Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0609 LUMBERT MILL ROAD - Health
609 Lumbert Mill Rd Centerville A= 147 - 088 INISMEAD No.H163OR UPC 10259 smead.com • Made in USA AvgcYc(,�, t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r U 609 Lumbert Mill Road ' Property Address Rebecca Hayes r Owner Owner's Name information is Centerville f required for every It, Ma. 02632 07-30-2019 page. City/Town State Zip Code Date of Inspection t"=, 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. Inspector Information on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name Y 52 Rivers End Road � Company Address Teaticket Ma. 02536 City/Town State Zip Code r � 508-280-3356 S13938 Telephone Number License Number I 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. ® Passes 2. ❑ Conditionally Passes i 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 08-02-2019 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form } Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 609 Lumbert Mill Road Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 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: This 4 bedroom home has a H-10 1500 gallon septic tank and a H-10 D-Box feeding a 12 x 38 leaching trench with 5 infiltrators. At the time of the inspection there were no visible signs of failure criteria. 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 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form iI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............. 609 Lumbert Mill Road u Property Address Rebecca Hayes Owner Owner's Name information is required for every .Centerville Ma: 02632 07-30-2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 FIND (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): 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 609 Lumbert Mill Road Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 page. City/Town 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 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. c. Other: I 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® 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 �n to Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 609 Lumbert Mill Road Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 page. Cityfrown 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 '/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. ❑ ® 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. El ® 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 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 1 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 609 Lumbert Mill Road Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 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? ❑ ® 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `.............. 609 Lumbert Mill Road Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 plus GPD Description: Number of current residents: 0 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? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: I Sump pump? ❑ Yes ® No Last date of occupancy: Fall 2018 Date I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �I4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 609 Lumbert Mill Road Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 page. City/Town 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/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/2 612 0 1 8 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 609 Lumbert Mill Road Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: 01-25-2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u, 609 Lumbert Mill.Road Property Address Rebecca Hayes Owner Owner's Name information is Centerville Ma. 02632 07-30-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"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: standard H-10 1500 gallon Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At the time of the inspection the liquid level was at working level and the tees were in place. I would recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form pI a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .;, 609 Lumbert Mill Road Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 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 u- 609 Lumbert Mill Road Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 page. Cityrrown 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 Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 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.): At the time of the inspection there were no visible signs of leakage or solids carryover. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts �- p Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 609 Lumbert Mill Road Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): * 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: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: one 12 x 38 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 609 Lumbert Mill Road Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 page. Cityrrown 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.): At the time of the inspection there were no visble signs of past hydraulic failure in the leaching trench. 