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0569 LUMBERT MILL ROAD - Health
5694XMBVRT 1VMILj kAz AD Centerville A`- 146 _ r'029 ft a M EAQ KEEPING YOU ORGANIZED No. 12534 2-153LOR U AIMLE MICANTENTIO%N.RECYCLED WRIATIVE ® Certfeaiibarsourcinp POST.MNSUMER www�praprantorp SFM1290 MADE IN USA GET ORGANIZED AT SMEAD.COM TOWN OF BARNSTABLE LOCATION S�� �..v���' '(u1 \\ ��� SEWAGE# a?0( 7 _ g VILLAGE ASSESSOR'S MAP&PARCEL D`Q!E� INSTALLER'S NAME&PHONE NO. 5Z3�7_ SEPTIC TANK CAPACITY SQna C Gw�'G cN..rvr,5dtr LEACHING FACILITY:(type) (size) QS° x Uw�y.S- NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ,_� Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY -„pr�,v� Ipr; „-G- ,y, o 1 ., .. `, Commonwealth of Massachusetts 1, &— Oe2 9 15=110'Y .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 569 Lumbert Mill Road F L Property Address Charles Shaffer Owner Owner's Name information is required for every Centerville MA 02632 May 15, 2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. Inspector Information l - 1�513 filling out forms on the computer, use only the tab Patrick T. Sullivan key to move your Name of Inspector cursor-do not Ready Rooter Excavating use the return Company Name key. PO Box 89 Company Address Forestdale MA 02644 City/Town State Zip Code 508-509-0802 S112843 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. 0 Passes 2. Conditionally Passes 3. Needs Further Evaluation by the Local Approving Authority 4. Fails May 18, 2020 Inspector's Signature _ Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.'The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Tice 5 Official Inspection Forth:Subsurface Sewage Disposal system•Page 1 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,--Ww 569 Lumbert Mill Road Property Address Charles Shaffer Owner Owner's Name information is required for every Centerville MA 02632 May 15, 2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ©_ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. )) Check the box for"yes", "no" or"not determind" (Y, N, ND)for the following statements. If"not determined," please explain. JJ The septic tank is metal and over 20 ye s old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltratio or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is repla ed with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass in ection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the nk is less than 20 years old is available. 8 Y N ND (Explain below): t5insp.doc-rev.7 ISM18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 569 Lumbert Mill Road Property Address Charles Shaffer Owner Owner's Name information is required for every Centerville MA 02632 May 15, 2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): 8 Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 8 Observation of sewage backup or reak out or high static water level in the distribution box due to broken or obstructed pipe(s) due to a broken, settled or uneven distribution box. System will pass inspection if(with approv I of Board of Health): broken pipe(s) are r placed Y N ND(Explain below): obstruction is re ved © Y N ND (Explain below): distribution box s leveled or replaced Y N ND (Explain below): i The system required pumping more than 4,:4imes a year due to broken or obstructed pipe(s). The system will pass inspection if(with approyal of the Board of Health): 8 broken pipe(s) are replaced ( L Y 0 N L] ND (Explain below): obstruction is removed I Y N ND (Explain below): r /i 3) Further Evaluation is Required by the Board of Health: ® Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Official . Title 5 Offic Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 569 Lumbert Mill Road Property Address Charles Shaffer _ Owner Owner's Name information is Centerville MA 02632 May 15, 2020 required for every page. City/rown State Zip Code Date of Inspection C. Inspection Summary (Cont.) Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioni g in a manner that protects the public health, safety and environment: The system has a septic tank an soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply o tributary to a surface water supply. The system has a septic tank d SAS and the SAS is within a Zone 1 of a public water supply. 