HomeMy WebLinkAbout0100 HIGHLAND DRIVE - Health , Highland Drive
Centerville
A = 190 136
SIII gECYCI£p`
IN ® zJ m
UPC 12534
No, 2 153 aR ��STGON`'Ja�
NASTINQS, MN
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` /C TOWN OF BARNSTABLE
t LOCATION/� 4 14- SEWAGE# 2J1 f "2-5'_/
VILLAGE (C tV ASSESSOR'S MAP&PARCEL eld /16 v
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) JT �?c 00 44404-S(size) /7 00,x 3 ;x 2 r
NO.OF BEDROOMS /
OWNER «� �/t/t►at�' `'f/
PERMIT DATE: 1 5- s COMPLIANCE DATE: '
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
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No. �011_ Fee I'v
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplilatlon for MispoSAY *pstrm ConstrUttion Pffmlt
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
�f ) Owner's Name,Address,and Tel.No.
Location Address or Lot No.ID a "
Assessor's Map/Parcel Q / 6 ✓�e� tr'�a�f C �-� �1 � W,
Installer's Name,Address,and Tel.No. 7 `7 Design s Name,Address,and Tel.No.
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) gpd Design flow provided L 1 A�gpdPlan Date Number of sheets Revision Date
Title h
Size of Septic Tank / Type of S.A.S.
Description of Soil
Vi sr
Nature of Repairs or Alterations(Answer when applicable) Cave! �"� -7�f Cf, n v� l�q�•f
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 s ss in operation until a Certificate of
Compliance has been issued by this Board of Heal
Signed Date
Application Approved by Date S
Application Disapproved by Date
for the following reasons
Permit No. �O 1 Date Issued
' ..Fn ,. ~' 'St ". R �..�`n, .. •A... IT.ry, 'hr.vY�•^, L'
No. r� o it� Fee
{ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: les
` PUBLIC HEALTH DIVISION - TOWWOF BARNSTABLE, MASSACHUSETTS
application for MisposaY6pstem Construction 3permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 'Owner's y Add'ss,and Tel.No.
Assessor's Map/Parcel.
Installer's Name,Address,and Tel.No.07-. -y6f'.>r(Z. Designe4Name,Address,and Tel.No.
JM0el [�.c.t�2'_/. �/(�Ltc�ti. 1 'I'�. la� _l/i� G✓'9f e
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) ` �� gpd Design flow provided f G� ► gpd, F
Plan. Date Number of sheets Revision Date
Title vC
Size of Septic Tank Type of S.A.S.
Description of Soil
wry S�.
Nature of Repairs or Alterations(Answer when applicable) �` ovP'! ���� fitC�/'+ ;�G'�t-d/ •rr
ray //mom ,S , ':' u„� 3 5 c //.., .��
Date last inspected:
"Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
4I` "
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Ce tificate of . .`
Compliance has been issued by this Board of Health. ,,.
Signed ��,� Date
i
Application Approved by lj y '� � K jR Date
Application Disapproved by y Date
for the following reasons
Permit No. i oT R t Date Issued
ems_----T�_---.-..-_�__.-_- - =_--- _.._�-�.._ -_�--=------------
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 e/-IF tip-�o�'o Se;, ..�-e r 'A .. at.
at_ )d A Ja D& has been constructed in accordance
Ywith the provision of Title 5 and thD <osal System Construction Permit No.r 0� 5� dated
Installer -dl'e' Designer
#bedrooms �'� Approved desigtyflow�A %yo gpd
The issuance of this p rmit shall not be construed as a guarantee that the system will ((function as designed.
Date -7 It YT ti Inspector �\ 4
S
-----------------=------------------- -
-- _ -—- _ -- -- -
No. t Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposar *pstem Construction 3permit
Permission is hereby granted to Construct( ) Re air( Upgrade( ) Abandon( )
System located at / a 2�`'
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 Approved by /
Town of Barnstable
OF THE tp�
yQ� pb z� Regulatory Services
Richard V. S4a.li, Merin Director
r unruvsr,�aus, `
Public Health Division
`�FDM1°A� Thomas McKean,Director
200 Main Street,Hyannis, MA 0260.1
ocrc 508-862-4644 Fax: c08-790-6304
Installer- & Designer Certification Form
Date: �� -1�9 Servabe Perrnit#Z61�Z<1 Assessor's MaptParcel
cy Cl
Designer: t'�Ll ,X uo LrjfUs C Installer:
Address: J Z t11, Criss /c/ /? Address: -V--x4- rt:.
- a- , i kc r '1 try N4 - G?
Qn — -7 1 b;- 1 �,C3vo�d '� was issued a permit to install a.
(date) (Installer) -
z—
septicsystem.at \CICI H LtiQ�O�pr'CevC -
-- � _-- _ � based on a design drawn by
(address) -
",�� of Lts h-L-C dated -- Z9 --
C-1'1 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. Q
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 c.ompotient
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 in with the terms
of the 1`'A.appro $'P`�v
--- Installer's Signature) CIVIL
— " M
N0.35109
REOtSt6�0�yQ-
(Designer's Signature) (Affix Designe ere)
PLEASE, RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIE, .BOTH THIS FORM AND AS-
BUILT CARi) .ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTI-I DIVISION
THANK YOU.
U.
i.-ner C:ertificetion Foni Rev 4-14-1 .doc
Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backiill.The
engineer did not supervise construction of the system.The installer assumes responsibil'ty or all materials,workmanship,backflung
to specified grades with proper compaction and setting-isers'covers as shoran on the design plan.
