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HomeMy WebLinkAbout0056 LAKEVIEW DRIVE - Health Lalceview Drive, Centerville A= 214 - 048 i 'p G. I e toW1 O BARMABLE - LOCA't'i0N VAG �Q f p,�5 $SQR'S MAp -Cyr FI�ST �`5 NAlt��PIHOIJB I+IO. �EP'lIC TANS cO� LEAiCii�1G 1PACII ;T1�X�.E � (size) yy�+. Sep rntiott R9ism Bstviesn tie:: � Maxiunum Adtusted Grauraitwater Viable the&�ttotn n� chinsu:ilit�r 1'c3va8e'�t'mtcr 5a�ly W4�and Lca�ia�g pacaUry .(tf may atells oxist Bcia9 ata site+�c evlthin.2A0 feat a�lnncbi�fnc�tlt3'). . Ed jo of.�fllet9r�►d*LOLAW(t l�acility..(If any we({andg exist r ittair►: feet a fi a' 08.�'ac '.1) r Q V D r �\ Commonwealth of Massachusetts °2Iy'D�U Title 5 Official Inspection Form al Subsurface Sewage Disposal System Form -Not for Voluntary Assessments > c+c' 56 Lakeview Dr Property Address ~' Robert Halliday,:, Owner Owner's Name information is required for every Centerville J MA 02632 7-25-19 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information 671-*-�g0/r Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system'at theproperty 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 7-25-19 y c 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-& Massachusetts ' Title 5 Official Inspection Form %l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7=25-19 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 2) System Conditionally Passes: ❑ One or more system components as described in the "ConditionalPass"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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts ,w Title 5 Official Inspection Form i�► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Lakeview Dr _ Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 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 El ❑ 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 El ❑ ND (Explain below): ❑ obstruction is removed El ❑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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts awl' Title 5 official Inspection Form 11�1I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 page. City/Town 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 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 Inspecton Form:Subsurface Sewage Disposal System•Page 4 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p y rY 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® 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 16,000 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 Title 5 Official Inspection Form —P'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f, 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 page. City/Town 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? ® ❑ Wasthe 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 Eli ,w Title 5 Official Inspection Form i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): (4 Assesors) DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Description: Number of current residents: Unknown 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)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 7-2019 Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts ,w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 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: Owner----pumped 3yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 i Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F >°i 56 Lakeview Dr _ Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 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 ❑ 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: Tank 1980's with new leach field in 2010 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 42"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Lt5msp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts -, Title 5 Official Inspection Form i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 36"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form ,f /ill Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 page. City/Town 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, 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts ,w Title 5 Official Inspection Form i i-'I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 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 workingorder: ❑ 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.): Good condition with water at working level and no sign of back-up from field. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ! �1ri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 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 orders stem is a p p g y 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: 3-500's ❑ 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 c Commonwealth of Massachusetts ll Title 5 Official Inspection Form w: „rn1 Subsurface Sewage Disposal System,Form -Not for Voluntary Assessments 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is Centerville MA 02632 7-25-19 required for every 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.): Leach chambers in good working order with no sign of back-up into d-box or surrounding stone. 12. 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 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 c ° Commonwealth of Massachusetts f Title 5 Official Inspection Form cill Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form wa i'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 e. City/Town State Zip Code Date of Inspection page. p D. 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 �d"y*- f� � 371 r� n rr irr 13 3 y � Sj/ t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 I • Commonwealth of Massachusetts Title 5 Official Inspection Form 'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 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: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. 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 '� i�► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Lakeview Dr Property Address Robert Halliday Owner Owner's Name information is required for every Centerville MA 02632 7-25-19 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 TOWN OF BARNSTABLE r LOCATIONlQ Lei 1. � u�e-r.� ��...,.c SEWAGE# �- VILLAGE ASSESSOR'S MAP&PARCELcf e`g INSTALLER'S NAME&PHONE NO. I rs.G�e,a l t�' �2 8 YU SEPTIC TANK CAPACITY \Sao W t Q LEACHING FACILITY:(type) 15� S?C% C li Z O (size) \Z,f 5 NO.OF BEDROOMS OWNER 5 PERMIT DATE: 3— 2b`0 COMPLIANCE DATE: .J m 2 Z o vQ Separation Distance Between the: Maximum.Adjusted Groundwater Table,to the Bottom of Leaching Facility ,Vv 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 L• aching Facility(if any wetlands exist within 300 feet of leaching'facility). feet FURNISHED BY LLC ` 6L so. S_ C3 cs s�s 13 51.. D S r� No. /0 Fee THE COMMONWEALTH OF MASSACHUSE17S Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Y 21ppYitation for Misposal *pstrm Construction permit Application for a Permit to Construct( ) Repair(*4 Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No. �4 to K6 l et✓,t�D f—CTj Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 'Zt`f �$ C ~` /I� �T evPh �Q • (,l�Qle SC Lgke.V 1 ek_, Or Cg- Pro,ll e 9I4 O u32 Installer's Name,Address,and Tel.INO. 4-&-u O� Designer's Name,Address and Tel.No. 5-ot 3(tj4 CuP�:LQe.. t l Q�,ies t_zz T PAv1D 1). �odGh�}00&'R, R-5 �o z r--Z C,e;J k� e--va-+ 6'L-" . 4 )P(alfi 1 P �+�' S44&1'ch MI 02-56 Type of Building: t Dwelling No.of Bedrooms Lot Size 1 ,.� Garbage Grinder(W) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) S S 0 gpd Design flow provided �"° 3 gpd Plan Date ft i I ?P 1010 Number of sheets L- Revision Date Title Se-me Nuaco( Y005 plyl Size of Septic Tank Ls(w 10 Type of S.A.S. cI l et- Description of Soil o4 - We /4"h %of Nature of Repairs or Alterations(Answer when applicable) wyo �` �� $ B(6q11d0PI n,4 L006i#k / S'Y�1lPtM -hc,��7�� Cal i�il/ ket y �� �-��CPyP1,111 C-- 3333 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. d Date / Z®G 6 Application Approved b Date Application Disapproved by Date for the following reasons 1 1.