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0360 LAKE ELIZABETH DRIVE - Health
� 360 LAKE ELIZABETH DRIVE, CENTI$R: A= 227. 029 71 ,fit pug `10 15 11:03p p.1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 360 Lake Elizabeth Drive Property Address John Magee F. Owner Owner's Name kM.I information is required for every Centeville MA 02632 8-6-15 F page. Cityrrown State Zip Code Date of Inspection F... •-0 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 rms A. General Information IIO�J 111ulnur on te comoputer, / \��� `SN OF�SS use only the tab 1. Inspector: 9 key to move your p `o== '•yG cursor-do not James D.Sears � JAMES use the return Name of Inspector key. CapewideEnterprises,LLCCompany Name ry_ i�'•.c� �o '� ` rr .•'� 153 Commercial Street Company Address Mashpee_ MA 02649 Cityrrown State Zip Code 503 477-8877 S1623 Telephone Number License Number B. Certification 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 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 5-10-15 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. III f 15ins-3113 T10e 5 01fidel Inspection Form:Subsurface Sewage Disposal System.Page 1 at 17 i i Aug 1,0 15 11:03p p.2 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 360 Lake Elizabeth Drive Property Address John Magee Owner Owners Name information is Centeville MA 02632 8-6-15 required for 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: The system is a 1500 Gal. Tank D Box and four infiltrators. B) System CondiRionally 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): 15ins•3M3 TING 5 Official Inspection Fomr.Subsurface Sewage Disposal System•Papa 2 of 17 { 1 t I I i _ i Aug 1.0 1511:03p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 360 Lake Elizabeth Drive Property Address John Magee Owner Owners Name information is required for every Centeville MA 02632 M-15 page. Cityrr wn 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/f 3 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System.Page 3 or 17 Aug 101511:04p p.4 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 360 Lake Elizabeth Drive Property Address John Magee Owner Owner's Name information is required for every Centeville MA 02632 8-6-15 page. Citylrown State Zip Code Date of Inspection B. Certification (cons) 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 ❑ 1E Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool i ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in is less than 6"below invert or available volume is less than r/Z day flow, J,M ellIAl6! t5ins•U13 TWO 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Aug 101511:04p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form Not for Voluntary Assessments 360 Lake Elizabeth Drive Property Address John Magee Owner Owners Name information is Centeville MA 02632 "-15 required for every - 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. An portion of a cesspool or privy is within a Zone 1 of a public well_ ❑ ® y P p P vY ❑ ® 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 rP m asses system if the well water analysis, erfored at a DER certified Y P Y 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 Il 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 Tide 6 Official lnspeftm Form:Subsurface Sewage Disposal System•Page 5 of 1 T t Aug 10 1511:04p p.6 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 360 Lake Elizabeth Drive Property Address John Magee Owner Owner's Name informationis Centeyille MA 02632 reqequiuirededfor 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 ❑ ® 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? El ® 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)] i 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 Otfidal 4mspection Forth:Subsurface Sewage olsposel System•Page 6 or 17 i i Aug 10 15 11:05p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 360 Lake Elizabeth Drive Property Address John Magee Owner Owner's Name information is required for every Centeville MA 02632 8-6-15 page. CityrTown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and four infiltrators. 