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HomeMy WebLinkAbout0402 LAKE ELIZABETH DRIVE - Health -- -- - 402 Lake Elizabeth Dr \ Centerville „n2n Commonwealth of Massachusetts R'c 7-- O.Q P �n Title 5 Official Inspection Form ti1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 402 Lake Elizabeth Drive Property Address Sally Overlock Owner Owner's Name / information is required for every Centerville V MA 02632 09/22/2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:WhenWhen fillingng out f A. Inspector Information 51* /W{ g Cv on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector dursor-do not Cape Septic I nspections use the return Company Name key. 52 Rivers End Road �p Company Address Teaticket Ma. 02536 City/Town State Zip Code � 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 09/23/2020 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u � 402 Lake Elizabeth Drive Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: This 3 bedroom home has an H-10 1500 gallon septic tank with a D-Box feeding 2 leaching chambers with stone. At the time of the inspection no visible failure criteria was found. There is a sink in the garage that is capped off. Putting this sink back into service would be a violation to Title 5 due to it drains onto the driveway. 2) 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): 1 I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �10 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 402 Lake Elizabeth Drive Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 i c Commonwealth of Massachusetts ie Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 402 Lake Elizabeth Drive Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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 r be attached to this form. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u � 402 Lake Elizabeth Drive Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ElStatic 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 'h day flow ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �n ,t� Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 402 Lake Elizabeth Drive Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form iI Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments u 402 Lake Elizabeth Drive Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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): 33 plus GP Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: 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)): Town water Detail In 2019-30,000 gallons were used and in 2018-31,000 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 402 Lake Elizabeth Drive u Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 f cum Commonwealth of Massachusetts �n = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 402 Lake Elizabeth Drive V Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool I ❑ 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): Approximate age of all components, date installed (if known)and source of information: 4/19/2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): " Depth below grade: 21feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and it came freely. I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 i Commonwealth of Massachusetts �n Title 5 Official Inspection Form III I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ............. !% 402 Lake Elizabeth Drive V� Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"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: H-10 1500 gallon 2" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? 