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Home My WebLink About0094 LIAM LANE - Health 94 Liam Lane " Centerville P A = 167 016013 a 1 r 71 No. Fee l ' 10VY THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Mgoal *pgtem Con5truction 3dermit Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. C(4 L lA i'vt LA WE CP"7ft- V f Owner's Name,Address,and Tel.No. :T C.lt-'N f D(t=CD(=� Assessor's Map/Parcel ' �� C)' q- 664WC ^1V Installer's Name,Address,and Tel.No.5Og—T7�'9 f51 7 Designer's Name,Address and Tel.No. 5QA-01 0 3 7-7 �gpEt�tl xtt5-eS ZL Clv<;F[[Jtz;fe1 'WC. 5 C r�cct Z�1'S'1 A c, M 0(.S#PEe I — Type of Building: Dwelling No. of Bedrooms 0?1 Lot Size ;LA13Gt p sq.ft. Garbage Grinder ( ) Other Type of Building RES t�—TJ A4 , No.of Persons Showers( ) Cafeteria( ) Other Fixtures MtN Design Flow(min.required) '3:3 0 1? 't 1` LE! V gpd Design flow provided 3 qq.4 gpd Plan Date 3`oZ a-a0 r Lf Number of sheets Revision Date Title C14 W 4M LAME Size of Septic Tank 11006 6xA L0M Type of S.A.S.(Ft bCO) -( CAC-- Gl-�/ {�t�S Description of Soil PUICTM 644-2 (i? f QL t SGEE 12-e-4 N (V--a a) Nature of Repairs or Alterations(Answer when applicable) V5E CIS t ttJi- 10 0 C-jt- .Lat> 5 (Wrlc=-T�1L1� ^lam 0 6-k) O -OQK � (aL) ®C, C�c ,fj [ 524#Gz�IP� tit.!i T 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 b s Board of Health. Sign q Date - - Application Approved by Date Application Disapproved Date for the following reasons Permit No. Date Issued TOWN OF BARNSTABLE LOCATION 94 L1tcin L.c4,y'1e- SEWAGE# �Q(4 68 VILLAGECef+-trV 1 11Q, ASSESSOR'S MAP&PARCEL LJ INSTALLER'S NAME&PHONE NO. W i ch C�'1 �✓�0�°j j L LC SEPTIC TANK CAPACITY 1000 C:,c, LEACHING FACILITY: (type) C,c,()c�w,,%berS (size) Id,3'X A NO.OF BEDROOMS oZ OWNER � , e go' , D e PERMIT DATE: 3°-a.'S I t4 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facilityd: umtc,-Q)4f 13, Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) IV A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY (�ApeWIot,-- EeJW P&1SM I six >Ectr, A-3 -� �CGI' Cal ° a A 4-3 %;A 3'• e- 2 31.4 _� e�LA.S' 3As B-6_ a No / �! l)� /� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Did oal i§p$tem Cow5trUCtion Vermit Permission is hereby granted to Construct ( ) Repair (/<) Upgrade ( ) Abandon ( ) System located at 94 L J,c M LAQ r ('ElJTEkY(LCJ,-- and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. iW1 Provided: Construct'flon must be c mpleted within three years of the date of thisDate 2� W Approved by r � All, 3 No. �/ V Fee O oV c THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Y Tipprication for �Bigozal 6pMent' Cor'�truction 30ermit rl Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon A. �)r ,1D r Complete System ❑Individual Components Location Address or Lot No. L.(A 11�( C iq u E C2=lUTC'�Yf LC �aevs.&Q 9y. Owners Name,Address,and Tel.No. S�"F�'$+*� ftMRW Assessor's Map/Parcel T Installer's Name,Address,and Tel.No. 509— 1,*19 9-1 1 Designer's Name,Address and Tel.No. �APEwt Dom. �Z'Q E ISES L- i 1 G C1v�l�J<✓ G Type of Building: Dwelling No.of Bedrooms Lot Size �a,t�j(o(p sq. ft. Garbage Grinder ( ) Other Type of Building RE(_;(bj0.JTI 44__ No.of Persons Showers( ) Cafeteria( ) Other Fixtures MIN Design Flow(min.required) 33 O P E'k "t 1`T L_ V gpd Design flow provided .3 q,9.4 gpd Plan Date ,3-a1-as( (4 Number of sheets Revision Date Title Q GI J4N(—/ Il)E Size of Septic Tank 1 I006 C-_yALi.ON Type of S.A.S.(2) SOQ 6t4L f Description of Soil Nature of Repairs or Alterations(Answer when applicable) U5t ��C(�`((t,J�r /OOU tJ._e7t> ��QTIL'TAll1t --- "lL� 1J 6i4> b —d o K TD (a) O p 4,0(_C.bou ws Gb4!6u 66-E (Xj I—W 41 ' DF :5 IUEr, 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 b t Ns Board of Health. f Sign d �," 9 Date Application Approved by /4 /� i A Date - Application Disapproved bye.. /Y Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS- BARNSTABLE, MASSACHUSETTS ` Certificate of Compliance � THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (X) Upgraded ( ) Abandoned( )by at 9 L- U&� 1 �._,.. �.� C i� CFitJ (C.C..C� has een c nsCructed� ae rdance with the provisions of Title 5 and the for Disposal System Construction Permit No. / dated Installer °CAO@&20 6W Pk15?,=S UK-- Designer %�C, /�f��,2 ll�c[•� z7NG_ #bedrooms Approved design.Iow 330 'Pc:kMWe CI 4T V gpd The issuance of this e t sh I1 Woe construed as a guarantee that the system w unto n as designed. J Date Inspector I/"'�� — —�r—t— #2910 P. 001/001 4/01/2014 21 :07 5082730367 Town of Barnstable Regulatory Services Thomas F.Geller,Director • .MWgrAO , Public Health Division 619. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508.790-6304 Date: y-�" y Sewage Permit# -OS Assessor's Map/Parcel l(07 10 !3 Installer&Designer Certification Form Designer: 'IC En3tnee<(0% T� Installer: Cage E.nkr��sc s Address: 285'1 C(on6ecQ6 ACgh Address: Fast KJortham MP 0253� MAsc4a E A oa-& 49 On 3 L 5 I ytP6WMC tktScS was issued a permit to install a (date) (installer) septic system at L a,ne- based on a design drawn by (address) 'Sc E0A(()eer irt1 , T'nG, dated 2-0( y . (designer) V/� 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. Stripout (if required) was inspected and the soils were found satisfactory. 