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 Seasonal use? Z Yes ❑ No Water meter readings, if available last 2 ears usage d 2013-51,000Gals g ( Y 9 (9p ))' 2014-9,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: DNa ate Commer'ciallindustrial Flow Conditions: Type of Establishment Design flow(based on 310 CMR 15.203): gallons per day(gpd) Basis of design flow(seatslpersons/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: i t5ins-U13 Title 5 Official Inspection Forn:Subsurface Sewage Disposal System-Page 7 of 17 Aug 10 15 11:05p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 360 Lake Elizabeth Drive Property Address John Magee Owner Owner's Name information is Centeville MA 02632 8-6-15 required for every page. Cityrrown 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: NA 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 VA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): I5ins-3113 Title 5 Official inspection Farm:Subsurface Sawage Disposal System•Page 8 of 17 j Aug 10 15 11:05p p,9 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - 360 Lake Elizabeth Drive Property Address John Magee Owner Owners Name information is required for every Centeville MA 02632_ 8-6-15 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1997 Permit #97-504. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer locate on site plan): ( P ) Depth below grade: 4 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.): Pipeing is 4" PVC SCH - 40. Septic Tank (locate on site plan): Depth below grade: 3' 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: 1500 Gal.Precast H-10 Sludge depth: 2" 15ins•3113 Title 5 Offidal Inspecdon Fort Subsurface Sewage Disposal System.Psge 9 of 17 Aug 10 1511:06p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form s, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 360 Lake Elizabeth Drive Property Address John Magee Owner Owner's Name requir reqll,ionuired is Centeville MA 02632 M-15 required for every page. Citylrown 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 28" Scum thickness 1 1" Distance from top of scum to top of outlet tee or baffle 811 Distance from bottom of scum to bottom of outlet tee or baffle 1711 How were dimensions determined? Asbuilt-Tape Sludge Judge 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 at working level.Tank at T below grade,inlet cove at 4",outlet cover at 27". In and outlet tee's. No sign of leakage or over loading. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethy;ene ❑ 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 bins•W13 Title 5 Official Inspection Form.Sub"ace Sewage Disposal System-Page 10 of 17 Aug 10 15 11:06p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 360 Lake Elizabeth Drive Property Address John Magee Owner Owner's Name information is required for every Centeville MA 02632 8-6-15 page. Cityfrown 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 151ns-3113 Title 5 Official Inspection Form:Submdace Sewage Disposal System-Page 11 of 17 Aug 10 1511:06p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 360 Lake Elizabeth Drive Property Address John Magee Owner Owner's Name information is required for every Centeyille MA 02632 8-6-15 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 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_): D Box is 16'x16"-62"below grade w/cover at 40". Box is clean and solid w/one line out. No sign of overloading or solid carry over. 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•3M3 Title S Official Inspection Form:Subsurfece Sewage Disposal system-Page 12 of 17 i Aug,10 1511:07p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 360 Lake Elizabeth Drive Property Address John Magee Owner Owner's Name information is required For every Centeville MA 02632 8-6-15 page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number_ leaching chambers number: 4 ❑ 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.): Leaching is four infiltrators ck D box-camera out to leaching. Chambers look clean and dry. 