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 inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 c� Commonwealth of Massachusetts p Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 609 Lumbert Mill Road Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 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 of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 609 Lumbert Mill Road Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 page. City/Town 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 L 4 a C ti ✓' ►'t 13- 2 = A? - 2 ^ a9 -Y. c - t = al C� v L c. J\ l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 � Commonwealth of Massachusetts Title 5 Official Inspection Form i1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 609 Lumbert Mill Road V Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ' ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and I shot it with a transit to show 4 feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. ; t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form + Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 609 Lumbert Mill Road Property Address Rebecca Hayes Owner Owner's Name information is required for every Centerville Ma. 02632 07-30-2019 page. City/Town State Zip Code Date of Inspection 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 I o' IA v llro 14Zv t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 a Town of Barnstable P# Department of Health,Safety,and Environmental Services Public Health Division Date t-1744'.Vz- 367 Main Street,Hyannis MA 02601 HARNBrABMMAM + . '/ FD ►� Date Scheduled J /� 120 0 ( Time l` Fee Pd'.100 Soil Suitability /Assessment for Sewage Disposal Performed By: / L= ` ( /' Witnessed By: LOCATION & GENERAL.NFORMATION Location Address 112���� `', �� — /_T Owner's Name ,�` A�✓%� / L ��/�"�`-) Address s yy, Assessor's Map/Parcel: CJz46�Engineer's Name gS7__ NEW CONSTRUCTION REPAIR Telephone# i. Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft j Drainage Way ft Property Line It Other It SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 46 yo- 1 Parent material(geologic) a, t;s Depth to Bedrock Depth to Groundwater: Standing Water in Hole: ��`�� Weeping from Pit Face IlD'rN Estimated Seasonal High Groundwater I70W-P_ .... DIETE MINATWN PDXt SEASONAL G 'WATEY2 TABILE __...;:. . ... .. Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# _ .Reading Date: Index Well level _._,_ Adj.factor Adj.Groundwater Level_ t'T+.t2COLAT�ON TEST T)afe :' b$ Time if' Observation Hole# Time at 9" Depth of Perc e4a Time at 6" Start Pre-soak Time @ I I `3U Time(9"-6") End Pre-soak 11 38' Rate Min./Inch M 0n Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant _. DEEP OB5ERVATION HI. OLE.-.L....O+C I3oIe . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,°o Gravel 0v�� to Yla gig 8� C. MSarr� .S"t{ 6j� �j3 ° c 5.,d BEEP OBSERVATION HOLE LOG Hole _. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistenc %Gravel i i' i DEEP OBSERVATION HOLE LO( - Hoae# ..... Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistenc %Gravel ................. ......... ............... ................................................. ............- ......... .. ... ..... ............ ........................................................... DEEP OBSERVATION HOLE LCG Dole# . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. C nsistenc %Gravel) —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 pervious material exist in all areas observed throughout the area proposed for the soil absorption system? S If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature' Date : ._•_ ' TOWN OF BARNSTA�yBLE cN LOCATION CG 0 VILLAGE % ZE�SSOXS= & LOT/JO�000? INSTALLER'S NAME&PHONE NO. 1%kC/-1 SEPTIC TANK CAPACITY /5 C—✓3 // LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER A4 i 209 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by s G � `` I � G � Q � � �� �3 � - �� � � .3 � .� G:A�z�l�° c T. TOWN OF BARNSTABLE LOCATION G �7 J L y,� (�i�„�i �7i1, �� �' SEWAGE # VI LLAGE /�l,)✓'s ASSESSOR'S MAP & LOT 'D 'INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) /•v%°"i T Y c) ,L S (size) NO. OF BEDROOMS BUILDER OR OWNER Ik/C ?Gk , �9,7I PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site.or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) F— s A.b y ' V r sr - C? 8 CE No. s� � �''45"i ' f Fee 1 �F THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z(ppliratton for 30ig ooar bp5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( 14'Abandon(I/) (&Complete System ❑Individual Components Location Address or Lot No.6(q(V p)bjF)Q jM1jjRd) Owner's Name,Address and Tel.No. /nt Assessor's Map/Parcel 111 1 ; l 2 /5 6 "vi 6`�Z eJt094`/—Zf ��Z���� ��5� � Inst ler's Address and`Tel.No / _ Designer's Name,Address and Tel.No. 0 Z6 4N . I /i �- iG _ �y �' sr coo c re ..Q 74,Po �2� ,P,L. Type of Building: Dwelling No.of Bedrooms ` Lot Size sq.ft. Garbage Grinder( ) Other Type of Building - d c No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow— gallons per day. Calculated daily flow //0 0 gallons. Plan Date ©Cl' 2.000 Number of sheets Revision Date A11A Title _ Size of Septic Tank /mod O < /IH— Type of S.A.S. 4 0 cSt' L.akff %!4- 45cription of Soils/U rrr S Nature of Repairs or Alterations(Answerawheg applicable) DNS-86b 4 r"/U'y IV ;3 RL- �o`r A�dyr+e . Date last inspected: Aua :2—mm Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on- ' sewage disposal system in accordance with the provisions of Title 5 of the Environmental e a o st r 'o e tion until a Certifi- cate of Compliance has been issued by this Board of e _ Signed 5aDate Application Approved by Date - Application Disapproved for the following reason Permit No. Date Issued 1�1 ' � 17 Qw " �Fee c✓' THE-COMMONWEALTH OF MASSACHUSETTS Entered in computer: - _ s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Migpogar *potent Congtruction Permit Application for a Permit to,:Constiuct( )Repair( )Upgrade(Y Abandon(1l) ®Complete System ❑Individual Components GinstaUer's ress or Lot No. v"1 1Umbo� M 1 MM . Owner's Name,Address and Tel.No. f/C q o4a Z) 9.4 T'�S ap/Parcel I ( � / G 6/Y/G u odttyr������,/ 5° � Addre andTel.No. Designer's Name,Address and Tel.No.s �- j �6 /rlrrJ0r7Gz�%�/ V � Type of Building: n� Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building t'/�- a!