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N/A OK NO
Is the system in a Designated Nitrogen Sensitive Area(Zone II for
a public supply well)? [310 CMR 15.214, 310 CMR 15,215 and 1
310 CMR 1.5.216 - also refer to Policy regarding upgrades of such ``7
existing systems]
Is the system.proposed on the same lot as served by private well.?
[310CMR15.2142 ]
Are the nitrogen loads proposed in compliance? [310 CMR
15.216(l
1VIis�ella►aeo�us�,f��,�. a �,°� �h;� � � ,�
Pumping to septic tank? 310 CMR 15.229
Shared.S stem [310 CMR 15.290]
e .
Address Sheet 7 of 7
C
TOWN OF BARNSTABLE
LOCATION &A'? 111411 44,4 ICY? SEWAGE #
V?LLAGE GAyTX<z114L.-6' ltrif ASSESSOR'S MAP & LOT i �r3Y
INSTALLER'S NAME&PHONE NO. Cllil[,TdP N�x���Khs �77- a83s'
SEPTIC TANK CAPACITY 600y'"E,0 cesS.00vL 19e-� Clil L
ass/+aoC 1 Y441 c�
LEACHING FACILITY: (type) Al r (size) le C/7c
NO.OF BEDROOMS 4�
BUILDER OR OWNER ?1A IVX-ia," J- AC-,9 Ve4e>,I4h' J,
PERMITDATE: %��?� � COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility �105� 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 o 1 > � a Feet
Furnished by 7
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Q�/C!l/��/a �:
/b K
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%, � _
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TOWN OF BARNSTABLE
LOCATION `00 �9�� \� c� SEWAGE # J - L B7
t i
VILLAGE 'ASSESSOR'S MAP 6z LOT 3
++ ar
INSTALLER'S NAME & PHONE NOX,,:,-►kw.�j �E'��.�'vl�S• �g]PI-��
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) ,, ° - (size) f aro o 4-'VL-a
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER M00 ;
DATE PERMIT.ISSUED:
DATE COMPLIANCE ISSUED•
VARIANCE GRANTED: Yes No 'tI
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THE COMMONWEALTH OF MASSACHUSETTS
OARD OF Hq ALTH
.... --- ...OF............... .
k,
Appliratilaltt for Uhiju al Marks Tonstr� t' rxtttit
Application is hereby made for a Permit to Construct--(--,)__or_ Repair ) an Individual Sewage Disposal
System ® l�1 h\ � .............. R Z ... - ...
- ..... -- ..... -••-••...- ---- -- - -----
Location- dress l - ort No
..... .�.�; �pa: .fit..... `�� '� -••-----•-- ----^^�---------..�.!.�}�...�..`_...._^_ .......... ...............
O er Address -
a .....
Installer Address
dType of Building c� Size Lot............................Sq. feet
Dwelling—No. of Bedrooms._._.:_-i'..........:...................•Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons____________________________ Showers — Cafeteria
Q' Other fixtures -------------------------------- - . .
W Design Flow............................................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.
3 Seepage Pit No-_____-_--_--__-._- Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
� Percolation Test Results Performed by.......................................................................... Date........................................
.-a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
--- - -------- ---•-•--••...•••-••....---••--•---------•--•-•-••-•••-•--•----..._.._.....--•---•--•----•----•----•••-•••-....__..._...---_...--
0 Description of Soil................ v`' :_---••------•--•--•-•----------------------------------•-----------------•------------------------ ......................---------------*-----------"--------*----------------------------------------------------*
W ------------------- ...
-•-•--------•---------------•---•••-•-••-•-•----•-•----•-•------•---••--•-•----•••••-•--•--•-•---...----- ---- ------ --------------.-•.•�••�••- '/
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 of TITL% 5 of the State Samt Code—.The undersigned furth agre snot to place the system in
operation until a Certificate of Compliance h b iss by th and ealth. ,
,,� �. 2-1
'
Signed. C ,.. 1 = !
Date
Application Approved By.............
Aafr! "�•-----------••....................... ------.. '� .-..��_-
Date
Application Disapproved for the following reasons_____________________•_•__________________-_-_____-_-__________--_--------------------------------._._..._..._._
------•--•------•---•---••---•---•...••---••-•••••--••-•-•--••--••--------------------•-------••----••------•-.._..-•---•••-•---•--•------•-•---...•---•----••-•-••----• •----•-----•-----••---•••--•---
Permit No........ �. ________________________ Issued.... ._..
.
A........................................
ate
AP
4.
No.....F� ....�. Z Fim.....�.®...C�O
THE COMMONWEALTH OF MASSACHUSETTS
OARD OF HEALTH o
... ........OF...............l...!. ....... ! O
'--------------••----....................__......_. f� .'
Appliration for Uiipooal Works Tomar #' rrrmi#
Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal
System at• A ` X Q() 1 ,36
.... .............' �r` `^••' .........._.......__..._..._... .........---••-------.............. .... _____......._................--------
.. _ ..
Location:-A dregs
...........:n�Coctt-::.S)....--.... :,..�.............................