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 6 official Inspection Form.Subsurface Sewage Disposal System•Page 13 of 17 Aug 101511:07p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 360 Lake Elizabeth Drive Property Address John Magee Owner Owner's Name information is required for every Centeville MA 02632 8-6-15 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.): t51ns•3113 Title 5 offidal kspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Aug 1.0 1511;07p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not fior Voluntary Assessments 360 Lake Elizabeth Drive Property Address John Magee Owner Owners Name information is required for every Centeville NIA 02632 "-15 page. City/Town State Zip Code Date of Inspection D. System Information (cons.) 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•3l13 Tille 5 Dffidal Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Aug 10 1511:08p p.16 Septic System Sketch L A K r E E L 1 Z #360 A B 14.25' E T ' H 17' 12.5' 50' 2.5' D R SAS 57.25' 1 E "D" Box Septic Tank r - Aug 101511:08p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 360 Lake Elizabeth Drive Property Address John Magee Owner Owner's Name information is required for every Centeyille MA 02632 6-6-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells No Estimated depth to high ground water: 11'-6" 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 propertylobservation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Past report Cl Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high groundwater elevation: Past report 11'-6" No G.W.. Bottom Chambers at 5'above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. j t5ins•SJ13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 16 of 17 i, Aug 10 1511:08p p.18 y` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 360 Lake Elizabeth Drive Property Address John Magee Owner Owners Name information is required for every Centeyille MA 02632 _8-6-15 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 15ins-W13 - Tille 5 official Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 17 1 TOWN OF BARNSTABLE 1Q LOCATION,������9� �1.� SEWAGE # Z. VILLAGE ASSESSOR'S rJ,l�e - ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY egge LEACHING FACILITY: (type) (size}��Gd NO. OF BEDROOMS J;� BUILDER OR OWNER ✓/ e PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: t 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 chi facili Feet Furnished b �r 9� SY � c Septic System Inspection Report ' 360 Lake Elizabeth Drive Centerville, Massachusetts May 17, 2001 Prepared For: Matt and Jennifer Driscoll 360 Lake Elizabeth Drive Centerville, Massachusetts 02632 Prepared by: Willam E. Robinson, Jr. Septic Inspections 43 Tomahawk Drive Centerville, Massachusetts 02632 COMMONWEALTH OF MASSACHUSETTS ' EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS A d DEPARTMENT OF ENVIRONMENTAL PROTECTION V� TITLE 5 ' OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 360 Lake Elizabeth Drive,Centerville Owner's Name: Matt and Jennifer Driscoll Owner's Address: Same as above Date of Inspection: May 8,2001 ' Name of Inspector:(please print) William E.Robinson,Jr. Company Name: William E.Robinson,Jr.Septic Inspections Mailing Address: 43 Tomahawk Drive Centerville,MA. 02632 Telephone Number: (508)775-7986 ' CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP ' approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: X Passes ' Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails r ' Inspector's Signature: Date: OS-08-01 The system inspector shall submit a copy of this injection report to the Approving Authority(Board of Health or ' DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the . DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving ' authority. Notes and Comments The septic system appeared to be in good functioning condition on the day of inspection. ' ****This report only describes conditions at the time of inspection and under the conditions of use at that P y Pre time.This inspection does not address how the system will perform in the future under the same or different conditions of use. r Page 2 of 11 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION (continued) ' Property Address: 360 Lake Elizabeth Drive,Centerville Owner: Matt and Jennifer Driscoll Date of Inspection: May 8,2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D ' A. System Passes: ' X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The