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0020 LOOMIS LANE - Health
20 Loomis Lane Centerville A=230-1.13 S M EA©o NUPC O. wwad wn • Me&In U$A w i TO OF BARNSTABLE LOCATION SEWAGE# D '� VILLAGE kilLIA,,e ASSESSOR'S MAP&PARCEL 30- l 3 INSTALLER'S NAME&PHONE NO. U SEPTIC TANK CAPACITY (s LEACHING FACILITY:(type) (size) prr NO.OF BEDROOMS - r*f f rldt OWNER I f PERMIT DATE: 'Ok.16COMPLIANCE DATE: 11 C) Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet: Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY S"ti Worse t shy A : 31*6 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pplifation for Mispo4ar *pstem Construrtion Permit Application for a Permit to Construct( ) Repair(i✓) Upgrade( ) Abandon( ) [K omplete System [1 Individual Components Location Address or Lot No. Q/yf�j ���0 Ow is Name,,—Address,and Tel.No. AsZse�os Map�arcel t✓l%� ��/�/� � / cJ©� Instal er's Name,Address,and Tel.No. Desi er's Name,Address,and Tel.No. f�v�v� Cyr e" �t , Type of Building: �y Dwelling No.of Bedrooms Lot Size —s=f Z7✓�sq.ft. Garbage Grinder vf�b Other Type of Building ��/ jjG� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided !� gpd Plan Date c/7 /�o Number of sheets Revision Date Title W- Q'f m �- Size of Septic Tank �`���9l�° i Type of S.A.S. y Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Bo f lth. S Date Application Approve by Date Application Disapproved by Date for the following reasons Permit No. Date Issued ..r `•+.-.,,wyi.::w s,P:•-,�- ",,,,.w..4-... ---..•..,.:,a..:.n.n.�+...wr..+'w.^...+'+-ry„p+..w.M*..fl�v+.fi,.+'r".t"...X,..16---�'''-'^"` - :,... '�..+vte++.- ••....• i�,:a av»+.�+ ' .nMw'*•�•„pr.r,i�•�•q .».. w^"y'•.,.T..wn• „j,-.� ....K`dtii'. c- w•T �• �� ya • No. 1'w�ICI` d'' J . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,IMASSACHUSETTS Yes RppffcatI6 for BIsposal 6psteut Construr IOII permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) Complete System [:1 Individual Components Location Address or Lot No. W 9 fijr 1"& Owner's �Name,-Address,and Tel.No. Assess 3ps Map/Pazcel �L�d� Insta er's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 9 7 Type of Building: /�j/ Dwelling No.of Bedrooms Lot Size/5_, 77�sq.ft. Garbage Grinder(1 )/''D Other Type of Building L°5/GY1eyC6 No.of Persons ' Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33D gpd Design flow provided gpd Plan Date �Z Z �( Number of sheets Revision Date Title j ✓/ O Z D zo f 5 X y Size of Septic Tank Type of S.A.S. ZI '" 76 ,3 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: r 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 x Compliance has been issued by this Board of ealth. _ Sig Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. k3 { Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )/by ®/- /,�/Q / ��j��j/>`. at 00. Gt�i� / $ /X has been constructed in accordance with the provisions of Title 5 and`t_h{ejor Disposal System Construction Permit No ?7 dated �v" l_ C / Installer Y-a D W 1 Designer ,-j n ) — #bedrooms ee_;� Approved design flow 4;L1;4 gpd The issuance of this permit shall not be construed as a guarantee that the system will funet* Widesigned. v. Date ( /,� Inspector C�/ 0; S, - ---------•-'----- --------------_ - - ------ -- --- --- No. ��r� 7 ap Fee Q THE COMMONWEALTH OF MASSACHUSETTS - PUBLIC HEALTH DIVISION BARNSTABLE, MASSACHUSETTS Misposal Opstem Construction i3ermit 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:Construct i n•�m�}}ust pe comple/te4--yVithin three years of the date of this permit. Date G�`' / �t/ ) ApprovM by Bk 24260 Ps 292 072338 12-24-2009 Q 08 _ 30a. DEED RESTRICTION WHEREAS, 'Ey f ' e Y—So h Of LOO/y) Is (ownee name) � / Ce n l eY- V i ` ��L� MA // (address) is the owner of aC� o o m(J' L r , located (address) at MA (hereinafter referred to as and being shown on a plan entitled "Subdivision of Land in MA, Property of et al, duly recorded in Barnstable County Registry of Deeds in Plan Book , Page Or on Land Court Plan Number WHEREAS, ✓dtl n 66i ?