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0054 LONGBOAT DRIVE - Health
`54 Longboat Drive Centerville P A = 193 152 4 00-5 i r i 3 Owrford, N . 0 1521/3 ORA 10% I V No. a019 / 6 Fee /V'. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes fipfication for his o5d 6pstetn Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System 4diidual Components Location Address or Lot No. 514 L od6eo QT Diu Ulf_ ` Owners Name,Address,and Tel.No. Assessor'sMap/Parcel CIViL�= N&Jdy J5IG4MAN Installer's Name,Address;and Tel.No. 50V_q77-897 7 Designer's Name,Address,and Tel.No. 5 C�9-X7�3 �-0 3-7 7 CA W-14C-- a ti C6&31 0-So J G EN GO N 1r�W C—. =tQC Type of Building: J rip I M��' , _,a �y&,t t� � Fit✓7`Y,�/a. a t'� Z`,t'►pf Dwelling No.of Bedrooms "► / Lot Size '4 t'1 3,; — sq.ft. Garbage Grinder( ) Other Type of Building RC;t t PLC_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) g110 gpd Design flow provided 4->—S,w-L- gpd Plan Date I I -30-20( S Number of sheets Revision Date Title S74 (.0 N Cz&)4 f bru (jc, 9 Size of Septic Tank l l000 G.�Ou,S Type of S.A.S. �G� Description of Soil it(&--7) rSGfrc/G� t 6 (3 ti 6ti5T PLA Aj Nature of Repairs or Alterations(Answer when applicable) V� �X -1b lUEx) 14-10 D -6 04 ,V (3) 5CQ Cv#u.�aa 14-10�Cdkaaa, ,q W 17b- 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. Si Date Application Approved by__ niDate Application Disapproved by Date for the following reasons Permit No. U �� 371 Date Issued .� 6 µ . 7. ro No- 019 / Fee'x j/, -` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 3. f ltlfitation for Misposal.*pstdt Construction 3permit Application for a Permit to Construct Repair ade Aban one PP ( ) p ( pgr ( ) , ( ) ❑Complete System t ndividual Components Location Address or Lot No.5t4 L ON*00r4T DRIVE" s Name,Address,and Tel.No. Assessor'sMap/Parcel f.9-5 j oZ. C"Vic.0 N on 51�kM E AV/ckg Installer's Name,Address,and Tel.No. 50j_q 7-$S7'7 Designer's Name,Address,and Tel.No. 5701-X73 -0 37 7 <�A WI4W ENG1"�__G;RJ&J Cx =NG, ( HASAP6W HWq Type of Building: ' f ><<}' `r S-U v (vc�j rAjp1SIM� � U� �� 7cMaf Dwelling No.of Bedrooms "( Lot Size + v oZ`-E7 3 sq.ft. Garbage Grinder( ) Other Type of Building RMJ( ,r t A&. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) q1l o gpd Design flow provided St.Z.., gpd Plan Date ( 1-30- gp,4 Number of sheets Revision Date Title 54 LoiyGz, � ' 1)m thr- -�►.� �C,C� Size of Septic Tank 1 10,00 G.CJ oXJ S Type of S.A.S. (3) r6ot bok.. Description of Soil 11t&_J) c5 CR 3 y f9 kA jJ / at Nature of Repairs or Alterations(Answer when applicable) U S6—_ GL(_5T(&JG ( (2op 6g wj 6c;'1<... -MAX -ib MOO K-l0 0 --1904 -r):> 0) c.0 c H-10, CHA_4016wS w 014 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.^� Si id\ Date Application Approved by �.�( ,, �O Date �. �. . Application Disapproved by Date for the following reasons f Permit No. 2 O `,? r 3 ?J i Date Issued t , THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by C/�p5Lc:�11Nl' I� S IC� - at `�7� L U�V Gc has been constructed in accordance - - with the provisions of Title 5 and the for Disposal.System Construction Permit No. :2 6 _2kted A/ Installer CAPQA)lpG CD- / 13Q Designer T'C, trc1 #bedrooms L� Approved desi flow A LJL11J gpd 4 The issuance of this permit shall not be construed as a guarantee that the system will function designed. Date 1 '} Inspector U 1A,,, • , 1 � ----------------------------- ----- ----------- No. d ' _ 7V Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal !&pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 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 be'completed within three years of the date of this permit. �+ Date' J if,� Approved by R ' Dec, 11. 2018 10:48AM No. 2846 P. 1 Town of Barnstable Regulatory Services Richard V,Scali,Interim Director b yA1WBT'AB�. � A M �e$ Public Health Division Thorhas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date. I�" $ Sewage Permit# Zo 1S- 3-7!, Assessor's Map\Parcel 153 / 2- Designer: SG Eo5mcuIn5 1ocY Installer: Gaee.wiJe- 6 4-p-cerise) Address: 285`I Cran\o4rry � jgq w a: Address: 133 Coww"Cia j s4r�C,+ cask Ware�nam N�1 oz53 d MaskQee� N� 0 2 y 9 On =Zo cgeewc& `Or t4ecfwl was issued a permit to install a (date) (installer) septic system at 5Y L6n 5Wo t _D C0Q_ based on a design drawn by f: (address) SC En lll&C(Cn 3 �r%16- dated (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. Strip out (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 stem but in accordance with State & Local Regulations. Plan revision or p system) g certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was construc nce with the terms of the RA approval letters (if applicable) oar JOHN L CHUB lu JR. VIL (Insta r' i i u e A N .41 7 esigner's 1 e) (Affix igne s S mp Here) PL E RETU TO BARNSTABLE PUBLIC HEA H D VIS N. CERTIFICATE OF C MPLL4NCE WELL NOT BE ISSUED UNTIL BOTH IS FORM AND AS- BIALT CARD ARE RECEIVED BY THE BARNSTABLE PU C HEALTH DIVISION. TRANX YOU. QAseptiODesigner Certification Form Rev 9-14-13.doe TOWN OF BARNSTABLE LOCATION LQN CA50AT7 rJP SEWAGE# �;ko 18 -3-7(o 'TILLAGE C&Jre"Zt 'V 1 LJL— ASSESSOR'S MAPP&PARCEL I�V INSTALLER'S NAME&PHONE NO. APSLOUDE 196JTt"WiV5�J 66 of 7 w-i SEPTIC TANK CAPACITY 1 ,000 -C 4LL,3?'DS LEACHING FACILITY:(type)(3)5-00 G,4L dWNt0,9a9L5(size) (a it �X -53,; � NO.OF BEDROOMS OWNER NA99 SiEKMAW PERMIT DATE: 19,-4 -1-0 COMPLIANCE DATE: I c,L-"7 -AQ t Separation Distance Between the: / Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility NIA Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Rra N A Feet FURNISHED BY CAM .d f DLL COTRywiseT /Rvu 25 ' A. z ZB.s A-3 12' A RCA& g - R-S g�t • Li o z 9-2 `f ------ g-3, 93i to I i B_4: 95.5LA i Town of Barnstable Department of Regulatory Services B ruvv+ar�n[� j Public Health Division Date !I i I �p Ms 200 Main Street,Hyannis MA 02601 l j° rfD h11'd k -• _ �y Date Scheduled- Time Fee Pd. �tr ' Soil Suitability Assessment for S age Disposal Performed-By: pi mwlto! { S- L Witnessed By: LOCATION&.GENERAL INI1'ORMATION Location Address s[/ 1-0eU60 0+—( M C,0 Owncr'e Namo jUf�il�L` 51� J� a `l / ✓ Address Pk co [U—tr 1' ! ! ��- C tivEcaJcar; CST aets�-s� o ' Assessor's Map/Parcel ` 9 3 Engineer's Name�G C- /U NEW CONSTRUCTION REPAIR Telephone It �( O Land Use• 111Q1P ��A/ Slopes(9G) V` 'S /© Surface Stones /lAA 9 Distances from: Open Water Body > /00 ft Possible Wct•Area� O ft Drinking Water Wall N- / tt Dralhage Way ft Property Line IQ ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pero tests,locate wetlands-In proximity to holes) SC-e. (a��c�,qj p)at) ��lt1 Parent material(geologic) r� Depth to Pedrook_ >13c� �GS Depth to Groundwater. Standing Water In Hole: > ^^3 a4 lJ�S Weeping from Pit Fnoe 3a" 13C93 Estimated Seasonal High Oroundwater DETERMINATION FOR SEASONALUIGH WATER TABLE Method Used: feP�— obf'eI a1or, Depth Observed standing in obs,hole: 1) /3 In, Depth to sail mottles: Depth to weeping from side of obs.hole: 7l3 ill. Ornundwalmr Adjustment Index Well Reading Data: index Woll Isvol___ Aru,tttCtbr, --Adj.Groundwater-Level PERCOLATION TEST bate Bf PtI fLQ aik Observation Holo If 1 `� -t••-� TI me at 9" Depth of Pero Time at 6" Start Pre-soak Time(� I rI 117 Gtti Timo(9"-0) End Pre-soak Rate Min./Inch Site Suitability Assessment; Slid Passed `e J SItF Failed: Additional Testing Needed(YIN) 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:ISEPTICtPERCFORM.DOC i ' DEEP-OBSERVATION HOLE LOG Hole# , Depth from Soil