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. Stripout(if required) was inspected and the soils were found satisfactory. �y►TH Oi4_ JOHIV L. c chU�+�H1�L Winstaller's Si re) • L 418 esigner's ignatur TALUTH p Here) to PLEASE RETURN TO BARNSTABLE PUBLIC DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH TINS FORM AND AS- BUILT CARD ARE RECEIVED JRY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoMce fonnAdesignercertifieation form.doc ri1E Town of Barnstable P# Department of RegWatory Services rfAaM8TA8I$, r Public Health Division mate MASS. �A 039. 1�� 200 Main Street,Hyannis MA 02601 Date Scheduled d' g Time Fee Pd, l/ d Scoil Suitability Assessment or Se e G Performed By: VAaeA VINY-()�0 LIT C S G Witnessed B � Y� ' . LOCATION&GE1. ERAL INFORMATION Location Address �} Owner's Name 7&tC%RlI F t✓.�f�"� (✓6'�'lll-C `��.IIiCC,E Address <�4 L i 4ai GN Assessor's Map/Pa-reel: ' 7 Engineer's Name,�,06ZO(bit- s - aacl NEW CONSTRUCTION REPAIR — �G �a�tnee�ir7� Telephone# 4t7 -T R / r 50$-273--M J/ Land Use Sirty12 Fcun��y a yGj�t�v Slopes(96) �' Surface Stones 7C1 Distances from: Open Water Body ft Possible Wet Area f[ Drinking Water Well ft Drainage Way ft Property Line 7 1 b ft Other - ft SIM'TCI:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) See cti{+ccw-d ."'mow w' � t 00 C^ L` O Parent material(geologic) w} 5� Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater 7 ( 3 2 n 1oc�S DE'I'ER1 RNATION FOR SEASONAL HIGH WATER TABLE Method Used: Direck• bbse,y o k", Depth Observed standing in obs.hole: 13?p g lu. Depth to soil mottles: .Depth to weeping from`side of obs.hole: III, groundwater Adjustment In. In, Index Well# Reading Date: Index Well level__ Adj.factor Ar(.C3rdutldwater Level PERCOLATION TESL' Date 3yy'/y 'rime 1i V34h Observation _ Hole# ( Time at 4" Depth of Pere Time At 6" Start Pre-soak Time @ 1 1 `13avrt - Time(9"-6") End Pre-soak 2ctm Rate Min./Inch 4 7- Site Suitability Assessment: Site Passed y Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***1.f percolation test is to be conducted within 100' of wetland,you Must first notify tile, Barnstable Conservation Division at least one (1) week prior to beginning. Q:\S EPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# j *2- Depth from Soil Horizon Soil Texture .Soil Color Soil . Other Surface(in_) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. `'�. � _ onsistency.46 Graven (4� �[G� /6-tZ lZ'l°y2 C, S 2,iY �016 DEEP OBSERVATION HOLE LOG Mole# Depth from Soil Horizon Soil Texture Soil Color Soil cOther Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ' Consistency,% ravel DEEP OBSERVATION BOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. t Consistency,95 Graven F rr ' DEEP OBSERVATION BOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, ConsistQncy, 6 a l)_ Flood Insurance hate Map: 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? y'e5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on to Z 7- y 9 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and expe ' ce described in 10 CMR 15.017. Signature Date Q:13BFTIC�PLI RCPORM-DOC s` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form ="Not for Voluntary Assessments Prope y)Tfre�ss- aAA Owner OW information is01 required ford every page. ItylTown State Zip Code Date of In pe �iio Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information /4/- 17— 0,/ When filling out forms on the computer, use 1. Inspector: only the tab key :to move yoor Michael DeDecko _ -- cursor-do not Name of Inspector -� use the return key. Compass Realty Development Corparatio_n _ - -- Company Name VQP.O. Box_2384 — Company Address ! = Ma µh' 02649 r. Mashpee _ - --- emm � City/Town State Zip Code c:7 508 -221- 5003 Telephone Number License Number r f 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 16.340 of Title 5 (310 CMR 15.000). The system: d"Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local.Approving Authority Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. blank form•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 � Commonwealth of Massachusetts � �N~��N°= �� *~��N N��=^�� °�� Title �� ^�� m� Inspection N—��mmmm Subsurface Sewage Disposal SvmtenmForm - NothnrVo|untaryAasessmenbs ' Owner ' information is required for every page. C'v'."=" nm� up�oo� Date o'm^pe="" B. � ~~. ��".cation (cont.) ' Inspection Summary: Check A.B.C.OorE/always complete all of Section D AJ Sy5elm Passes: I have not found any information which indicates that any of the failure criteria described \n31OCK8R15.3O3orin31OCK8R15.3D4 exist. Any failure criteria not evaluated are indicated below. Comments: BN System Conditionally Passes: El One or more system components ars,described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yea, no or not determined (/. N. NO) in the E] for the following statements. If"not ' deternnined." please explain. Fl 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 im replaced with a complying septic tank aa approved by the Board ofHealth. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance \ndioaUng that the bank is less than 20 years old is available. � ^ NO Explain: | . ' Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): blank form-08/06 broken pipe(s) are replaced obstruction is removed Title s Official Inspection Form:Subsurface Sewage Disposal System'Page 2m`5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ChM .k , Property Address A Owner CZwner's;Name ---- information is required for �, r ,!• v, `<� , _ :.' i r every page. City/Town State i,5 Code Date of lnspectlon " B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 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. blank form-06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Propert�Address Owner Owner'*.Name information i's required for every page. City/Town State Zip Code-- Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): El The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other-failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No E] Backup of sewage into facility or system component due to overloaded or clogged SAS or CeSSP001 El 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 E] Liquid depthin cesspool is less than 6" below invert or available volume is less than 1/2 day flow EDT/ Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipe(s). Number of times pumped: El lz 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. blank form-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address Owner w information is required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont) D) System Failure Criteria Applicable to All Systems (cont.): Yes No El EJ Any portion of a cesspool or privy is within a Zone I of a public well. El E2; Any portion of a cesspool or privy is within 50 feet of a private water supply well. El 0 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.] 1, e system is a cesspool serving a facility with a design flow of 2000gpd- The system falls. 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 b e considered a large system the system must serve a facility with a 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 El the system is within 400 feet of a surface drinking water supply El the system.is within 200 feet of a tributary to a surface drinking water supply E-1 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 ' If you have answered ^vas^ bo any question in Section E the system ia considered a significant threat or answered ^yeo^ inSeoUnnO above the large system has fmi|ed Thef ' system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 5.30*. The system owner should contact the appropriate regional office of the Department. blank form-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address 1 Owner Owner's,Name information is o r h required for ..�`.: t� +r. '�.. a ' +.�t every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ E 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 NIA) ❑ 0 Was the facility or dwelling inspected for signs of sewage back up? LI y+ ❑ Was the site inspected for signs of break out? ETf ❑ 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. 0 ❑ 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)] blank form•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name information is ) r• +,� `'^ i required for every page. City/Town State Zip Code Date of Insp8ctlon D. System Information Residential Flow Conditions: Number of bedrooms (design): — Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): ---- Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes E] No Laundry system inspected? ❑ Yes 4.Q ,-'No Seasonal use? ❑ Yes ❑ '`No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes Eg No Last date of occupancy:'°� — 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: Last date of occupancy/use: Date Other (describe): - blank form-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Addrs Owner Owners Name information is required for every page. City/Town State Zip Code Date of inspection- D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes g❑` No If yes, volume pumped: gallons How was quantity pumped .determined? --- Reason for pumping: Type of System: r 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes El"No blank form•08I06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address Owner Owner's Name information is A f t— /—. required for " 1effnL every page. City/Town State Zip Code Date of Ihspe6ti6n D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 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 ofleakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet Material of construction: Dr Concrete ❑ metal E] 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 E] No ------------------------------------------------------------------------------------------------------------------------- Dimensions: Sludge depth: 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? blank form-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage'Disposal System Form Not for Voluntary Assessments pq a_ Property Address Owner Owners Name information is required for every page. City/Town state Zip Code Date oflnspe6t Fon 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.): Grease Trap.