrooms Lot Size q C 2 S �- sq.ft. Garbage Grinder( ) Other Type of Building :1�� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 O gpd Design flow provided 3 J�,S, 2 Q gpd Plan Date i a -4 LO O0q Number of sheets Revision Date Title Z$ 6 r4.a r r 73.o,,-1 Size of Septic Tank I Ono Type of S.A.S. S-COdI e.(e.,c Description of Soil P �� C� 5 2 Nature of Repairs or Alterations(Answer when applicable) cif T2� 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 Hea h. ' ed Date Application Approved Date Application Disapproved by Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired ) Upgraded( ) Abandoned( )by (-1 A- Q,o%(io yl � ?u,t rC S LLC- at 2S (-�. 4A A.(5� (Z.e�,) Ciz �yw1' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No -y—7G ated Installer (_l.g�p� ,40 (yi Designer .1�(_ t Last #bedrooms 3 Approved design flow V gpd The issuance of this hermit'shall }not be construed as a guarantee that the system w�Jill function as deliigne�d. J Date f 2-r D 1 Inspector I � ^�G.l-�� -j .. _ No. -- ��.�i`G.� ., .�.,.. �_._ _ ._ ._ . .- - •• - -- ---_ ____-----------�---________ ` Fee y---©�=r------- _ Y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(4) Upgrade( ) Abandon( ) System located at (o(t4k-V M 43 N �JAJ t^s_m n/" ��Y 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 ompleted within three years of the date of this permit. Date / �/� / Approved�y_ * 7 . 9 LOCATION " 5EW6,C4E PERMIT UO.-. - - - - /LLB - - - WSTQLLER'S IJ(), AE ADDRESS i _bUILDER.5 Q L V AF- P, &.DDRE.SS. _ _ i DATE PERMIT ISSUED '— �� = _ — D ATE COMPLI L ACE ISSUED ; 1�- 4 � - ��ra .' A c .�-�,�u,� e �� '' � � �7f :, a `F � � lie�-t �I�R5 � �.p. l own of liarnstame Regulatory Services r a�nN �e�. Thomas F. Geller, Director 1 i t � MAN, Public Health Division o 'Thomas McKean, Director 200 Main Street,lllyannis, MA 02601 1 Office! 508.862.4644 tax: .5i).7. -6304 lr�staller & Desi&ner Cglifigation, For rm Date; 12. -a t ` b 9 Designer; L rn tr�e�r�r►_ '3 C . Installer: _C4)PeW ,&. &JFeclp(Uke�') Address; Z& Y Cc'cw%be..cr N vtwn Address: a look 763 Gash- ujoce.v?c�rr� M�R 6d.�.`�3 f' _. � L-% i l t< 1;-;4_ ©_2 b 2 on .?ajg 2°® ___ g • __47 11�ej twe was issued a penn.it to install a (cfatej ; {installer) septic system at 2 b _ C,ce�wt C1 o-csVI V o0 c_I —__ based on a design drawn by _^•_ �(address) SLn�:r�e.ec i r 1r7 c., dated a�°c crvFbe r y a ue?`1 1(d�tyigrier) _. 1 certify that the septic systc-m referenced above was installed substantially.acr,nrdtti ; ti the design, which may include 'minor approved changes such as lateral relocation of t.hc distribution box and/or septic; tank. - I certify that the septic system referenced above: was installed with major changes'(,.e greater than 10' lateral relocation of the SAS or any vertical relocation of any comlaancn; of the septic system) but in accordance with State & Local Regulations. Flan re:vi?,ic�zr of certified as-built by designer to follow, m (Ina r`s Srgnrtt>a`�e�.. .,.�.�w . ;I✓I,'' • ait?ci is (DesigT er's .r i j-- -- (Aff�i esrg er taxnp Here) PLEASE RETU TO BARNSTABI UBLIC HE ply (��NCE F1G,�l,�ik;; ,IANC WILL NO' I ARE U.CEIVED BXI JUE BAIANSTABI E PUBI TC JJEAJ IffIY gI :: THANKNOU, Q Health/Seplic/Designer Conificution Form i 01 •,a J 9S0 2LZ 80S !)N I a33N I!DN33I' Wd LS: Z T 60OZ—T Z-33U Town of Barnstable P# la 7� Department of Regulatory Services ELZMSM tr, Public Health Division Date b c 200 Main Street,Hyannis MA 02601 Date Scheduled �. Timed Fee Pd. u 0 .Soil Suitability .Assessment for S`ewaQ Performed By: YUCi1weA ?Cyytpal� O e zSposal C-1 i CSC Witnessed By: v w, LOCATION & GENERAL g�0 Location Address �$ 6re.4r � RMATION "q Owner's Name Ce rqA j, .... . . Address Assessor's Map/Parcel: "Z 3O/®® Engineer's NameC_A qA ,; &. FtJ�4l i e !JC EVn5 veewv NEW CONSTRUCTION RE J PAIR Lt 2Z T f"f rj Z.