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HomeMy WebLinkAbout0469 MAIN STREET (CENT.) - Health (2) 469 Main St - 208-085-002 Centerville r t 1 floe 4210 1/3 ORA o 1n�01 o -4 r { q �i i d /9 IOCATION F SEWAGE PERMIT .NO. �', — l T VILLAGE I N S T A LLER'S NAME i ADDRESS ' t U I L 0 E R OR OWNER LLB at , DATE PERMIT ISSUED 1�2- 13 _ ?5'3 � DA T E COMPLIANCE ISSUED � ?/ _�::. /� �� �D /� . a' � 5 _.�.. �y . LOCATION SEWAGE PERMIT NO. 12 VILLAGE INSTA LLER'S NAME i AD-DRESS BUILDER OR OWNER DATE PERMIT ISSUED D-ATE COMPLIANCE ISSUED -1� � w�3• JT�d Arc fj,.tov��p - - w/re p..,•T/, u�r��•-r ems. L O C A T ION 17';rc `'`�"" SEWAGE PERMIT M0 VILLAGE Gov/GC.c I N S T A LLER'S NAME i ADDRESS i lil L D-E R OR OWNER D ATE PERM 1.T ISSUED DATE COM-PLIANCE ISSUED ��,` L li A Commonwealth of Massachusetts' Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 469 Main Stree, Centerville, MA Property Address. Morris H and Susan J Ford Owner Owner's Name 1jj �_ information a Centerville ✓ MA. 02632: 08/20/2018 required for every page. Cltyrrown State Zip Code Date of Inspection r { 1U Inspection results must be submitted on this form.Inspection formsy manot be altered man way.Please see completeness checklist at the end of the form.. Y Important:When A. Inspector Information 6/4 13-Z9 9 filling out forms on the computer, REID C,_ELLIS use only the tab key to move your Name of Inspector cursor-do not ELLIS BROTHERS CONSTRUCTION use the return key, Company Name 23 ENTERPRISE ROAD rib Company Address YARMOUTH PORT MA 02675 C" Irown dy State Zip Code 508-362-6237 S121891 Telephone Number license Number. B. Certification I certify that I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000) I 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 mainte nce of on-site Sewage disposal systems.After conducting:this inspection) have determined that 7- P tem: 1: sses 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Z_;,,� ,_,�r &�- 1 �� � �6� .�.� Ins or's ignature 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. 15insp.doc•rev.7/26=8 Title 5 Official Inspection Form,Subsurface Sewage Disposal System'•Page 1 of 16 �v pa Commonwealth of Massachusetts a - l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 469 Main Stree, Centerville, MA Property Address Morris H and Susan J Ford Owner Owner's Name information is required for every Centerville MA 02632 08/20/2018 page. CityFrown 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 foun enyrmation which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are. indicated below. Comments.- 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, u on completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not deb rmined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 yeE rs old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration r exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replacec with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspectior if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is lei s than 20 years old is available. ❑ Y ❑ N ❑ ND(Ex lain below): t5insp.doc-rev.7/262018 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 469 Main Stree Centerville , MA Property Address Morris H and Susan J Ford Owner Owners Name information is required for every Centerville MA 02632 08/20/2018 page_ City/Town state Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operatio al. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break ou or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a I roken, settled or uneven distribution box. System will pass inspection if(with approval of Board o Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replac d ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 imes a year due to broken or obstructed pipe(s). The system will pass inspection if(with approva 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 Bo rd�&Health: ❑ Conditions exist which require further eva uation by the Board of Health in order to determine if the system is failing to protect public heal h, safety or the environment. a. System will pass unless Board of H alth determines in accordance with 310 CMR 15.303(1)(b)that the system is not fun inning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 - Too 5 Official inspection Forth:Subsurface Sewage Disposal System•Page 3 of 18 ti Commonwealth of Massachusetts r_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .•L 469 Main Stree, Centerville, MA Property Address Morris H and Susan J Ford Owner Owner's Name information is required for every Centerville MA 02632 08/20/2018 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 feeielt f dering vegetated wetland or a salt marsh b. System will fail unless the Board ofah (and Public Water Supplier, if any) determines that the system is functionin in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil a sorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributa to a surface water supply. ❑ The system has a septic tank and SAS nd the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS nd the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS nd 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 prese ice of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other fail ire 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.M 2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t (� 469 Main Stree, Centerville, MA Property Address Morris H and Susan J Ford Owner Owner's Name information is required for every Centerville MA 02632 08/20/2018 page. City(rown 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 thhe f lure. -6) 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 gpi 1. For large systems, you must indicate eith r"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 00 feet of a surface drinking water supply ❑ ❑ the system is within ZOO feet of a tributary to a surface drinking water supply ❑ ❑ the system is locateil in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a apped Zone II of a public water supply well t5insp.doc•rev.726/2018 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 469 Main Stree, Centerville, MA Property Address Morris H and Susan J Ford Owner Owners Name information is required for every Centerville MA 02632 08/20/2018 page. Citylrown 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 NIA) ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? AI ❑ Were all system components, cluding 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.7262018 Title 5 official Inspection Form:Subsurface Sewage Disposal system-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 469 Main Stree, Centerville, MA Property Address Morris H and Susan J Ford Owner Owner's Name information is required for every Centerville MA 02632 08/20/2018 page. Cityrrown state Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: ` Number of bedrooms(design). 1W Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: Number of current residents: Does residence have a garbage grinder? ���� � ❑ Yes [! " No Does residence have a water treatment unit? ❑ Yes I/ No If yes, discharges to Is laundry on a separate sewage system?(Include laundry system inspection El Yes L1 No information in this report.) Laundry system inspected? ❑ Yes VNo, Seasonaluse? ❑ Yes ;r/No Water meter readings, if available(last 2 years usage(gpd)))- Detail:�54rt ., !7�� A& J5 Sump pump? ❑ Yes No Last date of occupancy: �/`�� J _1-^1 7911Z';�P 1�P Date t5insp.doc•rev.M612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 469 Main Stree, Centerville, MA Property Address Morris H and Susan J Ford Owner Owner's Name information is required for every Centerville MA 02632 08/20/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: /00 Type of Establishment: Design flow(based on 310 CM 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 sy tem? ❑.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 How was quantity q y pumped determined? Reason for pumping: �� ��✓ t5insp.doc•rev.71 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 469 Main Stree, Centerville, MA Property Address Morris H and Susan J Ford Owner Owner's Name information is Centerville required for every MA 02632 08/20/2018 page. Clty(rown State Zip Code Date of Inspection D. System Information (cont.) 4. Type 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 DE approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: - Were sewage odors detected when arriving at the site? ❑ Yes 7No 5. Building Sewer(locate on site plan): Depth below grade: t�Material of constructi;/40 Elcast-iron PVC ❑ other(explain): Distance from private water supply well or suction line: 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 r� Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ^ 469 Main Stree, Centerville, MA Property Address Morris H and Susan J Ford Owner Owner's Name information is every Centerville required for eve MA 02632 08/20/2018 page. Citylrown State Zip Code Date of Inspection" D. System Information (cont.) 6. Septic Tank(locate on site plan): "/- Depth below grade: d� feet Z iat of construction: ncrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain) � 40" If tank is etal, I' t age: years Is ag confirmed by a Certificate of Compliance?