8 The system has a septic tan and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic t nk and SAS and the SAS is less than 100 feet but 50 feet or more from a private water su ply well". Method used to determine stance: i r **This system passes if the/well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates..absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 569 Lumbert Mill Road Property Address Charles Shaffer Owner owner's Name information is required for every Centerville MA 02632 May 15, 2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded — or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. 8 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate e' her"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No the system ' within 400 feet of a surface drinking water supply the sys m is within 200 feet of a tributary to a surface drinking water supply the stem is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/2 61201 8 'Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 569 Lumbert Mill Road _ Property Address Charles Shaffer Owner Owner's Name information is required for every Centerville MA 02632 May 15, 2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No Pumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks? _ 8 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? 8 Was the site inspected for signs of break out? M L] 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? WN th@ fa(ARY owner(and owwponts If dftw fre-m ov/fl@r) provided Mh 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: z 0 Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts -_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 569 Lumbert Mill Road Property Address Charles Shaffer Owner owner's Name information is required for every Centerville MA 02632 May 15, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow b@ry@d @n 310 CMN 15,203(for oxampis; 110 gpd )(,#of Wdrmofs): 342 GPD Description: 2 Number of current residents: Does residence have a garbage grinder? Yes No Does residence have a water treatment unit? Yes No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection Yes No information in this report.) Laundry system inspected? Yes No Seasonal use? 8 Yes No 2018= 122 GPD Water meter readings, if available (last 2 years usage(gpd)): 2019=99 GPD Detail: Sump pump? Yes Z No Current Last date of occupancy: Date t5insp.doc-rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I V_ v 569 Lumbert Mill Road Property Address Charles Shaffer Owner Owner's Name information is required for every Centerville MA 02632 May 15, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203) Gallons per day(gpd) Basis of design flow(seats/persons/s .ft., etc.): Grease trap present? 0 Yes No Water treatment unit present? / Yes L] No If yes, discharges Industrial waste holding tan present? 8 Yes 8 No Non-sanitary waste discha ged to the Title 5 system? Yes ® No Water meter readings, if vailable: Last date of occupanc /use: Date Other(describe bel ): 3. Pumping Records: Source of information: Ready Rooter recods: Pumped 05/2017 Was system pumped as part of the inspection? Yes No If yes, volume pumped: 1000 gallons How was quantity pumped determined? Site tube on truck Reason for Maintenance pumping: t5insp.doc-rev.7126/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 569 Lumbert Mill Road Property Address Charles Shaffer Owner Owner's Name information is Centerville MA 02632 May 15, 2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: E Septic tank, distribution box, soil absorption system 8 Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) 0 Innovative/Altemative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract Tight tank. Attach a copy of the DEP approval. Other(describe): Approximate age of all components, date installed (if known) and source of information: Septic tank installed 1979. D-box and leach field installed 05/24/2017.tificate of Compliance on file at Health Dept Were sewage odors detected when arriving at the site? Yes ® No 5. Building Sewer(locate on site plan): 30" Depth below grade: feet Material of construction: cast iron 40 PVC 8 other(explain): n/a Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 J ON Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments <4, 569 Lumbert Mill Road `l Property Address Charles Shaffer Owner owner's Name