� l Telephone# l 50b'2-73'6 377 Land Use 5(151e- ly /ft5(do�1{(' I r ----__ Slopes(9'0):___ Z Distances from: Open Water Body ' Surface Stones �ft Possible Wet Area —_ _ft Drinking Water Well N _ft Drainage Way ft Property Line 7 10 --_ft Other ft SKETCH: (street name,dimensions of lot,exact locations of test holes&pert tests,locate we tlands in proximity to holes) See al4��l P1��, Parent material(geologic) 00 6u",) Depth to Bedroe>t Depth to Groundwater. StandingWaterin Hole: 7 In 6�S Weeping tyom Pit Pace Estimated Seasonal High Groundwater 7 12 6 S DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: V:rec+- obse4wabd,%, Depth Observed standing in obs.hole: -7 t Z Depth to weeping from side of obs.hole: _ 7 (�Q tn. Depth to soil mottles: '7 i Z 8 Index Well# _ _in, arnundwaterAdustment tn, Reading Date: -index Well level •� ft. -- AdJ,factor ;-� Adj,Clroundwater Level Observation PERCOLATION TEST ST bate ll-l2-o y TimeHole# -_- '35A/1 Time at 9" /ae/7,4.7 Depth of Pereri9 - Time at 6" } Start Pre-soak Time @ 1-5SA/I — !� Time(9".6") `ns End Pre-soak /0;/0 A/7 "------ Rate Min./Inch ?J 1 Site Suitability Assessment: Site Passed 1� Site Failed: Additional Testing Needed(Y/N) A/ 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 notifythe Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC Depth from DEEP-OBSERVATION HOLE LOG Hole#_ Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones';Boulders. 0-3o on istenc % travel 3_ C- ( L 5 / l rZl S 2 e � _ 5Z- i2f3 G {2. M _L S 2.5yG�e — / DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. 0-30 Consistency,%Gravel) ) G-2 -05 2.5 1 /6 - ua s� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.} Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co i to rY Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten I Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes ._.._ Within 500 year boundary No Yes Within 100 year flood boundary No ✓ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? _ ` e15 If not,what is the depth of naturally occurring pervious material`? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of.Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and ex p ence described in 310 CMR 15.017, Signature 4Date 11 -Z y-0 i !u Q:\SF-PTIC\PERCFORM.DOC 5 C)--d No..--_.124L. Fug. .................. THE COMMONWEALTH OF MASSACHUSETTS BO %R-p OF HEALTH ,✓ Appliration -fur 43i uiitti Workii Tonstrnrtion Punift Application �(is hereby made for a Permit to Construct ( ) or Repair ( -T-a- Inldiv`idduual Sewage Disposal Syst at: L u�-'� -�'S o � C La(� f IG.JI 6'L`►--�. n (�t I�. ---------- ---------- anon Address or I of 'o. s� ' i. -' ............................••. ...'°`.................................. Address C' -P1C......................... E �-�11i.1 ll ------------------------------------------------- Installer Address d Type of Building Size Lot____________________________Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) `L p-, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ____________________ W Design Flow...........................................elions per person per,day. Total daily flow............................................gallons. WSeptic Tank T Liquid capacity/_'�-�__gallons Length................ Width................ Diameter..........-..... Depth_--•----.----. x Disposal Trench—No..................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area-___-_-._-________sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by___________________________________________________________ --__ Date.__-.________-_-_____-_________-___-.--- a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..____--_---_--.__... fZ, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Dept to ground water------------------------ a .............................•-------••---- O Description of Soil-.-_____-_:"�___--f cx� ------------- ------- n --- ----------- - --- --- UW - U ---------- ----- ---- �------------- Nature of Repairs�®rAlteratidns Answer w e�applicable... :---__ _-_ __-__- -.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance e • sued 4 •d of health. , n Sig ne ..... ..... I---------------------------- ------------ -- ----!1 D--.e....�----.. . ate ApplicationApproved By--------------------------•-•-------------•----•--•--•--•---•------•-•----•---------------------- ---------------------------------------- Date Application Disapproved for the following reasons------------------••---...--•--•-••-•-•--•-------............-•------------------•-•---••....................... Date ---- Permit No..........)............................................. Issued.....q----- Date L------------------------------------------------------------------------------------------------------ J �1/ Fps. "...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ..... _ ....._.........OF....................................................... ......---...................... Application -fur Bi Voiial Works Tonutrnrtion Prrntit Application is hereby`made for a Permit to Construct ( ) or Repair ( n Individual Sewage Disposal Sys at Luj�.,e i j eVj c ,, O' C.C,ea� ��s�� -. �n�rV1I� J Location_Address or Lo lio. !A cr• e_��..pS...,c � ----------------•---•-•---- /--- ` :2--.-,/ _ Owners_ Address a Tel wIU _ ------------------------------------------- Installer Address Q Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................... . .Expansion Attic ( ) Garbage Grinder ( ) aq Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank f—Liquid capacity/_445rallons Length________________ Width................ Diameter................ Depth-.-._--_-.----- x Disposal Trench—No- ____________________ Width-------------------- Total Length-._-__-__-_-._----- Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet_-___--_______-_____ Total leaching area-------.----------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by--------------------------------------------------------------------------- Date---------------------------------------- a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water--------.----.---------- �Xq Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Dept fi to ground water------------------------ 'I t ----------------------------------------------------- 0 -------------of Soil--------- <,=-t r �_-e ,�a•r y'` `�y= ------------ -- --------- ..................................... (.a x w ----------------------------------------------- c V Nature of Repairs or Altera.....At _7; nswer when applicable. /0 `j �_/ -ar`.-------- .. ---- .... .... ........................... . ....... = ' _ --- I ._A�:_?A ::' r_ ✓-_ r ._......... .......................................... Agreement:. f The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance su�'ed d of health. Signe�P7�� Date ApplicationApproved By-------------------------------------------------------------------------------------------------- --------------------....