(attach opy of certificateVN o Yes Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top Of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle U How were dimensions determined? ' Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): MiXW X-10 01 ,4/ �l • .r t5nsp.doc•rev.7/26/2018 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 469 Main Stree, Centerville, MA Property Address . Morris H and Susan J Ford Owner Owners Name information is required for every Centerville MA 02632 08/20/2018 page. Cityrrown 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 0 baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and o tlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leak age, etc.): 8. Tight or Holding Tank(tank must be pumped a time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fib rglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/2612018 Title 5 aal Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commolrn"aPtti of Massachusetts 193 Title 5 Official Inspection Form ' Fla Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 469 Main Stree, Centerville, MA Property Address Morris H and Susan J Ford Owner Owner's Name information is required for every Centerville MA 02632 08/20/2018 page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) 8. or Tight Holding Tank g g (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, tc.): *Attach copy of current pumping contract(requir ). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids over, any evidence of leakage into or out of box, etc.): -v4 /1 t5insp.doc•rev.7M/2D18 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form u� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 469 Main Stree, Centerville, MA Property Address Moms H and Susan J Ford Owner Owners Name information is required for every Centerville MA 02632 08/20/2018 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, condit on of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, syste is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: b Type: e ❑ leaching pits number: Vleaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 � 469 Main Stree, Centerville, MA Property Address Morris H and Susan J Ford Owner Owner's Name information is required for every Centerville MA 02632 08/20/2018 page. City/Town 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.): r� .% c a-- ec>4F IV / 0 dr N-;44AAV1-4C-' tD&D _ 12. Cesspo (cesspool must be pumped as pa t 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 hyc raulic 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 Fib 469 Main Stree, Centerville, MA Property Address Moms H and Susan J Ford Owner Owner's Name information is required for every Centerville MA 02632 08/20/2018 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 hydf aulic failure, level of ponding, condition of vegetation, etc.): Q - o r 14) 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 le Subsurface Sewage Disposal System Form-Not for Voluntary Assessments =� 469 Main Stree, Centerville, MA Property Address Morris H and Susan J Ford Owner Owner's Name information is Centerville MA 02632 08/20/2018 required for every page. Citylrown 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 A/ the building. Check one of the boxes below: ❑ hand-sketch in the area below / ❑ drawing attached separately f � . r J I � 2 d ZW 13 99'4 '943 i 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 '^ l Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 469 Main Stree, Centerville, MA Property Address Morris H and Susan J Ford Owner Owner's Name information is required for every Centerville MA 02632 08/20/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam-.. ❑ Check Slope ❑ Surface water /�� ✓ e, ® /� ❑ Check cellar ❑ Shallow wells d Estimated depth to'high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of 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: b You must describe how you established the high ground water elevation: dr Z 97 ar 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 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •' 469 Main Stree, Centerville, MA Property Address Morris H and Susan J Ford Owner Owner's Name information is Centerville MA 02632 08/20/2018 required for every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: 5/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 /J/A'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.7282018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Invoice Capewide Enterprises/JP Macomber _ A Robert B.Our Co.,Inc.Company Date Invoice# 153 Commercial Street Mashpee,MA 02649 8/28/2018 5396 508-477-8877 Bill To Morris&Susan Ford 469 Main Street " Centerville,MA 02632 r Job No. Terms Due on receipt Quantity Description Rate Amount 1 Plumbing Service at 469 Man St 8/25/18 278.80 278.80 Remove garbage disposal and install new basket strainer and p trap Labor and materials Thank you for your business! Please make checks payable to Capewide Enterprises. Total $278.80 Payments/Credits $0.00 Balance Due $278.80 11t+l+U.ullL 1V utltUM SERVICE 9/2/06 . � ldoo top C. ems__ -VIC ,� 71 P01 � ]FORD, MORRIS & SUSAN IJOT #A OR 3 r G-7270-F 469 MA3:N STR=ll � TOWN OF BARNSTABLE CC OCATION �� �� /�f. SEWAGE # d "'vULAGE, ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ✓ '- LEACHING FACILITY: (type)( Y Jd (size) 7—IX'P?ld /Ji NO. OF BEDROOMS C BUILDER OR OWNER v PERMITDATE: COMPLIANCE DATE: UZ 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 ope3ching-1acili Feet Furnished by�� . /1 �- 62 LY rly vv JN t No. ' 02 -a 8; J Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS p. f 2ppfication for Mig;paal bpgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) 2Complete System ❑Individual Components Location dress or Lot No. Owner's Name,Address and Tel.No. Alfo9 Mcun S+ CsLv— �tl�x Assessor's Map/Parcel MC�Q�S SV•�C►lv ��� Installer's Name,Address,an Te.N / Designer's Name,Address and Tel.No. 2 ss--o y�y Qo►� c�<<�� Type of Building: Dwelling No.of Bedrooms Lot Size!hTnNYt:sq.ft. Garbage Grinder M Other Type of Building RP-S. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 3- � y 6,k Description of Soil L� � 2 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been.is tied by is o of He Signed Dat/ Application Approved by Date o J- Application Disapproved for the following reasons Permit No. �UG -Ql8 Date Issued /ZC& '- — ,ram-- .,. ..-..,. � '., .. ,•.}, �;;i 5. _ --» ... r No •�9V( � 919 �1 : a. Fee / / THE COMMONWEALTH ,')fi�AtASSACHUSETTS Entered in computer: Yes n PUBLIC HEALTH DIVISION TOWN OF,BARNSTABLE., MASSACHUSETTS Application for ]igpo9;a1 *p5tem Congtructfon Permit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) 2-complete System ❑Individual Components Location A dress or Lot No. /\ Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,an Tel No � R`� Designer's Name,Address and Tel.No. Type of Building: j7 } Dwelling No.of Bedrooms 5 Lot Size'i� 1�- sq.ft. Garbage Grinder N63 -Other Type of Building -S . No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date' t Number of sheets Revision Date Title Size of Septic Tank 1�SCE Type of S.A.S.3- 9J Gas n, r! Description of Soil, 2 'Nature of Repairs or Alterations(Answer when applicable) NJQl,,_� G n SAS - _j) - � ( 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-Ti le 5 the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been's tied brld" is o d of He -. - Signed Datg/ Application Approved by Date f /joirl 1- Application Disapproved for the following reasons Permit No.�!)G]- 6l Date Issued ,op '- - w-_d 4 THE COMMONWEALTH OF MASSACHUSETTS 1 BARNSTABLE, MASSACHUSETTS Certificate of. Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(�/) Abandoned( )by at 1- cl ,n has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2r CIS dated� 1�/� tv� Installer Designer The issuance o .thfis permit shall not be construed as a guarantee that the syste will functio as designed. Date I()� Inspector ) � i v ---------------------------------------- No. ' Fee led — . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS, , Migpo5al &p.5tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade )Abandon( ) ' System located at -'-I GC) �-4c."A QakN�, Vt 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 compl led wi• i three years of the date of t Us permit. f� ILI Date: 116 12 tid s- [/ Approved by i , I TOWN OF BARNSTABLECL Q LOCATION �� ��_ ��o SEWAGE # ,2,0 o�2 VILLAGE to�� '�''�' (f�Z 4 C ASSESSOR'S MAP &.LOT. ,r INSTALLER'S NAME&PHONE NO. ✓�/ l' c> '�f I`�� � SEPTIC TANK CAPACITY LEACHING FACILITY: (hype)j -/ E p G•�•t/C G `F (dize) i i NO. OF BEDROOMS LS� BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: UZ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet I. Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of hin cili Furnished by I i ro �JY` ,T TROY WILLIAMSeit � L SEPTIC INSPECTIONS R&HIV 19 Certified by MA Department of Environmental Protection%1140999 (508) 385-1500 64 19 Hummel Drive gpy South Dennis, MA 02660 A 4* ti COPY_ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COKE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CECERTIFICATION(J Property Address: /6 7 M L�,►� S>4"�'c t Name of Owner PA j.I,t, Cj VS 7�c 7CS o M C-— t✓ vi f I c Address of owner• yb Date of Inspection: 7/I ��� eLNtriv Ne A4 v , 0Z6 32 Name of Inspector:(Ptease Print) Troy Williams I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) COfT1pany Name: Troy wlliams Ge tp it Inspections Maaing Address: 19 Hummel Drive. So. Dennis, MA 02660 Telephone Number: (508) 385-1300 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: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails n kspector"s Signature: �+� 'jJ, Date: 7 The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)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. NOTES AND COMMENTS Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: 469 Main Street, Centerville,MA Date of Inspection: Phillip Gustafson July 1, 1999 INSPECTION SUMMARY: Check A, B, C, of D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B_ SYSTEM CONDITIONALLY PASSES: A114 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. Indicate 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 complying septic tank as approved by the Board of Health. — 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). 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 f S e d 9/2/98 ,„ : ,r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (contirwed) Prop"Address: 469 Main Street,Centerville,MA Owner; Phillip Gustafson Date of kupection: July 1, 1999 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: tJ11? 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 IN ACCORDANCE WITH 310 CMR 15.303(1)(b)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 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 AND SAFETY AND THE 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 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 r rev ; Page 1 of I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 469 Main Street, Centerville,MA Property address: Phillip Gustafson Owner: July 1, 1999 Date of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the 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. LARGE SYSTEM FAILS: A M 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: 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 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. sc<i 9/2/9 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 469 Main Street,Centerville,MA Owner: Phillip Gustafson Date of kupection: jUly 1, 1999 Check if the following have been done: You must indicate either "Yes' or 'No' as to each of the following: Yes, No Pumping information was provided by the owner, occupant, or Board of Health. l None of the system co P P Y components have been um ed forat least two weeks and-the system has been•receivmg'norrnal 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. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. y[ _ 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: Existing information. For example, 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)1 y - — The facility owner (and occupants,if different from owner) were.provided with information on the.propermaintananca of SubSurface Disposal Systems. revised 9/? '(+}- Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: 469 Main Street, Centerville,MA Dace of Inspe-a : Phillip Gustafson July 1, 1999 FLOW CONDITIONSRESIDENTIAL: Design flow: //0 g,p,d./bedroom. Number of bedrooms(design): 3 Number of bedrooms (actual):Z5 Total DESIGN flow 3?zo — Number of current residents: i5 Garbage grinder(yes or no): Ala Laundry(separate system) (yes or no):No ; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use(yes or no): No Water meter readings,if available(last two year's usage(gpd): �L3 = S0400. 4/y >00 �0/a;�f Sump Pump (yes or no):-A/—D r Last date of occupancy:,, �p�rox a�w COMMERCIAL/INDUSTRIAL: /�I/� Type of establishment: Design flow:_ qpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or nol_ Industrial Waste Holding Tank present:(yes or no)— Non-sanitary waste discharged to the Title 5 system: (yes or no)— Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of Information: System pumped es part of Inspection. (yes or no).ClO If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM _/ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known) and source of information: �y;rAp,p.- X- t58S . Sewage odors detected when arriving at the site: (yes or no) No 2 I'a�r 6 of I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 469 Main Street, Centerville,MA Dace of k spaction: Phillip Gustafson BUILDING SEWER: July 1, 1999 (Locate on site plan) Depth below grade: Material of construction:_cast iron_Z40 PVC_other(explain) Distance from private water supply well or suction line ///,I Diameter t/r, Comments: (condition of joints, venting, evidence of leakage,etc.) A SEPTIC TANK: (locate on site plan) Depth below grade:�8 rr 1,H, ✓-S�� Material of construction:Zconcrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age ls.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: ci Sludge depth: li Distance from top of sludge to bottom of outlet tee or baffle: .2 /AO Scum thickness: o Distance from top of scum to top of outlet tee or baffle: A10 S C-J fti . Distance from bottom of scum to bottom of outlet tee or baffle: NJ S c-- w+ How dimensions were determined: Comments: (recommendation for pumpin ondition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structuroHntegrity, evidence of leakage,etc.)-' .' �,�,,t o a✓;� .0 =Zia... GREASE TRAP: A//,l (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) revised 912/98 I,yg � of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 469 Main Street, Centerville,MA Date of Inspection: Phillip Gustafson July 1, 1999 TIGHT OR HOLDING TANK: N114 (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions: ____...._... ..._._._.. Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes_ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX:y (locate on site plan) Depth of liquid level above outlet invert: J c 1 Comments: (note if level and distribution is equal, evidence.of solids carryover, evidence of leakage into or out of box; etc.) I� / h r11.� PUMP CHAMBER:—&/O (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) revised 9/?/98 P-dgr8ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Ownef: 469 Main Street,Centerville,MA Date of Inspection:Phillip Gustafson July 1, 1999 SOIL ABSORPTION SYSTEM(SAS):, (locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits, number: Ohc X �G�L� �� 7 ('j" n, -2` jtV t , 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 hydraulic f ilure, level of ponding, damp soil, condition of vegetation, etc.) c1, toS ,., . o. t✓ c rs y e G b.Jw41 t o S h /u r f. w �• e. . CESSPO LS:�/�j /--,7 e (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(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding,.condition of vegetation, etc.) PRIVY: A119 (locate on site plan) Materials of construction: Depth of solids: Dimensions: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(corttinued) Property Address: Owner: 469 Main Street, Centerville,MA Date of 1ntpe-6-:Phillip Gustafson July 1, 1999 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) rb✓r 4-. yo ' 3s' yxr V3 f /000 y.Ir,ti 53 ! - p_i3nx G � Ice, 1,1`21 t' e revised 9/2; cif' Page 10ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contirxied) Property Address: Owner: 469 Main Street, Centerville,MA Date of Inspection: Phillip Gustafson July 1, 1999 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site JAbutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) y/ i-evised 9/2/98 jog �.rcSa'�F©off a DATE:_ PROPERTY ADDRESS: 469 Main Street ___Centerville LMass_______ ------ FOV OVED 02632 1995 -o---------------- HEALTH DEPT. 