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HomeMy WebLinkAbout0230 KNOTTY PINE LANE - Health Z30 Knotty Pine Lane Centerville A=191-071 i Commonwealth of Massachusetts �`'� - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 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. A. General Information -- 7 13 1. Inspector: 8 Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that 1 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 u sewag disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5i310 CMR 15.000).The system: lasses ❑ Conditionally Passes ❑ Fails 6suCz WIuatione Local Approving Authority m ll�— c; 5-17-13 Inspector's Signature JOV Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the , report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 page. City/Town 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: y ® 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: System is in good working order with no sign of failure. 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 i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 page. City/Town 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-3113 Title 5 Official Inspecbon 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 s 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 page. City/Town State Zip Code Date of Inspection B. Certification (cost.) 2. System will fail unless the Board of Health (and Public water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *" This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Fora _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® 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): 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 f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 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: 5-2013 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 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 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: Owner--pumped 3-2013 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 1� o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 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: 2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 14"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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 6"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 6" t5ins-3/13 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 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 page. City/Town 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 26" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: 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 w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 page. City/Town 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.): Good condition with water at working level and no sign of leakage. 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. 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 16-biodiffusers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leach field in good condition with no of sign of back-up into d-box or surrounding stone. 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is Centerville MA 02632 5-17-13 required for every 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Sub surface Sewage Disposal System Form Not for Voluntary Assessments �M 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 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 S F3 - 3F � 6 r r � r t5ins-3/13 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 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 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: Original design plans show groundwater at 12'. 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 230 Knotty Pine Ln Property Address Amy Manfredi Owner Owner's Name information is required for every Centerville MA 02632 5-17-13 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TABLE TO ! ' AR S ATION a36 l<s►v 2 G SEWAGE # v� / I NSTAT.? WS NAME&PHONE NO. ;EPnC TANK CAPAcrry // .EACI3 N FACI�.I M (type) a d` tplC� s�i--5 (size,) f 6 10,GF'BEDROOMS_ a—," WELDER Old 'ERMITDATE;_ �r , COMPLIANCE DATE:_ separation Distance Between the: 4aximum,Adjusted Groundwater'T'able to the Bottom of I.eachinb Facility �ivate Water Supply Well and Leaching Facility (If iviyy ivclls exist on site or within 200 foet of leaching facility) ---..Feet idge of Wedand and Leaclgng Facility(if any wetlands st within 300 feet of aching facility) Feet "urnishcd by 3 A a -l- 13` 38 ' P6 ' . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owner's Name information is required for Centerville, Ma. 02632 4/25/2011 every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms the �I computer, r, use 1. Inspector: +{ only the tab key to move your Raymond Dumas cursor-do not Name of Inspector use the return key. Dumas Landscape Const. Inc. Company Name 564 Old Stage Rd. Company Address Centerville Ma. 02632 'Q01 City/Town State Zip Code 508-778-0249 S 1437 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. TWinspection 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 system4nspector pursuant to Section 15.340 of; Title 5(310 CMR 15.000).The system: w=� 'V_ ® Passes ❑ Conditionally Passes ❑ Fails '' ❑ Needs Further Evaluation by the Local Approving Authority S;��' aA,-. .ri0 4/25/2011 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. . I t5ins•09/08 Title 5 Official Inspection Form:Subsurface Se a Disposal System• 1 of 17 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owner's Name information is required for Centerville, Ma. 02632 4/25/2011 every 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owner's Name information is required for Centerville Ma. 02632 4/25/2011 every page. CityTrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ 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•09108 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 �M 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owner's Name information is required for Centerville, Ma. 02632 4/25/2011 every page. Citylrown 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. El The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owner's Name information is required for Centerville, Ma. 02632 4/25/2011 every page. CityrFown 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•09/08 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 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owner's Name information is required for Centerville, Ma. 02632 4/25/2011 every 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 M ❑ 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? E ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? • ❑ Were all system components, excluding the SAS, located on site? Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 230 Knotty Pine Ln. G„M Property Address Steve M. Everett Owner Owner's Name information is required for Centerville, Ma. 02632 4/25/2011 every page. Citylrown State Zip Code Date of Inspection D. System Information Description: 1000 gallon H10, D-Box and bio diffuser leach field as per plan dated 10/4/2008 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: 2010 57000 gallons 2009 45000.gallons Sump pump? ❑ Yes ® No Last date of occupancy: occupied now 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 E] No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owner's Name information is required for Centerville, Ma. 02632 4/25/2011 every page. Cityrown 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: 10/2010 as per Scott Frank 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: N 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): I t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owner's Name information is required for Centerville Ma. 02632 4/25/2011 every 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: Plan on file. Upgrade 10/2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: approx 36" 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.): all good Septic Tank(locate on site plan): Depth below grade: 6" inches feet Material of construction: ® concrete ❑ metal ❑ fiberglass 0 polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No Dimensions: 1000 gallon with filter on outlet tee Sludge depth: no sludge t5ins-09108 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 ,M 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owner's Name information is required for Centerville, Ma. 02632 4/25/2011 every page. CityrFown 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 no sludge