septic system was found to be in good working condition on the day of inspection. ' B. System Conditionally Passes: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please ' explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the ' existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or ' obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced ' obstruction is removed distribution box is leveled or replaced ND explain: ' The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: I Page 3 of 11 ' OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION(continued) Property Address: 360 Lake Elizabeth Drive,Centerville Owner: Matt and Jennifer Driscoll Date of Inspection: May 8,2001 ' C. Further Evaluation is Required by the Board of Health: N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system ' is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: ' _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh ' 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform ' bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. ' 3. Other: w f Page 4 of 11 ' OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION(continued) ' Property Address: 360 Lake Elizabeth Drive,Centerville Owner: Matt and Jennifer Driscoll Date of Inspection: May S,2001 a ' D. System Failure Criteria applicable to all systems: N/A You must indicate"yes"or"no"to each of the following for all inspections: ' Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or ' — clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/Z day flow. ' _ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface ' water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. II ' _ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds ' indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] ' No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. ' E. LargeSystems: N/A To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or`no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) ' yes no 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART B CHECKLIST Property Address: 360 Lake Elizabeth Drive,Centerville Owner: Matt and Jennifer Driscoll Date of Inspection: May 8,2001 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: ' Yes No X Pumping information was provided by the owner,occupant,or Board of Health(none available) X Were any of the system components pumped out in the previous two weeks? ' X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ' X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? ' X _ Were all system components,excluding the SAS,located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition ' of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? ' The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes / No ' X _ Existing information.For example,a plan at the Board of Health. (as-built plan) _ X Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)j ' Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION Property Address: 360 Lake Elizabeth Drive,Centerville Owner: Matt and Jennifer Driscoll Date of Inspection: May 8,2001 ' FLOW CONDITIONS RESIDENTIAL 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 gpd (340 grpd provided) ' Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] ' Laundry system inspected(yes or no): N/A Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd): 1999—69K gals (189 epd).2000—88K gals.(241 gpd) t Sump pump(yes or no): No Last date of occupancy: Currently occupied. COMMERCIAL/INDUSTRIAL N/A Type of establishment: Design flow(based on 310 CUR 15.203): Rvd Basis of design flow(seats/persons/sgft,etc.): ' Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: ' Last date of occupancy/use: OTHER(describe): ' GENERAL INFORMATION Pumping Records Source of information: Barnstable Sewase Treatment Plant—No information available. ' Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system (4 Infiltrator units w/stone—10100'z2') _Single cesspool ' _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) ' _hmovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: ' Installed in 1998—BOH information Were sewage odors detected when arriving at the site(yes or no): No r ' Page 7 of 11 