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HomeMy WebLinkAbout0063 JOYCE ANNE ROAD - Health &3 JOYCE-ANNE ROAD, CENTERVILLE A=20q-117 LOT 18 i uu UPC 17534 No.2�153CCOR �, W KASTONGS,ION r , No. l r Fee ` v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes applitatiOYC Or MispoSal 6pstem Construttion 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ( 3 P Owner's Name,Address,and Tel.No.. �►o�( �i�'- G.3 .i o�c.v AKA_ Assessor's Map/Parcel CG ,�A,,/, A4- �' �K �� So re>771-2 Installer's Name,Address,and Tel.No. Designer's Name,Ad ress,and Tel.No. Rados A- 6ro as-i Tw �c�g-�GYy-'jf S� C,3 c Mc,n r SF Type of Building: Dwelling No.of Bedrooms Lot Size 15 0042 sq.ft. Garbage Grinder(� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) yY62 gpd Design flow provided 'Yreo gpd Plan Date z�y�h Number of sheets t Revision Date Title Size of Septic Tank /5-00 Type of S.A.S. ,Gc�c,K 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.Signed Date 7A3)4 p Application Approved by Date Application Disapproved by Date for the following reasons Permit No. t — Date Issued -3d {rp No. F. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t -- S:'i des PU IC HEALTH,.D.IVISI.O:N� TOWN OF BARNSTABLE, MASSACHUSETTS 1plication OY MisposaY .6pstem Cone-tCULtion Permit `Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (,3 ,7�`� �nnz �•,. " Owner's Name,Address,and Tel.No_ Assessor's Map/Parcel C rr Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Ar ibro,,oto TN< �rc�g- °lam 7/5-5 S� �J✓ti Le. Se tL- >i� � Type of Building: Dwelling No.of Bedrooms Lot Size /5 Uoy sq.~ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ,.�/�/U gpd Design flow provided `/`!G gpd Plan Date ;71, y / Number of sheets / Revision Date Title II Size of Septic Tank /`j U(..) Type of S.A.S. ,ram ✓c, Description of Soil C uo Vcf c", „ ,) 0* ,.. 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. Signed Date -7A3)1,�— Application Approved by Date —�� Application Disapproved by r Date for the following reasons 4 rmit No. Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance R THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by ,17)11tJb!, IJ((S�A9n s. n)r at has been constructed in accordance t 3v-�rS with the provisions of Title 5 and the for Disposal System Construction Permit No.o?(16°1 Ll/ dated Installer Designer ` #bedrooms Approved design flow gpd The issuance of this pe ,i;s all not be construed as a guarantee that the system will nctio�d�ne•. Date �0 Inspector ---- ----------------- No. go! 5 Fee 1 15 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS lI sp at 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair ) Upgr�a ee \) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit'�� J r Date 4�' �6 Approved by t l Thomas F.!Getirer,Di eeior MA-M. Public/Health DLA1sl on. _ 16:go aE Mite, Thomas 1`i mean,Director • �@�Q��tanm�dn°eel,�[yan�,l+`/1L�s.®���DJI. Cface: 508-862-4644 Fax: 5o3-790-6304 Mstalille Designer cCertffieation ro��m Date-.3 �f � Sewage per mit4i 4ssess®r's l�atp�]Pa¶°sale.`7 rnstaill ere �U / d(n y Designer, Address: MA,(rt cJ t, Address. On was:issried a perm tto install a (date) (:mtaller) septi+:system.at 63 l� o e2 GC r1&, FQ ' based on a design&-awn by (address) a lot PLJ dated l certify that the septic system referenced above was installed substantially according to the design,which may include minor approved changes such as lateral relocation d the distribution box and/or septic tank. I certify 1ihat the septic system referenced above was installed will major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Reg-Ldations. plan revigion or certified as-Built by designer to follow. 4ZH OF MASS�cti '�KaUeei oo DANIEL OJALA G� �si atLlTe) CIVIL N No'46502 sr�����``� • l/`�✓ �� �sSIONAL t (Designer's Signature) (l��Designer's Stamp l�eie) ]?LF,+A,'T E- l7'-1 FN TO BANUR31�.1kbJLL F�J�JLb� 49E1 &�A�Y1l ��l 1. G LT�+LiC I N 0 pen1�yWdCE '-�j, kTUI .m.� d geTkD aird'a'�, � �' 8 O r�S UYE,T CARD JPT CE D ff J T1.E B TdSTAB LE k�N UC�ALTH]O][��[,�Ti�Pd. '1�H94K YO U. �13 Tom of:�ornatable )Oepalrtiaz=t of Regulatory.Services TS Public Health-Division Date 200 Main Street,Hyannis MA 02601 Date Scheduled7. Tirrte^ I Fee&'nY, Soil Suitability AsseSgment for ,fie ge is� sal Performed By: h Gay S a 1 u es ` t Witnessed By: fin" t 1J LOCATION&GENERAL 1I 'ORMA° OAT Location Address (3 C-c �K Owner's Name V v l o Y Address Assessor's Map/Parcel: eZO� `(? Englncer's Name NEW CONSTRUMOAI REPAIR n_ Telephone �d04 �f7d- Land Use:_ Vaea' Slopes(%) V '"r Surface Stones N,04 C Distance's from: Open Water Body 7(GG ft Possible Wet-Area ft Drinking Water Well i�_O ft Dralhmo Way ft Property Line !f ft Other ft tec7r;g•a 7A f tares • �a°2�`Ez-�- b 