......� a ►-� �� \ t No:....Via......... .............--
` Ow�erp
a --------- 1 '`r' `�... ............... ..�i.:..`�a.��.---------•—
Installer Address
Type of Building Size Lot............................Sq. feet
U DwellingNo. of Bedrooms............................. .....Ex anion Attic
a — ---•--.--- p ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures .----•------------------•------•----------...--------.......---------------------------------•-------•-----..........-•---------------...----------_..
W Design Flow............................................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.
Seepage Pit No..................... Diameter..._................ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
►-' Percolation Test Results Performed bY.......................................................................... Date....................
........
"...........
a
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
......... --.--•.... ........ ........................................................••-•--••------•--.............----.........---.._._.
D Description of Soil........... -----------
•-------._.----•---•-------------------------------------------------------------------------------------------
V -----------------------------------------------------------------•-----•-----•-------------------.-------------------••-•---------------... -
---•--------------------------------•------------•-------------------------------....----- ..._.. -•----------•. �-.(:...
-..._....
U Nature of Repairs or Alterations—Answer when applicable_......__ .S.�`�._.....�.� ..._....... �._ 0V
... .............................•--------------........----••----------------.................•-----------..................._.............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITI 5 of the State Sanit Code—.The undersigned furthe agre snot to place the system in
operation until a Certificate of Compliance h b issued by the rd o€ health � 2__
Signed---- --------------------------------------------------•--•-----..._.._....._------ -•-----�-...............
Date
Application Approved By..............� �. . - ..... ....................................
..... .-........................k Y
Date
Application Disapproved for the following reasons:..........................................................................................................---
.......................•-•----------------------•---------.........---•-------....--•--------....-------------...---------------•----------•-----.....------....-----•---•------.....__.................
}te
Permit No.------..F. ::J... ---•-----------------_ Issued.......�..�-2�-----•----------b••-----
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................1�7� ....OF...... ........................k.1.5...
...........
Tutif iratr of Toutplionrr
b THIS TO CER�IFY�, That e�Indivi�lu S�ewv g D�isposall'LS�stem constructed ( ) or Repaired
Y ......--. --•--••.....�
` scalier j y
at .�.b................
..---•--._�.` Gl .- c............................................................... ..------------•..`.. ....-----...........
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No........F.S._..._.... ....... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SABMACTORY.
DATE. - ..............................................................I 5C:h Inspector------------------------4..... .........-----------------...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O(F� HEALTH
No... r�.._.-I 7.. ...... ............ .OF........... tl . .J.(..........--------•4-. .............. F aD,®b.....
�io�r ork��onofr ` iu�n rrut�#ILS-
Permission is herebyanted. rv.s.. ` =
............_..
to Construct ( ) or Repair ( an Individual S age pisposal S6tem
e�w ci
Street
as shown on the application for Disposal Works Construction Per No. rf�:� _' -. Dated...._.-L-2 7 0 0
--------------- ! .!
................................................
�DATE......_.. ..
............................ Board of Health
FORM 1253 A. M. SULKIN, INC., BOSTON
i
AIX
COMMONWEALTH OF MASSACHUSETTS
' EXECUTIVE OFFICE OF ENVIRONMENTAL-AFFAIRS
n r
A d DEPARTMENT OF ENVIRONMENTAS
PRl�
JUN 2 3 2004
TOWN OF BAR,NSTABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 100 Highland Drive
Centerville,MA 02632-2860
Owner's Name: Beth Murphy
Owner's Address: Same
MAP
Date of Inspection: 5-10-04 3
PARCEL
Name.of Inspector:Paul Tyrell ®° 3
Company Name: N/A
Mailing Address: 19 Fredith Road
Weymouth,MA 02189,
Telephone Number: 781-33.1-6128
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
_X_ Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
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 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.
Notes and Comments Pey`� ��•,>rrFw>� /�E4�tA�2 ����^�6 o�G -s�"`�� L
****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.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11 ,
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 100 Highland Drive
Centerville,MA 02632-2860
Owner: Beth Murphy
Date of Inspection: 5-10-04
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:
t
1
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.
Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please
explain.
N//-� 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.
ND explain:
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
obstruction is removed
distribution box is leveled or replaced
ND explain:
I / 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
obstruction is removed
ND explain:
T41. '�T--.,..;—F...•.,,All r%i')nnn 2
A
P �
page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 100 Highland Drive,
Centerville,MA 02632-2860
Owner:Beth Murphy
Date of Inspection: 5-10-04
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
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
�/A
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 coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: N/�
' 41. G Tr.—,f;n»r,.—An ciInnn 3
1 Y
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 100 Highland Drive
Centerville,MA 02632-2860
Owner: Beth Murphy
Date of Inspection: 5-10-04
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''/Z day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
An portion of the A e SAS,cesspool or privy is below high ground water elevation.
— — YP P P vY g
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
v 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility 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.]
(Yes/No)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.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
C,"the system is within 400 feet of a surface drinking water supply
v 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.
4
'Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 100 Highland Drive
Centerville,MA 02632-2860
Owner: Beth Murphy
Date of Inspection: 5-10-04
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No
V 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?
r
C,Have large volumes of water been introduced to the system recently or as part of this inspection?
v
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?
L_ _ 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:
Yes no
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(3)(b)]
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
5 �, .
T;410 S T„�„A,•r;,,.,Rnrm F./i G/1nnn `.