��Y,a as the owner of said lot has (own is name) agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building perm.it for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, deedr NOW, THEREFORE, �Jd YA does hereby place the (owner's name) following restriction on his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. a0 Loo rn; � kIlL may have constructed (address) upon the lot a house.containing no more than r,Jo (4)bedrooms. __ >✓y�l'�i n (�a �✓Jv� agrees that this shall be permanent deed (owners name) restriction affecting located on MA, and being shown on the plan recorded in Plan Book , Paged Or on Land Court Plan For title of see the following deed:. Book a ��� , Page /0 . Or Land Court Certificate of Title Number Executed as a sealed instrument �%day of a Owner's signature Owner's signature Owners signature COMMONWEALTH OF MASSACHUSETTS , ss z — ._ 20 Then personally ppeared the above-named I J known to me to be the pe on who executed the foregoing instrument and acknowledged the same to be free act and deed, before me, Public t- Notary My commission expires: (date) deedr — _ - FROM :down cape engineering inc FAX NO. :15083629880 Jar. 11 2010 12:34PM P1 0 r. tory SenNie-es `EhO'EMUS F. Geifer,DireUar N .'AU PTQ1bH';-' Hemith Divishm ACO M-011 Sh-ect,Hy2mis, M4,076on Office: 508-1 862-4644 Yam 50f�-790-6.304 Form Assessor's M 111PTured Dc-dguier". b d tn101 �A.p 2 i5\�/ rj 60,,—\ 0117' Aoldre,,4,q: A CJri �Z z�/g ©� � � -��lJ� Q K�k Py-t MA Mar-,t—b 1-vo Ki [(1 144 WIS ISSILed a pemlit to install a sk'ptie system at based on a dosign.drawn by (addmss) CL/4, -j /�-E. ,e l`-f dated I certify that the Septic System i-e-fel-enced above was installed substmlially acciotdiug to the dus-IR11, Which may include minor approved changes sud as hatual relocation oFthe (1.1,14rN7fim boxand/cm-septic,tank. I certify that ffic septic sysWm i-efexeiiccd above was in.statl.ed with maJor ol-nniges (i.e. gmlf-e-r thau. 1.0, I-em-al Woeation of the SAS or,any veitical rclocatim-i of any componeiit Of thc septic SvSkarObUt in accordance with State & Local Regulations. Plan rc.visaUll or CeftfliVAI LIS-built by desigmej.,to fallow. OF Aq yn -DANIFT.A. Qjr s 'naturc) OJALA CIVIL 0. 502 9 T IP-0" Sp/ON L (Affix 1"ri 6t',,: '.BA:RNSTA131,E PUBU.c HIKALTR 30.Vjii.Pj.?.N CTUITWIC.ATE OF C,'01YRUJANCE VVIT..T, , NOT BF, j;o,r�j p-us FORT AN:K) A JIU'j- kKj!� T HANK YOU. Cerfilcat'jori F(m-n 3-26-W.,Ivc TRANS. NO.: CITY/TOWN: APPLICANT: �- ADDRESS: : 2<j L.� DESIGN FLOW: pd 33� REVIEWED BY: DATE: N/A OK NO 'LY�IV:JL� {! f Legal boundaries denoted [310 CMR 15.220(4)(a)] K Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CNR 15.2204(t)] ✓ Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades] if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] daily flow ✓ septic tank capacity(required and provided) soil absorption system(requixed and provided) whether system designed for garbage grinder ✓ North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR ✓ 15.220(4)(h) and (i)] d Location and date of percolation tests (performed at proper f elevation?) [310 CMR 15.220(4)(1)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(11)] Address Sheet 1 of 7 f - Nl/ _ OK NO F15220(4)(k)l on of every water supply, public and private, [310 CMR within 400 feet of the proposed system location in the caseface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[11) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor (required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] F oles adequate (two in each of the primary and reservetrenches as permitted in 310 CMR 15.102(2) or ased for an upgrade under LUA at 310 CMR 15.405(1)(k)] le adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR �- 15.000] System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] Address Sheet 2 of 7 i N/A } OK NO S JL�1L:J,.CC 11-i1Y YS. ..i RM 'A"'S'? ,`+,". t ��,vu �i�tF�r A7x Size OK? [310 CMR 15.2230)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater / (except as described 310 CMR 15227(5)) or permitted for ✓/ upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - , middle access at least 8" (by 7/07) [310 CMR 15.228(2)] V Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] ✓ All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] Required when other than single-family dwelling or flow>l000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and (3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] c Address Sheet 3 of 7 N/A, OK NO !lf Lt least ten feet from any water line? [310 CMR 15 ] Disposal piping at least 18" below water line (when water and / sewer cross, see 310 CMR 15.211(1)[11) v Cleanouts required/provided? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CZAR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable 1310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/ (leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] Capacity(emergency storage above working—design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR. 15.211 (same as septic tanks)] Watertight 20-in miruum access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and(8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed? Provided? [310 CMM 15.221(8)] Address Sheet 4 of 7 N/A OK NO SQr��BSORP, �1 � ' EM ( i S) Csl ��1�" T', �" .. . :t.. '•' ± �,� °' F`: Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] ✓ Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.2411 . Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I'minimum- 4' maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet -maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] ��1�3� ���.� "a�►i£in�aa�sz� f���'e �ffie�` 50�®O g1��d) ,. ., N minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CUR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(0] Bottom area used in calculations only [310 CMR 15.252(2)(1)] Address Sheet 5 of 7 N/A OK NO Pressure Dosed system ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative / systems under remedial approval [310 CMR 15.254(2) and I/A ✓ Remedial Use Approvals] If used in gravelless system-make sure jet is directed as not to scour soil interface [Guidance Document] ✓ Inspections once per year (systems<2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] -7/1 Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] 1 At least 5 ft. fiom impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Ura elles� ;asw 7 f P�; 1 :e tee s Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge t�o�y scour }soil interface al 1 !1L'C er( ,j L } /k' tk1&�RYW79iiL4 ers-e ..r,.r.,...;7 1 e is Says.e��i fI/,, '�p�a#gv Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance race Are the variances listed on the plan? [310 CMR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within live feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414] Address Sheet 6 of 7 N/A OK NO Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CNM 15.214, 310 CMR 15.215 and 310 CMR 15,216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CNM 15 216(1)] IMW1 7.r�J Fj C'�"`!f ; MI5 fib '•: dSCB��Cl�l2®ZSS u ?r:, d N,r_� � ,r Pumping to septic tank ? [ 