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HomeMy WebLinkAbout0580 LUMBERT MILL ROAD - Health 580 Lumbert Mill Road Centerville A= 147 - 086 UPC 12543 No.53LOR HASTINGS,MN a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 580 Lumbert Mill Road, Centerville M - 147 P-86 Property Address Janet&James Preston Owner Owner's Name information is 580 Lumbert Mill Road, Centerville MA_ 02632 April 2, 2014 required for every _ P 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 filling out forms A. General Information on the computer, (� I use only the tab 1. Inspector: key to move your cursor-do not Troy Williams V _ use the return key. Name of Inspector Troy Williams Septic Inspections ,Q Company Name 19 Hummel Drive Company Address South Dennis ___ MA 02660 _ Citylrown State Zip Code (508) 385- 1300 _ _ S1682 Telephone Number License Number B. Certification s I certify that I have personally inspected the sewage disposal system at this address.amv d that thex information reported below is true, accurate and complete as of the time of the inspedtjon. The irigpecticn was performed based on my training and experience in the proper function and maintenance of,bn site sewage disposal systems. I am a.DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ;}w ® Passes "❑ Conditionally Passes ❑ Fails _ 03 ❑ Needs Further Evaluation by the Local Approving Authority A IU� April 2, 2014 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official I p i n orm:Subsurface Sewage Disposal System•Page 1 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 580 Lumbert Mill Road, Centerville _ M - 147 P-86 Property Address Janet&James Preston Owner Owner's Name information is required for every 580 Lumbert Mill Road, Centerville MA 02632 April 2, 2014 page. Citylrown 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: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. II� : B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be t replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 T T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 580 Lumbert Mill Road, Centerville M- 147 P-86 Property Address Janet&James Preston Owner Owner's Name information is 580 Lumbert Mill Road, Centerville MA 02632 Aril 2, 2014 required for every _ p page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 580 Lumbert Mill Road, Centerville M - 147 P-86 Property Address Janet&James Preston Owner Owner's Name information is required for every 580 Lumbert Mill Road, Centerville MA 02632 April 2, 2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: `*This system passes if the well water analysis, performed at a DEP certified laboratory, for 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/Z day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 580 Lumbert Mill Road, Centerville M - 147 P -86 Property Address Janet&James Preston Owner Owner's Name information is 580 Lumbert Mill Road Centerville MA 02632 April 2 _required for every � p �il , 2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 580 Lumbert Mill Road, Centerville _ M- 147 P-86 _ Property Address Janet&James Preston Owner Owner's Name information is required for every 580 Lumbert Road,Mill Centerville MA 02632 April 2, 2014 _— _ 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 580 Lumbert Mill Road, Centerville M - 147 P-86 _ Property Address Janet&James Preston Owner Owner's Name information is 580 Lumbert Mill Road, Centerville MA _02632 April 2 2014 required for every p � — page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 -- Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 13=48,000 gals. g ( y g (gP ))' 12=47,000 gals_ Detail: Sump pump? ® Yes ❑ No Last date of occupancy: occupied Date Commerciallindustrial Flow Conditions: Type of Establishment: N/A - Design flow(based on 310 CMR 15.203): N/A Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A 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: N/A _ t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 580 Lumbert Mill Road, Centerville M - 147 P -86 Property Address Janet&James Preston Owner Owner's Name information is required for every 580 Lumbert Mill Road, Centerville MA 02632 April 2, 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) N/A Last date of occupancy/use: Date Other(describe below): N/A General Information Pumping Records: Source of information: Last pumped in 2013 per info from owner. 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) 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): pump chamber l5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 580 Lumbert Mill Road, Centerville _ M - 147 P-86 Property Address Janet&James Preston Owner Owner's Name information is 580 Lumbert Mill Road, Centerville MA_ 02632 Aril 2 2014 required for every p � page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Pump, d-box& leaching were installed to existing tank on 2/3/06 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 72"+- 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.): Lines were found clear at the time of inspection. Septic Tank(locate on site plan): Depth below grade: 6'with riser to 1' 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: 5'X9'X6' 1000 gallon — 4" — Sludge depth: -- t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M5.1580 Lumbert Mill Road, Centerville M - 147 P-86 Property Address Janet&James Preston _ Owner Owner's Name information is required for every 580 Lumbert Mill Road, Centerville MA 02632 April 2, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2' 8" Scum thickness thin layer Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? probe/measured 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 were found present and in working order. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. Grease Trap (locate on site plan): Depth below grade: N/Afeet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/ADate t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,.