� Permit No. �T®/a ^ p �- Date Issued Cj No. 1 o = O "eta--- a', :. .,. n Fee V SHE'COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABBLE, MASSACHUSETTS 2p#lication for Zisposat-6 stem—Construction'permit Application for aPermitto Construct Repair(� Upgrade( ) Abnon( ) ❑Complete System ❑Individual Components , Location Address or Lot No. C4 tA Kevi ew D r _GTE Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel 'at4 C �t //� ��e✓Ph /�'. f,�1Q(ei �c 1—mte�►e �0 32 Installer's Name,Address,and Tel. o. (Z$_ O Designer's Name,Address,and Tel.No. S19e 3� Okq¢ CaP.eE.a%a 6VLL4• q-,S�e.� LLC 1 POVID, 7. Coo�hpl�owR, R-S , o 215A7c."> (_ \ice ?r -lN I e fi r Wic OZS6 i, a , Type of Building: - Dwelling No.of Bedrooms Lot Size I.G� a L ,,Sq., Garbage Grinder(N) n Other Type of Building No.of Persons Showers'(°° ) Cafeteria( ) Other Fixtures •. cP. `, Design Flow(min.required) S S 0 _ gpd Design flow provided t�J�'�j 3 gpd Plan Date hA P i I V, ),010 Number of sheets Z Revision Date s Title Size of Septic Tank � �!/a L+ Type of S.A.S. let 4 Description of Soil 51m4y mv wew;vn Nature of Repairs or Alterations(Answer when applicable) ti It'll_qlMijk0l 0 kj` 6,ok ,� Bj , lrP,I Date last inspected: E Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal syst rf in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ed Date ..r.. Z 01 0 Application Approved b Date 513 1/1!5> Application Disapproved by Date for the following reasons Permit No. A�O/Q rD_ Date Issued �/O r THE COMMONWEALTH OF MASSACHUSETTS �BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CCERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired OC Upgraded( ) Abandoned( )by C A f�PP.,a. at S6 Lowe V t ew t'k ✓e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Noo."' °, d /a'�ated < 5 Installer � Qa,�� ''1��?��cS ( L Designer Nr14 � C,,> ghpi✓r #bedrooms - ApprovediE � gpd The issuance of this permit shall not be construed as a guarantee that the systemn as de ignee� Date(1•i Inspector ,✓ «. r 1- . y ------------------------------ --------------------------------------------- ----------------------------------------- --------- No.f' �^ Fee THE COMMONWEALTH OF MASSACHUSETTS —� PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction lermit Permission is hereby granted to Construct( ) Repair( >p Upgrade( ) Abandon( ) System located at :—6 -mil{Ct?V j ow I r,✓e ce of u l d e and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must e completed within three years of the date of is permit. Date �,� �d Approv f BED ROOM BATH LIVING BH KITCHEN ROOM BED HALL/FOYER ROOM BATH OFFICE DINING ROOM GARAGE MAIN FLOOR BATH C L BED ROOM CLOSET HALLWAY BATH BED ROOM BED ROOM, SECOND FLOOR FLOOR PLAN 56 LAKEVIEW DRIVE CENTERVILLE. MA APRIL 30, 2010 Town of Barnstable Regulatory Services .. Thomas F. Geiler, Director • suwsri►HL& Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-750-6304 Installer & DesiQrier Certification Form Date: Designer: D , (0VGHRN0w92 R.5. Installer: Address: 43 TR1 MJ GLC CtRCLC Address: PC) 2 c.3 ,ram On � '` ��� , �t ( -,5<5 0-C was issued a permit to install a (date) (install ) septic system at LaKeU;r.h/ l�r Ater va lip based on a design drawn by (address) l� . �.c� �t��a�o�r dated . /�-pr, Zvll�' . (designer) - __�_, I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF DAVID o D. Installer's Si tore) 0 COUGNAN,OWR Cn No. 1093 PSG, T e'?- o .� Sgh+TAR J„a (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information � on the computer, e use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. Company Address Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: r ® Passes ❑ Conditionally Passes ❑ Falls ❑ Needs Further Evaluation by the Local Approving AuthorityI -- ^ ,i a ' 4/13/2010 Inspector's Signature Date V.A rr~a 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. Z � i5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disp I ystem•Pa 1 6}97 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ..�� 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 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: Dwelling is served by 2 separate septic systems, this report represents 1 system consisting of a cesspool and a cesspool overflow. This system was found to be functioning and is passing, the other system was was determined to be failed and is on a separate inspection report. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-09/08 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven We Owner Owner's Name information is Centerville Ma 02632 4/13/2010 required for every — page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09108 Title 5 bridal Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owners Name information is Centerville Ma 02632 4/13/2010 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (coat.) 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 indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded ❑ ® or clogged SAS or cesspool Cl ® Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 IN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mete Owner owners Name information is required for every Centerville Ma 02632 4/13/2010 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Ij Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yt 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): private well Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: 1000 gallons How was quantity pumped determined? Reason for pumping: cesspools are required to be pumped for inspection Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yy� 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed (if known)and source of information: unknown, possibly original 1940+/- Were sewage odors detected when arriving at,the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ® cast iron ❑40 PVC orangeburg ® other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): Depth below grade: fe et 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: Sludge depth: t5ins-09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yr< 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-OWN Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .�' 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. CityfTown 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 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °yf 56 Lakeview Drive Property Address Steven Mele Owner Owners Name information is required for every Centerville Ma 02632 4/13/2010 page. City/rown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ 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.): At time of inspection the overflow cesspool had approx 1'of standing water and no sign of past hydraulic failure. Cesspool was structurally sound. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 main 1 overflow Depth—top of liquid to inlet invert 6" Depth of solids layer Depth of scum layer _M Dimensions of cesspool approx 6x6 Materials of construction concrete block Indication of groundwater inflow ❑ Yes ® No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 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.): Soil was dry, vegetation normal, no sign of hydraulic failure. Cesspool was structurally sound. Outlet pipe had a 90 degree bend(orangeburg) I Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Page 1 of 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately r 3 .2'Y'(z o , - 34 ' A..2 HYbr f1, L '� •JJ k�Da Off- Bax 3 ' ;37' A-5--- rid http://sz0117.we.mail.comcast.net/service/home/—/Septic%20diagram jpg?auth=co&loc=en US&id=122... 4/14/2010 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owners Name information is required for every Centerville Ma 02632 4/13/2010 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20'+/- feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Property is elevated compared to visible water elevation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09106 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments lug 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable P#_ Department of Regulatory Services rusrrereets, Public Health Division Date A .6,9.h ' 200 Main Street,Hyannis MA 02601 Date Scheduled t a c f Time_ Fee Pd. ( b d Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By:—0" J L LOCATION& GENERAL INFORMATION Location Address j�, Lgit ev J FLw �f Owner's NameMtele I 5-f p v l e Address. 