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HomeMy WebLinkAbout0636 LUMBERT MILL ROAD - Health 636 Lumbert Mill Road Centerville P 147 082 f //lcqd- ' 1IPC 125a3 No. 53LOP MAST:"IGS, VN L ,v v) i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name / information is Centerville V Ma 02632 8/1/2019 required for every ' page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered.in any way. Please see completeness checklist at the end of the form. Imngoutforms A. Inspector Information c5'/� /gbalf filling out forms on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Company A Lane Co r� Company Address Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 8/1/2019 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 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 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: The property located at 636 Lumbert Mill Rd Centerville is served by a Title V septic system consisting of a 1000 gallon septic tank, pump chmaber, distribution box and 6 Hi Cap Infiltrators. The system was found to be in proper working condition at the time of inspection. 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 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 ❑ 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): 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.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,V 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 page. CitylTown 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: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 page. City/Town 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 %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. ❑ ® 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 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)] 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 I - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 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): 444 gpd provided Description: Number of current residents: 2 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 El 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: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �a Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commerciallindustrial 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 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: system repaired 3/5/2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 4.5 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.): Joints in good condition, no leakage, vented through roof. 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 4 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: 1000 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2° Distance from top of scum to top of outlet tee or baffle 711 Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and tookmeasurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 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 c Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No 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 of, 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.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1.. W Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 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.): Pump and alarm functioned when triggered manually. Recommend installing riser on access cover. * 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: 6 Hi Cap Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ 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 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 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.): No Sign of past overloading, soil and stone surrounding leaching facility was dry with no signs of past saturation. No lush vegetation 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 636 Lumbert Mill Road u Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 page. Cityrrown 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.): 15insp.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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 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 C r o � � I M ZD 13� Z76 4Z 31'� -� A/ t5insp.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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is Centerville Ma 02632 8/1/2019 required for every page. City/Town 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: 124 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: Groundwater was established by accessing town of Barnstable groundwater contour maps. 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 i Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �r '.�; 636 Lumbert Mill Road Property Address Elizabeth Pereira Owner Owner's Name information is required for every Centerville Ma 02632 8/1/2019 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 No. Fee THE COMMONWEALTH OF MASSACHU.SETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for �Digogal 6pgtem Cott.5truction Vermctt Application for a Permit to Construct( ) `Repair(V Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. i O Owner's Name,Address;and Tel.No. (D3 to L.v,-A6cA- r_%`1\ S4i Assessor's Map/Parcel � : Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S-r�y�elm owb� S so�3�a 3� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( j Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures QQ � Design Flow(min.required)`-C LkQ) gpd Design flow provided �( l.�`,( gpd Plan Date > ty O Number of sheets Revision Date Title Size of Septic Tank dy Qx k5 Type of S.A.S. Description of Soil �0_CC R iw� 5h^j� oar O Nature of Repairs or Alterations(Answer when applicable) f"1P d y y r, S G/e 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 a not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heal Signed Date ` Application Appro d by Date C5/D p Application Disapproved by: Date for the following reasons Permit No. Date Issued _ 0_ ——————— t———————.———————————————— .-- „� �, V6 r ..l ..-ta��•r' 1",�,-, _:.,..*a`+.Y''+�F''�y" . . ;r "'.`�d..�(,�_�m�`M1•1 ._K`�_'r.*M,�- �...r:-..�+r,�.....w .-.. No. v ci- -." - -T � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. 70 PUBLIC HEALTH.�DIVISION - TOWN OF BARNSTABLE,-MASSACHUSETTS Yes hi Application foraigogal .pgtem Con0tructton Vermtt Application for a Permit to Construct O Repair(V Upgrade O Abandon O ❑.Complete System ❑Individual Components Location Address or Lot No. LA ��. Owner's Name,Address;and Tel.No. (c b L ran t�s-fit- M 1\ S C- c \. c e. -{.t" ' f r~� atc,. Pv 1 Assessor's Map/Parcel CA, , Installe`r'`s Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -7 r Type of Building: �1� Dwelling No.of Bedrooms N Lot Size sq.ft. Garbage Grinder Vv I Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures tt � l t Design Flow(min.required)`i Lk gpd Design flow provided 14 ��'9 u gpd Plan Date 3 (O Number of sheets Revision Date Title Size of Septic Tank QX S!SN Type of S.A.S. li�l CSNC„AA6tr Q56\S h Description of Soil UT G_ ��i( S 1&W '5h^k- c�rUv Nature of Repairs or Alterations(Answer when applicable) M{c) ♦1 r� S CA^ t Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date G Application Disapproved by: Date for the following reasons Permit No. �' - Date Issued ——————— -——————————————————————=———————————— THE COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE, MASSACHUSETTS (fertificate of Comphance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (✓) Upgraded ( ) Abandoned( )by Qp� , trC at �t k jr M t`\ 2-jCs r V \ as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. j ' -0<�_',)---dated Installer ::5CQ,�C\ C-A Designer GG #bedrooms �A Approved desig fln ow LA gpd v U The issuance of this permit sha 1 o be co'strued as a guarantee that the system wil unet' ,as de ign d. Date Inspectorj�l� v i �V No. ^�v �""`� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Mtgpogal 6pgtem Congtruction permtt Permission is hereby granted to Construct ( ) Repair ( � Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions, Provided: Construction must be completed within three years of the date of this pe i . Date / �� Approved by • Town of Barnstable oFtHe roy' Regulatory Services Thomas F. Geiler, Director • BARNSTABLE, 1639. Public Health Division ArED 1A°�a Thomas McKean, Director 200.Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# A QQ 11 Assessor's Map\Parcel /Y - ©qZ- Designer: PE Installer: S�-� -r- x f Address: 9z 3. a rc- Address: //3 oz� "o-w 7-H A-,*) On -� (�J v� �'a�-�— �/4w� was issued a permit to install a (date) (installer) septic system at 63 e- L0A46&- ..; ,L1 /L4- A--N ._ based on a design drawn by (address) �'-b'/-�-�� / dated `3Lq O� �e�e� ��i7��� (designer) L/ I certify that the septic system referenced above was installed substantial) according to the design, which may y g g y include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. ��11 OF . STEPA. �tG (Installer's Signature) S., HPAS ZZK CIVIL No.35461 (Designers Signature) (A fix D igner's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Revised.doc �ttte Town of Barnstable P# l L�� Department of Regulatory Services n� HAM AT1il;,y, : Public Health Division Date e •bsy �� 200 Main Street,Hyannis MA 02601 d/ FD Mltt ��l/Ja Date Scheduled ® r v(� �. Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By:_H(C,,A e Q,W V"N el , ET i, C S(= _ Witnessed By: Dbovk4 LOCATION& GENERAL INFORMATION Location Address 3 4. Owner's Name Address 046 LuvAo,:E Kcit MA Cenl-rvtdk',jt4 Assessor's Map/Parcel: 1`411 U%-L Engineer's Name j,�„ ��p,�i NEW CONSTRUCTION REPAIR Telephone# S�%^ a.'j Land Use Sih (e (---ily f CeLc�¢,��l .I Slopes 9'0) Z- S `�---� P ( Surface Stones Distances from: Open Water Body' 7 IGU ft Possible Wet Area >/d o ft Drinking Water Well t SO ft Drainage Way 10 0 ft Property Line 7 10 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) see zt�ai-.d SJc Pton ey C(tj5ineerd„n yVIC. dated Fero. 81 2008 , f Parent material(geologic) Otsttva5�rt Depth to Bedrock i0 693 Depth to Groundwater. Standing Water in Hole: bis Weeping from Pit Face 10 bqs t Estimated Seasonal High Groundwater (t) S DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: ciurcl+cri d\,eru0ho-v% Depth Observed standing in obs.hole: 12 Q in. Depth to Soil mottles: Z in. Depth to weeping from side of obs.hole: n in. Groundwater Adjustment Index Well# Reading Date: - "- Index Well level Adj.factor, ,v� Adj.Groundwater Level,, PERCOLATION TEST Date 2-7-09 Thne L ysAft Observation _ Hole# Time at 9" Depth of Perc 50"b�i Time at 6" Start Pre-soak Time @ I i'y5 flN Time(9"•6") End Pre-soak I I 1 35 A tl Rate MinJlnch 2 Site Suitability Assessment: Site Passed Site Failed: _ Additional Testing Needed(Y/N) AJ Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) 0-2 2-l0 tA LS 1.�i�11 6 --36 31v-5o G-( CS L.S f b�U Loose !;o-(20. c-2 rS Z 7 6/b Low e DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% 0. -z Lcr 2- G-3b S 36-Sb L GS Z ��tl�b Z- sp_(ZQ L�2 NS Z:�Y"A0 LVcS4 DEEP OBSERVATION HOLE LOG Hole# Depth from . Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, 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? l e5 __ If not,what is the depth of naturally occurring pervious material? Certification I certify that on �0-L�" 9 (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 Q:\SEPTICVERCFORM.DOC 0 CO `s m J C3 Postage $ fU Certified Fee Return Receipt Fee. (Y `W P Her � (Endorsement Requstmar ired) / Her 45 Restricted Delivery Fee US p (Endorsement Required) to Total Postage&Fees fl.l �p Sent To _ _ - o `� Elizabeth Pereira S 'WAY sneer,Apt No.; 636 Lumbert Mill Road h or PO Box No. ----------- ------- Centerville,MA 02632 City,Stare,ziP+a --- _- -_ -� -— ---— Certified,Mail Provides: l a A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Importanl Reminders: a Certified Mail may ONLY be combined with First-Class Maile or Priority Mails n Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee a`Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage,to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. s For an additional fee, delivery may be,restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ® If a postmark on the Certified Mail receipt is desired,pplease present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.,Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 r °FVE r ti Town of Barnstable Regulatory Services Barnstable BARNSrABLE, = Thomas F. Geiler, Director AtAmad=Ciry 9� 1639. ' Public Health Division plF°'"AAA Thomas McKean,Director 2007 f 200 Main Street Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 15,2008 CERTIFIED MAIL— + 7006 2150 0002 1038 6 810 RETURN RECEIPT REQUESTED Elizabeth Pereira 636 Lumbert Mill Road Centerville,Massachusetts 02632 NOTICE OF VIOLATIONS OF BARNSTABLE CODE CHAPTER 360 ARTICLE VII &360-16, ARTICLE 14 353-9. VIOLATION OF 105 CMR 410.354 STATE SANITARY CODE The property owned by you located at 636 Lumbert Mill Road, Centerville, was inspected on February 7, 2008 by Donna Miorandi, RS Health Inspector for the Town of Barnstable, because of a complaint. The following violations were observed: 4360-16. Town of Barnstable Code: The septic system is in hydraulic failure. Raw sewage was observed at ground level. 1) You are directed to hire a licensed septage hauler to pump the overflowing septic system within twenty-four(24)hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary(daily, if need be)to keep it from overflowing onto the ground. 3) You are further directed to contact and hire a professional engineer to design a septic system which meets local and state regulation requirements within twenty one (21) days of receipt of this letter in order to repair this system or connect to town sewer. 4) The newly installed septic system shall be completed on or before sixty (60) days from receipt of this letter. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the dateJthe_order is served. Non-compliance may result in the issuance of a$200.00 non-criminal ticket citation. PER ORDER OF T E BOARD OF HEALTH omas A. McKean Director of Public Health q:\septic\failedsystem6361umbertmillyd.2007.pereira.doc , Barnstable Assessing Search Results Pagel of 3 Home: Departments:Assessors Division: Property Assessment Search Results New Search P � w New Interactive Maps » v�s K Owner: 2008 Assessed Values: PEREIRA, ELIZABETH 636 LUMBERT MILL ROAD Appraised Value Assessed Value Map/Parcel/Parcel Extension Building Value: $ 159,500 $ 159,500 147 /082/ Extra Features: $ 11,300 $ 11,300 Outbuildings: $0 $0 Mailing Address Land Value: $ 149,900 $ 149,900 PEREIRA, ELIZABETH Totals $320,700 $320,700 PO BOX 1685 Residential Exemption Received=$105,082 HYANNIS, MA.02601 2008 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Community Preservation Act Tax $42.56 Fire District Rates Town Barnstable FD-All Classes $2.04 $6.58 C.O.M.M. -All Classes $1.03 Commei C.O.M.M. FD Tax(Residential) $330.32 Cotuit FD-All Classes $1.03 $5.80 Hyannis-Residential $1.53 Persona Town Tax(Residential) $ 1,418.77 Hyannis-Commercial $2.35 $5.80 Hyannis-Personal $2.35 Other R; W Barnstable-Residential $1.86 Commur W Barnstable-Commercial $1.86 W Barnstable-Personal $1.86 Total: $ 1,791.65 Construction Details Building r� eCroperrt detch & ASBUILT Building value $ 159,500 Interior Floors Hardwood Style Cape Cod Interior Walls Drywall Model Residential Heat Fuel Gas Grade Average Heat Type Hot Air Stories 1 1/2 Stories AC Type None http://www.town.bamstable.ma.us/assessing/assess/displayparcelO8map.asp?mappar=1470... 2/14/2008 Barnstable Assessing Search Results Page 2 of 3 Exterior Walls Wood Shingle Bedrooms 4 Bedrooms Roof Structure Gable/Hip Bathrooms 3 Full Roof Cover Asph/F GIs/Cmp living area 1438 Replacement Cost $179169 Year Built 1983 Depreciation 11 Total Rooms 6 Rooms Land3 3r CODE 1010 IT 3 Lot Size(Acres) 0.4 � � 7. W%' »' Appraised Value $ 149,900 AsBuilt Card N/A Assessed Value $ 149,900 " -View Interactive Maps > Sales History: Owner: Sale Date Book/Page: Sale Price: PEREIRA, ELIZABETH Jun 16 2004 12:OOAM C173378 $347,750 CASS, RONALD I & ROSE-MARIE Nov 15 1995 12:OOAM C138975 $ 125,000 RADCLIFFE,THOMAS A& Mar 15 1992 12:OOAM C125921 $ 117,000 COUGHLIN, CAROL E TRS Oct 15 1990 12:OOAM C121735 $ 100 COUGHLIN,CAROL E Jun 15 1990 12:OOAM C120677 $ 100 MORGAN,JOHN S JR TRS Oct 15 1989 12:OOAM C118725 $ 1 COUGHLIN, CAROL E Oct 15 1986 12:OOAM C108204 $ 149,900 ROMEISER, DAVID E May 15 1983 12:OOAM C91886 $ 14,500 BAYSIDE BUILDING May 15 1983 12:OOAM C91737 $ 13,000 Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL2 Fireplace 1 $2,700 $2,700 BFA Bsmt Fin-Aver 642 $8,600 $8,600 Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area UST Utility Area (Unfinished) (Finished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story (Unfinished) http://www.town.bamstable.ma.us/assessing/assess/displayparcelO8map.asp?mappar=1470... 2/14/2008 Barnstable Assessing Search Results Page 3 of 3 FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story (Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/assessing/assess/displayparcel08map.asp?mappar=1470... 2/14/2008 -- • (r' pP TOWN OF BARN`STABL ,CATION b W J-oo tsA �"� L� SEWAGE# O Q VILLAGE�._}tl��!'� �� ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY QXI S4 /®0 0 LEACHING FACILITY:(type) E��1 (,ao U oW (size) /6 l� X \T tti.�fS NO.OF BEDROOMS �"^ /� OWNER � / PERMIT DATE: � S /0 COMPLIANCE DATE: ! Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S� ��t,' Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) ls,6 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) //� Feet FURNISHED BY —� r A*0 eQPT s 3 X H +ro w row A ko t s 3 7 a A Ao .3 D R*0 0 C3®X No. ©� 7 Fee v _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Migpogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(�Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. u I./S I` (a Owner's Name,Address and Tel.No. Assessor's Map/Parcel j �. `�I 6"F g� (Sol, 1�� 1 o00 Ohl RoSCmbv r (-aw Installer's Name,Address,and Tel.No..J O q-S t{�} -3�5 l Designer's Name,Address and Tel.No. Kali�✓2, ( 13 ,ij 4 Fo GUS' J:3,0 , I Ll 9 u O Type of Building: Dwelling No.of Bedrooms q Lot Size sq.ft. Garbage Grinder( ) Other Type of Building !!Utl d A No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow `��(� gallons per day. Calculated daily flow�4 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank %o 0oXaAP Type of S.A.S. Le-a c t Ij 311 Description of Soil 5-�- Nature of Repairs or Alterations(Answer when applicable) Date last inspected: 1*kAP- ),117 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 issu y this Bo f He . Sig ed Date 6'0 Application Approved by Date Application Disapproved for the following reasons Permit No. `f ^ �S Date Issued a� �No."