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HomeMy WebLinkAbout0068 JOYCE ANNE ROAD - Health (2) 68 JOYCE ANN RD., CENTERVH LE A=209-104 o05� I N/I UPC 53 R � `4a W1itW!!.WM TOWN OF BARNSTABLE LOCATION C NNz9 SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. ;2c4L05 4 73-o )n1 'qS-,3z/ SEPTIC TANK CAPACITY Fx/5:1-rNc LEACHING FACILITY.(type) (size) NO.OF BEDROOMS 3 OWNER AA PERMIT DATE: COMPLIANCE DATE: 2-—/ 5 Separation Distance Between the: voAje 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 L1.C7t)CIG �tJW�Ur A f -�B�Lf OO` 38 f0 k Or de ' Ovt D'�26�8 9 . �6,C 0 our, - 0 cce\ 1�eFk �r P No. ��� ` Fee QV THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plication for bisposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (yg wyce kf,4t,)e -j?,C) Owner's Name,Address,and Tel.No. As e ss or's Map/Parcel -O Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Z":S QoIGS A 1�]JCc7�A9�J ANC >S --400-7f L igN 1ev P✓t`^s P1yk Type of Building: Dwelling No.of Bedrooms 3 Lot Size /S,28z sq.ft. Garbage Grinder( ) Other Type of Building t✓r5 tc2��a(G1 No.of Persons Z. Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '3 22 cd gpd Design flow provided `j H Q,7 gpd Plan Date S'22.-1 S Number of sheets I— Revision Date Title Size of Septic Tank 1:x/Z r;n% Type of S.A.S. 2 I-= 7C.,I e6 C,) Description of Soil 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. Signe Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. p�G/ '� Date Issued 1� _-_ -------------- --------------- �-- - - - _—�--- ------�i No. E9/J 1 Fee 4 Qv. ' THE COMMONWEA64-00 MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for IDisposal i�pstem Construction Permit Application for a Permit to Construct( ) Repair( v/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ,o Owner's Name,Address,and Tel.No. Assessor's Map/Parcel -/C7 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 4D�L1 os A 3(c>_�__< Co`a -t4Od -7ls5 1 r�N ,rvr P✓;^'S l�vdlc Type of Building: Dwelling No.of Bedrooms 3 Lot Size /�,2OY sq.ft. Garbage Grinder( ) Other Type of Building (re,tOfF 04 re') 1 No.of Persons 2— Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3'3 y gpd Design flow provided 3 H?i,' gpd Plan Date ' 2 ? - 1 6- Number of sheets "L Revision Date Title Size of Septic Tank Type of S.A.S. 2 SOCK !t C�1 C I4 CKS 4,L y 1 S tOA(- Description of Soil 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. Signegn Date Application Approved by Date //5 Application Disapproved by Date for the following reasons Permit No. / a Date Issued 15 --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Urtificate of Complianre THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( � Upgraded( ) Abandoned( )by w t2 a s A 17 at 6 F) i b y c P A N ev-e !< ) C(-,+P r J AN e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No?03 -IS'�L dated s);-> ,L �. Installer `D©y0a 5 A A'�(C W ti `t ry C Designer jv-e-e #bedrooms 3 Approved design flow gpd The issuance of this permit shall not be donstrued as a guarantee that the system will ncti nn design Date S ' L' 1 A I ( Inspector 1l'i V�_ --------------------------------------------------------------- ------------------------------------------------- --No. / 15 c�. Fee ��� - � �_"" THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem (Construction �ermit Permission is hereby granted to Construct( ) Repair( � Upgrade( ) Abandon( ) System located at 6,F) J O�l C e A Newt Re) Cj+ P✓v ��) e 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 m be�c et mpl within three years of the date of this permit. us Date / 6 Approved by -�' Town of Barnstable yOpTHE 7Q��� Regulatory Services Richard V, Scali, Interim Director * BARNSTAHCE, MASS, Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Of5 e: 508-862-4644 Fax: 508-790-6304 nstaller & Designer Certification norm Da e: (2 1 I Sewage Permit# PC Assessor's Map\Parcel ` — ` -,A--Q-1r M f. nee ') D es igxier: Installer: k �.AC, lad _teas: a7� w. Cris • to Address: a�3Z 0p. — 660J A- ►'�L was issued a permit to install a _ (date) (installer) se l 'ic system at .SC3 �'� Gv4- based on a design drawn by (address) vti Ifl fin, V4 W IYL` dated ZZ (designer) I certify that the se l tic system referenced above was installed substantially according to the design, which rr ay include minor approved changes such as lateral relocation of the distribution box mad/or septic tank. Strip out (if rcgUired) was inspected and the soils were found satisfactory. I certify that the se tic system referenced above was installed with major changes (i.e. greater than 1�' lateal relocation of the SA5 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�;caozp7ane with the terxr s of 1 I the AA.approval letters (if applicable) (Izastaller's Signature) �, u� i f,�f!n ti� C'Q; tr.� 1 signer's Signature) (Affix Designer's Stamp Here) ?I EASE RETURN TO B ARNSTABLE PUBLIC HEALTH DIVISION. CERT.LFICATE -O COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH—THIS FORM t, 1) AS B. T CARD ARE RECEIVED BY THE BARtt STABLE PUBLIC EYALTH DIVISION. 