(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete El metal F-1 fiberglass El polyethylene ❑ other (explain): 'Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottombf 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.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete E] metal El fiberglass ❑ polyethylene ❑ other(explain): blank form-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts r Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name e information is required for every page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 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 outof box, etc.): �i , � �� Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No blank form-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address\ OwnerOwner's Name information is required for _ .� � F! �� every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑� leaching pits number: ❑ leaching chambers number: — ❑ leaching galleries number: — — ❑ leaching trenches number, length: — --- ❑ leaching fields number, dimensions: - ❑ overflow cesspool number: —= ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of poriding, damp soil, condition of vegetation, etc.): -.._ '. _. ..� •SE; i 4 d..'. n ... . 1l..Nl ..1'6.„. k. y 3 .11 ry ".1 I � { 4 P e 3R v `� r i `�K.:t: �a ;. '�i. u'�' 1'm f blank form-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Pro ert Address X , �. "._ t. J = Owner Owner's Name information is required for 9 '' '�� F :ti Ar. every page. City/Town State Zip Code `' Date of Inspec D. System Information (cont.) 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.): 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.): blank form-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Addrbss P d 1— �--Q Owner 0 er's Name information is required for every page. City o n State Zip Code Date of lhspectibn a. D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Del*S Y a7 V blank form-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 • r �L\, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name information is � �- required for S 'i�x 4(a§ t _ • `t a w �.�.,. every page. City/Town State Zip Code Date of„Inspecfion" ` D. System Information (cont.) Site Exam: EI/Check Slope EfSurface water ❑ Check cellar ❑ Shallow wells Estimated depth to 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: blank form•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 TOWN OF BARNSTABLE L(iCATION SEWAGE # VILLAGE �A *-61 �� ASSESSOR'S MAP & LOT/G� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �X� (size) 6,41, NO. OF BEDROOMS BUILDER OR OWNER pe,( C l � PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachii g facility)-- Feet. Furnished by 145RCG 1M .� ♦CD/� a � � I a ao6 3a 3 18' 38" y a-7 11 1S� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS RECENED DEPARTMENT OF ENVIRONMENTAL PROTECTION DEC 2 2003 TMN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 94 Liam Lane 1 Centerville, MA 02632 MAP Owner's Name: David Feldman PARCEL, ' `�� (0 OI Owner's Address: Date of Inspection: November 6, 2003 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs F rther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: November 10, 2003 The system inspector shall4subm* a of this inspection report to the Approving Authority(Board of Health or f DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 94 Liam Lane Centerville, AM Owner: David Feldman Date of Inspection: November 6, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined", please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 94 Liam Lane Centerville, MA Owner: David Feldman Date of Inspection: November 6, 2003 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 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 I 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 I "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 94 Liam Lane Centerville, MA Owner: David Feldman Date of Inspection: November 6, 2003 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 94 Liam Lane Centerville, MA Owner: David Feldman Date of Inspection: November 6, 2003 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: Yes No ✓ 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(3)(b)]. 