5(o �7 Ken CeR 4evJ /1P Assessor's Map/Parcel: 214/� Engineer's Name D�UJ C'o v hy6ly t< NEW CONSTRUCTION REPAIR Telephone# 5e>f- f Land Use -� I,4 144I of( Slopes(36) 220 Surface Stones 0 etc Distances from: Open Water Body %00 t ft Possible Wet Area 10 b t ft Drinking Water Well i bo t ft Drainage Way 10 0 t ft Property Line to y ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) WELL � - r- lm LOT L 1A AREA =1.66 J �p O 1 � m M0 m J m � W O'l`R/ I50 F!Flxw WFLL WEL r i L, 3 M o Ica-zL _ Y \ t 44R5 FLAN WELL Parent material(geologic) P PClGa� �ufi�v9S h Depth to Bedrock ®� Depth to Groundwater. Standing Water in Hole: H P Weeping from Pit FaCe h o h e Estimated Seasonal High Grou da er le I f O N b Ly C' V 11P���i�v�f Uj t-0),-4C41 Fes/ Vq/ DETERMINATION FOR SEASONAL NIGH WATER TABLE Method Used: die-Vgf1011 0-f AdI-Ci4ht C0AtPOited 4-0 4 [c4KE Depth Observed standing in obs.hole: __— _in, Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level� ,�, Adj,factor— Adj.Groundwater Level,, PERCOLATION TEST We 41 zq 110 Thne Observation Hole# Time at 9" Depth of Perc Time at 6" j Start Pre-soak Time @ j101.5C_ 'lime(9"•6") End Pre-soak Rate MinJlnch - P / A' Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) 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-ASEPTIMERCFORM.DOC SOIL TEST L 0 G DATE TEST: I 29. 2010 SOIL EVALUATOR: DAV DAVID D. COUGHANOWR. R.S. WITNESSED BY: DAVID STANTON. HEALTH DEPT. ! PERC NUMBER: 12907 NO NCOUNTERED TEST PIT I PAARENTU MATERIAL: PROGLAC AL OUTWASH PERC AT 66 in - 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 46.05 ' 0-4 A SANDY LOAM 10 YR 3/3 NONE FRIABLE I 4-34 B SANDY LOAM 10 YR 4/4 NONE FRIABLE 45.22 34-150 C LOAMY MED SAND 10 YR 6/4 NONE LOOSE 35.55 NO TEST PIT 2 PAARENOTUNDWATE MAATERIA ENCOUNTE PROGLACA LED OUTWASH 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 48.20 0-6 A SANDY LOAM 10 YR 3/3 NONE FRIABLE I 6-36 B SANDY LOAM 10 YR 4/4 NONE FRIABLE 45.20 36-13B C LOAMY MED SAND 10 YR 6/4 NONE LOOSE 36.70 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv. Gravel) 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 Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes . ' Within 500 year boundary No✓' Yes Within 100 year flood boundary No.._ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? t eo If not,what is the depth of naturally occurring pervious material? Certification �� S I certify that on hod (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consiste the required training,expertise and experience described in 310 CMR 15.017. �SN oF,uy DAVID Signature G"^ '' C Date _ U D. COUGHANOWR �O���CENSE�EVAt. OQ- QAS.EpT10pERCFORM.DOC ` UP� TOWN OF BARNSTABLE LOCATION SEWAGE'# VELLAGE P�(�L°/"L)���P- ASSES R'S MAP & LOT, K IN AME&PHONE NO( �� , G�IS�� 9�L a TANK CAPACITY l; SEPTIC �Od(� COI. �2.0 c- LEACHING FACILITY: (type) 6P (size)1000 Q,2 u: ev NO.OF BEDRO BUILDER rROWNER PERMTTDATE: 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 �� �� e �q•``' �',�a �" (p��u << �a1 �0 Asa. y,. w1 �a F1 Town of Barnstable Barnstable ti AN-Am o •( �� efigaCRY Regulatory Services Department N1A3$. i639 � Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas P.Geiler,Director Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205009335 6/02/2010 Steven Melee 56 Lakeview Drive Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic systems (2) located 56 Lakeview Drive, Centerville MA was last inspected on April 13, 2010, by Sean Jones, a certified septic inspector for the State of Massachusetts. The inspection of the front septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00.) due to the following; • Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. • Static liquid level in.the'distribution box above outlet invert due to an overloaded or clogged SAS. • Liquid depth in cesspool is less than 6"below invert or available volume is than the %2 day flow. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH �^o as McKean, R.S., CHO Agent of the Board of Health i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven We Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may,not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key, S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. Company Address Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maiptenance.of on si e sewage disposal systems. I am a DEP approved system inspector pursuant to?Section 15 40 Title 5(310 CMR 16.000).The system: ❑ Passes ❑ Conditionally Passes ® Falls ' ❑ Needs FurtherEvaluation by the Local Approving Authority Q) 4/13/2010 r n Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board 1;�nof Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner. and copies sent to the buyer, if applicable, and the approving authority. *!."This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage posal System•Page 1 0 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Miele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be .replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CHAR 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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: Dwelling is served by 2 separate septic systems, this report represents 1 system consisting of a 1000 gallon septic tank, d-box and 2 leach pits. This system was found to be failing, One leach pit was observed to be full above inlet, the water level in the d-box was above the outlet inverts and the 2nd pit was full. D-box and 2nd pit were inspected with a camera from the outlet end of the septic tank. System#2 is represented on a separate inspection report. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® El than depth in cesspool is less than 6" below,invert or available volume is less than Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 } Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Cl ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® An portion of a cesspool or privy is less than 100 feet but greater than 50 feet Y vY from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins 09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °t 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. CityrFown State Zip Code Date of Inspection D. System Information Description: Number 2 umbe of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): private well Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "¢ 56 Lakeview Drive Property Address Steven Mele Owner Owners Name information is required for every Centerville Ma 02632 4/13/2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 r { Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Tank, d-box and 1 of 2 pits installed 1988, 2nd pit added 1990 Were sewage odors detected when arriving at.the site? ❑ Yes ® No Building Sewer(locate on site plan): 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.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): Depth below grade: 3.3 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: 1000 gallons Sludge depth: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (coot.) Distance from top of sludge to bottom of outlet tee or baffle 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 w How were dimensions determined? measurements not taken Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank was structurally sound. Inlet tee and outlet baffle intact and in good condition. Inlet cover on riser approx 1.5' below grade. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal El fiberglass [I polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 2.5 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 was inspected with video camera from outlet of septic tank. water level in d-box was observed to be well above the bottom of outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: 1 ❑ 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.): Water level in one pit(#5 on diagram)was observed to be above inlet invert. Second pit(#4 on diagram )was inspected with video camera run from septic tank through d-box, This pit was also determined to be overfull. 