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION(continued) Property Address: 360 Lake Elizabeth Drive,Centerville Owner: Matt and Jennifer Driscoll ' Date of Inspection: May 8,2001 BUILDING SEWER(locate on site plan) X Depth below grade: Below basement floor level. Materials of construction:_cast iron X 40 PVC' _other(explain): line:Distance from private water supply well or suction e: N/A Comments(on condition of joints,venting,evidence of leakage,etc.): No evidence of leakage,all joints appear to be in good condition on the day of inspection. SEPTIC TANK: X (locate on site plan) ' Depth below grade: 1_5' Material of construction: X concrete_metal_fiberglass_polyethylene other(explain) ' If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10'x 5'x 4' Sludge depth: None found ' Distance from top of sludge to bottom of outlet tee or baffle: N/A Scum thickness: None found Distance from top of scum to top of outlet tee or baffle: N/A Distance from bottom of scum to bottom of outlet tee or baffle: N/A ' How were dimensions determined: Direct measurement Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): ' Inlet and outlet tees in good condition. No signs of leakage,liquid level at outlet invert. No recommended pumping at this time. GREASE TRAP: N/A (locate on site plan) ' Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): ' Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: ' Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS ' Page 8 of 11 PART C SYSTEM INFORMATION(continued) ' Property Address: 360 Lake Elizabeth Drive,Centerville Owner: Matt and Jennifer Driscoll Date of Inspection: May 89 2001 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): ' Dimensions: Capacity: gallons Design Flow: gallons/day ' Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): ' DISTRIBUTION BOX: X (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.): "D"box level,no evidence of solids carryover,no evidence of leakaee. ' PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): ' Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION(continued) ' Property Address: 360 Lake Elizabeth Drive,Centerville Owner: Matt and Jennifer Driscoll Date of Inspection: May 8,2001 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) ' If SAS not located explain why: ' Type leaching pits,number:_ leaching chambers,number: ' X leaching galleries,number:4 Infiltrator units surrounded by stone(10'long x 30'wide x 2'deep) leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: ' innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): ' The SAS was not excavated due to its type and depth below the surface. It was found to be in good working condition on the day of inspection based on evidence found in the other system components. CESSPOOLS: N/A (cesspool must be pumped as part of inspection)(locate on site plan) rNumber and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: ' Depth of scum layer: Dimensions of cesspool: Materials of construction: ' Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: N/A (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.): r Page 10 of 11 ' OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION(continued) ' Property Address: 360 Lake Elizabeth Drive,Centerville Owner: Matt and Jennifer Driscoll Date of Inspection: May 8,2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. ' Please see attached sketch 1 1 1 1 1 1 Page 11 of 11 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION(continued) ' Property Address: 360 Lake Elizabeth Drive,Centerville Owner: Matt and Jennifer Driscoll Date of Inspection: May 8,2001 SITE EXAM Slope: Moderate in SAS area Surface water: None in area Check cellar: No water ' Shallow wells: None in area Estimated depth to ground water 13.3 feet(below the ground surface at the SAS) Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: ' 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) ' X Accessed USGS database-explain: You must describe how you established the high ground water elevation: ' The depth to seasonal high groundwater was determined by finding the approximate elevation of the site(21 feet above Mean Sea Level(MSL-according to the Barnstable GIS map of the site) and subtracting it from ' adjusted high groundwater