-��G / t O� 5 Fee So ' l "THE COMMONWEALTH OF MASSACHUSETTS t """' Pered in computer: Yes ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppfication for Migponl *pgtem Cowaruction Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 43 u w4 .0 r-rS rl t TIN Owner's Name,Address and Tel.No. Rom and Rose/nal r Casc Assessor's Map/Parcel {`�"� �-61 ),� �i�l 11� Installer's Name,Addre s,and Tel.No. SO q-S�� -3q5 1 Designer's Name,Address and Tel.No. r, ar�v`Gtls t,vx rt+ a f,M o 1111 o-A s-7'1 Type of Building: �! Dwelling No.of Bedrooms q Lot Size sq.ft. Garbage Grinder( ) Other Type of Building IV o o No.of Persons Showers( ) Cafeteria( ) :,—Other Fixtures Design Flow 1 gallons per day. Calculated daily flow 41 Ll 6 gallons. Plan Date - Number of sheets Revision Date Title Size of Septic Tank 000 a t Type of S.A.S. I-C a ch 'A O X .3(f Description of Soil t Nature of Repairs or Alterations(Answer when applicable) Date last inspected: aL r Agreement: ��. i / 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 be 1%11�b�hisoaAUIf la, h. A Sig ed Date r Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued i. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY, that tbe On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by h/1,Q i) ti rN l�v 1, at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. U 0 V ' 57 dated -S!;Z Its Installer Designer The issuance o, is ptrmit shall not be construed as a guarantee that the systemw� ill�nction as de i ed. Date bl 1 U 0 Li. Inspector vf ———————— ———————— ——————— ——————————— No.� / �� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogal *pgtem ConMruction Permit Permission is hereby gr n ed to C airo pnstruct( ) ep ( Up r de bando System located at `-'''''� � �r � �� ,F 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 conditions. Provided:Cons `ction ust be completed within three years of the date of this e t. Date:_ �l/ "y Approved-by. TOWN OF BARNSTABLE 1 Q)CATION �� (f i 61 SEWAGE VILLAGE i ��kQ tN-\*ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. dQ - F SEPTIC TANK CAPACITY /0-40 C:5 I �''rs? I (size C) Z 6 � LEACHING FACILITY: (type) , ) �� NO.OF BEDROOMS BUILDER OR OWNER Ra k Cass PERMITDATE: t1a 146e1 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 fe of leachin facility) Feet y Furnished b 11 ; s3 i TOWN OF BARNSTABLE LOCATION , Z9 , _Y ° , SEWAGE # d l' ,25 VII..LAGE x _ ASSESSOR'S MAP-&LOT � INSTALLER'S.NAME&PHONE NO. 2l ►'�`� ��=-�'—��`" SEPTIC TANK CAPACITY LEACHING FACILITY.: (type) (size). -)( an NO.OF BEDROOMS u BUILDER OR OWNER�rt C. ��� ' PERMIT DATE: M� '�.a� COMPL•IANCE DATE: 0�, Separation Distance Between the: Feet Maximum'Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist facility) Feet on site or within 200(get of leaching Edge of Wetland and Leaching Facility(If any wetlpds exist Feet within 300 f of leachin�facili ) Furnished by 30 Town of Barnstable DEtNE ram, Regulatory Services Thomas F. Geiler,Director * BARNSfABLE, 9� MASS. Public Health Division p'FD '� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: �j X Designer: �'�7,f c�(/2 ✓�= n� Installer:- 4 kL t' ��l J a 'f- / /lt- � Address: %'11Y 7 29 Address: PEA lie ( �{ AO e2 On 6 114 �U L was issued a permit to install a (date) ins a ler) septic system at L6/-j lft r based on a design drawn by /v & r�V�`✓ i dated (designer) zl S ✓I certify that the septic system referenced above was installed substantially according to ,/'T the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. H OF htgss-9°\� EDWARDA. oy� (Insta ler's Signature STONE Cn No.289 Zes igne�'s Cagn% ` 0.`e � (Af ix Desi e tamp Here) PLEASE RETURN TO BARN) STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Z DEPARTMENT OF ENVIRONMENTAL PROTECTION w � + d M A TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Ap 4� Property Address: 636 LUMBERT MILL ROAD CENTERVILLE,MA 02632 DUVICEL , Owner's Name: CASS C7 Z M Owner's Address: 636 LUMBERT MILL ROAD CENTERVILLE,MA 02632 Date of Inspection: 4/7/04 ry Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS ;F Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 ( 1 i Telephone Number: 508-564-6813 FAX 508-564-7270 cn CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the informat on repoKO bel�w is true,accurate and complete as of the time of the inspection. The inspection was performed based on my raining rfr"id M experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP app oved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _ Passes _ Conditionall sses _ Needs Furt Evaluation by the Local Approving Authority X Fails // Inspector's Signature: l� Date: 4/7/04 The system inspector shall submit.aIn. opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspectiIfthe system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shaIf the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM FAILED TITLE V INSPECTION.THE LEACH PIT WAS PONDING AT THE TIME OF THE INSPECTION- THE PIT HAS NO EFFECTIVE LEACHING LEFT AND IS IN HYDRAULIC FAILURE. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title '; IncnP.rtinn Fnrm 6/1 S/,)nn 1 1 Page,2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 636 LUMBERT MILL ROAD CENTERVILLE,MA 02632 Owner: CASS Date of Inspection: 4/7/04 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 FAILED TITLE V INSPECTION.THE LEACH PIT WAS PONDING AT THE TIME OF THE INSPECTION-THE PIT HAS NO EFFECTIVE LEACHING LEFT AND IS IN HYDRAULIC FAILURE. B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a 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: n/a n/a 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: n/a n/a 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: n/a Page-3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 636 LUMBERT MILL ROAD CENTERVILLE,MA 02632 Owner: CASS Date of Inspection: 4/7/04 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ 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 n/a "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: n/a Page'4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 636 LUMBERT MILL ROAD CENTERVILLE,MA 02632 Owner: CASS Date of Inspection: 4/7/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped SYSTEM WAS PLUMPED SUMMER 2003. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed 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 (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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. a Page's of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 636 LUMBERT MILL ROAD CENTERVILLE,MA 02632 Owner: CASS Date of Inspection: 4/7/04 Check if the following have been done.You must indicate"yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection '? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site X _ 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? X _ 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: Yes no X _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] S Page'6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 636 LUMBERT MILL ROAD CENTERVILLE,MA 02632 Owner: CASS Date of Inspection: 4/7/04 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 4 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)).-O 3 •— �j(�U Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: SYSTEM WAS PUMPED SUMMER 2003 Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/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): n/a Approximate age of all components,date installed(if known)and source of information: 1983 PER OWNER Were sewage odors detected when arriving at the site(yes or no): NO F Page 7 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 636 LUMBERT MILL ROAD CENTERVILLE,MA 02632 Owner: CASS Date of Inspection: 4/7/04 BUILDING SEWER(locate on site plan) Depth below grade:30" Materials of construction:_cast iron =40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade:24" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6" H 5' 7" W 4' 10"" Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle: n/a Scum thickness: I" 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: n/a How were dimensions determined: 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.): SEPTIC TANK AND ALL SETPIC TANK COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a 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/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 f Page-8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 636 LUMBERT MILL ROAD CENTERVILLE,MA 02632 Owner: CASS Date of Inspection: 4/7/04 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): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): UNDETERMINED DUE TO LIQUID LEVEL IN LEACH PIT. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 636 LUMBERT MILL ROAD CENTERVILLE,MA 02632 Owner: CASS Date of Inspection: 4/7/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type PIT leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: nla n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): LIQUID LEVEL IS UP IN RISERS. SAS WAS PONDING-THE PIT HAS NO EFFECTIVE LEACHING LEFT AND IS IN HYDRAULIC FAILURE. 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 or no): NO 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 4 f 'Page'10 pf I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 636 LUMBE.RT MILL ROAD CENTERVILLE,MA 02632 Owner: CASS Date of Inspection: 4/7/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. �S v G I AA � 1yy � 35 1n A � NO CATION ii S E AGE PERMIT NO Y I l�l A G t I N S T L. ,, EA'S NAME ADDRESS d U I L 0 E R �OR6 OWNER r MATE PERMIT ISSUE DATE COIMPLIANCE ISSUED r t V` ' 'Page-�I Pf 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 636 LUMBERT MILL ROAD CENTERVILLE,MA 02632 Owner: CASS Date of Inspection: 4/7/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12 feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-1f checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12 FT. 11 '.