Scum thickness none Distance from top of scum to top of outlet tee or baffle none Distance from bottom of scum to bottom of outlet tee or baffle none How were dimensions determined? visual and dip stick ruler Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): pumping not needed ae this time 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owner's Name information is required for Centerville Ma. 02632 4/25/2011 every page. City(rown 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.): tees good Zeibel filter in at outlet tee 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments GSM 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owner's Name information is required for Centerville Ma. 02632 4/25/2011 every 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 at level Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): no carryover, no leakage, box is level cover 24"inches below grade 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: as per plan on record t5ins•09108 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owne►'s Name information is required for Centerville Ma. 02632 4/25/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 16 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: h 10 bio diffusers Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): soil dry no ponding 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 El Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owner's Name information is required for Centerville, Ma. 02632 4/25/2011 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•09/08 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 °M 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owner's Name information is required for Centerville, Ma. 02632 4/25/2011 every page. Citylrown 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Knotty Pine Ln. Property Address Steve M. Everett Owner Owner's Name information is required for Centerville, Ma. 02632 4/25/2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar h II II Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: z Obtained from system design plans on record If checked, date of design plan reviewed: 10/4/2008Date ❑ 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: no water at 12 ft as per plan on record Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 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 230 Knotty Pine Ln. Property Address Steve W Everett Owner Owner's Name required fo is Centerville, Ma. 02632 4/25/2011 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems)completed E System Information— Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN ORBARNSTAB.LE LOCATION -2-3- SEWAGE# 710-F VILLAGE _ASSESSOR'S MAP&PARCEL j f f 7/ INSTALLERS NAME&PHONE NO. a,,,,,,r IL�A f__ '1 10 ,f SEPTIC TANK CAPACITY lrjoo £in I r LEACHING FACILITY.(type) ( /-f /V g1t1 •t�(size) NO.OF BEDROOMS OWNER 5�wa_ I A Ila 1 PERMIT DATE: ��' `Loea(� COMPLIANCE DATE: t O' Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 6 J40 7i dt ryT ZS-0 ^� '13 39,Y Aq 39.6 �(o Yf.z rJ-7.. $ A7 rvu Bl t3.0 a� tu. 2 134 �3•� ' 13S olio• (�j$ yU•e ' of 2 4/19/2011 06:40 I t f TOWN OF,BARNSTABLE LOCATION 3c) SEWAGE# L��' 3�� VILLAGE �'pn �✓� ((� ASSESSOR'S MAP&PARCEL /9/ 7./ INSTALLERS NAME&PHONE NO. } 2/Z 9 ejo 2,f SEPTIC TANK CAPACITY` LEACHING FACILITY.(type) /-f Iy 3/0 ONsize) j NO.OF BEDROOMS j OWNER 54 ea:x ► A PERMIT DATE: �G" L Lo© e, COMPLIANCE DATE: (U" Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility A'0 /f Feet Private Water Supply Well and Leaching Facility(If any wells exist j 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 l•if Z� �'Vr� ,(Q�l S�� L�. I i Fj2 ZS,v 9y 3g,� Iq s" 31. F-76 L A-7 q3,� �} 8 T-8 7 83 �2(°`' 64 I �7 31 .6 f \ 1 T a. • T No. (7Dr ' Fee /©d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpphration for �DtopoeW i§pmem (Cou.Otructton Vermtt Application for a Permit to Construct ( ) Repair(w Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components IL Location Address or Lot No. Z�j� A©' q P L a a P_ Owner's Name,Address,and Tel.No.401)e- ti P.�t�L'.C'lYt\ � Z�0 �•[ 4�dtE l�cn e Assessor's Map/Parcel e q` t MA Installe'r{'�s`Name,Address,and Tel.No. Crn.Q e-W �e C-kmc! Designer's Name,Address and Tel.No.��' �g t c�a e•—i +Inc., `1 '46 tip, P O 6b .-1. 