Horizon Soil Texture Shcl Color Soil• Other Surfaoo(in.) (USDA) (Munsell) Mottling (Stnucture,Stonei;Boulders. Consistency,%t3ravoll o f Sa„ IO:ii'r S DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sol]Color Soil Other Surface(In.) (USDA) (Munich) Mottling (Structa o,Stones,Boulders. Consistency. DEEP OBSERVATION HOLE LOG Holm# Depth from Sol Horizon Soil Texture Soil Color Soil Other Surrace(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistency, OBSERVATION DEEP OBS N HOLE LOG Hole# Depth from Sail Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Siopei;Boulders, Consist Flood Ingurance Rate Maa: Above 500 year f lood boundary No Yes Within 500 year boundary No v, Yes._ Within IGO year flood boundary No.T_ Depth of Naturally Occurring Pervious Materlal Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorption system? V10- , If not,what 19 the depth of naturally occurring pervious material? Certificati°t' �J I certify that on 7 (date)I havepassed the soil evaluator examination approved by the Department of Envlronmental Protection and that the above analysis was performed by me conslstent with . the required training,expertise a experIence described in�10 CNM 15.017. Signature -� Datb Q XSBpTILVERCPORM.DOC �� .��\� \`� X` ' �� , `^L \./� ^A�V \ / V / i V l.l� �`Q Moin Levd ri 1 . N r _ A 1 TOWN OF BARNSTABLE � L6CATIOND�L� Y'� 7" �� SEWAGE# ASSESSOR'S &ILOT INSTALLER'S NAME&PHONE NO. / /S SEPTIC TANK CAPACITY LEACHING FACU-r Y: (type)r� 4'; %4� (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE:` t 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 v•=' feeygf 1 */itity) FP�r Fum N9gut Dr Cemre v,Ile ~ 1 sock RECEIVED ECOJECH Environmental SEP 16 2002 www.eco-techms TOWN OF BARNSTABLE HEALTH DEPT. THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSEFARTMENT OF ENVIRONMENTAL PROTECTION(revised 6/15/2000) TITLE 5 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM 1 4— PART A �T � '� Property Address: N-Longboat Drive CERTIFICATION Centerville Owner's Name: _ Joan McCarthy Owner's Address: 74 Longboat Drive Centerville Date of Inspection: September 9,2002 MAP I Name of Inspector:(Please Print) David D. Coughanowr,R.S. PARCEL : S— Company Name: Eco-Tech Environmental LOT Mailing Address: 43 Triangle Circle - Sandwich,MA 02563 Telephone Number: (508)364-0894 CERTIFICATION STATEMENT: I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. I am a DEP approved system inspector pursuant to section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature -S Date: S&l f Ot WO 2 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 NOTES AND COMMENTS Inspector's Note—> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. ****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 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 74 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9,2002 INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D: A] System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 5.303 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,or 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 breakout or high static water level 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 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 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 ND explain 2 Page 3 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 74 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9, 2002 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 and environment. I System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) System will fail unless the Board of Health(and public water supplier,if any) determines that the system is functioning in a manner that protects the public health,safety,and environment The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed by 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 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 74 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9, 2002 D)System Failure Criteria applicable to all systems: You must indicate either"yes" or"no"to each of the following for all inspections: I have determined that one or more of the following failure conditions exist as described 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. yes no X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high groundwater elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well X Any portion of a cesspool or privy is within 50 feet of a private water supply well X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.(This system passes if the well water analysis, performed by 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 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 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 i Page 5 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 74 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9,2002 Check if the following have been done: You must indicate either"Yes" or"No"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant or Board of Health. X Were any of the system components pumped out in the last two weeks? X _ Has the system received normal flows in the previous two week person? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available as N/A) X _ Was the facility or dwelling inspected for signs of sewage back-up? X _ Was the site inspected for signs of breakout? X _ Were all system components,excluding the SAS. located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the septic tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid, depth of sludge and depth of scum.? X _ Was the facility owner(and occupants,if different from owner) provided with information on the proper maintenance of subsurface disposal systems? For information on the proper maintenance of subsurface disposal systems please go to: WWW.ECO-TECH.US The size and location of the Soil Absorption System(SAS)on the site has been determined based on: X _ Existing information.For example,Plan at the Board of Health. X Determined in the field(if any of the failure criteria related to part C is at issue,approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 ' Page 6 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 74 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9,2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): n/a Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a(no plan on file at Board of Health) Number of current residents 4 Does the residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no): no :(If yes, separate inspection required) Laundry system inspected (yes or no): n/a Seasonal use(yes or no): no Water meter readings,if available(last two year's usage(gpd): 205 gpd Sump Pump(yes or no): no Last date of occupancy: current COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203):: gpd Basis of design flow(seats/persons/sqft/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: System last pumped in Febrnarv, 2002(Owner) Was system pumped as part of the inspection: (yes or no) No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM: X Septic tank,distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternate 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: Age: 17+years Certificate of Compliance issued 4/3/85 (BOH permit#85-19) Were sewage odors detected when arriving at the site: (yes or no) no 6 i Page 7 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 Longboat Drive Centerville