information is Centerville MA 02632 May 15, 2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 26" . Depth below grade: feet Material of construction: concrete metal Ll fiberglass 0 polyethylene 8 other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) 8 Yes Q No 8.5' x 4.5'x 5' 1000 gallons Dimensions: 2" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 32" 4" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" Dip tube and tape measure How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet tees in place. Liquid level at outlet invert. Risers bring covers within 6" of grade. Tank pumped and cleaned after inspection by Ready Rooter, Inc. Recommend maintenance pumping every two years. t5insp.doc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 569 Lumbert Mill Road Property Address Charles Shaffer Owner owner's Name information is required for every Centerville MA 02632 May 15, 2020 page. City[rown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: Lj concrete Lj metal fiberglass 0 polyethylene 8 other(explain): Dimensions: Scum thickness Distance from top of scum to to of outlet tee or baffle Distance from bottom of sc to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: concrete 8 metal fiberglass polyethylene other(explain): Dimensions: ' Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 569 Lumbert Mill Road Property Address Charles Shaffer Owner Owner's Name information is Centerville MA 02632 May 15, 2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: / Yes © No Alarm level: Alarm in working order: Yes No i Date of last pumping: / Date r Comments(condition of alarm and floa witches, etc.): "Attach copy of current pumping contract(required). Is copy attached? 8 Yes No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): One inlet,two out.Very light solids carryover. No high water staining over outlet inverts. H-20 DB-3 34" below grade. Riser brings cover within 3" of grade. t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 569 Lumbert Mill Road Property Address Charles Shaffer Owner owner's Name information is required for every Centerville MA 02632 May 15, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: 8 Yes No' Alarms in working order: Yes No" Comments (note condition of pum chamber, condition of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: 0 leaching pits number: leaching chambers number. 4'to0eal ea. w/ leaching galleries number: leaching trenches number, length: leaching fields number, dimensions: overflow cesspool number innovative/alternative system Type/name of technology: t5insp.doc•rev.7I26=18 Title 5 Off ial trispec6on Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 569 Lumbert Mill Road — Property Address Charles Shaffer Owner Owner's Name information is Centerville Y MA 02632 May 15, 2020 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Liquid level 2"from base. High water staining 1.5+'from invert. No sign of past hydraulic failure. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert % Depth of solids layer Depth of scum layer Dimensions of cesspool , Materials of construction Indication of groundwater inflov�/ Yes 8 No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7126f2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 569 Lumbert Mill Road Property Address Charles Shaffer Owner Owner's Name information is Centerville MA 02632 May 15, 2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs f hydraulic failure, level of ponding, condition of vegetation, etc.): i t5insp.doc.rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts kjTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ..19. w" 569 Lumbert Mill Road Property Address Charles Shaffer Owner Owner's Name information is Centerville MA 02632 May 15, 2020 required for every page. CPtyrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below [� drawing attached separately i 1 �y 1o) c� QQ 3D `?`04 t5insp doc•rev.M 2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 5 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ., 569 Lumbert Mill Road Property Address Charles Shaffer Owner Owner's Name information is Centerville MA 02632 May 15, 2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: 8 Check Slope 8 Surface water Check cellar Shallow wells >5 Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of p design Ian reviewed. 