'TOWN OF BARNSTABLE On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1-1000 galoon septic tank. 2. 1- Distribution box. , 3. 1-1000 gallon leaching pit. Packed in stone. Based on my inspection, I certify the following conditions: 1 . This is a title five septic system. l 78 Code ) 2. The septic tank should be pumped. 3. The septic system is,: in proper working order at the present time. -- SIGNATUR 'Name: Joseph P.Macomber, Jr. Company:_j.E_M8_Q mh es_ Address:—.Box 66 ------------------ __�e�.t�'y�,lle �Mas_s__02632 Phone: 508-775-3338. --------------------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY RWNWm- ---- CP. MACOMBER & SON, INC.Tanks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections 66 Centerville, MA 02632-0066 .775.3338 775-6412 • • t (Tt-2 ztl CommonweOnh Of Massachusetts Executive Office of,Environmental Affail'S Department of• Environmental Protection William F.Weld Ganmor Trudy Coxe a'- Soustsry,EOEA David B. Struhs ('.pmml{ilOMf SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 469 Main Street Centerville Address of Owner: Date of Inspection: 10/27/95 (If different) Name of Inspector: Jose�h P.Maeomber Jr. Company Name, Address an Telephone Number: J.P.M comber & Son Inc Box 6� Centerville ,Mass. 02632 508-775-3338 CERTIFICATION STATEMENT age disposal system I certiF)�that I have personally inspected the sew at this address and that the information reported below is true, accurate performed based on my training and experience in the proper function and and complete as of the time of inspection. The inspection was maintenance of on-site sewage disposal systems. The system: XXXX Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Date: 10/27/95 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: yX— 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. B) SYSTEM CONDITIONALLY PASSES: NO One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) NO The septic tank is metal, 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. (revised 6/15195) 1 • AX 617 55&1049-- 9 Telephone (617)292-5500 ,:�Y`;. Z•!' , I 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A .CERTIFICATION (continued) Property Address: 469 Main Street Centerville,Mass . •02632 Owner: Edward Spellman Date of Inspection:1 0/27/95. BJ SYSTEM CONDITIONALLY PASSES (continued) " 's J,0 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): 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 CJ FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: NO 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: JL0 Cesspool or privy is within 50 feet of a'surface water IRO 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 PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: NO The Sv$lem nd> d SE'{)Ul ldllR dlw bull' dUbUrpllUll SyilEll'i and h`-ILlii'i luv icc, to d $U, a:C %':ait:r SI:pN!y C, u.uu.a^j IC a surface water supply. NO The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _M The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _R0 The sys►en•I has a septic tank and soil.absorption system and 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. DI SYSTEM FAILS: NO I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is.identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. �Q 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. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 469 Main Street Centerville,Mass. Owner: Edward Spellman Date of I nspection:10/27/95 D] SYSTEM FAILS (continued): ' NO Static liquid level in the distribution box above outlet invert due to an overloaded or'clogged SAS or cesspool. A/A Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. NO, Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped IM Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. _go Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 0 Any portion of a cesspool or privyls within a Zone I of.a public well. N�- Any portion of a cesspool or privy is within 50 feet of a private water supply well. DLO 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] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: .U�A The design flow of system is 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: _1 A the system is within 400 feet of a surface drinking water supply A/A the system is within 200 feet of a tributary to a surface drinking water supply -N/A 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 owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Propertybkddress: 469 Main Street Center lille,Mass. Owner: Edward Spellman Date of Inspection:10/2 7/9 5 Check if the following have been done: /Pumping information was requested of the owner, occupant, and 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. YThe facility or dwelling was inspected for signs of sewage back-up. , The system does not receive non-sanitary or industrial waste flow ZThe site was inspected for signs of breakout. ZAll system components,44luding 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. 46he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. , The facility ov.ne� sand occupants, if different from owner) were provided with information on the proper maintenance of Sub.. Surface Disposal System. Recommendations. 1 . Septic should be pumped. 2. Covers raised on the septic tank. 3 . Cover Raised on the distribution box. 4. All of the above have ben done. 10/27 Tank covers and distribution box cover were raised. 10/28/95 Septic tank was pumped. (revised 8/15/95) 4 • c SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 469 Main Street Centerville ,Mass, Owner: Edward Spellman Date of Inspection: 10/2 7/9 5 FLOW CONDITIONS , a RESIDENTIAL: Desig �3_ ___gallons per day Number of bedrooms: 3 Number of current residents:2 Garbage grinder(yes or no):Y s Laundry connected to system (yes or no):X;D..S Seasonal use (yes or no)U_Q_ 802.7 ] er da Water meter readings, if available: 1993_199 _2 000 allons= _ 9811.Pnz pop day Last date of occupancy: 10/27/95 COMMERCIAUINDUSTRIAL: Type of establishment: Design flowN. A_ aallons/day Grease trap present: (yes or now Industrial Waste Holding Tank present: (yes or nou'-A n-sanitary waste discharged to the Title 5 system: (yes or no) N.A. water meter readings, if available: Last date of occupancy: N.A OTHER: (Describe) N Last date of occupancy:___ GENERAL INFORMATION PUMPING R10 g5/and89 source ando1i0/2a8tion: System/pumped as part of inspection: (yes or ngLCL_ , If yes, volume pumped. N_ gallons Reason for pumping: TYPE OF SYSTEM XXXXX Septic tank/distribution box/soil absorption system NO Single cesspool NO Overflow cesspool NO Privy NO Shared system (yes or no) (if yes, attach previous inspection records, if any) —70— Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Tn s t,ql l cri Anr i—1 12R4 11 nears old cage odors detected when arriving at the site: (yes or no)11Q,_ (revised 6/15/95) S c SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C- SYSTEM INFORMATION (continued) Property Address: 469 Main Street Centerville,Mass. Owner: Edward Spellman. Date of Inspection: 10/27/95 • a SEPTIC TANK:1-1 000 gallon tank. (locate on site plan) Depth below grade:' Material of construction: X concrete ,_metal _FRP other(explain) Dimensions: ' " Long 51711 High1 e Sludge depth:--,I Distance from top of sludge to bottom of outlet tee or baffle: 3711 Scum thickness: 18 11 Distance from top of scum to top of outlet tee or baffle:Even Distance from bottom of scum to bottom of outlet tee or baffle: 21' below Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liqu' level in rel Lion to outlet invert structural integrity, evidence of leakage, etc.) Pum septic tank annually. Grease trap present. Inlet and outlet tees are o. ep o I I iqui , I ziriKctura'1 sound,No signs or leaXage or soil intrusion. Uovers shoulbe raised GREASE TRAP: NO (locate on site plan) Depth below grade:IL A. Material of construction: concrete metal FRP_other(explain) N.97 — —' Dimensions: N.A. Scum thickness: N•A. Distance from top of scum to top of outlet tee or baffleN.A. Distance from bottom n)Frum t- bottom of outlet tee or baft(e: N.A. Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth-of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) None (revised 8/15/95) 6 S ' P - , f SUBSURFACE SEWAGE 61SPOSAI,SYSTEM INSPECTION FORM PART C,.'