5 f Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 94 Liam Lane Centerville, MA Owner: David Feldman Date of Inspection: November 6, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x# of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Weekend use COMMERCIAL NDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Qpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: Qallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box, soil absorption system Single cesspool Overflow cesspool Privy \ Shared system (yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Jan. 7183-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 94 Liam Lane Centerville, MA Owner: David Feldman Date of Inspection: November 6, 2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting, evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 94 Liam Lane Centerville, MA Owner: David Feldman Date of Inspection: November 6, 2003 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 94 Liam Lane Centerville, MA Owner: David Feldman Date of Inspection: November 6, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits, number: 6'x 6'(1000 gal.) leaching chambers, number: leaching galleries, number: leaching trenches, number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): The pit was dry. The scum line was approximately Y up from the bottom There did not appear to be any signs of failure The bottom to grade was 9. The cover was 2'below grade. CESSPOOLS: None (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 or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: None (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.): 9 Page 10 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 94 Liam Lane Centerville, MA Owner: David Feldman Date of Inspection: November 6, 2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. a � L0 3a 10 Page 1 1 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 94 Liam Lane Centerville, MA Owner: David Feldman Date of Inspection: November 6, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30 +/- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom ofthe leach Ditto grade was 9. Using the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 30'+/-to groundwater at this site This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 LO.CIAj ON 6 SEWAGE PERMIT NO e v VILLAGE c 11 A� IN A R'S NA i ADDRESS d e U I E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED le Wl 77 1 P 2 No. .73� Fxs.... ..... . THE COMMONWEALTH OF MASSACHUSETTS BOARD QF.. HEAL ....5�. ....--...OF......:.............."1"1! a(!. '.........._.... Appliration for Disposal Works Towitrnr#iun Prrutit Application is hereby made for a Permit to Construct) or Repair ( ) an Individual Sew g Disposal System at: �\ A d ...l.................. .................�.T 11 l 1.�._ ocaf �e o tNo.sC ....-•-•-----•------------. ......... .. ...... �. ....•••...... ..................... er Address a :.-• / - .F C�q`� 5r'� --------------------------•---- �"� Installer Address Type of Building Size Lot__ _______ _ ____...Sq. feet Dwelling—No. of Bedrooms...............�----------------------Expansion Attic (�?7 Garbage Grinder (Xt aOther—Type of Building ............................ No. of persons----------------------------- Showers ( ) — Cafeteria ( ) P4 Other fixtures ................................. - 5.7' w Design Flow............: ..........__._..._..gallons per person per day. Total daily flow._._......... 3..b.....................gallons. WSeptic Tank—Liquid capacit�(. 4}.k.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 (A Dosing tank ( ) J Percolation Test Results Performed by______________________(�_�? _�'�._ � Z Y� a �`�---------`mil••------ Date.---•-••�-----/..��.. Test Pit No. 1....4=rr5-S_minutes per inch Depth of Test Pit....... Depth to ground water_______ _____ (T, Test Pit No. 2.....`tZ __ 1inutes per inch Depth of Test Pit.................... Depth to ground water-----...... ---- -of w D � ------------------------------..0=.- ()A-- • ` --------------------------Z-----•-- ------------... _T ---- •--•-•-----••---•-... 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 ITL 111: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board iealth. r gned . ? .. .��..•-• . ... .......... Application Approved B ` Da ..:....... -- 1/ ® y ate Application Disappro d f r the following reasons---------------•----------------------------------------•------------------------------..._...-••-----........... ---------------------------••--...............................................................................................................................................................t Date Permito........---•-•-------------------••---•-•-•-•----•------- Issued....................................................... Date ` ......73� Fizz... .r.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H EALT1,-L �� ,�,� a 1 ............... ...................oF............................�... ....._._...... .................. Appliration for Dispaiial Vorkg Tom3trurtion ramit �4 Application is hereby made for a Permit to Construct�.kA.:�) or Repair ( ) an Individual Sewage Disposal System at: ................-- = �•'-—#.T ......................... ......