•''~ 580 Lumbert Mill Road, Centerville M - 147 P-86 Property Address Janet&James Preston Owner Owner's Name information is 580 Lumbert Mill Road, Centerville MA 02632 April 2, 2014 required for every P _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): . Dimensions: N/A --- Capacity: N/A p ry' gallons Design Flow: N/Agallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments(condition of alarm and float switches, etc.): N/A Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments *M 580 Lumbert Mill Road, Centerville _ M - 147 P-86 Property Address Janet&James Preston Owner Owner's Name information is required for every 580 Lumbert Mill Road, Centerville MA 02632 April 2, 2014 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): q Depth of liquid level above outlet invert level P Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found level and in working order with equal distribution to outlet lines. Inlet tee was present. No evidence of backup in the past was found present at the time of inspection. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump, floats and alarm were in working order at the time of inspection. * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments m M 580 Lumbert Mill R - -Road, Centerville M 147 P 86 Property Address Janet&James Preston Owner Owner's Name information is 580 Lumbert Mill Road, Centerville MA 02632 Aril 2, 2014 required for every p page. Ciwr own State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: - --- - ® leaching chambers number: 2 -500 gallon with stone ❑ leaching galleries number: 25'X 13'X 2' _ ❑ leaching trenches number, length: — ❑ leaching fields number, dimensions: —-- — ❑ overflow cesspool number: -- ❑ innovative/alternative system Type/name of technology- Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil was sandy. Chambers had a low water level present at the time of inspection. Checked stone and found dry and clean. No evidence of hydraulic failure or problems in the past were found at the time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A — Materials of construction N/A — --- -- Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 580 Lumbert Mill Road, Centerville M - 147 P- 86 Property Address Janet&James Preston Owner Owner's Name information is required for every 580 Lumbert Mill Road, Centerville MA 02632 April 2, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A Privy (locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 I 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 580 Lumbert Mill Road, Centerville _ _ M - 147 P-86 Property Address Janet&James Preston Owner Owner's Name information is 580 Lumbert Mill Road Centerville MA 02632 April 2, 2014 required for every 1 P page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately O O o 31' 3 Q 0 131 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 580 Lumbert Mill Road, Centerville _ M - 147 P-86 Property Address Janet&James Preston Owner Owner's Name information is 580 Lumbert Mill Road, Centerville MA 02632 April 2, 2014 required for every —.--- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 19.0'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: 11/4/05 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: SDW 253 Zone C 48.9' 4.1' adjustment You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found at 11.2'. Hand augered 6' below bottom of leaching with no water found at a depth of 12.0'. Groundwater adjustment at the time of inspection was 4.1'. Bottom of leaching at 6.0'was found not to be located in the high groundwater elevation at the time of inspection. _ Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 580 Lumbert Mill Road, Centerville M - 147 P-86 Property Address Janet&James Preston Owner Owner's Name information is 580 Lumbert Mill Road, Centerville MA 02632 Aril 2 2014 required for every P —__ page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. Fee �d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for Mtgpogaf 6pgtem Congtruction Permit Application for a Permit to Construct(cam Repair(z4-Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. sg4 �v{�llj�` �i� Owner's Name,Address and Tel.No. Assessor's Map/Parcel �5' .-8� ���r-�••l,G 9' h _���v Or 1 i- �row s�. Installer's Name,Address,and Tel.No.jOd—412,0-4Y7�5 Designer's NamF,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms j Lot Size sq?ft. t Garbage Grinder( ) Other Type of Building No.of Persons � ' Showers( ) Cafeteria( ) t Other Fixtures i Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S: Description of Soil i Nature of Repairs or Alteration,(Ans=hlble) �/����TLi �✓'Sta�/= l �G'Ur9 ".�i=� .��bh�= 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 Certifi- cate of Compliance has been issued by this Board of Health. Sig Date Application Approved Date - Application Disapproved for the following reasons Permit No. row(D —6 e7-- �D Date Issued No. � y (� _ S _ 1. `Fee THE COMMONWEALTH OF MASSACHUSETTS n Entered in computer: Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Mf6pogal *pMem Congtruction Permit Application for a Permit to Construct'(LTRepair( 1�- CJpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Namg,Address and;'el.No. Rio; SravPIY i t Assessor's Map/Parcel p G r.a C ' Y' < /4' ZOH G'!(JC(/ C) f�/'��I%/1 Inst let's Name,Address,,and Tel.No. ;U��l2;De � Designer's Name,.Add' an el. o. O +y�7- �v5 ,�/W/p A 95 S k ' 'ype of Building: > Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of,Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Al eration (Answ/er whe applicable) C� 1-411 �`li _y'.�"�aHi !4`cr�H /1`7, 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 Certifi- cate of Compliance has been issued by this Board f He th. Sig, ed Date bb Application Approved b i Date -7 Application Disapproved for the following reasons S Permit No. — aFO Date Issued b THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance Y �� THIS IS TO CER/TIFY, t aW O -site Sewage Disposal System Constructed ( � ') Repaired ( `")'Upgraded( ) Abandoned )by �/OSz!