3.10 CMR 15.229] Shared System [310 CMR 15.290] Address Sheet 7 of 7 60 Town of Barnstabk P#_l Qy THE P IDepartmcnt of Regulatory Services 4 tu➢�&g� ���aI th Division Date u DARNBT EM * . AE& 200 Main Street,Hyannis MA 02601 �PFD PAA'1 a Date Scheduled 1 Time � Fee Pd. Foil Suitability . ssessrizent forr° Sewage Disposal _ �erY�i Performed 13y: l��' witnessed By: r IL G CA7[ION & G]ENERAJL][Nl[+GRK&TION Localion Address ^' l\ oo M I� La Owner's Name �(� Q�✓.f�- Ce�Iw ✓1 l�Q Address Assessor's Map/Parcel: �3t7 1/� Engineer's Name W(I v),^— NEW CONSTRUCTION REPAIR Telephone IF Land Use. Slopes % �'S Surface Stones Distances from: Open Water Body YUU± R Possible Wet.Area 150 ft Drinking Water Well tt Drainage Way ft Property Llne _VV ft Other SKETCH' (Street name,dimensions of lot,exact locations of lest holes&pert tests,locate wctlands'in pioxi[idly to holes) 411 �� cP i , C /- -7V 2/Lif Parent material(geologic) /)riy'LLJ/95�f" Depth IQ Qetll'oek?ar.) Depth to Groundwater: Standing Water-in Hole: NvN Weeplltg I1'Ulll Pit Pfh:e 4-M Estimated Seasonal High Groundwater OM46f7: D ETEMUNA7CION FOR SEASONAL HIGH WATER FABLE Method Used: Depth Observed standing in obs.hole: T,,. _In, Deptll 10 soil 1n0t11..m: 4 116 Depth to weeping from side of obs.ho c: I!l. Groundwater Adjustment,_ Pt. Index Well I# Reading Date: Index Well level Adj,Awtnr_ Aril,e)roundwuter Level PERCOLATION TEST Date Time Observation Hole# Tinte at 9" Depth of Pere 67 /l Time at 6" _ Start Pre-soak Time @ Zo 0U _ Time:O"-6") _ End Pre-soak Rate Min./Incli Site Sullability Assessment: Site Passel!_` 5it.�Failed: Additional Testing Needed(YIN) Original; Public Health Division Observation Hole Data To Be Completed on Back--- ***If percolation test is to be conducted wit➢sill 100' of wetland,you must first u 0tify t➢lle. Barnstable Conservation Division at least one (I) wee➢s p>ricir to begiawiungo QAS GPTIC\PERCFORM.DOC 1 DIC]CP. Depth from OBSE VATION FI®I, LOG -------- Soil Horizon Hole # Surface(in.) Soil Texture Soil Color Soil• ` • (USDA) Other (Munsell) Mottling (Structure,Stones;Boulders, /Z L C `U y Con istenc %a' ravel /2— 36 G �J2 .11 REP ORgFRVATI®NH®I,E LOGDepth from Soil Horizon frole # Surface(in.) Soil Texture Soil Color Soil (USDA) (Munsell) Mot O tling (Structure,Stones, Boulders. G� r� Al— /� `O Consistency, %Gravel 7 Depth from Soil Horizon Hole# Surface(in.) Soil Texture Soil Color. (USDA) Sail (Munsell) Mottling (St ructuree,Other Stories,Boulders. Co siste c G ve D-r1r',P 0-BSERVATIOIV�IC�LE OG Depth from Soil Horizon Hole# Surface(in.) Soil Texture Soil Color Soll (USDA) (Munsell) MottlingOther (Structure,Stones;Boulders, Consi tenry. a I Fgood gnsurance Rate Ma Above 500 year flood boundary No Yes Within 500 year boundary No_ Yes Within 100 year flood boundary No� Yes e to o, I�Truta¢>r�lly n�Peivious lVlateria�6 Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the Soil absorption system? ,/ fz If not, what is the depth of naturally occuriring I)ervious mararial? Ce?>rti�catioa� c '. •. I certify that on • (date)I have passed the soil evaluator examination approved by the Department of Environmental.Pl-otectiori and that the above analyt;is was performed by me consistent with Ure required training, expertise and experience described in�10 CMR 15.017. Signature Data r6 Q:\S.EPTIC\PERCFORM.DOC Town of Barnstable Barnstable Regulatory Services Department j edCe j Z B"NSPABM "3AM Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205009595 10/30/2009 Evelyn M. Patterson 20 Loomis Lane Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 20 Loomis Lane, Centerville was last inspected on September 12, 2009 by Patrick O'Connell, a certified septic inspector for