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•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,•'t 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address rR Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately e0 A,2 y6. OC 3 ' 37* t5ins.09108 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Lakeview Drive Property Address Steven Mete Owner information is required for every Owner's entervillee Ma 02632 4/13/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20'+/- feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Property is elevated compared to visible water elevation. Before fling this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 T Commonwealth of Massachusetts Title 5 Official Inspection Form R a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 56 Lakeview Drive Property Address Steven Mele Owner Owner's Name information is required for every Centerville Ma 02632 4/13/2010 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Certified Mail: 7006 0810 0000 3525 0052 Town of Barnstable Regulatory Services snsxsr�ter.�, Thomas F. Geiler,Director Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 21, 2007 Steven A Mele 56 Lakeview Drive Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE CODE The property owned by you located at 0 Falmouth Road, Hyannis, Assessors Map\Parcel 250-023-XO1 was observed in violation on March 20, 2007 by Health Inspector David W. Stanton R.S. The following violation of the Town of Barnstable Board Code was observed: $ 353-1 Responsibilities of Owners: A 55 gallon drum and two 5 gallon buckets. One of the 5 gallon buckets had some oily product on the ground around it. You are directed to remove the 55 gallon drum, two 5 gallon buckets and the contaminated soil around the 5 gallon bucket on your property and dispose of it properly within 30 days of your receipt of this notice. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Failure to comply with an order will result in a fine of$100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, RS, C Health Agent Q:\Order letterMazmatValmouth road-0 Wequaget lane.doc / G /�-- 4,o BORTOLOTTI CONSTIIUCTION,.INC. Ne le 765 WAKEBY ROAD,MARSTONS MILLS, MA 02648 -T S EP a 508-771-9399 508-428-8926 FAX: 508-428-9399 `iJ Est , e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM � �I PART A CERTIFICATION Property Address: C ,L'EtJ�•t`(J ry U_ e �L'l't�i��iC Date of Inspection: 3 — Inspector's Name:_ _ �; CARD �• ner's Name d Address: �do���lJ �js Ue• CERTIFICATION TAT .M NT• I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed bas on my training and expericuce in the proper function and maintenance of on-site sewage dispos stems. The System: Passes Conditionally Passes Needs Further Evaluation By the Local Aproving Authority Fails _ Inspector's Signature: ' �• Ual.e: ���/� The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(30)days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving au(hority. INSPECTI//ON IMMARY• A)SYST�CM PASSES: VVVVVV I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair, passes inspection. Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - 1 - w r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if ' the system is failing to protect the public health, safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND Tl1E 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 APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system amd is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a lone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system►and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following G►ilure criteria as def red in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of elluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clog- ged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year PL(U due to clogged or obstructed pipe(s). Number of times pumped -2 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART A CERTIFICATION (continued) Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 Fect of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 Feet of a private water supply well. Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. if the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large Sys(cm)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: The system is within 400 Feet of a surface drinking water supply The system is within 200 Feet of a tributary to a surface drinking water supply The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)or a mapped Zone 11 of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: ✓Pumping information was requested of the owner, occupant, and Board of Health. -None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓As-built plans have been obtained and examined. Note if they are not available with N/A. .�The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. ,-'The site was inspected for signs of breakout. ✓All system components,excluding the Soil Absorption System, have been located on site. JV-_The septic tank manholes were uncovered,opened,and the interior of the septic tank was in. spected for condition of baffles or tees, material of construction,dimensions,depth of liquid, rdepth of sludge,depth of scum. ✓ The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 11 CHECKLIST(continued) V 'The facility owner(and occupants, if different froth owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDENT I A L: Design Flow: rallons Number of l3cdroouts:__ 4/. N rtnbcr of Currcnt Residents:_ Garbage Grinder:_ Laundry Connectcd'fo Systcnt: ,O _ Seasonal Use: O Water Meter Readings, if available: Last Date of Occupancy:� ,e�~l'e/)f� COMMERCIATANDUSTRIAL., Type of Establishment: Design Flow: gallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of System Pumped as part of inspection: if yes, volunie pumped: gallons Reason for pumping: TYPE}OF SYSTEM: V' Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other(explain): _ APPROXIMATE AGE of all co ponents,date installed(if known)and source of information: S cad 1906 Sewage odors detected when arriving at the site:AIL _ -4- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PA RI'C GENERAL INFORMATION (conlinued) SEPTIC TANK: Depth below grade: Material of Construction: ✓concrete metal FRP_Other (explain) Dimisions:$.��' Y� �/J� "' Sludge Depth:. '� Scuin Tliickitess: /t 01)e Distance from top of sludge to bottom of outlet(cc or baffle:_ _ Distance from bottom of scum to bottom of outlet tee or baffle: Lf/Q.r1 Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage,etc.) GREASE TRAP: - -------�----- De th Below Grade: Material f n r o Co st ti � P uc o t. concrete . metal FRP Other (explain) _—__ Dimensions: Scum'I'hickncss: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage,etc.)_ TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction:-_concrete_metal_FRP_Otlier(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet tee,condition of alarm and float switches,c(c.)_ DISTRIBUTION BOX: Depth of liquid level above outlet invert:: Comments: (note ` level and distri ution ' ual,evi nce of solids carryover,evide tce of 1 cage 'nto or out of box, c.a1 -�(��2�I �l PUMP CHAMBER: �z Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) i -5- - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): ✓ (Locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods) If not deternuned to be present, explain:_ Type: Leaching pits, number:Leaching chambers, number: : Leaching galleries,number: Leaching trenches, number, length: —_ Leaching fields, number,dimensions: Overflow cesspool, number: Comments: (note condition of soil, signs of by raulicc filiftirejpvel of oudin condition of ve etation, etc.)' �_ Pl-_ CESSPOOLS: --------------- ------ - 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(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -- -- PRIVY: Materialsofconstruction: — Dimensions: -.-___--_ Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -6 - r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. OF 69 c� O DEPTH TO GROUNDWATER: Depth to groundwater: /j Feet Anv Me od of Determination orAppr ximation: /'D.kl��l�y �, 5. r©I' eO�O lei _QO—1 � -7- TOWN OF BARNSTABLE LOCATi g�P c�t t'.tj A) , SEWAGE # PC? ' , 1 VILLAGE �Ll� �e c' v =' 'e® S.'iSSESSCR'S btAP & LOT A= �-" -M& INSTALLER'S NA ME & PHONE NO. s)c t A 59-S SEPT:C TANK CAPACITY: L_A ,IHING FACILIxfttVPe) 2 � (size) 4002 5a t 1 NO. OF BEDROOMS `l PRIVATE ELL Oft PUBLIC WATER;, WE BUILDER OR OWNER 14,+' vv. � DATE PERMIT ISSUED: / DATE COMPLIANCE ISSUED: VARIA-NCB GRANTED: es No . 