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.): recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c , Commonwealth of Massachusetts Title 5 Official Inspection Form <�I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments h, 402 Lake Elizabeth Drive Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, r liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 cam, Commonwealth of Massachusetts iv Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 402 Lake Elizabeth Drive Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. 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.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. a t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 c Commonwealth of Massachusetts �� Title 5 Official Inspection Form k �� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 402 Lake Elizabeth Drive Property Address Sally Overlock Owner Owner's Name information is r equired for every Centerville MA 02632 09/22/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2 r ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form f, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cam !% 402 Lake Elizabeth Drive Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): 0s 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection� Form lI p Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 402 Lake Elizabeth Drive Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): Lt5msp.coc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 _ Commonwealth`ofMassachusetts Title='5' Official'lnspection Form Subsurface'Sewage Disposal System form -Not for Voluntary Assessments 402 Lake`Elizabeth Drive Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. Cityrrown State Zip Code Date of Inspection W System Information (cont.) 14: 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 (R)r It S i I t3 13 t5irisp.doc•rev.7,26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 I ' Commonwealth of Massachusetts �v Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 402 Lake Elizabeth Drive Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: plus feet feeee t Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with a transit. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form tii; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 402 Lake Elizabeth Drive Property Address Sally Overlock Owner Owner's Name information is required for every Centerville MA 02632 09/22/2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 ► SOIL TEST LOG DATE OF TEST: _ MARCH 3. 2007 SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. WITNESSED BY:_ DONALD DESMARAIS. HEALTH DEPT. TEST PIT I _ — p0A ENOTUNDWATE MAATERIA RNCOUNTE ED L- OUTWASH• - - PERC AT 108 in - 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER I . (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 20.10 0-40 FILL i 40-64 Ap LOAMY SAND 10 YR 2/2 NONE FRIABLE i 14.77 64-110 Cl MEDIUM TO 10 YR 6/4 NONE LOOSE COARSE SAND 110-144 C2 MEDIUM SAND 10 YR 6/3 NONE LOOSE 8.10 TEST PIT POARENOTUMDATERER ENCOUNTERED OUTWASH 1 2 MIN/INCH IN C SOILS I ELEVATION ((INSOIL COLOR SOIL CHES) HORI ETH SOIL ON TEXTURE USDA L MUNSELL) MOTTLING OTHER 20.00_ 0-36 FILL r 36-62 Ap LOAMY SAND 10 YR 2/2 NONE FRIABLE 14.83 - - 62-112 Cl MEDIUM TO 10 YR 6/4 NONE LOOSE f COARSE SAND 112-144 C2 MEDIUM SAND 10 YR 6/3 NONE LOOSE ��6-00 ) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Consi ten .t Flood Insurance Rate Man: ,/ Above 500 year flood boundary No_ Yes `�.