05/09/2017 g Date 8 Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: maps massgis state ma us/oliver.php You must describe how you established the high ground water elevation: Test hole in 2017 found no ground at 138" (elv= 33.14). Base of units at elv= 38.35 per engineered plans. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 569 Lumbert Mill Road Property Address Charles Shaffer Owner owner's Name information is Centerville MA 02632 May 15, 2020 required for every page. City/Town State Zip Code Date of Inspedion E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this section. B. Certification: Signed & Dated and 1, 2, 3, or 4 checked C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.72612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Town of Barnstable P# n4E Department of Regulatory Services 1 i Public Health Division „,,� Date 2 i419 200 Main Street,Hyannis MA 02601 'Q • _ lfu tried� -� Date Scheduled " �_— Time Fee Pd. mil Suitability Assessment,for Se e Disposal Performed By I (f e1V\1 me Witnessed By: LOCATION&GENERAL INFORMATION Location Address SQ \ ' R�Owners Name C(A s� � /ter �•!`L�<�� b C 1�1I�p Address SO l . Assessor's Map/Parcel: i Engineer's Name V.•Ad` d�"A' \ Gy c.T--a sovds,�k NEW CONSTRUCTIONV%N n �.rREPAIR _�,� Telephone# Sow- ® —✓? l l Land Use RCS.11 �E/V! �� Slopes(%) 6 —S 'A Surface Stones Distances from: Open Water Body ft Possible Wet Area �'�J� g Drinking Water Well�,— ft Drainage Way ft jProperty Line ?- .O ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes) 4 � Iq Y7 6_ 181 Parent material(geologic) `!4,1) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face r Estimated Seasonal High Groundwater D RMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Ob rved standing in obs.hole: In, Depth to loll mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment Ft. Index Well# Reading Date: Index Well level —, Adj.factor ,y A41.Groundwater level _ PERCOLATION TEST bate Time.Y� Observation ,I Hole# Time at 9" r" Depth of Perc 36t—! 3l Time at 6" � It)'b Start Pre-soak Time @ 'rime(9"-6") End Pre-soak (f✓(y r • Rate Min./Inch Site Suitability Assessment: Site Passed X Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted:within 100' of wetland,you must first notify the. Barnstable Consel}vation Division at least one(1) week prior to beginning. Q:\SEPTICWERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. t► onsistency.96 arnvel) _M" G M eto q-Nb 2•S DEEP OBSERVATION HOLE LOG 'Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o si en % DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv. DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Solt Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Consis oncy. y )Flood Insurance Rate Man: Above 500 year flood boundary No Yes Within 500 year boundary No - ' Yes Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio s m t terial exist in all kreas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per ious material? Certification: Q I certify that on 1 (date)I have passed the soil evaluator examination approved by the Department of Enviro ental Protection and that the above analysis was performed by me consistent with . h required a 'n ex erti a and ex rience descri in 10 CMR 15. 7. the req p � y Signature Date Q:\S.EPTICVERCFORM.DOC t' ;i 11 ( ! ' l ' No. d""'a � �"1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYitation for Misposai *pstern Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(%/)<Abandon( ) ❑Complete System P111,dividual Components Location Address or Lot No. S�n ( bGs G �M i�� QCQ Owner's Name Address and T No. g-737- 't �.� �te Assessor's Map/Parcel 41 E, Installer's Na a Address,and Tel.No.3_1�171 77'?` Designer's Name,Address,and Tel.No. S7---7aL _3;®_33!L ` K O`dS-3 7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Buildings, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ��3 0 gpd Design flow provided Y gpd Plan Date '(nAt \91 Q Q)�"� Number of sheets � Revision Date Title Size of Septic Tank i©©p ��o Type of S.A.S.Ca v.C„rL�, Description of Soil := p� Nature of Repairs or Alterations(Answer when applicable)` ,� �a d �<<-a C.j `a 5 > L, ,� 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. Signe Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. -�L—C9 7—/ Date Issued �'i { 6 No. Fee Fee . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Disposal 6pstem Construttion Permit Application for a Permit to Construct( ) Repair( Upgrade(Abandon( ) ❑Complete System Individual Components i Location Address or Lot No. S o� ?YOwner's ame Address,an No. n _ IQ Assessor's Map/Parcel `4' C ` '"` e u v Installer's Nan e,Address,and Tel.No�'j`777'�'=� -` Designer's Name,Address,and Tel.No.Ste'?- �:(n)_3 3 K,cr�C + Type of Building: Dwelling No.of Bedrooms Lot Size (G 1 a sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) 'i Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 3 Y c gpd Plan Date Q O t`j Number of sheets oC Revision Date Title Size of Septic Tank (40© Type ofS.A. Z* b�,.E? ` Description of Soil I I i Nature of Repairs or Alterations(Answer when applicable) �a o 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 hastbeen issued by this Board of Health. 1 Ij Sign -� Date S� Z Application Approved by ViA �� Date Application Disapproved by Date j for the following reasons Permit No. o 1 7 - p Date Issued - -- ----------------------------------- ---------- -- - '_ ------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system-Constructed( ) Repaired( ) Upgraded Abandoned( )by ®co i�S u l\ �. at C L c R4 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. d /7-/Y((Sdated Installer `c-.p�� p�\��3" �-Sr�t,s."C'.'y., Designer (Y\<3_.t CAI''ti #bedrooms Approved design w., 3 C7 gpd The issuance of this permit shall t be const e*'d�as a guarantee that the system will ction as g ed. Date / Inspector No. � ) f 7- l 5 D Fee / Q O THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit i Permission is hereby granted to Construct( ) Repair( ) Upgrade(✓) Abandon( ) System located at S6� L`y vv��,►-c�� �� �0:4�i C�vCC`G I L:� .��'� 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. i Provided:Construction m st be completed within three years of the date of this permit. Date Approved by I / Town of Barnstable Regulatory Services .� Richard V. Scali,Interim Director MRNnABM M"aPublic Health Division 039.c► ° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 11L11,0 Sewage Permit# Q< lO- i S g Assessor's Map\Parcel .% Designer: 1 1114 4,' Installer: , Address: /- 0 of Address: On S (� �, -r�rccwas issued a permit to install a (date) (installer) septic system at S(,6AZ M g T- KlL L, based on a design drawn by < l,, (address) ` Y16 dated 1 (design �Lf ti Me, I certify that the septic system leferenced 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 system)but in accordance with State & Local Regulations. Plan revision or 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 construct a with the terms of the IAA,approval letters(if applicable) ( taller'3 Signa e) 1 , 99 Ak (Designers Signature) (Affix Designer mp Here) b PLEASE RETURN TO B STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM :AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DMS10N. THANK YOU. Q:\Septic\De igner Certification Form Rev 8-14-13.doc r t No ` ate- ---"� Fps.... l�... o...............,......... THE COMMONWEALTH OF MASStiCHUSETTS BOARD OF HEALTH �µ G-r.....=� -""-"--- ----....OF..... —---------------------------------- A Vftration for UiopooFal Works Tonotrnrtion Frrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: L ation-Address or Lot o s.e.....LAI.(..................... l. .Q -.... 7...........tt:- l.�.P -............. Owner ddress a - .. �.CI..N.S.t7d�sl_ l_6. .............. 1. J 1.. :.-..... .............. Installer Add ess Type of Building Size Lot..�Zj.U---------Sq. feet Dwelling—No. of Bedrooms________ _______________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) w Other fixtures -----------------------------•---- WDesign Flow..... . .._._ S.................gallons per person per day. Total daily flow.�'_....... . ......................gallons. WSeptic Tank—Liquid capacityLU".gallons Length............. Width...:__(.o_-----.. D ameter________________ Depth--_.________-_-- x Disposal Trench—No..................... Width.................... Total Length.................... Too�l leaching area....................sq. ft. Seepage Pit No---------r.._______- Diameter....s�'.�.5...... Depth below inlet...... Tot l leaching areaZl(o.:_5...sq. ft. Z Other Distribution box Dosing tank ( ) '~ Percolation Test Results Performed by........ ._€�.A ck.............1_!?J11 Date........................................ Test Pit No. I................minutes per inch Depth,of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ................................. •••...•--••-••--••-•••..........................................•----•---------.......----••••---_----- --------- -------- O Description of Soil--Q L..._.C.iJ.rfrM.. .. �!_�Sll° -- ".IL.(LUJA------S-�'^I�-_-... �'.I--'-•----- Uh .......S��C+J�-----rt �•-- ... � ---�r�.�rt��,_...._S_�_a�__._�.. �-�... � � -----------------•........._ x -4..f-�. .�i s -------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ...•••- ------------------------•--------------------. ..----------------....-----.•..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI'HZ- 5 of the-State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued/� e�ard of he th. J..� ..Si ne _ Q Date Application Approved By.......... ... � -••h-('✓1�•h�C, - ...... Date Application Disapproved for the following reasons---------------------------------------------------------------------- .......................................... ..--••••----•••---•---•--••.............•••-••••-•---••-•---••••-••-------.....--•---........••-••---•---•-••----•--•-------•-----•-•--•--•-----•-•-••-••••-•-•---------•------------------------------- Date Permit No...................................................... Issued..... q Date 4 .f 12 N Lf'CATION SEWAGE PERMIT NO. VI''LLAGE pe r V i, PIP I N S T A LLER'S A i ADDRESS re- �� l 4 .H t OWNER . xs DATE PERMIT ISSUED DAT E COMPLI-ANCE ISSUED i. � �o � - _ _ . ,�. 1, ~ �' � � �� i � � (`Jx1� L� iI /,: . _ as......... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1/W ..............OF...... > ............................... ApplirFa#inn for Disposal Works Tonstratrtinn Frrutit Application is hereby made for a Permit to Construct (y) or Repair ( ) an Individual Sewage Disposal System at: Gr .......1..J.�.- . .. ._....- ..... r Loca n-Address Lot No 1 t: . ti -^ .�.................. y c4..se ... - = ... Owner Address — Installer Address -- •-�.......... UType of Building Size Lot.Z:-2q.&&. ?...._..Sq. feet �-, Dwelling—No. of Bedrooms..... ...................................Expansion Attice�( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons................. ... Showers ( ) — Cafeteria ( ) _ < Other fixtures --------•--•-•----•-•--••..................................................... ... W Design Flow._..._....�._-Z;k.........................gallons per person per day. Total,-daily flow_=i_____-:•_---3_1b_....................gallons. Disposal Trench—No.................... Wi h....._._....._.. - Total Length_........._......... Tota leaching area Depth................ C4 Septic Tank—Liquid capacityl`G-_.gallons Length-__---&....... Width._...... Seepage Pit No.......(..........._ Diameter........,........ Depth below inlet.....................'.to 1 leaching area.-___..._.___..._._.sq. ft. L.. � p � tal leaching area.z:I.(-=:_5._sq. ft. z Other Distribution box (X ) Dosing tank ( ) _ Percolation Test Results Performed by........�,1__-__--__0_C L.L.e-.............................. Date............... ......0............. a; Test Pit No. 1----------------minutes per inch Depth of Test Pit.........:.......... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water........................ ... ......------•-------•-----•.........................................f_.....................•.. --•--•--•-•----••----•----............._�_....•--7..._._. 0 Description of Soil... ..---....�C1_A_1hl 'Yt°i. 1t:1.L:......r...L......�.- +.tA...-- Q - 5 v .�-!J.�...%. 5 I. P--....C_ !4 5. .......S.�--b---....� ...... ....... cvnl.t ll._ •---••---•-••--•----•------------------------------------•---•-••-----------•--•---•--••----•---••--•----•---•--•-•-----.................................. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -------•-------------------•-----........------------------------------------------........------•-----••-------------------------------------------------------------------------------.............-• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has n issued b t boa d of health. Si n d.. :. t YS� . . . . ••.. .............•-••.....-- .....�-f-.---........