Page 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 100 Highland Drive
Centerville,MA 02632-2860
Owner: Beth Murphy
Date of Inspection: 5-10-04
FLOW CONDITIONS
RESIDENTIAL �f
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): �yU
Number of current residents: / A9a-1-- —Z erAd
Does residence have a garbage grinder(yes or no): I"
Is laundry on a separate sewage system(yes or no): t4a [if yes separate inspection required]
Laundry system inspected(yes or no):_
Seasonal use: (yes or no):A✓o
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no): A/°
Last date of occupancy: aL&.vA,t=19
COMMERCIAL/INDUSTRIAL W//�
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: eTOi7�D�N��
Was system pumped as part of the inspection(yes or no):—v
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
T S 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)
Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information: ���"'�°� Al
o�✓i%ry. . �,Ff Nor-
Were sewage odors detected when arriving at the site(yes or no): A10
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
T;+iA r,r.,A,.+;. F..—All;i,)nnn 6
Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 100 Highland Drive
Centerville,MA 02632-2860
Owner:Beth Murphy
Date of Inspection: 5-10-04
BUILDING SEWER(locate on site plan)
Depth below grade: 3 O
Materials of construction:_cast iron _40 PVC ' other(explain): ���7✓����
Distance from private water supply well or suction line: nV/lf
Comments(on condition of joints, venting,evidence of leakage,etc.):
SEPTIC TANK:_(locate'on site plan)
Depth below grade: �a
Material of construction: Vconcrete_metal_fiberglass_polyethylene
other(explain)
If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of
certificate)
Dimensions: S o' J"Arr• -,e o-c ` 7>4�19
Sludge depth: *,"
Distance from top of sludge to bottom of outlet tee or baffle: 3
Scum thickness: O" ,
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: 2•_G
How were dimensions determined: /15-Ec!>
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage;etc.):
Srs.Fr( 6✓A3 �rrsO� /�1�.. !/f/s!°�'�i'7v,�< �1 ��,,�f' o� �lydc�rr`_
GREASE TRAP:_(locate on site plan)
Depth below grade:_
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:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS.,
T41. G Tncr +i-,R..,-,,,Aii r,11000 7 .' r
Page 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 100 Highland Drive
Centerville,MA 02632-2860
Owner:Beth Murphy
Date of Inspection: 5-10-04
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/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
f
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
T;tIA G Tncnart;nn Fnrm(./1 S/)(1(1!1 8
C �
Page 9ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 100 Highland Drive
Centerville,MA 02632-2860
Owner:Beth Murphy
Date of Inspection: 5-10-04
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓leaching pits,number:
leaching chambers,number:
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.):
/1/ CESSPOOLS: (cesspool must be pumped as art of ins ection locate on site plan)�/9" ( P P P P p )(
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 or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.):
PRIVY: (locate on site plan) A/�
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
t
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
r;+iA c r„o-+;-17-All 9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 100 Highland Drive
Centerville,MA 02632-2860
Owner: Beth Murphy
Date of Inspection:42&ftd
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch 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.
t3
I /
V
10
Page 11 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 100 Highland Drive
Centerville,MA 02632-2860
Owner:Beth Murphy
Date of Inspection: 5-10-04
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
t / J
Estimated depth to ground water �Z feet C ��` �E✓�� /�5���'`��
Please indicate(check)all methods used to.determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
7 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: A"e-770-0
4 �
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La cEv�f�JN
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24
S�
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
1O F Z �
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Y
M
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TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 100 HIGHLAND DR CENTERVILLE,MA 02632 �� J
Owner's Name: ZOLA C/O TODAY REAL ESTATE
Owner's Address: RT.28 CENTERVILLE ATT.GEORGE WRIGHT 3 �-
Date of Inspection: 9/21/01
Name of Inspector: (please print) JOHN GRACI
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536
Telephone Number: 508-564-6813 FAX 508-564-7270
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is
true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and
experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system
inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
_ Conditionally Passes
_ Needs Fujrvaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: 9/21/01
The system inspector shall submi 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.
Notes and Comments
THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO
PROLONG THE SYSTEM'S USEFULL LIFE.
****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,he same or different conditions of use.
Page 2 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 100 HIGHLAND DR CENTERVILLE,MA 02632
Owner: ZOLA C/O TODAY REAL ESTATE
Date of Inspection: 9/21/01
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X 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 SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO
PROLONG THE SYSTEM'S USEFULL LIFE.
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.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain.
n/a 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.
ND explain: n/a
n/a 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
_ obstruction is removed
_ distribution box is leveled or replaced
ND explain: n/a
n/a 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
_obstruction is removed
ND explain: n/a
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 100 HIGHLAND DR CENTERVILLE,MA 02632
Owner: ZOLA C/O TODAY REAL ESTATE
Date of Inspection: 9/21/01
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
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the k
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 S'surfacewater supply.
_ The system has a septic tank and SAS and the SAS is within a Zone I 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 n/a
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and
volatile organic compounds indicates that the well is free from pollution from that facility 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:
n/a
it
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 100 HIGHLAND DR CENTERVILLE,MA 02632
Owner: ZOLA C/O TODAY REAL ESTATE
Date of Inspection: 9/21/01
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
_ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped nLa.
_ X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool 66 privy is within a Zone 1 of a public well.
_ X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X 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,forscoliform bacteria and volatile organic compounds indicates that the well is free
from pollution from thatafacility 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.l
_ (Yes/No)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.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
X the system is within 400 feet of a surface drinking water supply t.