11 A.NK YOU. - QAsepticTesigner Certification Form Rev 8-14-13.doc C Town of Barnstable Bare Regulatory Services Department � 1ARNSfABI.E, � ' I " Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70141200 00010358 3803 April 9, 2015 Francis E&Leah M Mogan 68 Joyce Anne Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located at 68 Joyce Anne Road, Centerville MA was inspected on 3/30/2015, by Michael T. Bisienere, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit with high liquid level, <12" below pit(per Town Code 360-9.1) You are ordered to repair or replace the septic system within two 2)years from the date of this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. P ER OF Tj BOARD OF HEALTH as McKean, • Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\68 jOYCE ANNE Rd Cent 2015.doc Parcel Detail x m � _ $ Apps ®http--www,town,barn.,. . Application Center Suggested Sites r]Imported From IE Parcel lookup { New Tab Bing I4idm 5Incredible Tn. � a �d r.YW lt4SS r 4? �' a109, a102da 7--'Parcel Info Parcel ID 209-104 Developer Lot LOT 5 Location 68 JOYCE ANNE ROAD Pri Frontage 20��� Sec Road J Sec Frontage Village CENTERVILLE Fire District C-O-MM J Town sewer exists at this address No _ Road Index 0611 Asbuilt Septic Scan: ti�` 1109104_1 Interactive Map N"f I 209104 2 •.Owner Info Owner'MOGAN,M LEAH&FR Co- Owner streett 68 JOYCE ANNE RD street2 City CENTERVILLE state MA Zip 02632 Country • Land Info: Acres 0.35 use Single Fam MDL-01 Zoning RC Nghbd 0109 J Topography Level J Road utilities Public Water,Gas,Septic Location •4-6111110ruction Info year 1978 R°0 GablelHip ii Aluminum Sidng Built Struct Roof__ I .__AC_,—__._ _1 _�_. __. _ __� � ___ _ _� . •. I' 5fart , Q 1SEPTIC�letters Septi., Parcel Detail Google Ch„ ® / l0,48 AM, Computer name : HEALTH899JF User name : flvnni Operatinq Svstem : Windows NT(5.1) 4 THE Tiy,. r . Town of Barnstable ► URNSTAHM Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/7/15 DEADLINES TO REPAIR FAILED SYSTEMS An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). . TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) XLeaching pit with high liquid level, <12"below pit (per Town Code §360-9.1) Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Joyce Anne Rd Property Address Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 03/30/2015 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:When filling out forms A. General Information on the computer, 1_ . J use only the tab 1. Inspector: c / key to move your cursor-do not Michael T Bisienere use the return Name of Inspector key. Cape Septic Inspections r� Company Name 624 Old Barnstable Road Company Address Mashpee Ma. 02649 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification 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. f am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority ..2 03/30/2015 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. """'This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 a Commonwealth of Massachusetts u W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Joyce Anne Rd Property Address Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 03/30/2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 68 Joyce Anne Rd Property Address Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 03/30/2015 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System.Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): . t ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 'i. Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. �M 68 Joyce Anne Rd Property Address Leah Mogan Owner Owner's Name information is required for every 32 Centerville Ma. 026 03/30/2015 -page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other;. D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters El ® due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 68 Joyce Anne Rd Property Address Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 03/30/2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000gpd- ❑ ® 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator.of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments H 68 Joyce Anne Rd Property Address Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 03/30/2015 •page. CityrFown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El 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 breakout? Z ❑ 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? t . Z ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual):. 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): '330 t5ins-3/13 Title 5 Official Inspection Form: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 68 Joyce Anne Rd Property Address Leah Mogan Owner Owner's Name information is Centerville Ma. 02632 03/30/2015 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No. Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Joyce Anne Rd Property Address Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 03/30/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 68 Joyce Anne Rd Property Address Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 03/30/2015 page. City/Town. State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: Apx, 19„feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): " Depth below grade: Apx. 12feet Material of construction: ® concrete El 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: Standard 1000 gallon septic tank Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Joyce Anne Rd lq,M Property Address Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 03/30/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 39" Scum thickness ` 1 Distance from top of scum to top of outlet tee or baffle 8"11 II Distance from bottom of scum to bottom of outlet tee or baffle 11 How were dimensions determined? Field Instruments Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,.etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments _w 68 Joyce Anne Rd