__-_ Within 500 year boundary No v' Yes ' Within t00 year flood boundary No �! Yes Depth of Naturally Occurring Pervious Material Does at least four feet of natur rring pervious material exist in all areas observed throughout the area proposed for the soil s ? �e� If not,what is the depth r� �c a� ervious material? Certification o D. - I certify that on'QoV - UGMIfR v assed the soil evaluator examination approved by the Department of Environ i4t , tectt at the above analysis was performed by me consistent with . the required training,exp 0 AL a described in 310 CMR 15.017. h Signature Date�h I Wn QASEPTICIPERCFORM.DOC Town of Barnstable Department of Regulatory Services Public Health Division � `2/ O 7 200 Main Street,Hyannis MA 02601 Date Date Scheduled Time Fee Pd. z00 Soil Suitability Assessment for Sewage Disposal , Performed By: D�$V i� 1`� - L 0 UG(-{ D I nI t? Witnessed By: DON RLP Qeq L pR#/ LOCATION& GENERAL INFORMATION Location Address I- 402 64ke ��i7xt�E�� Dr- . Owner's Name bowl - �+�, j� i �Dz Lemke Address Assessor's Map/Parcel: 7� 7�i C��1YV i I i✓e / Engineer's Namel��v1� /�v��ctviow NEW CONSTRUCTION REPAIR ✓ t� �7 Telephone#Land Use Use Q es i Q� nfl`pt Slopes(%) ( -/p i 1. Surface Stones h D t'1 e Distances from: Open Water Body V fit Possible Wet Area `DO r --__ft Drinking Water Well Drainage Way 7 O t ft Property Line 10 -+ ---__ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlandsn proximit to holes) ) I, -- -- 134.04 Ff -- -- 1 - @I I GROUNDWATER ADJUSTMENT ~ I ADJUSTED GROUNDWATER LEVEL �\ BASED ON SOIL EVALUATION DONE e \ AT ADJACENT PROPERTY ON 5/9/05 ! , ��—J I ®•: _ OBSERVED GW 6.25 IIJIZONE C INDEX WELL M1W-29 111 e ® I READING DATE APRIL. 2005 READING 6.4 ADJUSTMENT 0.9 ADJUSTED GW 9.15 .. - 12671 Ff --- C) 1 Parent material(geologic) GI Cl O(Tf"5i Depth to Bedrock h e Depth to Groundwater. Standing Water in Hole: k 0 K e Weeping from Pit Face Estimated Seasonal High Groundwater See °160 P e DETErNATION FOR SEASONAL HIGH WATER TABLE Method Used: $P.� OV Depth Observed standing in obs.hole: Depth to weeping from side of obs.hole: In. Depth to soil mottles: In Index Well# Reading Date: Index Well level In. Groundwater Adjustmentt �.. .r AdJ,thctor ry Adj.groundwater Level PERCOLATION TEST bate 3f 3}6 �e o- ,p km Observation _ Hole# (� Time at 4" Depth of Pero U t k c Time at 6" Start Pre-soak Time @ © �$ y( ----- Time(9"-6") End Pre-soak 10'0 3% - Rate MinJlnch Site Suitability Assessment: Site Passed SitcFailed:_T Additional Testing Needed(Y/N).v _ Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify"the Barnstable Conservation Division at least one(1) week prior to beginning. Q:1S EPTICIPER CFORM.DOC TOWN OF BARNSTABLE �K LOCATION 4 6 e M1 SEWAGE# �.' 09 / V-'LLAGE A;SSSSESSOR'S MAP&PARCEL � -� INSTALLERS NAME&PHONE NO. !1 6 b! A' so I' J SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER U v Z/%, PERMIT DATE: i3.r S 'c) COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY r / Ito 1 S- TOWN OF BARNSTABLE LO ATION 410--- la eli Za e �� SEWAGE # VILLAGE Crg t-CP Ui 11-' ASSESSOR'S MAP & LOT �2 b y y INS fALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACELrN: (size) NO.OF BEDROOMS el OR OWNER �at/�� yWR�t�C/� PERMUDATE: 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 f_aaIci Feet. Furnished by 0&J Ir A n c P `E 0 2 k a tie. D yo- �� No. ko q__ f` $11.