_ X the system is within 206 feet''-of a tributary to a surface drinking water supply
X the system is located in al ;:mtrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes'lEto any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large syste»1 has failed.The owner or operator of any large systent considered a sigidefint threat
under Section E or failed under Section D sliall upgrade the system in accordance with 310 CMR 15.304.The system owner
should contact the appropriate regional office of the Department.
i
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 100 HIGHLAND DR CENTERVILLE,MA 02632
Owner: ZOLA C/O TODAY REAL ESTATE
Date of Inspection: 9/21/01
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out'?
X _ Were all system components,excluding the SAS, located on site?
X _ 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?
X _ 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:
Yes no
X _ Existing information. For example,a plan at the Board of Health.
X _ 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(3)(b)]
3:
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 100 HIGHLAND DR CENTERVILLE,MA 02632
Owner: ZOLA C/O TODAY REAL ESTATE
Date of Inspection: 9/21/01
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: 2
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO
Seasonal use: (yes or no): NO
Water meter readings, if available(last 2 years usage(gpd)): n/a
Sump pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow(based on 310 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no):NO
Non-sanitary waste discharged to the Title 5 system(yes or no): NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: n/a
Was system pumped as part of the inspection(yes or no): YES
If yes,volume pumped:.2500gallons--How was quantity pumped determined? n/a
Reason for pumping: MAINTANENCE
TYPE OF SYSTEM
X 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)
_Tight tank Attach a copy of the DEP approval
Other(describe): n/a
Approximate age of all components,date installed(if known)and source of information:
ORIGINAL SYSTEM OVER 25 YEARS OLD
Were sewage odors detected when arriving at the site(yes or no): NO
r
Page 7 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 100 HIGHLAND DR CENTERVILLE,MA 02632
Owner: ZOLA C/O TODAY REAL ESTATE
Date of Inspection: 9/21/01
BUILDING SEWER(locate on site plan)
Depth below grade: 36"
Materials of construction:_cast iron _40 PVC Xother(explain): ORANGEBURG
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 6"
Material of construction: Xconcrete_metal_fiberglass_Polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: 6' X 8' BLOCK CESSPOOL"
Sludge depth: 0"
Distance from top of sludge to bottom of outlet tee or baffle: 0"
Scum thickness: 0"
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: n/a
How were dimensions determined: MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
MAIN CESSPOOL AND ALL COMPONENTS APPEAR TO BE STRUCTURALLY SOUND.RECOMMEND
{ PUMPING EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.
GREASE TRAP: _(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
n/a
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 100 HIGHLAND DR CENTERVILLE,MA 02632
Owner: ZOLA C/O TODAY REAL ESTATE
Date of Inspection: 9/21/01
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX:_(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: n/a
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into
or out of box,etc.):
NO-BOX
PUMP CHAMBER:_(locate on site plan)
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a
Q
Page 9 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 100 HIGHLAND DR CENTERVILLE,MA 02632
Owner: ZOLA C/O TODAY REAL ESTATE
Date of Inspection: 9/21/01
SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GAL 6' X 6' H10 leaching pits, number: 1
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
6' X 8' BLOCK CESSPOOL overflow cesspool, number: 1
n/a innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
THE LEACH PIT WAS FULL AT THE TIME OF THE INSPECTION.THE BLOCK CESSPOOL WAS EMPTY.
BOTH APPEAR TO BE FUNCTIONING PROPERLY AND ARE STRUCTURALLY SOUND.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
Page 10 of I I
1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 100 HIGHLAND DR CENTERVILLE,MA 02632
Owner: ZOLA C/O TODAY REAL ESTATE
Date of Inspection: 9/21/01
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch 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.
Pec�
A Q B
AA
V
D
Q
a6 ���'
AD CIS
33 10
x
in
Page 1 l of 1 I
+ V
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 100 HIGHLAND DR CENTERVILLE,MA 02632
Owner: ZOLA C/O TODAY REAL ESTATE
Date of Inspection: 9/21/01
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 1.2+feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators, installers-(attach documentation)
NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
GROUNDWATER WAS DETERMINED BY AUGER-NO WATER AT 12' -BOTTOM OF CESSPOOLS AT 10'
AA�e
t�
13v A/
CERTIFIED SEPTIC SYSTEM REPORT
[REC R tl 2®
LOCATION J U L 2 8 1995
HEALTH DEPT.
100 HIGHLAND DR. -mvmOFam*o mE
CENTERVILLE, MA
MAP 190 PARCEL 136 LOT 34
e
PREPARED FOR
cb
SELLER J4 IV
MR. & MRS. RAYMOND J . HILL j
70 FERNBROOR LANE S 199 �4
CENTERVILLE, MA 02632
S �
BUYER
MR. JOHN R. ZOLA
850 MAIN ST .
YARMOUTHPORT, MA 02675
PREPARED BY
HILLIARD HILLER, JR.
P .O. BOX 250
CENTERVILLE, MA 02632
508-778-1472
i 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Address of property /;� 11161>411AC
Owner's name
Date of Inspection
PART A
CHECKLIST
Check if the following have been done:
Pumping information was requested of the owner, occupant, and Board of
Health.
' None of the system components have been pumped for at least two weeks
and the system has been receiving normal flow rates during that
period. Large volumes of water have not been introduced into the
system recently or as part of this inspection.
As built plans have been obtained and examined. Note if they are not
available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
✓ The site was inspected for signs of breakout.
All system components, ewcluding the SAS, have been located on the
site.