1\ � IV \ 41 13 C „ 316 l THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for lliipniittl Works Tijudrnrtinn ramit Application is hereby made for a Permit to Construct (✓ /or Repair ( ) an Individual Sewage Disposal System at: .....L�Keoer,l ............L Nit!�V i ) .. Lo j G M14P 214 /�/ �g ..-... .•..••.• • ............ ...... ..••._....•.._ ...................R. •..•......... / Lo9cJ��ion-Address f� n Q or t N. ! J f � DAJ I k�Owrier ..�'.'!.llC C �fa� N�l� re� l C l.......................•-^ Add W Installer Address 2 Q Type of Building !� Size Lot._.23)OJ?........Sq. feet U Dwelling—No. of Bedrooms..............---1•-------_____.__--._.-•---Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other tures - �,�, Design Flow---•-------•••�-- •..............gallons per person Per day. Total dai;y flow........................._.................gallons. W ��-- -•---------- � Width---------------- Diameter Depth---------------- .W Septic Tank—Liquid capacity__.__._____gallons Lengt Total Length Total leaching area _____.____s ft. locx, S x Disposal Trench—No................. Width. :. g _ g q. Seepage Pit No........Z-___-__ Diameter......6---------- Depth below inlet...1!-_E)..... Total leaching area...Z. .--....sq. ft. Z Other Distribution box ( Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit------------_....... Depth to ground water........................ 0 Description of Soil----E)�S�f u/ /cx�0 � l fN t �A TT� L /I U �s Ie $7 . _21---------------- W ----------------------------------- �'-o' �----*-AA ...---•-••--.......x'° Cat �j�. --------------------- ----------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----•---•-----------------•-----•--••------•----------------------------------------........--------------------------------------------------------=--•---------•--................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of CompLioace has been issued b�te board of health. Signed -------------- Dace Application Approved By -------- ----- �C - �n'.- a-�G Daw Application Disapproved for the following reasons: ..--_--------------------------------- --------------------------------------------------------- ---------------- ....................................................---- --------------------------------------- Dace PermitNo. � ---------------------------- Issued ......................................................-------------- i Dace No.... =- .. - Fps....... ...(�0...F e� THE COMMONWEALTH OF MASSACHUSETTS 36 BOARD" OF HEALTH TOWN OF BARNSTABLE Appliratinn for Dispnottl Marks Ton,strnrfion rami# Application is hereby made for a Permit to Construct (V�or Repair ( ) an Individual Sewage Disposal System at: - Z,4.te l ew ..A.... 11 j - .... � 214 I l �9 . ............CE ------------ ..... .-----------------. ........------..Loc ti-n-Address /`,. J fRI �rl (/CCLT . . f�CJL�r t4---! CAII�ffV1��� Owner W Address Installer Address Type of Building L�. Size Lot.... 1.0%........Sq. feet Dwelling—No. of Bedrooms............... .. ...........•--•----Expansion Attic ( ) Garbage Grinder ( ) tk Other—Type T e of Building .............. No. of ersons........_...._._...._._.__.. Showers — Cafeteria 0.1 YP g -------------- P ( ) ( ) al Other xtures - --------............ g W Design Flow........................��_.�b..._._____gallons per per-son per day. Total daily flow----------- WSeptic Tank—Liquid capacity__f4�?.gallons Length__ c,!�7.__. Width._S.._..... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit NO.......... Diameter....__ ____........ Depth below inlet_ •.. .... Total leaching area....6__......sq. ft. Z Other Distribution box ( Dosing tank ( ) Percolation Test Results Performed by••------•......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ------- ------- 0 Description of Soil-----ex�S-F�u! t'�- ' Icx'o �i6 .......11k WI�k---- .. �l - 'r�i 1uSj _IIG t'-rl`�— 9 x -------------------------------------- -----� 'e-•------ta:..�d..•-------._....----&'u-Gkrs---Y -------------------------------------------------------------------------. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -•------------•----------------------•-•---•----------•----------------------------•-•--•------•--------•--------------------------......--------------•--------------------------------................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compl•. ce lias been iss�byboard of health. Signed ------- .............. - --�a-- --�9 b Date ---- Da Application Approved By ...... ........ ��..—Dae Application Disapproved for the following reasons- ...............................-- ----- --------------------------------- --------------- ------------------------ - - y ....................................................... ..----..-.-.--...-----------------..-..---.....---..........................................-......---....---...---..-------------.......... ..................---------------------- Date Permit No. ........ O..�- -- ---- ------------ ---- Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (gerttfirate of (ga tyltttn>Le THIS IS TOCERTIFY, That the Individual Sewage Disposal System constructed ( �) or Repaired ( ) by.....-.. ..-...nfY�-.,. 1 1 ^,- ,�,..�..........lost......................................................... ................................................................ ......................... .... .. 4 at /.0..!....-.. Lid :.V 1 {'��.. ------------------------ ...-.-....-.-........---------------------...------------------------------ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........0 ' .--. --�, .... dated ........................................I....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......... .j'.....�C.. .". P ------ ----- ----------•----...� ..... ----------- ... .................................................. Ins ecto ---- ��� -- �----------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ¢ TOWN OF BARNSTABLE Disposal Iforko Tono#rndion anti# Permissioni�.hereby granted....................................................................................................:......................................... to Construct (✓) or Repair ( ) a Individual Szwage isposal System at No... .....4......� _l[.t i._._._W.. :._.._.�.P ..............." Street /D 19� �� as shown on the application for Disposal Works Construction Permit No 23 Dated....... ......... /. ..../........ f - L%..".. /J� .�•• �, /AQ Board of Health c DATE....... --------.....----...-----•--.......................... FORM 36508 HOBBS&WARREN,INC..PUBLISHERS y i z•�.. 1 V No.- z'=-3-t---- Fee---- -�-~--r BOARD OF HEALTH TOWN OF BARNSTABLE Zppficatiou-for Verr Con.5tructiouPermit pli ation is her made for aopermit to Construct (X), Alter ( ), or Repair ( )an individual Well at: -- ----------- --------------------------------------------- Location — Address Assessors Map and Parcel �� �, G -- - -- -- - ---------------------------- ---- Owner --_--Address ---_-----_---------_---_--- ov � -J ----------- Installer — Driller Address Type of Building - Dwelling---------------------------------------------------------- Other - Type of Building-------------------------- No. of Persons----------------------------------------- Type of Well ------------------- Capacity - ------- -Purpose of Well �� �= - --—- - - - Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to t place the well in operation i a Cer "ficat of omp ' rice has been issued by the Board of Health. t ' Signed ---- --- ------ - =-------------------------------------------- ----- ------ �=------- i date Application Approved By----- — "" -- - - - Application Disapproved for the following reasons:----______________________________________________________________date ------------------------------------- -- - date Permit No. Issued----- - — ---- - ------------------------------------ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individ al Well Constructed ( ), Altered ( ), or Repaired ( ) by----------------------------- VT ------- -——— —- ----------- - ------------------------------------------------------------- _ Installer --------1 , LI'_------------------------------------------—--------------------------------------------------------- has been installed in accordance with the provisions`of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -_-"-j-=-3/--2-.Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------- Inspector� ----------------------------------- No. ---- ���, BOARD OF HEALTH TOWN OF BARNSTABLE ZppYication-*rWefr Con!gtructionAermit A-pplication is hereby made for a•permit t�o Co.n.struct (X), Alter ( ), or Repair ( )an individual Well at: le Location Address Assessors Map and Parcel Owner Address - - -- - - ---------------- --- ---� Installer — Driller Address --- Type of Building Dwelling------- Other - Type of Building No. of Persons------------------------------------------------------ 07e6¢6 Type of Well ---�"e- �—— ____------ - Capacity- --- - - -- -- - ---- --- - Purpose of Well-2y0`,s�---------__—___—_____ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation ntil�a Cer,ifl atelof Eom i nce has been issued by the Board of Health. l Signed — - --- - .- -- - -- -- - � �----- date------------- \ �r Application Approved By — —`� ^=."="�- -- ---- —�i5 - ..;J�� � — � date Application Disapproved for the following reasons:-- --—--—-------------- --------------------------------------------------------------------- date Permit No. Issued---- -- -- - date BOARD OF HEALTH TOWN OF BARNSTABLE (certificate (Of Compliance THIS IS TO CERTIF the Individ al Wel Constructed ( ), Altered ( ), or Repaired ( ) by-------------------- //�r - --- - -=- - ----------------------------------------------- At ---------------------------- �]'� Installer —--------—�_ r�_1—_�_��__ cSL ( '.J.f�'_ ------------------------------------------ ------------------------7------------------------------------------ has been installed in accordance with the provisions of the Town of Barnstable Board Qof Health Private Well Protection Regulation as described in the application for Well Construction Permit`No. � '!��3 6 Dated----__—A__--__- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------------------------------------------------------ ------ Inspector—------------------------------------------------------------------------ �, ' BOARD OF HEALTH TOWN OF BARNSTABLE Well Cootructionpermit No. Fee--` a=- - = ---="-- - Permission is hereby granted-----------I- ------_ ---- �� to Construct ( ), Alter ( ), or Repair>e) an Individual Well at: No. C. d is_ /i ra5�'�e.�x e.ul' - �• �t a— — -__—-------------------- ------ ----------------------- ------ --------- ----------- --------------- Street as shown on the the application for a Well Construction Permit v No.--------- V_ -�b — — ------ ---------------- Dated----------------------------------------------------------------------------------- i l.�oard of Health DATE----------1 — = U - ---- --- - ���1ltfittitTtitt(tt'?tti((f(tttittitititSttititt (tiitttittFt'TTt'Ttt?itt(!Itttiltll'Ijttl?!'?tt(t(f?tt?'t?t?!i?t?Tt??[i!tTit??t?('i'ittT?tTTit'?'i(?ttt??'1'?t(i'?(?ltttitittti!tt(nitl'tt^ittit(f!t(tTiTnt(t(tlniTi[Iiitt[t[ttti!I[t((tj?Iflf ENVIROTECH LABORATORIES 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 CLIENT: Arthur Williams LOCATION: Lot 56 Lakeview Dr'. Oak Street Centerville, MA ADDRESS: -: Centerville, MA 02 32 COLLECTED BY: Fred Clifford SAMPLE DATE: 11-1-90 TIME: Sam = DATE RECEIVED: 11-1-90 SAMPLE ID: 247A-1 c JOB �: New Well WELL DEPTH: 45' RESULTS OF ANALYSIS: =_ F- Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 p pH pH units 6.0-8.5 5.10 Conductance umhos/cm 500 117 = -, Sodium mg/L 20.0 16.2 Nitrate-N mg/L 10.0 0.13 Iron mg/L 0.3 0.06 Manganese mg/L 0.05 = Hardness mg/L as CaCO 3 500 Sulfate mg/L 250 - Potassium mg/L 20.0 Alkalinity mg/L 200 Chloride mg/L 250 Turbidity NTU 5.0 =? F - Color APC units i5.0 £: Background bacteria COMMENT: Low pH indicates high corrosive characteristics. YES No WATER IS SUITABLE FOR-DRINKING PURPOSES FOR PARAMETE TESTED. z XNX ❑ / r c DATE i f ��:t1JJ71JLJL1J11Ji ill JJtJIuUJ1JtilJJJ1JJJJJ1J111 III 1J is!1IlJUlltuJ III JIJJ it!i Ili!tJ1t1J311J11{JJuJiiti Jillt:lJlllitllitiiliiti 11111J111:t31{itlt lit ij1111 111JJI11JJJiJJIlJili1J11 III ilIliJ1111113JJ1tJJ111�� TOWN OF BARNSTABLE LOCATION ' Ce Uc SEWAGE # �2' a VILLAGE C 0-11`-t ll 1yc C P__ ASSESSOR'S MAP 6z LOT �� Lt INSTALLER'S NAME & PHOE NO... L N -OLV ` ULQ<f � SEPTIC TANK CAPACITY ( ( O O l d LEACHING FACILITY:(type) CQ®o cec L (size) l 4 NO. OF BEDROOMS _PRIVATE.WELL. OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ct�//�!t ►/ . J� r - t9 ,.. b O r(p�r r �� . _. ti� ,� ` 3 �; �. � �5 . /s � -- ��o� :: �vr�/ � o -�� , a No......................... Fmc.c ..................... THE COMMONWEALTH OF MASSACHUSETTS �- SOAR OF HE LT _.-.1.J 0. , I.............OF.... ......0[........... ' ._. .... ........................... Appliratian for Disp.aiittl Worse Tomitrnrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (,<an Individual Sewage Disposal System at: Location-Addr- ss No. wner Addres Installer Address QType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ________-__-•-_--_•._____--- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ........:................................................................... W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area-___-_--_____.___-__sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' --••------•--------------••-•-•--•--•-•-------•--•----•------•-.....--------•---•--------•---••---•.......................................................... 0 Description of Soil...... ...................... =------------------------------------------------------------- -------•-------••-•-•------ -------------- W -•••-•-----••---------------••----•--------------•----•-------•-••--------------------•-•----•--------••--•-. .� ----------------•--........................ - U Nature of Repairs or Al ration Answe�w��n/apnl�cable._____ G _'-_. _s /� .5___ ___-__--_,o-�- �--�•�---•-•-_c � -�------------------- Agreement: "Z / The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'IZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss e b the boar f health. SignedG% ® Date/ Application Approved By.............- �'� ..` ..................•-- ------ �� L Date Application Disapproved for the following reasons:..............................................................�=-............................................... ------•---------••-------------•••----.....--•-•-----•-----........-------------•---•------------.........--•-----•...-------------•------•-•---------•------------•-----•-------•-•••--•-------•-------- - Date PermitNo...................................... __ .__....... . Issued....................................................... Date \_' No...._...........-....... Fxs ............... THE COMMONWEALTH OF MASSACHUSETTS ,.. - BOAR OF HE LTH ...........OF..........Y ..... ram- .............................. Appliration for UWpooaal Works Tonstrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: .... . " ---- -kll k -- ...........&0........ ....................... •--••-------------------- Looccation-Add`rxss�� 7 ..1.. r'ad lLat...... J //�J No. _ OwnerAddres ----••-•--- -----• ------- ......cke��Mffif Installer Address d Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width_................... Total Length.................... Total leaching area........._..........sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-----------------_-____. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ----------•-------------••-----•-••-••--------•-----------••-•---------•-------•--•-----•-•••-•--••......................................................... x Description of Soil S........ ........ _ ............................................................. U I . - W ------- ----------------------•--•----•----•--•-••--------------•-------••-----••--------•-•--------------- ,,,,//-°--•------•-------------------•-------- -----•--•- ----- x Nature of Re or Al ration Answer w en a cable_.__ `l%_. ._." � + 1 -. ........... f � -- ..... ................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1 d� 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has��b--ee�errn issued by the board of health. Signed '' +� :zip- ......................... /Date Application Approved By.................. _..... - -�.