�c No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow //0 0 gallons. Plan Date 0�7- 3. 2 CO Number of sheets, Revision Date AJIA Title ° Size of Septic Tank 1S00 aim Type of S.A.S. I_qa SFL �ltZ Description of Soil B Nature of Repairs or Alterations(Answerwheti applicable) A%u/5 S1 ► V i��� 2 �/� c?S�� ONE BE�,P�O�'► "Q%'7%0N ?D 3 -Rtr 9o� �Foh►P , Date last inspected: /4U4 20aD Agreement: / The undersigned agrees to ensure the construction and maintenance of the afore described on- sewage disposal system in accordance with the provisions of Title 5 of the Environmenta - de not>t p ac - s in o nation until a Certifi- cate of Compliance has been issued-by this Board of a h. Signed " Date 6kTf wv Application Approved by L Date 04f Application Disapproved for the following reasons Permit No. > 0°°'' Date Issued THE�COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS _ (Certificate of (Compliance THIS IS TO CE ,that the On- it Se ,age Di s osal System Constructed( )Repaired( )Upgraded( ) Abando ed( )b at Ai141 Xe has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No244*9t,-;�, ed/L1 r _-2C Installer Designer t The issuance of this permit shall no be c nstrued as a guarantee that the sy At m,will funcdtio` as//designedl Date Inspectors� �. hlip_0,411126- No. �''� ' ----------------'r—,\------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE, MASSACHUSETTS migpogal Opgtem Congtruction Permit Permission is hereby gran ed to Cons . ct( )Re air( U ade( don( ) Q �. System located at � �' and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and a following local provisions or special conditions. Provided:Constructs n gust b W/plet d within three years of the date of i perntft: / A roved b r `' Date: pp Y / r � COMMONWEALTH OF MASSACHUSETTS �ft`�,I e n EXECUTIVE OFFICE OF ENVIRONMENTAL tiF,,IRS DEPARTMENT OF ENVIRONMENTAL IV�ROTECTI ONE V1'IN'fER STREET, BOSTON. MA 02108 617-292 500 ppT � w Vey 'OwNOF2 4 997 WILLIAM F.WELD H�(ry�p�Tgg�F �T DY CORE Governor Secretary ARGEO PAUL CELLUCCI ID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM L cJ Commissioner PART A CERTIFICATION 609 Lumbertj Mill Rd Evelyn Downes Property Address: Centerville, MA Address of Owner: Phillip Tilton Date of Inspection: 9—a sf_It-1 (If different) PO box 286 Name of Inspector: Wm E Robinson Sr W Kennebunk, ME 04094 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Wm E Robinson Septic Service Mailing Address: PO Box 1089 , Centervi 1 1 a , MA 02632 Telephone Numbers r 308 775-U76 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _V Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: L I Date: ^off Ll The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BJ YSTEM 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. Indi ate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (rwiaad 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:lhvww.magnet.state.ma.usldep >�j Printed on Recycied Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 609 Lumberts Mill Rd, Centerville Owner: Downes/ Tilton Date of Inspection: —,Z /—�j SYSTEM CONDITIONALLY PASSES (continued) Sewage.backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 609 Lumberts Mills Rd, Centerville Owner: Downes/Tilton Date of Inspection: 9-A V—1I 1 Dj S TEM FAILS: You mu t indicate ei;,:er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis or this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct he failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. _ Static liquid level in the 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LAR E SYSTEM FAILS: You m st indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well) The o ner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program require ents of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. I (revised 04/25/97) Page 3 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 609 Lumberts Mill Rd, Centerville Owner: Downes/Tilton Date of Inspection: $_;L Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No yt-j _ Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. /Ui5 _ The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of / baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Y _ Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)J (revised 04/25/97) Page 4 of 10 � •V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 306 Lumberts Mill Rd, Centerville Owner: Downes/Tilton Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:133® G.p.d./bedroom for S.A.S. Number of bedrooms: Z Number of current residents: O Garbage grinder (yes or no):L2.0 Laundry connected to system (yes or no):�-5 Seasonal use (yes or no):_Z-0 Water meter readings, if available (last two (2) year usage (gpd): 1995 — 38, 000 gals Sump Pump (yes or no): 1996 - 63 , 000 gals Last date of occupancy: CO MERCIAUINDUSTRIAL: Type establishment: Design ow: gallons/day Grease t p present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-san ary waste discharged to the Title 5 system: (yes or no)_ Water, eter readings, if available: Last ate of occupancy: OTH R: (Describe) Last e of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Ate System umped as part of inspection: (yes or no)_Ajt— If yes, volume pumped: Gallons Reason for pumping: TYPE OF �.YSTEM &/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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: ������ S �a- � Sewage odors detected when arriving at the site: (yes or no)LL d (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 609 Lumberts Mill