4/ The septic tank manholes were uncovered, opened, and the interior of
the septic tank was inspected for condition of baffles or tees,
material of construction, dimensions, depth of liquid, depth of
sludge, depth of scum.
The size and location of the SAS on the site has been determined based
on existing information or approximated by non-intrusive methods.
The facility owner (and occupants, if different from owner) were
provided with information on the proper maintenance of SSDS.
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION
FLOW CONDITIONS
If residential
number of bedrooms
b number of current residents
No. garbage grinder, yes or no
BS laundry connected to system, yes or no
_ Imo seasonal use, yes or no
If nonresidential, calculated flow:
Water meter readings, if available:
, - Last date of occupancy �'�a ta9,c�� Get
GENERAL INFORMATION
Pumping records and source of information:
P�//>.�f� a
System pumped as part of inspection, yes or no
if yes, volume pumped
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)
Other (explain)
Approximate age of all components. 'Date installed, if known. Source of
information:
/�/� Sewage odors detected when arriving at the site, yes or no
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SEPTIC TANK• 4--'
(locate on site plan)
depth below grade: '11:51"
material of construction: concrete metal FRP other(explain)
dimensions*_�ovE/?�1 EIZSS��L 7
sludge depth
distance from top of sludge to bottom of outlet tee or baffle
�/x scum thickness
.3,$" distance from top of scum to top of outlet tee or baffle
7" distance from bottom of scum to bottom of outlet tee or baffl aE/-oc../
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,
depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, recommendations for repairs, etc. ), ^
01-4 6 5SAyZ- /S L/ci+y/-7 L/;t-EG /5 07/ F/�o�j olJjL�T
5G/I!//GE RB�o�.7 .vo �c%yi�ivG /'</�.cY .�-3 j/,��•2S
DISTRIBUTION BOX:
(locate on site plan)
— o - depth of liquid level above outlet invert
Comments:
(note if level and distribution is equal, evidence of solids carryover,
evidence of leakage into or out of box, recommendation for repairs, etc. )
PUMP CHAMBER:
(locate on site plan)
pumps in working order, yes or no
Comments:
(note condition of pump chamber, condition of pumps and appurtenances,
recommendations for maintenance or repairs,etc. )
10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SOIL ABSORPTION SYSTEM (SAS) : ✓
(locate on site plan, if possible; excavation not required, but may be
approximated by non-intrusive methods)
If not determined to be present, explains
Type
leaching pits and number / G 10/7 1Z
leaching. chambers and. number
leaching galleries and number
leaching trenches, number, length
leaching fields, number, dimensions
overflow cesspool, number J G'�5 tIPPiPi.•sAT.c�v /a 5v F�G�
Comments:
(note -condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
AA 5/6,61 b/- '�i i_e:,W E /Q�Gy/�1M L.yO ��•'ri°i y� Gr/E.��� yT�1,E R Ti�rit'
CESSPOOLS (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 (cesspool must be pumped as
part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,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, recommendations for maintenance or repairs,etc. ).
11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
. locate all wells within 100'
eaCkHEAO _
� 1
i
L
GBSSj�t�L -_.
.o.
/o41
DEPTH TO GROUNDWATER
�f-06- depth to groundwater
method of determination or approximation:
�QA/1�srAa��' &/i- 7-rW,,-
,D�'�EST Sf.�S /S /D,SS �. T/��' o/3S',�/1 v,�� !T✓r9T.e�t Ti9is 1/L Jvr✓� /�i m-
</lOG✓ 71//- C,�f�i r�✓f Ti9/�G.� i 9 T a s t* TA/4
GorPRdcr/�� /s �,/S'. S3 ,io.9s --ate - S= %oS•
12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
FAILURE CRITERIA
Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of
determination in all instances. If "not determined", explain why not)
Backup of sewage into facility?
QUO Discharge or ponding of effluent to the surface of the ground or
surface waters?
A,49' liquid level in the distribution box above outlet invert?
//0_ Liquid depth in cesspool <611 below invert or available volume< 1/2 day
flow?
k-10 Required pumping 4 times or more in the last year?
number of times pumped
O Septic tank is metal? cracked? structurally unsound? substantial
infiltration? substantial exfiltration? tank failure imminent?
Is .any portion of the SAS, cesspool or privy:
below the high groundwater elevation?
A,10 within 50 feet of a surface water?
within. 100 feet of a surface water supply or tributary to a surface
water supply?
O within a Zone I of a public well?
within 50 feet of a bordering vegetated wetland or salt marsh
(cesspools and privies only, not the SAS) ?
j VV within 50 feet of a private water supply well?
less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis? If the well
has been analyzed to be acceptable, attach copy of well water analysi
for coliform bacteria, volatile organic compounds, ammonia nitrogen
and nitrate nitrogen.
. - �-_-------------- ------TOWN OF BOARD OF HEALTH---------------.--
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION
-TYPE OR PRINT CLEARLY-
PROPERTY INSPECTED
STREET ADDRESS /l/G-�GA.yO Iel � Tt%Ir//GG/G �ifl
ASSESSORS MAP, BLOCK AND PARCEL
OWNER' s NAME AX NlfXeggo" J R.r/o 4e..Q51,Z171-1 J f7�/GG
PgRT D - CERTIFICATION
NAME OF INSPECTOR IIIZII-II /1-1-9 /Mzz" 'Pe
COMPANY NAME
COMPANY ADDRESS AU o-2So G,�iylt`/ll//GG,E
Street Town or City State LIP
COMPANY TELEPHONE FAX
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposa-1 system at
this address and that the information reported is true , accurate , and
complete as of the time of -inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Check one :
___4Z System PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 15 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form.
