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0047 HALYARD WAY - Health
47 Halyard Way A= 194-065 Centerville i F Slll JA!`��yh No12534 22-153LO�R ''bsr co eASTINGO,UN 4. TOWN OF BARNSTABTE i LOCATION JAr\s.(CNS-d SEWAGE# o p-)a VILLAGE C U, ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. � M �rt.vSJC- � OO(m SEPTIC TANK CAPACITY (2!X(IA C m O LEACHING FACILITY:(type) C%SbQ� Cs ck. 1A1Q� (size) Ja.k X X S X 2 NO.OF BEDROOMS 3 OWNER rcS��/ PERMIT DATE: COMPLIANCE DATE: o f I Q Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY AL S 3 ZLA z3 c No.' / I u Fee , �� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliLation,for Disposal 6pstrm Construction 3prrmit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 14"� �-� � � ���� Owner's Name Address,and Tel.No. QC,`! Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name Address and Tel.No. rI 3 TI pe of Building: Dwelling No.of Bedrooms 3 Lot Size �•• sq.ft. Garbage GrinderN 0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures "� v Design Flow(min.required) ��3 gpd Design flow provided 11 y Q gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Q_"X(Sk `%13® G C `.. Type of S.A.S. a b o &C,\` LQ,G, Description of Soil 0 0 j 'Sy_ d C Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. i S' ed Date /�;t S f 5 Application Approved by Date 0K Application Disapproved b Date for the following reasons Permit No.ZA 97i- Date Issued ������ .1 4 12 44� No r • ti "� Entered'.in comuter: ,! THE\COMMONWEALTH OF MASSACHUSETTS, P yes ram' PPUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACH'USETTS ' appfiratiowf�r Disposal 6pstem Construction Permit j Application for a Permit to Construct( ) .Repairv) Upgrade O Abandon(i) ❑Compldfe System"Ej Individual Components Location Address or Lot No. Owner's Name Address,and Tel.No. C y`�l�. S�r•�c.�...c— l='�s C L/' W'� �t��y-w`C� t,JG Assessor's Map/Parcel �QL •Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: rDwelling No.of Bedrooms 2 Lot Size (o.• Ff3j sq.ft. Garbage Grinder.N 0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) if r Other Fixtures Design Flow(min.required) �21 gpd Design flow provided C c gpd Plan Date Number of sheets Revision Date ' Title 1f Size of Septic Tank �X tstt L4Q(� l9(A Type of S.A.S. 'M d &CG \. Lcc, G� Description of Soil o.� 5c.h d ('In G."A " Nature of Repairs or Alterations(Answer when applicable) `. -. ('1n�rn � "s Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date WAS 1 /: Application Approved by Date �i �•s / ,,,�,ry Application Disapproved bye + Date t for the following reasons Permit No.X r ✓ l/i7_ Date Issued __________________.______._.___-__.___-___.___.______._.__-__-___,______.___._________._.___-___- -____ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by v:n�.n� at CCU�5, � ) ��fn�f C „ {—t��il� Q has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.Z9f'r'"YZ? dated (t J-Z y p-zy, Installer \C 'AI V. Designer� W S�r C_,5 #bedrooms 471 Approved design floes F)lk as�,.designed. t &- gpd The issuance of this pe it shall not be construed as a guarantee that the system will tonDate J Inspector � r c,,•J' - -- - - - -- - - - - ---=------------=_--- No. �� _ Gr�Z - 19 _ _ ._ _ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS i Bisposal Ops_tem Construction Permit Permission is hereby granted to Construct( ) Repair(t/f Upgrade( ) Abandon( ) System located at \,,JC,, 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. y Provided:Construction must be completed within three years of the date of this permit. Date ( t /2 5 WA Approved by k1 ilia Town of Barnstable Departinelat of Regulatory Services Public Health Division Date -7Z/4, re3P 200 Main Street,Hyannis MA 02601 f lftt tAKI h � � ,¢, 11 rnrn .� Date Scheduled Tune— �' Fee Pd. 11U " i 17 �yD Soil Suitability Assessment for Sewage .Dis oral Performed By:. Witnessed By: (nv( GV1 n �J LOCATION&GENERAL INFORMATION Location Address Owner's Name 5/I AE Flit1S'13 7 ��r9�ev�way, •� y Address L/`7 Af/%Ytl,cd &61,4- ' Assessor's Map/Parcel: Engineer's Name STerhel(/ H AA5 NEW CONSTRUCTION s'ug REPAIR Telephone tt (e •- /(�j�! 0 oA-3C z Land Use Z. Slopes(46) Surface Stones tic. Dlstanceb from: Open"Water Body ft 1'ossiblc Wet•Area ft Drinking Water Well . ft Draihago Way �G'# ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) E4kf 0� ; A-Ly? Parent material(geologic) fSzX7"Y�r`rr5 11 Depth to Bedroe!