---------------- Date Application Disapproved for the following reasons_________________________________________________________________________________________________________________ ._.._•-....-•--------•-...-•-•...-•------••-••---•-----...•••---•----------------•----•••••••------••---••-----------_---••-----__-•-•----------•--------...-..-•-•-----__.._.._------------------------ f Date Permit No-------- Issued.... / --'-✓...... ....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF OEALTH i ..........0.��Ate.............OF.............. ..�...%�..a......:-�....:��............................... (11rrtifiratr of f-lomtalittnrr THIS hS TO�jC',�ERTIFY,�hat the Individual Sewage Disposal System constructed ( ) or Repaired (�) J ,_e Installer at--------'-`--') /� x. ,�� L�f !n, P �C.J-- ,f f R. ............ ..... .............. ...•--•--...--•_---- •--- ------ -•'-•--------------•------•-- .................................................. has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.( �y...__>.?.(/_______________ dated-'.-,9.--....�(. .- ..'—.__ ._. ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. r DATE------ --..... ------------- ----•-----•-•--•-----••--••--•---- Ins ector_------ 4/"))--s✓'� THE COMMONWEALTH OF MASSACHUSETTS _ BOARD F HEALTH 3 r�r ........:�.............................................................. No.---•••-•-•�-•----•-•••• FEE; ----....... Bispouttlk grkii CITTonutrurtion rrrmit Permission is hereby granted....... !'_f(<= ^_ ___._ /-t?...:............. to Construct ( );Aor Repair an Individual�ewage Disposal System at No---- �t--- �2?......-=-=9............................... ........ ......-------•--•-••-- r Street as shown on the application for Disposal Works Construction Poefruit No.j_________________ Dated.......................................... l_ 7 � }ioard of Health /�- �r DATE ...• . --- •-•---•---•- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS PROVIDE PRECAST CONCRETE 4"SCHEDULE 40 PVC MIN. SLOPE 1 % T.O.F. EL.= 98.8 ± EXTENSION RISER WITH CONCRETE INISH GRADE OVER D-BOX= 97.9 ± FINISHED GRADE OVER BIODIFFUSERS= 97,9 - 98,4' GENERAL NOTES SLOPE @ 2% MIN. COVER TO WITHIN 6"OF F.G. OVER INSPECTION PORT WITH INLET AND OUTLET COVERS. REMOVABLE WATER-TIGHT COVER OVER ACCESS BOX TO WITHIN 1- UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE RISER TO WITHIN 6"OF FINISHED GRADE 3"OF F.G. (ONE PER ROW) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 97.6�± FINISHED GRADE OVER TANK EL. = 97,8'-f- 5" DIA. OUTLETS) __ CODE AND ANY APPLICABLE LOCAL RULES. -" -j - 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE - I DESIGN ENGINEER. " EXISTING 4' PROPOSED 4" 36"MAX. 36"MAX.IN. TOP OF SAS/B.O. = 95.40' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE PVC SEWER PIPE i SYSTEM UNLESS OTHERWISE NOTED. 6' 3 3"DROP MAX „ PROVIDE WATERTIGHT4 I 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6 3 2" DROP MIN 3 9" JOINTS (TYP.) ELEVATION =95.40' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A c7SLOPE 10'. t 4" PVC IN FROM 1.08' f 13„ ! 