� '-�`. _ --•--_.....'r?! "C.................................. .. y ............. ' ,I,,ocat on Adcyess Lot Nof Q - .... ........_ ........................ .- wner Address a ................................................ fr '��••-•••-•---• .................................... ,!.".�e::`"t a........... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.................i_.__................._...Expansion Attic ( } Garbage Grinder (/t-o' a'4 Other—T e of Building ___.... No. of persons............................ Showers YP g ---------------•----- P ( ) — Cafeteria ( ) d Other fixtures ------------------------------------•--•-- W Design Flow_____________r= ........_._.......___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. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box („ ) Dosing tank ( ) f Percolation Test Results Performed by---------------------- .. f*.A;r!-x._... `Y ....__. Date._.._____ 7.'1�..'�- ,-� ---- e Test Pit No. 1.... -•S.iminutes per inch Depth of Test Pit...... f�f..... Depth to ground water...... F 44 Test Pit No. 2......::%f" ^minutes per inch Depth of Test Pit____________________ Depth to ground water... .-_..........._._. a' "--=--------------------------c•-....------.....I............. .._._..._.._._...........y _ O Description of Soil f 6 ...._: ; .. ... -r ---1--Uf .....�"''-------•----------------- G _ �,. C, .�> .........�---------•----.'----------------------------•------------ s' -----.._...- W -------------------------------------------------------------------------------------------------------------------------•-------------------------...------............--------•------...-••--•------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -- ...................................-.........................................................................................•...................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provision of'Tmf 5 of the State Sanitary Code—The undersigned further agrees not to place the system in ..� operation until a Certificate of Compliance has been issued by the board of-health. '7 t{ Srigned.............. . ,; :. fir ... ..i.... .... � f._Y � �1 «° Dat, Application Approved BY •:�•-------------------------------------------•-•-----••-••-------------•----_-• 1 ;`. -�'=•--•--- f . } Application Disapproved for the following reasons:-------•-------------------------------------------------------------------•-----••--••-••---•-------......._. f / ....................•--.....------•-••-------------------•-------------------------•-•--••-•--------•----........-------------•--------- ----•-•-----•---•-------------•---------•--•---•----.....-•--- r ✓r Date am PermitNo................................•---------•-•--------.... Issued---------•---•--------------......._..... ---------.. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... :: ✓...„.............O F.....................4!`:........................................................... f......... Trrtifiratr of Toutpliunre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) - _.... - ............................ f/ _ Installer - ` , f�;•t f r i4. r .,lam# - r'1 (.Z' /ed -at -----•....-----•.......................�............------. x. .....----------------- ,�has been installed in accordance with the provisions of TITL ;.of The State Sanitary CodesEril in the application for Disposal Works Construction Permit No. @.. ... . . ............. dated__. � .............. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTR D AS A GU RANTEE THAT THE SYSTEM W "NOTION SATISFACTORY. DATE..../ 1... ......................................................... Inspector... ... .--------••-------•-------•-----------------•••----------•••••••-••-_----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No........................ FEE........................ Rap ors_al Vorkv 0uatutr irrn rrutit Permission is hereby granted................. 11.21--�-e'-17.•-----. ....................0...-...---••-----------•-•-•...--•...................-•---..._.. rr . to Construct_( ) or Repair-( )an Individual Sewage Disposal System ✓ at No..S '` ==•t') f f�, -(i�,.� _, t w-t --- ._.......... ------.-• --------------•• - i Street as shown on the appli do or Disposal Works Construction Permit No.............c✓- ated..f?'_., ......................... i...< r . �� .._... / Board of He Ith DATE FORA? 1255 HOBBS & WARREN, INC.. PUBLISHERS r Y� rr 14 z v_ o �Z 36,S s,F ,� \ \ nn T P 4- �j / _ ►� t 1 (^ ,tN OF Iygssqu' I`1-5r VJ�L1�--is � FEEWS F; S:B • , ft n814 �CIsTESURN It a` �Noo LEGEND ► � CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION Ox0 _ �Ss EXISTING CONTOUR ---'O --- ��/�`i '� , L D� /5; L. rA FINISHED SPOT ELEVATION r�'v Ar FINISHED CONTOUR ® o oRsE APPROVED , BOARD OF HEALTH oA p`sc N� 10951�nQ I�N� ` y C, DATE AGENT rov°°v°��' SCALES i= SO ' 'DATES /l � 7;%rS' - LDREDGE ENGINEERING CQ CLIENT. I CERTIFY THAT THE PROPOSED EGISTERE REGISTIERED �O® NO. �2.Q �� BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEY R DR.BY y OF BARNSTA 'LE , %MASS. a 712 MAIN STREET CH. By J HYANNIS, MASS. SHEET: OF DATE gEG. LAND SURVEYOR n NO T€ /F E/TNER TNE.S�PT/C TAN/C OR €. 