<�.T�v t Depth to Groundwater Standing Water in Hole: Weeping ft'om Pit Pnee Estimated Seasonal High Oroundwater �— DETERMINATION FOR SEASONAL-HIGH WATER TABLL Method Used: _ �. &"C__ Depth Observed standing In obs.hole: In, Depth Ib soil mottled: Death to weeping from side of obs.hole: ater �Juetment A In, Groundw Indcx Well tr Reading Dater Index Well level� /{ ,}undw,ter A� Adj,Groundwater level Observation PERCOLATION TEST U81e6 t Ayn,� !l7— -----f•— Hole S Time at 9" r( Depth of Pere Time at G" Start Pre-soak Time @ �' � Timo(9" End Pre-soak Rate Min./Iuch Site Suitability Assessment: site Passed 'Site palled: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-- - ***If percolation test is to be conducted within 100'of wetland,you must first notify tll<e Barnstable Conservation Division at least one(1)week prior to beginning. Q!\SEPTIC\PBRCPORM.DOC' DEEP-OBSERVATION HOLE LOG Hole# --�— Depth from Soil Horizon Soil Texture Sdil Color Soil, Other Surface(in.) (USDA) (Munsell Mottling (Structure,Stones;Boulders. Coyi!iltcfic%Vorayell to YA- DEEP OBSERVATION HOLE LOG Hole# 7- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stonea,Boulders. 1241 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Slopes;Boulders. Consistency, i I_+food Insurance Rate_Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yee._., Within 100 year flood boundary No. Yes . Depth of nturally 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? '�� If not,what is the depth of naturally occurring pervious material? Certification I certify that on 11h V & (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 trainin a pertise and experience described in 110 CNM 15.017. Signature Date 1f Q.\SBPTICWBRCPORM.DOC Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Y Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form e i Date: Sewage Permit# U aLI Assessor's Map\Parcel Ii Sr Designer: S E11- fkF_1J a. 11A A.S - (� Installer: e-CF C'- l.A. �-- Address: ~' �• �Ok �I® Address: Its Oct YID &OTi-( Rhi svv A `��a��S E-l� gykiJQ i S , k A.`Sn2 lGo I On W o3S 1 1S $Car was issued a permit to install a (date) (installer) septic system at�A_D based on a design drawn by (address) Wdated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed Dance with the terms z of the IAA approval letters (if applicable) "x 'r T (Installers' ignature) IL (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:1Septic\Designer Certification Form Rev 8-14-13.doc I Jf/I f I A L � C 1 J V C y ` 1 �L p P i fi 7 C { { 1 i r c.a i E o i i ti g i � Ii of INE taw Town of Barnstabrle ' - Barnstable Regulatory Services Department ;edcaC'j > ■ARN%rABLE, + "Ass. i639' Public Health Division �� Arf0MACA, 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Thomas F.GeilerLeach pit is only3f )undwagter,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3525 5538 June 27, 2011 Estate of Theresa Hillen c/o Atty. Laura McDowell-May P0 Box 910 Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 47 Halyard.Way, Centerville,MA. was last inspected on 5/28/2011 by Joe Martins a certified septic inspector for the State of Massachusetts. According to the private septic system inspector, the system"Conditionally Passes" due to the following: • Septic Tank is leaking. It needs to be made watertight or replaced. ; The System, upon completion of the replacement or repair, as approved by the Board of , Health, will pass. You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period may result in future enforcement action PER ORDER OF THE BOARD OF HEALTH mas McKean, R.S., CHO Agent of the Board of Health r Q:\SEPTIC\Letters Septic Inspection Failures\1-1 SAMPLE 60 Day Deadline.doc Commonwealth of Massachusetts / Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 Halyard Way, Centerville MA Property Address Estate of Theresa Hillen c/oAtty Laura McDowell-May PO Box 910 Owner Owner's Name information Is Dennis MA 02638 5/28%2011 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information " When filling out Joe Martins forms on the Accu Se computer,use 1. Inspector: �heck only the tab key 17 Northside Dn - � to move your S. Dennis, MA 02660 use the return cursor- not Name of Inspector key. Company Name Company Address City/Town State Zip Code 50� 38 • s s • �9/ SI ly7 