1�7 6 I- i�5 SI "TCHo(Slrcet name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands n proximity to holes) THE 010 Parent material(geologic) V G!4u " Depth tv 13edmak a00 Depth-to Groundwater. Standing Waterin Hole:/"/TT ._ Weeping from Pit Frew /`/ ZA N�Estimated Seasonal High Groundwater 'VPONATION FOR SEASONAL MGH WATER TAB)B R, .Method Used: _ Depth Observed standing in obs.hole: lu. Deptit;tn 5911 fOttlaB:. ln, Depth to weeping from side of obs.hole: 1t1, ©rnunrlwaterAdJudtme'nk >; Index Well#{ Reading Date: Indox Well laYul AdJ, cttiC, At ..atptliltlwsterl.evsl PERCOLATION TEST make. Tltme Observation Hole# Tiuma at.9" Depth of Pero. ` T1mr at 6" _ Start Pre-soak Time @ 'Time(9"-6") Bud Pro-soak Rate Min./Inch SNtc Sultablllty Asaessment: Sito Passod Sitp Fallod: Additional Testing Ncedcd CY/N) 'V Original: Public Health Division Observation Hole Data To Be Completed on Back------ ***1f ipercokati®n test is to be conducted within 100' of wetland,you merit first notify the Barnstable Coaase>}vation Division at least one(1) Week prior to beginning. Q:ISEPTICIPERCFO.RM,DOC � V5 DEFP.O13SFRVAI,�OX"tIOLr LOG Hole g Depth from Sail Hari= Soil Texture Shcl Color Soil.. Ot'hcr -Surface(in.) ([15DA) (Munsell) Mottling (Structurc,Stones;Boulders, - o i`ten�y.96'Cravcl) ' 72-i3� C Depth from Soil Horizon Soil Texture Soil Color Sail Other SurPacc(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. a sis ency,To Grave • .o-.fig F,� 1 � . . ��-120 /cS Z,57 7/t DREP OBSE Ld..rV'ATION ROLE]LOG Role 9._ Depthfrom Soilfforizon Soil Texture Soil Color Soil Other' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,l3ouldtrs. Corlsisto c G e ]DREP OBSERVATION ROLE LOG 11olp"I Depth from Sail Horizon Soil.Texture Sall Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stoats;Boulders. Ca si tan b CIMYXD— Flood Insuraxics;�1a1p: Above 500 year flood boundary No Yes "Within 500 yearboundary No Yes ' Within 100 year flood boundary No.-. Yd5 _ ti Y)entYx.of naturally!Occnrring Pervious Material Does at least four feet of naturally occurring pervious material exist in all arelis nbset•ved throughout the area proposed for the soil absorptibn systeml '1/f� -—1 If not,what is the depth of naturally occurring pervious matdriall C�rti�cation ' I certify that on / Z (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was perfonnod by me consistent with . 'the requited training,expertise and experience described in�10 CMR 15.017. • uQ �_• .7�z y �S Signature Datb QAs,>?MaPB-RCF0RM.D0C y t C��"►7 T 7.' &V Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Joyce Anne Road r Property Address I a Francis and Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 04/1;042015 page. Cityrrown State Zip Code Date of-Inspection 1— 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, use only the tab / IQ 1 key to move your . Inspector: cursor-do not Michael T Bisienere use the return key. Name of Inspector Cape Septic Inspections �y Company Name 624 Old Barnstable Road Company Address Mashpee Ma 02649 Citylrown State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 04/11/2015 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .•'' 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 04/10/2015 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: Vacant lot. 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 u Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 04/10/2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 04/10/2015 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: y You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 04/10/2015 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. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 04/10/2015 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts w - Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 04/10/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: No use in the last two years Sump pump? ❑ Yes ® No Last date of occupancy: unknown 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 04/10/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 l_ Commonwealth of Massachusetts W Title 5 Official Inspection Form Vk R s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 04/10/2015 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: 08/27/1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: no sewer pipe vacant lot. 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): 211 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Standard 1500 gallon septic tank Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,.' 