System FAILED*
The inspection which I have conducted has found that the system fails to
protect the public health and the environment in accordance with Title
5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form.
Inspector Signature _..✓ 2,60A• Date
One copy of this certification must be provided to the OWNER, the BUYER
(where applicable) and the BOARD OF HEALTH.
* If the inspection FAILED, the owner or operator shall upgrade the system
within one year of the date of the inspection, unless allowed or required
otherwise as provided in 310 CMR 15 . 305 .
partd.doc
KEY NUMBER <2557 >
NAME <HILL, RAYMOND J, JR > B-C 1 B-C 2
B-C 3 B-C 4
STREET 100 HIGHLAND DRIVE
CITY CENTERVILLE ST MA ZIP 02632-2860 REF 1 REF 2
PHONE ( ) - REF 3 REF 4
METER NO. < 2474> DATE READING CONS
STREET <HIGHLAND DR NO. 100> 06/30/95 580 42
CITY CEN K L34 ST LOC 12/31/94 538 62
PHONE (508 ) 778-6838 06/30/94 476 591a1
12/31/93 417 103A/1
ROUTE NUMBER 27 06/30/93 314 61
SERVICE DATE 08/08/63 12/31/92 253 75 ,
METER DATE 11/28/90 06/30/92 178 54/a
CAPACITY 7 12/31/91 124 67
STYLE T10
SIZE 1 RATE SCHEDULE
KEY PIT PLASTIC
NOTE RR RIGHT SIDE ADDITIONAL CONS 0
ALTERNATE MIN 0
I
LEGEND N
GarteOC
tan ~
LCP 30545 A - -- EXISTING CONTOUR D waadvae ��
RIVE
a x 100.98 EXISTING SPOT GRADE
^ 97,12 97 20 W EXISTING WATER SERVICE 0 so
N I EXISTING GAS SERVICE
� y 98 25 Ci a Great Marsh Rd
y OVERHEAD WIRES LOCUS °
Y 97,95 97.73 TEST PIT
•$ •:'•:::`R=75. 0 BENCHMARK
9____ Ro
99,37 x 99.30
99.11 PK SET hr
I 98.59
'0�% 99.32 Roue
CBSEAL
✓� - -- 1 07 LOCUS MAP
-5-� OR G) 99;`44 99,33 3j' NOT TO SCALE
SPI E00,00 100-1� 98.97
100,42 \
B�a° + WALK 100, 0 9 9,5 0 :.; ': Ost•... 99.31 GENERAL NOTES:
`L ' . .
?� Q ' 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
o, LOT 34 s� 99,83 99,41
16,117fSF x 100.31 0 BOARD OF HEALTH AND THE DESIGN ENGINEER.
99,70 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
x 100,67. , EXI STI NG 3. LOCAL RULES AND REGULATIONS.
�- THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
0
100.53 + HOUSE(#100) TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
T.O.F.=100.97f 1 1.20 DESIGN ENGINEER.
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
\ 99.92 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
WER 0 ENGINEER BEFORE CONSTRUCTION CONTINUES.
I •- 0
x 101• EXIS _g8 5t x 100,06 / 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM.
\ NV \
\ � 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
0 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
\ 100.55 x N HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
\ DEC N / 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
�7CL, _100.09 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
100,11 9\ \ \ . ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
/ i AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
100.53 x / BENCHMARK DIRECTED BY THE APPROVING AUTHORITIES.
\ SEPTIC \- OUTSIDE COR/STEP 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
EXISTING CESSPOOL / 0 x', 100.0 EL.=100.94 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
TO BE PUMPED, FILLED 100, TANK CONSTRUCTION
W/SAND & ABANDONED. \ to SHED F 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
G IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
R \ TP-3 v� REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
O� �\ 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL.
13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
t Q�TP-2 �p� o NOT CONSIDERED TO BE A PROPERTY LINE SURVEY.
14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC
\�•. o �` r SYSTEM COMPONENTS NOT SHOWN ON THE PLAN
..
101.58 \ p: \ 100.74
� ,. o ~; x i PARCEL ID. 190-136
Ftic\ TP-1 �q :. . '. �' EXISTING LEACH PIT
o PETER T. s w/ TO BE PUMPED, FILLED PROPOSED SEPTIC SYSTEM UPGRADE PLAN
McENTEE ``
cfvfL "' W/SAND q& ABANDONED. 100 HIGHLAND DRIVE, CENTERVILLE, MA
o. 35109 \101.26
G/SfE��O x� Q Prepared for: DiBuono, Sewer & Drain, 35 Content Lane, Cotuit, MA 02635
E � Engineering by: SCALE DRAWN JOB. N0.
9 OWNER OF RECORD
1"=20 P.T.M. 205-19
I f I(4 PLAN REVISION 7/18/19
NOWAK, GREGORY Engineering Works, Inc. '
CORRECTION TO SOIL LOG DATE & WITNESS 152 EVANS STREET 12 West Crossfield Road, Forestdafe, MA 02644 DATE CHECKED SHEET N0.
a OSTERVILLE, MA 02655 (508) 477-5313 6/29/19 P.T.M. 1 of 2
t%a
NOTE: TO PREVENT BREAKOUT, FINAL GRADE
SHALL NOT BE AT, OR BELOW, EL.=97.50 F ��
FOR A DISTANCE OF 15 FROM THE EDGE g
SEPTIC TANK PROPOSED D-BOX OF THE PROPOSED S.A.S.