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�`bf orelte sewage disposal systems. I am a DEP approved system inspector pursuant.to Section 4340W Title 5 (310 CMR 15.000).The system: - �= `:z 6� ❑ Passes 2/Conditionally Passes ❑ F ads :x ❑ Needs Further Evaluation by the Local Approving Authority -77 rn In actor's Ngnature 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. I � i5ins•09108 Title 5 Official Inspection Farm:Subsurface age Dis I System•Page 1 of 17 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 Halyard Way, Centerville MA Property Address Estate of Theresa Hillen c/oAttx Laura McDowell-May PO Box 910 Owner Owner's Name Information is required for Dennis MA 02638 5/28/2011 every.page. City/"Town State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. if"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound(—exhibfts substantial W€t bw iuMor exfiltration-Or tank failure is imminent. System will pass inspection if the existing tank is replac wrt 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): n C- �__G c _ s L k, 1� boVo4e v- --b k D/L.. t5ins•09108 Trte 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 47 Halyard Way, Centerville MA Property Address Estate of Theresa Men c/oAtty Laura McDowell-May PO Box 910 Owner Owner's Name Information is Dennis MA 02638 5/28/2011 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 ❑ 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 broke obstructed pipe(s). The system will pass inspection if(with approval of the Board of He ❑ broken pipe(s) are replaced ZY N El ND (Explain below): El obstruction is removed 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•09/08 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 47 Halyard Way, Centerville MA Property AddressEstate of Theresa Hillen c/oAtty Laura McDowell-May PO Box 910 Owner Owner's Name information is Dennis MA 02638 5/28/2011 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 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 is within 100 feet of a surface water supply or tributary to a surface water suppl ❑ The system has a septic tank and SAS and the SAS is W ' a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and th AS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and t AS 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 wel ater analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent an a presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided at 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 ❑ ET"' 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 ❑ L� Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ �/ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 Halyard Way, Centerville MA Property Address Estate of Theresa Hillen c/oAtty Laura McDowell-May PO Box 910 Owner Owner's Name information is Dennis MA 02638 5/28/2011 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 121 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ E?/ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ d Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ [2�/ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ E!f/ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Lk 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.] ❑ L4/ The system is a cesspool serving a facility with a design flow of 2000gpd- ❑ The g s 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 16,000 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 s ce drinking water supply ❑ ❑ the system is within 20 et of a tributary to a surface drinking water supply ❑ ❑ the system is ted in a nitrogen sensitive area (Interim Wellhead Protection. Area—I )or a mapped Zone II of a public water supply well If you have answered " s"to any question in Section E the system is considered a significant threat, or answered "yes" ' Section D above the large system has failed. The owner or operator of any large system cons' red a significant threat under Section E or failed under Section D shall upgrade the system ' ccordance with 310 CMR 15.304. The system owner should contact the appropriate regio al office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form A WE Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 Halyard Way, Centerville MA Property Address Estate of Theresa Hillen c/oAtty Laura McDowell-May PO Box 910 