�---,ti______________ .... Date Application Disapproved for the following reasons:................................................................................................................ -------------------•-------------••-•---...------------••-----••-•-•-----...--•-----......-----•-•--=----'••-----------•-•-•---•---------•-••---•--•---•---••-----------••------- ....................... Date Permit No...................................... -' Issued Date THE COMMONWEALTH OF MASSACHUSETTS .... BOARR OF HEALT ............. '::..� ........0F... '" ....`, lie.....••..................... Tntifirab of Tompliaanrr THL, IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by... Gf ...., �.-� ----------------------------------------__.------------.`...-----------•. .............................r . Inst at. - �� f' �(/ice:----------•-.. .. f J has been installed in accordance with the provisions of TIC 5 of The State Sanitary Code as escribed in the application for Disposal Works Construction Permit No----_�--7__-__-�._ -_�_.__.. dated-........ =. --c�--t- (-•_--•-- THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANT@E THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... ._"_T_Y--...es5. .•--•-•--------•--..._..._....._. Inspector....-.J ..... ___-_______------•----_____- A 2 THE COMMONWEALTH OF MASSACHUSETTS -�- BOARD,,-OF HEALTH �1^ .-. `,,� 1 IC�..t, vJ.............OF...........l� L .t' ._. ....s:....__... _......_................. No.•••............... FEE.__.4._0 0... Disposal .V5vkii y;� nstr ion rrntit Permission is hereby granted '- - el ----------------•- ./'f.�,!.. -------•---------•----------•------•-•--•---•-•---•-•--••-•--- ._... ..._....... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No. Street • as shown on the application for Disposal Works Construction Permit No ............... Dated..... r' L/-� 7 • ........................•-----_•_••_• Board of Health DATE--�--p ry-'`-�-.-�-.-:-�-[-------...................... FORM�1255� HOBBS & WARREN, INC.. 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F (�-' j ? r t y - .� z � -. i...._"*. •- --- _ -+-.. ...".....,._g.:...`..,. � _ ._..� ,.. t k � � I I ? . - ' - � ' I ( I i ' � i � i 1 f f � # i` !.,��_-.r� a,._ -t •-4_ ' _._ ° _-t, x •�,_ �, _�'.,.-,.--4 _ t i , t` � 'i. ..� r �' �. �. F t r > } i �, f i rAlaati tx w WAUCW m PON"6111AOa S R.drlant SOIL TEST PIT DATA (� tutu oA c nsosm� �T�"br tc wl inA �NloOliA+lad111 U w INDICATES INDICATES OBSERVED I �---_ "0 T u4 TM`�"n��Ovn II-m uAow I • , PERC GROUNDWATER �l r Ise a of oA[7 7a Af POW*M rGWv4~tn TEST - I !=�, I a, prwmtw ItYllmm�oa rt/R �u.a lu" T r. IE. 1.$' '� 1.=mo rat v r.r an or im TP NO. TP NO. - PRECAST.STEEL - Q' , 1 1 a" I yTlarllTg4 a0A m K VD LLT6 fr'aA CID.EL.— CRD.n _ RE]NFORCED _ L "o PION VIEW •M[odrao[o r,wnACnroi- . A ¢' tact ow to. OLRLLT N,A)D Oa ArraaVm W/AL GW.EL GW. EL SEPTIC TANK 7¢ UaAO o[17N TEE '!: 0 0 EXISTING : r @I.31e TO t-I/rtTONa Nlo+otv6li covet T YAL 1 1 i •1 •1: a•tr r CIA.OUKLT( r 01A.IIacT :Aruaror 11 1 ,r^ rACM : ) J 2 2 24'DIA. MANHOLE COVER BOTTC4/CN STABI�B, Al WATUtT1ANT •• PLAN VIEW ;It aAir �Ts�) J 3 CROSS SECTION VIEW 4'ouw 4 ♦ NOTES " _ •• S S 1)SEPTIC TANK TO WITHSTAND H-10 LOADING J)INLET AND OUR.Ei LEES TO BE CAST IRON. �•,� ow UNLESS UNDER PAVEMENT,DRIVES. OR TRAVELED SCHEDULE 40 PVC OR CAST-IN-PLACE CONCRETE. T- •' � "� / 6 6 WAYS.WHERE BY M-20 LOADING SHALL APPLY. TEES TO BE CENTERED UNDER MANHOLE COVER. ?" �r-ir.R" ^.IM aA+[ +dt"h►^'+tf• a 6 �`• 7 7 2)ALL PIPE CONNECTIONS AND CONCRETE CON- CROSS SECTION NEW L'_ e B mucnON TO BE WATERTIGHT. DISTRIBUTION BOX DETAIL SEPTIC TANK DETAIL NO. of GALLONS: P �Dcr COrNrnFTr LrAQ6Nc Prr LOCUS MAP y y T TO SCALE NOT TO SCALE EXISTING -am m r�AA- sc ,-zoe� t0 10 DESIGN ANALYSIS 1t tt DESIGN FLOW: 12 12 GATE: DATE: SEPTIC TANK REQUIREMENTS: ProJ•d TIU.: T'ESTBY: TESTBY: WITNESSED tM WITNESSED Br PERC RATE PERC RATE: MIN-ANCH MIN./INCH /��� TP N0. TP N0. LEACHING FACILITY REQUIREMENTS: r' /�-�`'I`J�- GRD. EL CRO. FT 4dabP"i) - - �. �I_I-`, .�1 1 L L- GW.EL CW.EL ----------------'-/-- - �- bw�nL Cr PcNwi• PSIS l J:�'�_I.,,E ..- 0 -1 ,I'. SEE SHEET 1 FOR PLAN VIEW s S LEACHING FACILITY PROVIDED a 6 7 6­ Ac.tFAN,•,fi luS Ili--, 7 7 51 DF_ rIo SF K 7_S'Pb ,c: S S 8a17�M•2�B_$SFLI,p4 b/S.___i.57(_I'D 7o76P1) D B 10 TD 11 11 __ tJOTES PRFPARED FOR - 12 12 DATE' DATE ELI VATIONS ARE RASED ON AN ASSLAIED DATUM Hl11NARD UFJIK D6Prx.FN AREAS WIL! DE PE'.'E+iA7_D AS c_ TES' N' TESTBY: .' Oplr'rF.OF COtICI TIOI•-� i0 F;E i" COI:OF":A TiCN C::A,'., WITNESSED BY: WITNESSED BY: UI4E55 oTHERAIS_NOTED. ALL CCn^TRUCc,1: ME:HCDS ARID MATERIAL' SI1AL_C:"I 11 ! - TIRE S OF THE STATE EIj V'F.o 'T'N TE Arin ANY APPLICABLE LOCAL PERC RATE' PERC RA nc cvLA.ni:::. G70UT AIJD 5EAL5 TO BE Ul rD AT NCN c ' � •• WHERE mr- ENTER OP 'EA- C u"C"l MW./INCM MIN./1 7-nuc:l:P._3 IN O-nDEP. TO PRo,= S_AL. PRECAST Cr1.7Er S-1c Dr,TR!BvncN Do,„ A.M. Wilson AND LEACF1114G iACILIT: TO'':A iH5 TArJL'H-IC LDADIFIG ASSOCIOteS UIILESS UNLEa PA'VE!A_IIT, DPIVEE. C= Ti•.AVE; E:i Inc. WAYS WHERE H-:D LOAD114G SHALL PPPL.Y. ' INVERT ELEVATIONS ALL SHIPLAP JOIIITS IN SEPTIC iArl✓, c.4L'_ SEAL"O WITH NECPRENE C i CF. A3%HFL of Mom,ft t CEIAE14T TO PROMOE A WATERTIGHT SEAL. Ort"./MA 02355 4' INVERT AT BUILDING ALL,PIPES IN THE SYSTEM SHALL BE SCHEDULE 10 503-NTtti1 OR EQUAL 4' INVERT AT SEPTIC TANK (IN) S4.1i Dra+lny TtUA: NOTE LOCATION OF EXISnNG SYSTEM IS APPROXIMATE. DIRI,D CRUSHED STOr:_S SHALL BE FREE OF TILL 4' INVERT AT SEPTIC TANK (OUT) 84.7 t TD BE VERIFIED IN FlE1D BY NNTFLACTOR DRAT,DUST, AND FRIES. SYSTEM WAS INSTALLED L1N B-IB-B7 SEWAGE SEPTIC TI 4' INVERT AT DIST. BOX (IN) Ed4.6 PERMIT# 87-521 HEAVEY EQUIPMENT SHALL NOT BE ALLOWED TO L r_ C OPEP.AIE OVER THE LIMITS OF THE S_'•'AGE DISPOSAL SYSTEM DURING THE COUP.SE OF C:'::C ,01i PLAN r 4' INVERT AT DIST BOX (OUT) g4.4 NO FIELD M SHALL FH"n,: OU SF AA_-- FI_-.^SAL. S:5 iEM SMALL F.i uf:_i v iHOUT os!r.q WP;T-•1 APPPOVAL DF THE ENGINL_= A:.- Tom_ LOCAL PROPOSED EXPANSION INVERTS AT LEACHING FACIUTY: eoar.D of HEAuTI EXISTING 4�PVC ro EXISTING LEACHING PT FINISHED . I 4' INVERT AT BEGINNING OF t �I OF F FINISHED GRADE.MANN GR TO WITHINWITHINADE. THIS SYS,�M SHALL BE INSPECTED AS REO!IiRE_+ SE EL. TOP OF TANK 86.03 FINISH GRADE BY LEACHING FACILITY aa`•I- CTION 210 o:TITLE S. •,,•'/"^0''�4 3 •`� A CERTIFICATE OF COMPLIANCE AS P.EOUIPED D'V \ \ I EXISTING SECTION 28 OF TITLE 5 MUST P.E OBTAINS^DY TiE _I 4 INVERT AT END OF DWELLING PBNST 7W0 FEET TO 2 LAYER OF PEASTTNE(VB-V2I LEACHING FACILITY N� BE LAID LEVEL CONTRACTOR'UPON COMPLETION OF THE FBO T IPA'. (y'; IF NT•ASDUILT P:J,C IS ETIO"F._D DUE i0 ^'111?AC- \A_J '�•/ lOR DEVIATING FROM T':ESE FLANS. 'L:II c' �— 314•-114' WASHED STINE 'xC PY. F I R' )• EXISTING $4T 4 t • S4.¢' L T PLANS SHALL BE COMPENSATED BY THE CGNRn CTOR. -- ?5 ` 4' INVERT AT BOTTOM SEPTIC TANK �o"Pvc r• THIS SYSTEM IS NOT DESIGNED FDR A "FROGS ')la.bN , DIPOSA1 UNIT OF LEACHING FACIUTY 1000 GAL EXISTING D-BOX SLOPE..O¢FT/TIT. e o SC01.: 1'-AS NOTED r� "7N.6! BOFTOM EL. ' A 112-+•-6 2-4 o rRT { OBSERVED GROUND WATER (PROPOSED) DAtc ii No: ELEVATION 73.2 LAKE I OWq L SYSTEM PROFILE f DS";IC � I - - 1 ke J -NOT TO SCALE 732 LANE Dro•+n: ,I ` � Job No: !'I 1 I Sheol 2 01 2 1 J CENTERVILLE R�MAknr. i DA19 00�9aK iii yp i r6s N W LOCUS i 0 PuBUC LAHOwc PROPERTY USES SHOWN HEREON WERE COMPILED WEOUAOUET - - FROM A PLAN RECORDED AT TT1E BARNSTABLE LAKE COUNTY REGISTRY OF DEEDS IN PLAN BOOK 1 PAGE 53 AND DO NOT REPRESENT AN ACTUAL " SURVEY ON THE GROUND. SCALE: 1'-2083' LOCUS MAP R�fanncec ELEVATIONS ARE BASED ON AN ASSUMED DATUM. _ _ _ _ _I I ASSESSOR'S MAP 214 LOT 48 EXISTING ZONE RD-1 I LEACHING I SETBACK REQUIREMENTS AREA FRONT 30' SIDE 10' 1 I REAR 10' unutY MIN.LOT AREA- 47,560 S.F. P. 1 Project nUe MAP 214 j LOT 49 IRON LOT L PIPE ' LAKEVIEW DWELLING N AVENUE USE (CENTERVILLE) ABBUTTER'S OpERTY \ ` o £ WELL I• pft ` 1 g46OT � BARNSTABLE 5 6 MA. �,• / / OVERHEAD WIRES. _ � UTILITY \ POLE, GRAVEL IRON _ - - UTILITY % / / \`- nLTYi _r`._ -�� \\\ ROAD f/ PIPE ' �•\ POl£ /• / POLE r -\ ,; - _ J/ / 1,69 AC. t,\ \ \ I �.