Rd, Centerville Owner: Downes/Tilton Date of Inspection: G)_p�clm q 7 BUI G SEWER: (Locate o site plan) Depth ow grade: Materi of construction: _cast iron _40 PVC_other (explain) Distanc from private water supply well or suction line Diamet Comm ts: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_V (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) q Dimensions:f `� C o �' Sludge depth: 3—Al Distance from top of sludge to bottom of outlet tee or baffle:"1 0 Scum thickness: t Distance from top of scum to top of outlet tee or baffle: 3 r Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: 6 lie aJ- Comments: (recommendation for pumping, condition of inlet anj outlet tees or baffles, depth of iqVid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) , a -S � w GREA E TRAP: (locate on site plan) Depth low grade: Materi I of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dime sions: Scum thickness: Dist ce from top of scum to top of outlet tee or baffle: Dist nce from bottom of scum to bottom of outlet tee or baffle: Date f last pumping: Comm nts: (recom endation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integri , evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 + 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 609 Lumberts Mill Rd, Centerville Owner: Downes/Tilton Date of Inspection: TIG R HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate o site plan) Depth ow grade: Material f construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimen ons: Capaci gallons Design ow: gallons/day Alarm le el: Alarm in working order_Yes; _ No Date of evious pumping: Comme s: (conditi n of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_✓ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) A ei PUMP HAMBER:_ (locate n site plan) Pumps in working order: (Yes or No) Alan in working order (Yes or No) Com ents: (note ondition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 1 � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 609 Lumberts Mill Rd, Centerville Owner: Downes/Tilton Date of Inspection: 9—d2 L/—Q SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydratz failure, level of ponding, condition_gf vegetation etc.) CESS OLS: _ (locate site plan) Number a d configuration: Depth-top f liquid to inlet invert: Depth of so ids layer: Depth of sc m layer: Dimensions f cesspool: Materials of onstruction: Indication of groundwater: inf! w (cesspool must be pumped as part of inspection) Commen (note cond ion of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of c struction: Dimensions: Depth of solids- Comments: (note condition o soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 609 Lumberts Mill Rd, Centerville Owner: Downes/Tilton Date of Inspection: 9-;z-1' 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) l� 1 36 I 0 n` n� l (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 609 Lumberts Mill Rd, Centerville Owner: Downes/Tilton Date of Inspection: �•,a `l 7 Depth to Groundwater J 6 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be comple ed) ' s , � LCo o PA Y (revised 04/25/97) Page 10 of 10 L0 CAT ION A &E W A G E PE MIT NO.,', ,� YJ Sri/11 �12 7 -- 3`�`-3 a VILLAGE INST All ER'S NAME i ADDRESS A c- B U I L D E R /OR OWNER / DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 43 i'j _ No.-••-•••--�,� .._ — FRs.._..:a.................... THE COMMONWEALTH OFWASSACHUSETTS BOAR® OF HEALTH ..........-•- . --------------_--OF........ :.... Appliratiun for Disposal Works Tonotrurtiun Prrmit Application is hereby made for a Permit to Construct ( ' or Repair ( ) an Individual Sewage Disposal System at: e 7- .............. ............ ................................................... •-••-•--•---•---•-•----.....---...._._......-------- ...-•-•-- L tion-Address or Lot No. • —- � •-----••------•--------------------------- ------------------------•----......_.......-----•-••-•------•-•--•------•-----..............__.... Xwner Address ,Wa f �E� t . .... . ....:.......•----..........._....-- -----------•---•--•-------..... Installer :r d ess Type of Building Expansion -_ Lot............................Sq. feet Dwelling—No. of Bedrooms............................ Ex p n Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of ersons____________________________ Showers � YP g ---------------------------- P ( ) — Cafeteria ( ) d Other fixtures ----------------------------------- ---- ----------------------------------------------------------••-•----------•.._...- �o , Design Flow_____ / ___________________________gallons per$ersoir opef day. Total daily flow...................-���_ ________ Ions. W Septic Tank—Liquid capacit/ gallons Length....<_...... Width._.._`'__....... Diameter________________ Depth_ _________-- x Disposal Trench—No_____________________ Width.....__.__,_........ Total Length.................... Total leaching area....................sq. ft. i Seepage Pit No...../........... Diameter__ '...____._. Depth below inlet_/O o__®___.._. Total leaching area. ......sq. fX. z Other Distribution box ( L4i Dosing tank ( ) a�a�L ,S`��f• ���° ��� a Percolation Test Results Performed b ...___.._____________________________ _______________________.............. Date__._ Y -2 --•-------- 04 Test Pit No. 1:!5;;._',?--minutes per inch Depth of Test Pit____________________ Depth to ground wat Gz, Test Pit No. 2................minutes per inch Depth of Test Pit................._._ Depth to ground water........................ a -----•-----•..:..................•-- ..................................... ODescription of Soil �,--=l �---- ...---............ ---------------------------------------------------------------------- ...