Owner owner's Name Information is Dennis MA 02638 5/28/2011 required for 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 ❑ 2*"/ Were any of the system components pumped out in the previous two weeks? ❑ Lg" Has the system received normal flows in the previous two week period? ❑ 21-� 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 bre9k out? ❑ Were all system c nents, a Ing 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): Number of bedrooms (actual): Z2o - 330 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y` 47 Halyard Way, Centerville MA Property Address Estate of Theresa Hillen c/oAtty Laura McDowell-May PO Box 910 Owner Owner's Name Information is Dennis MA 02638 5/28/2011 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information Description: 1 /0 q 114, Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? [f yes separate inspection required] ❑ Yes No Laundry system inspected? A11A ❑ Yes ❑ No Seasonal use? ❑ Yes 1W No Water meter readings, if available past 2 years usage (gpd)): Po Detail: �� l 9r77 Sump pump? ❑ Yes No Last date of occupancy: ate 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. tc.): Grease trap present? ❑ Yes ❑ No Industrial waste hol ' tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09M Trtie 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 Halyard —r Centerville MA Property Address Estate of Theresa Hillen c/oAtty Laura McDowell-Mary PO Box o1— Owner Owner's Name information is required for Dennis MA 2638 � every page. City/rown State Zip Code Date o ns512842011 lof n- D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Ls Ole— 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/Altemative 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•09/08 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 47 Halyard Way, Centerville MA Property Address Estate of Theresa Hillen c/oAtty Laura McDowell-May PO Box 910 Owner Owner's Name information Is Dennis MA 02638 5/28/2011 required for 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: Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): 7 Depth below grade: p g 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.): oIL lU hpr Ks 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: S ' 7 Sludge depth: t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s` 47 Halyard Way, Centerville MA Property Address Estate of Theresa Hillen c/oAtty Laura Mcnciwell_May Pn Box 910 Owner Owner's Name information is Dennis MA ._42618 ^51?81701 1 required for State Zip Code Date of Inspection every page. Cityfrown D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 11 C d+r-?tt��Q✓ 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.): ito �i 2� ca�f le �L v0-e A-el Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ pol ne ❑ other(explain): Dimensions: Scum'thickness Distance from top o um to top of outlet tee or baffle Distance f bottom of scum to bottom of outlet tee or baffle e of last pumping: Date t5ins•09/08 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 47 Halyard Way, Centerville MA Property Address Estate of Theresa f illen c/o&ty Laura McDowell-May PO Box 910 Owner Owner's Name Information is Dennis MA _02638 5/28/2011 required for every page. City/Town 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: allons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumpin Date Comments ndition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-09/08 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 47 Halyard Way, Centerville MA Property Address Estate of Theresa Hillen c/oAtty Laura McDowell-May PO Box 910 Owner Owner's Name information is Dennis MA 02638 5/28/2011 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan):Depth of liquid level above outlet invert: 1 " 4t`�/ nt,, 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.): ' t L obit/ /4 ✓PA, �d � S 4,0e- 12.e Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order. Yes ❑ No Comments(note condition of pump chamber, c Ion of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavatio quired): If SAS not located, explain why: t5ins•09/08 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 47 Halyard Way, CentervilleMA Property Address Estate of Theresa Hillen c/oAtty T airra Me owe!! May POBe o�g-- Owner Owner's Name information Is Dennis MA _D2638 required for State Zip Code Date or Inspection every page. City/Town D. System Information (cont.) Type: 42-*11 leaching pits number. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failurr?, level of ponding, damp soil, condition of vegetation, etc.): 6;z 1—o 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 c ruction Indication of groundwater inflow ❑ Yes ❑ No t51ns•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 117 I Commonwealth of Massachusetts 27 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,y 47 Halyard Pr operty Address Estate of Owner Owner's Name information is Dennis MA_ . -02& ---- required for State —tip—Code Date every page. City/town D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, c ndition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, I I of ponding,condition of vegetation, etc.): ritie 5 official Inspection Form:Subsurface Se+vage Disposal System•Page 14 of 17 t5ins•09/08 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V�. 47 Halyard Property Address ' Owner Owner's Name BOX information is required for De S MA state 826 Code Dat every page. City/Town 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 F.2o N PV s J1 ZD 3 oy /' 2- j %35- � t5ins•09l08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 Halyard Way Property Address Estate of Theresa Owner owner's Name information is jeers MA �26 ---- required for State ip Code bate-otfh every page. City/Town D. System Information (cont.) Site Exam: [Check Slope Surface water [Check cellar M Shallow wells s� Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date f ❑ 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: 9aever-nsl�!/� To A6 , You must describe how you established the high ground water elevation: J—" !s �001 /�• J-• L- �, ax yw' 7" 3,5 ff• ,5 L S G q t f 1A_ 'fC kfe ahov2 Itfd790 G Before filing this Inspection Report, please see Report Completeness Checklist on next page. Tide 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 t5ins•09108 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 47 Halyard WU, Centerville MA Property Address Fsta-te of Theresa 14i11en c%oAtty La-ura Mc-Dowell vn Box 910 Owner Owner's Name information is required for Dennis 519812-011 every page. City/Town State�26 ip Code Date o nspec ion E. Report Completeness Checklist ER/Inspection Summary: A, B, C, D, or E checked QYinspection 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No.")o Fee ®V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppfitatlon for Nsposal *pBtrm Construction Permit Application for a Permit to Construct( ) Repair ) Upgrade( ) Abandon( ) ElComplete System ElIndividual Components Location Address or Lot No. Lf 7 ore( Ali►% O ne 's amePAd ress,and Tel.No. Assessor's Map/Parcel �Pn{er✓j/�� 65 /jam °Fp L�v �� Installer's Name,Address,and Tel.No. / Designer's ame,Address,and Tel.No. S—W.?d57.f q Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3l7 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title nn Size of Septic Tank Type of S.A.S.Ti t Description of Soil Nature of Repairs or Alterations(Answer when applicable) � /� z � t7rRc Date last inspected: ��IPA Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health S' Date -3 f/ Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ( � �� Date Issued +.,. No.C7Q Fee ©V! THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,'MASSACHUSETTS Yes 21pplication for Ospool *vstent ' Cous-trurtion vertnit Application for a Permit to Construct( ) Repair ) Upgrade( ) Abandon( ) ElComplete System ElIndividual Components Location Address or Lot No. c��� Al,�,f On7� iNaD o,Ad ss and Tel.C� Assessor's Map/Parcel ��r}�P/ •�l/r��� 6, GY P/(t' o ���, '1- 6 T10- er's Name,A dress,and Tel.No. ✓ Designer's ame,Address,and Tel.No. -r Nar a s J44 /+Cor A�6/100'v/t ���- Type of Building: 3 �e .nor 76 S Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3l7 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title _�✓ Size of Septic Tank Type of S.A.S. / Description of Soil Nat�of Repairs or Alterations(Answer when applicable) Date last inspected: Id el d o F 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 . Signed Date '3 '` Application Approved by Date .3 Application Disapproved by Date ,for the following reasons Permit No. l ,. Date Issued I w G r)kE COMMONWEALTH OF MASSACHUSETTS r BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIF ,that the On-site Sewage Dis o al system C nstructed ) Repaired Upgraded Upgraded( ) Abandoned( )by ��'—//�—s � i� �KP �f?PWC at ! 