4 C,cU.c _r j L h Type of Building: Dwelling No.of Bedrooms Lot Size 'L0o5j-(9 fi sq.ft. Garbage Grinder ( ) Other Type of Building e QZ, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided ��5 ,3 gpd Plan Date 10, �A, 2 Cd% Number of sheets 1 Revision Date Title O Y(•R�a Ny Lc fey C 2� _��c-J> �•e Size of Septic Tank Type of S.A.S. IU- 1301 1�,-N,�' � Z-%a'.�vSels Description of Soil S e,e_ lA o (\ `!L �, �h Nature of Repairs or Alterations(Answer when applicable) p kC� VN 10a0 5t.1 Cs%&dffiL10DeXS Date last inspected: zwe I 2a4 �vuL'w».�1•kt 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 ID Application Approved by Date `G �CJFj Application Disapproved by: Date for the following reasons Permit No. L(30�?—q � � Date Issued No. �OO �"t Fee /0 O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: (/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Mi.5ponl *pztem Con0tructtou Permit C. Application for a Permit to Construct O Repair(.*4.%Upgrade O Abandon O O Complete System ❑Individual Components I Location Address or Lot No. ZjO {CA p'4s,P\�G. L_a►n Owner's Name,Address,and Tel.No.<ACJ e Clle(e'�A e cac ec �i� o r rt�- 1 � t,.c. L_.n e Assessor's Map/Parcel `q + v41 k, e. MA Installer's Name,Address,and Tel.No. Ctq c Designer's Name,Address and Tel.No.� ,UO 46L% 11,9 Ni Dot (i Type of Building: Dwelling No.of Bedrooms Lot Size 1-00S1. '+ sq.ft. Garbage Grinder ( ) Other Type of Building aN No.of Persons Showers( a,.) Cafeteria( ) I� Other Fixtures !Design Flow(min.required) 3�� gpd Design flow provided gP 5 ,3 d Ek Plan Date I Qd Number of sheets , Revision Date I Title 3 U y Size of Septic Tank T e of S.A.S. �� P yP ��' 13 l ' PkrL 3b 8�ae1.�vSecS Description of Soil Sn e a Nature of Repairs or Alterations(Answer when applicable) \ . Joe Date last inspected: _ , U4 Agreement: I 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. ' f Signed Date %D ' Co ?_Q0% I4 Application Approved by Date l0 4. 2UOF�_ Application Disapproved>;y: Date F for the following reasons Permit No. 2,7 GG 8 �' � Date Issued f THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal Systee onstructed ( ) Repaired `N Upgraded ( ) x Abandoned( )byoc-kses at a has been constructed in accordance with the provisions of Title 5 and th for Disposal System Construction Permit No. ?_OOF) - 3� dated /0' • ZCxj� Installer -09elA ���CCA,ve�5 Designer #bedrooms Approved des' - flow gpd The issuance of this permit a. n e c nstru s`a guarantee that the system 1 un ationde igne Date insp6`-R � , 7V i ———————————— ————— No. 0d 151 Fee 0 THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS wi!5po5al *p$tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( *,) Upgrade ( ) Abandon ( ) System located at W _ Lm� C e.4 e C u Z�` I i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this p trait. Date /U �� Z 00 5 Approved by ,/ Ig 1 own of tsat,nstablfr ,k Regplatolry ServicesBAR sto. " T'liolttas F.Q41er, Director b o: , Public, Health Division Thoinits 1Mclkean Director '200 Main Street,IH[yanthis,MA02,501 Office:ice: 508.R62.4644 t Fare; 508-190.61A installer � De.4-i n er C;ert atlo nrm p I Date: tg A ---• tr i , { � 1 �3 Desle4er: jV)e e cC((� J v,r c Installer: Address: z• . � crr*n�Derrry �u� r AddCes�' - -- On —• .- .___._ _ was issued a permit to install a _(date} Fin'; t lerj . septic system at 230 tw�oit i� : € 1 --- : i based'on'a design drawn by ,% � 1 (adrlrt:ss) Wi a . ;'C Lrlc trlQeci s1 cJ ��; L1�lp4ae<< (1�1 ,wW..�-...._. datodY 8 es l certify � , __.. y thak the septic systerli referrrnoed 3b{pvevas installed substantially according to the do&ign, which may incl+adle minor Approved changes such as lateral relocation of the distribution box and/or septic tarok. i i I certify that then septic s ste;in referenced abov i h major chant l P Y. a wiis installed w t es i.e. greater than 10' lateral relocation of the SAS, or any vertical relocation of any component of the septic system) but in acicordak'e with State kLocal Re utationsL Plain revision ar certified as-built by design r to follow, (bistal s Signatuc• t 1 �.. Des]gnt is t e)_..... ! Asilpier s f amp Meeie ELEASE U T'O BARMST,WLE PUBLIC. %VI_0 ' 'RTI�' CrAT �? OF CO �I WILY I Y T� D : �.... 