(00.00 \ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes i` \ application for 33ig;po5af *p5tem Cougtruction permit �p Application for a Permit to Construct( ) Repair()5Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 7 71 -01 21 402 Lake Elizabeth Dr, Centerville Donald Overlock Assessor'sMap/Parcel 227 24 402 Lake Eliz ..Dr, Centervill Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—O 8 9 4 Wm E Robinson Sr Septic Eco—Tech PO Box 1089 Centerville 43 Trian le Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder (jo) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 septic system to plans of Eco—Tech, ##ETE-2554 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He alth. l� Si ed / O Date J Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. ' Date Issued No. f'' $ 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �Y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Migo!6al *p.5tem Con5tructiott 30ermit Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) ❑Complete System 0 Individual Components Location Addressor Lot No. Owner's Name,Address,and Tel.No. 7 71 —01 21 402 Lake Elizabeth Dr, Centervil a Donald .Overlock Assessor'sMap/Parcel 227 24 402 Lake Eliz,Dry Centervill Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel:No. 3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco-Tech PO BOX '1089, Centerville 43 Trian dik Cir, Sandwich Type.of Building: Dwelling , No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder :(lo) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures De sign;Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets '` Revision Date �`. Title' Size of Septic Tank Type of S.A.S. i Description of Soil 1 Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 ,-septic system to plans of Eco-Tech, #ETE-2554 : Date last inspected: Agreement:` The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar o�alth. —7 Signed �� Date .I 5:7 C) Application Approved by /, _� ' Date �5 0 Application Disapproved by: /V Date .'for the following reasons Permit No. v 4 Date Issued ——————————— —— , THE COMMONWEALTH OF MASSACHUSETTS Overlock BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the'On-site Sewage Disposal System Constructed ( ) Repaired (X ) Upgraded ( ) Abandoned( . )by Wm E Robinson Sr Septic at 402 Lake Elizabeth Dr, Centerville h sbeenconstructed cordance in with the provisions of Title,5 and the for Disposal System Construction Permit No '�D dated ­77- 5 YJ Installer � ��3 f1: �`✓t Designer ey,, #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will u to"as designed. Date , ' 0 Inspector_ ( 1 T, ,/`�"'�� ---------- ------------------------- $ e20.00 ---- - adl No. Y �/ Overl�l,� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Xigpo!9a1 *p5tem Construction permit Permission is hereby granted to Construct ( ) Repair (X ) Upgrade ( ) Abandon ( ) System located at 402 Lake ElizahP#-,h Dr. ront-Qru; 1la r 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 Friust b�completed within three years of the date of i ape, Date Approved by ) Y t i Town of Barnstable IKEFes. , teguiaory Services MASS. Thomas F. Geiler,Director Pnbiic Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601- Office: 508-8624644. Fax: 508-790.6304 Installer &Desi er Certification lEorrn Date: Sewage Permit# 2 2 7/2 4 Assess©r's 1VIaplParcei � I Designer: Eco.-Tech Installer• Wm E Robinson Sr Septic Address: 43. Triangle Circle Address: PO Box. 1089 Sandwich Centerville On. Wm E Robinson Sr. Septic (date) was issued a permit to:install a , (installer} septicsystemat4.02 Lake Elizabeth- Dr, _ Centervi le (address) �iased on a design drawn by Eco-Tech dated 03-07=07 : (designer) 7 certify that the septic s stem referenced above design, which may y the desi was installed substantially according to include minor distribution-box and/or septic tank approved changes such as-lateral.relocation of the ;.. I certify that the septic system, referenced above was