7 Hq �y c r0( j/V 4 y C'Pn f has been constructed in accordance ( J A with the provisions of Title 5 and the for Disposal System Construction Permit No. cJGated / l Installer Designer #bedrooms Approved design flow gpd The issuance of this per/merit shall no be construed as a guarantee that the systeerr't wig ll nc�aslesigned. Date �d �., � Inspector ----------------- No. C / — + Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal Opste Construction permit Permission is hereby granted to Construct )/ Repair Upgrade( ) Abandon( ) System located at �7 ;4 i4aVv( Oar, C Pn{+"r✓/��� P and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this p it. Date ,�� 1 Approved by YuB pTHE COMMONWEALTH OF MASSACHUSETTS \_ BOAR® 9F HEALTH OOF... -------------•-•------- , Allpliratiun for Disposal Works Tonutrnrtiun 11trutit l,1 Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System .... -- l� ........ ---------------------------•------ n �pa .., aon- ess � or a^�T..�� r��r.... _ W ow es .... ..... y............................ 46� ......................... Installer Address ((''+��+ Type of Building *��* Size Loo?r_d'FJ(.Sq. feet Dwelling—No. of Bedrooms........... ...........................Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons...._.....__._.............. Showers ( ) — Cafeteria ( ) a' Other fixtures --------------- ------------------------•------•----.--------.....-------------------------------- W Design Flow.... _.� ............................gallons per person per day. Total daily flow...... 3 .....................gallons. WSeptic Tank—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 t Percolation Test Results Performed by-___ --- --------- -------V_.._ _ Date... ........ as Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--___-_______--------_-- G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil....9.�..�-: ,[�.... ; _..__ __ x .. ------------••------------------------------•----------•---- ---------------------------------------------------------------- ---•-----------------------------------------------•----------------------------••---------------------------------- V Nature of Repairs or Alterations—Answer when applicable.__............................................................................................. -------•--•-----------------------•-------•--------------------------------------......._..........----------•--------------------------------•-•-----•-•---------------------------...._.............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the aprov'isionsf iITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in opea om lia a$-been issued by the boardof h lth. rSigned----- . ... -..... . -�------------ --roved B ._.... .nP Y --•--•---•--..._..---•------------- Date Application Disapproved for the following reasons---------------------•---••-•----------------------------------------------------------------------...-----...._ ..-•-•-•----•-•------•---••----•-•------•-•-•---------------------•------------------------•---.....-----------------------------------------------------------------------------....-----•------------ Date Permit No.... �� �� -�� •--- Issued--•------------------------------------------------•--. Date r Fzs... ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Disposal Works Tonstrnrtion rumit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: .... -`` ... ..��.-..��:: �..�...f�'i���.. .............. .��;�'=� i��.��.J................................... fi-Location Address l/ Ow er 71 Address f a ...... �. r - �..: ... :-:-�_...-•--•--------------•-•- ..................-----•--•--• ��' -- .f •, -•----........_.....-----•--- -••_... !f.. . .Installer Address ��J �� Type of Building Size Lot.........:................Sq. feet 1-4 Dwelling—No. of Bedrooms.........:. ...........................Expansion Attic .(elU) Garbage Grinder aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures _________________________ W Design Flow...f v_____________________________gallons per person per day. Total daily flow.... . .......................