19 ILT C ,, CEIYED E4Y TE I All UT'V ON• fa U. 1 i 1i c,►: Health/Scpric/Designer Certification F'om I 1 0 'd L_920 2.LZ .809 9N I N33N I ON33f' Wd S I : 90 800Z-91:-130 LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS BUILDER 01t 11'-- Z31 // e�- /(X/ DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ;LL ` � I 13 3 �6 N r `� 4 1 TOWN OF,BARNSTABLE LOCATION 23 eo ✓%-k SEWAGE# VILLAGE Cei 4eodr(tt ASSESSOR'S MAP&PARCEL 19/ 7i INSTALLERS NAME&PHONE NO. l e o Y 2k 90 2 CE SEPTIC TANK CAPACITY /U 6�_( l Cl c Kt I'� LEACHING FACILITY:(type)0) 11 /V 13iC) (size) NO.OF BEDROOMS OWNER 5� w L PA 'Fat r 4 PERMIT DATE: J�' ' —0®g COMPLIANCE DATE: 10" "�`�6� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility.(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY A, 17.s n2 ZS.() f3 39>'( A`I 39.6 t4S 31.9 A Yf.z A-7 q3>(D Q( �3. 0 aZ �u. 2 53 �y 3 Y 4� 31 .6 Zg ��. No.��.�.1_.. � Finc...�..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............:....OF.............................................------------......_---------.............._.. Appliration for Uiipn,ial Workii Tomitrnrtiun Permit Application is hereby made for a Permit to Construct ( or Repair ( )-an Individual Sewage Disposal System at: �oTr� piN ' Dk. ............. . .............................................. •-----------..... Location-Address or Lot N ......................-.......................................................................... '� L21. .! .....,ft,� ' -• -�QA....S4.0,0./1C P er Ad ress a ?ref - �' �r, Pic�l(-,1 d�c,,,J............. ... C �/ 'o 0J.1 e..------------...-----......---........... Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............ ............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers (2) — Cafeteria ( ) Other fixtures ................................. . d .--•-------------------•--------------••----•---......_.......--------------•-------.----------- Design Flow......,, Q.. gallons per person per day. Total daily flow.......J�Q.........................gallons. WSeptic Tank—Liquid capacityl.0d..?..gallons Length... ........ Width---......... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.---__--/.......... Diameter........4X4... Depth below inlet................ Total leaching area..................sq. ft. Z Other Distribution box (Z,)" Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1/, ? .,..minutes per inch Depth of Test Pit......�;�._........ Depth to ground water......6............... rX4 Test Pit No. 2......«.......minutes per inch Depth of Test Pit.......!.!........ Depth to ground water........................ .-------•--•------------------------------------------------ ----------•-•---•---•---•--.....---...............•..............•.... .......•---....-- ODescription of Soil.........4k W .........Sl-.i 60-•--•-••-----•--------------------------------------•--•--------............................................ x 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 Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b the board of health. --•••• ...... ............. Application Approved By............... M• •. .. ..... ........ ®" _ Date Application Disapproved for e f oll ing reasons:................................................................................................................ -- ------------ ........... n(0-741-4- --'---•-•-•-........---------------------- •--- -------Date ------------ PermttNo. ............. .�...... Issued......................................................... - ------------------------------------- —--- -- 4 4/0 1i........................ Fm&............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................... .......... . ......O F..........................................................-......... ..........-........... Aplifiratiun for DigVuuttl Workii Tomitrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: . ................ c.t .. ;- ...... .........................•••-••---•------.......-•----••--......... --•-....�iJ i N ............... ` ......1v1 N ` � . .S�v . Owner Address W Installer Address d Type of Building Size Lot............................Sq. feet - U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.....................------. Showers ( ) — Cafeteria ( ) Otherfixtures ................•-•--------......-•----•----••---............--•-••---........................----•-•-•----•------••-------...........---••-•-•.