/d Y45 at �B �v� !IW,71 Ra zi-110f,llowl;"s has been constructe in ac dance with the prov}}'sions of Title 5 an the for Disposal System Construction Permit No. 6 �a 'dated j Installer t/���� U� �r�O-f Designer /H� y�h G�/Or•�Cf The issuance of this ad, not b c stru d as a e that t e s ste iw 1 un ion as designed. Date � "{ w �� '�� guarantee y g No. ��Q C4 —p �� -----------------------=Fee THE COMMONWEALTH OF MASSACHUSETTS . , PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1=i!5poga1 *pgtem Congtruction Permit Permission is hereby granted to Construct(l%jRepa}r(�Upgrade'S' )Abagflo�t( ) System located at S84 Gu�i�l/� i"r��/� and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special co�n`d`itim.� Provided: Constructio'n'j 4ist.be completed within three years of thc4 date of this p�'`e ,t. Date:_ 1 Approve t b� Town ®t Barnstable Replatcry Servkn Tbouae F.`ewers Dwam PuNk nedth DivWIM User McKamb DMa w M Nab t at,Nyaeols,"A owl (Xfka to 14W tea gs,,. ssoe �4 -r Mc115114 z 1F� 8tsw"rr; 1104, ,a��. {v..,^'vL IautaYer: _ �•e �s � �d�-s'�rZ�,�cs� W. C z sS:Li\,ck Address: on L Z—) . &., s was issaw a pstutit as inateli a (dau) (tngtal6er} sspac system of .� _�M M d on a de sip deaWO by (addrsas) - ; r, I certify thm the sepov system mferenced sbovs was installed subeta�ttiall to the deai$n, whilm easy int}ado tesietor approved changes gush v o the dietributtgn boZ erty'oc I*e tank• t cerufy that the ssoc system mfersnced above was insWlsd *Ah yr elves (i.e. �s tam tr:atsr ttlaae 10 Iatsral relrCat�oa of the SAS or as vsrtias!rrloci��of any oor of the septic syMm)but to avcotbaaes with Sots Local Resublim Phk Nvuloa or comfled ag.bWlt by dssipw to!below. ..fit PETER T. ( fies stiftwx*) McWEE CIVIL No 36100 (l�ljfter'i tgltat't6ts���_ {A t[ W > ' TIMW IsM tt®r_���CwytU n1wa_®la_ cr�r�tcsrn 6�t �C� Wi�� 11�QT L�U Lllt79< IIpT�N gmia ib� NS" a&ON Z GAME M Q t '.lNe,c•'t�eri�rwa C�endtcsr�i�a f•is•46.sac 9116/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION VEST AND SOIL EVALUATION EXEMPTION FORM pe.; - "- M-C_ '?�_ hereby certify that the engineeed plan signed b me � Y dated 11 S ,concerning the property located at !a O L='"t'l M" HOlfsV tM S meets gall of the. following criteria: * This failed."em.is connected to a residential dwelling only. There are no cornmerciat-m---- - business uses associated with the dwelling. e The.soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. * There is no increase in flow and/or change in use proposed * There are no variances requested or needed. * The bottom of the proposed leaching facility will be located.no4ess than five feet above the maxirnaum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the Bellowing; V A) Top of Ground Surface Elevation(using OIS information). "f 3± D B) G.W. Elevation 1-7 � +adjustment for high O.W;,U - ® �W/ Z52- DIFFERENCE BETWEEN A and B SIGNED : DATE: ] f S NOTICE Based upon the above information;a repair pen-nit will be issued for _bedrooms maximum.. No additional bedrooms are authorized in the future wi plans. thout engineered septic system w0 @ eQ �9 g4CPtiC aCexftM,doe I)o ,A r L- _ -7 0) . �o 12ew'>"� fio Gr.W. 1"?4 t w COMMONWEALTH OF MASSACHUSETTS 4 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ^ J e .DEPARTMENT OF ENVIRONMENTAL PROTECTION r �t v TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: Sgo zc,,.,�r� er, ..........r r Owner's Name: Owner's Address: oh ✓ti,� aw �� . Date of Inspection: �yy/�o //S 05 Name of Inspector: (please print) / '/of✓!�' ��� �� Company Name: 4f—";vv1 ' — 4e c y Mailing Address: �F�-- Telephone Number:�� c�c� CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Zs Further Evaluation by the Local Approving Authority Fails Inspector's Signatures 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 regio office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable, d the app3oving:authority. C:Z) Notes and Comments- c, " c cn; p 00 ""This report only describes conditions at the time of inspection and under the condition of use what time.This inspection does not address how the system will perform in the future under the me or dPthat —conditions of use. Q i Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTE M INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 14— e ton Owner: oop 1-f Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: J/ 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.,(SS ern Conditionally Passes: / One or mo re system components as described in the `Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain:. The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: T:tlo Q Tncnarfinn rnrn.l.�T ai�nnn 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A n CERTIFICATION(continued) Property Address: V �,94 v� ✓ C C�oZ 6��-- Owner: t,i o D, Date of Inspection: o 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. l. System will pass unless Board of Health determines in accordance with 310 CMR 15.303 1 b that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. — The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**.Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform. bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Tifln Q Incn>�f�nn Rn�m�n ai�nnn 3 ' I 1 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Jyo LU 11, V,, ✓�I r �} Od- �1-- Owner: -5+Lj o r� 6 Date of Inspection: 0 �3 0�' D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes o 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 vl- logged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or �cesspool ' � Li „quid depth in cesspool is less than 6 below invert or available volu me is less than/:day flow �kequired 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. 