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 1_ 14" SEPTIC TANK 4" PVC OUT TO 0 59, (�'P') 7 13"(TYP) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 7 LEACHING FACILITY o 4 + 5. SLOPE ALL SOLID PIPE AT 1.0 /o MINIMUM. " "CONTRACTOR CONTRACTOR SHALL95.30' MIN. 6 ' 94.91' 94.32' (laid flat) 2.875'(34.5")\ 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF 95.13 5 0, (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES22 ZABEL FILTER 6" CRUSHED STONE (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS MODEL#Al801-4x22 OVER MECHANICALLY 4' MIN. 11.50' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 25.0' (TYP FOR ALL ROWS) AND DESIGN ENGINEER. --- 5 OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON ASSUMED DATUM OF 98.75' ESTABLISHED ON A NAIL TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 87.33' SET IN UTILITY POLE#33 AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 20 - BIODIFFUSERS PROFILE BIODIFFUSER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW rr�� 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES L.O - � 3" HIGH ARC 3!� (#3613 B D j BIODIFFUSERS O D I F F U S E RS TO THE DESIGN ENGINEER. *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL TO ANY WORK& NOTIFY ENGINEER IF DIFFF NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. - - 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM NOTE: MAP 230 °00 • Hayes PERC NO. 12755 APPROPRIATE AUTHORITY. PARCEL 18 • 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP I?t , INSPECTOR: David W.Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS EDGE OF EACH SEPTIC SYSTEM COMPONENT. -' LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE apt Litt{ EVALUATOR: Michael Pimentel, EIT, CSE " 8 f THEY SHALL WITHSTAND H-20 LOADING. (I� r��t C.S.E. APPROVAL DATE: 10-27-99 2. CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE �\ ••, Pt DATE: November 12, 2009 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE • 0 or •• ��• TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM AND UNSUITABLE MATERIAL CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. �� APPROXIMATE LOCATION OF EXISTING �� •• • / -I'� � IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. REPLACE ALL / LEACHING PIT TO BE PUMPED, FILLED + :''. r • '..� ELEV TOP = 98.00' REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS }/ � '� ess *•• ,• _ \< UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, FINES OR OTHER ARE NOT CONSISTENT WITH TEST PIT DATA. }/ / �\ WITH CLEAN SAND AND ABANDONED LOCUS +• • ' . ZONE 2 ELEV WATER= 87.33' UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). 3. PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS. /}/ +`STj • •. r " •.; •�•• • PERC RATE = 3 min./inch 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN • �! SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. /}/ / tic��\ , ••`+• • �� J DEPTH OF PERC = 30"-48" ro 4/1 APPROXIMATE LOCATION OF EXISTING • Q +• . ••�• • 16. PROPOSED PROJECT IS LOCATED WITHIN: (�' TEXTURAL CLASS: 1 ( ASSESSOR'S MAP 230 PARCEL 5 C } �Ty 1,000 GALLON SEPTIC TANK TO BE RA • y� + + • '` • w• . - C14Y /}/ LP 97x5 'oJ UTILIZED AS PART OF THIS DESIGN �+ �1 + •+ ' / 0 /} • •.• /i a OWNER OF RECORD: GENEVIEVE M.ARIES 0 / * so, * w ADDRESS: 28 GREAT MARSH ROAD Z �� ` "��•-� +• i t • 0" 98.00' CENTERVILLE, MA g t- / • ss 4! � ° +\ 97x4 ••'��0 + • •40 Fill MAP 210 �� 9O7x8 MAP 230 � • 26 � 95.50' FEMA FLOOD ZONE C PARCEL 163 Q, I 0 `ssi" • PercO COMMUNITY PANEL# 250001 0005 C p r� OjI PARCEL 140 . Loamy Sand o CIt o . C-1 48" 2.5Y 6/6 94.00, 17. DEED REFERENCE: DEED BOOK 5351, PAGE 132 • • 52" 93.67' 1 18. PLAN REFERENCES: 1. BOOK 228, PAGE 29-F3(GREAT MARSH ROAD L.O.) � 2. BOOK 122, PAGE 89 ' . // • •. + • • 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. PROP. 40 MIL. IMPERVIOUS / cc+ , • �7 + • • GEOMEMBRANE LINER �`S'Tj • ` � • I 20. PF_: ^EF�TY LINE INFORMATIr`!I IS 0N11_' /APPROX7MATE. THIS PLAIN IS TO BEUSE:111:.?