Property Address Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 03/30/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 68 Joyce Anne Rd Property Address Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 03/30/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): 01, 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes El No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 68 Joyce Anne Rd G„M Property Address Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 03/30/2015 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): The leaching pit was full at the time of the inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 ti Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 68 Joyce Anne Rd Property Address Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 03/30/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont:) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc..): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Joyce Anne Rd Property Address Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 03/30/2015 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately rear 18 37 42 28 25 60 t5ms•11N0 Tib B 0ffidal tupectlon Foam:8u0surtace srNwe Dls=1&/seem•Page 40117 I - Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Joyce Anne Rd Property Address Leah Mogan Owner: Owner's Name information is required for every Centerville Ma. 02632 03/30/2015 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date Observed site(abutting property/observation hole within 150 feet of SAS) ElChecked 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: augured a hole at a lower elevation and shot it with a transit Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 68 Joyce Anne Rd Property Address Leah Mogan Owner Owner's Name information is Centerville Ma. 02632 03/30/2015 required for every page. Citylrown State Zip Code Date of Inspection E. Re ort Completeness Checklist p p ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file p i t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION •. SEWAGE # C-16 VILLA ,E Q/d SSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC 'TANK CAPACITYV LEACHING FACILITY: (type) �6y© 12i1- (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 FS c4 IF.g � rA 399 �7 g li Town of Barnstable P# f �Y IKE►�, Department of Regulatory Services Y BARNSTABLE, i Public Health Division DateI MASS. 200.Main Street,Hyannis MA 02601 ' t � � �-1� •�. CIzJ I Date Scheduled__ '� Time Fee Pd. Soil Suitability Assessment for Sew ge Disposal •-- Mee (� Performed By: Ye�.r C � IS��) Witnessed By: 1 V LOCATION & GENERAL INFORMATION I Location Address (pir Owner's Name L�A,1�`-- (V`6.. f-1 � 'Z 3-o-t ce A r ►\,.t rz,,j Address Assessor's Map/Parcel: 20 9 -- G Engineer's Name NEW CONSTRUCTION REPAIR _ Telephone# 15-6F LI �'7—S-3 I ' Land Use _ f"'�b t e1�Eve' Slopes Surface Stones_ ! j Distances from: Open Water Body _ft Possible Wet Atrea1� ft Drinking Water Well ft Drainage Way !v A- ft Property Line "lG1 — ft Other _ R i ! SKETCH: (Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) I l IAJ -f 3 • �"� H tx/�.e Q t ' amil Parent material(geologic) ©Ui'v�GS�I Depth to Bedrock Depth to Groundwater: Standing Water in Hole: /Jdn� Weeping fiom Pit Face Estimated Seasonal High Groundwater i' 13 2-'r t i DETERMINATION FOR SEASONAL HIGH WATER TALE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: _in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment i Index Well it Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date--- Time Observation I Hole# r1 _ Time at 9" �w �• �'_ ____ � I Depth of Pere _ Time at 6" + C) /1 u Start Pre-soak Time @ �/ �� Time(9"-6") ` _ _ it End Pre-soak 'Z _ Rate Min./Lich j Site Suitability Assessment: Site Passed _L Site Failed: Additional Testing Needed(YIN) f! 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 the Barnstable Conservation Division at least one (1) week prior to beginning. j Q:\SEPTIC\PERCFORM,DOC � I i ' I I DEEP OBSERVATION HOLD LOG Hole# [epth from Soil Horizon Soil Texture .Soil Color Soil Other Surface ace(in.) (USDA) ;.(Munsell) Mottling (Structure,Stones;Boulders. i o i tenev.%Gravel) I L -KZ�� DEEP-OBSERVATION HOLE LOG Hole# EI pth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) ;(Munsell) Mottling (Structure,Stones,Boulders. --- ons' tengy.%Gravel) j I i DEEP? OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other I Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. I Coil istengy,%Oraveh 1-7 I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other S�rface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. • !II F oo.d Insurance Rate M i I Above.500 year tl(y)d boundary No_ Yes Within 500 year boundary No...A Yes Within 100 year flood boundary No,_ Yes - e Aeepth of.N�LtuLafly occurring Pervious M_aterlal I woes ai least four feet of naturally occurring pervious material exist in all areas.observed throughout the I ea proposed for the soil absorption system? a - i�not, what.is the depth of naturally occurring pervious malarial? erty i!ation �[certify that on (date)I have passed the soil evaluator examination approved by the C epartment of Environmental Protection and that the above analysis was performed by me consistent with tl�e required trai ' ,expertise and experience described in�10 CNM. 15.017. � r! Date s g Signature_ i I I i Q;\S p PTlC�PBRC:FORM.DO C i Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's Name information is required for every Centerville MA 02632 05/05/13 