-.................................. U --- ---------•-----------------------------------•----------- -----------------------------------------r-'`-/YX............................................���.--► '° i.." `.."' 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'JI'LLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been�sd by the board of heal Signe ................................ Date ApplicationApproved By.................................................................................................. -••-•----------------------------_------ Date Application Disapproved for the following reasons-.........-...................................................................................................... -----------------------------•--------------•---...:----------•--•-------•....--------.......-------•••-------•---...--•-------------------•--------------------------------------------------------•--- Date PermitNo......................................................... Issued----- 7 !..._.._...._.._...__. ': Date No................- Fps....... .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH .............. OF Appliratiun for Disposal Worko Ton.itrnrtion ramit Application is hereby made for a Permit to .Construct ( ) or Repair ( ) an Individual Sewage Disposal � System at: 4.r A4111-------/!h '.1..eo.r�..�.: ,�,_��<.............. �`'�----- �---••.......------. - L ation-Address or Lot No. ..__.. ...Vre:......................^------------... ..........--...................................................................................... r caner Address FW1 ........................ ........................................ o `. -`--... .......•------•--_...........•••-•-••••.....................----..... i nstaller dress Type of Building ' , 1 �``L6t............................Sq. feet U a Dwelling—No. of Bedrooms ------------ ------- -Expansion Attic Garbage Grinder ( ) p, Other=Type of Building ............................ No.,of persons............................. Showers ( ) — Cafeteria ( ) d Other fixtures --------------- ---------•------- --------- W Design Flow..., gallons per Total daily`flow__-____--_--_}-_ ....... ............gallons. WSeptic Tank—I squid:capacity/ iallons Length.--_ ..... Width....-4/....._ Diameter................ Depth..4/...... W Disposal Trench—No..................•.. Width.................... Total Length-................... Total leaching area....................sq. ft. Seepage Pit No t ..._____.. Diameten.,�o.__ ..... Depth below inlet..-----_�_____. Total leaching area..��, sq. ft. Other Distribution box Dosing tank ( ) G .. �l,r f j J XC! e ` W Percolation Test Results Performed by.......................................... Date. d .... 1. ._ 1.41 Test Pit No. 1 C�.___minutes per inch Depth of Test Pit.................... Depth to ground water _- ----- pl, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground waterset-�ehr-•e/:-r�x a ------•----------------------------------•-•---------•-•------------------------------------•--------------•------------••-----------------. f. D Description of Soil---�1-/`'...:�... �f'��1�------------------•---•------------------------------------------- ---------------- ._•--•_•• ------......--•--•---c.� — - J' ----------- ,�� Z. 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 TLTU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is by t rd of h� Signed--- Date ApplicationApproved By......................................................................................(..:........ ........................................ Date Application Disapproved for the following reasons:---•------------------------------------------------------------------------------------------------------------ ------------------------------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............OF........... . . ...!''� ......:T...}.........................._.............. Tntifiratr of feomplitanre THj IS T CERTIFY, That the Individual Sewage Disposal System constructed (�--r or Repaired ( ) b ,-, y gnI 4aance ------ ;� - ---- ------------- - -------- ------ r / r Installer has be with the provisions of T - 5 of The State Sanitary Code as described in the No_application for-Disposal Works Construction Permit No_ ._ .............. dated... - � � �............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CX ED AS UARANTEE THAT THE Inspector SYSTEM. WILL F NCTION SATISFACTORY. DATE................. ----•--..d_--�-�--�.�.�:....................... ...._ --------•- •- -------=----------------•--..._....._.._..--•--- THE COMMONWEALTH OF MASSACHUSETTS " BOARD OF HEALTH .......:....OF......... k�sl ?.......-•.......................................... ..`c!-• �i��ruu�tl urk� nu�nr�ion Fermi# . Permissio i hereby granted-""-----rni�,jdual J -_ --................................................................ to Constru C Repair (� ) an Sewa k Disp sal yst at Nc�' ---� ° ' .. s•••• ---..... - Stree .. as shown on the application r Disposal Works Construction mit No..................... Dated./.ti..:_. �''�<.......-__. 7 ---------------------------------------- DATE � '7 card of tli ---- 7- ,2.......•••• .............................................. "FORMI 1255. HOBBS & WARREN. INC., PUBLISHERS , r / V.OFCATIO'N - SEWAGE PERMIT NO. VILLAGE y LlO INSTAL ER'S N ME & ADDRESS r B U K D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ,•//�_� • i l y� 3/ 2 Sri o, r No................_...... . ............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Taw. . ..................OF........ S..r.. .e.. .................................. ApplirFa#ion for Ditipm al Works Tnnitrnrtiun Prrutit Application is t�ereb}' made for a Permit to Construct ('K) or Repair ( ) an Individual Sewage Disposal System at: � # (p o ... ..u. .....m.i. ........ ................... J,oc�atio"n-Address or Lot No� �4..---:t' !.!�l' ------1-.a(1 ----------------------- .........CAI...... ...... ------------- p / �y�Owneer ..................................................Addres ,,y C Installer Address Q Type of Building Size LotJ___l.j_.!ik:P........Sq. feet V Dwelling—No. of Bedrooms... Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............... No. of persons___.._.__.__.........._._... Showers Cafeteria P4 Other fixtures ............................................. . W Design Flow-:--- .................................gallons per person per day. Total daily flow.............3�........__..--.-__..gallons. WSeptic Tank—Liquid capacity(Qld..gallons Length.......&...... Width___ .......... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------j............ Diameter.1......!........ Depth below inlet....... ......... Total leaching area'Ll-e.,c7._.sq. ft. Z Other Distribution box (y,) Dosing tank ( ) a Percolation Test Results Performed by.-_...... ............................. Date........... ........................ ,.a Test Pit No. 1----------------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 ....................................................................................................•-------='•-••-•-----•----------------•-------- rh Description of Soil -� M.._:..._.�a.U..:. .5 P1► 6�1 U- '----- ........1`:Lh4lL A o .;_...`�' _ -Ll, ` _.Ik?_ .d�.c- C G.A t� s E.: A = N_d_...__4�1_ �. -------------------------------------------------------------------------------------------------------------------------------------------------------- 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 TITI.L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha en issued y �of Sig 6 ...s ..._..._ Application Approved By.....- .Zx• .4'L' *..f..... ------_----_- 7' -- ------------- 7 Date Application Disapproved for the following reasons---------------•---------------------•-----------------------------------------------------------------......._._ ............................•---•----------------•--------------•---------------------................................................................................................................ Date Permit No......................................................... Issued_..4:S Z?'.8..........""-'-"-'-'-'_.. Date l y � 73 No.......... _ ----- • ' r< ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -----7,17d.4-------------------OF.......P.�- -2f-.5..T.-�9-Ra ............................. Apli iration for Woposa1 Works Tonstrnr#ion Urrmit Application is hereby made for a Permit to Construct (A or Repair ( ) an Individual Sewage Disposal System at: UL rn_3 AJr..._Mi LL.....ea&D-------------------------- - -----C k.E.....t_IA?...................................................... L lion-Address r Lot No. -�"►°- .. r!'IS.. ..r!�C.= --------- ------I.... ------..�_��. �T.�... -- ��1__ j.N..� :.--- Owner fi- Addr .... ---.(�_ A�N.�.S- W a _ Installer Address Type of Building Size Lot_.V_t__:�ft-b........Sq. feet V Dwelling—No. of Bedrooms............ .............._.............Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .--•---•--------------------•-•-----•-••••-•••••••...----•-••••---•------•••-----•---._.._..---••••-•-••--•--•-•••••-••-•-••--••--••...._.......-••- W Design Flow......... ..........................gallons per person peu• day. Total daily flow........... ......................gallons. WSeptic Tank—Liquid capacityl�lTl'�_gallons Length_._._...... Width___ta_......... Diameter________________ Depth................ Disposal Trench—No. .................... Vidth.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......I-------------- Diameter_._. ..... Depth below inlet........(i......... Total leaching area__ __.(:._�_.sq. ft. Z Other Distribution box ()() Dosing tank ( ) 7 Percolation Test Results Performed by.........t,,__.___.( A_-4 L -------•--. Date------=-- - F_k................. 06 .................. ------------ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground wat r........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ----------------------------------------ff- -•-....••-•-•-•••......•-••..........---•----•-.._..---........--•---•-•--.....__....--•••---•------...._.....-- D Description of 5oil--t--4 �I.:.._�C-f�f49 = rn c� t M !4 .Q----=- = Alhll�?- •.--.---� 1 .---•- IS '�.I.I�./�1. t-...... &-5-E...-5-A'N-)----......--N.6...-----.W;i. ....... ----••-•-------------•------•---•-------------••---•---------------------..._---------------------•-----------•--------------------------....----------- 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 TITILE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has a issued by he �trd f health. Sie -----------••••_. - Date Application Approved BY------ ;r--- •---•--•-•- - ---+is�/1�. ..-------•--------•-•-••---. _..-�-t�-- ----�-�-'��----- Date Application Disapproved for the following reasons------------------------------------------------------------------------------------------------•••••-•........-- ....................•--•-----------._.._..._..__....---------------------•--•----•---------•-----------...-----•----------------------------------------------------------------------------------------- Date Permit No...............................--........................ Issued..... �� � .................. Date THE COMMONWEALTH OF MASSACHUSETTS , Y BOARD OF HEALTH ........fe...... .............. `OF.........- G��yt,!,t�,,C �� Tatifiratr of fWvInt�rli�tnrr , TH�isO C RTIFY That e Individual Sewage Disposal System constructed ( ) or Repaired�•-- ....��� by... . -•-• . --- ---. --•••-- .