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER PROPOSED S.A.S.
OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE DECK`
INSTALL RISER & COVER OVER one CHAMBER AND
T.O.F.=100.97t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT
F.G. EL.=100.1 f F.G. EL.=100.5f f F.G. EL.=100.2f F.G. EL.=101.0t IRS
MAINTAIN 2% SLOPE OVER S.A.S. S to
�.
L = 24' L = 12' _ �- N
® S=1% (MIN.) ® S=1% (MIN.) p S=1%2MIN.) ��
4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2"
6 DOUBLE WASHED STONE
10"t as Who
(OR APPROVED FILTER FABRIC) ♦ �. 'do.
�4" s" 2' EFF, aWho
INV.=98.0 48" LIIQLID DEPTH aaaaaaa --3/4" TO 1-1/2" DOUBLE
ADD INV.=97.40 PROPOSED 4' 4.8' ¢' WASHED STONE A
GAS BAFFLE D-BOX INV.=97.23 EFFECTIVE WIDTH = 12.8' \ ��.0 ♦ CF
INV.=97.75 3 OUTLETS ♦\ OS \♦ FF�
INV.=97.00 \\ FO
PROPOSED SEPTIC TANK 3-500 GALLON LEACHING CHAMBERS S �,
SURROUNDED WITH STONE AS SHOWN S`♦ .S
CONNECT TO EXISTING SUITABLE SEWER H-20 RATED ♦ / 00
PIPE AT HOUSE, SEWER INV.=98.5t ♦\ `L'
TOP CONC. ELEV.=98.1 t
BREAKOUT ELEV.=97.50
INV. ELEV.=97.00 !1313NOTES: aaaaaaaaaaSEPTIC LAYOUT
aB
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & BOTTOM ELEV.=95.00
INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. 4' OF NATURALLY OCCURRING 4' I_ 3 x 8.5' = 25.5' I 4'
2) SEPTIC TANK & BOX SHALL BE SET LEVEL AND TRUE PERVIOUS MATERIAL EFFECTIVE LENGTH = 33.5' _
TO GRADE ON A MECHANICALLY COMPACTED 6" CRUSHED ) ABOVE G.W.5' (MIN.
STONE BASE, AS SPECIFIED 310 CMR 15.221(2). LEACHING SYSTEM SECTION ®® 0
3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=89.7 "
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE - �#(E:DE3
®®®® ® ® ® 37AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. N > ®®®® ® ®®®®
102"
DESIGN CRITERIA SOIL LOG 4" KNOCKOUT
DATE: JUNE 24, 2019 (REF#TPT-19-62) 20" DIA. COVER
SOIL EVALUATOR: PETER McENTEE PE(SE#1542)
NUMBER OF BEDROOMS: 4 BEDROOMS
WITNESS: DAVID STANTON R.S. HEALTH AGENT 4" KNOCKOUT / 4" KNOCKOUT 58"
SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH ELEV. TP-3 DEPTH
DESIGN PERCOLATION RATE: <2 MIN IN
101.2 q 0 100.7 q 0 100.5 A O„
0
DAILY FLOW: 440 GPD SANDY LOAM SANDY LOAM LOAMY SAND
10YR 4/2 10YR 4/2 10YR 4/2 4" KNOCKOUT
DESIGN FLOW: 440 GPD 100.6 B 10" 99.9 B 10" 99.7 B 10"
GARBAGE GRINDER: NO-not allowed with design SILT LOAM SILT LOAM LOAMY SAND
10YR 5/6 10YR 5/6 10YR 5/8 500 GALLON CAPACITY, H-20 LOADING
C1 C
LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF 96.7 54" 97.7 36" 97.5 36" CHAMBERS
.74 GPD SF C1 L PERC
PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY F-C SAND F-C SAND 36"/54 N.T.S.
PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-20 RATED 2.5Y 6/4 2.5Y 6/4
10% GRAVEL 10% GRAVEL F-C SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN
USE 3-500 GALLON LEACHING CHAMBERS IN SERIES 92.9 100" 91.7 ,oa" 2.5Y 6/4
SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES C2 C2 10% GRAVEL 100 HIGHLAND DRIVE, CENTERVILLE, MA
MED. SAND MED. SAND VERY DENSE pre Sewer & Drain, 35 Content Lane, Cotuit, MA 02635
SIDEWALL AREA: 2(12.8' + 33.5') X 2 = 185.2 S.F. 2.5Y 7/3 2.5Y 7/3 pared for: DiBuono,
BOTTOM AREA: 12.8' x 33.5' = 428.8 S.F. Engineering by: SCALE DRAWN JOB. NO.
TOTAL AREA:.............................................................. 614.0 S.F. 89.7 138' 90.7 120" 90.5 120' Engineering Works, Inc. N.T.S. P.T.M. 205-19PERC RATE <2 MIN I/N. "Cl" HORIZON (TP-2) 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74 GPD/SF(614.0 SF) = 454.4 GPD NO GROUNDWATER ENCOUNTERED (508) 477-5313 6/29/19 P.T.M. 2 2 2
j