-•---- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter------.......... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------_------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... f24 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ g ----•--•--•--••---------•---•••...................................•---------._.......---•---•-....--......................................................... 0 Description of Soil........................................................................................................................................................................ x U --•--••---•-••-•---•---•••...................•--------------•-----................•-----......---------•-------••-----------------•--•--•----...••-----••---•---------------•------•---•------•-------• 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 Sanitary Code—The undersigned further agrees not to place the system in operation until a_:Certificate of Compliance has been issued by the board of Health. .ig d :.............•-----------•------.........---........----..........-- r ..2........... ApplicationApproved By......... -----••--• -•----------------------------------•...................................... Date Application Disapproved f o the ' owing reasons--------------------------------•----.......-------------------•----------------.........--=-----...••-•......... r' ............. .------ ..------------------- ••--•------------- ....67-------•-•---- ....----•------------ ------------Da� •--•-- -------- PermitNo.................. = .. C1"� Issued.--�• - . ---• ....._•___...__. .................................... Date THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH f ..........................................O F..................................................................................... Tertifirab of Toutpliattrr � /__ o CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---- -------••------------•---------•--•------------------------------------------------------------------•--•--------••---•-------------•-------------•--.----.---------------------••-•-•------- Installer at--- ...................... has bee '' i cord'a ce e ovI 'o �io TLC 5 of The State Sanitary Code as described in the of i f n/ . application' for Dispo Works o tru io'rrtm t _,. dated ------------ THE ISSUANCE OF TH TIFICATE SHA OT ONSTRUED AS A G TEE THAT THE SYSTEM WILL FUNCTIO SATISFACT RY. ��� � l0 Z_ � �� DATE. 1. .. x.. Inspector....... ` ..........--•-•-----------------•-•-----••--••-•-•-•-------•-•--•--- THE COMMO WEALTH OF MASSACHUSETTS BOAR-D OF HEALTH .....................................OF..................................................................................... No......................... FEE........................ K 3 '�'�� Uiupuuttl Works Tonstrnr#iott "rrutit Permission is hereby granted ....... . ...................................•---------....-----...------.............---............--------.......................•. to Construct ( ) or Repair (� an ridividual Sewage Disposal System �.�✓ str/t) as shown on t Ion for, P 9r oi3 trt Ott it Per•--------••-•----.... Dated......................................... ..................................................... ,---•-- DATE.......... I---.`-...� .----.................. .................... FORM 1255 A. M. SULKIN, INC., BOSTON �,i-� �''"'•�� 51 /w <,�NGL� FAMILY -- :6 aE012-00H N NO 6ARgGrGt= �jWNDE2 :, ►ry II DAILY FLOW z IIU A 3 = Z)-3 p • i !� SEPT►C. TAQK = 330x15c> = -4956.P0 I U5c— 1Ooo GA►-. n' D%5Po5AL PIT U5E Ivoo GAL, 5►DGWALL A2Cla = 1 JO S.F 5. /73 /d �50 F x 2.5 = 3?SG.P� _ 50TTOM AREA= ,�1� 5F•- 9Z� 9 I 9 .B �5o SP- x 1• o 5 0 G.P. C I a7. 7 /4- -T oT A 1-. U E 51 GN = 42-5 G-P D. o-T-- /Q -Te>TAL- DA 1LY F�-ov! = 33o G•PD // 1e i II PE2co�AT1oN RATE. I'�IN 2MIN o�L•�55� /0,3•�oi�LAI?- N ew �k OF Mqs V 9c�1 `N GF o WILLIAM R C. /IV ALAN N 1 .;o N V E W. v ,p No. 19334 I� J ES �,� /!/Q. /O - 39ti►� �Na sUF-1 At tN p TOP FND c 107.0 Ioov lN�• IST�iP.� P15T• INV. SBPTIC. (OOP K /o3.g BUK /o3.G TAN lNv, GQ►-. jd3,p INV, INY. r iT WASUGD 6TvNE ' ' �ICE2TIFICD P -o TP1_AW /z. ' PRaFIL� -r ►o N C�i�T�,e V11- L - 'G No� SGAL.E SCALI_. �,. ��'.. VA.Ta F S IZ<rN C.ti= C F gz-T -T H AT I N E PPvFb`�� ,c^5uO 4YN N6.REoN COMPL` 15 YJITN'CHE �,I ��LIt-1 ,LOT A.VJtD 5S'T5AGK R6Qv1R.EMENY� oF -tN� 9 ioWN p'F= 5AZr45TA3L1_ANC IS Nv'T- • G. Z/i��/i� C LOCp.T r,> 'WITNI oOD PL. i DAT1�- ��ll BAxTE2e N`{E INC. RED l sz>ce�.v I..aA o s�Q.v EYoes T1115 PL&r.