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:When A. General Information filling out forms on the computer, I �� use only the tab 1. Inspector key to move your cursor-do not Michael Kellett use the return Name of Inspector key. Aardvark Environmental Inspections ffi Company Name PO Box 896 Company Address ream East Dennis MA 02641 City/town state Zip Code 508-385-7608 SI 3742 Telephone Number License Number 3' r , B. Certification .o I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15 000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority i M.1113 w Inspector's Signature Date ; a� The system inspector shall submit a copy of this inspection report to the Approvi g A ithorARBoarr of Health or DEP)within 30 days of completing this inspection.If the system is a hared system o 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. (4PIq / L U t5ins•11/10 Tilde 5 official Inspecti n S"Unlace Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's Name information is required for every Centerville MA 02632 05/05/13 page. Citylrown State Zip Code Date of Inspedion B. Certification (cunt.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined"(Y,N,ND)for the following statements.If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health_ *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•11/10 Trite 5Of vial Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form GI Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's flame information is Centerville 02632 05/05/13 required for every page. Citylrown State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes(cunt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. p 1. System will ass 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 priory is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh wins.11110 Title 50ffcial Inspection Fbmr: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 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's Name information is required for every Centerville MA 02632 05/05/13 page. Cityffown 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 flank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: **This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow t5ins•11/10 Sidle 5Official Inspection Form.Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form & Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .�' 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's(dame information is required for every Centerville MA 02632 05/05/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliforrn bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following,in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered `fifes"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.Deparlment. t5ins-11/10 Title 50ficial Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts ffi Inspection Form ial Title 5 Official Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Joyce Anne Road Property Address Leah Mogan Owner Owners Name information is required for every Centerville MA 02632 05/05/13 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with ® El 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 (f any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)P10 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15203(for example:110 gpd x#of bedrooms): 330 t5lns•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's Name information is required for every Centerville MA 02632 05/05/13 page. City/Town state Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings,it available(fast 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Commerciainndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the T"ltle 5 system? ❑ Yes ❑ No Water meter readings,if available: t5ins•11/10 Tide 5 official inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonweafth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's Name information is required for every Centerville MA 02632 05/05/13 page. Cityrrown state Zip Code ©ate of Inspection D. System Information (coat.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: every year per owner 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 VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5Official 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 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's Flame information is required for every Centerville MA 02632 05/05/13 page. CityrFown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components,date installed("if known)and source of information: 20 years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.6 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.): Tank locate on site plan): Septic Ta ( p ) Depth below grade: 1.0 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: 1,000 gal Sludge depth: 4" t5ins•11/10 Title 5 Official Inspection Form:Subsurtace Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not forVoluntary Assessments 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's(dame information is required for every Centerville MA 02632 05/05/13 page. City/Town state Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" 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): The tank was sound and tight with tees in place and liquid at outlet invert Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 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 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's Name information is Centerville MA 02632 05/05/13 required for every page. City(rown state Zip Code Date of Inspection D. System Information (font.