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is Centerville Ma. 02632 04/10/2015 required for every 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 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 11" 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.): The septic tank is structuraly sound and has a pvc tee on the discharge side of the tank. 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 a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments bV•,� 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 04/10/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •°° 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 04/10/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 04/10/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 60 x10 x 2 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology.- Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is Centerville Ma. 02632 04/10/2015 required for every 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•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 y( 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 04/10/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Assessing As-13Uilt Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION Lad/S Joyei ai Rsr SEWAGE ii20 — VII t sa . G 1'riterW e ASSESSOR'S MAP d<LOT:-9. )07 INSTALLER'S NAME&PHONE NO. U04 4 17' A)a /AP SEPTIC TANK CAPACITY /Soo i LEACHING FACILITY:(type) $is /trt�t (siu) �,AR.L NO.OF BEDROOMS_ BUILDER OR OWNER M14/Nis �•• L�a.Jr pERM1TDATE: 5;"A7-97 COMPLIANCE DATE: $`�W—97 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Meet 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 wedaW s exist within 300 feet of leaching facility) Feet ! Furnished by � 1orc� �,w• Aa o Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is required for every Centerville Ma. 02632 04/10/2015 page. Cityrrown 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) ❑ 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: I augured a hole at a lower elevation and shot it with a transit to show five plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Joyce Anne Road Property Address Francis and Leah Mogan Owner Owner's Name information is Centerville Ma. 02632 04/10/2015 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file rr:.�2 J S�. A s e "v t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is required for every Centerville MA 02632 04/22/13 page. Cityfrown State Zip Code Date of Inspection S' 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 ►►►���qqq on the computes, 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 IC=Y Company Name --- PO Box 896 �J Company Address East Dennis MA 02641 Cityfrown State Zip Code 508-385-7608 Si 3742 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: C'J cji —� ® Passes ❑ Conditionally Passes ❑ Fails `- I ❑ Needs Further Evaluation by the Local Approving Authority ; �� - 0425/13 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving AuthoritABodffl 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•11/10 Title 5 Official In n :Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is required for every Centerville MA 02632 04t22/13 page. Cityrrown state Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: There is no house on the lot 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 ortank 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ol Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is required for every Centerville MA 02632 0422/13 page. Cityrrown 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. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(i)(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 vein's•i1i10 Title 5OYcial Inspection Fors:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Joyce Anne Road Property Address Paul Bonk Owner Owners Name information is required for every Centerville MA 02632 04/22/13 page. Cityfrown state Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the 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 fo►m_ 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 El ® 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 ❑ 0 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 day flow t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is required for every Centerville MA 02632 0422/13 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 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 e)dst as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following,in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant.threat, or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins-11/10 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Rage 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 's Subsurface Sewage Disposal System Form-Not for Voluntary Assessments < 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is