the.State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 20 Loomis Lane Property Address Sue Gilgun Owner Owner's Name information is Centerville MA 02632 September 12, 2009 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name VQ 189 Cammett Road Company Address Marstons Mills MA 02648 Cityrrown State Zip Code 508-428-1779 SI 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the inform tion reported below is true, accurate and complete as of the time of the inspection. The inspection - was pJrformed based on my training and experience in the proper function and maintenance of on site o` sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: 03 ril ❑)Passes ❑ Conditionally Passes ® Fails ILA- 1 ❑ deeds Further Evaluation by the Local Approving Authority September 12, 2009 Tecto4esgnature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. U 09-151 Gilgun.doc-0a106 Titles Official Inspection Form:Subsurface Sew Disposal System•Peg 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Loomis Lane Property Address Sue Gilgun Owner Owner's Name information is Centerville MA 02632 September 12, 2009 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 09-151 Gilgun.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Loomis Lane Property Address Sue Gilgun Owner Owner's Name information is Centerville MA 02632 September 12, 2009 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 09-151 Gilgun.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 I Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Loomis Lane Property Address Sue Gilgun -- Owner Owner's Name information is Centerville MA 02632 September 12, 2009 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the grouhd or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 09-151 Gilgun.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Loomis Lane Property Address Sue Gilgun Owner Owner's Name information is Centerville MA 02632 September 12, 2009 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails: The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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. 09-151 Gilgun.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Loomis Lane Property Address Sue Gilgun Owner Owner's Name information is Centerville MA 02632 September 12, 2009 required for every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 09-151 Gilgun.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Loomis Lane Property Address Sue Gilgun Owner Owner's Name information is Centerville MA 02632 September 12, 2009 required for every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): Unknown Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Unknown Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 09-151 Gilgun.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 I - Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Loomis Lane Property Address Sue Gilgun Owner Owner's Name information is required for Centerville MA 02632 September 12, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1950's Were sewage odors detected when arriving at the site? ❑ Yes ® No 09-151 Gilgun.doc 08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Loomis Lane Property Address Sue Gilgun Owner Owner's Name information is Centerville MA 02632 September 12, 2009 required for every page. City/town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site Ian): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? 09-151 Gilgun.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 20 Loomis Lane Property Address Sue Gilgun Owner Owner's Name information is Centerville MA 02632 September 12, 2009 required for every page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 09-151 Gilgun.