Owner: Joan McCarthy_ Date of Inspection: September 9,2002 BUILDING SEWER_(Locate on site plan) Depth below grade: 2 It Material of construction:—cast iron X 40 PVC other(explain) Distance from private water supply well or suction line 20+ Comments: (on condition of joints,venting, evidence of leakage, etc.) Sewer is vented through roof and appears structurally sound with no evidence of leakage or backup into dwelling SEPTIC TANK: X (locate on site plan) Depth below grade: 15" Material of construction: X concrete—metal_fiberglass_polyethylene other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(yes or no):_(attach a copy of certificate) Dimensions: 8.5 It x 5 ft x 5 ft(1000 alg lon) Sludge depth: 4 in Distance from top of sludge to bottom of outlet tee or baffle: 30 in Scum thickness: 1 in Distance from top of scum to top of outlet tee or baffle: 9 in Distance from bottom of scum to bottom of outlet tee or baffle: 14 in How dimensions were determined: Probe to top of tank Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Pumping not required at this time but maintenance pumping recommended everyyears Liquid level at outlet invert Tank and tees appear structurally sound and functioning as intended No evidence of leakage in or out 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: 74 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9, 2002 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 inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: at outlet invert Comments:(note if box is level and distribution to outlets is equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.) D-box appears structurally sound with no evidence of leakage in or out.Effluent level at outlet invert Few solids in tank. 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 E� Page 9 of I OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9,2002 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan;excavation not required) If SAS not located, explain why: Type: X leaching pits, number 1 .—leaching chambers,number _leaching galleries,number _leaching trenches,number, length _leaching fields,number,dimensions _overflow cesspool, number —innovative/alternate system Type/name of Technology Comments: (note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.) Soils above leach pit appeared unsaturated.No evidence of surface ponding,breakout,lush vegetation, or other evidence of hydraulic failure was observed.Effluent level 6 inches below invert. CESSPOOLS: none (cesspool must be pumped at time 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 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9,2002 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'(Locate where public water supply enters the building) LOCATIONS LEACH 2 PIT A B D-BOX 1 25 f t 16.5 f t SEPTIC 22 32 f t 28 f t TANK M 3 30 f t 49.5 f t B SLIDER A 3 BEDROOM DWELLING # 54 J z J W H Q 3I LONGBOAT DRIVE NOT TO SCALE 10 Page 11 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9,2002 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to ground water: 50+ feet Please indicate(check)all methods used to determine high ground water elevation: Obtained from system design plans on record-If checked. date of design plan reviewed X Observed Site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of health-explain: Checked local excavators,installers-attach documentation) Accessed USGS database You must describe how you established the high ground water elevation. Town of Barnstable GIS Department records indicate that the groundwater table lies over 50 feet below the surface of the lot. 11 ECOJECH Environmental www.eco-tech.us THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION(revised 6/15/2000) TITLE 5 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 54 Longboat Drive Centerville Owner's Name: Joan McCarthy Owner's Address: 54 Longboat Drive Centerville Date of Inspection: September 9, 2002 Name of Inspector:(Please Print) David D. Coughanowr,R.S. Company Name: Eco-Tech Environmental Mailing Address: 43 Triangle Circle Sandwich,MA 02563 Telephone Number: (508)364-0894 CERTIFICATION STATEMENT: I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. I am a DEP approved system inspector pursuant to section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature `=CJe'4 f�S Date: �/�� � 2-00 :�t 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 y 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 Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. ""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 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 54 Longboat Drive Centerville Owner: Joan McCarthy_ Date of Inspection: September 9,2002 INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D: A] System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 5.303 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,or 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 breakout or high static water level 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 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 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 ND explain 2 i Page 3 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 54 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9,2002 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 and environment. 1 System will pass unless Board of Health determines in accordance with 310 CMR 15.303 (1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) System will fail unless the Board of Health(and public water supplier,if any) determines that the system is functioning in a manner that protects the public health,safety,and environment The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed by 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 k ' Page 4 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 54 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9,2002 D) System Failure Criteria applicable to all systems: You must indicate either"yes" or"no" to each of the following for all inspections: I have determined that one or more of the following failure conditions exist as described 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. yes no X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS, cesspool or privy is below high groundwater elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well X Any portion of a cesspool or privy is within 50 feet of a private water supply well X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.(This system passes if the well water analysis, performed by 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/N.o)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 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 F t t . Page 5 of 11 W. OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 54 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9,2002 Check if the following have been done: You must indicate either"Yes" or"No"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant or Board of Health. X Were any of the system components pumped out in the last two weeks? X Has the system received normal flows in the previous two week person? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available as N/A) X _ Was the facility or dwelling inspected for signs of sewage back-up? X _ Was the site inspected for signs of breakout? X _ Were all system components,excluding the SAS. located on site? X Were the septic tank manholes uncovered,opened,and the interior of the septic tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of scum.? X _ Was the facility owner(and occupants,if different from owner) provided with information on the proper maintenance of subsurface disposal systems? For information on the proper maintenance of subsurface disposal systems please go to: WWW.ECO-TECH.US The size and location of the Soil Absorption System(SAS)on the site has been determined based on: X _ Existing information. For example,Plan at the Board of Health. X Determined in the field(if any of the failure criteria related to part C is at issue,approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 54 Longboat Drive Centerville Owner: Joan McCarthy_ Date of Inspection: September 9,2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a(no plan on file at Board of Health) Number of current residents 4 Does the residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no): no :(If yes, separate inspection requiredl Laundry system inspected (yes or no): n/a Seasonal use(yes or no).- no Water meter readings,if available(last two year's usage(gpd): 205 gpd Sump Pump(yes or no): no Last date of occupancy: current COMMERCIAL/IND US TRIAL: Type of establishment: Design flow(based on 310 CMR 15.203):: gpd Basis of design flow(seats/persons/sqf/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: System last pumped in February, 2002(Owner) Was system pumped as part of the inspection: (yes or no) No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM: X Septic tank,distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternate 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: Age: 17+years Certificate of Compliance issued 4/3/85 (BOH permit#85-19) Were sewage odors detected when arriving at the site: (yes or no) no 6 Page 7 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9,2002 BUILDING SEWER_(Locate on site plan) Depth below grade: 2 ft Material of construction:—cast iron X 40 PVC other(explain) Distance from private water supply well or suction line 20+ Comments: (on condition of joints,venting, evidence of leakage,etc.) Sewer is vented through roof and appears structurally sound with no evidence of leakage or backup into dwelling SEPTIC TANK: X (locate on site plan) Depth below grade: 15" Material of construction: X concrete_metal fiberglass polyethylene other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance (yes or no):_(attach a copy of certificate) Dimensions: 8.5 ft x 5 ft x 5 ft(1000gallon) Sludge depth: 4 in Distance from top of sludge to bottom of outlet tee or baffle: 30 in Scum thickness: 1 in Distance from top of scum to top of outlet tee or baffle: 9 in Distance from bottom of scum to bottom of outlet tee or baffle: 14 in How dimensions were determined: Probe to top of tank Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Pumping not required at this time,but maintenance pumping recommended every 2 years.Liquid level at outlet invert. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out. 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: 54 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9,2002 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 inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: X (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: at outlet invert Comments: note if box is level and distribution to outlets is equal,an evidence f solids r( q y de ce o so ds carryover, evidence of leakage into or out of box,etc.) D-box appears structurally sound with no evidence of leakage in or out.Effluent level at outlet invert. Few solids in tank. 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: 54 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9,2002 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan;excavation not required) If SAS not located, explain why: Type: X leaching pits, number 1 _leaching chambers,number _leaching galleries,number _leaching trenches,number,length _leaching fields,number,dimensions _overflow cesspool,number —innovative/alternate system Type/name of Technology Comments: (note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.) Soils above leach pit appeared unsaturated.No evidence of surface ponding,breakout, lush vegetation or other evidence of hydraulic failure was observed. Effluent level 6 inches below invert CESSPOOLS: none (cesspool must be pumped at time 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 y Page 10 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9, 2002 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'(Locate where public water supply enters the building) LOCATIONS LEACH 2 PIT A B ❑ D-BOX 0 1 25 f t 16.5 f t 20 TANK o 2 32 f t 28 f t SEPTIC 3 30 f t 4 9.5 f t I B SLIDER A 3 BEDROOM DWELLING # 54 w 5 J W F- I S 3 LONGBOAT DRIVE NOT To SCALE 10 Page 11 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Longboat Drive Centerville Owner: Joan McCarthy Date of Inspection: September 9,2002 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to ground water: 50+ feet Please indicate(check)all methods used to determine high ground water elevation: Obtained from system design plans on record-If checked. date of design plan reviewed X Observed Site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of health-explain: Checked local excavators,installers-attach documentation) Accessed USGS database You must describe how you established the high ground water elevation. Town of Barnstable GIS Department records indicate that the groundwater table lies over 50 feet below the surface of the lot. 11 0j DATE: .11/30/98 PROPERTY ADDRESS: 54 Lofit?'boat 'Drive' Centerville ,Mass. 02632 •" On the above date, I Inspected the "ptic system ate,,`he abgye add 8''s. This system conalsts of the following: (�` RECEIVED 1 . 1-1000 gallon septic tank. 2 . 1-Distribution box. DEC 9 1998 3 . 1-1000 gallon precast pit . TOWN OFBARNSTABLE l HEALTH DEPT. Based bn my Intoc-action, I certify the following con'dltlons: ��'" 4. This is a title Five Septic System ( ''78" Eode ) `Y• ;� I �� 5 . The septic system "is in'proper •working order at the present tim b. 81GNATUR 7 / • , Name J P Macomber Jr. ------- Company:_J• p_MacotQber_ & � on•`Inc , —_-- — Address• __CentervilLekUj. _¢2632 Phone:__�508...Z7.S-.3338_______ •. THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY r RM JOSEPH P. MAGOM-BER & SON; INC, T+nka-CsupoolYL#&chfIeIds • Pump+d L Instsllsd ' Town Sewer Connections P.O. Box 66' Centerville, MA 02632.0066 77.6"33U 775-6412 'r ,per -\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 WILLIANI F.WELD TRUDY CO: Govcmor Sccrct ARGEO PAUL CELLUCCI DAVID B.STRU' Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissiol PART A CERTIFICATION Property Address:5 4 Longboat Drive Centerville Address of Owner: Date of Inspection: 1 1/3 0/9 8 Mass . (If different) Name of Inspector:,Toca=h P Marnmber Jr . I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: J.P.Macomber & Son INC . Mailing Address: Box 66 Centerville,Mans _ 02632 Telephone Number: 5 f)R—7 7 5_3118 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Zpasses Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 own( and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES: 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. COMMENTS: BI SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upo completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes no, 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; c the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiitration, or tan! failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:/hv%w.magnet.state.me.us/dep Printed on Recycled Paper U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 54 Longboat Drive Centerville ,Mass . Owner: Elizabeth McAdams Date of Inspection: 11/3 0/9 8 BJ SYSTEM CONDITIONALLY PASSES (continued) Sewage backup 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). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced ,dZ6 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: Vb_ 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 THE ENVIRONMENT: 49 Cesspool or privy is within 50 feet of a surface water JA 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 FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: d26 The system has a septic tank and soil absorption system (SAS) and the SAS 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 the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the 5A5 is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS 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 that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance�_(approximation not valid). 3) OTHER (revised 04/35/97) Pays 3 of 10 SUBSURFACE SEWAGE DISPOSAL,SySTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 54 Longboat Drive Centerville ,Mass . Owner: Elizabeth McAdams Date of Inspection: 11/30/98 D) SYSTEM FAILS: You must indicate ei;,,er "Yes" or"No" as to each of the following: A10 I have determined that the system violates one or more of the following failure criteria as defined 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. Yes N� Backup of sewage into facility or system component due to an 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 d' tribution box above outlet invert due to an overloaded or clogged SAS or cesspool. / Liquid depth in caupo is less than 6" below invert or available volume is less than 1/2 day flow. !V 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 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. Q LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: V_ . The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 AW 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) 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. (revised 04/25/97) Day• 3 of 10 SUBSURFACE SEWAGE DISPOSAL SY$TEM INSPECTION FORM PART B CHECKLIST Property Address: 54 Longboat Drive Centerville ,Mass . owner: Elizabeth McAdams Date of Inspection: 11/3 0/9 8 Check if the following have been done: You must indicate either "Yes" or"No"as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least 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,4luding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. —The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)) (revised 04/25/97) Page 4 o1 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 54 Longboat Drive Centerville ,Mass . Owner: Elizabeth McAdams Date of Inspection: 1 1/3 0/9 8 FLOW CONDITIONS RESIDENTIAL: Design flow: "S g.p.d,/bedroom for S.A.S. Number of bedrooms: Number of current residents: Garbage grinder (yes or no): D Laundry connected to system (yes or no1j_lr___� Seasonal use (yes or no):_&� /J Water meter readings, if available (last two (2)year usage (gpo): 9G- — d/V Sump Pump (yes or no): 71 AIW �Q� /I �� c /7 ,0 Last date of occupancy: COMM ERCIAUINDUSTRIAL: Type of establishment: Zo Design flow: AM Yallons/day Grease trap present: (yes or no)-&-6 Industrial Waste Holding Tank present: (yes or no) /i Non-sanitary waste discharged to the Title 5 system: (yes or no)A Water meter readings, if available: �Ur� AM Last date of occupancy: OTHER: (Describe) IVA Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS a source of inform�s'ion: �A �� r T System pumped as part of inspection: (yes or no) If yes, volume pumped: �*)A allons Reason for pumping: TYPE OW STEM Septa Septic tank/distribution box/soil absorption system Alb Single cesspool ,b Overflow cesspool ,*V62 Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 1/ Cl AN """IF" Sewage odors detected when arriving at the site: (yes or no) (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertyAddress:54 Longboat Drive Centerville ,Mass . Owner: Elizabeth McAdams Date of Inspection: 11/3 0/9 8 BUILDING SEWER: (Locate on site plan) Depth below grade:A Material of construction: �-cas Iron 40 PVC_other (explain) nr3�yt/iAT gun Distance from ivate water supply well or suction line /0V- Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) ,points appear tight No evidence of. lPakngP - System vented thrnngh t-hp hnrtca vane SEPTIC TANK:,(cV f'4 (locate on site plan) i1 Depth below grade: Material of construction: Zoncrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list aged Is age confirmed by Certificate of Compliance/Y,(Yes/No) Dimensions: j�fJd +0/0p jl9iiJl�L`�'7 Sludge depth: Distance from top ofrsludge 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 t e or baffle: /T How dimensions were determined: 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.) Pump tank every 2-3 years ; Inlet and outlet tees are in place . Liquid level at the outlet invert is 49" The tank i s Gtrnrtttral 1 y -,mind and ahnwc nn pvi rlpnrp of 1 pakaRe GREASE TRAP:,41we, (locate-on site plan) Depth below grade: Material of construct ion:V,4 concrete.,L)A meta 14AAF i bergla ss WA Polyethylene 4Aother(explain) A/A Dimensions: iW Scum thickness: AN Distance from top of scum to top of outlet tee or baffle: 4144 Distance from bottom of scum to bottom of outlet tee or baffle:_&d_ Date of last pumping: A2.4—L 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 is not present . (reviaad 04/25/17) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:54 Longboat Drive Centerville ,Mass . Owner: Elizabeth McAdams Date of Inspection: 11/3 0/9 8 TIGHT OR HOLDING TANK:A&9(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of con struction�{Lconcrete4 metaWAFiberglass, Polyethylene, other(explain) Aj A4 Dimensions: AJA Capacity:gallons Design flow: gallons/day Alarm level: 414 Alarm in working orderNA Yes; 4No Date of previous pumping: _A _ Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Tight nr hnl di ng taNks 8r'e not; pr-eseat: . DISTRIBUTION BOX:Z (locate on site plan) Depth of liquid level above outlet inven:�(Z Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) The distribution box has one lateral .No Pyidpnrp of aoliric tarry nvpraNn pvidAncn of leakage JetA Ar out A #h•e b9# . PUMP CHAMBER%AA0& (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.) P,Amn chamber- is ft (revised 04/25/97) P&g• 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART'C SYSTEM INFORMATION (continued) Property Address: 54 Longboat Drive Centerville ,Mass . Owner: Elizabeth McAdams Date of Inspection: 11/3 0/9 8 SOIL ABSORPTION SYSTEM (SAS): 1Q' OA1 kJV �T �'t�'�',7 At ,locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:[, leaching chambers, number: leaching galleries, number:_0 leaching trenches, number,length: leaching fields, number, dimension overflow cesspool, number:Q Alternative system: n Name of Technology: Lcrk Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Loamy sand to mark "m fine Snud -NA 61gas of h-T4rreulie €a , - - - or ponding - VagPtat; nn ; s nsrmaj CESSPOOLS: �p4tle, (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Vq Dimensions of cesspool: JJA Materials of construction: Indication of groundwater: Al inflow (cesspool must be pumped as part of inspection) Cesspool-, art, not pracpnt Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) f'.t,-,-,Pnn1 g Arent prasent . PRIVY: A/Wt. (locate on site plan) Materials of construction: dli4 Dimensions: Depth of solids: A)4 , Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Privy is not present , (revised 04/25/97) Page to of 10 SVBSVRFACE SEIVACE OISPOSAI SYSTEM INSPECTION FORM 'PART C SYS1 EM INFORMATION (continvcdl PtoptnlAddtetr: 54 Longboat Drive . Centerville ,Mass . 