20 FT.. M/Iti/. �!EAC.IqIIVG P/T AR.— MORE TNr9,�/ /2"�BELOJV� uJ -f"' /O )wr. /•'1/N, �RAOE� fi 24 'O/AMETEK C0NCR.E7-E COliER _ SMALL eE BROUGHT To 4/TAD, /✓ EXTRA rA CONCRETE �' PVC.P/pE h'EAvy CAST /RO/Y Cover .Sh1.4LL (3E US60 ES E`✓. �q to COVERS - MIN.. P/TCN /F/iv OR/v=IWA Y �9�I�EiQ FT. A ="a a— G1tADE CU VER CL EAN SA/V O &ACXFILL 7 _ ' —LAYER 4 :• IRON 6 JNIN:P/TCN GAL: ' e • • • • • • • • • e •4 {yASHF0 57XJNE I: .. %4'PE/t fT. SEPT/C TANK D/sT, , b • • . . • • • A =••:• BOX v • • e . r • • .•• • • fir; s • r • •EFFECT/VC ` • 314 - �2 • ° • • • • DEPTH • too • v WA5h+E0 STONE 7 . . . v. , • • . • • . • • p PRECAST SEEPAGE 7a x. J,o s a • • • • • • • e o P/7 OR WL//V. INVERT_AT 041ILD/1Y6 35 o FT 6 FT D/AM. INLET SEPT/C TANK • FT, / F7 O/A1+'f• C�SFE TABULATION OUTLET SEPT/C TANK FT. INLET DJSTR/8!/T/ON BOX 34•4- FT. SECT/ON..OF GROUND ItrfiTEK TABLE ouTLETDisTRieurioN BOX 34•ti � .SEI�AGE O/SPOrS'A L SYSTEM /NL.ET LEACHING /�/T 34•� FT• TA8411-.4T/DA/ LEACH/New =/T 3 FT SCALE %~ /=o DIMENSION A DES/G/Y CRITERIA DL�fe�rs/.o/v 8 G fT• NUMBER OF BEORoOMS 3 D/HENS/GN C 4 FT. ��"l, It GARBAGED/SPO-S.4L UNIT i✓ONC 50/1- LOG TOTAL EJTIMrATEG FLOW 3 3 y G.4L.1DAle SOIL TEST 0/ SOIL 7W 7- '2 .SOIL TEST ` •fEK3 _NUMBE ROF LEACNl1V6 P/TS OA 7-C OF SO/LTEST , SIDE LEACii/NG PER P/T RESULTS is//TNESSEO dY��'C s `"�" D— Z f BOTTOM L64CN/NG PER P/T 7� $Q, pr. PERCOLA710 v eATE#/ =sS M,1"11NCH { TOTAL LEACH//YG AREA " SQ. FT. TUT'saiL,_ P1EJtCOLNT/ON RA7,EIk2 RESERVE LEAC'N/N6•ARE,4 SQ. F T Z _ 1-2 ' rI—Tr�'r 1' _ P- I IG1 �ZN OF Mq,syOFS al �!o, ALB S' C IV l�Lw,2 G•e' `L o i o +/ C��RZi'� ar ��o AVNfO"R5E N No.10951 Q ELOREDGE ENGJIVEEi4//VG CO,ING. 5('Q>sYB�►ypQ /jv <,, ql�; < , L,--V, 21 �" 712 JN^//Y Sr. , HYANn/iS, MASS. N� SURF' FSS/oNAL ENS\ J NO GROUNv. YNi4TER ENCOU/VTEREO CL Mc"T:C7iz`Ef/3"1?" DATE l /f/? v t Q GROUND WATER AT 6LEL� _ � .JOB NO: 8 2.c / SHEET Z OF z ' PROP.VENT WITH CHARCOAL FILTER TO ABOVE GRADE GENERAL NOTES T.O.F. EL.= 39.1�± FINISH GRADE OVER D-BOX= 38.2 +_ FINISH GRADE OVER CHAMBERS = 3$.0' - 40.0' PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC OUTLET TO WITHIN 6"OF F.G. INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL LE WASHED FINISH GRADE , F.G. OVER TANK EL. = 37,7'± 5" DIA. OUTLET(S) MIN SLOPE 1% BOX TO F.G. (SEE NOTE 21) STONE OR GEOTOEXTILEO FILTER4FABR ASHED i CODE AND ANY APPLICABLE LOCAL RULES. @ FND. EL.= 37.8 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE i , DESIGN ENGINEER. " �� TOP OF SAS = 35.50' PLACE RISERS ON ALL � -EXISTING 4" _�-_� PROPOSED 4" 9"MIN. 4.50'MAX. CHAMBERS WITHi 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE SCH. 40 PVC 36 MAX. 34.50' SEE NOTE 22 BREAKOUT EL= 35.00' INLET PIPES TO 6"OFSYSTEM UNLESS OTHERWISE NOTED. - SEWER PIPE I FINISHED GRADE Tfl] 6�3" 3"DROP MAX 3„ 9" ' 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2"DROP MIN L=34 ± PROVIDE WATERTIGHT ELEVATION = 35.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A - MIN. 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 10" 4" PVC IN FROM JOINTS (TYP.) � 14" \-*35,2'± SEPTIC TANK 01 4" PVC OUT TO 0 O 0 0 0 0 0 0 0 0 Gb OTHE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE LEACHING FACILITY To0 00 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN 124' " oo 0 0 INLET AND OUTLET CONTRACTOR " CONTRACTOR SHALL OUTLET TEE 34•85' MIN 6 34,6 8' 2� oo 00°0 o� 6: THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48 VERIFY CONDITION OF LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE 00 000 o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY o0 00 o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE _ I AND DESIGN ENGINEER. 4.0' 8.5'(TYP) 4.0' 4.0' 4.0' 5 OUTLET DISTRIBUTION BOX 4.83 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 38.00, TO BE INSTALLED ON A LEVEL STABLE 25.0' (NP') ESTABLISHED ON CORNER OF BULKHEAD AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 32.50' GROUND WATER ELEV.= 27.00' 12.83 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK 2 - 500 GALLON CHAMBERS 5' MIN. CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES 'CON!-RA(,1 Cr- i U VERIFY EXISTING CROSS SECTION VIEW H TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. ELEVATION PRIOR TO ANY WORK & SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL -20 CHAMBER DF TAILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE -�-�- 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING - TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM -• Q • i PERC NO. 14309 APPROPRIATE AUTHORITY. ZONE 2 ''s t -. r INSPECTOR: Donna Miorandi, RS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS • - -- •� LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE EVALUATOR: Michael Pimentel, EIT, CSE ,' THEY SHALL WITHSTAND H-20 LOADING. • �# _ p � �. C.S.E. APPROVAL DATE: Oct. 1999 '� • 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. • `` DATE: March 19, 2014 r�, ,/►a` • 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE { fl # * TEST PIT#: 1 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. + • �, • ELEV TOP= 38.