► 1 <j Norr 4nsc D o osTEVvILLE - NA'S5. I1J5TRuMENT 5U2ve y Er 'fNE oV-FSETS Suo►JLD ' NoT DEUSEDTd C�E7EFL1^11-I� L-.o"►" 1-INE.S APPLIGA►JT' T.O.F. EL.= 67.3� ± PROVIDE PRECAST CONCRETE 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE OVER INFILTRATION= 64.0' - 65,0' GENERAL NOTES EXTENSION RISER WITH CONCRETE INISH GRADE OVER D-BOX= 64.9± SLOPE @ 2/0 MIN. COVER TO WITHIN 6"OF F.G. OVER ACCESS PORT WITH INLET AND OUTLET COVERS. REMOVABLE COVER OVER RISER TO ACCESS BOX TO WITHIN 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE WITHIN 6"OF FINISHED GRADE 6"OF F.G. (ONE PER ROW) INSPECTION PORT w/ACCESS BOX METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 65.4'+ FINISHED GRADE OVER TANK EL. = 65.2'± 5"DIA. OUTLET(S) SEE NOTE#21 CODE AND ANY APPLICABLE LOCAL RULES. -_� - -- - } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE - I DESIGN ENGINEER. EXISTING 4" PROPOSED 4" 9"MIN. 9"MIN. ^ ' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PVC SEWER PIPE 36 MAX. 12 COUPLING 36 MAX. TOP OF SAS/B.O. = 12 COUPLING SEWER PIPE ---�- ; SYSTEM UNLESS OTHERWISE NOTED. " 3"DROP MAX PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6 3" 2" DROP MIN 3 9 JOINTS (TYP.) ELEVATION =62.49' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 117::1 MIN.SLOPE�1% 10" = 4" PVC IN FROM 1.08' 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" \'' *63.4'± SEPTIC TANK 4"PVC OUT TO 0 59, (TYP-) ;007.13-(TYP) 13 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. • LEACHING FACILITY + 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. " CONTRACTOR CONTRACTOR SHALL OUTLET TEE 62.42� MIN. 62.25' 62.00' 61 .41' (laid flat) 2.88' (34.5 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES 5.0' 22"ZABEL FILTER 6" CRUSHED STONE (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS MODEL#A1801-4x22 OVER MECHANICALLY 5'MIN. 11.50' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 23.6'(TYP FOR ALL 4 ROWS) AND DESIGN ENGINEER. 3 OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 65.00' ESTABLISHED - TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= 54.17 ON A NAIL SET IN FENCE POST AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET CTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 16 - BIODIFFERS (PROFILE) BIODIFFUSER END VIEW 9 THROCONTUGH DIG SAFE AT LEAST 72 HOURS PRIOR O COMMENCING WORK ON SITE AT CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL 16 - 1 3n HIGH ARC 36 (#3613 B D) BIODIFFUSERS TO THE DESIGN ENGINEER.TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING SWING TIE MEASUREMENTS - TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM r a r APPROPRIATE AUTHORITY. DESCRIPTION HCA HC-2 12.i a • " • � • � �, » � 3; PERC NO. 12374 ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LEACHING CORNER(1) 27.6' 40.3' • + ' • ~ INSPECTOR: Donna Miorandi LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE + • " + + THEY SHALL WITHSTAND H-20 LOADING. LEACHING CORNER(2) 39.1' 50.0' `• ,� • r r • +s EVALUATOR: Michael Pimentel, E.I.T. 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. • • ' • " ew DATE: October 3,2008 LEACHING CORNER(3) 45.7' 64.7' � � * � a r ` � a p TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE • • • • r MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. LEACHING CORNER(4) 36.4' 57.6' ..y • r r � ELEV TOP= 64.80' • • i • * ,,_ REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, MAP 191 ' •• r r ELEV WATER= <54.47' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). r •C) Na 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN X X PARCEL 26 • ,•a . • , , •• PERC RATE _ <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. � • + 1 • r • A r ' DEPTH OF PERC= 32"-50" X-- X s84°30'30'E • . FLCUS 16. PROPOSED PROJECT IS LOCATED WITHIN: • X ,�( _ TEXTURAL CLASS: 1 ASSESSORS MAP 191 PARCEL 71 / V a t • 0 -••, r r 7173. -- 04 X`v /CB/DH d �' •; R .`�,�. • OWNER OF RECORD: STEVE M. EVERETT 5 -- r a r f •� „ ADDRESS: 230 KNOTTY PINE LANE UP#9.5 -' �,* • -r r a ••� '`�•ti, • • 0 Fill 64.80, CENTERVILLE, MA h2 I * . ' 4" 64.47 h�O / 71��x-x-x-x-x_x_x_x_X_X_ 64_____ dALoamy Sand FEMA FLOOD ZONE C / XX - I +ra a a . r lf+l ^ 10Yr 3/1 64.30' / �� / I X "X X�- I� 3 • � • a h'tt • 6 COMMUNITY PANEL# 250001 0015 C / X _ * +„ :• ••r 4 Q B Loamy Sand x . . ,, 10Yr 5/6 17. DEED REFERENCE: L.C.C.