required for every Centerville MA 02632 0422/13 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each.of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The sae 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): 5 Number of bedrooms(actual): 0 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 t5ins-11/10 Tide 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 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is required for every Centerville MA 02632 0422/13 page. City/rown state Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[f yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ 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: never Date Commemialllndustrial 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 Tide 5 system? ❑ Yes ❑ No Water meter readings,if available: t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is Centerville MA 02632 04/22/13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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) (f 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 VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11110 Title 5 Official Inspection Forth: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 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is required for every Centerville MA 02632 0422/13 page. CitylTown state Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 0827/97 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.9 feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): Depth below grade: 1.1 feet Material of construction: ® concrete ❑metal ❑fiberglass ❑polyethylene ❑ other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1,500 gal Sludge depth: 0" t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is required for every Centerville MA 02632 04t22/13 page. CityrFown state Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 17" 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 El 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 s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is required for every Centerville MA 02632 04M13 page. Cityrrown state Zip Code, Date of Inspection D. System Information (cont.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No. Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): i 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 A Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is required for every Centerville MA 02632 04/22/13 page. Cityfrown state Zip Code Date of inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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 TAIe 5 Official Inspection Form: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 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is required for every Centerville MA 02632 0422/13 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 8 ❑ 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 8 infltrators in a 10'x60'field of stone.The system has never been used. 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 Official Inspection Form:Subsurface Sewage Disposal Sysfem•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is required for every Centerville MA 02632 04/22/13 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.): t5lns•11110 Title 5 Ofiaat Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Tithe 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is required for every Centerville MA 02632 0422/13 page. Cityfrown state Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Deposal 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 Joyce Anne Road bound bound 96 130 105 138 t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is required for every Centerville MA 02632 0422/13 page. Cityfrown 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 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Joyce Anne Road Property Address Paul Bonk Owner Owner's Name information is Centerville MA 02632 04rM13 required for every City/Town page. 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 i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 7 TOWN OF BARNSTABLE G� LOCATIONS y+ce �ft"? Rd SEWAGE # VILLAGE— � ��'�� /le ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY fS�� LEACHING FACILITY: (type) $ r ti /7� toY s (size) I �fo` ?`/Je.�► NO.OF BEDROOMS BUILDER OR OWNER 1*6J �« � gaid-r . PERMITDATE: ��Z�—�.� COMPLIANCE DATE: ?'27'�7 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 r moo FJ � 'c y FIts....... 17�..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diaipattial Wnrlui Ta tustrnr#um ranfit Application is hereby made for a Permit to Construct (,\-}' or Repair ( ) an Individual Sewage Disposal System at: 6..:....... ) ... 