•i SYSTEM INFORMATION'(continued) Property Address: 469 Main Street Centerville,Mass . Owner: Edward Spellman Date of Inspection:10/27/9 5 TIGHT OR HOLDING TANK:N.A (locate on site plan) i Depth below grade, L. Material of construction: _concrete_metal _FRP other(explain) N.A. ` Dimensions- N.A. Capacity: ptal Ions Design flow: NA AA� allons/day Alarm level: N A Comments: (condition ,( t tee, condition of alarm and float switches, etc!) DISTRIBUTION BOX: 1 Distribution box 6—Hole (locate on site plan) Depth of liquid level above outlet invert: NO Comments: (note ii level and distributocn, equal, evidence of solids carryover, evidence of leaks a into or out of box, etc.) Distribution box is level,No•. signs of solids carry over, No leakage in or out of the distribution box. The box cover s ouh T—Fe- raise No other repairs needed at this time . PUMP CHAMBER:N.A. (locate on site plan) Pumps in working order:(yes or no) N_ A . Comments: (note condition of pump chamber, condition of pumps and appuftenances, etc.) (revised 6/15/95) 7 S SUBSURFACE SEWAGE DISPOSAL,SVSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 469 Main Street Centerville,Mass. Owner: Edward Spillman Date of Inspection: 10/2 7/9 5 • SOIL ABSORPTION SYSTEM (SAS)'L-1000 gallon >!et:h pit. Packod in sMe. (locate on site plan, if possible; excavation not required, butenlay app ximated. y non-intrusive met, s If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number: 0 leaching galleries, number: 0 leaching trenches, number,length: Q leaching fields, number, dimensions:,n overflow cesspool, number:Q__ Com ents: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) Toamy sand to fine sand No signs of hydraulic failure or ponding, vegetation gFeen and normal. o repairs needed at this tjmp CESSgOOLSN_A (locate on site plan) Number and configuration: 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: N_ A -_ inflow (cesspool must be pumped as part of inspection) NONE Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) NONE PRIVY: N.A (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 _ • yy, (revised $115195) ; 8 �•.,,•_.; SUBSURFACE SEWAGE DISPOSAL:SYSTEM.INSPECTION FORM J PART C SYSTEM INFORMATION (continued) Property Address: 469 Main Street Centerville,Mass . Downer. K Edward Spellman Date of Inspection:•10/27/95 1 � SKETCH OF SEWAGE"DISPOSAL SYSTEM: Include ties to g least two permanent references landmarks or benchmarks• locate all wells Within 100' Town Water ±., 1 `,� Ski � 3 e y6 9 A A/;v � T •:, DEPTH TO GROUNDWATER .' . Depth to groundwater:3 01 t feet method of determination or pro imati n: System installed, April 83. Test hole 121 no water encountered a t�ia e.House is on knoll Plan on file at t e Town Of Bar_nstable ;Health Department. (revised 8/15/96) 9 •,mn,••r rnrre�•rr+rn.—+�'.nsr+rs�**+asrrm+n:�•s+a.rf+.rrsrnn+nsrnvu r.rm�s+r� i TQ OWN OF 'Rarn +phla BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION 1 „r.m,�,,.1z,,, rmn,r...,-�.•..9.,.-.:,r,•,.R•,,,.-.-.-•..•ter-,.J •••ar•,-r•:':: --rr,r.-.-r*+:arm•n..++rrnrs•.arrrsrm�-rs��rmrtiarmor-•n^n'4'++m . A -TYPE OR PRINT C1.EARL1'- PROPERTY INSPECTED 469. Main Street Centerville,Mass. STREET ADDRESS ASSESSORS MAP, BLOCK AND PARCEL # OWNER#. s NAME Edward Spellman ,®- I PANT D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr.. COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66' Centerville,Mass . 02632 Street Sown or City State LIP COMPANY TELEPHONE (�0R f 775 3338 FAX 1508 r790 -1587- rarnsnsm rr Qnn m. CERTIFICATION STATEMENT I certify that I have personally inspected the sewage diaposa-1 system at this address and that the information reported is true , accurate , and complete as of the time of .inspection . The inspection was .performed and any recommendations regarding upgrade , maintenance , and repair are consistent width my training and experience in the proper function and maintenance of on- site sewage disposal systems`, Check one: XXXXXXSysteci PASSED The inspection which I ' have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILEll* The inspection which I 'have conducted has found that the system fai_1-s to protect the public health and the environment in accordance with Title 6 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . + � Inspector SignatureA Date 10/ 0/95 One copy of this ce ificatio;n must be provided to the OWNER, the BUYER ( where .applicable ) and the BOARD OF HEALTH. If -the inspection FAILED, the owner or operator shall upgrade the systems. within one year of the date of the inspection, unless allowed or requi're� otherwise as provided in 310 CMR 15 . 305 . purtcidoc �- _V) W b THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Ha--._satisfied the. Department's, qualifications as__required and is hereby authorized 'to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21 A of the General Laws. Issued by The Department of Environmental Protection. June 8. 1995 Acting Director of the 'Zion of Water Pollution Control r 'i Watqr Coris'ervatiori SAVE dips' '- MEl ' • CHECK FOR LEAKS Water Loss In-Gallons Due to Leaks Leak this Loss Per Day ,Lost Per Month Stto ' • .120 0,600 • • �. 360 10,800 • • ,093' 20,790 • 16200 30,000 • • '` ; 3096• '• 92;880 ' •.O •4y296 . 128,980 • • ® •• 0,040 199,200, ' 8',9,84 '• 20Q,520 • • •''• 0 424 ' 252. � ,720 , ,® , 11,324 339,720 12,720 .381,600 f4,952 448.560 ' TOWN OF BARNSTABLE 1,0;1ATION01 SEWAGE# ~ VILI-AGE ;1i0n;/JUe, ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by yG 9 Al,A 3 T CONSERVATIOM No.za..�� . COMMISSION Frm$.....��..�........... THE COMMONWEALTH OF MASSACHUSETTS ; BOAR® F HEALTH .................OF...... fir.✓..titi�' � , pptiration for UI,ipuiia1 Works Towitrurtinrt Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ��fE2g/�11Q ?/�: d �r`� ✓���iT��l/lt ...... ®� r1' - r l r� L_ocation•Aldr s -- or Lot o --.- ` � 1gL7 .t.!✓ynr/�T ��-- Owner dress v fj/ LF/ Installer Address Type of Building Size Lot... .--_----_---Sq. feet Dwelling—No. of Bedrooms.......j.....................Expansion Attic ( ) Garbage Grinder (moo) aOther—Type of Building ___________________-____-- No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures . ..... ----------------------------------•------------ W Design Flow..............�5. ....................gallons per person per day. Total daily flow....... .........................gallons. WSeptic Tank—Liquid capacity./.02gallons Length.. .-.-6... Width.. ..- ... Diameter................ Depth..41!. A/..... x Disposal Trench—No..................... Width.................... Total Length........._. ..._.... Total leaching area....................sq. ft. Seepage Pit No........../-------- Diameter.......oi--------- Depth below inlet.... Total leaching area..�s_P.._..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by..................................................... __ Date............................. _......._. Test Pit No. 1._..�_......minutes per inch Depth of Test Pit......147........ Depth to ground water...A4_�4w- ,, fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lei ...........................r............................................................................_.....--------------------•--••--------.......----- O Description of Soil..... a�9 %:. .,S1.�Q5P/�.-------•-•-------------------------•----•---------------•-••-----...----•--•---•----•--•--••............•--- V .....................•-•-----•---.... /Z----- G tJGa �dEQl.� -SIN, ----•------------------------------•------------------------------------------------------------------... -- - - ----------------------------------------•----------•--------------- 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 iITI,:�. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate.of.Compliance has en d b e boar f.health. Si ned / - - •---•.....- .......................... �� .......... -- ------J� ..� Application Approved B Date Date Application Disapproved for the following reasons:____________________________•_--_--•---••---------•---•-•-•------------------..._.___.__._..._._ ----•------------------------- ----------- ••--------- •--------------------------------- -•-------------•----------------------------------------•-------------- PermitNo......................................................... Issued_................. Date FEB THE COMMONWEALTH OF MASSACHUSETTS ` J BOARD OF HEALTH rG7.hc/.h/................OF...... ...............-. Appliration for Disposal Works Tonstrnrtion rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....... .....�.. �". t_r./':/ .'44111�.2..................... ( l..r.� 5.4........: .. .�caT, / Location-Add re or I_t No.