-/ FIRST RST 2 ' TO INSPECTION 9" MINIMUM COVER ACCESS COVER MUST 36' MAXIMUM COVER INVERT EL E VA T I ONS DES i GN CR I TER 14 BE BE TO FINISH GRADE / LEVEL 7 PORT �M1N 2" OF DESIGN FLOW: ACCESS COVERS MUST BE WITHIN 4'vE:vr r PEASTONE OR INVERT OUT PUMP CHAMBER: 28• 1 4 BEDROOMS AT Il0 G. P.D. PER \� 6' OF FINISH GRAD TEE / l FILTER FABRIC 3/4 " 1/2' L'lA. ' IB' ,�rN INVERT IN DIST. BOX 33. 27 BEDROOM EQUALS 440 G. P.D. 7D 2x --�,� DOUBLE WASHED STONE INVERT OUT DIST. BOX: 33. 11 _ INVERT /N LEACH CHAMBER: 33. 03 NO GARBAGE GRINDER L RT ' i 33.27 T/D 32. 2 5 VAPOR40 LBAPRI ER BOTTOM LEACH CHAMBER: 32.2 SEPTIC TANK REQUIRED R`` �g�1 _ 2' SCH 40 PVC 0 33. I Eft. LOCUS 6 ^ o _;3. 03 6 HIGH CAPACI TY INFILTRATOR � 131 6 ADJUSTED GROUND WATER: 27.2 EL 440 G. P.D. X 200x - 880 GAL . / GAS I CHAMBERS W/3. 5 'S STONE AROUND OBSERVED GROUND WATER: 22.5 SEPTIC TANK PROVIDED: /000 GAL EXISTING \� BAFFLE 3 OUTLET 10 •„ X 50 '1 X I O'd BOTTOM TOM OF TEST HOLE s J : 22. 5 i D BOX INDEX WELL SOW 253. ZONE C ( �`'� L ' SOIL ABSORPTION SYSTEM REQUIRED: \ I \ EXISTING EXISTING oesERVEO FEB 08 READI!`JG-49. 3 ' , ADJ-4 7' DESIGN PERC RATE ( 5 MIN/INCH \ - GROUNDWATER. EL-21.S 1000 GALLON PUMP CHAMBER SOIL TEXTURAL CLASS - l SEPTIC TANK \ EFFLUENT LOADING RATE - 0. 74 GPD/SF 440 GPD / 0. 74 GPD/SF - 595 S.F. REQUIRED LOCUS MAP PROF l L E : Nor ro scA�E PROVIDED: 6 HIGH CAPACITY INFILTRATOR CHAMBERS W/3.5 '' STONE AROUND. A-600 S 600 S.F. x 0. 74 - 444 GPD GENERAL NOTES .- N SOIL TEST PIT DA TA s I . THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION OF THE SEWAGE DISPOSAL SYSTEM ONLY s sb.o /ND I CA TES 17_ I ND I CA TES i� PERCOLATION = OBSERVED TEST GROUNDWATER 2 VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS - SET. SEE SITE PLAN. i,� TP s1 Ps/2113 TP +2 SOIL REMOVAL LOT 2 �p 3. ALL CONSTRUCTION METHODS AND MATERIALS AND SEE NOTE lo. ` HOR I ZON TEXTURE COLOR HORIZON TEXTURE COLOR 37. 3 MAINTENANCE OF THE SEPTIC SYSTEM SHALL 1 7. 250' S. F. O 37. 3 O" CONFORM TO MASS. D.E. P. TITLE 5 AND LOCAL A LOAMY A LOAMY IOYR OO , � 10 WILL POLY SAND 2/122 SAND 2/2 BOARD OF HEALTH REGULATIONS. h� VAPOR BARRIER 8' 36. 6 6" 36. 8 p L OAMY 10 YR p L OAMY IOYR 4 ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER ` D SAND 4/6 L7 SAND 4/6 AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 0 F+ 36 ' 34. 3 24' 35 3 THAN 3 ' IN DEPTH SHALL BE CAPABLE OF WITH- VENT \ ExrsrrNc ro�r� \ C / MED I UM IOYR C / MED I UM IOYR STANDING H-20 WHEEL LOADS. PUMP CHAMBER 'A's SAND 7/4 SAND 7/4 A) S.5 0 ALL SEWER PIPE SHALL BE SCHEDULE 40 OR D Box 6 HIGH CAPACITY �o APPROVED EQUAL INFILTRATOR CHAMBERS EXISTING W13.5't STONE AROUND ' SEPTIC TANK 54 /O 6. SEPTIC TANK. PUMP CHAMBER AND D-BOX SHALL BE c4 REINFORCED PRECAST CONCRETE. WATERTIGHT AND c �� WATERPROOF. D-BOX SHALL BE WATER TESTED TO i CHECK FOR LEVEL WHEN THERE IS MORE THAN ONE , �; NO WATER OUTLET. o9oo'tic j a A F�' 178- _ 22. 5 /62' 23. 8 0 BEFORE CONSTRUCTION CALL D/G-SAFE'. 117 yo+F��9 a� B _ � DATE: FEBRUARY 21 . 2008 I-888-DIG-SAFE AND THE LOCAL WATER DEPT. ' / TEST BY STEPHEN HAAS FOR LOCATION OF UNDERGROUND UTILITIES. WITNESSED BY: DONNA M 1 ORAND I o o E0 PERC RATE: C 2 MI N/I NCH :3 SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE Qp,� WALK ` `\\ gip' • ___^-V- / VARIANCES REQUIRED DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE BM, CORNER STEP �`� f TITLE 5. MAXIMUM FEASIBLE COMPLIANCE CONSTRUCTION INSPECTIONS. / EL 38.56 -4 ] 3 A. r 116' WHITE PI $ Hi NE SECTION 15.21I : (1) MINIMUM SETBACK DISTANCES r j 10 ' IS REQUIRED BETWEEN THE SAS AND A SLAB. 6 ' IS PROVIDED. 35,[�jp. 9. EXISTING SAS TO BE ABANDONED. 36� .35 7 A 4 ' VARIANCE IS REQUESTED, 10 ALL UNSUITABLE MATERIAL (A 6 B HORIZONS) `;44 '1'� \ �F -A t �~ ENCOUNTERED BELOW THE INVERT OF THE LEACHING 6° / ��. YD'nwr rE PINE ` / FACILITY TO BE REMOVED FOR A DISTANCE OF 5 ' AROUND AND REPLACED WITH SAND /N ACCORDANCE WITH TITLE 5. pis TNI �~' tip/ P 7- C S STEM - S G/V TP*2 � I /� �� 636 L- UMBER T � / L LRO4O . ",4 P / -4 PARCEL 82 \ .l' � 37.z S A R /V S TA S L E' . "A . ( CE/VTERV / LLE % LEGEND L EGEND ro << EL R A ■ CB CONCRETE BOUND \ -W- WATER L /NE SC,4L E / 20 "ARC/-1 4 2008 O HYDRANT -G GAS LINE EAGL E SUFRVE `r 1 NG I NC OHW- OVER HEAD WIRES i4 LIGHT POST 923 Ro u t e 6A Yarmouthport MA 02675 -E- UNDERGROUND ELECTRIC L I Nf / / � 5 0 8 3 6 2 -8 -1 3 2 -T- UNDERGROUND TELEPHONE LINE ��!� I / l� ( 508 432-5333 -CTV- UNDERGROUND CABLEVISION LINE + 40 4 SPOT ELEVATION -40 EXISTING CONTOUR REVISED: MARCH 17. 