1/... 67 O encr Address Installer Address UType of Building Size Lot_._,fa ....Sq. feet Dwelling— No. of Bedrooms............ --------------------------- Attic OLX.,) Garbage Grinder (AX.)) aOther—Type of Building ............................ No. of persons.---_---_---_------_-----.- Showers ( ) — Cafeteria ( ) a' Other fixtures ................................... -- W Design Flow..............��....................gallons per person per day. Total daily flow.... _...�..°.=___ . ................gallons. WSeptic Tank—Liquid capacity/..gallons Length-1(_......... Width---& Diameter- .--_--- Depth.....5.22... x Disposal Trench--No. .................... Width.................... Total Length.............._----- Total.leaching .area.............. ....sq. ft. Seepage Pit No.......2- .............. Diameter......../..G...._ Depth below inlet......CP.�...... Total leaching area.--Y.-..sq. ft. Z Other Distribution box (x ) Dosing tank ( ) ~' Percolation Test Results Performed ` � .............. 0 Test Pit No. 1--4.�_.__minutes per inch Depth of Test Pit......f-Z 1....... Depth to ground water... ...... Test Pit No. 2..= Z....minutes per inch Depth of Test Pit......! ._`_...... Depth to ground water..... a --------------------------------------•-----.-•------------•----•-•------------------- ------------- .-.----.......... ••.................. 0 Description of Soil..............7��;�t.�...._6-5 ......��e v v -------"4,,ti►•• Cry►- ...............................................................................°. -? ....----...•--........_•---- W ----------------------------------------------------------------- -------------------------------------------------------------------------------------- -----------------------------•••-•-------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian h been issued by the board of health. Signed ........ r�- _9....3�9y .. . . Dace Application Approved By ............... .kli�: �-�-' 1 '�.. i e. ....... Application Disapproved for the following reasons: ...... .......................... .....---. . ... ...... ...........................--.. ....... ............. . ..................................... . ................ .......... .................... ................. --....... --. . .....--..-- ...................................... � Dare PermitNo. �- ............................ Issued .......................... Dace YJ' Tt THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,_TOWN OF BARNSTABLE ApVfirafiott for Diri uiul Winks Tonstrnr#inn ramit Application is hereby made for a Permit to Construct (,\4 or lRepair ( ) an Individual Sewage Disposal System at: , ........ a. �:��.".. �/ E ...tea e4. g' ?✓..L.. E ���- .................... 7 `'° u� --••-- --------------- -------- ----- -•: ................. •..... �7 O„-»cr '- - Ad W , OLe r► �, !�a f I`� /VGrS or, s /►`/.1f4, � 7,r-, a,:P ----•-•--- -•-•------•-•--•----------•--------- --•------- ----------------------------------------•-----•--• --•-------••--•-----•- i Installer Address Type of Building Size Lot..../5!;L:Sq. feet g— p� (Kx�) Garbage Grinder(Ak' .� Dwelling No. of Bedrooms...........................................I✓s Expansion Attic ` a Other—Type of Building ____________________________ No. of .persons__---_-_-_____-.._______.__ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------- ----------------------------------••------------------------- -------------••-•----•-•-----••.,/`-�- --------- W Design Flow...............��....................gallons per person per day. Total daily flow....` ?.1/v_�.._7_Z..v..........gallons. 1:4 Septic Tank—Liquid capacity/50P..galIons Length__//-'______. Width___,(&......... Diameter---........... Depth.....S_.�.. Disposal Trench--No. .................... Width........._.......... Total Length.................... Total leaching area---------__.._.....sq. ft. Seepage Pit No-------?........... Diameter--------11>'.__. Depth below inlet.......6R.�_,__.. Total leaching area...53. .....sq. ft. Z Other Distribution box ()< ) Dosing tank ( ) '_4 Percolation Test Results Performed by._�ar`f�? �?` 5........................... Date....... 1.4 Test Pit.No. l..L. _.__minutes per inch Depth of Test Pit------/Z......... Depth to ground water. ...... l L74 Test Pit No. 2....L.&....minutes per inch Depth of Test Pit------lA'_.__.. Depth to ground water...... ''�?�. a' O Description of Soil.............` �e ;?ra.4___._ .�._._.. �_.___. x :V --••----._... ¢a!' r _.•-,v-lEl N-_ C a�+......E' f?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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian h s been issued by the board of health. Signed .......... T.-- S- 9�/ Application Approved BY ............. .. ..,.