using the Cape Cod Commission/USGS method. The elevation of groundwater was approximated from a map entitled "Town of Barnstable Groundwater Contour and Road Index Map" and found to be at an approximate elevation of 5 feet above MSL(in 1992). ' The site is located in Zone B of USGS indicator well MIW-29,which had an adjustment of 2.7 feet upwards in June of 1992 (according to the Cape Cod Commission). This adjustment results in an approximate seasonal high elevation of 7.3 feet above MSL. Subtracting that elevation from the approximate surface elevation of 21 ' feet above MSL equals a 13.3 feet. The bottom of the SAS on site was found to be 5 feet below the surface. When this measurement is subtracted from 13.3 feet the separation between seasonal high groundwater and the bottom of the SAS is equal to approximately 8.3 feet. 1 tLocus MAP & SEPTIC SYSTEM srczrCx I , I ' I ' 1 1 1 1 1 1 1 }} Lewis ' t uller °!� k • �n' / • a. I u a ' • art - a n IN00 In '>p• orl Pt .•••• W �a • k c ry c Hayes 0o •/ P ' 0fall �� itt • '• ! • •r <' ' R Great Pt , °'�q •� a e S ��.... � ,i. Q•��,, Pt•• , ��a_ ° �. .'11 �.pQ �,; sty •1;ra beer, o �ti� �• • 1 � •��1 28 - • .b'•�..�,y� :4' .(/�� Note •a• 50 �-. WFs¢ tlF .1 � `Q .ss 6' •V _ yj/y�� p• � t a �:A � r � •�• � ' .� min: '� A /�� ''• � e E., ''r "! ,.,.� Q w. -'� "'A �i& � •.�•.• rr / 1 is• T �� �''. ell -,� $• 0� b'r •�. � .,� �„� y-9x.p �=.�. — •� �, " w ��'y10• + •i - \T �.,.r.,�j.. ,.�I` Q .�.� ,. �G9 ._` JM1 ,r. �.. ••s• •iU•I,.� Q • `._ 7Y :�0 1 r .p.. Kl •te,, o ti�' r':;:.: raiBvltle�Bea. :r !rl I� A�� n h •%•. ° rye° vv .. . s—CoVI:.. •-r, Yip n n ;��I l ° �' ' Lancing BesChj ✓r o Y r tf a• •1• G� Landing 20 ER yrLLE ,-4ARB ti /9 a d to HYa 20 AkSc' kat #� r 19 16 m / { Gannet / \ / ;1 g W Rocks ,Q 16°W ! ' Name:HYANNIS Location: 0410 38'39.2" N 070°19154.711 W Date:5/17/2001 Caption: Locus Map Scale: 1 inch equals 2000 feet 360 Lake Elizabeth Drive Centerville,MA ' Copyright(C)1997,Maptech,Inc. ' Septic System Sketch L A K ' E E ' L I ' Z #360 A B 14.25' ' E T ' H 17' 12.5' S0' 2.5' D ' R SAS 57.25' I / N\< ' V E "D" Box Septic Tank ' Cross Section ' Ground Surface 2.5' ' 3' Foundation El ' Septic Tank „D11 Bog SAS ' William E. Robinson, Jr. Site: 360 Lake Elizabeth Drive Septic System Inspections Centerville, Massachusetts Not to scale 43 Tomahawk Drive ' Centerville, MA. 02632 Date: May 17, 2001 (508) 775-7986 1 1 1 ' Se tic Inspecbr's Certificate 1 1 1 1 w r b'jy �/71 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT William E. Robinson, . Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR ° as provided in 310 CMR 15.340 and Section 13 of Chapter 21 A of the General Laws. Issued by The Department of Environmental Protection. April 20, 1995 Acting Director of the �- 1011 of Water Pollution Control 'R'G129 TOWN OF BARNSTABLE t `� LOCATION IZ+ a0 LAL G ZAIZAL 1SI SEWAGE# 91 J A VILLAGE Cff f.SkIl V d Icy ASSESSOR'S MAP & LOT 3Q` c 2- INSTALLER'S NAME&PHONE NO. of G A w,�� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ' I�.z�l a� �`t (size) /O W X ,10 L k A_0 NO.OF BEDROOMS .3 _ BUILDER OR OWNER M8 � NIJ� ca�1t. 2i��cI I PERMITDATE: I - o�tq—�1 _COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge-of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by J3 3 'G /L/ 3" .d� oa d • i- 44 , No. �� Fee � .., o tE THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .",\1 Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for i,5poga1 &pztem Construction Permit Application for a Permit to Construct(' Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. LOT --0 Owner's Name,Address and Tel.No. Assessor's Map/Parcel 1 5o -k\LL Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. STEPHEN J. DOYLE & ASSOC. 2-9 42 Canterbury Lane East Falmouth, MA 02536 Type of Building: Telephone: 5 0 8/5 4 0-2 5 3 4 Dwelling No.of Bedrooms Lot Size iltZ►`� sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3�® gallons per day. Calculated daily flow `3"3 gallons. Plan Date %t= Vs. IBAJ Number of sheets Revision Date Title 5i re. I?L^�A 0>r, "Mb i%,X GIAc.4V IlLt— ot-, —,%,>Zi Ce al Size of Septic Tank n C4--u — Type of S.A.S. ti���L �►L T 1�4 Description of Soil L_4 S. "I S:rac_,r. Z M i`F. 