� Owner ress J - W � t�yt a �1a1..:. �'c.�?�� q ✓............................................ � -------------------c-.............-•----•---- Installer Address U Type of Building Size Lot___ ...Sq. feet I-•I Dwelling—No. of Bedrooms....I /_.....3........................Expansion Attic ( ) Garbage Grinder ( ) aOther—T e of Building _______________ No. of ersons______.__.._._._.._.__._._._ Showers YP g ----•---•-•-- --------------•.P ( ) — Cafeteria ( ) Otherfixtures ---------------------------•-••- -.......•••---•-•••••-••--•••-- •-•--•••-••-•--._...•••--•••..__. ............................... W Design Flow..............,;:`.....................gallons per person per day. Total daily flow.......41;1,0..........................gallons. WSeptic Tank—Liquid capacity--,¢tpZVallons Length___'-_ _. Width___, !_�._ Diameter________________ Depth_ __'K_..._ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area................. .sq. ft. Seepage Pit No-----------/_______ Diameter......... Depth below inlet___.......... Total leaching area...".F, r ...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed by.......................................................................... Date........................................ a T P P ra-•�-•- P g Tf✓Tc ,•a Test Pit No. L____�_.___.mmutes er inch Depth of Test Pit__.____/_ Depth to ground water____„�,l�T-es/erww GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.............._..... Depth to ground water........................ W ..................-••••• ••-••-••---•••-•••-••••••...............................•-•----______-•-----••---....____--•-_________._....-----••-•••••---•- DDescription of Soil.....A_Z.......�v9rea..s-�c��C�S <--............................................................................................................ U ------------------------•-----------Z -/Z...._.. ��G, llZ r� a ����a s4�idx---•------------------------•---------____---•---------------______ W -------------------------------------------------------------------------------------------------•----------------------- ••-••• ••-•--•-•••-••••--••-••••••-•••••----•-•••••-•-••---.....••_•-••-- VNature 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 TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance,has been,issu d by e boar f health. Signed••-• ---••--••- ��4f/------- � ' D Application Approved By...... _',' ... y1-,�;-' Date Application Disapproved for the following reasons:-•-----------------------------•------------•--•-------------------------------•-----------------••-••-•--_...._ ...._--•--••--••••----•-•-----•••--•-••-..._..-••...•••••••-----•-•••••-•-•-••••-•---••-__....•-•---...--••••-•-•-----•------••--•-••------••--••-•••-•----••--•••-•••-•-•----••••••-•••••••--•.....--•- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................OF..... ............................. .. Trrtifiratr of Tumptiaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by............. --•----�-�----•---._c.�?.G'.4!�lrJe?xe1--=---------------------------------------------•---•---•------------------------•------•--••------••--.._.... Installer at.-••-----f-�' --••4-•••••-•-• ! iv 'tzvv�C-------- C�=�Ti2�/1LL -r has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..... ,0............... dated............................:................... THE ISSU NCE F THIS CERTIFICATE SMALL NOT BE CONSTR AS A GUARANTEE THAT THE SYSTEM` WI FU CTION SATISFACTORY. DATE` -•.. .:.......................................................... Inspector..•••-__ ___-----•--..._...--•••••••---•--•-••-•--____.............--•_______..... THE COMMONWEALTH OF MASSACHUSETTS �. ' BOARD OF HEALTH ! T! �-... ..__..-._..._....._..............................OF....-.. No A.na........ y.' FEE-. 5� Disposal Works Tanstrnrtion rranit Permission is hereby granted______ _ ___-__ , to Construct or Repair ( ) an Individu Sewage Disposal, stem at No04 Street as shown on the application for Disposal Works Construction Permit No...................... Dated........................................... ✓ DATE_ of Health FORM 1255 HOSES & WARREN. INC., PUBLISHERS CAT ION Lot /� RNBROOK, off Main Street.. ille NO. ILLAGE Centerville I _ DATE 1I 81 PPLICANT+ Alfred Cec,ere et al, Trustees FEE $25.00 DDRESS c/o Delta -Homes , Inc. TELEPHONE NO. 771-7765 (Non-refundable NGINEER Peter Gavin TELEPHONE NO._ ATE SCHEDULED December 4, 1981 (Applicant' s signature) O,O O 0 0 0 • 0 . O 0 0 O O . . . . . . . 0 0 0 . 0 . . . . . . . . O . . a o . . ... . . . . O . . . . e . O . . . . . O . . O . . . . . , ;t SOIL LOG UB-DIVISION NAME FERNBROOK DATE ' 12/4/81 TIME 2: 00 P.M, XPANSION AREA: YES * NO Peter Gavin ENGINEER :. OWN WATER # PRIVATE WELL Ron Gifford BOARD OF HEALTI Dan Speakman EXCAVATOR KETCH: (Street name, etc. dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) NOTES: See Attached Plans �_ T== -- ERCOLATION RATE.: -==_w-- TEST HOLE- NO: -==--------- ELEVATION:.-_--- TEST HOLE NO.: ELEVATION: 1 LDAopi s StA6ol� 1 21. 2 3 _= 3 - 4 _ 4 - 5 _-= . 5 7 vJ� 8 - - - 5AwD 8 - < 9 9 10 10 11 11 12 12 13 13 14 l 14 15 15 16 16 SUITABLE FOR. SUB—SURFACE SEWAGE: LEACHING FIELD# LEACHING PITS # LEACHING TRENCHES # UNSUITABLE FOR SUB—SURFACE SEWAGE . REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL• COMPLETED IN ENTIRETY BY P . F , AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT THE COMMONWEALTH OF MASSACHUSETTS ORDER WETLAND PROTECTION ACT G.L. CH. 131, S, 40 'SE 3-799 TOWN ,OF BARNSTABLE FILE NUMBER ........... To: Name _Alfred F. Cecere Address _ and _ ^_ 736,Main Street, Hyannis, -Ma. 02601 __,.......__......__-_._.._.._..._.. __. Thomas W. West Recorded Owner _._...-._......__......--------_..... ...._._.____ PROJECT LOCATION: CERTIFIED MAIL NO. _. ..Hand.Delivered......... off Main Street, Centerville., Ma. Address __.........._.......-...........- ..-------._.._...._._..............._._.................----.-.---...._.............._.......------..........-.._._.........- Title Reference, Registry of Deeds; Book _._.._.._.....-...._................__...._ ..-_.__..._ Page Certificate (if registered) _._...... ...................__.............................................. and as shown on Town of 208 85 (portion) Barnstable Assessors Map #•-------_._......................................_. Lot #--._......_....._...._..--_•---__. REGARDING: December 11,1981 December 22, 1981 Notice of Intent dated _._........................................_ Date of Hearing ..................................-----._.._._..___...___ Plans entitled _"Site Plan Showing Proposed Construction, Location: Centerville,Mass. , _ .. .. ...................__....... ................................_...................._....... - for Alfred F. Cecere et al Trustees; Reference: being Lots 3 & A _shorn*za...on._Lan-d Court: -PIAD' #14972C" .by Peter A...---Gavin-,-_Re-gi..s.t<ex_e-(I - Professional Engineer, 44 Prince Road, West Yarmouth. Same as above: for Lot 9r. _Lot 5, Lot 7, and Lot 8 (Sheets 1-5 of 5) ' Plans dated _December 5, 1981 Stamped and signed by -_.-_.-..__....._----Richard .James.._O..Hearn...__P.E. __........... Peter A. Gavin, P.E. THIS ORDER IS ISSUED ON January 6, _1982. - - Pursuant to the authority of G.L. Ch. 131, S. 40, the BARNSTABLE CONSERVATION COMMIS- SION has considered your Notice of Intent and plans submitted therewith, and has determined that the area on which the proposed work is to be done is significant to one or more of the interests described in the said Act. The BARNSTABLE CONSERVATION COMMISSION hereby orders that the following conditions are necessary to protect said interests and all work shall be performed in strict accordance with them and with the Notice of Intent and plans identified above except where such plans are modified by said conditions. CONDITIONS: 1.- Failure to comply with all conditions stated.herein, and with all related statutes and other regula- tory measures, shall be deemed cause to revoke or modify -this Order.,-'-,. --- 2. This Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state, or local statutes, ordinances, by-laws and/or regulations. 4. The4 work authorized hereunder shall be completed within one (1) year from the date of this Order unless it is for a maintenance dredging project subject. to Section 5 (9). The Order may be extended by the issuing authority for one or more additional one-year periods upon application to the said issuing authority at least thirty (30) days prior to the expiration date of the Order or its extension. ;ONDITIONS CONTINUED FILE NUBE$ _SE 3-Y799 M — _ 5. Any fill used in connection with this project shall be clean fill, containing no trash, refuse, rubbish or debris, including, without limiting the generality of the foregoing: lumber, bricks, plaster, wire, lath, paper, tires, ashes, refrigerators, motor vehicles or parts of any of the fore- going 6. No work may be commenced until all appeal periods have elapsed from the Order of the Con- servati,on Commission or from a final Order by the Department of Environmental Quality En- gineering. 