-......' .r-- i .e,l ........ �--, ............................................................................. Application Disapproved for the following rearonf. . ............................... .... ....................................... .............................................. ................................................................................................................... --- -- ........ ..-...--.....--...........-----------. ............... .................. i Date PermitNo. ...../ .�'/..-........, . ./-..---------------------- Issued .................................................................... Date t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE V-Pl' ttCMP II V•II>rltlt�I1TCE '4 THIS I TO CERTIFY, That the Individual Sewage Disposal System constructed ( K ) or Repaired O by ..................... -...n1.-.-........ ..... ........._..-..`....... ....... ............................ ........... . .... ...... .... --. . . . ....... Installer at ............... .....v C............................................................. -.e..... '-. .� �.-✓-----t'-LE---------------------- ......'J . .. .................... has been installed in accordance with the provisions of TITLE of The State Env iron mental/Code as described in 1 the application for Disposal Works_Construction Permit No. -....... a/.. ............... dated .._......--...._..--....................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....................9.........)�_,7......... - Inspector .....__ .":��. THE COMMONWEALTH OF MASSACHUSETTS BOARD' OF HEALTH ? TOWN OF BARNSTABLE Bispnlittl nrkii Tnno#rur#inn �lernti# Permissionis hereby granted------------_-- ------- -------��- ---------------------------------------•--...------....-•:------------............... to Construct (x) or Repair ( ) an Ind v dual Sewage Disposal System at No............----------- &.:.... •-•---C `'�z-''� L//L��- ................................ Street as shown on the application for Disposal Works Construction Permit No. �_:,j�./-__ Dated.._..__.�_-._.�..'.�.,�-1..... ------•-----•-•••.•----• •.t. --I------•--------•----....---•----•------•--^--•---•--•--•--•--•-- Board oP,Health DATE--..... 7 - L� •-•-------•--•---------••----- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS �� TOWN OF BA.RNSTABLE p LOCATION loll/5 7L /�Hae Rd SEWAGE # ,.V L:LAGF C? �yy/ � ASSESSOR'S MAP& LOT � �7 INSTALLER'S NAME&PHONE NO. �b�'►y /7• /�a It SEPTIC TANK CAPACITY LEACHING FACILITY: (type) $ (size) �/v x ?'p. NO..OFBEDROOMS r— BUILDER OR OWNER /��4 A9/f fu•• /�w,�T PERMIT DATE: S r 7'9 7 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by v _ � 3 I 1, ENGINEERED BY: OL rn a0�` 3u a mt °m a°u EmUm m 00 7'.2 6 d b d b b d q'- " !a'-!o' 1 1'-q" 1=i•_1„ 11'-I 1" 9'-2" A A m 0 0 A d o ma 32'vg° e\ \ 0\ �� Pr P O c 0 P O m m J,P P O c 0 P O 3f 3f 3fx k ;s 3� 3f 3� a- `r v ` 24'x12'OeCga-i5 u5 u� mN ao i 4 d d 9 Q d d o d d 4 d C 0 L L L w Uss Prasarip#IVa�asidenliwl Weod .,` oak GOnstrua+ion 4uida OGp�-09 \� bwsad on the Z 009 In+arnw+lonwl �asidan+Iwl Goda,+o build dsak. t ___________________ _______ __ __ _-__ _ i - -------- CIE - a 1 f Geillnq Iine e 1 2'-O" ----------- \ J 8 I \ c Andersenm TW 2 0 4 1 0 P��O�OOry•% k..A o P L 1 _ ois•x- lix•• -io iir.. ._ova• a L P d zx a 1 1"IAIiTBP-PJCOFOOry T ; x� mw.r w.0 S O [ Q �; q d 4 d A- R ------------ O P F-{•O r. s G(=CAT�OOry/pITGNCN j j —a w o+ele a W e f 1 +0 Anders.na'TW 2 4 4 1 O-2 1 5 n V 7/B" 5 a IL O 1 x =� - 1 J - I aio x oiu aio x aia• , r = , r j P n+ry ___ ®� ___ / a _ d 0 0 n r a_ 1 aox oio• __________ P z /2'X I 7/B"V Anders.nm TW 2 4 4 1 0 P i .rsnLwm hewdcr _ e 1 _ Q w/double j<ek studs both sides soled - I oxoxom• .. ': �I \V.lux®�iun TunnelTM 5oi Flex pitched-ryodel T1"IF a \ I I u ' IU p m K s a TW 20410 7•_%" 1 •\ /I d \ Z to �a 30 r.o.2'-2 I/B"x Z'-O 7/B" ' ' d I 4` •� W mU 3 0 # E a S »�eo�oOry•2 ° �' m j \\ / '_--____-----____________ V z U vm v I � Z0. T i IL I ------------- ---------- m o ° \r---- �' o`'� DA IEL cyGs g p, I bs CROTEAU �4 - Q I ----------------------r--------- P 1 � I -I 1 1 I 1 ------ - I U CIVIL N - - - _ a c �- ---------- L1 i I � 1 No. 46253 /STER ud�o_am s , SS a o I I I /ON L r P Q m Y=m i P P u+°OOr O J f f f J au PIP-hT-FLOOF-PLAN Zeaa '+ < aa=wtaa o oe�i� t ° ` 0 House Aspect R-.,+la f L/W)• I.!0 2 �L�-"v �E d J�+ \ %2 2 4 Gross h9uare Fee+under roof. J 3f x 3� O E E �n W This plan wws designed In accordance with K d d.oL d J 0 r the In}erne}lonwl�esiden+lal God.2 oo 9 y f d f +0 B f _ r, t Cdl+ian and the 1-Iassachuset+c 7 BO G7-IR- C E I.o0 B+h Cdl+bn. onfar wi+h DRAWING TYPE: d t d f 3 \ %O I.2.1.2 Pro}ec}ion of openings. First Floor Plan 7'-2" 6 �•-7" b 6 %'-O" d d Use Prescrip+I,xe R-cs41-4-W Wood S'-B" Oeck Gons+ruc}ion Guide 06Aen-09 based on the 20091n+ernnt'mnwl d �esiden+lal Gade,+o build deck. 1 4'-4" 12'-9 %/q" -B 1/ •• co•-o'• I I'-4•' 20'-]" I 2'-%" O5 hmokaoc+ea+or SHEET NUMBER: Nc}e:All ry A 2 O O esuremen+s�Dimensions wre be site verified by +o General Gon+roe+or a+}Ime of cons+ruc+inn GENERAL NOTES : DESIGN CRITERIA : : I N V'ER T ELEVATIONS : l . THIS PLAN IS FOR THE DESIGN AND DESIGN FLOW: INVERT AT BUILDING: 101 ,20 - 4 BEDROOMS AT- 110 G.P.D. PER INVERT IN' SEPTIC TANK..