- InV---- at-.." ,�,�.�/--- -------- •• . =..... --•- - ----- --•--•-----------•---•- . -- with the aas been installed for Disposalosal WorkseConstru lion Permit N T _ F 5 of The State,Sanitary Code as described in the provisions .. -r— 77•--•-•-----•-••- PP Po•-7 � -------------••••_. da.ted_- 49_..-.._-- ------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY , yv.---11�:..: s� Inspector �'�'� ,i �Am.........DATE.............1,� ' ` - ��.ed.r y .�,r a. .,. Kl'"a, ✓G t t,` t��r>. zv.,'4"` r.M,.� // tR�ri.... ,,,. ' t ,� •!y�},,B."''�-rY w THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH 3 �le... .............OF... ..y . .-......... N ....... .._..._.. FEE..�.h��-� Disposal for ii one # on prrmit Permission is hereby granted ....._ ,P"r_-___________________ ..................................................... to Construe or Rep ( ) In iv' al S >vc gej is sat Sys atNo.-i ----�j . ---- -- . ....... -4- ----- -------------------------------- - Street as shown on the application for Disposal Works;Construction' P it No__ ________________ Dated.. . 7 ��j/_ �y � �.., s - Board of Health DATE.. ..... -------/--------------------------------•--•------------•--•--- J \ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS _ ' 28 /000 q.Ac . zZ _ ��•�o Ts�,..i„c \ __ \ _• 'a �_ .¢ � G -wc.c. pig - -o o ----o -O2F Proposed 9ro`b,col pro f i ;P Z�' 300 302- SCM�A. 4O GV C. Ch' — --- —/cL Ol.k/ — -- ------t- ��� -- F4¢67 - •r EQ u,A� To SEaTi� 2 ' of / ,, -� _ _ _ _- ri m�nrirrur►� �4 per �e - %/ZR wcistieo/ stood TR9^.;AIc� . ' I . ° • ©/5 77 eox46 T6 .� 1 i — _ 0 3 - r .• /000 GAL SEPT/G TA;I/�c __ • O O . 2 P/ T ip / of l7 00M /-/o )vsE La.19TE �1CJ77 TEST BT � r7o c%sPoser / C. .e,9 T 6- - Z -- M/A.1..//At/C H n \ ow ,e- q rEE3arnstob/� Bd of.�Nea.lty v r 1 3 S E PT1 G TANK u 30 x / S 495 TEST f-/OL E # / TEST HDG E � C�/9C.. i.�9NK w e/ H P i T: /oa.r77 %�.5 /2 -_ ` EFF OEPTfr+ - Co•O _ Su6Soi/ k �p Z� q Z� S/O E!•t/A L L. _'l_/� S.F �„ - B/ Z/.7 c� C JJ 58/. 4 G/t"0,r7 t I f + f - r7c Gc�caf�r BnG�un�•'P_/-eol > _ �_ / G ERE?T/F y' THAT THE B U/L L�/it/G � R/ T� "- S C...- �`✓ / / C.� � / L �7 /V j P'RE'D�DSEl.� piV' THE- GRE�DUiI,/© r95 l-V/l1 D Al T/ i/S P L N litl/L L F t %.. C T GOA/FOR'C ✓•,/ TO TH& aUllC-)I /G SET- BAGk .� EQui�'E .'vIE/�lTS OF THE �- �MBE,FT /i''I/LL iE' pFaG, T O 441A.1 0)1- 15,49 fit./S 7-,'9 W �F .M .. � E• Q��/� E : 1-1EA-lT6 �NofMQ� ARE CAJT- /`��i' .6VFREt'd S / c i o _ EYE4EpT 7� r2 HaN 9CLtT l� Ho /.-t/A./ � � TE Grp 13�30 p 1787 N s N /GAL /� q Ai A /It ZEE- X , sf r7 6o�7 / our �' s B o iq�E' ,O of f-/E A L T H - c,"C'osed 4- a ,-�tour5 _ ,E'/l./Z'57 T�e L - S.S. r /a n l Cen-rervi i ,e. MN 02632 REFERANCES: Subsurface D i sposa l Pro-file View N #F�0ac! gown Barnstable � Lu Lumbert Top Of Foundation E . = 39 . 0 ' I . Site Sewage Plan for Lot 16 ( Not t o S c a I e ) Pond LC Plan #37432A. Lumbert M �a Mill Road. dated: Oct 1977 PROPOSED FINAL GRADE �-4 " PVC @ . 04 FT/FT OVER SAS E <'�0 2. Town of Barnstable GIs 4 PVC @ 02 F T/F T N L T 35 -- basemiap and Assessors To Hyannis Map/Parcel - 147/88 � - J To CL 3. 310- Commonwealth of Mass- 3 6 . DO ' ep c _ .�K-_ �._. -_.�� Cotuit � _{.. � p achusetts Regulation: Dept Tank - � 2"w� +-- I C) of Environmental Protection 34 . 25 ' Bo — _ _ 4„ Fi Iter fabric 7 , 500 Gad . 34 . OC N Engineer 8� I nsta I I er -9 \ 34 . 75 �" 3 _7 " OCUS Map 34 . 50 to con-f � rm 5 suitable tab I e f Bedding as Req 'r L ecch Aree 19\33 x 40 so ! I around SAS edd i ng cs Req r. TITLE 5 ---I 15 / Foundot ; on Tang PROFILE OF LEACH BED -501 TITLE 5 i 5 I " �.F Iter Fabri� .u. .„..tiv. -....wws...i..eYr...r_...,u.,nlr...,...R...>.,c ...........:a- •4 SAS BED BOTTOM 2-- T 0 Tank - D-Box 4" � NOT DESIGN DATA --  �AAzE DOUBLE WA SHED STONE AROUND S YS TE SAS LEACH FIELD DESIGN Test P % t DatC` 6 " to 8 " LAYER on BOTTOlq BED Project r;t;E: SINGLE FAMILY - 4 BEDROOM Indicates I DAILY � LOW: 4 x 1 1 0 GPD = 440 GPD Terc estCon-Firmed 1 G/3 /00 L e end SEPTIC TANK : 440 GPD + 250% = 1100GPD Ground El. = 35 ' by T . Dohert / , P . E . 40 ' _ SUBSURFACE USE 1500 GAL SEPTIC TANK Loam 6 // EXISTING ELEVATION - � _ _ _ - - - - - SEWERAGE APPLICATION AREA REQUIRED : Pit No. 1 I BUILDING STRUCTURE - D I SPOS' AL 440 GPD / 0 . 74 GPD/SF = 595SF Medium Test ey: P • V Tray LOT L I N� TE PLAN Scnd DES ._ G N BOTTOM AREA : 40 ' x 1 9 ' = 760 SF 7 5 / Test Date: 1 0_' 1 8 / 7 7 Witness: � ��_�_!_�r OLD SEPT 1 C S ? RUCTURr - - - - - - -- - ! 609 L umLert I USE 19 ' by 40 ' LEACH FIELD WITH 3 EA Fine sand < SEPTIC S r'�.., TEM - - - - - - - - - - '° M i I I Road 4 " SCHEDULE 40 PVC PERFORATED g � Pe, � Rc � e ----- DISTRIBUTION LINE WITH CAPPED ENDS .tedium Course BM-Top o-F Fnd-SW Cr 41 6 // j Centerville Sand 12 No Groundwote, MA } General Notes J \ PREPARED FOR: roperty L nes Shown Hereon Were Comp i led \ � J Richard Bates rrom Referenced Data And Do Not ?epresen t An Actual Survey On The Site . c� . Voter Supply For This Lot is Municipal Water , f .. . � j� 'REPA,,'ED B Y l evat i ons Are Based On N. G. Ve D . ` T . O ERTY his Lot Is Not Located In A F. E. M. A . Flood Zone . o� ASSOCIATES 'h i s Lot Is Not Located In A Town Of Barnstable Zone Of Contribution. W co CD Notes • ,i:ltr�! 6l �Ig Bid 41 6" X - For A / / Aspec is Of The Sep t i c Sys tem The Top of Foundation _ �C ; o, (D-) l Con troc for Shall Comp l y W i th All Go vern i ng 4' Codes & Regulations ;l o t i ons ; I n Particular, 3 / 0 CMR '`\-" }>" >� g /J \ i c 1 son. ,v 9 5 . 