7ZAny portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. y portion of a cesspool or privy is within a Zone 1 of a public well. ✓_ any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form] Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 2yes 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 — _ e system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone f 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. Titlo Q �nennrtinK Rnrm A/1 c/7nnn 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B Q / CHECKLIST Property Address: �O Lr✓IV) v► ✓v c Owner: lit o i Date of Inspection: /O /S/Oj Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes o 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 art o p f this inspection? _T Were as built plans of the system obtained and examined?(If they were not available note as N/A) v — Was the facility or dwelling inspected for signs of sewage back u ? g P _ Was the site inspected for signs of break out? T 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 bit les 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: Yp//no Existing information.For example,a plan at the Board of Health. Determined in the field an if ( y of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)J Titlo G incnnrtinn �nrm 4/1 ciinnn 5 f Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C Q SYSTEM INFORMATION Property Address: 'D Q Owner: >TtnO f/ Date of Inspection: !p >r/0 FLOWCONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): _7 3 c2 Number of current residents:' -I-- Does residence have a garbage grinder(yes or no):_PS Is laundry on a separate sewage system(yes or no):/ [if yes separate inspection required] Laundry system inspected(yes or no): AW Seasonal use:(yes or no):-.0J Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): &0 Last date of occupancy: 11-4- JL— COMMERCIAL/iNDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): Pumping Records GENERAL INFORMATION 0 ` d w� ✓� Source of information: 99 _ /`/ Was system pumped as part of the inspection(yes or no): If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for mg: TYP 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 knownj and source of inf tion: Were sewage odors detected when arriving at the site(yes or no): Title G fncnortinn Fn�m F/1;mnnn 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C • ,p SYSTEM /INFORMATION(continued) Property Address: — 0 Q Z--C4 7 k,r-1— 1 (_ ,,1 ✓vl t /j�� Od-6�� Owner: S I In m k)( S Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: 'cast iron _-4b PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ate on site plan) ) Depth below grade: Material of construction:_c✓oncrete_metal fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) r. / Dimensions: 7 X Sludge depth: /o Distance from top of sludge to bottom of outlet tee or baffle: /9 4/ Scum thickness: _ (I o Distance from top of scum to top of outlet tee or baffle: 3 Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: plo I e R.ts vc0 Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc)- C,l-At nH. /vV . . ..����✓�. GREASE TRAP: locate on site plan) Depth below grade: Material of construction:_concrete metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Titlo G lncnurtinn Rnrm �ii ai�nnn 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: J -9( ^�0 " i /// &"�?�f / '^ ✓�� /1l' Od,6 ?� Owner:S7 (A o02, f Date of Inspection: A � TIGHT or HOLDING TANK: L(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass__polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:-A-6f 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: ecate on site plan) ) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Titlo IncnArtinn Rn�m !./1 G/7Mn 8 r Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYST EM INFORMATION(continued) Property Address: f vy ,' Owner: 54 VI N dij Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type (.� Pl e leaching pits,number:1 l leaching chambers,number: leaching galleries,number: leaching trenches,number,length: p leaching fields,number,dimensions: �atS — /'�t l�✓ overflow cesspool, number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): oN c'111 �o rl lee ��iI ,ti fF e- t4-e— . CESSPOOLS:/v (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: 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.): Titlo 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS + SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: fo � G2C_J- ,r e�► v, lkz zv/ pa�c .-3 Owner: S W 4,1 L Date of Inspection: /O /S�O 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 wilding. � I U y � l 12I - 13 ' 3� ' a�- S). � Title C fnenontinn Rnrm���annnn 10 f Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) t 0 (l i, Property Address: �4 • � L C3�- Owner: '�d Date of Inspection: �� �✓r S SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 1�0 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: e jr ✓! L -eV Ze We.— tv,� c T�tlo C fncr+ontinn Rnrm�ii si�nnn 11 ell LA co Ti - � 9l -CL 8�. Go►a es,�-t-T�� 2% IS F _ N oF 11A of Mass � q RICHARD �� ° PETER cy�: A. = o SULLIVAN Ala 24048 No-99733 �©� �ciST£R�o� -- - .e9p ���tsTa�c.`�4 11 �a� LL ►� � .. oNa ti� . �??UC�v.�T: � ��►�K�S µ�.S BEY. S Lpr z S, 19a is- IQ'X!O 10 lHr-iNCM. - .. 5,`F.V \ ..:4-1 t//D f 330 G.P.O � 2!��!►S�� ZA 41- —t--1— t ! i 1 P s _ t -�ToT.4� �,4iLrF10yr/ �.3.30 G..�o. / f 4' ' jl 4 ',"'�`• � _ t p (IL EVAN i a - r t .00 ! f T ur r 1 oo'0 1 / , - , G s�� t - �Z�'� '- - l �sro) /,00 .mac.) + � '� /.r/� .93,? • Y /ivy :a �C .v�it/92:Z Box g2.,�'a S.E�G �3�� ''• ..:e. TANK _:, -te 71a : � N'��a ,_-. � � •• iN� ivy �: 5��7 . . 'IP to _ f r G'--•�,�,�""� 7 LoC.QTiov `1 kc. :'S l: �. ' � � , R. •� _+ �Jc�L� ,�i �,.��'r �Q?� 1 �f"1u1�..,`rt�4�7 r— .a,r,µ0' I�C.G �►*�.. ;..1 +_... ,_.. � GEeriFyTh'E.'?Fo .a� is�.1,SHcw.v. .y Ti'+�E.SidE�✓ivE BxxTE.e�NJ�E/•tvC. - d�tiv'.fE7"1/.aG, :,2E41J/�E�vlEivr.S Off.Th' - .2E6✓srE.ecOLsrNo slie�/Eya4S . ,TDIf/// ctF� S 'CF- ►- Q.vP /.S NOT. Q�T2".2Y/LLC a i1f �Go�•�rE� W/ri�iiV T,�E �La000�iry _ — _. ., A.Ra,C./caso-- C Y-c.'St j,:.P.- : . 14��1�u.:s� 71W��.v /s mop- XXtEv OiV sti(/�iY,•sT,rZ- - aC- VSEv Ta E.rdaL/.</vI •Car-lJNE,S BANTER & NYE, INC. Registered Land Surveyors and Civil Engineers 7 Parker Road/Osterville,Massachusetts 02655/Tel. (617)428-9131 WILLIAM C.NYE,R.L.B.-President RICHARD A.BAXTER,R.LS.