- 10( . 00 CONSTRUCTION OF THE SEWAGE DISPOSAL 104,0 FIRST 2' To ACCESS COVER$ MUST BE WITHIN BEDROOM EQUALS 440 G. P.D. INVERT OUT SEPTIC TANK; 100. 75 SYSTEM ONLY. 12' of FINISH GRADE BE LEVEL INVERT IN DIST. BOX: 100. 70 NO GARBAGE GRINDER 2. ALL CONSTRUCTION METHODS AND 4- PVC �-MIN. 2- of INVERT OUT DIST, BOX l00. 50 MATERIALS FOR THE SEPTIC SYSTEM SCHEDUL PEA STONE INVERT IN LEACH PIT: I00. 30 SHAL L CONFORM TO MASS. 0. E. P. 01.20 00.75 SEPTIC TANK REQUIRED: loo.�o '-�° 1 16- 440 G.P. D. X I50x - 660 G,qL, 80TTOM OF LEACH PIT: 94. 30 TITLE 5 AND LOCAL BOARD OF HEALTH 100 30 ti3/4' - 1 1/2- DIA, ADJUSTED GROUND WATER REGULATIONS. . OUTLET 94.30 WASHED STONE SEPTIC TANK PROVIDED: 1•500 GAL. 10• MIN. 1500 GAL D-BOX 12 6, 2, OBSERVED GROUND WATER: SEPTIC TANK SIZE OF LEACHING FACILITY REQUIRED: ON LEVEL STABLE BASE 2-LEACH PITS 3. ALL SEPTIC SYSTEM COMPONENTS LOCATED 440 G. P.D. - UNDER AREAS SUBJECT To VEHICULAR TRAFFIC PROFILE : NOT TO SCALE DESIGN PERC RATE --f_Z�MJN/INCH OR GREATER THAN 3 ' IN DEPTH SHALL BE ZONE : R C CAPABLE OF WITHSTANDING H-20 WHEEL LOADS. PROVIDED: 2 . 6 PITISI W/ 2 'STN. SETBACKS: FRONT - 20 ' 4. ALL SEWER PIPE SHALL BE SCHEDULE 40 S I DEWALL: 377 S.F.X�_ - 943 GPD SIDE 10 ' OR APPROVED EQUAL BOTTOM: 157 S.F,X I. 0 - 157 GPD REAR - 10 ' TOTAL : 534 S.F. 1100 GPD 5. BEFORE CONSTRUCTION CALL 'DIG-SAFE'. 1-800-322-4844 FOR LOCATION OF SOIL TES T P 1 T DA TA P-8! l8 UNDERGROUND UTILITIES. INDICATES 4 INDICATES OEMW lwtK PERCOLATION -- OBSERVED 6. VERTICAL DATUM l S: ASSUMED M rAe 33o TEST = GROUNDWATER - EZEY-ros.e3 N TPf 1 rP• 2 TPA 3 TPf 4 TP* 1 7. FOR BENCH MARKS SET. SEE SITE PLAN. GRND EL. 10I,9 GRND EL. 100.3 GRKD EL. 10/.5 GRND EL.100-8 GRND EL 101,9 CA h G.W.EL. N/A G.W.EL. N/A G.W.EL. N/A G.W.EL. N/A G.W.EL. N/A 8. IT SHALL REMAIN THE CLIENT'S RESPON- `' TOPSOIL TOPSOIL TOPSOIL TOPSOIL S I B I L I T Y TO HAVE THE PROPOSED DWELLING m FOUNDATION DES/GNED TO ACCOUNT FOR THE a � SUBSOIL 1.5. SUBSOIL sBesotL � SUBSOIL 2' FILL FILL FILL FILL EXISTING GRADE AND SO I`L CONDITIONS AT THE TOPSOIL • 3' - LOCATION OF THE PROPOSED DWELLING. �-- SUBso�t i ILL CArr a - _ REAR OF REAR OF ETC. LOT 6' LOT 6' 6• Tf.L EDMAL COARSE ti ,E �:r ,e MED I UM MED I UM SAND , COARSE �,p l 'p6 `Y 8 NO WATER 92,58 -SAND COARSE COARSE N Zb•$���' - SAND SAND 10' NO WATER 9Q.3 I3' COARSE 1°• t ,����. �,�Y�•-� �� ��. \ � 2'G��-eon "4f(- NO WATER SAND 1 1 • IOY \ �\ T 12, NO WATER 89.9 J5. NO WATER 86.5 1 1 ,' /'' Via , TP .3 ,��` o DATE: SEPTEMBER 30 1993 LOT + I l 1 ; J w N Iol.s� �P TEST BY, STEPHEN HAAS 15. 000 S F.I 1 1 a c e d 1 7• Wl PINE k. •GERR Y DUNNING t 1•, ,J, J N � � c r_-- W! TNESSED BY. PERC RATE: { 2 MIN/INCH RES % • .- ... 04p5 kf00 GAL -SEPTIC TANK o c o ,. ~:.; f� T / C' S Y S, T zE 1 � rP 03 s 1:t % *0 D-sox p' ♦ � i ' 'y BAR N S T A S L G l CE/V TER V l L L E > MA 61 PITS ��'`�����������., rP #1 -'' �� P R EPA W/2• STN \�� ��� �`\ ��\roe s \p3'�5fl Z-�� /V R S _ P A U L; 8 0 /V fK SCALE .• / » 2O` ' 11UL Y r45 T q S 2 N J -5"ear tx b O car 1- or .L canes ` /, 0 !0 20 40 , JOB NO: 93-313 FIELD:CFW/RVB LCALC.- SXH/CFW CHECK: CFW DRN: SAH ALL TEM LL SYSTEM PROFILE MARKED WITHCMAGNETICTTAPEAOR BE NOTES 5 (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT 1. DATUM IS ASSUMED ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS AVAILABLE n Gee° \ TOP FOUND. EL. 52.5' FILTER FABRIC OVER STONE 0 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. -9 1.5 t 50.5' MINIMUM .75 OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 49 �o, PRECAST H-10 THICKNESS REQUIRED UNITS STO BE AAIGN ISHO HNG R 1A(ZLL PROPOSED PRECAST � Pos Rd. BLOCKS OR RISERS (TYP.) PRECAST RISERS 2 Sur Old 2'0 4"4sSC L' PVC COMPONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. ate H-10 R� u/lrR . � PROP. :TEE PIPES LEVEL 1ST 2' ENDS SIDES 46.0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 9 *48.75' 10" 1500 GAL H-10 t4" ° WITH 310 CMR 15.000 (TITLE 5.) 