000 Tit / e V of the S to to Environmental Code - _ - - v � DRAWING TITLE: And Any Applicable Local Regulations. �; Including R &/or A of Old Septic System ' \ `' R E S I D E N I A ` f \ 7 I �' ' \, S I TF & S - PT I C Precast Concrete Septic Tank , D -box, And a� \ p Leaching Structures To Withstand H- l 0 Loading DESIGNED 3Y: Unless Under Pavement , Drives , Or Travelled Ways T . L . DOHERTY Where H-20 Loading Shall Apply. APPROVED BY: All Pipes In The System Shall Be Schedule 40 Or Equal . 'D tNOFk.I No Field Modifications To The Sewage Disposal System /<? 6 � T DMA EHlITYE L. y, Shall Be Made Without Prior Written Approval Of ' . a T _ - CM �� , - - - , The Engineer And The Local Board of Health. No .41189 � , \ � o � AL The Contractor is Required To Secure Appropriate Permits From Town Departments , And Is Responsible For Location ' te:0atober 3. 2 HOC! - - -- _ sr,aet.�, + DeslGn:T.Q.Dra�.n:T.J Of All Underground Utilities & Notification of Dig Safe . ���<: �.�. of: 1 , Centervi I le. MA 02632 REFERANCES:f� ,C ,��,Subsur ace • sposaf Pro-File V • �v Town of Barnstable um lan for Lot l O f Foun do t ion E I - 3 9 . 0 No -':- � c i ' . Site I LC Pion 9u37432A. Lumbert6 �r � l IVo t0 Sca I e Pond �I Mill Road. dated: Oct 1977 PROPOSED FINAL GRADE \ I /-4 " PVC @ . 04 FT/FT o , OVER SAS :. E y <>�0 ' 2. Town of Barnstable GIS 4 VC @ 02 F T, F T N L T 35 a� TO Hyannis basemap and Assessors Map/Parcel - 147/88 —s - a a --� S To 3. 310- Commonwealth of Mass- a 6 . 00 ep i C --- .. - w•4 _,w.s Cotu i t R t 2 8 achusetts Regulation: Dept „ �_rank 2 -a— of Env i ronmenta I P-otect 1 on B o 411 F7Iter fabric i 7 , 500 Gol . 34 . ?5; -1 34 . 00 - Lng i neer & I nstc I I er 4 . 7 L . 7 . 6„ to conf ' L ocus Map 3 5 34 . 50 rm 5 su + tab I e Bedding as Req 'r. Bedding os Req 'r. L each Area 7 9\33 x 40 so i 1 around SAS Foundot i TITLE 5 on - Tank TITLE 5 PROFILE OF LEACH BED 501 i 5 --� . 00 1 ,5'" I 4'. Via. 5„ i 5" ..)—R-,. Filter F ab r i q SA S BED BOTTOM Tank - D-t3ox 4" � 5�S N O T T O DESIGN DATA �)C°E OUBL E WASHED STONE AROUND S YS TE i SAS LEACH F I ELD DES I GN Test Pit Data L 6 " R to `� " LAYER on BOTTOM BED Project Title: S 1 NGL E FAMILY -- 4 BEDROOM Indicates DAILY FLOW : 4 x 110 GPD - 440 GPD Perc Legend rest Con-Firmed 1 0 '3 /00 SEPTIC TANK : 440 GPD -- 2`0% _ ' 1 OOGPD i---_ Ground El. = 3rJ ' by +T - Doherty , P.E . � _ , 40 , _ _ � � SUBSURFACE U'�E 1500 GAL SEPTIC TANK Loam 6 " EXISTING ELEVATION SEWERAGE APPLICATION AREA `AEU I RED : R. U I L D I A/C S TRUC TURE D I S P O S A L Pit No. 440 GPD / 0 . 74 GPD/SF = 595SF Medium Test By: P • Mu '. r SITE PLAN Sand ay L 0T LINE & DESIGN BOTTOM AREA : 40 ' x ' 9 ' = 760 SF _ • 5 ' Test Dote: 1 0/ ' 8 / 77 — _ — — �I @ Wi tness: -W--.to per' OLD SEPTIC S RUCTURE i 00 - Humbert USE 1 9 ' by 40 ' LEACH � I El D WITH 3 EA Fine sand Perc Rote : < 3 / / // SEPT I C S YS TEM - - - - - - - - - - M ; I Road 4 " SCHEDULE 40 PVC PERFORATED , „ Cen + ;� rv , I le DISTRIBUTION LINE WITH CAPF—`D ENDS edium course , ! BM-Top of F ^d-SW Cr 1 6 Sand 2 /Vo GrounJwo / er i �; MA i jl V ° PREPARED FOR: 'roper ty Lines Shown Hereon Were Compiled °` Richard Bates prom Referenced Data And Do Not ?epresen t An Actual Survey On The Site . 9 BF�T Voter Supply For This Lot is Municipal Water ; (J. PREPARED BY: l e vot i ons Are Based On N. G. V. D . IN, 40 T . L . D 0 H E R T Y his Lot Is Not Located In A F. E. M. A . Flood Zone . °° �, ASSOCIATES 'his Lot Is Not Located In A Town Of Barnstable Zone Of Contribution. ' ' \'� W Notes : BM For All Aspects Of The Septic System The _ \°p of FapNdation _ _ _�° cc- Contractor Shall Comply With All Governing °� Codes & Regulations ; In Por t i cu l ar, 310 CMR -' .'"��;' so�o,' 0 6 ACa)don f S i 5. 000 Title V of the State Environmental Code _ _ - /r � o:� S.T. �;4- f�lco I DRAWING TI TLE: And Any Applicable L oca l Regulations. ` ' \\\?o- R E S I D E N T _ A E Including R &/or A of Old Septic System a �' � , � , `w�. �`� ��\ SITE & SEPTIC Precast Concrete Septic Tank , D-box, And `� ,, ��, P L A N Leaching Structures To W i the tond H- i 0 Loading ` " '�` \ ��� � � �� �� DESIGNED BY: Unless Under Povement , Drives . Or Travelled Ways ,��, � ' T . L . D OH E R T Y Where H-20 Loading Shall Apply. t X APPROVED BY: All Pipes In The System Sho l l Be Schedule 40 Or Equal . OF No Field Modifications To The Se wo e Disposal System c . + OD RE L. ' / 3 00HER7Y 1 Sho l l Be Mode Without Prior Written ',pprovc l Of •,� } _ - \% ' �' �° MAL C r i No.41189 The Engineer And The Local Board ",f Hec I th. The Contractor is Required To Secure Appropriate Permits From Town Departments , And Is Responsible For Location oata:October 3. 2000 r n r Of All Underground Utilities & Not i f i cation of Dig SofF . ..:..z.:-..,,,:...r._<.,s+> ,,.au.>,+x»,r.,,,.,,.an..,.•.x...w..•.,way..c.u.o.,:.-ne, a ..:+.++�, MS L '-r r / Z W 07 25 07 So z(,S Pr-of/ /� C C` T/ O /� HOB/Z. SCALE : / " _ /O `../ ' v (/ E- AeT. •5Gr9c_ � - o --o—o—o-- Prop05CO' 4rour7od profl1G SGNEO 40 A-' V C 02 ( /-rr,rr/mUrn �.f• Per foot , 2.. Qf yap_ /Z" wctshao Stor7 Equ qL. TC, IAJ .. o/sr sox II 6 S�rr-7P o a of -Y14 /000 6AL S&,XpT/C T/9N,4e washed/ Stone / 7) 30.0 �� © Jp SCALE 60 O O O,I T7 .. � %�7 �� TEST '• B E O.E' M O f-1 v E-s �3 s T ,e A9 T E- C Z M i ti///A/G ©ATuM MSL.'-� # � T�.vA _330 .iucF / '/'3 • '� /aP c/SE ,��JJJ GA C.. -,-,-g -- i EL. Z 0 T: 0, E P TN 4�- ��' 'u..t*' GG t S�O E w A L[_ _ /(va.� S F < 2 S ) = Oo•s C3 AL 5,� / ' BOTTOM = ,L` �'.2 S F _ Ski•J .. sy.v.O TO _V,2' Z 6ALS.�l�i9Y 3 7•S ..o 411t4V r /Z' Gig � w.4 rcc'r,� E-i.iCOr✓�+ti'•[.•d�'� y do w r, C 6L 1-':F ,1-7 -7 e- e r CIV/4- &AJ6 /„-1EE)CS SOT C L I-gAJ 3743Z � G ANO SuAE 1/E YO ES 41-- UMB E Ae T M /e- L AE--o�GD GEti/TE .eE// LLE-� /Y111955• -- �ev,e M v r rY M S 5. AP e E)a oeq,2 6 o AB : - 7-i9 /Ai C.- lOi4 TG• : OGTJBE� �`p'OP kq s AJAJES �- � - s , - S� L.4C- - BO,AiAeO OF NEAL7-A4 Pi-oP05G o/ CO .-7 r'-S ��,eA/ST/9B /- C MASS 91;e- 77-0/