-Vice President PETER StTLLIVAN,P.E.-Vice President-Engineering October 30 , 1985 Town of Barnstable Board of Health 367 Main Street Hyannis, MA 02601 RE: Lot 6 - Lumbert Mill Road Marstons Mills Revised Site Plan dated August 27 , 1985 Dear Board: In accordance with your request I have in- i spected the installed septic system at Lot 6 Lumbert Mill Road. Based upon visual inspection, the system has been installed in accordanc e with the Revised Site Plan dated August 27 , 1985 . I trust that this meets your present needs . very truly yours , a Peter Sullivan, P .E. Baxter & Nye, Inc. is PS/fmj Of cc: C. Mickunas PETER o SULLIVAN } No. 29733 h o 06 �SfeNa` MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS �rii •wii:viwi ri is,.r-i 1 TOWN OF BAR/NSTABLE LOCATION /ym k/'T /y, SEWAGE # 200 ,ILLAGE G'EM7'rrV ASSESSOR'S MAP & LOT /�17- SG INSTALLER'S NAME&PHONE NO. .5-02 Y20-9/7-f8 �oS e* /D-�961-105. SEPTIC TANK CAPACITY /D-90 u/!T4 1000 PvrH,d FACILITY: LEACHING (type) 2 0hl-SOD 0/o� yowiGrf' (size) 2SA II NO.OF BEDROOMS 3 BUILDER OR OWNER /� rA 57>'UD/2/5 PERMTTDATE: / GG COMPLIANCE DATE: 2 Separation Distance Between the: 'Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching fa ility Feet Furnished by -� �" (-ran f yy No....... .5=Al2, F�s.............................. T wr! THE CO®ONWEALTH OF MASSACHUSETTS b BOARD OF HEALTH CO P .................:........................O F.......................................--.----..........------------...._.._...._......... � Diu uutt rani M�� ,���lirtt�iun for � 1 Works Chumitrnrtiun Application is hereby made for a Permit to Construct ( ) or Repair ) an In i idt% Sewage Disposal System at• C� 4 Nl"1LL 2 �L o. .# ....... . .En y....►� QuE.. go...............•--•......._. Location-Addre s f' or Lot No. ..--------- "��� �_N5---- . ...................................................... ,`�, Owner �7 ---- ••-.--• Address ,J�.........- --• F--•-•----•--_--__--•-------- � .............................. ........................................... Installer .Address Type of Building Size Lot___as So ....Sq. feet U Dwelling—No. of Bedrooms.........??..............................Expansion Attic ( Garbage Grinder (Alp) '4 Other—Type T e of Building _______________ No. of ersons__.____.___.________________ Showers — Cafeteria is� YP g ------------- P ( ) ( ) GlaOther fixture -------------------------------------------------------------------------------------------------------------------- W W Design Flow.............t ......gallons per person per day. Total daily flow...............33.0__-______________gallons. 04 Septic Tank—Liquid cap city...iaQVgallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........j........... Diameter...___. ....... Depth below inlet........4___1...... Total leaching area...-�_ $....sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test.Results Performed by.......................................................................... Date........................................ a Test Pit No. I........I........minutes per inch Depth of Test Pit......! .... Depth to ground water_____n!:A........... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-•-•-•------•-----------•--•---••...............•-•----...•••......----••-•----•...----•--------_•-........................................................ 0 Description of Soil...... a`........L.:k=L-••-•......_ Z A ).--•••--- W •-•-•---------------------------------------------------------------------------•-------•-----------------------------------------------------------------------------------------------•--------------- UNature 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 IITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sined..............................•--------..._........--------------...-•-•--••-•-•••-•- Date Application Approved BY•---•---•--•-----•....... ............ ...._g _ � --- Date .--- _..._.. Application Disapproved for the f ollowi reasons-----------------------------•--•------------------------------••----------------------------------•••-••-...._. .....................•-----------....---......_......----------------------------•-------.......-------..._......_...._......------•-------•--------•---------------------•-----••-----•-•---.._....----- �Dat Permit No.---•--tea, . . _ Issued...................................... ..- - I Date ------------------ No.... Fimic .......... .... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. ........................OF ApplirationJor,14spasal Works Tonstrartion jhrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal .S s at: Snjrm ......... r-X -----5.. n........................ .........../..O..T 15...........L.V.M2JER.7..... (1..... ....... Location-.Adde r or Lot No. ..................��tll�Tjak............ .................................................................................................. Oyner A Address ....C�D ....................uf R. ..... S&LE ........................... .................................................................................................. Installer PQ Address.:.".��: Type of Building Size Lot....-A5.tAPP....Sq. feet ...... ................Expansion Attic Dwelling—No. of Bedrooms........ (AIN' Garbage Grinder (JO-1✓J�) Other—Type of Building....,.,,........... ....... No. of persons,........................... Showers' Cafeteria P4 CL4Other fixture!V................. .......................................................... ................................................................. < Design Flow_____________1a�.�1 _.15S.4......gallons per person per day. Total daily flow...............3'a 0..I..............gallons. 7.9 Septic Tank—Liquid cap kity...10.00gallons Length__.____:::_:._._Width................ Diameter__._.___.____.__ Depth.______________. Disposal Trench—No_................... Width________._._.___._._ Total Length._____._.___...__... Total leaching area...................sq. f t. Seepage Pit No.........I------_-- Diameter....... ....... Depth below.,inlet........4........ Total leaching area...a ...sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by............ ...................................................... Date........................................ Test Pit No. I........I......minutes per inch Depth of' Test Pit......!., ........• Depth to groun;L. d Water.....61.1.14.......... Test Pit No. 2................minutes per inch Depth of'T6s't Pit................... Depth to ground water.__.___..__._._:__ ..........................7 .................................................................................................................................. 0 Description of Soil_...- ........L.*:.S..............I&,—.M6......... ........................... ..............;............... U ........................................................................................................................................................................................................ ............................................................................................................................................................I...................*------------*--------------- U Nature of Repairs or Alterations—Answer when applicable...........................................................t�'. ... ...... ...........................- ............................................................................................................................. ........................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ned........................................................................... Date Si,je....... Application Approved By........................ U"I_­ ..... ......... ......... Date Application Disapproved for the followi reasons:................................................................................................................ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------.................................. Permit No........ Ile ........... Issued..............I Date . .......... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................0 F...,.:............................................................................... Tutifirati lif Tourpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by.......................ALFaAC9......FU.U_jf.4�........................................................................................................................ Installer at......................... ...........5 .. Ia.Em......... L----------R-1-- ----------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE - RThe State Sanitary Code as described in the application for Disposal Works Construction Permit No_________________________________________ dated_-_..____.._..,__._...._....._...__.__..________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C07STRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.------- ..................................... Inspector......_. ........ .... ................... .........................* THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... OF.......................1............................................................... FE 14sposal Works Tanstrurtion rprmit Permission is hereby granted......At --Pzisq;� .................................................................................. f to Construct or Repair an Inn ividual Sewage Disposal System ZVO..........LU.m_ZjW........AA-LL-L--------RD........... .......................................... Street as shown on the application for Disposal Works Construction Permit Nos '4N�. Dated._____. ...... ............................... ----------- ----------- Boa, ­ illallilh DATE............ -------------------------- ........ FORM 1255 A. M. SULKIN, INC.. BOSTON V� ` c Lot1 i W113 4 9 Tt 4-2 ; _ 95 . •` ` 1 � EG oTo f %14 : L K-la AZ OF . �. OF R16HARO ' G 1� PETER A• a SULLIVAN BAXTER Na 24.048 No.29733 ti E'ss�ON!! FN�'\� A??U C���b.�l• : �. �`��L K L}f��S ZS) 19a 10`X 10 10 1HE.INCH 5•'1`1`+� \�. 44 2- ' i E oo`A* 0.2ooM rt/O GL1,2Q4GEf 'S1-F . -�E 2 tOA/LYLoW� !_- f rj/D X 3 330 G.PO I el9j- i . �IJ� :Z. r { S : : d ' -�ToT.4t: �.4iLY�LoW -i..330 G.:w, OES/G!L!,�E.2CDGsIT/Q�S/_ p� I .�{..�.�•W.��I - '� .t_ � i ��- 'i ,� ,i .' I- fl t iil N � 1 � � I Ij. r ZHQFM t- ' PETER 1. ', ? j v BAXjER "'ia� _ v ULLIVAN if �{ i' Na 24048 - 1 A }1- -� _:_ � 9 2� :T�Tf,�alE�t , i - --� I tl Ncoo +. ta�a Pir 92 g? SE�r�G I • : ,� � G',E�2T/F/EO PG OT pG,Q�t/ ,nn �� : �_ ►�.�' `-' /; (��,G. � � 7 . , 'LoG.�T/ON '�r`A�1�.5'�b►J,5 '���c...L,S D all t7 IL IuD ELEYtLT1k�,1 ,G,Q,{/ T 7 ' i t Co % .LE2TyFY �Tf/.4T'TNE''"'�o�► av;r�7�urrtsi/aric��t/ . . -. .yE.QEaN GOM�LY.S Gti/T//_T,yE�S/.vE�,/�t/E B�IXTE,2�,t/YE/.c�C. - - h'� .2EGisrS,er'IJ:Gvo sl�,e,iEYS ' ,4NO�.St7'.11�/�G.e ,2�QlJ/:L'ENI�NT.S D� T L-iT2:pwly 4;-- .1Jab'C�L:�i _- A1,47 is NOT �sTc�J2Y/.GLC iiV-TNT �L�o�t...4i�v, 4 csmy ��u ru.4 t 5_.! T�ES?�lG/S.S/ LoT-G/NE,S BOARD OF WATER COMMISSIONERS 4 . . CENTERVILLE-OSTERVILLE FIRE DISTRICT - OSTERV I LLE,,MASS. 02655 October 9, 1985 Board of Health Town of Barnstable Town Hall Hyannis , MA 02601 Re: Town Water - Lots #5 & #6 Lumbert Mill Road, Centerville + Gentlemen: Town water has been installed on Lumbert Mill Road in Centerville in front of Lots #5 & #6 . At the present time, the new main must be pressured tested and disinfected before domestic service is available. This should be accomplished within the next week to ten days . Veryr l u Y yours s nald F. Rugg Superintendent DFR/ec 94 Overlook Drive Centerville, MA 02632 October 10, 1985 Barnstable Board Of Health Hyannis, MA 02601 Gentlemen: I, Chester C. Mickunas, promise to supply Town water service to the house located on Lot #5, 590 Lumbers Mill Road, Centerville, MA. I also will supply Town water service to the house located on Lot #6, 580 Lumberts Mill Road, Centerville, MA. All expenses in connection with the supplying of the water service will be paid by me. Sincerely, E este . MiQcn as BOARD OF WATER COMMISSIONERS CENTERVILLE-OSTERVILLE FIRE