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x ; Disposal Trench—No_____________________ Width.................... Total Length.................... Total.leaching area_...................sq. ft. .4 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z i4 Other Distribution box ( )` Dosing tar}k Percolation Test Results Performed by... __.....................'� ...... l 1. _ Date./._. `4_ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water.....................__. w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ...................;�-------------........---- - Descriptionof Soil.... =. ....... ------------------------------------------------------------- (xj --------------------- ------------------------M-•--------•------------------------••-------------1..•--••------••-----•-----------------------------••-------------•------------------._....--•-----------•---•------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -•------•-----•-------------•-----........--•------------•-•--..__...---------...-.-•-----••----....---•--••--•-----------------...------------••--------••---•-----•---------------........._•-•---••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions f TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in opeWicationA omilian ;.laas-been issued by the board of health. _ e ApdBy................ ` :_.. ...... --�)-;. ................................ D t ' Date Application Disapproved for the following reasons--------------------------------•--------------...._..-•-------...-------------...---------------------•__------ .........................................••-••-•••••------......•----•-----••---••------•......•----•-------------...........--------------•----•••------------•--•------------•-----...-------••-_-•--- Date Permit No..._._.._. .."�-"a" �. ...... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARDO F HEALTH J ,:.G�/J'l� z-�........OF-,--r//!/iF-� :.!, �t,s'r� .<;Cam;_ .. ..................... Tnrtifkate of Tnntpliattrr THIS IS TO CERTIFY�,That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--_:...� :=-'�' l :..< ........r','`-,-j.. ......:•-•-•--•-•---•---•--------------•--......--------•----._............------•---........--------....------....----•-•-•------- j '/� /f f / Installer f •---••• �._ . . ,.. ........_.. has been installed in accordance with the provisions of TITIF .„ , -- 7� datedy_.____de ap described in the application for Disposal Works Construction Permit No........ The State Sanitary Code a describ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT 13E C NSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. '. r................ ••-•---••.........._. Inspector THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH -�r -� �..�-• .....OF.. y. ...................... id�G, +r l _.,a. FEE.... ..... y No............ :. ! Disposal Works T11ntrnrttinn rrntit Permissionis hereby granted.............................................................................................................................................. �. to Construct (—_�'or�Repair ( ) an Individual Sewage Disposal System at No..... /_ � � �. - i _,-�.��' «! ✓ ,��' Street �a�s shown on the application for Disposal Works Construction Permit No.__.�s_.S'.A�� —at .... ....... ...� 1 - -- ............................... y �t Board of Health yD TE................ • -••------- 7 35'-•-- ...... F RM 1255 A. M. SULKIN, INC., BOST..ON , F <n S/N E 6t: AA- AllL.Y 3 4 I Z3 A10 G4.2BAGE G•2/�t/OE.2 -—T-- 2 0 o Y , OA/LY SLOW = //O X 3 r 330 SE.�T/� 74AI - _ 3.�IX/SO o.=5�9 (/SE -000 !O/.5.�32S,4L /T•-USE /,000 6,4� . �fF Co M m o n W ECG C.-rp G co /1-o s.� �t Z•S = 3T�G.Po EC�Sc. MT a� - ,So T•07;4 OE.S/bit/ _ �f7✓S��.PO w m r TO Wl- OES/G�6/ �.E.2COL.•CT/aN.2.4TE' � �5� � - �� S/. O.e LESS i qrr< - q$p s , , r PETER cN t R1-7 ICAARf7�"; �� U �ULLIVAN BAXTER No..29133 a. No 2404e .O 9 ' } r { }�. t 1g1�.Y t , ss�oNA �5 � , r YTS T j. 3.89 - / <; s a Sow E�sfo) j oo0 2M-CLIC /voo /.w � • 6•dG /Y✓ BOX j /N✓.: � �.�v Pir.• 9•S•6. W--/ '3/y` 7Atirc C(uj� Ta/%. e • /rt/K /Ni/ , r=,NE .Siz,vE �jS,B �j6,o CE,2T/F/EO ;PGOr- �L4,y 5A/voLoe,Q�'ioy vT 2t1r4 �/ C2 - / GE2ri,Cy Tf/,4T TN•E F-ov,�J b q-r1 7�$v '0rt/ L/E.�Eav GOMPGY,.S' !•d/T:�/TyE'Si��'�,/Jt/E Bfl x7Z.2€�t/YE /.c�G. A�vO.fETa�G� .eEQv/�E�I�Nr.S 4� Ti'/� .2E6/. r/` A clJ,Ga�!o sve�!Equ , ToW.v aF 134Iz�vsrA6 LE ,Q�v' /s .voT- �sTF,2/////.•= .sl•�sr G ocarE.v �//Th'/ism T.