� cATCH )! . ' 73,616 SF BASIN STONE' / ^1 A O' f\ O I i WALL EXISTING 600 GAL.•R.11/ - / - i1 �1 \ , 1 1p LEACHI FM NG PIT VL2 SANE �•1 / �_ P"�'A'® PROPOSED, E ISTINOT t000 GAL.TANK WF /: i / / �Jj OVERHEAD / f,• i GARAGE / ADDITION CONCRETE <<� L / - - f /^ WIRES. HOWARD ONIK I DECK BELOW - WALL57 - _ i A / /4/— / T ! ROOF f I91L14' 70 _ , _ _ _. r , •♦ \ \� r- ! GRAIN 1 .. - 'IOU / ' I I I OUTLETS/ 5. ALKAREA < /\ N _�2p R TE(ISTING D-BOX, - �.* 1 NE X _ PROPOSED 600 GAL. _ - l -- INOUS OR \ � 'L(�.- LEACHING PIT W/2'STCNE / "'T..... .� 0 /JN4SCAPE U' PINE J' EXISTING 4°PvC I 1 _ - 1t' - -- ..� tti s. f \I I I �IFLAGSTONE j S - --'�— - ./UnLTY IIII IfI I IPAnO \ K'ELL /B1 -\ \ j l I CONCRETE IEL�91.7�0� �'_ ..-v �-_-�' _.it _ / POLE w DECKS D 0 1 STORY - 4' WIDE -- III DWEWNG GSTONE T /I PROPOSED 4"PV o / IL IItI�Illlt 1 '00 a C� Q Q T.O.F. - WALK 1 / p - M D soalve ��' ;� r - A.M. Wilson }777 ,.'CONCRETE �� J_ •tli BIN 1N U i i %� /' i mC' A930CIOt89 F. �L--,STAIRS pci COVERED I / i o Inc.InG G I 4 PORCH / CATCH / 1 1� •� 1 [_BASIN I r Y STONE GRILL 1 = , T - 0 I 1 1 S MVI1 YiISindM $]] 1 I 3 WIDE \ OkWAM/YA 02555 FLAGSTONE-� GARAGE _ - .____ I 1111 WALK \I'ry1 SOb126-1/30 1 7i Il I II'\111V� AI Orcrinq TIU4: POST k , /' I ! I _ 9� _ •CB/OH RAIL FENCE { I \ I 1\ ,/ 1, PROPERTY USE / , I.� . L- RiOPOSED 4' j�'W 400 46 ' SITE PLAN FENCE ABBUTTER'S PROPOSED ADDITION {7{t EXISTING WELL { I \` CB/OH ti.M EL=66 69 I 1 I ,� {}{{ EXISTING SEPT COTTAGE O S (} ,•\� SYSTEM I SHED R SHED _ NOTE { LOCATION OF EXISTING SEPTIC SYSTEMS AND WELL ARE APPROXIMATE BASED ON \' a DISCUSSION WITH HOhEOWNER Scale 1'-20' MAP 214 LOT 47 I• EXISTING SEPTIC Oate 6-25-90 I SYSTEM D. :C.P.J • Check PRF • ,D(ISTING H(ASE,' Dra.n: J.V.B. t. Job Na 2.0495.0 ST��I 1 of 2 a 1 FN 9 CENTERVILLE. MA VARIANCE REQUESTED , RDA° CONTOURS MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH 1NSPECY J1L OR. r' EXISTING - - - - - - - 50 310 CMR 15.221(7) - COMPONENT N MINIMAL GRADING PROPOSED DEPTH TO FINISH GRADE. 36 In F VIEW DRIVE y MAX REQUIRED - VARIANCE TO p LAKE z` IL 60 in OF COVER REQUESTED. prp LOCUS m r O T W + -48.!.0 Ff __ 50 HUJ F-W O w Q L` m YFAVE WEQUAOUET W dmJCD m m ��e�� LAKE > m� dEXISTING CESSPOOL SYSTEML-OCuS M�P > TO REMAIN IN USE.maz wBENCH MARK NOT TO SCALE O eUZu7 PAINT SPOT IN DRIVEWAYW I jELEVATION =51.02 w J d em DBARNSTABLE GIS DATUMF. o G_ a°w° CD > _ w oGARBAGE GRINDER LEGEND Z J=Om �J Z //��// Wo IS NOT ALLOWED EXISTING JUZ(D (n_j r-( LL .3 ar 3 — PAVED DRIVEWAY (n m<W T_ I , I LJJ Z �+ SEPTIC TAONK ®( lLLJIWITH THIS DESIGN.J W N W v J > O pmp Y DRIVEWAY EXISTING LEACH a zJ(L _ < _j � J (V J —� (]1 PIT/CESSPOOL Q '. O CD Z m O WI (< W W O rn x UTILITY POLE $ W W m m J v v O frI-{ rn Wm TEST PIT w= o :c w LOT L �� r-o-0 I— Cl J U Q T B W a �1 H-20 D-BOX O DRAIN 10 W Z m U W v : Ul AREA = 1.68 I- L7 Q O (+) B ti ~ DECIDUOUS CONIFEROUS QY O W Q Q 'z^1 TREE qQ TREE J ' z O Z J O BASKETBAL L rS� / '0 +0 NUMBER REFERS TO DIAMETER IN ti� IL 0 Lo � Q \ I INCHES.LETTER DENOTES TYPE. W W O J X +�(� CO O O-OAK M-MAPLE P-PINE C-CEDAR W O W W Z O m w N (�N UR T e O (Y m N co v in O O I W W W = v o ' / PFr�fNrN Z T LL ❑ G WALL 'f- U YO i� to �T rcoc�n 5e/ TF 1 PINj "S0 PAVED ® DRIVEWAY � �ZH OF MgSs9c ESN OF MAssq L0 U Ut� AVIDZ W? js0 �—®—_ o00 goy �` �� D. W �m FROG�F< z OVERHEAD WIRES —hF --�� v COUGHANOWR D. N LLJ z 3 Z z / / �_ --- <<-- -- ------ — COUGHANOWR O �_ No. 1093 WORi ~ Z~ I OD �_— ---�--- 44 447.5 Ff �ccGISTS,?- cS0 CeNS��0 l(1(W1l � 0 3 (DZ 48 46 N I T R ,� E V L P w w m L 41.5 FL x 12.83 FL x 2 f L ee C ��-- J 0 W LEACHING GALLERY FLAN N / LU w SCALE. 1 in = 30 F L ` D 30 0 30 60 W < w w Z v 0 10 20 30 SEWAGE DISPOSAL SYSTEM PLAN H z J O O i R��®� ����jo -TO SERVE EXISTING DWELLING J W L z J - � NO OTHER WELLS WITHIN 150 Ft OF 3 Q< '—' J ~ WELL 'eft THE PROPOSED LEACHING GALLERY EST. 0 S T E V E N A. M E L-E �] � O L� __ _— -- � (n _U �'`'mac OWNERS OF RECORD ° `L x Ir nor —_4e1.eFt___ a—�_ ►� e �' d 56 LAKEVIEW DRIVE '' "' lij � r 1ti AREA - 1.68 eo �- 0 _ �� 1J95 �� CENTERVILLE. MA I J Z + (�j M f t— o NOTES ®�ON PROPERTY ADDRESS w INSTALLER MAY MOVE VENT PIPE ASSESSORS MAP 214 PARCEL 48 m Rl 0 43 TRIANGLE CIRCLE WELL, '�`° '"�' O W w TO A DIFFERENT LOCATION. 0 c, �A l 3 � SANDWICH MA 82563 PLAN BOOK 1 PAGE 53 �� z z �`�� / o I W ADDITIONAL LEACH PITS NOT DEPICTED 588 364 0894 DATE: APRIL 30. 2010 Y z lU N N x G m ON THIS PLAN MAY EXIST. �O x w w Rl o --�-- --- — f�ft J $ JOB #E T E-3 3 3 3 PAGE 1 OF 2 VERSION: w > 447.5 Ft , INSTALLER SHALL CONTACT ECO-TECH THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED PLAN WELL ENVIRONMENTAL BEFORE STARTING SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM INSTALLATION. DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING SCALE. 1 ,r, - 120 Ft ! PLACEMENT OF ADDITIONS. SHEDS, FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. DATE OF TEST: APRIL 29. 2010 SOIL TEST , L O G SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. DESIGN CALCULATIONS WITNESSED BY: DAVID -STANT,ON. HEALTH DEPT. PERC NUMBER: 12907 DESIGN FLOW: 5 BEDROOMS X 110 GPD = 550 GPD SEPTIC TANK: 550 GPD X 2 DAYS = 1100 GALLONS NO GROUNDWATER OUTWASH USE EXISTING 1500 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL TEST PIT CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) PERC AT 66 in - 2 MIN/INCH IN C SOILS DISTRIBUTION BOX: USE 3 OUTLET H-20 D-BOX. ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOIL ABSORBTION SYSTEM: A 41.5 Ft x 12.63 Ft x 2 Ft LEACHING GALLERY CAN LEACH 48.05 (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING Abot = ( 41.5 x 12.83 ) = 532.45 sF 0-4 A SANDY LOAM 10 YR 3/3 NONE FRIABLE Asdw = ( 41.5 + 41.5 + 12.83 + 12.63 ) x 2 = 217.32 sF Atot, = 749.77 sF 45.22 4-34 B SANDY LOAM 10 YR 4/4 NONE FRIABLE Vt 0.74 x 749.77 = 554.63 GPD 34-150 C LOAMY MED SAND 10 YR 6/4 NONE LOOSE USE A 41.5 Ft x 12.83 Ft x 2 Ft GALLERY. Vt = 554.83 GPD > 550 GPD REOUIRED 35.55 NO TEST PIT 2 PAARENOTUNDWATEMAATERI L: PROGLACENCOUNTEA LED OUTWASH 2 MIN/INCH IN C SOILS L EA CHILI G GALLERY 1500 GALLON SEPTIC TANK DIMENSIONS AND DETAIL ELEVATION NOT TO DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SCALE (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING USE SHOREY PRECAST 500 GALLON NOT TO 46.20 LEACHING DRYWELL (H-20 LOADING) SCALE 0-6 A SANDY LOAM 10 YR 3/3 NONE FRIABLE CONSTRUCTION DETAIL 1 1n 6-36 B SANDY LOAM 10 YR 4/4 NONE FRIABLE 45.20 TAPER 36. 36-138 C LOAMY MED S_ AND 10 YR 6/4 NONE LOOSE DRYWELL UNIT ST 70 ON �{•- 41.5 Ft o 0 t- ' 0 8 1n 5 f DISTRIBUTIDN BOX mL.IT L. m DIMENSIONS AND DETAIL USE SHOREY DS-3 H-20 N 4 8 Q �k 4 Ft 8.5 f t 4 Ft 6.5 Ft 4 Ft 6.5 F t 4 Ft 10 f _6 j 7 41.5 FL" NOT TO 12 in SCALE MIN INLET OUTLET CENTER END COVER END ' O FROM C TANK SOS 500 GALLON DRYWELL A DIMENSIONS AND DETAIL �3 IN DROFLOW LINE f FROM = 6 to STONE BASE USE H-20 UNIT INSTALL ONE INSPECTION BUILDING 10 to = 14 TO !. RISER TO WITHIN THREE !n D-BOX 1� INCHES OF FINAL GRADE ' 21 In 21 CROSS SECTION VIEW , AND INDICATE LOCATION 46 in ON AS-BUILT PLAN LIQUID GAS LEVEL BAFFLE NOTES0� 36 SEPARATION BETWEEN INLET AND OUTLET TEES �C' In SHALL NOT EXCEED LIQUID DEPTH 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 00000000000 �p�� CROSS SECTION VIEW 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED ���00000a �� i� FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS 10Z 1� OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. CROSS SECTION VIEW SEWAGE DISPOSAL SYSTEM PLAN 5) EXISTING LEACH PITS TO BE PUMPED. COLLAPSED, AND FILLED OR REMOVED. 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. 2 In PEASTONE 2 to PEASTONE -TO SERVE EXISTING DWELLING 7) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES o 0 AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. 28 3/4�, To EFFECTIVE 3/4 in ro 26 S T E V E N A. M E L-E 1n -1/21 GRAVEL DEPTH 1-1/2 i„GRAVEL 1n 56 LAKEVIEW DRIVE CENTERVILLE. MA 81 SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. ECO-TECH ENVIRONMENTAL ' 31 1n 58 to 31 In 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH 120 In 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. INSTALLER MAY SUBSTITUTE AN APPROVED GEOTEXTILE FABRIC IN PLACE OF THE 2 in. PEASTONE LAYER SPECIFIED. ETE-3333 APRIL 30. 2010 1 12121