``t' '��, • •, +. I Med.-Coarse:and FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY • C-2 2.5Y 6/6 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. a ti��A 21. IN ACCORDANCE WITH 310 CMR 15.401 - 15.405,THE FOLLOWING LOCAL UPGRADE APPROVAL IS REQUESTED FROM 310 CMR 15.211: 101, - Cy MAP 230 MAP 230 (1.) A 10.0'WAIVER(20.0'- 10.0') FOR THE SETBACK FROM THE PROPOSED LEACHING HC 1 #28 PARCEL 5 PARCEL 141 LOCUS PLAN- FACILITY TO THE EXISTING FOUNDATION. y/� / , O• EXISTING ____1 2) 3 B DROOM 9,025 S.F.± SCALE: 1" = 1000' 128 87.33' DWELLING CO ` TOF = 98.8'± 9, No Mottling, Weeping, or Standing Observed P1 98x4 - - DESIGN DATA EST PIT DATA LEGEND \ � PERC NO. 12755 98x0 \\ \ ' INSPECTOR: David W.Stanton, R.S. 50xO EXISTING SPOT GRADE TP2 0� NUMBER OF BEDROOMS (DESIGN) 3 EVALUATOR: Michael Pimentel, EIT, CSE - 50 -- - - EXISTING CONTOUR PROPOSED DISTRIBUTION BOX L 98 c0 _9 3) EXISTING GARAGE DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E. APPROVAL DATE: 10-27-99 \\ �S 98x5 TOTAL DESIGN FLOW 330 GAL/DAY DATE: November 12, 2009 -E 50 PROPOSED CONTOUR PROP. 20 - 13" HIGH ARC 36 \ J \ �j � ✓ HC-2 DESIGN FLOW X 200 % = 660 GAUDAY 2 (PROP. 0 BIODIFFUSERS13" HIGARC IN . ��? TEST PIT#: ❑/H/W EXISTING OVER HEAD UTILITIES FIELD CONFIGURATION \ USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 98.00' W W------- EXISTING WATER LINE \ 22 TEST PIT LOCATION 97x6 ti�l,. / P�� ELEV WATER= 87.33' \ 4) ��,� �� INSTALL 20 - 13" HIGH ARC 36 (#3613BD) BIODIFFUSERS PERC RATE _ PROPOSED INSPECTION PORT (TYP OF 4) 0" \9� ^p �00, 4/ pp�� LP EXISTING LEACHING PIT STUMP co ,+"Z , SYSTEM CAPACITY DEPTH OF PERC= \ MAP 230 TEXTURAL CLASS: 1 Q X S G ,000 GALLON SEPTIC TANK (TOTAL L.F. OF BIODIFFUSERS&COUPLINGS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD PARCEL 6 (100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING/DAY PROPOSED 4'SOLID SCHEDULE 40 PVC PIPE , �� \O'y�w \ 0��, O� TOTALS: 0" 98.00, 13 PROPOSED DISTRIBUTION BOX ru' o� �s Ok, 97x � Fill Q PROPOSED 13" HIGH ARC 36 (#36136D)BIODIFFUSER TOTAL NUMBER OF BIOI, /S/ 0� / � O TOTAL NUMBER OF COUPLINGS DIFFUSERS: 00 95.50' 30" TOTAL LEACHING AREA: 480.0 SQ.FT. Loamy Sand O 98- TOTAL LEACHING CAPACITY: 355.2 GAL./DAY 2.5Y 6/6 ,\` 0/ 52" 93.67' \ ti REV. DATE BY APP'D. DESCRIPTION Benchmark \ �w s PROPOSED SEPTIC SYSTEM UPGRADE Nail in UP#33 V SRO NOTE: Elev. =98.75' (Assumed) EXIST. CBN 95�0 3�cc EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE PREPARED FOR: RIM =96.9'± DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER Med.-Coarse Sand CAPEWIDE ENTERPRISES "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO C-2 2.5Y 6/6 ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST MODIFIED JUNE 30, 2009). TRANSMITTAL NUMBER=W000052. LOCATED AT \ 28 GREAT MARSH ROAD CENTERVILLE, MA `y. SCALE: 1 INCH = 10 FT. DATE: DECEMBER 4, 2009 SWING-TIES F6_ \ �',\ 128 87.33' 0 5 10 20 40 FEET I DESCRIPTION HC-1 HC-2 �O,cA\ No Mottling, Weeping, or Standing Observed r�kW" VA4. ti �l��N` PREPARED BY: BIODIFFUSER CORNER(1) 22.3' 54.6' F?7 RESERVED FOR BOARD OF HEALTH USE .��jR." JC ENGINEERING, INC. 2854 CRANBERRY HIGHWAY BIODIFFUSER CORNER(2) 11.7' 51.3' Nc -18, EAST WAREHAM MA 02538 BIODIFFUSER CORNER(3) 21.2' 27.1' ' SITE PLAN 508.273.0377 BIODIFFUSER CORNERT(4) 28.5' 32.9' __ ___.__ _.____.._. SCALE: 1" = 10' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.1720