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 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 forVoluntary Assessments 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's(dame information is required for every Centerville MA 02632 05/05/13 . page. City/Town state Zip Code bate of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even 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.): The box was level and tight with no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: t5ins•11/10 - Me5Offmcal Inspection Fomc Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's Name information is required for every Centerville MA 02632 05/05/13 page. Citylrown state Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number. 1 ❑ 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 failure,level of ponding,damp soil,condition of vegetation,etc): This system has a 6'x6'precast pit surrounded by two feet of stone.There was 17"between th inlet invert and the liquid. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Offidal Inspection Fotm:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's Name information is required for every Centerville MA 02632 05/05/13 page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): t5ins-11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's Name information is required for every CenteMlle MA 02632 05/05/13 page. Citylrown State Zip Code Date of Inspection D. System Information (coat.) Sketch Of Sewage Disposal System:Provide a view of the sewage disposal system,including lies 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 rear 18 37 42 28 25 60 t5ins•11110 Me 5 Official Insped ion Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Farm s, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's Name information is required for every Centerville MA 02632 05/05/13 page. Citylrown state Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 20.0 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators,installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS maps show an elevation of over 20.0 feet. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 e Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Joyce Anne Road Property Address Leah Mogan Owner Owner's Name information is required for every Centerville MA 02632 05/05/13 Page. Cityfrown state Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A,B,C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 50fficiaf Inspeclion Form.Subsurface Sawage Disposal System-Page 17 of 17 r 1 d RtAVE3, 2000 �� r0 2�srlk 0 COMMONWEALTH OF MASACHUSETTSa � �` EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 68 JOYCE ANN RD CENTERVILLE, MA 02632 Z (OLA L5 ' Name of Owner MARK GREELEY Address of Owner: 68 JOYCE ANN RD CENTERVILLE,MA 02632 Date of Inspection: 4126/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608-664-6813 FAX 608-664-7270 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 inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evalu y the Local Approving Authority Fails Inspector's Signature: Date:4126/00 The System Inspector shall sub it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.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 inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life" THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS FOR PROPER MAINTENANCE. revised 9/2198 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 68 JOYCE ANN RD CENTERVILLE, MA 02632 Name of Owner MARK GREELEY Date of Inspection: 4/26/00 INSPECTION SUMMARY: Check A, B, C, o/D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination In all instances.If"not determined",explain why not. nfa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nta Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced n1a The system required pumping more than four 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 revised 9/2/98 Page 2 of 11 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 68 JOYCE ANN RD CENTERVILLE, MA 02632 Name of Owner MARK GREELEY Date of Inspection: 4/26100 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of 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 SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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,Method used to determine distance n&(approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 68 JOYCE ANN RD CENTERVILLE, MA 02632 Name of Owner MARK GREELEY Date of Inspection: 4/26/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an 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 1/2 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 0. - X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - X Any portion of a 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 or privy is within a Zone I 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No - X the system is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply _ X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 68 JOYCE ANN RD CENTERVILLE, MA 02632 Name of Owner: MARK GREELEY Date of Inspection: 4126/00 Check if the following have been done:You must indicate either"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 _ 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. X As built plans have been obtained and examined.Note if they are not available with NIA. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X - 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 Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, X - Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)) X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 68 JOYCE ANN RD CENTERVILLE, MA 02632 Name of Owner MARK GREELEY Date of Inspection: 4/26/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual): Total DESIGN flow: 330 gpd Number of current residents:2 Garbage grinder(yes or no):YES Laundry(separate 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 two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: Na COM M ERCIAL]INDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow: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:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):YES If yes,volume pumped 1600 gallons Reason for pumping:MAINTENANCE 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) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: 1980 Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2198 Page 6 of 11 I _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continuEd) Property Address: 68 JOYCE ANN RD CENTERVILLE, MA 02632 Name of Owner MARK GREELEY Date of Inspection: 4/26/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 18" Material of construction: _ cast iron _ 40 Pvc X other(explain) Distance from private water supply well or suction line: n/a Diameter: 4" Comments: (condition of joints,venting,evidence of leakage,etc.) THE SYSTEM HAS TOWN WATER. SEPTIC TANK: X (locate on site plan) Depth below grade: 12" Material of construction: _concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 8'6"H 6'7"W 4'10 Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 1" 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 dimensions were determined: MEASURED 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, etc.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS. 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: (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, etc.) n/a revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 68 JOYCE ANN RD CENTERVILLE, MA 02632 Name of Owner MARK GREELEY Date of Inspection: 4/26/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or 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: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. 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 revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 68 JOYCE ANN RD CENTERVILLE, MA 02632 Name of Owner MARK GREELEY Date of Inspection: 4/25/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)1000 GAL 6'X 6 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,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a 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 PITS ARE STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD 3'OF WATER IN IT AT THE TIME OF THE INSPECTION.THE PIT HAS NOT HAD MORE THAN X OF WATER IN IT. CESSPOOLS: _ (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: n/a inflow(cesspool must be pumped as part of inspection)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 revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 68 JOYCE ANN RD CENTERVILLE, MA 02632 Name of Owner MARK GREELEY Date of Inspection: 4/26100 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) 6tid A v o PS PA Ii u 14 ig Ac ayLj �Lo revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 68 JOYCE ANN RD CENTERVILLE, MA 02632 Name of Owner MARK GREELEY Date of Inspection: 4/26/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet+ Please indicate all the methods used to determine High Groundwater.Elevation: Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions _ Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) UGSS MAPS AND CHARTS-12+ FEET revised 9/2198 Page 11 of 11 cw � D, 15 No.........-• 44--- Fzc ............ a........... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH .................. .....OF......... + i ................................ Appliration for Disposal parks Tvu;strurtinat Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Sys at: �ntjC ...... .............� ........... ......... . ......... Coca Address6 -1 4 No. � Cd rRl C7�. [r •�• 'er- 1: /.S..s................ Owner Address ,Wa ....il.; ZL^------------------•--•--•--•--- .....---•----------------•----•-•-•--- .....•......r.---------......---- Installer Address Type of Building Size Lot___ :,f...FVSq. feet aDwelling—No. of Bedrooms.._.___ ...............................Expansion Attic ( ) Garbage Grinder ( ) 44 Other—Type of Building ............................ No. of persons............................ Showers (2) — Cafeteria ( ) a' Other_fixtures .................................. W Design Flow-_ _ ..__ ..._.........gallons per person per day. Total daily flow...............! 0.................gallons. WSeptic Tank—Liquid capacityAPOA.gallons Length................ Width................ Diameter__-_____-____ - Depth................ x Disposal Trench—No..................... Width..........._._.... Totallength.................... Total leaching area....................sq. ft. . Diameter... .___.__ f Seepage Pit No._..._../....._._... _-. Depth below inlet. .... otal leaching area..................sq. ft. Z Other Distribution box ( Dosi tank ( ) d/ _�� '—' Percolation Test Results Performed by .? ¢.p_-.-_- �t .... Date....o�J/ f7 _-------. . Test Pit No. ........minutes per inch Depth of Test Pit---/2.......... Depth to ground water-__ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------- .