48.50' TEE SEPTIC TANK TEE == �D�C� ���® �0�� o0000000° 48.25' a0��®�a00007 00��®®0®®®® >g0000�go 000000000°00tFOR D BOX p >o°o°o000 oao®®aa�oo® ®®®®®�0��00 >o�°0000� 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND GAS BAFFLE;; °°°°°°°°°°° VELNESS °°°°°°°°" >°o°a°o°o Sao®®®®®®®ram aao®®®oaaoo :°o°o°o° o 0 0 0 0 0 0 0 0 0 ° ° ° ° NOT TO BE USED FOR LOT LINE STAKING OR ANY 4' LIQ. LEVEL (ACME OR EQUAL) '" 47.0' 3' o0000 43.17 OTHER PURPOSE. r` 6" MIN SUMP 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 000000000000000°00000000000000000o0o00000oo0000 " " , LH-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 1,o�o o_�_°_�_�_0 0 0 0 0 0 °.0 0 12" MIN. INT. DIM. 3 4 -1-1 2 DOUBLE WASHED STONE 4 MIN. / / 3 UNITS REQUIRED ALL AROUND PRECAST STRUCTURES ( ) 9. COMPONENTS NOT TO BE BACKFILLED OR 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 33.5' X 12.83' CONCEALED WITHOUT INSPECTION BOARD OF COMPACTION. (15.221 [21) HEALTH AND PERMISSION OBTAINEDD FROM BOARD MIN rn OF HEALTH. ( 2.5% SLOPE) ( 31% SLOPE) ( 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP CALLING DIGSAFE (1-888-344-7233) AND 10' SEPTIC TANK 4' D' BOX 13' LEACHING 34.0' BOTTOM TH-3 VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE FOUNDATION- FACILITY OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF NO GROUNDWATER FOUND WORK. *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL ASSESSORS MAP 209 PARCEL 117 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS m X RAP 209 LANDSCAPED PARCEL ANY UNSUITABLE MATERIAL ENCOUNTERED LOT SIZE: 15,000 SF PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM z� PARCEL 118 ISLAND SHALL BE REMOVED 5' BENEATH AND AROUND THE LOCUS IS WITHIN FEMA FLOOD ZONE "X" c)z PROPOSED LEACHING FACILITY. STAKE SET (T?P)Qp 12. EXISTING LEACHING FACILITY SHALL BE CONFIRM SUITABLE SOILS IN AREA OF SEPTIC 7 �6 x 46 C-lb REMOVED/RE-LOCATED AS ABLE SYSTEM PRIOR TO INSTALLATION OF ANY PORTION OF C BENCHMARK: USE C.BASIN SYSTEM OR ANY CONSTRUCTION 50 13. IF RESERVE UTILIZED, WATERLINE MUST BE RE-ROUTED ISM NEt7 E RAW / q��� AT ELEV. 47.0' TO BE MIN. 10' FROM SEPTIC COMPONENTS 8a / 14. EXISTING SEPTIC SYSTEM INSTALLED 1997 TEST HOLE LOGS EX , \x 49, 17 _ �O REF: SITE AND SEPTIC PLAN D. 7/1/94 BY EAGLE SURVEYING FED 2 x 4 \ 49 , \�� AND ENGINEERING � � � 8.75 5123 / ENGINEER: STEPHEN HAAS WITNESS: GERRY DUNNING x 5 .67 48.9 �� %� % ��� / V / Ak 48.02 ELEV. ELEV. DATE: SEPT. 30, 1993 \ 54.75 /� \ - 47.84 4 4 PERC. RATE _ < 2 MIN/INCH s ,�� GAR. SLAB ���i� j TEST HOLE LOGS 0" 48.5 p" 48.5 CLASS SOILSTS 8.3 \\ �'�8 ENGINEER. DANIEL E. GONSALVES, SE #13587 4 ELEV. �7 ELEV. X 3 7 •� / J N 47.38 p11 49' p" `�l' 48 ``� % \ \ / WITNESS: DAVID STANTON, RS 2 1 ��%,� PROP. 4 BR ,�i \ TH 4 / 5 FILL FILL a3� DWELLING ii \ \ \ 7, DATE: 7/24, 1 TOPSOIL J % i TH \ �/x90 TOPSOILx 48.54, // SUBSOIL SUBSOIL ��867 ��� o���!i TOP FNDN. �% A 46 < 2 MIN INCH i �o �� � O H e� PERC. RATE _ 24" FILL 18 0` ELEV. 52.5' i 0 FILL �� A� o1 -1i// i� 0 �g 49 yi CLASS I SOILS P# 14764 72„ 42.5' 4800 44.5' 0.45 8 REAR OF 72 � x �i� /�,, �� \ LOT REAR OF 36" p� ��'� i� �i� �� C C �- LOT �� / / x 50 5' REMOVAL OF UNSUITABLE SOIL REQUIRED ��i , AROUND PERIMETER OF LEACHING FACILITY, DONSI TO SUITABLE\ S� \\\ % TH 1 s �� NTH CLEAN MED. SAND, TO MEETEPLACE M/CS M/CS MEDIUMCOARSE COARSE MEDIUM �s�\� �� //% / G��RING ' SPECIFICATIONS OF 310 CMR 15.255(3) SAND PERC SAND x 49.��� of O / �s� 50 2.5Y 6/4 2.5Y 7/4 EXIST. SEPTIC SYSTEM TO 4.2 �� E� x 50.78 BE REMOVED/RE-LOCATED �� S0.81 144" 37' 120" 38' 3.14 2 ti „ 0 132 37.5 120 38.5 MAP NO GROUNDWATER ENCOUNTERED PARCEL��7 I 0.34 \G. MAP 209 NO GROUNDWATER ENCOUNTERED ELEV. ELEV. ELEV. �' 1 PARCEL 116 3 OF ��SN OF MAcsq 0" 4 49' p„ 48' p" 48.5' �' -4.64 �ySH MAssq �� cyL TITLE 5 SITE PLAN CB/DH FND. c o DANIEL s DANIELA. yGs A. A OF o OJALA `�+, o OJALA u' TOPSOIL TOPSOIL SYSTEM DESIGN" No. VI N PN0 40980P suBsolL SUBSOIL 63 JOYCE ANNE ROAD FILL FILL � ��orsTER������ �'�NosuR�Eyo� CENTERVILLE GARBAGE DISPOSER IS NOT ALLOWED FS eNG TOPSOIL SOIL 72" 42' 72" 42.5' DESIGN FLOW: 4 BEDROOMS @ 110 GPD = 440 GPD PREPARED FOR SUBFILL USE A 440 GPD DESIGN FLOW ED. MOGAN STUMPS ETC, SEPTIC TANK: 440 GPD (2) = 880 N '- 0. \OFMA6 � OFMASSgcy ;., � S �s JUNE 12, 2015 COARSE COARSE USE A 1500 GAL. SEPTIC TANK �� DANIELA. DANIEL A REV. JULY 24, 2015 (ADDITIONAL TEST HOLES) SAND SRC SAND (o OJALA OJALA v, off 508-362-4541 LEACHING: '46502 �No. 40980� fax 508-362-9880 SIDES:2 (33.5 + 12.83) 2 (.74) = 137 GPD �° �F „4 oFESs 0 I downcape.com 156" 36' BOTTOM 33.5 x 12.83 (.74) = 318 GPD c s, -7-�-�-�,- m, , N L �NG'a ° �R VWN: y° l® down cope engineering, inc. " COARSE " TOTAL: 614 S.F. 455 GPD DATE DANIEL A. OJALA, P.E., P.L.S. civil engineers 180 SAND 34' 96 40' 120 38.5 Scale: 1"= 20' land Surveyors NO GROUNDWATER ENCOUNTERED USE (3) 500 GAL. H-10 LEACHING CHAMBERS 939 Main Street ( Rte 6A) (ACME OR EQUAL) WITH 4' STONE ALL AROUND MA 15- > 13 APPROVED DATE BOARD OF HEALTH 0 10 20 30 40 50 FEET YARMOUTHPORT MA 02675