installed with major Chan e ' greater than l o' lateral relocation of the SAS or any vertical relocation of any com onent of the septic system)`but in accordance with State&Local Re p certified as-built by designer to foilow. Local-Regulations. Plan revision or DAVID (Installer's Signature) D. " COUCHANOWR N . No. 1093 . O �FGISTER� SgNlTARkPN (Designer's Signature) (gffix Designer's Stamp Here) PLEASE RETURN. TO BARNSTABLE PUBLIC HIEALTH. DIVISION. .. CERTIFICATE COIVIPLL�NCE wIL L.NOT. BE ISSUED UNTII, BOTH THIS FORM AND AS-BUILT CARD AARE RECEIVED BY THE BARNS I AISLE PUBLIC HEALTH DIVISION. THANK yOD. Q:Health/Septic/Designer Certification Form 3-26-04.doc I ire � 4 ��q n - �•- -.. x.a � � � �Y�• �i eya, YY� a m' ga. Al r s z , I r iJ b14 - y Ws d �n 5 L x a� ,r {7 x ~t ° r x. a t } " a r $ r ° .z§ui.� .h•tl "je I „ d s ° z� 1 r' �-:w•� k''>^ s' � ,:, � tea„ • :� ., "Y ------------ s f IV! Sla x y h _ �. rt � U� Sri � % s .F ,.. � to _ fi i' ' i*��Wa�'•' l� � a f WA �1 ` 1 44 � :.FAM ' Yi ..da Y aA"per 'i x h n � 7¢ In An ot R ` P •' `tr� � . e w, � q c R Y •` x Y ' F mrJP .s4fK• _ v � . / .x J s R r .r"i sp lilt 4 CUPS p� .; Y •� "f'' Y• iysz 4a S t?kBl:. yu ,t E y v { "n 'ar .. :. ° -lob- box, m ' r 're,s ,� ,�. 6q• ".si" ":"+w.£L":* rP a" mot:.•Sol +� �� ,�* Ott , 16 1 s 4 ' r NVTES L­ -JUZI\ CONVERSIOND1 ST NOESzCONTOURS CHART DEC HES TO CESSPOOL LOCATIONS DEPICTED ON PLAN AREU� EXISTING - - - - - - 5m 1n �t TO, LEACHING GALLERY APPROXIMATE. INSTALLER TO LOCATE CESSPOOLS Nww< a FINAL cj� ALL_ DISTANCES ARE IN DECIMAL AT _TIME OF INSTALLATION. PUMP. COLLAPSE ANDm = w 0 0 FEE_T NOT IN FEET AND INCHES. FILL EXISTING CESSPOOLS. ANY PORTION OF THE0 m u? O oo 1 .08 1 CESSPOOL SYSTEM OR ASSOCIATED CONTAMINATED� F-y- �m� 2 .17 + A B SOILS THAT EXTENDS INTO THE LOCATION OF THE w'" 3 .25 1 37.1 65.3 PROPOSED LEACHING GALLERY OR SOIL REMOVALw7O" oJ 5 .3 2 60.8 81.1 B CLEAN MEDIT O BE9nRDEMOVED AND REPLACED WITHwOw~ - mooco m Qi 6 .50 3 3 60.4 73.3ap F .58 4 36.5 55.3 ALL UNSUITABLE SOILS ENCOUNTERED WITHIN THE C Ln 8 .67 o SOIL REMOVAL AREA ARE TO BE REMOVED DOWN TO E A VENUE o 9 F` 2 o THE Cl MEDIUM TO COARSE SAND STRATUM. AND q CENTERVILLE. MA ( 1� 83 REPLACED WITH CLEAN MEDIUM SAND PER TITLE 5. _w 92 12 1.0 LOCUS MAP W<:K NOT TO SCALE cozo 20 A cnoz \ v J ow° CD � <cncD cy ww U > /~ s <fti ' GARBAGE GRINDER Jz w= -io U~i z w �N w� \�� 1 IS NOT ALLOWED 3�0 —�v �u u 3.. = W > o BENCH MARK TF� \ 4 �. WITH THIS DESIGN. zw < _j p Q N PK NAIL IN ROAD fr WZ I w c_< �❑ W W ELEVATION = 21.47 Z uN aj w < " o BARNSTABLE GIS DATUM VVV��C/ \ /Vp� \ 19 20 I W p J< m w OBI EO \ I v CD 0wLo � o 19 LEGEND w ZZI < �C, / <j T 15 ►- N X m ,, V Q� / i �\ L D 1500 GAL L ON O - W W w �zo p N '� `� /�[, / �/ Ii j m AREA = 9920 sF +- SEPTIC TANK �lL O z w m C0 Lo N v r -2 - w o w z m / Q 1 D BOX -� W �O o u �- Li O �� / TEST PIT u WwQ / �^ LJ ? dwu / / p v f-lLl (n=O 6-D >O x ?Z� �zocwn TP- o�tim \� 0 EXISTING W Z cn w-- CESSPOOL • W m = zU If "� UTILITY POLE ~ J20 \ / (n 3 Q_z �/ ��9 rr� 6-D �w *16-p�xo Z�w � � / ,v TREE X -NUMBER REFERS TO DIAMETER IN INCHES.rLETTEO--OAK RM--MAPLES TYFE P-PINE o 24 Ft x 125 Ft x 2 Ft 19 � u m LEACHING GALLERY m \ i \� SOIL REMOVAL AREA 20 �--� ZO '�� ��\ / ®o p� SEWAGE DISPOSAL SYSTEM PLAN w w Q z �� �� �� -TO SERVE EXISTING DWELLING m 3 Q L z J FLAN \��\ / EST. DONALD AND SALLY OVERLOOK w O c)m �� OWNERS OF RECORD n/ 0 cn �/ �/ ABETH DRIVE 0 i CD 0 �� cn_ 402 LAKE ELIZ SCALE: t i n = 20 f t e c ED ED W 20 0 20 :10 � jNOFMgss9cy ��y�NOFMgssgc ��� 1JJ5 ��� CENTERVILLE. MA Z + LID (n y �o DAVID GN o�' DAVID �G �0N PROPERTY ADDRESS co 0 10 20 E D. ma`s `f'cn43 TRIANGLE ASSESSORS MAP 2 2 PARCEL 2 4 Nm -+ o D. SANDWICH MA m1R5 3E PLAN BOOK 118 PAGE 3 O COUGHANOWR "' " COUGHANOWR N 0 z w ; �No. 109�0 `, 0 588 364—f�8J4 J c N OISTE� O CENSE DATE: MARCH �. 