-•---•-----_--- a ..... 0 Description of $oil.....Q ---�z- ------- -! ---------------------•--.---------------------------------------------..._......---- U --- .. ...f.2-.1........... --` W UNature 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 TITIE 5 of the State Sanitary Cod The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i by the . d of health. Sig . .... . .... ........ ................. . ............................ ---- -/---Z- ��... Date ;�- � - Application Approved BY-_--.-- - - ... ._. . .. ..G:�;�ll�..� _....,�................ .. � - Date Application Disapproved for the following reasons:............ ____..__.__......__..........._.._._........_.............................. --------------------------------------------•--••-•-----------------•----------------.......----------...--------•------•------------------------------------------------------------------------------- Date Permit No_______________-------------•--•--------•--------- Issued_-----•-- -.......... --- Date Y 4 +LVy Q� ae THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ;. ..._................OF..... .............------------ Appliratioat for Disposal Work, Cfoattitratrtion rprmit Appption is hereby made for a Permit to Construct (r/�or Repair ( ) an Individual Sewage Disposal Sys at: / �- .C.R.�............. K+ ..... ......... (�q— J ---------•.._- - ---------------•---- .. _..... .. .._-.__. .........................��.. ._......._... ..._!S/.Y..i'.' V.._......_........................_.__......._... ......_..._..... O Address W , � :_ ...................................................... Installer Address Q Type of Building ,;{{ Size Lot___1LZ._Sq. feet aDwelling—No. of Bedrooms.__________s�_____________________Expansion Attic ( ) Garbage Grinder ( ) p l Other—Type of Building ____________________________ No. of persons............................ Showers (2) — Cafeteria ( ) Other fixt res .----•-------------------------- - W /Design,,; low____ Z_ ........... gallons per person per day. Total daily flow.........3__,3 G________.________.____.gallons. WSeptic Tank—Liquid capacitylof _gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width___4�....... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._.___f............ Diameter.................... Depth below iplet. ____ otal leaching area..................sq. ft. Z Other Distribution box (.%j Dosi A tank ( �""' • '-' Percolation Test Results Performed by� _-, __ j__ __ Date.__.._._ �� .. Test Pit No. 1______ _ ___minutes per inch Depth of Test Prt_. _Y__.____ Depth to ground water_-44_______________Vi a( Test Pit No. 2................minutes per inch Depth of Test Pit_,_.._'................. Depth to ground water........................ -•- __ -------- ----------------•- --------•-•----•--••------------___---------•--______--------___----- Description of - -- --X----� .-. . . -• ---•- ......................................................................... W UNature 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 TITU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is by the boiard of health. Si -- - ------- --- ----------•--•-------------•.....----------------- - Date Application Approved By....:_" - ��_. '-.._?_ _ 7�Date - Application Disapproved for the following reasons-......................-- -----•----------------------------•--•---•---•--•-------•-----•-•-----------------••- -----------------------------•-----•--------•------------------•-•---•---..._..-=-•--------•---------------------•----••-----------------------------------------------------------------•------------- PermitNo---------------------......................................................... Issued...............................' Date f r THE COMMONWEALTH OF MASSACHUSETTS {BOARD OF HEALTH ................................ ......OF....... :................................................................. ......... rrtifiratr of Tnutph attrr ° T IS IS' TO CE IFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by: .......... .............................................;. ....................................... •-•---......_ a, -test lera has been installed i accordance.,yvith the provisions of T "' S of The State Sanitary Co e as described,,in the application for Disposal Works Construction Permit No. �__ _______�Al............ da.ted_..... 'Z.��_._�� _____._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WI L FUNCTION SATISFACTORY. �' � DATEv ................................ Inspector`::: _ THE.COMMONWEALTH OF MASSACHUSETTS BOARD OAF HEALTH F ../......L .........OF....................................�...........-.._.__....---_...................... � Iry ioott o k oator uan rrattit Permission is hereby granted..._..__.:_ C: ... to Constr}u�c�t�� or pair ( ) an Individual Sewa e Dis al- em l. w at No.--- "t___ ._G ��„f.. k ,-------- ---------------------•-- ------------------------------- ••---•--......__ ------ - ----- reet as shown on the application.for Disposal Works Construction P it N ._ ____ _. _._ _ Dated_."�1`_ _ '__T. .�._._._.. o d o Hf ealth DATE-------- / ............................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS '' -� tdO GAtza c,G.S - 6cz1�.tv�. 1 t 0 3 SSO °re - A-95 ex Ft0. u s� toad 6Q 1_. 1 po5,&L PIT usE. t©oo E„cu... SarjA/AL-L AtzE.A. t= 7r G•Pv. 