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 I f Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Loomis Lane Property Address Sue Gilgun Owner Owner's Name information is required for Centerville MA 02632 September 12, 2009 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 09-151 Gilgun.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 20 Loomis Lane Property Address Sue Gilgun Owner Owner's Name information is required for Centerville MA 02632 September 12, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: ,Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: One ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Overflow pit shows signs of surcharge into primary cesspool, system in hydraulic failure. 09-151 Gilgun.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 20 Loomis Lane Property Address Sue Gilgun Owner Owner's Name information is September 12, 2009 Centerville MA 02632 Se required for p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration One with overflow pit Depth—top of liquid to inlet invert 2' Depth of solids layer 6" Depth of scum layer 2" Dimensions of cesspool 6x6 Materials of construction Block Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Observed solids on top of outlet tee indicating surcharge from overflow pit. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 09-151 Gilgun.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 20 Loomis Lane Property Address Sue Gilgun Owner Owner's Name information is Centerville MA 02632 September 12, 2009 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Driveway ater ervice iCommonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Loomis Lane Property Address Sue Gilgun Owner Owner's Name information is Centerville MA 02632 September 12, 2009 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells N/A Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) Cl Accessed USGS database-explain: You must describe how you established the high ground water elevation: 09-151 Gilgun.doc-006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 of THE r Town of Barnstable- Regulatory Services Department AlAmedeaChy w HAftNSCABLE, ' Public Health Division 200 Main Street,.Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: " 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205009021 10/02/2009 Sue Gilgun 20 Loomis Lane Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 20 Loomis Lane, Centerville was last inspected on September 12, 2009 by Patrick O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. You are ordered to repair,or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. ORDER THE B ARD,OF HEALTH 0 s cKean, R.S., CHO ,. p� Agent of the Board of Health SHALL SYSTEM PROFILE ALL MARKED WITHCMAGNETICTTAPE OR BE NOTES (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT 1. DATUM IS APPROX. NGVD tiVequaquet ACCESS COVERS TO WITHIN 6" OF FIN. GRADE Lake PROVIDE INSPECTION' PORT TO WITHIN 3" OF FINAL GRADE 2. MUNICIPAL WATER IS EXISTING \ 49.1' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 46.0 MINIMUM .75' OF COVER OVER PRECAST 2% SLOP- REQUIRED OVER SYSTEM 46.0' DESIGN4. PRECAST H-10 MIN 8" DIAM. UNITSTO LOADING L PROPOSED PRECAST BE AASHO H RISERS (TYP.) COVER O 2'0 PROP. TEE 4"OSCH40 PVC 2" DOUBLL WASHED PEASTONE PIPES LEVEL 1ST 2' OR GEOTt�TILE FABRIC 43.5' 5. PIPE JOINTS TO BE MADE WATERTIGHT. *46.0'f 10" 1500 GAL H-10 14" a o 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE �c P 44.0' TEE SEPTIC TANK CD TEE WITH 43.75' 0000000 °`° 6" SUMP 000 310 CMR 15.000 (TITLE V.) ° ° o 43.0 GAS BAFFLE;; °_o_o_o0o�o° 12" MIN. INT. DIM. 