7. No work shall be undertaken until the Final Order, with respect to the proposed project, has been recorded in the Registry of Deeds for the District in which the land is located within the chain of title of the affected property. The Document number indicating such recording shall be submitted on the form at the end of this order to the issuer of this Order prior to commence- ment of work. 8. A sign shall be displayed at the site not less than two square feet or more than three square feet bearing .the words: "Massachusetts Department of Environmental Quality Engineering. Number SE 3.799 _>>, and a copy of this Order shall be available at the site. 9. Where the Department of Environmental Quality Engineering is requested to make a determin- ation and to issue a superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before the Department. 10. Prior to any work being done at the site, all legal advertising bills incurred by the petitioner in relation to the Wetlands Hearing held on this project shall be paid. 11. Notice shall be given to the Barnstable Conservation Commission or Conservation Officer no more than two weeks nor less than two days prior to the commencement of the work. 12. Shellfish shall be removed from the work/dredge areas prior to construction under the direc- tion of the Barnstable Natural Resource Officer, at the applicant's expense. 13. Dredging may NOT be done between June 1st and. Sept. 1st of any calendar year. Dredgespoils are to be disposed of ......................._.._...................................................._........._._._........__........_.._. ._..._. 14. Excavated material is to be disposed of away from banks. 15. Staked haybales_ shall_be_-used throughout construction to control erosion. 16..All disturbed areas are to be revegetated following construction. Areas stripped of vegetation during construction may NOT be left unvegetated or unmulched for more than 60 days, unless other erosion control measures have been provided for herein.. 17. There shall be maintained a buffer strip of natural vegetation TWENTY (20)+ feet in width around all wetlands and water bodies shown on the plan_ . Selective. limbing may be allowed within the buffer strip to allow for a view. 18•_The limit_of.work shall be TEN (10) feet-from the foundation of each of the _five .houses, as shown on the herein-cited plans. 19. The project shall not reduce the flood storage capacity of any wetland, water course, or water body. _for each of the five houses shall 20. Septic systems—/ .`conform with Town of Barnstable Board of Health Regulations and Title V, unless specifically ordered otherwise herein. 21. Immediately following completion, the project shall be certified to be as per these conditions and plans, in writing, to the Barnstable Conservation Commission by the project ..._Engineer......._ who shall be registered in the state of Mass. Upon* certification b the Engineer the applicant shall forthwith P Y Project ..__........._.......................................... request, in writing, that a Certificate of Compliance be issued stating that the work has been satisfactorily completed. 22. Copies of all other permits obtained in connection with this project, and a copy of the certified foundation plan, as prepared for the Barnstable Building Inspector, shall be delivered to the Barnstable Conservation Commission as they become available. 23. Work shall also conform to Order issued under Article XXVIII of the Town of Barnstable By-Laws. SE 3-799 CONDITIONS CONTINUED FILE NUMBER ..... ....................................... The applicant, any person aggreived by this Order, any owner of land abutting 'the land upon which the proposed work is to be done, or any ten residents of,the city of town in which the land is located, are hereby notified of their right to appeal this Order to the Department of Environmental Quality Engineering, provided the request is'made in writing and by certified mail' to the Depart- ment of Environmental Quality Engineering witihin ten (10) days from the issuance of this Order. ISSUED BY: ...... ......................................... .................................................................... ..... L .1z-rn ..................._... ................................ ............... ............_........................__......_.............- ... • �...._........ 1.... ... _.............._ .........................................................................---.._............_................._......._.......- —)44 On this ...............................�......................... day of ..... ... Gl�c. r .........., 19..r#� ..., before me personally appeared 11 �`1 ....... -i ........... .................... zome known to be the person described in and who executed the foregoing instrumen and acknowledged that he executed the same as his free act and deed. I (em u!✓�'. 11...��.... ...(...G_c� ' ....:_..........................._..........._ No y Public My Commission Expires Detach on Dotted Line and Submit to the Issuer of this Order Prior to Commencement of Work. To Barnstable Conservation Commission (Issuing Authority) PLEASE BE ADVISED THAT THE ORDER OF CONDITIONS FOR THE PROJECT AT .................. ................_...........................-._................._......I FILE NUMBER ...................................... HAS BEEN RECORDED AT THE REGISTRYOF ............................................................. ........................... . _. ON (DATE) If recorded land, the instrument number which identifies this"'transaction is ......................................................... If registered land, the document number which identifies this transaction is ................................................... __. Signed ......................................._................_...._.........._....._._....-............._ .. Applicant M1 y ~\r 1 I I exec"M r11ice a/environmental 61.4 �A/ b DAVID STANDLEY /00W2mG�� O Jf/IPP�/, AiAwv 02202 COMMISSIONER February 17, 1977 Down Cape Engineering RE: .BARNSTABLE---Subsurface Sewage Disposal - Route 6A Proposed Iernbrook Health Care Facility,. Yarmouth, Massachusetts Pine Street, rob No SE 76-229 Gentlemen: The Department of Environmental Quality Engineering, in response to your request,, has had one of its engineers examine the soil at the a.borve-noted site and has reviewed a set of plans in two sheets , the first of which is titled; to PLAN OF PROPOSED SUB-SURFACE, SEWAGE DISPOSAL SYSTEMS FOR "FERNBROOX - 14EALTH 'CARE FACILITY PINE STREET CENTERVILLE MASS. OWNER CARMALITE SISTERS DESIGN: AHO DOWN CAPE ENGINEERING SCALE: AS NOTED DRAW14: WGW ROUTE 6A - YARMOUTH, MASS. DATE: DECEMBER 1976 CHECKED: HB JAMES H. BOWMAN, P.E. SHEET 1 OF 2 SHEETS Soil examinations conducted at the subject site on November 1, 1976 in the areas proposed for subsurface sewage disposal indicate that the natural soil,_ beneath loam and . subsoil, consists of clean medium sand which has a percolation rate of 2 minutes per inch. Ground water was not encountered down to an elevation of 22.5 feet. The plans propose to dispose of 13,855 gallons per day of sewage from the subject project by means of eight separate subsurface sewage disposal systems: The systems are described as follows, Systems #1 and ft2 each consist of a 3,000 gallon concrete septic tank, a three-outlet distribution box, and three seepage pits with a total effective leaching area of 952 square feet. Sys tem,3 consists of a 3,500 gallon concrete septic tank, a three-outlet distribution box, and three seepage pits with a total effective leaching area of 1,243.6 square feet. d ,•' a • x » - systems 4 a.nd #5 each consist-of,a 2;500 gallon`concrete septic,tank, a two.