06cams O�t1 Elizabeth MAd of Intp.cliontf . 11/30/98. SKETCH OF SEWACE OISPOSAL SYSTEM: include ties to It least two permanent (e(e(enees landmarks or benehmoks locate III wells within 100' )locate where pvblie watt( svpply comes into house) s t 0 / ell. i i lr.•i..• 01/11/111 SUBSURFACE SEWAGE DISPC L SYSTEM INSPECTION FORM P.., C SYSTEM INFOI;'•: .fION (continued) Property Address: 54 Longboat Drive Centerville ,Mass . Owner: Elizabeth McAdams Date of Inspection: 11/30/98 1 Depth to Groundwater.-Feet Please indicate all the methods used to determine High GroundwatV EIcJvation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, baseme.nh sump etc.) fletermine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater E levation. (Must be completed) Used Water Contours Map . Gahrety & Miller Model 12/16/94 IN( 10 (rwis•d 04/25/97) Yag 4. �. a•1•wnT rn.rr•+tr\.wrww•wnarr•nna•w�dnanT+ww►r�wn na�sll►.,a•„r�Ua,1r.1 .�—.�-..�..r'.4 TOWN OF Barnstable GUARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM IN � ION FORM - PART D •- CERTIFICATION� - 1 .-TYPL OA PAINT CLEAALY- 1 PROPERTY INSPECTED STREET ADDRESS 54 Lonpboat Drive Centerville .Mass , ASSESSORS MAP, BLOCK AND PARCEL _ �0 z 4� OWNER' s NAME Elizabeth •McAdams PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J. P.Macomber & S614 *Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 gtraat Town or City Slat• L1P COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 w A CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this nddress and that the information reported s,,tfi Ge , accurate , and complete as of the time of�inspection . The in'sp6ction was performed and any recommendatlons regarding upgrade , maintenance , .a.nd repa'ir. are consistent with my training and experience in- the proper funct-loh and maintenance of on- site sewage disposal systems . Check one ; Z1/ S Y s teui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healtl►. or the environment as defined in 310 CMR 16 . 303 . Any fai.1kire criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED# The inspection whicli I have con ted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form. Inspector Signature Date One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and thv DOARD OF 1{8AL1'II, If the inspection FAILED, .th`e owner or"� orator ehall u e i p upgrade ' the eyetem within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 16 . 306 , partd .doc VO CAT ION SEWAGE PERMIT NO. VI 11 LLAGE INST LLER'S NAME A ADDRES � . o - t UIl 0 R OR OWNER 414 DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 4 , 3 O 51;,e,r �or�:h '� �s � ,�'�Z o � "f�%Z � � Fs ....4?...��.............. No....� --�- -A SS , j q j—1 5�N—DO0 THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEAB LTOV- n / GIIYN.............OF...... .. 5. ....._....... , pptiration for Dippusttl Workii Cfnmitrnriiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal �Sysjt at: t.. _.......... es- --------------------------------------�--- . ._./ Address or Lot �� ✓ / � iVccL. 0 �.---- -- , olowner / Address Installer Address d ype of Building Size Lo �7,0----Sq. feet U Dwelling—No. of Bedrooms........... ._..........Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------•------------------•-------------------•---•-••--•----•-•--------•--•••--------•-------------•............--- W Design Flow......J1.0.........................gallons per person day. Total daily flow..........3.3- .U.....................gallons. WSeptic Tank—Liquid capacity/4."-_gallons Length---(...... Width..... _._... Diameter________________ Depth....'.Z ...... x Disposal Trench—No..................... Width.................... Total Length_........... Total leaching area............ __. sq. ft. Seepage Pit No.........,�........ Diameter......1A...... Depth below inlet...... Total leaching area-.ZArsq. ft. Z Other Distribution box ( ) Dosing to ~' Percolation Test Results Performed b �. GSA _r1.�l vt.. ........................ —/j1.." y. G._. � Date_._ ,.a Test Pit No. 1................minutes per inch epth of Test Pit _..._.._...._.. Depth to ground water........................ �4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O p o G o o _— �----d �_lJ.� Description of Soil Q f��4?---------- - G' 1 = 0'6 1•2 0 --------- - •... ��.................................-------•-------------------------••--•------•------- U Nature of Repairs or Alterations—Answer when applicable-------------------------------------------------- _.._........__.........._._.._. • ----------.......................................................... Agree nt: h undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t pr -isions of T TL% 5 of e State Sanitary Code—The undersigned further agrees not to place the system in per on i er t Compliance een iss ed by the boa f health. Sig G t ......... .......................... �49 ...Z..... �1 J Date Apis Approved By.............. .................... .. .... . ...........----_..._ ........................................ Date p cation Disapproved for the f ,lowing reasons--------------------------•-----•---------------------------------------------•----.......................... -•----•.-.Date Permit No.----�?S. ---1----•---•-----•-••-------------- Issued.-. 1 Date <2........I..I 5- 1 No....... 4. Fps.............................. -A THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... .. ..................OF.......................................................................................... 'ApOirati o"n"f-r'l-or Disposal 1 Works Tanstrurtion "amit Application is hereby made for a.Permit to Construct or Repair an Individual Sewage Disposal System at: Z.....2... . ........ ........................................................ .......................................... ............................ Location-Address or Lot No. .............................................. ........... ... .................. !) OwnerAddress ......... _ ........................................................................................ . .......................................................................................... Installer Address Type of Building Size Lotz�--- feet U Dwelling.—No. of Bedrooms...........i%.............................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons.....____.._................ Showers Cafeteria aI Other fixtures ........................................................................................ ............................................................. Design Flow___..._ Z�........................gallons per person per day. Total daily flow.... .:................._.....__...gallons. W ......................Septic Tank—Liquid capacity.-/.,.,..'.,..'? Z�R.gallons Length.. ....... Width....!� ...... Diameter................ Depth_"a_......... Disposal Trench—No. .................... Width_._.._.._...._...... Total Length.................... Total leaching area............. ........sq. f t. Seepage Pit No............./--------- Diameter......Z .......... Depth below inlet...... .......... Total leaching area.2f�f.'. /.K..sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by._'..::�...........�:..................r,f................................... Date... ..... Test Pit No. I................minutes per inch Depth of Test Pit.._Z........... Depth to ground water..___...._....__._.._... 4, Test Pit No. 2................minutes per inch Depth of Test Pit...._..._._.._.____. Depth to ground water......................... P4 ............... ------------------------*...... -----------------"..................."-----------*------------------ ----------------------------- 0 Description of Soil—.--- ..............��-e,e "� -.;, I- I ' - I I ...................................................................................................................................... ................................................................................................................................................... ------------------I------------- ------------ J---------------------------------------------------------- .......................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable........................................... .................................................... ----------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- 'k.'Agree rit h undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t pro of rm MT �=i 5 of e State Sanitary Code— The undersigned further agrees not to place the system in per on i er V t Compliance hasbeen issued by the boar'd-of health. % I " .Z I Signed.. Z�'"'/""�.^- r— -; W.IV -- Date - ----------------------------------------------------- ------------------ Ap 'i c Approved By......... 0.4 � ......................... ............ 6.0---- __---------------------- -----------_- Date p cation Disapproved for the Mowing reasons:................................................................................................................ ... ................................................................................................................................................................................................... > Date Permit No...... ................................ Issued._. ............................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...........�.f�7.X............................................................... watifirate of TOUtphatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired b ...... ................... -------------------------------------*------------ y........................................................... . Installer at..................... ........... . .. .. . ..... ...................... has been installed in accordance with the provisions of TT.T.1�F he State Sanitary C a'a d in the application for Disposal Works Construction Permit No._'IF ..........OF---------------- dated....__ _di... ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO NM AS UANTEE THAT THE SYSTEM WILL NS,.'-TPN_S6T SFACTORY. DATE. .................... .................................. Inspector........... u -5 ... .. ........................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. ......................................OF.......................................................................... ......... No. ... FEE... ................. ................................................ Permission is hereby granted..._..._..-6(........... ............................................ to Construct or Re air an InAividu SewaEe Disposal �Ystem at No...........L!§..............Tjlf�* ... �_Sr cY+.J.Z------ .......... ................ Street as shown on the application for Disposal Works'Constr'hction Permit No..................... Dated........................................... ................................................................................................ Board of Health DAT ....... t t(a..A.GZ...................................... FORM IZ A. M. 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MS f -0 �v �" �"z- . , ,-,rl�7 . , -, � �, g;_ 0X IL ZS*547 g -, '� �- IS � ar5�4YMm401, jV - - _ - y , , , __ � �, V7� � ? k- 6� A &&A7- -Wia �- ` :� , g " , _ . -- mHfff� q A- 1 r _ _ x � --� v;� _ Ww Wm 1 63 " � , -__7 , m __ g0,�- 4� - ' W ., m -0- % .�� � ��z._ ��P - _ _ _ -- � , � - � . ...'.- I _ , ,.,i..; �-i . _ 1 -,- T�-i �i-- -- � a L- a , - �! - M ,- �- '_ _ � - _ , M - I,W � g-- .g T1�1_,- _ fim �- ��,f�, � _ X.1 FI _ - %� � -i - 7 KI� �;' - M6� K _ D- 4 _ M 15_aM %S -,- _� � F:g R- - _ ;NW, W;-UF V � 7 g,M ? V 1 Sl__ � I�� t _ _ ,_�� � ��gg ;n� 9 X- % gm g Wr ? _ �'- : l�! ,,7.. - I& w , - _ n MM _ - �M I Ex r � --- .. , E �z ,,,T�_ � l _ �% - -_ ,_ ,_ ----I--.- _,-- _111.�� — �- ... "a , �I'll C-1,L FINISH GRADE OVER D-BOX= 94.5'f FINISH GRADE OVER CHAMBERS = 94.0' - 94.8' GENERAL NOTES SLOPE 3/4"TO 1-1/2" DOUBLE WASHED PROVIDE EXTENSION RISER @ 2% MIN. OVER SYSTEM STONE TO CROWN OF PIPE 1• UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE MIN SLOPE 1% BOX TO F.G. (SEE NOTE#21) 2" OF 1/8"TO 1/2" DOUBLE WASHED OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6" OF FINISHED GRADE 4" SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS CODE AND ANY APPLICABLE LOCAL RULES. @ FND. EL.= 108.0't F.G. OVER TANK EL. = 106.0'f 5" DIA. OUTLET(S) STONE OR GEOTEXTILE FILTER FABRIC 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE } --_ -__ - -- DESIGN ENGINEER. I I TOP OF SAS = 91 .83 PLACE RISERS ON ALL 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN EXISTING 4" PROPOSED 4 9 MIN. ;� DISPOSAL PVC SEWER PIPE 4" PVC TEE MIN. CHAMBERS WITH 36 MAX.. 91 .00' 36" MAX. , INLET PIPES TO 6" OF SYSTEM UNLESS OTHERWISE NOTED. SEWER PIPE BREAKOUT EL= 91 .5O FINISHED GRADE1 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN -. I ELEVATION = 91.50 FOR A DISTANCE OF 15 AROUND THE PERIMETER OF THE SAS. UNLESS A 6" 3" 3" DROP MAX 3" 9" L = 50'± 11 2" DROP MIN MIN.SLOPE@ 1 j PROVIDE WATERTIGHT o 0 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF II II 13" 4" PVC IN FROM JOINTS TYP. ���� o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. IL�J� 14" �* 02 $'+ SEPTIC TANK 4 PVC OUT TO 0 O 0 0 0 o o = = O 0 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. CONTRACTOR TO PROVIDE - O LEACHING FACILITY To0 00 o SPECIFIED DROP BETWEEN 12" 6" oo o o 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL OUTLET TEE S 91 .40 MIN. 91 .23' 2 o 0 00 C)CD 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK SHALL VERIFY SIZE 48 VERIFY CONDITION OF FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS 00 AND CONDITION OF EXISTING TEES GAS BAFFLE 6" CRUSHED STONE 00 0) oo NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY oo 0 0 o TANK NECESSARY COMPACTED BASE I - AND DESIGN ENGINEER. 4.0' g 5' (TYP) 4.0 4.0' 4.0' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK#1 ELEVATION 5 OUTLET DISTRIBUTION BOX TYP.) OF 95.00' ESTABLISHED ON A HYDRANT BOLT AS SHOWN ON PLAN. BENCHMARK -- TO BE INSTALLED ON A LEVEL STABLE 33.5' ( #2 ELEVATION OF 106.54' ESTABLISHED ON THE CORNER OF A CONCRETE PAD AS BASE. FIRST TWO FEET OF OUTLET ZS8 9 00, GROUND WATER ELEV.