#135156 I r a 18. PLAN REFERENCE: L.C. PLAN 24654-C X I X 0 • �4 0*•, . • erc Q P I I i 0 • : 'r � • 50'. 60.63' X � 1 0 • It •+ * • • . � r � 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. P I X 0 • ' 3U •r Gravelly Sand 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO RE USED ONLY P / / ^�-+� OSC,P X I� ` �a Q, ��` �'.�? o C-1 2.5Y 6/6 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY / / �Q� ��/ OI`Z` ( .• . 400, •• 0 0 (10-20%Gravel) I FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. X 0 • . •��• I } Q . • M� `� • 21. A 4" PERFORATED SCH.40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A • • •/ ,�� 80" 58.13' DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A x �{ I O • ^ REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. J Medium Sand / w = o LOCUS PLAN C-2 2.5Y 6/6 X / I I� X ) � J (loose) -" DECK X OIL � a Z w SCALE: 1"= 1p00' X / I � L_ b No Mottling, Standing or Weeping Observed BH to I�,,� MAP 191 j o I DESIGN DATA TEST PIT DATA LEGEND / 0 4 I PARCEL 71 X � O HC-2 _ 50xO EXISTING SPOT GRADE 19,998 S.F. ± ^ i NUMBER OF BEDROOMS (DESIGN) 3 I PERC NO. 12374 0' DESIGN FLOW 110 GAUDAY/BEDROOM INSPECTOR: Donna Miorandi - - 50 - EXISTING CONTOUR o N - #230 X to °' TOTAL DESIGN FLOW 330 GAUDAY EVALUATOR: Michael Pimentel, E.I.T. 50 PROPOSED CONTOUR EXISTING K I 3 DESIGN FLOW X 200 % = 660 GAIUDAY DATE: October 3,2008 3-BEDROOM T X t\ ❑/H/W EXISTING OVER HEAD UTILITIES EXISTING 1,000 GALLON SEPTIC TANK TO TEST PIT#: 1 Z DWELLING I / BE UTILIZED AS PART OF THIS DESIGN USE EXISTING 1,000 GALLON SEPTIC TANK TOF = 67.3'± / ELEV TOP= 64.50' W W- EXISTING WATER LINE ELEV WATER= <54.17' PROPOSED DISTRIBUTION BOX INSTALL 16 - 13" HIGH ARC 36 #3613BD BIODIFFUSERS I ) I PERC RATE HCA - TEST PIT LOCATION O� 0 �l`-- 64.80 2 ! EXISTING LEACHING PIT SYSTEM CAPACITY I DEPTH OF PERC= LP X 2��• X PROP. 16 - 13" HIGH ARC 36 (TOTAL L.F. OF BIODIFFUSERS&COUPLINGS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD TEXTURAL CLASS: 1 O a EXISTING 1,000 GALLON SEPTIC TANK I (#3613BD) BIODIFFUSERS j (94.4')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 335.3 GAL. LEACHING/DAY X 2.88, 2) I WITH 12 COUPLINGS PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE 3 I y% t 0"WITH X TP _ PROPOSED DISTRIBUTION BOX " I 64. X PROPOSED INSPECTION PORT TOTALS: A^ Loamy Sand 64.17' STONE X I ci 10Yr 3/1 PROPOSED 13" HIGH ARC 36 (#3613BD) BIODIFFUSER DRIVEWAY PXISTI DISTRIBUTION BOX TO BE ABANDONED ` TOTAL NUMBER OF BIODIFFUSERS: 16 6" 64.00' X TOTAL NUMBER OF COUPLINGS: 12 B Loamy Sand f 1 X � PROPOSED ACCESS PORT TOTAL LEACHING AREA: 453.1 SQ.FT. 32^ 10Yr 5/6 61.83' PROPOSED 13" HIGH ARC 36 (#3613BD)COUPLING LANDSCAPED EXISTi G LEACHING PIT TO BE REMOVED X - ri I (TYP OF 4) TOTAL LEACHING CAPACITY: 335.3 GAL./DAY AREA IN ACCORDANCE WITH TITLE V X �� \ REV. DATE BY APP'D. DESCRIPTION `�,� ' ° O O pox\ NOTE: C-1 Gravelly sand PROPOSED SEPTIC SYSTEM UPGRADE X O\62 3 I (4 % 2.5Y 6/6 PREPARED FOR: C) X 11.5' 3) i EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE (10-20/o Gravel) DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER CAPEWIDE ENTERPRISES S84°32'20"E \ X gq 'o "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO 80" 57.83' 3 c'- 0/H UP#182/9 ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST 148.10' \ LX--X-X-X-X_ /H/W MODIFIED FEBRUARY 14, 2008). TRANSMITTAL NUMBER=W000052. LOCATED AT Medium Sand 230 KNOTTY PINE LANE 62x7 C-2 2.5Y 6/6 CENTERVILLE, MA \ ❑/H/W R=25 �� Benchmark (loose) `4 J- ` Nail in Fence Post 124" 54.1 T SCALE: 1 INCH = 10 FT. DATE: OCTOBER 4, 2008 / Elev. =65.00' 0 5 10 20 40 FEET H Approx. M.S.L. No Mottling, Standing or Weeping Observed r�Fr'`"DFM _- /H/w KNO 62x0 /� - - -- _ aJ° ��°RAN y°m PREPARED BY: RESERVED FOR BOARD OF HEALTH USE ° JR. INC. RESERVED LANE C JC ENGINEERING, 62x5(40'WIDE LAYOUT) No 18 7 2854 CRANBERRY HIGHWAY NOTE: EAST WAREHAM7 MA 02538 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG SITE PLAN 508.273.0377 THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. - - ------ - JOB No.1500 SCALE: 1" = 10' Drawn By: MCP Designed By:MCP Checked By:JLC