DISTRICT OSTERVILLE, MASS. 02655 October 16 , 1985 Board of Health Town of Barnstable Town Hall Hyannis , MA 02601 RE: Town Water '- Lot. #15--Lumbert Mill Road , 'Centerville Gentlemen: Town water, has 'been installed on Lumbert Mill Road in Centerville in front of Lot #15 . At the present time, the new main must be pressure.. tested and disinfected before domestic service is available. This should be accomplished within the next week to ten days . Very truly yours , Donald F. Rugg .. . _ Superintendent DFR/ec 593 Lumbert's Mill Road Centerville, MA 02632 October 16, 1985 Town of Barnstable Board of Health Gentlemen: This letter is to inform you that Chester C. Mickunas has offered to install town water at our house, located on Lot 15- #593,VCenteryille, MA, at his expense. � � 1d.. We have accepted his offer and agree to disconnect the existing well as soon as the town water has been connected. Very truly yours, Hugo R. Nelson Emily K. Nelson 94 Overlook Drive Centerville, MA 02632 October 16, 1985 Town of Barnstable Board of Health Gentlemen: In order to eliminate the existing water well , I Chester C. Mickunas, agree to supply town water service to the house located on Lot 154593, Lumbert' s''Mill Road, Centerville, MA, owned by Mr. & Mrs. Hugo R. Nelson. All installation and application costs will be paid by Chester C. Mickunas. Very truly (yours, CkesteC. Mickunas 2 '411) C A ICE SEWAGE PERMIT 400 rJI !LAGS IrIST A, 11 - R'S &ME ADDRESS r DATE PE RMIT I S S U F 0 �� 5 } a + a, i 4 �i T ��. S n LOCATION SEWAGE PERMIT NO. INSTALLER'S NAME i ADDRESS IlU1LDER. OR OWNER DATE P ERXIT ISSUED ����� T` - DATE COMP-LEANCE ISSUED �__ .:� �T �.,__ � � . ��; �`-.,\ f `f� � �'. � I �� 4 � � ��, -: � ��., �� r � . BAXTER & NYE, INC. Registered Land Surveyors and Civil Engineers 7 Parker Road/Osterville,Massachusetts 02655/Tel. (617)428-9131 WII.LIAM C.NYE,R.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering October 30 , 1985 Town of Barnstable Board of Health 367 Main Street Hyannis , MA 02601 RE: Lot 6 — Lumbert Mill Road Revised Site Plan dated August 27 , 1985 Dear Board: In accordance with your request I have in- spected the installed septic system at Lot 6 Lumbert Mill Road. Based upon visual inspection, the system has been installed in accordance with the Revised Site Plan dated August 27 , 1985 . I trust that this meets your present needs . Very truly yours , Peter Sullivan, P . E . Baxter & Nye, Inc. PS/fmj jN OF cc : C. M i c k u n a s s PETER 6 to SULLIVAN �3 Ne. 2ri133 H}.. t:. F�S TNA MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS Y + 4k 1 • • ' A� '► LEGEND Ens Ro - ° "�°n �o PROPOSED CONTOUR n f 2 yy 2� �3mF9_9_1 PROPOSED SPOT GRADE 1� a Lumbert Pond `� — 40 EXISTING CONTOUR �pQ v' P\a9 // \\ •� �� 30.23 EXISTING SPOT GRADE LUMBERT] *1 P` // \ 1�•�� s°---_.", _ � ;, � TEST PIT +\\ei �oB��•. 81'f W EXISTING WATER SERVICE 1-4 \ N---3Z Edge�of 1 D nc to R\ 0 pl `gam -- Z g Mer eh LOCUS G� LOT 6 ��?--__ 45 ti2�_�` M niberf ylil Rd = Rd 20,54E \C.`.F �����._ ��• — 1\ _. o 'foram°° Map �4y\.,-•-�eo `--------- -86_ -`�� — Parcel �6 �•�—� ""�\ \ Route 28 EXISTING DWELLING — \ \ (HOUSE #580) \ TOF=101.4 + 7 � � --"--- LOCUS MAP N.T.S. ^9?,A _ —_ �� 90� \\ (Assumed) �\-- +o'er -- `92� �\ \\ Garage w GENERAL NOTES: \ \ \ \ \ o. \ 1 ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS T•.By °�� �\\ �p OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE+ ° •� ,p 96\ N L \\ s° I vi i I LOCAL RULES AND REGULATIONS. vei r„ 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR — \ i TO INSPECTION AND APPROVAL BY THE BOARD OF' HEALTH AND THE `-• ��� �1 0,�� DESIGN ENGINEER. o I o Deck _ 'A100• BUFFER I a-J 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING B.v.w. FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN N --{ 13.2' ENGINEER BEFORE CONSTRUCTION CONTINUES. EXISTING DWELLING o• �� 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. Z (HOUSE 1.47 o'o S.A.S. LAYOUT 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF roF=lor.47 ��' a° o THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF (Assumed) w �12 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. '3 Benchmark set Garage otcr + ,1 7. WATER SUPPLY PROVIDED BY TOWN WATER MAIN. Left car. bot. brick step P e� 0 g8 Existing Septic Tank 8. THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S. E1.=101.62 (Assumed) rah °r 0 \ o (to remain) / ,�oo•i \ Propo d \ q$' 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED BY LOAM ham r 1 1 iNV.(OUT) EL.=92.13f AND SEED AND AS NOTED UNDER SECTION A-A, SHEET 2. C paved /\ �. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE Drive l TP_-2 / 2 � Pbye 1 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING I tioo°' DTP-1/ L, 1 �F M CONSTRUCTION. °l paved j'. o f i `t F� S. 1 1, WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS l Drive `" IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. / g / r 1.`. •` 01 N Zorn o� PETER T. G� AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). McENTEE N 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY CIVILNo. 35109 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 13.2' x"' J p 13. CONTRACTOR SHALL VERIFIY EXISTING INVERTS PRIOR TO CONSTRUCTION. 02�9 Water I /� a' Q SEC/SZE�F "tip IFS l Shut—o f m �-110.00' R=2030.00 l fSS 0 PROPOSED SEPTIC SYSTEM UPGRADE 580 LUMBERT MILL ROAD, MARSTONS MILLS, MA Ede bf �� pavement q(o' 0`O 4 co. Prepared for: Rita Stuopis, 19 Longmeadow Drive, Canton, MA 02021 of ��' ' WETLANDS CONSULTANT Engineering by: Surveying by: SCALE DRAWN JOB. NO.Existing S.A.S. VACCARO ENVIRONMENTAL CONSULTING To be removed P.O. Box 955 EngineeringXarkr Warner Surveying 1 "=30' P.T.M. 223-05 LUMBERT MILL ROAD (See Note 11) 0 Ha Snadwich, MA 02563 12 West Crossfie Road Long Rood (508) 888-5855 Forestdale, MA 2644 Harwich, MA 02645 DATE CHECKED SHEET N0. (508) 477-5313 (508) 432-8309 1 1/5/05 P.T.M. 1 of 3 P PROPOSED PUMP CHAMBER PROPOSED TANKNOTE: TO PREVENT BREAKOUT, THE PROPOSED INSTALL RISERS WITH COVERS SET INLET: INSTALL RISER WITH COVER SET WITHIN 6" OF FINISH GRADE. FINISH GRADE SHALL NOT BE < EL:96.5 TO WITHIN 6" OF FINISH GRADE OUTLET: INSTALL A 4' X 4' METER BOX FOR RISER WITH HEAVY FOR A DISTANCE OF 15' AROUND THE TOF=101.47 DUTY FRAME & COVER SET WITHIN 6" OF FINISH GRADE. F.G. EL: 99.5 F.G. EL: 99.5 PERIMETER OF THE S.A.S. (Existing) EL.99.3t F.G. EL.99.5t e MAINTAIN 2% MIN SLOPE OVER LEACHING AREA MAX. COVER OVER S.A.S. = 36" Aml 500 GALLON LEACHING CHAMBERS INSTALL RISER OVER ONE CHAMBER CELLAR FLOOR WITH 4' STONE-ALL SIDES WITH HEAVY DUTY FRAME & COVER L =13'(MAX) IN SERIES SET TO FINISH GRADE - 4" SCH 40 PVC -*--2" LAYER OF 1/8" TO 1/2" pVC �.