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, ELEV WATER 27.00' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). * • = Benchmark * . • * 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN Bulkhead Comer EXISTING 1,000 GALLON SEPTIC TANK * • ' f PERC RATE _ <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. MAP 167 Elev. = 38.00' TO BE UTILIZED IN THIS DESIr'BLOCK 16 Approx. M.S.L. DEPTH OF PERC = 12"-30" 16. PROPOSED PROJECT IS LOCATED WITHIN: Cb U � �,o LOT 14 _ _ -44 I LOCUS TEXTURAL CLASS: 1 ASSESSOR'S MAP 167 BLOCK 16 LOT 13 m M _ ,. - p OWNER OF RECORD: JENNIFER A. DIFEDE °42'22"E '�n Z - - N8p MAP 167 < 1 0 p" 38.00' 203 83 LOT 43 d �"` Fill ADDRESS: 94 LIAM LANE 40 X 9 a o 6 37.50 CENTERVILLE, MA 02632 Loamy Sand B 12" 10Yr 5/6 37.00' ! FEMA FLOOD ZONE C 38 \ ��.��' \ \ aD Perc COMMUNITY PANEL# 250001 0016 D r. 30„ MAP 167 Lu 35.50 l� �� 17. DEED REFERENCE: L.C.C. 182874 CNN BLOCK 16 N 18. PLAN REFERENCE: L.C. PLAN 37478-C LOT 13 a' -f- -' LS \ W 1 EXISTING LEACHING PIT TO BE a Q 0 22,366±S.F. PUMPED REMOVED & REPLACED • a . 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 1 fV ~ /� WITH CLEAN COARSE SAND PER ` VP ' r Sj Medium Sand #94 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY S I 310 CMR 255(3). • x �+ C 2.5Y 6/6 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY y�W EXISTING PR. D-BOX 0 V -wS' 2-BEDROOM OCP ■ * yam° FOK USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 0o S W V DWELLING DECK \ N • • '' 21. A 4"PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A TOF = 39.1'± DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A 3HxO' �,' Ln REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. m 22. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE C, O 37.6' LOCUS PLAN APPROVAL IS REQUESTED FROM 310 CMR 15.221 (7): vP �I� O (1.) A 1.50'WAIVER(3.00'-4.50')FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. SCALE: 1"= 1000' 132" 27.00' � ;,�O s cp 1 PROPOSED No Mottling, Weeping or Standing Observed 0xOO' INSPECTION DESIGN DATA LEGEND oGF o TEST PIT DATA PROPOSED 2 - 500 GALLON PERC NO. 14309 - � H-20 LEACHING CHAMBERS / 41x3' PROPOSED 4" INSPECTOR: Donna Miorandi, RS / 40x1' NUMBER OF BEDROOMS DESIGN WITH AGGREGATE PVC VENT PIPE; (DESIGN) 3 MIN. PER TITLE 5 50x0' EXISTING SPOT GRADE `r EXACT LOCATION EVALUATOR: Michael Pimentel, EIT, CSE � PER OWNER MAP 167 DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E. APPROVAL DATE: Oct. 1999 50 - - EXISTING CONTOUR I. �I LOT 44 TOTAL DESIGN FLOW 330 GAUDAY DATE: 50 PROPOSED CONTOUR March 19,2014 DESIGN FLOW x 200 % = 660 GAUDAY TEST PIT#: 2 50 PROPOSED SPOT GRADE S82°45'33"E USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 40.00' GAS EXISTING GAS LINE 159.68' ELEV WATER= 29.00' PERC RATE _ ❑/H/W -- EXISTING OVERHEAD UTILITIES DEPTH OF PERC= W W- EXISTING WATER LINE MAP 167 INSTALL 2 - 500 GAL. CHAMBERS w/ AGGREGATE TEXTURAL CLASS: 1 -� TEST PIT LOCATION BLOCK 16 SIDEWALL CAPACITY LOT 12 (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY _ _ (25.0'+ 12.83')(2 ) (2' ) (0.74 GPD/S.F.) = 112.0 GAUDAY 0" 40.00' 0 0 EXISTING 1,000 GALLON SEPTIC TANK Fill BOTTOM CAPACITY B 6" Loamy Sand 39.50' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE SWING-TIES SCALE: 1"=20' (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY 12" 10Yr 516 39.00' i ❑ PROPOSED DISTRIBUTION BOX DESCRIPTION HC-1 HC-2 (25.0'x 12.83') (0.74 GPD/S.F.) = 237.4 GAUDAY PROPOSED 500 GALLON H-20 LEACHING CHAMBER CORNER OF STONE(1) 31.4' 20.4' TOTALS: CORNER OF STONE(2) 52.2' 30.7' TOTAL NUMBER OF CHAMBERS 2 REV. DATE BY APP'D. I DESCRIPTION --- ------- - CORNER OF STONE(3) 58.8' 40.3' TOTAL LEACHING AREA 472.2 SQ.FT. i PROPOSED SEPTIC SYSTEM UPGRADE TOTAL LEACHING CAPACITY 349.4 GALJDAY Medium Sand CORNER OF STONE(4) 41.4' 33.2' C 2.5Y 6/6 PREPARED FOR: CAPEWIDE ENTERPRISES LOCATED AT #94 EXISTING 94 LIAM LANE 2-BEDROOM CENTERVILLE, MA 02632 MISCELLANEOUS NOTES: DWELLING DECK 2) TOF = 39.1'± 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC HC-2 cS 132" 29.00' SCALE: 1 INCH 0 10 20 40 80 FEET = 20 FT. DATE: MARCH 22, 2014 i SYSTEM COMPONENT. p�- � o `cP No Mottling, Weeping or Standing Observed ��of r��as c J! 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED "' O / JOHN PREPARED BY: LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. HC-1 3) RESERVED FOR BOARD OF HEALTH USE J JC ENGINEERING, INC. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH O CF1uF,t; ii R. <„ TEST PIT DATA. (1 5 � No l\"1 07 2854 CRANBERRY HIGHWAY /`� :, EAST WAREHAM, MA 02538 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS ONLY. SITE PLAN- (4 `r �� 508'273'0377 SCALE: 1"=20' 1 Drawn By: MCP Designed By:MCP Checked By: JLC JOB No.2684