---.... Date Application Approved B / `- Date Application Disapproved for the following reasons:-----•----------------------------------•----------------------•-•-------------•----------------•-----••-------- ----•----------------------------------------..----•-....----•---•-------•--•--••---------••------•----------••------.... ......---•--•--- Date PermitNo......................................................... Issued.......................................................Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ......... ....::t..... .........OF...... .................................._...... (9rrtifiratr of Tnntphaurr ,.- TFIIS IS TO,CERTIFY, That the Individ al Sexbrage Disposal System constructed ( ) or Repaired ( ) bY----------- . .......................... .................... ......................... IIntller # has been installed in accordance with the provisions of TIT 5 of Th tate SanitaryCode as described in the application for Disposal Works Construction Permit No... �_._4_.7 ............... da.ted -./G)._"_A.S -~7�......._... THE:: ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU ® AS ,GUARANTEE THAT THE �.,. SYSTEM WILL FUNCTION SATISFACTORY. DATE---...J..:..�l— ..7.... ------------------------------------------- Inspector------ �� IL.... THE COMMONWEALTH OF MASSACHUSETTS a, y BOARD. O HEALTH NO......................... FEE ..f•.,z . ` •... Dispos al . or s �nntr inn rranit Permission 's here�oy granted-------' -- . . ------.....� -• 4 to Construct or_, a- Ind' idu 1 Sewa,a is al Sy Istem _ at No.^�~ ._ ---�-- - ( ) i b is al ; ye ti.0... ........ as shorn Street on t lication for Dis osal Vl orks Construction, t No._..___ _.. r_ Dat M DATE t/�,�, ;7 Board of Health 10, FORM- 1255 HOBBS & WARREN. INC., PUBLISHERS ... ' LEGEND CENTER VILLE Opp PROPOSED CONTOUR • - ® PROPOSED SPOT GRADE —— 98 —— EXISTING CONTOUR 00 + 96.52 EXISTING SPOT GRADE ONV9DFP� ,� ` 9 W— EXISTING WATER SERVICE fV_ o TEST PIT SCALE: 1"=20' LUM RTPOND �O LOCUS oqa 45 BENCH MARK _ ROUTE 28 _ PAINT SPOT ON '•� �\ _ __ STEP CORNER \ _ 45 756 44.65 LOCUS MAP \ - / 2T 44 BARNSTABLE GIS DATU (P // +I LOCUS INFORMATION / __ PLAN REF: LCP 37432-A 15 ft I TITLE E D: C122701 PAR. 029 L.O T 13 AREA = 16927 sf+— TF-1R\ i I FLOOD ZONE: "X" ' / I LAND COURT PLAN 37432—A DRIVCWA� COMMUNITY PANEL: 25001CO542J DATED:07/16/14 � \\ SF-II-/D I AssF inAP146 PCL 29 � SEPTIC SYSTEM \\ 1 REPAIR PLAN O \\ LOCATED T: o 569 LUMBER/ MILL RD. I Q CEN TER VI LLE, MA. 44� � ' Z z �� i O PREPARED FOR � vz,,t - , 43 � CHARLES A. SHAFFER/ 2 �� 20 Lu ft " , o READY ROOTER . EXC. bi a MAY 18, 2017 EXIST. 1,000G -_j �� o .SEPTIC TANK ~tj _ �' ,42 WATER D RR EN Gn AGATE M�YF2 " 1 PAVED // / /41 ti6 42------ ��\\ ���----- // /IDRIVeWgyor `� -------- --- / / S0IT00 c/ Lu - i PLAN14 \ �'----------"-- - ,-40 � MEYER & SONS, INC. 9.05. - P.O. BOX 981 SCALE: 1 in, = 20 ft 41--- — 39 o zo 40 40 ,_ EAST SANDWICH, MA. 02537 39 PH: (508)360-3311 0 10 20 40 _ FAX: (774)413-9468 meyerandsonstitle5@gmail.com SHEET 1 OF 2 J 1912 ELEV. TOP FOUNDATION NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE FINISHED GRADE (44.50) 45.0 F.G.EL: 44.50 F.G.EL: 44.30 F.G. EL':' 44.50 VENT A MAINTAIN 2% MIN SLOPE OVER LEACHING AREA X F.G.EL: 42.26 2" OF 3/8-DOUBLE WASHED 3/4" - 1-1/2" STONE OR FILTER FABRIC DOUBLE WASHED STONE 6" 4" SCH 40 PVC LL 10"I ®®®® p ®®®® TEE'S ARE TO BE 14 s S= 1 (MIN•) ®®®®®®®®®®® 4" SCH 40 PVC INV.40.70 2' EFF. DEPTH ®®®®®®®®®®®. INV.40.95 PROPOSED DB-3 4' 2 X 8.5' 4' EXISTING OUTLET BAFFLE INV.40.50 INV. 41 .20 DISTRIBUTION BOX EFFECTIVE LENGTH = 25' _ (1-120) INV. ELEV.= 40.35 EXISTING 1,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ��`� �F '�q , BREAKOUT OUTLET TEE AS MANUFACTURED BY o� ELEV.= 41 .35 Gr TUF-TITE, ZABEL, OR EQUAL RREN M. TOP CONC. ELEV.= 41 .35 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING N 1 0 "' INV. ELEV.= 40.35 �® �®® PIPE INVERTS PRIOR TO CONSTRUCTION \ ®®®®®®® . 2) D-BOX SHALL BE SET LEVEL AND TRUE TO \ �Pf�/ � E0310 ® GRADE ON A MECHANICALLY COMPACTED SIX NITA?0 BOTTOM EL.= 38.35 ®®®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN 3.75' 5 FT. 3.75' 310 CMR 15.TING 1 EFFECTIVE WIDTH = 12.5' 3) REPLACE EXISTING 1,000 GALLON, SEPTIC TANK SEPARATION 5.21 FT. WITH DAMAGED, GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE ' DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SOIL ABSORPTION SYSTEM SECTION 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 33.14 ( GAS BAFFLE AS REQUIRED (500 GALLON (1-120) LEACH CHAMBER) GENERAL NOTES: DESIGN CRITERIA I. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOGS P#:15345 NUMBER OF BEDROOMS: 3 BEDROOOM DESIGN BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: MAY 9, 2017 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE. TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN IN LOCAL RULES AND REGULATIONS. EXCEPT AS REQUESTED BELOW: SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 / -.310 CMR 15.405 (1) (B): WITNESS: 1 DON DESMARAIS, BARNSTABLE HEALTH DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. E) A DBEs Fr. VARIANCE(MAX FROM 3E GRADE To ALLOW LEACHING GARBAGE GRINDER: NO not designed for garbage grinder) TO BE 3.15 FT (MAX) BELOW GRADE VS REa'0 3 Ff. (H2O/VENT PROVIDED) ( 9 9 9 9 � ) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR ' SEPTIC TANK: TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE Elev. TP- 1 Depth 1 Elev. TP-2 Depth 330 gpd x 200% = 660 gpd, USE EXISTING 1,000 GAL. SEPTIC TANK DESIGN ENGINEER. 44.64 0" ;44.90 0" A A (330) = 445.94 S.F. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING LOAMY SANG LOAMY SAND LEACHING AREA REQUIRED: FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 10YR 4/2 10YR 4/2 .74 ENGINEER BEFORE CONSTRUCTION CONTINUES. 44.31 4" 44.57 4" !)t 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. B LOAMY SAND B LOAMY SAND USE TWO (2) 500 GALLON H-20 PRECAST LEACH CHAMBERS W/ 4' 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF IOYR 6/6 10YR 6/6 STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x. 12.5' W x 2'D i THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 41.64 36" 41.90 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. C C 36" BOTTOM AREA: 25 x 12.5= 312.5 SF 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. PERC O SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED EL. 40.22 MEDIUM MEDIUM TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. SAND SAND THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 9. IT SHALL THE RESPONSIBILITY THE CONTRACTOR TO VERIFY THE 2.5Y 6/6 2.5Y 6/6 DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd CONSTRUCTION. 10. EXISTING LEACHPIT TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. PROPOSED SEPTIC SYSTEM UPGRADE PLAN REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 33.14 138" �33.90. 132" <2MIIN/INCH IN "C" SOILS 569 LUMBERT MILL ROAD, CENTERVILLE MA 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY NO GROUNDWATER OBSERVED Prepared for: Shaffer Read Rooter Exc. AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO PRIVATE WELLS WITHIN 150. OF PROPOSED LEACHING. Engineering and Survey by: SCALE DRAWN 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. I, Darren M. Meyer, R.S., CSE, hereby certify that 1 am currently a MEYER&SONS,INC. DMM y Y �h' tti approved by MADEP pursuant to 310 CMR 15.017 N.T.S. 15. ALL PIPING TO BE 4" SCH 40 ® 1/8"/Fr (UNLESS SPECIFIED) to conduct soil evaluations and that the above analysis has been performed by me consistent with the - PO BOX981 requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. EAST SANDWICH,AfA02537 DATE CHECKED SHEET NO. 50es622922 05/18/17 DMM 2 of 2 { MSG # 4 ,. , • � , u o c� 33 � f a , a _.. _._ ,. .. ... .. w....r.,.. ,:. , « ..:. .. N.....,, ,.:e .. .... 1 „ ♦ ,. ...... _ -,4 --.« ...-.yam..»_., ...._: ::: ... ...._,.ate.._.,..,,., ,,:..,.:"... _...-,::,..,. .,.:.. .._ , .'. .. _.. _ , ,�td .. { • � p 4 lvsl G � 1� ry S r' 3a, s` o,z Zl- r c 4 _ _.: ._ -._: ,,_... ::_ _....,,_. . .,,...,_,_.:„: ,...,...»-....,.,...;;,. ..u.,7,.... .,>,.•. tea. ..... , —•-� is-•*, # #_: F AW J. ti r� �1 urn o� pr / ✓ / .. / )e T.` S l ro � 5 p c> v o farop�5cd G�l'D4�r7C! f� ,fi! I SCNEA. •�C.� F?tJ.G; 0,(a _ � r•a�<nirnurr� �� p��•�-. f'no7`•,,�, " o �8 - �� cucr..sh ed 1e. l,I .S ✓ti'�z? 2.5 L1 G L-YU�-G-.q— ..-T7.H�om' fLp G✓GEL�,�'-C 3�G?. ». 2%Sd2•/ta ' 77 n�T'e TA AJ F o 7 P'/T 32�07- 77 T�S T fy Q f n.1 � /C 0 � GT �1E� 'E CG La ,9 ,,� l7i9Y 14 A-1 n G ap e C 1-7 r7 e t-ir7 7- �' 7.�' LOT 1f 0 74 1. .5VAT V YO�5 Ng �� T �T'E, A--r70JTh' A-1G &�, - ! 7 G3 S A S l" 7f ! SG � L 6- 30 3 1-7 S Go,-7 0urS --o-- o —a—o 57 : 8 # 77- 0/