-outlet ;' distribution box and two seepage pits,.With a total ,effective'leaching area,of $29 square. System #6, consists of a 1,.Op0 gallon concrete grease trap.; a 2,560 gaiion concrete x ' se ptic t 6 two di'st,ibutioh box, and two �eepags pity with a tptai effective beaching area.af :$29,square jebti t _ System c4nsi is ©f a'a -SO0.gallon concrete-•sd' f tang; a 6ne--oui$ t,c tribution b�a ,:and one seepage°spit with an effective leaching,area of 41 .'S equara feet. ,y T System_#� consists of a 4p4 gallon concrete septic tarn:, a 275,Q gallon concrete ' tamping ch Rb"br'equipped nrith'two alternating l80 ,gym pumps, a l,00Q•gallon:°«concrete. . }. *; surge tank,-e .lour-cutlet distribution b© ;°Wand four seepage pits vith'a 'total effective leacYiing;area of �.,S5S=scivare feet. rFts4„ s Tke 'Department of.Ervironmertal'Cuality 'ngineerxng:terby.apptoves ,the plans vuitYi r 4 c 1 the following prb`visioris ro , 1 portion of the:water line shall be jocaCpd t�vith nf"lb,feet of any cor iponcnt'oE any septic system. :. 2 The 1 000 gallo ofoct surg _ttdhk in•Sysem fshlbvented bmas ,of an e e e.' en .,.. vent riser with a gt�ose neck.or by rise of a''`v6At atack extended up the side of . -the building to the roof £. - w, Qns truction:shall .be,''in-s tr ct accordance withj the approved,pjai s and Title S ; . of:the EnvirQnmental Code and no further chaiig s .will be m6de in the`a pprc vt ' Y Plans. without the prior written'epproval of this.Department. N8 r a 4.' A i?ispQsal Works Canstructi6 1 1 Pe,�mit 'muat`tip obtained from the SB�rnstable.Boca d. of Health prior to the star'';t ofpnstruction if , .Written �erti�icatie�n that the°disp¢saI facilities 'have be 'cons in - accordance with the approved plahs and Title'5 cif, the Envir�inmerzta.l bode mint' be subrr f'tted to1he Barnstable Board of Health with a copy to'this office by your , h.,. engineering company prior to the','system.,being backfilled. Mothing in this provisiorx ls ntended-io:lnterfero with the rght'of. the Board of Health to inspect the disposal �facilitios>at any ti-me.during con tructipn. - m The building'shall not be occupied until a Certificate of Complidnce:;is issued by the- Barnstabze Beard of Health, a ° No enviro'ho ental assessment form is required to be' submitted.-for this project since f itU kemOt under the Environmental ProteCtidA FZegulat ons of the Executive Office of "Environmental AMits, and the project`het.therefore been determined to cause no'significant' ` damage to the environment. =fie f i t i LOT > yy N/F I' MOTNCY LANDLORD A Q, LLC t Li'PAAVk W Or Pr�CET S8854'30'W r 258.83' -cam_ 43,6 4 3.7 \4?\ rP I N \\ GA` a-_ P1CK t \\ i `� \ \ t�ET F 4 LOOT f EN RJ IFS�44\ 41 s RR \\\ \`�s\ `3\�C°�- 31.5 N/�' N `— ~ nFS 3`' '\ PIN LAWN \\ �32\G GA �0 CHAIN RL'G�l'NCY\ 3 _ \ \ \ �_`_ LINK R.R. TIE A�\ .78 1e 36.8 \\ \\ o r� __--t}_ ��NCF LANWo" J 4, LLC PAVED ` STEPS O \ \\ \ /61 wmr \ �\ c, DRIVEWAY \ 43 J \ \ IN,PINr, / 45 4 �rO/ -- 42.9 << 38. E' \\ \\ L\9T 2 44. . — \ 4 O6S�f S.F. Oou BL { Z \g \ 42,6 77.4' q ----- FLAG IRCH , Iz 46.4 38vp . \ 44.1 PIN 43.0� FLAG ' \\ — - co 4� 0 \ \ LAWN \ \f ' 2 2 --- _ n 30.1 k — WALL .39.4 .�(Afr<G ° or�LL � a Z 35.51 I a4 464 42.6 PPROXIMATE -- - _�_� 35.5 i� ! OVERGROWN ✓ / EXISTING SEPTLOCATION IC IC 3D.0 i BOG Llgi�344.3 / SYSTEM AS-BUILTFROM // / S - --1� 39.1 58.2' 1 C POST` 0 / j' 46.4 TFA ---- IT i r z 46.1 — A.C. 39.9 A- " �4v ry :C / LAWN :6.0 \ 4c6 h / / , 31 cc z LAWN // / 2 0 0� LAWN e / / 7 / tb tq t Orr K � i 2 - i - - I ' r F .. K_. n.. a ►,.� - - - - ' 'k 03 ............ -- ---------- -- .... .......f==>' — ►►� ARC Ca __-iMA _.:_.S.T..-c�. .cu�.. Z%, Np,32507 K MSS James M. 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Tf'/E RUSSEL L 4 Wl-lE,4 TLEV COINC• 700 Sr 4011VG rON, 4-14S6• a993 ce1 •� AROPEP7 OvVi�/EFa C.4/QMEL/TE SISTERS. j T •ti0 �k '2o,v ' •LBE//VG p S4460///S/0/V OF G/VO 99 PL 4 IV 149 72 e L O T 2.`p "� � 4 7y' o I cer-reify 71ha7" 7"h/S acfudP/ was made on fhe ,ground/n actor-ryenee ,...;.: Wirth r`he Land COUr7`In.91,-UC 7'/0n9 Of /971 k , on or- befween NOVG, c917dN011/2, /9B/. G r`/e PL.S, i'c- I Ccr-fify c cn1-7ai71/017S on 7- 9rwndcprc XJ 7fic same now as -7,-1 Me Time oJ�'r`he oryrna/ 3vrvey. Ivor ,eE.Pug,ezb Rus p'c// ,4 Wh JOB NO. B01-12 �0o ZONING DISTRICTS: RC2 & AQUIFER PROTECTION PROPOSED TANK IS 7" HIGHER NOTES Ford.dwg Sro ��• FRONT YARD: 20' THAN EXISTING---RUN NEW NOT TO 1. LOCUS IS A.M. 208, PARCEL 85-002. �. SCALE SIDE YARD: 103PIPE RACK TOWARD HOUSE 2. ELEVATIONS SHOWN ARE ASSIGNED. REAR YARD: 10 AS NEEDED. 3. LOCUS IS IN FLOOD ZONE C ON FIRM DATED JULY 2, 1992. 4. ALL PIPES TO BE 4" SCH 40, AND PITCHED AT 1/4" PER FOOT. (UNLESS NOTED) Pl. o. N/F 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100' ARE ON TOWN WATER. 6. COMPONENTS TO BE AASHTO H-10, UNLESS NOTED. � OAKWOOD LIVING CENT. MA INC. PROPOSED WORK LIMIT 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". ` 200' RIVERFRONT BOUNDARY B. IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW her p`ve• LD-BOX EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET. fit^ s 88.54'30' w 9. DEPTH OF COMPONENTS NOT TO EXCEED 3', OR VENTING MUST BE PROVIDED. S.B. tad BUILD UP COVERS TO WITHIN 1' OF GRADE. MORTAR CHIMNEYS IN PLACE. 25883 ONE COVER OF TANK TO BE WITHIN 6" OF GRADE. x 26.8 7,51 d x 1s,e 10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEA STONE ON TOP. za,9 28'29 44,oo S.F. x 6.1 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, LOCATION MAP \ CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC. \29.2 12. IF AN OVERDIG IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING / \ 25 x 12.3 IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3). TEST N� I " 2 ,3 13. PUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN 100' RIVERFRONT BOUNDARY LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. x zt.s 1 ALL CONSTRUCTION TO MEET TITLE 5 AND LOCAL REGULATIONS. DEPTH (inches) ELEV.(feet) /27.7 / 9' `�,.. \ ^ j TEST HOLE DATE: June 14, 2001 0 A toyer)10yr 3/328.5 22, 1 \2967 r . 25.7 `�N/F 5 / 4 �� "1` to PERFORMED BY: Ron Cadillac, $oil Evaluator 6" onm Bond ��l� / ,• vo 'S�� 1 ts,7 1.6 30.96 WITNESSED BY: Glen Harrington, RS B toyer 10yr 5/6 CRAWFORD i / `�` g+� �Z "+ a`'• PERC RATE: <2'-00"/inch (C toyer) roomy sand 271 t11 9'a fsyar � t Top Fnd. SOIL SURVEY0993': Carver coarse sand 6C1o°a r so ds/ Ctj / • c� 25. GEOLOGIC MAP(1986): Harwich outwash plain deposits 30' ( 50%grate) v' ,( .7 / 3: `:;; �, 15.7 r Invert 27.65 25.0 " A. U � . •30.''• \ 3,6 Invert 26.90 w J 26.gs � ;•:. S" 27.9 �o\ w 4. Exist. Cast Iron r1 C 52'a C layer 10yr 5/6 2 ?"� �` jp O Use Gas Baffle DRY WELLS r n ••� 0.4 -'� ,^� Proposed Invert 26.03 Coarse sand +0 �► 8 +isp 2 P17' !� �^ Proposed (10%grovel) � 7 » a / 9.as E X yQ a"c4 © S=1/2"/ft 9" min. cov8r Top Conc.=26.7 E ;6 $i� GS'•.::. 5=1�4"/ft Top Peostone=25.4 o Proposed S=1/$ /ft min. Q 29.79 30,00 ` 9®Q i� 7 �� t� + i' Invert 27.15 1500 Gal. - - -� 132" no water 17.5 26.i4 � • i r I Proposed x 24,2 25, fit. .:: i3p, Q `0 E 24" 28.39 " x 27,4 95, 9 }}// ( T 29,6 32 Invert 26.20 Invert 25.90 23.90 I 6" Stone or compact Proposed Proposed 23•5, 6•4, Bottom D 8.6 t• 89.6 5.9 1 .99 � 11 � ----•� � 7 ,( 48 5 . 0.8 s.s •t �- cp 13� Bottom TH1=17.5 .. ...� 29, 2 26.28 !&S, .6 15,4 Pond water El. (7 3 01 =0.4 z 2 . DESIGN DATA / / } C.B. tnd / x 26.7 5 88'54'10" w rn 283.75 .1 / 50 24,17 c 8,9 8 2 ✓fir' 10. �6.0 4.3 BEDROOMS: 5 LEACH AREA •� s s4 27.9 2.8 GARBAGE GRINDER: No r� � 24,5 12 A7' E 22.7s ,� - USE . DRY WELLS SET 4 APART AND "' .� 6 sy''� 25,6 19s.91' 2 ,j .2 „ 1 ' REQUIRED CAPACITY: 550 GPD W� �4 i i WITH 4 UE STONE ALL AROUND FOR A FS'05' • e3.2 235 24.0 �, 'n� ,� ,� SEPTIC TANK: 1©32 GAL. 41'-6" X 12'-10" X 2' DEEP LEACH AREA. ,,� o a BOTTOM LEACHING AREA: 532.4 5F N Re•.`.4'10" E .22 .1 � '�� ((41.5' X 12.83')) 2311 SIDE LEACHING AREA: 217.3 SF p�-r N/F 3'5 (2(12.83'+ 41.Ei) X 2' DEEP)) !�. , GLADCHUK ` 20.9 xis. z r DESIGN CAPACITY-. ) X GPDSF1532.4 SF .74 4 GPO 6J C( / 5 * 8.8 I) WHERE PROPOSED SEWER CROSSES �1kF II 100' FROM BvW I1, "I] WATER SERVICE, USE A 20' SEc11aN BENCH MARK--S.E. CORNER OF II (,o �v UU Or SCH40 PIPE, OR DWSEWERLLINE BOTTOM STEP = 30.71 ASSIGNED 3,7 II ATN/Raga) �"------------ _ 4a a I� SFP 2 7 261 �Q 0'` BENCH MARK--TOP & CENTER OF BARNSTABLE C074SERVATION WOOD STAKE= 30.00 ASSIGNED w POND NEARIMP, OCT 2 3 2001 OAT, tr, SITE FLAN FOR THIS PLAN IS A VALID COPY ONLY IF IT BEARS AN ORIGINAL RED STAMP AND SIGNATURE. MORRIS & SUSAN FORD j\AOF LOTS 49 10 & A, 469 MAIN ST., CENTERVILLE, MA ZN OF Mq �*r ' ZN OF Mqs LEGEND R AM �� T F: SEPTEMBER 7, 2001 SCALE: 1 "=30' i✓ TH I TEST HOLE LOCATION, NUMBER :i` # 1060C w a�#35779 r W WATER LINE MARKINGS V\ E UNDERGROUND ELECTRIC WIRE MARKINGS x c+sTER ;' tq Ess� 0 r!' 9.5 x 8.7 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) � SANI7AR�PNr., t ��suf� d RONALD J. CADILLAC, PLS, RS EXISTING CONTCIUR 7 1 k� (1�� �t PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN � PROPOSED CONTOUR P.O. 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