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 2 0� + NOT TO BE USED FOR LOT LINE STAKING OR ANY 43.17 000 0 4' LIQ. LEVEL (ACME OR EQUAL) . 43.0 ���� 0 41.0 OTHER PURPOSE. y,• °o°o°o°o°o°o°o°o°°°o°o°°°°°°°°°o°o°°°°°o°°°o° H-20 305,0`INFILTRATORS _l1 5 9h o°o°°°O°000°000°°°°°O°O°°°o°O°o°o°o°o°o°o°o°o "Sl Cho o,o o_°_ ° o o ° o °_ 0 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 3/4" TO 1 1/2" DOUBLE WASHED STONE �' sf 6" CRUSHED STONE OR MECHANICAL 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION. (15.221 [21) OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30.4' X 10.25' S, HEALTH AND PERMISSION OBTAINED FROM BOARD - ($ % SLOPE) ( 19% SLOPE) ( 1 % SLOPE) OF HEALTH. *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL 31�4 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS CALLING DIGSAFE (1-888-344-7233) AND NOT TO SCALE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM m` 34.16 VERIFYING THE LOCATION OF ALL UNDERGROUND & o x 34.15 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF m' /�� BOTTOM TH-1 & TH-2 + WORK. ASSESSORS MAP 230 PARCEL 113 FOUNDATION 25 SEPTIC TANK 3' D' BOX 2' LEACHING 1 / ,� NO GROUNDWATER FOUND 36.0 FACILITY ' 34.16 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE LOCUS IS WITHIN GP DISTRICT AND ESTUARINE q _ PROPOSED LEACHING FACILITY. PROTECTION DISTRICT ' 12. EXISTING LEACHING FACILITY SHALL BE PUMPED ***2 BEDROOM DEED RESTRICTION REQUIRED AND REMOVED OR PUMPED AND FILLED WITH CLEAN L E G E N D SAND. 99- EXISTING CONTOUR x 99.1 EXIST. SPOT ELEV. 99 PROPOSED CONTOUR SYSTEM DESIGN. 79-9-1 PROPOSED SPOT EL IRON PIPE FND TH1 o 40.46 GARBAGE DISPOSER IS NOT ALLOWED 0 TETEST HOLE 2� OPE of GROUNDx 4 . 9 DESIGN FLOW: 2 BEDROOMS ® 110 GPD = 220 GPD \\ / USE A 220 GPD DESIGN FLOW*** C-Q-) IUTILITY POLE \ a� N \ **CRAWLSPACE FLOOR IS 3.6' ABOVE THE FIRE HYDRANT \ 9. _ TOP OF SAS ELEVATION (SETBACK TAKEN SEPTIC TANK: 220 GPD (2) = 44O x 2.53 FROM SLAB). NOTE: NOT ALL SYMBOLS MAY APEAR P IN DRAMANG _ g66 USE 1500 GAL. H-10 SEPTIC TANK x 41.15 �L �1 LEACHING: TEST HOLE LOGS I\IN, SIDES: 2(30.4 +10.25) 1.85 (.74) = 111.3 GPD "1 43 x 42.35 BOTTOM 30.4 x 10.25 (.74) = 230 GPD IRON PIPE FND �� \ x 44. 4� i BENCHMARK: USE TOP FNDN. ENGINEER: ARNE H. OJALA, PE, SE ss 461 S.F. 341.3 GPD HERE AT ELEVATION 49.1 TOTAL: WITNESS: DAVID W. STANTON, IRS 2.43 �ti � 4. 3 _ __. '' �k USE (4) H-20 3050 INFILTRATORS, DECEMBER 18, 2009 1� . DATE: 5.09 45 45 44.66 WITH 1, STONE AT ENDS AND 3 AT SIDES 4 PERC. RATE _ < 2 MIN/INCH x 41 � 45 �D/ CLASS I SOILS P# 12791 x 46 x 48.06 R3 6 �`76 00 5. 46.06 , MA ELEV. ELEV. 46 1;, APPROVED DATE BOARD OF HEALTH O» `1%' 46.0' O„ 46.0' 99 6 1 �6 x 46.84 HED ��, 42 A A 46.48 47 LS LS 45 46.95 ,1 . TITLE 5 SITE PLAN 10YR 4/2 10YR 4/2 x 44.31 PORCH LOT AREA 12" 10of rx� 47.61 151295± S.F. OF EXIST. DWELL. 0 x 47.07 TOP FNDN. =49.1 47. 7 48 20 LOOMIS LANE B ' B 2' CRAWLSP. LS LS �s� 1� 0 IRON PIPE FND „ 10YR 5/6 43.0' ++ 10YR 5/6 43.0 �s WATER METER PIT 88 x 48 O8 �(48.24 �`48.51 CENTERVILLE 36 36 \ / 48.02 / / PREPARED FOR 48.64 x 48.47 98 49.21 49� BORTOLOTTI CONSTRUCTION/ / PERC t✓ C x 48.88 ��o PATTERSON MCS MCS 9 �L 49 49.29 oRN j / DECEMBER 22, 2009 i PI 1 OYR 6/6 1 OYR 6/6 C' Q�w of rwA,sti �� o , 9.4 yy� ,----• \sy� off 508-362-4541 65 O;AIIEL. �� o fax 508-362-9880 49.60/ /g n� I3AY�lI L�. �p I ( A. a downcope.com o �� O.IALA --� ��, ( J,"�L fU CIVIL /� W 5 49.87 C, Noo 40980 5 c e 1 eeri 1/!c IRON PIPE FND 0y 00�\ / Q � 0.46 02 i�O�IQ Qpe /Ig' n ng� 36.0' 120 36.0 // L ,n 55. �� � T� �� civil engineers x'S0.22 �uRv fl I`a s G Scale: 1"= 20' r�rvAL k f; land surveyors NO GROUNDWATER ENCOUNTERED �/ '`�-l�z -�01 939 Main Street ( Rte 6A) 0 10 20 30 40 5o FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 0 9-283 09-283.DWG(SBO)