'S•tr-_ Aq Nature of Repairs or Alterations(Answer when applicable) Date last inspected: f Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the vironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue f He Signedl� Date /2" / 9 Application Approved by Date _ - l Application Disapproved for the following reasons Permit No. Date Issued bit aj -•'°"i�.. ` ' ,�'^�� �� .. - ' -2`1"� D No. .--�./. tt ��l 7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes r PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS application for i5pooar *potent Conotruction Permit Application for a Permit to Construct( Repair( )Upgrade( ).Abandon( ) ❑Complete System ❑Individual Components FAssessor's ss or Lot No. LOT Z0 Owner's Name Address and Tel No. LAwr— T---txZAT3,S?k { /Parcel `y1`/ /A nlet e,Address,and Tel.No. Designer's Name,Addps DOYLE & ASSOC. ,'-2 — 2-943 Crnu Lane i 1111 -"' Fasr Falmouth, tmouth, MA 02536 - Type of Building: Dwelling No.of Bedrooms_� Lot Size lt Z1 sq.ft. Garbage Grinder( ) Other Type of Building No.of Per,pns Showers( ) Cafeteria( ) Other Fixtures Design Flow 3"t gallons per day. Calculated daily flow 33 0 gallons._ i' Plan Date Sy-m� %I k5M Number of sheets 71L Revision Date Title 51se awl 01.► F LAtiN \\,� G.QAA jvN-r-- _240N�T�S2lL C'. Size of Septic Tank 1.5Dn CaAgj*4S Type of S.A.S. IN�1L"fluTalL'C-R�11C} Description of Soil r F.= 5ev,— " S o" 5k►o � :z m, Nature of Repairs or Alterations(Answer when applicable) ~ Date last inspected: A reement: 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 E vironmental Code and not to place the system in operation until a Certifi- 'cate of Compliance has been issu Heal Signed Date 9 7 Application Approved by Date Application Disapproved for the following reasons ! t + d Permit No. f " J Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance _ THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7- dated ,Installer Designer The issuance of this permit shall n94e construed as a guarantee that the system wi function as designed. Date f `1- `� Inspector Nw Fee THE COMMONWEALTHAF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Rio v- , potent Conotruction Permit. Permission is hereby granteeto Cgn,[o t ( )Upgrade( Abando ( ) System located at ZG fie 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 permit. Date:_�� Approved by TOWN.OF BARNSTABLE f=. C' SEWAGE LOCATION w�� .) ASSESSOR'S MAP &LOTSI! - i� VILLAGE INSTALLER'S NAME&PHONE NO. J C A►� -{ta SEPTIC TANK CAPACITY. �, �� I Q )G �O is �0 LEA HING FACII:TTY: (type). j Frt' (size) 3, -- NO.DjFBEDROOMS' -3 r_ .s. .. Tts Nnl rlsrfL. SC�� BgOER OR.OWNER . A: OMPLIANCE DATE: 1 a-m � PERMITDATE: /�- P —e1.1 C Separation Distance Between thc: Feet Maxiiiivat Adjusted Groundwater Table and.Bottotn of Leaching Facility P144 a Water Supply Well and Leaching Facility (If any wells exist Feet t on.site or within 200 feet of leaching facility) e ocility(If any wetlands exist Feet Edg..: f Wetland and Leaching Fa ,. thin 300 feet of leaching facility) Ftiriushed by 2/ 4_09W2I/ bl 1 9 pl T/ i , � '.. .•, •, 'St•fD aJist - 111Q , Pk- , 6 lleH�s'• "• ve rCral yFO `�r' sekw r. .r II n . ' USGS LOCUS SCALE: 1: 25.000 iIly t , i DEED REFERENCE: 9578/137 REFERENCE PLAN: 118/3 ZONING DISTRICT: RC 1 OVERLAY DISTRICT: AP / BENCH MARK: i CATCH BASIN BUILDING SETBACKS: Cd U/Polk i RIM Q EL 16.9' FRONT 20 '� �� DATUM: NGVD'. existing SIDE 10' REAR 10' i 7 , 20. dwelling .ASSESSORS MAP 227 PARCEL 29 �� � � 4, 2 M FEMA DATA: LOCUS DOES NOT LIE IN A FLOOD HAZARD ZONE. �� (� Q�� /„gyp , o : ..,•_,•• Zy00 APPLICANTS: '� i „ y. } Sq S 1•• / ,moo y�? - N RISCOLL MATT AND JEN IFER C D , T �� - •1 SON 30 _pr9,pO3@ 1.1 y T1 i i i pROp R,OPO�SEb �o 3 BE ROOM / fe t8 " 30 SCSI, 13� NO. ►�` U/pole O - D/B' 1 0 N song, ,moo c oN l -pR� a� / Y I ) ) 34 Za• ^a LOT 20 existing l o dwelling so ) 11,212 sq.fi~' .o 99, h 3Z, 34. SHEET 1 OF 2 St1 OF Atgss? S ITE P LAN O IFL.ANT� •� �EGISTERfp 01 •�' STEPHEN GN IN J. DOYLE . No.37559 - GRAPHIC SCALE PRofESS�o�' CRAIGVILLE -- BARNSTABLE, MASS: .11 q UR 20. c 100 20 40 eo Np N DEPICTING THE PROPOSED ID IS G O I-,I—, R � � ID � NC 1 inch = 20 ft , - - H SCALE. i 20 DATE. SEPTEMBER 8, 1997 AND 'ASSOCIATES STEPHEN J. DOYLE A y� LANE. _ 2536 -I RB Y FALMOUTH ,42 CANTEUR LA NE �AST , MA 0 TELEPHONE. 