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'j C> Mt�t= D�C' l_th1+::�sitlli127:. t�il�fWGt�D f L °-F s A^ LOCATION �� SEWAGE PERMIT NO. 20 / I I LPL AG E I N S T A LLER'S// NAME & ADDRESS BUILDER OR OWNER �y ) / C: -o Uri DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED r r r� tz yr �� .k --98-- EXISTING CONTOUR �a x 100.98 EXISTING SPOT GRADE ova e LOCUST' g� 44 PROPOSED CONTOUR N -Wy EXISTING WATER SVC. -G EXISTING GAS SVC. -U UNDERGROUND WIRES S��O �. TEST PIT BENCHMARK EXIS71NG SEPTIC TANK \ a. LEGEND TOP OF TANK, EL.=98.5 v INV.=97.17 r A � Z !� ° m x „ * -,X 98.92 as ZL 6� 9.95 LOCUS MAP e 100,27 O' NOT TO SCALE ferc LOT 5 15,282 ±SF 8.09 +MBgL 209-104 +.98.2 EXIS77NG LEACH PIT TO BE PUMPED, FILLED WITH + 100.66\ SAND & ABANDONED. ( 0 99,Ob' ' CO 99.4 TP-J} JP100.95 -2 x 2 CV 9.01 BENCHMARK I .SS o �`;, CORNER OF STEP � � q S:: DECK O" EL.=101.49 I O - . 2$ rQ + I 100.96 \ 98.15 +100.68 I 'edge Of ' x 161.45 01 9 98.18 EXISTING ' 102.46 x GARAGE BRZ. HOUSE(168) shr. WAY T.D.F.=101.85E / 101.81 101.58�? / SHED O O1. / O / 97.24 101,2 J °C WA LK + •/ !n / 97.92 •/•ice ---_ aa'o 00.96 / 97.36 e f lawn �09:47 o co edge 97.19 t / 03.0 101,84• .:.::•:`.. o f•lOf.51 �- // 6.87 P + 101.73 �i 4 / 98.87 103.71 x "'Q '..:o. 102.00 103. -102.29 102.81 Q C9. \ w (10 LO to 101.12 100.88.' ( N \\� OF Mgss9�� 0 51� o o PETER T. F Z McENTEE CIVIL No. 35109 100.31 100,96`, £CISTER�� 100.38 SS E� 100.11 -o JO YCE A NNE ����ti OWNER OF RECORD MOGAN, M LEAN & FRANCIS E JR 68 JOYCE ANNE ROAD ROAD CENTERVILLE, MA 02632 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 68 JOYCE ANNE ROAD, CENTERVILLE, MA Prepared for: D.A. Brown, Inc, P.O. Box 145, Centerville, MA 02632 Engineering by: SCALE DRAWN JOB. NO. Engineering Works, Inc. 1.,=20' P.T.M. 144-15 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 5/22/15 P.T.M. 1 Of 2 ti NOTE: TO PREVENT BREAKOUT, FINAL GRADE SHALL NOT BE AT, OR BELOW, EL:=97.15 FOR A DISTANCE OF 15' FROM THE EDGE 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 INSTALL RISER & COVER OVER EACH CHAMBER AND T.O.F.=101.85t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT FG =100.0t � F. --- ----- �F.G. EL=100.3t F.G. EL=100.4E MAINTAIN 2% SLOPE OVER S.A.S. ' L = 26 L = 5' ® S=1% (MIN.) ® S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1 s" 1a"1 " DOUBLE WASHHEDED STTONEE 6 aBa�aaa (OR APPROVED FILTER FABRIC) 14" a6aaaaa EXISTING 48" LIQUID aBaaaaa -3/4- To 1-1/2" DOUBLE LEVEL WASHED STONE ADD INV.=96.89 PROPOSED 4' 5.2' 4' D BOX INV.=96.72 BAFFLE • . . .... . ... - Gas. . .. INV.=97.17 EFFECTIVE WIDTH = 12.8' 3 OUTLETS INV=96.65 ' EXISTTNG SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-10 RATED TOP CONC. ELEV.=97.4t BREAKOUT ELEV.=97.15 INV. ELEV.=96.65 m1mlomilum amaa NOTES: aBaaaaaaaaa aaaaaaaaBaa 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & BOTTOM ELEV.=94.65 INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. 4' 2 x 8.5' = 17.0' 4' 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL STONE BASE, AS SPECIFIED 310 CMR 15.405(2). 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=89.6 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. SEPTIC SYSTEM PROFILE GENERAL NOTES: SOIL LOG DATE: MAY 12, 2015 (REF#14,680) 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL EVALUATOR: PETER McENTEE PE(SE#1542) BOARD OF HEALTH AND THE DESIGN ENGINEER. WITNESS: DAVID STANTON R.S. HEALTH AGENT 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS ELEv. TP-1 DEPTH ELEv. TP-2 DEPTH OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: 100.7 A 0 100.6 A 0" -310 CMR 15.405(1)(b): SANDY LOAM SANDY LOAM 1) A 10' variance, S.A.S. to cellar wall, for a 10' setback. 100.2 10YR 4/2 100.1 10YR 4/2 B 6" B 6" - 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR ` TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE LOAMY SAND' 'LOAMY-SAND DESIGN ENGINEER. 10YR 5/6 10YR 5/6 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 98_0 32" 97.8 34" FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN C C ENGINEER BEFORE CONSTRUCTION CONTINUES. PERC 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 30"/48" 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF M-C SAND M-C SAND THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 2.5Y 6/6 2.5Y 6/6 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 89.7 1 132" 89.6 132" DIRECTED BY THE APPROVING AUTHORITIES. PERC RATE <2 MIN/IN. "C" HORIZON 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY NO GROUNDWATER ENCOUNTERED THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 3 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL N� PROP. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND C3 S.A.S. NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC ��� �J1 SYSTEM COMPONENTS NOT SHOWN ON THE PLAN 2 �` DECK 24.1' DESIGN CRITERIA NUMBER OF BEDROOMS: 3 BEDROOMS ! SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) �� EXISTING DESIGN PERCOLATION RATE: <2 MIN/IN GARAGE CRY• HOUSE(#68) shr. DAILY FLOW: 330 GPD T.O.F.=101.85E DESIGN FLOW: 330 GPD GARBAGE GRINDER: NO-not allowed with design LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF .74 GPD/SF SEPTIC LAYOUT EXISTING SEPTIC TANK: 1000 GALLON CAPACITY PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED USE 2-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 68 JOYCE ANNE ROAD, CENTERVILLE, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: D.A. Brown, Inc, P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:................... .......................................... 471.2 S.F. Engineering Works, Inc. N.T.S. P.T.M. 144-15 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 5/22/15 P.T.M. 2 of 2