= < 83.50' 12 83 SHOWN ON PLAN EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 3 - 500 GALLON CHAMBERS 5' MIN. CHAMBER END VIEW 9• CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION CROSS SECTION VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT '`CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL CHAMBER [DETAILS TYPICAL CHAMBER PROFILE 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE TO THE DESIGN ENGINEER. 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. r _a kl� �� ' '' � TEST PIT DATA TFST PIT DATA 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING I SWING-TIES SCALE: 1"=20' ��'� pEl PwEM� ' s*`.� �., . -� '" ?� ` PERC NO. 15849 PERC NO. 15849 REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM ,k '�) - APPROPRIATE AUTHORITY. \ P ° p ` �, , INSPECTOR: Donald Desmarais INSPECTOR: Donald Desmarais DESCRIPTION FC-1 FC-2 Ply--S�OUP -60�v� DOGE OF FC-2 -47._ ,. /` ~� 700 . O �( �p,Y �/ _ , ° ° - =�` iY' -ramp EVALUATOR: Michael Pimentel EIT CSE EVALUATOR: Michael Pimentel EIT CSE 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED uN� l x 1� . _ UNDER E CORNER OF STONE 1 58.1' 72.2' 6 CO `` ` ' �� 0 '/ + r-% Oct. 1999 Oct. 1999 ER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR O �192 p� --� p r .. `e of p C.S.E. APPROVAL DATE: C.S.E. APPROVAL DATE: TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. MAP 193 - November 29 2018 November 29, 2018 CORNER OF STONE (2) 53.2' 68.3' 1 0/, DATE: DATE: LOT 153 1 �s 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. y )� � TEST PIT#: 1 TEST PIT#: 2 CORNER OF STONE (3) 85.8' 36.3' ��E ° 51 `a 94.50 a. , ELEV TOP= 94.50' ELEV TOP = ' 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE CORNER OF STONE (4) 89.0' 43.4' N�2116 p9' (3) 1 = �� MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ELEV WATER= < 83.50' ELEV WATER= <83.50' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). PERC RATE - < 2 min./inch PERC RATE - O 4.0' � � / ~ � = -�''-------� ' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN I (2) p 2 1 - '' „r_ �' ' - . ' ✓` DEPTH OF PERC = 36" -54" DEPTH OF PERC = SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. FC-1 0 LOCUS TEXTURAL CLASS: 1 TEXTURAL CLASS: 1 16. PROPOSED PROJECT IS LOCATED WITHIN: M MAP 193 LOT 151 ASSESSORS MAP 193 PARCEL 152 1 � FZ� 1� �-•..` �'" '��-- /� OWNER OF RECORD: NANCY MARIAN SIEKMAN Z c \ 0 5` R�S�R 1 ' c� 1\ r'. , ` t 0" 94.50' 0" 94.50' ADDRESS: 54 LONGBOAT DRIVE - Loamy Sand Loamy Sand a - m �"...,, -i �� '�``_-.-•- � �="`__. r ..r �, •r x P` ( P` CENTERVILLE, MA 02632 c • ��___�0+ - ��-�` 10Yr 3/1 10Yr 3/1 MAP 193 _ r �i ``ti �-- -' '1` _ °."''' 12" 93.50 12" 93.50 LOT 152 . �\ � '~ Benchmark#1 > c-�, - cat r Hydrant Bolt `cox, 16,732± S.F. • ,� --�=- - o ' B Loamy Sand B Loamy Sand FEMA FLOOD ZONE X Elev. = 95.00' $ fi -- "� ,\%r� 10Yr 5/6 10Yr 5/6 COMMUNITY PANEL# 25001CO561J Approx. M.S.L. f J , ` E . L., �1• / • • . , ,Y: i _ �i, • 17. DEED REFERENCE: DEED BOOK: 27314, PAGE: 138 " 36" 91.50 36" 91.50, - o �• / ' �'� { Perc 18. PLAN REFERENCE: PLAN BOOK: 312, PAGE: 14 - -- • F` • • f • 1 6. . ` • # • !, Q ICI t a; 54" 30.00' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. / � r U.P. #32 70 �' Q • . • 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY `/ /�� f �4 /" .� . ` •� FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY �` w • �, J !• •/; • • � Medium Sand Medium Sand SCR 60``N\O olNl /'• O ( ! ` + r '(3�i'' C 2.5Y 6/6 C 2.5Y 6/6 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 00( UN��( L OF P 1 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A 1g26 GO EOG-- w i DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3" OF FINISH GRADE. A l '�?) ��N �i MAP 193 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. rw LOT 153 LOCUS PLAN 1 22. OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL 2 ol�`I CLUSTER SCALE: 1" - 1000' i i REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. / OAK 1 132" 83.50' 132" 83.50' / " AZE 16 OAK - .. m ling _:.__ �2° 51 „ � 1 PROPOSED No Mottling, Weepi�ngy or Standing Observed No Mottling, Weeping y or Standing Observed N 1160g, 18/lOA INSPECTION PORT �. ,�.�,., f� � ��1�1 �� � � �S I r" �� �.4�!`1�A - - - - ,` ,w / TP 10"/12" ," DESIGN DATA LEGEND / c / / 2 O5 OAKS// I N PROPOSED 3-500 GALLON UMBER OF BEDROOMS (DESIGN) 4 PERC NO. 15849 PERC NO. 15849 01N/w x INSPECTOR: Donald Desmarais INSPECTOR: Donald Desmarais � , w � LEACHING CHAMBERS EVALUATOR: Michael Pimentel, EIT, CSE EVALUATOR: Michael Pimentel, EIT, CSE '�ti Q TP 1 DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E. APPROVAL DATE: Oct. 1999 C.S.E. APPROVAL DATE. Oct. 1999 50x0 EXISTING SPOT GRADE 4 94x5 12" � 1 PROPOSED TOTAL DESIGN FLOW 440 GAUDAY DATE: November 29, 2018 DATE: November 29, 2018 - - 50 - - - EXISTING CONTOUR W pll ' OAK 1 DISTRIBUTION BOX DESIGN FLOW x 200 % = 880 GAL/DAY TEST PIT#: 3 TEST PIT#: 4 PROPOSED CONTOUR \ OAK j -9a� 1 USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 94.50' ELEV TOP = 94.50' - MAP 193 �- � 12" OAK O/H/V EXISTING OVERHEAD WIRES LOT 151 \- _ �gR // - - - EXISTING LEACHING PIT TO BE ELEV WATER= < 83.50' ELEV WATER = <83.50' 00� PUMPED AND FILLED WITH CLEAN W W - EXISTING WATER LINE / 16"/14" �1 SAND & ABANDONED PERC RATE _ < 2 min./inch PERC RATE _ OAKS - _ -J02- INSTALL 3 - 500 GAL. CHAMBERS w/AGGREGATE DEPTH OF PERC = 36" - 54" DEPTH OF PERC = TEST PIT LOCATION / EXISTING 1,000 GALLON TEXTURAL CLASS: 1 TEXTURAL CLASS: 1 EXISTING 1,000 GALLON SEPTIC TANK 9a� //10" OAK i'� SEPTIC TANK TO BE SIDEWALL CAPACITY / "I UTILIZED IN DESIGN LENGTH + WIDTH 2 SIDES) (2' HIGH (0 74 GPD/S.F. GAUDAY -10 ( 2' ) O O 6 (33.5' + 12.83') (2 ) ( 2() ( 0.74 GPD/ S.F.) = 137.1 GAUDAY 0" 94.50' 0" 94.50' PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE Benchmark#2 BOTTOM CAPACITY A Loamy o10Yr 3/1nd Loamy 10Yr 3/1nd 7 �102/ PLL A I ❑ PROPOSED DISTRIBUTION BOX Corner of Conc. Pad (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAL/DAY 12" 93.50' 12" 93.50' DECK CIO Elev. = 106.54' (33.5' x 12.83') (0.74 GPD/S.F.) = 318.1 GAL/DAY PROPOSED 500 GALLON LEACHING CHAMBER Approx. M.S.L. Z '-108 - - - - Loamy Sand Loamy Sand > #54 N B 10Yr 5/6 B 1 OYr 5/6 U` TOTALS: EXISTING > ° o >a? DWELLING TOTAL NUMBER OF CHAMBERS 3 36" 91.50, 36" 91.50' REV. DATE BY APP'D. DESCRIPTION TOTAL LEACHING AREA 615.1 SQ.FT. Perc PROPOSED SEPTIC SYSTEM UPGRADE m TOTAL LEACHING CAPACITY 455.2 GAL./DAY 54' 90.00' PREPARED FOR: WATERLINE NOTES: f(APRROX. LOCATION CAPEWIDE ENTERPRISES \ Medium Sand Medium Sand MAP 193 1.) MAGNETIC MARKING TAPE SHALL BE C 2.5Y 6/6 C 2.5Y 6/6 LOT 152 0� PLACED ALONG THE TOP EDGE OF EACH 16,732± S.F. \ 1� Q 632 SEPTIC SYSTEM COMPONENT. LOCATED AT 54 LONGBOAT DRIVE m 2.) CONTRACTOR SHALL VERIFY SOIL CENTERVILLE, MA 02632 51 CONDITIONS IN THE LOCATION OF THE a3 p0 PROPOSED LEACHING FACILITY TO ENSURE , SCALE: 1 INCH = 20 FT. DATE: NOVEMBER 30, 2018 CONSISTENCY WITH TEST PIT DATA SHOWN 132" 83.50' 132" 83.50' o io 20 ao ao FEET ON THIS PLAN. REPORT TO ENGINEER AND No Mottling, Weeping or Standing Observed No Mottling, Weeping or Standing Observed 0- OF �ss� LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. CHURCHILL•JR.GN�; PREPARED BY: NG� v� -�0 NO CIVIL JC ENGINEERING, INC. OP \OE RESERVED FOR BOARD OF HEALTH USE C �(O 3.) ENTIRE PROPERTY IS NOT LOCATED pUgL\C\'P WITHIN A DEP APPROVED ZONE 2, THE c' 2854 CRANBERRY HIGHWAY GROUNDWATER &WELLHEAD PROTECTION EAST WAREHAM, MA 02538 SITE PLAN OVERLAY DISTRICT, OR THE ESTUARINE ZONE WATERSHEDS. 508.273.0377-- SCALE: 1" =20' Drawn By: SJI Designed By:SJI Checked By: JLC JOB No.4475