508 540 2534 GENERAL CONSTRUCTION NOTES 1. ALL WORKMANSHIP AND MATERIALS"SHALL CONFORM TO D.E.P. TITLE 5 AND .THE TOWN OF RULES AND 'REGULATIONS FOR PROFILE- OF SEWAGE (DISPOSAL SYSTEM THE SUBSURFACE DISPOSAL OF SEWAGE 2. AT LEAST .ONE ACC ESS PORT OVER TANK TEES SHALL BE ACCESSIBLE NOT t0 SCALE W41THIN SIX INCHES OF FINISH GRADE WITH ANY REMAINING ACCESS -PORTS BROUGHT TO WITHIN TWELVE INCHES OF FINISH GRADE. 3. ALL COMPONENTS OF THE SANITARY SYSTEM . H S ALL '6E CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' TOP FOUND, EL. 33.p OF DRIVES OR PARKING. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING UNLESS NOTED. 4. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF ALL Y w SITE UTILITIES PRIOR TO ANY:EXCAVATION. : + 5. SEWER PIPES SHALL BE 4" SCHEDULE 40 PVC LAID AT 0.02 SLOPE. 's ','•�S` 6. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE t MORTARED IN PLACE. FLOW LINE WATER TIGHT COVER 7. FINISH GRADE SHALL HAVE A MINIMUM SLOPE OF 0.02 FEET PER FOOT. INV. EL. t9.3 r .� - 3 •h^A.�c cVEtZ "off c.d�•t�o�.ic=+�'rtS.: 4• UQUID DEPTH 1 Ale _ •Z-o a _ - SUNP INV. ELEL t7. 1 ti 7.3 + 'F RFoR.AT>;'2> pVC. 2nutil ova'' 2" MIN. - 1/8- TO 1/2- WASHED STONE 1500 GALLON PRECAST REINFORCED CONCRETE SEPTIC TANK PRECAST REINFORCED CONCRETE L,, H-Zo MINIMUM CONSTRUCTION MATERIALS PER 310CMR 15.2*2) w INFILTRATOR DISTRIBUTION BOX - 2. TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND L EFF. DEPTH SHALL EXTEND A MINIMUM OF 6" ABOVE THE FLOW LINE v 3/4 - 1 1/2 WASHED STONE 10� �' OF THE .SEPTIC TANK AND B IINSTALLE ON THE CENTERLINE OF.THE ON A LEVEL BASE 's=t. \s.O 1 , SEPTIC TANK LOCATED DIRECTLY UNDER THE CLEAN-OUT MINIMUM WALL THICKNESS 2' MANHOLE MINIMUM INSIDE DIMENSI 1 30 ' ON 2 S.A.S. LONG x Id WIDE x ?EIFF. DEPTH THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2" NOR INV. EL ��t.p= VATH(54,)HIGH CAPACITY INFILTRATOR CHAMBERS ' MORE THAN 3":ABOVE THE INVERT ELEVATION OF THE INVERTS SHALL BE EQUAL TO EACH OUTLET PIPE. OUTLET OTHER AND AT 2" MINIMUM BELOW INLET INVERT. SEPTIC TANK SHALL BE INSTALLED LEVEL AND TRUE TO GRADE THE DISTRIBUTION LINES FROM THE DISTRIBUTION BOX ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY - SHALL ALL:HAVE EQUAL INVERTS AS DETERMINED BY FLOODING , THE DISTRIBUTION BOX TO THE HEIGHT OF THE DISTRIBUTION 5 1 .1=�V+aus4t_ COMPACTED AND ON TO WHICH SIX INCHES OF.CRUSHED STONE LINE INVERT AFTER ALL LINES HAVE BEEN SEALED IN PLACE. :. HAS BEEN PLACED TO ENSURE STABILITY AND TO PREVENT INVERT ADJUSTMENTS SHALL BE,MADE BY FILLING WITH DURABLE SETTLING. AND NON--DEFORMABLE MATERIAL PERMANENTLY FASTEND TO THE SEPTIC TANK SHALL.HAVE A MINIMUM COVER OF 9". UNE OR RECONSTRUCTING THE LINES UNTIL ALL INVERTS ARE OF EQUAL ELEVATION. THREE 20"-MANHOLES WITH READILY REMOVABLE IMPERMEABLE COVERS OF DURABLE MATERIAL SHALL BE PROVIDED NTH ACCESS PORTS BEING PLACED AT THE CENTER AND OVER THE INLET AND OUTLET TEES. THE'OUTLET'TEE SHALL'BE EQUIPPED NTH GAS BAFFLE. NOTE , REMOVE LIMITS OF IMPERVIOUS t So1L FROM ELEVATION. o.o l DOWN TO ELEVATION THROUGHOUT S.A.S. AND S'' LATERALLY ALL AROUND S.A.S..'REPLACE IMPERVOIUS SOILS WITH CLEAN COURSE MATERIAL FREE FROM ORGANIC MATTER AND DELETERIOUS SUBSTANCES. REFERENCE MAP: SOIL OBSERVATION DATA: CAPE COD DESIGN DATA: - $9 ct to WATER TABLE CONTOURS AND PUBLIC WATER SUPPLY STRUCTURE 1`3 , -✓ O TEST DATE e-Z8-°1+� . WELLHEAD PROTECTION AREAS TYPE NO. BEDROOMS GARBAGE DISPOSAL SOILV S,i`.J o �_ SEPTEMM I N8 v EVALUATOR y� DESIGN FLOW 3 �C. 1 0 - '33J / WATER RESOURCES OMCE � �P►�. 1�-s'.� sa s it B.O.H. AGENT _: ��e.-�7uw,�.c t CAPE 000 carr►pSSM ,A�t OFA,�s O� RE fp fi + STEPHEN + EXCAVATOR �4Na��, ��Irt_`�`tom .c to - �; J. . -+ PERC/RATE L S�Si l �N ti DOYLE N SEPTIC TANK 330 V_ Z; -bbV v �.�- \SC70, sa�1.t)1L i C/cS"" - --f-- I No. 37559 P�fESS►� � , ! O SHEET 2-OF 2 n LEACHING FACILITY - \p o �r_�•Zo FU 1 1( + t t 3U�t 3CDr k( -) -t fox 30>1 0,'7*� 3�i z t Yn 7./I � 1 `{TL /I tE s :Irkas-Y I o y tz G a s � it A to 3G *ZAa �- TzC NMLZ �„ '4tZ z.�y . '-I 3 �.� SCALE:. AS :SHOWN DATE: 5 S. TEPH EN J. QOYLE AND ASSOCIATES i 42 AN C TERBURY LANE. FALMDUTH MA. 02536 a © ,Zp I 1 TELEPHONE.,a xU 1'`i � �, TELEP 0 E. 501�J540-2534 .: ;