��• �L adoPl4iiV, �' !. Las T//G���.v /s �VoT a.4sEv a�v a.v lit%sT.e •. _ ...: -�/�IErYTsv,2c/�'Y,4NO TyE o�F,S.�1.,:��:..-_°� • S�jlO�,r/it/f�E.eE4�t/..S.�o!/t-��aT l�tE USEp Ta 70 VILLAGE c,EX7;-/LyI�L_�_ � FAD&6� MST ALL ER'S NAME ADDRESS (� wgzz=o _ SA, 17-4If 8 UiLDER . D OWNER OAT PERMIT ISSUED DATE CCAIPLIANCE ISSUED oh OC i e V- ACCESS COVERS MUST BE WI THIN 9" MIN/MUM. INVERT EL C VA T l ONS : DES l GN CR l TER l A : n ' 6" OF FINISH GRADE 3' MAXIMUM COVER GENERAL NOTES : FIRST 2' TO INVERT OUT SEPTIC TANK: 98.25 DESIGN FLOW: BE LEVEL MIN 2" OF PEASTONE INVERT IN DIST. BOX: 98.17 3 BEDROOMS AT 1/0 G.P.D. PER I. THIS PLAN 1S FOR THE DESIGN AND CONSTRUCTION OR F I L TER FABR l C INVERT OUT DIST. BOX: 98.0 BEDROOM EQUALS 330 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY. 4' DIAM PIPE INVERT IN LEACH CHAMBER: 97.9 3/4" - l l/2" DIA. „ ` NO GARBAGE GRINDER 2. VER T I CAL DATUM IS ASSUMED. FOR BENCH MARKS o BOTTOM OF LEACH CHAMBER: 95-9 98.25 98.0 $oB 2• �° DOUBLE WASHED STONE • GAS / 98. 17 0 97 9 95.9 ADJUSTED GROUND WATER: N/A SET. SEE SITE PLAN. eAFFLE OBSERVED GROUND WATER: N/A SEPTIC TANK REQUIRED: 3 OUTLET 2-500 GAL LEACHING CHAMBERS •EXISTING D-BOX W14' STONE AROUND. 12.8•w x 25*1 x 2'd BOTTOM OF TEST HOLE 1: 90.4 330 G.P.D. X 200% - 660 GAL. J. ALL CONSTRUCTION METHODS AND MATERIALS AND --- SEPTIC TANK PROVIDED: 1000 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL 1000 GAL H-20 CONFORM TO MASS, D.E.P. TITLE 5 AND LOCAL SEPTIC TANK 6" CRUSHED STONE OR SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS. COMPACTED BASE DESIGN PERC RATE ( 5 M/N/I NCH SOIL TEXTURAL CLASS - I 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER ZOp OG R R D F I L : NOT TO SCALE EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 330 GPD / 0.74 GPD/SF - 446 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH- STAND I NG H-20 WHEEL LOADS. ' PROVIDED: 2-500 GAL LEACHING CHAMBERS W/4' STONE AROUND, A-471 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR 471 S,F. x 0.74 - 348 G.P.D. APPROVED EQUAL. J ✓ SOIL 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED - f TEST P ! T DA TAB PRECAST CONCRETE OR APPROVED POLYETHYLENE. ' �J 'r•R TI 9 1NDICATES N f PERCOLATION OBSERVED BOTH SHALL BE WATERTIGHT, D-BOX SHALL BE WATER TEST - GROUNDWATER TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE TIP s1 Pw/4779 TIP s2 OUTLET. f I 0. HORIZON TEXTURE COLOR 100.4 0" HORIZON TEXTURE COLOR 100,4 LOAMY IOYR LOAMY IOYR 7• BEFORE CONSTRUCTION CALL "DIG-SAFE". f ` '4 SAND 212 Q SAND 212 1-888-DIG-SAFE AND THE LOCAL WATER DEPT. / 5 - ' l00'0 6' ' - - - - - ' - - ' ' ' - ' - 99.9 FOR LOCATION OF UNDERGROUND UTILITIES. f f ' B SANDLOAMY 416 SAND IOYR Y 416R f IS` - - ` - - - - -- - - - - - - 98.9 20` - - - - - - - - - - - - - - - 98.7 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE LOT 28 f I C l MEDIUM IOYR Cl MEDIUM IOYR DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION SAND AND 614 SAND AND 614 C ION 26, 833+ S.F. f f ! coseLEs COBBLES OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE CONSTRUCTION INSPECTIONS, 9. EXISTING LEACH PIT TO BE PUMPED DRY, REMOVED f / pWE�L+NG -_ 6 - AND BACKFI LLED WITH SAND. c9• / '$t!NG ri- - l20' NO WATER 90.4 120- NO WATER 90.4 97.6 DATE: AUGUST IO, 2015 , TEST BY: STEPHEN HAAS l WITNESSED BY: DAVID STANrON am. CORNER $TEP � ZI PERC RATE: ! 2 MIN/INCH 6 PDR 100.6 EXISTING 1 \� i� t10 SEPTIC TANK •'.::..:. � c, +9s.9 f PA 100.7 :':.'. TP*1 100.2 LEACH a� PIT TPm2 � D-BOX m i0 21 UP 5 v N ay. OMH100.4 100.6 + 01 i / ( �? 4 r PC K SOLID CATCH BASIN 49 2-500 GALLON lei 3 LEACHING CHAMBER t�r g 100.5 W/4' STONE AROUND R� VM i - � SEPT / C SYSTEM DES / ON d 47 HALYARD WAY MAP 194 . PARCEL FS / BARNS TABLE . tcENTERV l LLE• ) R PREPARED FOR : s SERY 1 ROAD r L EG[VW , CPY� ■ CB 'CONCRETE BOUND S l / l V A E7 � i 1 I S L.:.7 / 0P ���� --W- �ATER L I NE - o-- �ASRLNNE SCALE l 20 ' SEPTEMBER 9 . 2015 s �, /� A uEr OHW--- OVER HEAD WIRES LAKE pH E N A . H A A SAKE -# `. �.1GHT,MOST S T E t"'"� LOCUS -E-- NDERG-ROUND ELECTRIC LINE ENGINEERING , INC ---T--_ NDERGRO(1ND TELEPHONE L I NE / ti r P . O . Box 16 --CTV-* bNDERG'ROUND CABLEV I S I ON LINE South D e n n i s , MA 02660 + 3 40.4" $POT ELEVATION S �� ( 5O8 ) 62-•-8 1 32 I 40------- Exi STING CONTOUR LOCUS MAP r p 0 10 20 40 40 PROPOSED CONTOUR lV JOB NO: 15-047 t