28(�J� O W w Ul Sq A PN /� E V u CO JOB E T E-2 5 5 4 PAGE 1 OF 2 VERSION: m w THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM f ",��G� 20 D DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER u�►t I SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. SOIL TEST LOG DESIGN CALCULATIONS DATE OF TEST: MARCH 3. 2007 �# If I DESIGN FLOW: 3 BEDROOMS X 110 GPD =. 330 GPD SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. f SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. INSTALL 1500 GALLON H-10 SEPTIC TANK (MINIMUM ALLOWED) 1 DISTRIBUTION BOX: USE 3 OUTLET D-BOX. TEST PIT 1 NO GROTUNDDWAT R :ENCOUNTER LD OUTWASH SOIL ABSORBTION SYSTEM: A 24 Ft x 12.5 F t x 2 Ft LEACHING GALLERY CAN LEACH PERC AT 108 in - 2 MIN/INCH IN C SOILS A = ( 24 x 12.5 ) = 300 sF Asdw = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 sf At.ot = 446 sF ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER Vt 0.74 x 446 = 330.04 GPD (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING USE A 24 Ft x 12.5 Ft x 2 FL GALLERY. Vt = 330.04 GPD > 330 GPD REQUIRED 20.10 0-40 FILL 40-64 Ap LOAMY SAND 10 YR 2/2 NONE FRIABLE 14.77 NO T TO 64-110 Cl MEDIUM TO 10 YR 6/4 NONE LOOSE LEA CHING GALLERY SCALE COARSE SAND USE SHOREY PRECAST 500 GALLON LEACHING DRYWELL (H-10 LOADING) 110-144 C2 MEDIUM SAND 10 YR 6/3 NONE LOOSE 6.10 CONSTRUCTION DETAIL 500 GALLON DRYWELL DIMENSIONS AND DETAIL TEST PIT 2 NO GROUNDWATER ENCOUNTERED DRYWELL UNIT STON USE H-10 UNIT INSTALL ONE INSPECTION PARENT MATERIAL: PROGLACIAL OUTWASH RISER TO WITHIN SIX 2 MIN/INCH IN C SOILS 2 4.0 f t INCHES OF FINAL GRADE m AND INDICATE LOCATION m ON AS-BUILT PLAN ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER ' (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING Ln m Lq 20.00 N Q N �p 33 In 0-36 FILL m` oo�ooa �o0 0000� 36-62 A LOAMY SAND 10 YR 2/2 NONE FRIABLE 3.5 FL I, Ft e.5 f t 5 ft C2 co ooa0000 000 14.83 p 0 0 1� 62-112 Cl MEDIUM TO 10 YR 6/4 NONE LOOSE 2a.0 Ft G�0 COARSE SAND 112-144 C2 MEDIUM SAND 10 YR 6/3 NONE LOOSE 8.00 CROSS SECTION VIEW 2 to PEASTONE 2 in PEASTONE a o 26 3/4 to TO 24 in EFFECTIVE to TO 26 NOTES to EFFECTIVE 1-1/2 In GRAVEL DEPTH 1-1/2 In GRAVEL 1n INSTALLER MAY ELECT TO SUBSTITUTE AN 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 46 1n 56 In 46 1n APPROVED E FABRIC IN PLACLAC OF OF 2) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL LAYERA L THE 2 �n.SPECIFIEDNE STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH . 150 1n SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING CESSPOOLS TO BE PUMPED. COLLAPSED, AND FILLED. OR REMOVED. GROUNDWATER ADJUSTMENT SEWAGE DISPOSAL SYSTEM PLAN 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. Z) LINES EXITING D-BOX TO RUN LEVEL FOR 2•-0'* BEFORE PITCH iNG DOWN. ADJUSTED GROUNDWATER LEVEL BASED ON SOIL EVALUATION DONE -TO SERVE EXISTING DWELLING 6) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW,.FLOW FIXTURES AT ADJACENT PROPERTY ON 5/9/05 DONALD & SALLY OVERLOOK AND APPLIANCES, AND BIANNUAL PUMPING OF THE SEPTIC TANK. OBSERVED GW 6.25 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. ;DO NOT , INDEX WELL M1W-29 402 LAKE ELIZABETH DRIVE CENTERVILLE. MA ZONE C PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. READING DATE 6.4 2005 READING 6.4 ECO-TECH ENVIRONMENTAL ADJUSTMENT 0.9 ADJUSTED GW 9.15 43 TRIANGLE CIRCLE SANDWICH MA 02563 ETE-25541 MARCH Z. 2007 1 212