�, ®® as • a0 s DOUBLE WASHED STONE ®aa aaa . ' 6• 4' SCH 40 PVC 2" gCN ® S= 1% (MIN.) ®a®�®aa ' 10 ta' ® S= 1% (MIN.) FORCE MP\N 2' EFF. DEPTH ®BB®a®r9 �- TEE'S ARE TO BE % ALARM ON 4' 5.2' 4' DOUBLE 1 A .:.. .. 4" SCH 40 PVC INV.92,13t 24" INV.=96.30 EFFECTIVE WIDTH = 13.2' STONE WASHED , ADD Gqs PUMP OFF 15 I EXISTING BAFFLE INV,=92.00 e" INV.=96.13 INV. ELEV.=96.00 EXISTING 1000 GALLON AA INV.=91.75t SEPTIC TANK 1000 GALLON PUMP CHAMBER(H-20) TOP CONC. ELEV.=96.8 -BREAKOUT ELEV.=96.5 INV. ELEV.=96.00 a®®ea (See Pump Detail, Sheet 3 of 3) EXISTING 4 2 x 8.5' = 17.0' _1_ 4 `I NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING BOTTOM ELEV.=94.00 PIPE INVERTS PRIOR TO CONSTRUCTION. 5' MIN. ABOVE MAX, SEASONAL EFFECTIVE LENGTH = 25' 2) PUMP CHAMBER AND D-BOX SHALL BE SET LEVEL AND HIGH GROUNDWATER ELEVATION --a TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX INCH LEACHING SYSTEM SECTION CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15,221(2). ADJUSTED HIGH G.W., EL 82.6 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL, ��P��� OF Mqs f9�y SEPTIC SYSTEM PROFILE SOIL LOG o' PETER T. McENTEE - N.T.S. CIVIL "' DATE: NOVEMBER 4, 2005 DESIGN CRITERIA No. 35109 SOIL EVALUATOR: PETER T. McENTEE .E., C.S.E. INSPECTOR: FLAHERTY-BOARD OF HEALTH NUMBER OF BEDROOMS: 3 ASS/ ENS SOIL TEXTURAL CLASS: CLASS I + Elev. TP- 1 Depth Elev, TP-2 Depth DESIGN PERCOLATION RATE: <2 MIN/IN 0" 100.0 A DAILY FLOW: 330 G.P.D. 99.0 FILL SANDY LOAM O DESIGN FLOW: 330 G.P.D. BUOYANCY CALCULATIONS 98.2 10" 10 YR 4/2 GARBAGE GRINDER: NO A SANDY LOAM 99'7 4'B SANDY LOAM EXISTING SEPTIC TANK: 1000 GAL. CAPACITY N/A-SEPTIC TANK AND PUMP CHAMBER ARE ABOVE WATER TABLE 97.7 10 YR 4/2 16 97.0 36"7.5 YR 5/8 PROPOSED PROPOSED CHAMBER: 1000 GAL. CAPACITY " B SANDY LOAM C1 M-C SAND E LEACHING AREA REQUIRED: (330) = 445.9 S.F. DOSING & STORAGE REQUIREMENTS 96 0 7.5 YR 5/8 36„ 2.5Y 5/6 C .74 DAILY FLOW: 330 GPD C1 MED. SAND E USE 2-500 GALLON LEACHING CHAMBERS IN SERIES DOSING REQUIRED: 4 CYCLES/DAY (SAND) 2.5Y 5/6 G 92.5 90" 330 - 4 = 82.5 GALLEONS/CYCLE SIDEWALL AREA: 2(13.2' + 25.0') X 2 = 152.8 S.F. C2 DISTANCE REQUIRED BETWEEN PUMP g2,0 84„ F-M SAND BOTTOM AREA: 13.2' x 25.0' = 330.0 S.F. C2 2.5Y 5/4 TOTAL AREA: 482.8 S,F, ON AND PUMP OFF FLOATS: F-M SAND 82.5 GAL/CYCLE a 250 GAL/FT = 0.33 FT/CYCLE 2.5Y 6/4 90•0 C3 F-M SAND 120" DESIGN FLOW PROVIDED: 0.74(482.8) = 357.3 G.P.D. STORAGE REQUIRED ABOVE WORKING LEVEL: 330 GALLONS 2.5Y 5/3 STORAGE PROVIDED: 87.5 138" 88.5 138" F5�8O ROPOSED SEPTIC SYSTEM UPGRADE INV.(IN) EL:92.00 - PUMP ON EL:88.75 =3.25' PERC RATE <2 MIN/IN. ("C" HORIZONS) M B ERT MILL ROAD, MARSTONS MILLS, MA STORAGE PROVIDED = 3.25' X 250 GAL/FT = 812.5 GALLONS NO GROUNDWATER ENCOUNTERED Prepared for: Rita Stuopis, 19 Longmeadow Drive, Canton, MA 02021 POND EL.=79,6 Engineering by: Surveying by: SCALE DRAWN JOB. NO. G.W. ADJUSTMENT 3.0' EnglneejfngN'or,& )Varner Surveying' N.T.S. P.T.M. 223-05 (SDW 252-OCT 2005) 12 West Crossfield Road 22 Long Road ESTIMATED HIGH G.W. EL.=82.6 Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO. (508) 477-5313 (508) 432-8309 1 1/5/05 P.T.M. 2 of 3 1 INSTALL V PVC CONDUIT TO HOUSE FOR WIRING PROVIDE WATERTIGHT CONCRETE RISER l WITH WATERTIGHT JOINTS. WIRE HIGH WATER ALARM WITH SECURED COVER TO GRADE FLOAT TO GP 2000 HIGH WATER ALARM PANAL ON A CIRCUIT SEPARATE FROM CIRCUIT TO THE PUMP. NEMA 4 JUNCTION BOX CORROSION RESISTANT & LIQUID-TIGHT CABLE CONNECTORS SUPPORTED 8'-3.5" HOISTING CABLE 7x19 STAINLESS STEEL BY 1-1/4" PVC CONDUIT. JOINTS TO BE MADE 1/8" DIAMETER. / 1,760 LB. STRENGTH. WATERTIGHT - - ----------------- - - 2"BALL VALVE w/ UNIONS SCH, 80 PVC f I 4"SCH. 40 GEORGE FISHER CO. MODEL NO. 560 B I B FROM TANK 2"SCH. 40 DISCHARGE TO D-BOX ALARM ON EL: 89.75 2"SCH. 40 TEE w/ CLEAN-OUT CAP INV.(IN) PUMP ON EL: 88.75 EL: 92.00 } PROVIDE 1/4N WEEP HOLE IN DISCHARGE PUMP OFF EL: 88.42 24" �Z" PIPE FOR SELF-DRAINING FORCE MAIN i BOTTOM OF e" 2" BALL CHECK VALVE SCH. 80 PVC PUMPCHAMBER ------------------A------•-------------------•------------- ELEV.= 87.5 100 P.S.I. FLOWMATIC MODEL No. 208S PROVIDE 2- WIDE ANGLE FLOATS: 2" SCH. 40 PVC DISCHARGE PIPE FLOAT NO.1: PUMP ON/OFF (BARNES 073618) 4" Dia. Inlets PLAN 5'-5.5" FLOAT NO.2: ALARM ACTIVATION (BARNES 073612) BARNES SEV412 PUMP .5 H.P. 115 V 8„ 4" Dia. Outlets 2" DISCHARGE PASSING 2" SOLIDS PUMP & ACCESSORIES AVAILABLE THROUGH WILLIAMSON ELECTRIC (781) 444-6800 O PUMP DETAIL 72' 72" 63.5" N.T.S. 54.5" 48" Liquid Level 51.5" 3" (� ) a 3" 8'-0.5" 5'-2.5„ (3) 5" DIA.OUTLETS 16" SECTION B—B SECTION A-�A t. INVERT Ed®®® ® ®®E NOTES: ®®�®®EI®®®®a 33' r 1 1 1. ALL PIPING JOINTS SHALL BE MADE WATERTIGHT. ®®E3®®®®®®®® 15.5' i ;', 8„ 2. 1000 GALLON CAPACITY (B" TOP) 24' EDk1F.3®®E3®®®®a 6 2„ MONOLITHIC PUMP CHAMBER 102' SECTION N.T.S. DISTRIBUTION BOX 4" KNOCKOUT N.T.S. 20" DIA. COVER 4" KNOCKOUT / 4" KNOCKOUT 62" OF Mqs 4" KNOCKOUT Q�PETER s9�y McENTEE a� PLAN CIVIL tiF5�8O ROPOSED SEPTIC SYSTEM UPGRADE No. S1 MBERT MILL ROAD, MARSTONS MILLS, MA 500 GALLON CAPACITY, H-10 LOADING ,o RF�,�S�ERSO��� Prepared for: Rita Stuopis, 19 Longmeadow Drive, Canton, MA 02021 CHAMBERS Engineering by: Surveying by: LDATE DRAWN JOB. NO. Warmer Surveying, .T.M. -05 N.T.S. Eng/neeNng Wor,Er ,Y g N.T.S. 223 12 West Crossfield Road 22 Long Road Forestdole, MA 02644 Harwich, MA 02645 CHECKED SHEET NO. 08) 477-5313 (508) 432-8309 P.T.M. 3 Of 3