2008 40i PROPOSED CONTOUR ExrsTl - WELc 0 IO 20 40 JOB NO : 08-0 13 F/EL D: CFW/EEK CAL C: SAH/CFW CHECK: CFW DRN: SAH I i STANDAI ' D MOTES PROPOSE, LE'ACHIN FA CILITY 1) THIS PLAN IS FOR THE OF A SEPTIC SY,"TEM. y` l) 4 t INS7`AGCA7/o14 PROC6IDURE S" AAJf kyq rZt& S)1Atl Co11f1=�RM TO 310 C'MR 5 Sb /3= 22 E x k 15(,�'J0, THL' STATE ENVIRONMENTAL CODE; --- TITLE 5, AND THE TOWN OF AF . J _ SUBSURFACE DISPOSAL REGULATIONS. r� - -- t S.00' 3) NO DETERMINATION FIRS BLZ'It MADE AS TO COMPLIANCE OF A VAILABLE PROPERTY INFORMATION WITH RECORDAD DEF,D.S Q w� Fir OR ZONING REGULATIONS. 4) TOWN WATER DOTS MW SERVICE THIS PRoO,y- T FKq I p 5-4 S 7_N4"& ARE NO EXISTING WELLS WITHIN 200' OF THE PROPOSED SOIL ABSORPTION SYSTEM �° � 6) ALL COVERS OF SYSTEM COMPONENT,' Sl1A U 8* 9R v t/G/-!7 I v Wir✓i "A" lv v I=�iN/4PED GRADE Jt7N Ct U "1 / `�._ ,$'7 /►°�� Ix��/�9ff' /d f os Pro e 7) ALL SYSTEM COMPONENTS SHALL REMAIN ACCESSIBLE FOR I11'SPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTLY p ' r x - � �P�/ '-'" � ���' UPON OR ABOVE THE COMPONENT ACCESS LOCATIO2US rYfJ_Cif WOULD D BOX 0 _ —+t -� - - �, /fi4VJ7"" LD INTERFERE #7 THE PERFORMANCE, ACCESS, INSPECTION „ t,`1 !` I � PUMPING OR REPAIR \t� ' 8) NO DRIVEWAY, PARKING OR TURNING AREA, OR OTHER IMPEL'VID US AREA SHALL BE LOCATED ABOVE A SOIL ABSORPTION y /'�YD/�d5 E' (� �. IT 1� lL 7 b p� L J L� % ��_¢�.7 _ SYSTEM, EXCEPT WHEN VENTING HAS BEEN PROVIDED. - 9) SEPTIC TANKS, GREASE TRAPS, DOSING CHAMBERS AND DISTRIBUTION BOXES SHALL BE PLACED ON A 6'" STONE BASE _. EX1Stln�' .F? ►' Exist Pit to be pumped/filled and TO ENSURE STABILITY AND PREVENT SETTLING. remove as required 10) OUTLET DISTRIBUTION LINES SHALL REMAIN LEVEL FOR A MIVIMUM OF THE FIRST TWO FEET OF THEIR LENGTH. Septic Tank - wA: Q 't, Apwrox. Y P � Test'Pit �r 11) ALL SYSTEM COMPONENTS SHALL BE CAPABLE OF WITHSTANDING H--10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' - ,f _ _ Location ,� OF DRIVEWAYS OR PARKING OR TURNING AREAS, IN WHICH CASE H-00 COMPONENTS SHALt, BE USED. II Deck Vag N _2) ALL BUILDING SEWER LINES SHALL HA VE AN IN DIAMETER OF 4" AND SHALL BE CAST-IRON— OR SCHEDULE 40 PVC. CP - 13) THE DEPTH OF THE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36" UNLESS VENTING HAS BEEN P RO VIDEO. I cv� I 14) IN THE AREAS OF EXCAVATION, EXISTING GRADES SII-1I,L BI' REESTABLISIII'M UNLESS _NOTED AS PROPOSED CONTOURS. I Bd CJ"c>I 6>, �� �{ x 15) IF SOILS ARE ENCOU '' r NIERED DURING TKE' LVC41%ATION OF JHF, ,SOIL, ABSORP770N SUT01 itNAT DJ1PE'R NOTABLY FROM 2 Gar 1 I 4 Bed 1�.� `Y� �— I THE DEEP OBSERVATION HOLE LOG, CONTACT THE ENGINEER BEFORE PROCEEDING. Gar ��. 16) CONTRACTOR TO VERIFY LOCATION OF ALL UNDERGROUND UTILITIES: r V I I ` IN- Exist I - - ------ D W Exist �i� / I " Gas DESIGNDEEP OBSERVATION HOLE LOG + I EWxisting I -- ----- Test Hole #f I Water Line !� (EL I Number of Bedrooms: _eo Sell soil I 1 ! I (idy I � ) Horizon Tezture Color (� Garbage Grinder: NO (USDA) (Bunsen) Design Flow: /1 yv (� -/ 2 ��5,� 14 (,oA1�_-�ax /oY,c *z (110 Gal/BR/Day x Number of BR) I - Septic Tank: Ex! -5-rtitr,y i, rA7 ►w 1,3 i r l"1{ 1.r �nJC "Y1 " � Design 7t.1 11Ao1 / 3Z ' Minimum = Desi n Flow x 20 IMF_ riq,1�� Leachin Area: .' Deep Obr Ilole Da S 7 Soil Evaluator. 5`0^� Witnessed L 8ai1 Surrey �eeori L uM ,be t Mill Rba ��' �' Pero Rn1a �- 2, n/�1/v�rl� S Z _ ►1� ! Geologic Materiel• OUTNASP N _.? ITepth to Standing Water. ZA - s 4 Depth to Weeping Water. 1- ��/ � t}-nm: . , f Depth to Hottling(Color):l Fat Seasonal A1gh GA: •� '< ;=,+ .c •'�L�^ .5r T Ft _��) -, USGS observation well <, : �S 3 zo�+G e-" r� � ►� �►� ---- ) =fir �1 Date of ast Measurement: r ( r„rlrx yD,2' �>� ` Q �A•I v i Commems: o Term Acceptance Rate (LTAR): 0. 74 ng Area Design Ca act M �t���ra) z Y ' LTAR (t 4�A45 _ 5 �► 5 t!- ran ) 17i` P ,' P20J&CT.LOCATION 6 36, LAM J�e_�r M111 �d FOUNDATION ---� Alarm & Con trol Box r'441 , S TOP OF MOUND EL_ 'r/_ /_ TOP OF installed inside Bldg Proposed — VENT W/SCREEN vv� / 5 > � ^ MIN 2 LAYER DOUBLE WASHED \ ASSESSORS MAP 1 9� LOT 8 "Z.- TC EL ¢� See Notes D-Box Vent Required .(� ) Z i��j p 4� .r.� q s Io�TOP EL 1/8'- 1/2' ST❑ � �(1'" -- Exist EXISTING GROUND SURFACE EL ------ 0�t'v��lar4 "� J /p - �iF T� - rx 4.0.'Z ~ A11)a / TEE -- - CONC W STONE BASE APPLICANT. — — - '° `--6' MIN 6. MI TI7 �i +:) �q p B(]� }`a ��y�� M�,1 EFFECTIVE . SURE PLPG �iL� i�/b0 O SIDEWALL !c> l�ljSE MPt� STONE BASE r. T LIQUID LEVEL TO DRAIN R G ✓a%' LV�'I6e 1^T� - - — 34•� PE Ct1ANB In1VEaT EL 2 ! -Sln PUMPING � 3/41- 1 1/2' DOUBLE . /� / / ��Arf epw 11l E i MA z.co 3 z INVERT EL ,0• / CH WEEP HOLE VALVE ALARM ❑N LEVEL - �', , C f WASHED STONE � GAS BAFFLE AT OUTLET �.,�. BOTTOM EL �r J r f r � 14 � INVERT ELL .. 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