Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0021 MERIDETH WAY - Health
[21 Merideth Way enterville A= 148 - 154 -i f No. 4210 1/3 ORA Pendaflex' 4h 10% I �I r F' Town of Barnstable P# ! 41 LS Department of Regulatory Services ` Public Health Division Date seTtxereat.& MA9,S •6Jy �e� 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. I GO'( Ck)_ a � Soil Suitability Assessment for Se age Disposal Performed By: IG � 1 '�C Q 15�-rZ Witnessed,By: I I ` LOCATION & GENERAL INFORMATION Location Address Z 1 'MeA c6+k �. Owner's Name (S,"v ,— Address Assessors Map/Parcel: — l's _ ��,aa��+�■wi..s� -_ $ - Engineer',-, NEW CONSTRUCTION REPAIR �_ �Teleephone# g Land Use l' s �.t Slopes(go) 1 " !:— y- Surface Stones Y� � Distances from: Open Water Body 73 ft Possible Wet Area /0 ft Drinking Water Well(-Slj ft Drainage Way �>3-VI) ft Property Line l� ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 'T1 , Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: A)l R- Weeping from Pit Face f�T Estimated Seasonal High Groundwater DETERNIINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: __— �__Tin, Depth to soil mottles: in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level_. m.� Adj,factor Adj.Grountlwnter` Vol PERCOLATION TEST bate , Time o Observation Hole# �- Time at h" Depth of Perc 7 (`j Time at 6" e A'LctA Sv,..�l Start Pre-soak Time J141 e`X' Time(9"-6") End Pre-soak I( (q RateMin./Inch. 2-M•4(, Site Suitability Assessment: Site Passed X Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTIC\PERCFORM-DOC I DEEP.OBSERVATION HOLE LOG Hole# ' Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones-Boulders. Consistency, r vet a DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% ravel) a NZ I 36�/'3� I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) - (USDA)_ (Munsell) Mottling (Structure,Stones,Boulders. -- Con i to c o Orave DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consist n i 1 Above 500 year flood boundary No— Yes ___ Within 500 year boundary No A. Yes r- Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (� i �� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tr 'Wing,expertise and experience described in 310 CMR 15.017. Signature ���� �— Date I Q:).SEVnC\PERCFORM.DOC 1 ior TOWN OF B_ ARNSTABLE 0 �/ LOCATION 6a SEWAGE# 1 VILLAGE ►•�}��Vi I I I ASSESSOR'S MAP.&PARCEL IY�r- /Sy � INSTALLER'S NAME&PHONE NOC Oy�'S C)cC 50�7 7 r �( � SEPTIC TANK CAPACITY 5 G� LEACHING FACILITY:(type) 2 J00 Cs�Aho ec-3 (size) / 3 K 33 NO.OF BEDROOMS OWNERU — PERMIT DATE: �( COMPLIANCE DATE: Ll I Separation Distance Between e: ,A Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f�, Feet Private Water Supply Well and Leaching Facility(If any wells exist or`< site or within 2.00 feet of leaching facility) V1 ✓,t Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY bt, CCA1 �41 K .33 13 y - << tirrLl� tilluiv rux PEXC:ULATiUN TE61' AND ULiSERVATION PITS )CATI,ON zeV779 Wne1QmT _ NO. 3 78, - _ I�LAG E �f/GL _ DATE PLICANT C"4114)sr 4/a es A:�__Kt �/LU1T FEE_ )DRESS"0 7)%V AWj))v Z*y TELEPHONE NO . 7 (Non-refundable ) GTNEER ,eaiG/, ,5/�5•/.d/ �/�, �iU<. _TELEPHONE NO. -035 TE SCHEDULED_ OY Z7j l fF�f _ - (Applicant.! s signatur ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SOIL LOG �� // / B-DIVISION NAME �L�OS.'� Q� DATE /Y_ 4y, Z71��41 TIME 9-'se PANSION AREA: YES NO _ )�f ��/6j �jvh.- 14)C. ENGINEEER MN WATER `J PRIVATE WELL .y,��j ''jjcca � BOARD OF HEALTH iC.hQ(�j¢lJi¢T/Q�J EXCAVATOR OR ETCH : (Stree,t name , etc. , dimensions of l.ot, exact location of test holes and percolation tests, locate wetlands in proximity to- =test holes ) .; NOTES : 15' 100 3a 0 /AU RCOLATION RATE : . 2 , MI� ST HOLE NO : 1 ELEVATION: TEST HOLE NO: ELEVATION: 2 2 ;L) 3 3 4 ---.... ._. 4 - 5 6 9)Aj D 6 8 8 -- — _. 10 - . 10 12 — - I W y ii 12 ---- 13 /VD WATER 13 — — 14 � -___-- �n1CDUl�I�(:�v 15 - 15 16 16 -!ITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD ,LEACHING PITS LEACHING TRENCHES !SUITABLE FOR SUB-SURFACE SEWAGE.. REASONS : )TE : ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION '.I.GINAL: COMPLETED IN ENTIRETYBY P . E . AND RETURNED TO BOARD OF HEALTH Y RETAINED BY APPLICANT Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is required for every Hyannis MA 02601 3-2-2015 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Darrell Stone use the return Inspector Name of Ins key. P Cape Cod Septic Inspection Company Name P.O. Box 1466 Company Address Harwich MA 02645 Cityrrown State Zip Code 508-240-2500 S14995 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal sal system information reported below is true, accurate and complete as of t at this address and that the me of the inspection. The inspecti was performed based on my training and experience inthe proper function and maintenance of on siteon sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ asses Conditionally Passes ❑ Fails e ds rther valu ' n e oc ng Authority Inspectors Signature 3-3-2015Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection V:Subs.,face Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts '• E Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is required for every Hyannis MA 02601 3-2-2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of Y P p the replacement or repair, as approved p p pp oved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. - The septic tank is metal and over 20 years old*bathe septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic-tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ® ND (Explain below): The septic tank outlet tee is structurally unsound and needs replacement. The septic tank is over due for service. Provides less than 12" between bottom of outlet tee and the sludge level. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is required for every Hyannis MA 02601 3-2-2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑- broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): r C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Insp ection Fonn:,Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is required for every Hyannis MA 02601 3-2-2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 1 c D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is Hyannis MA 02601 3-2-2015 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply_ ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,0009p d. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 i;r t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �. 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is required for every Hyannis MA 02601 3-2-2015 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes or"no as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? an of the system obtained and examined? If the were not Were as built plans y ( y ® ❑ available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information n ' wConditions:Residential Flo Number of bedrooms(design): N/A Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 c Commonwealth of Massachusetts . Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is required for every Hyannis MA 02601 3-2-2015 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 2 bedroom residential dwelling Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d 187.67 gpd 9 ( Y 9 (gP ))� Detail: 2014-62,000 gallons 2013-75,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments <,a m �M 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is Hyannis MA 02601 3-2-2015 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Unknown Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If es, volume pumped: y gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is Hyannis MA 02601 3-2-2015 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1970 +/- Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"+/- feet Material of construction: ❑cast iron ❑40 PVC ® other(explain): Orangeburg Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Apparent good condition Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 22" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 5e' 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is Hyannis MA 02601 3-2-2015 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 10" 4" Scum thickness Distance from top of scum to top of outlet tee or baffle 5 Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Normal liquid level No sign of leakage Concrete outlet tee is structurally unsound and requires replacement The septic tank is over due for service. Provides less than 12" between bottom of outlet tee and the sludge level. Recommended maintenance pumping every 2-3 years Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts ID Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is required for every Hyannis MA 02601 3-2-2015 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Foam:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is Hyannis MA 02601 3-2-2015 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): N/A Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name informrequired is Hyannis MA 02601 3-2-2015 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology.- Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1(6x6') pit with stone Grade to pit 34" Bottom 111" Dry Staining around 18" below inlet No sign of hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is required for every Hyannis MA 02601 3-2-2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts _ . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 222 Bishops Terrace Property Address Fannie Mae Owner Owners Name information is required for every Hyannis MA 02601 3-2-2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately R .1) O O 3 A EB �I- W_2 2 3 33- 10 4 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s•�''� 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is required for every Hyannis MA 02601 3-2-2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >4 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: See below You must describe how you established the high ground water elevation: Approximate elevations from USGS maps Property ELV. 72.0 Bottom of SAS ELV. 62.75 GW ELV. 39.0 Adjustment 5.3' A1W-247 Zone C 24.77' February 2014 Separation >4' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 222 Bishops Terrace Property Address Fannie Mae Owner Owner's Name information is required for every Hyannis MA 02601 3-2-2015 page. Cltyrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. C?.e,) I5 61 Fee ( 6i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitatlon for Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.�I DE,j Owner's Name,Address,and Tel.No. y Assessor's Map/Parcel 1"\ I lj-!� 'rS,g 2 y>vU 1-- 2 1 Installer's Name,Address,and Tel.No. �6 g '(�ro �6.3 Designer's Name,Address,and Tel.No. Lc— ��� J Cu�S•� G(�,s 0 `15(Nte-erIV% ��I S L:kcv-%V�l S h) -Af,t ��s-(�►a/ Q jok y,�s5/3 4Y.Oks Type of Building: Dwelling No.of Bedrooms Lot Size 1(, ,q 6 2- sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.7, 17,15 uir gpd Design flow provided '�3 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) P kke. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board th. i, Signed Date d Application Approved by Date —((� ^/�� Application Disapproved by Date for the following reasons Permit No. �d J o —3 Date Issued — /5 No. /Vl / `l 11 Fee% ( v THE COMMONWEALTH O'F-MASSACHUSETTS Entered irtjcomputer: Rt PUBLIC HEALTH`DIVISION - TOWN.OF BARNSTABLE;MASSACHUSETTS Yes k Zipplicatlon for Disposal *pstem Construction Permit i Application for a Permit to Construct( ) Repair( ) Upgrade(y) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.2 I WVQ�.` C'i L UDAy Owner's Name,Address,and Tel.No. u n Assessor's Map/Parcel l q�°-- /,f (S/� V� V�-c.) I -1- 2 Installer's Name,Address,and Tel.No. S a Q (o ��6 3 Designer's Name,Address,and Tel.No. l 1 ^ /� W0J4-C (-C.) cu 9 1lnt--erlYt � ' 5 l;kctnVtA+(� SA h+ 1 `-ACt, C JOk y09ss/3 wa�/CS Type of Building: , Dwelling No.of Bedrooms Lot Size 16 C( 6 2 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.requir7,153 3Q gpd Design flow provided `3 3 C'� gpd,, Plan Date �� /UNumber of sheets 2 Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) to�„� I .p t-c_k�, kA r e 1 1 � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o th. Signed Date Application Approved by �—e Date (—/1` — /� Application Disapproved by Date j for the following reasons j i Permit No. d ' d 13 Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at 7Q has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer #bedrooms Approved design flo gpd j The issuance of this permit all not be construed as a guarantee that the system will nc on as desig d. Date I Inspector -----------------------1------ --- ------------------------------------------------------------------------------- ----------/-- No. pZ G Irf — 1 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS ]Disposal 6pstem Construction permit Permission is hereby granted to Construct( ) e it( ) Upgrade( ) Abandon( ) System located at Ill/ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date U Approved by i I, Town Of Barnstable I4oF� pr o Regulatory Services Richard V. Scali, Interim Director ABA' Public Health Division 9. Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 i Office: 5 8-862-4644 Fax: 508 790-6304 Installer & Designer Certification Form Date: Sewage Permitn ,A/cam' Q 9,3 Assessor's Map\Parcel Deb Installer; c6Yn S AdOres q 2 W(? �,rnss�t e (d � Address: Ong Css �5 �J CS Mtn CG\,\8o., was issued a permit to install a date (installer) septic system at i (�Cr`'e,Q.e+4x- ���'` - based on a design drawn by (address) �.in-QJ2-rl R �t dated -4 to (designer) certify that the septic system referenced above was installed substantially according to i1he design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I 4 certify that the septic system referenced above was installed with major changes (i.e. seater than 10' lateral relocation of the SAS or any vertical relocation of any component f the septic system) but in accordance with Sta.e & 7 oval Regulations. plan revision or ertified as-built by designer to follow. Strip out (if required) was inspected and the soils ere found satisfactory. certify that the system referenced above was construc�� QF with the terms of he IAA approval letters (if applicable) civil_ ND, , .0 st er's Signature) , ONAL esigner's Signature) (Affix Designer's Stamp Here) i PLEA 'E RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF C 1NIPLIANCE WILL NOT BE ISSUED UNTIL BOTH TES FORM AND AS- BUIL CARD ARE RECEDED BY TIC BA UNSTABLE PUBLIC HEALTH DIVISION. 'I YOU. Q:lseptic esigner Certification Form Rev 8-14-13.doc Y EXECUTI , OFFICE OF E-ti;� T- - > _ Rpm DEP T?t R E T OF -NTAL -FROT Cf0N cs?� TITLE 5 OFFICIAI, E SPECTIO\FORD-'SOT FOR ti OLLT-N-T-ARY ENTS SUBSURFACE SEWAGE DISPOSAL: SYSTEM FORM PART A CERTIFICATION 1 3 a Propem �Address: �/ eYl de 1� tl� �G Doi 6 3�} �- Owner's Name: R h �c r!— ' Owner's?kddress: O C GT r/boro y p/�S� r �'•� Date of Inspection: v ame of Inspector: (please print) / "�GYr�{^%o�f G��i \ COM a--- ame: dF chi O �1= vlailing address: 1190 Qaj,4 oftry Telephone tiumber:�-j �y CERTIFICATION- STATET EIN7 D2rSOna!!V' i nSnecte.d-He sevvaq �� - disposal sysre c� 1S a c 2?d ? below is Sue, accurate gild co=11ete as orLue L,�e of I%z in5l7eCa�0^_ 1 oa' e mi s�L�o_-was- TaiIl1IIa and 2 Ype^_e3Ce i iLe jZOv��i�C o�cLQ iP31IIIeIla C�o on site seviage rd-Lzw-sa S _f I aft a DEP approved system inspector pursuant to Sec on 13.340 of Title 5(310 SIR I .013 y ?asses a`:ses Cond-'&nailli?asses oCai ��_o -- rails luspector's Signature: � ' Bate. 06 i e Systems inspectof siiail STSCi_iit a copy or this i=- er-ton repo:-,to�e_A_:n—mu=-': ^ - 1 -= .�- iJ Y)v+^c !iIl 30 day� C I� SSL'euoI tTZ i je SVSTem.is a s112r�i - d or Qreater. -e _Tspector and the sys=em oWueI sh I Slib172It e r�o-i`0-fie a�:o'�a-w-- y-- ----- P. _ i Ge _ ._ - �� Tze Or gi--sal should serer t0 the S�"Stem O=one_aid copies en_ ;`e= _- _ =- Notes and Corr-renrS "*This i ED02 L Only deSC ibes conditions at the lime of Inspection=? under�e ceaz di_or s f use aI r'Iat nnI??e]]. L his(f inspection does-riot address flow the system wiff perform iTi the iiliure ti der=�2 Sri-?: .;'"3re „- c ondillons of:.use. =__i...l ec. l Pace 2 of OFFICIAL ItiSPECTIO V FORYI-.NOT FOR VOLUI T.AR�� ss cc � s -A- SUBSURFACE s w�c>r nrspos�r. Y-5-r vl -L SPECTIO� FORM PART :� CERTIFCERTIFICATION(conned) Property address: �PV/ r✓g Owner: r�h 7 — Date of inspection: p-b Inspection Summary: Check A,B,C,D or E!ALWAyS complete all of Section D A. Syst asses: 1 have not found any information which indicates ihat anv of-,-"2e failure c_tenia desc=oec in 2 n 1 03 or in 310 CMIR 15.204 exist.Any fa-lure c teria not evaluated are i:� icat d below. C • : Comments: B. Stistem Conditionally Passes: / One or more System corYnonents as describer)in the"Condition _ repaired. The system-upon completion of the replacement or e air �c al��"sects need to oe;ep_aceo or as approved by the Board of H 1 Za_ :YiR�aCC Answer yes, no or not Bete mined(Y,ti D) n the explain for the fol?owirlg statements. '°please -- ne septic taak Liz metal and over 7 j ) 0;ears plc or the sepiic tack(:vhetuer Leta)ar no) ,ansound, exhibits substantial infiltration or extiltration or tank faillre is im. ent, Sys � �;existing tank is replaced with a complying septic tank as approved by the Board of iiealtu. pass M-gDe-,-L he *A metal septic tank will pass inspection if it is structurally solmd,not lealdn---and if a Cernificate of Conmidaunce mdlcating that the tank is less than 20 yearn old is available, �\T'D e.Xp lawn_ Obse:ration of sewaize back„p cr bier out orgII static wa er Ie=,eI obstructed pipe(s) or due to a broke ne msT�"lion =lox-e o tires=n:or n sett or uneven distrl�ution bex system s pass. approval of Board of Health): broken t)lpe( 1 7--ry,I_-A Obstruction is removed distribution box is leveled Cr-replaced ND exr,,2;n: 1 Ile System required pu;niiLg:i ore than.4;tee 7aSS 1nSpeCi1CII if('V`l a s a year due to broken or1. <' :c- - pprova,of the Board of Heai1h): -,--__ 4 broken pipe(s}are rerlaced e J � i P ` aUe OFFICLAL.-INSPECTION FORM-NOT FOR VOT-rw---R- _ r-T Sissy �c SEWAGE DISPOS_�SYSTEM�SPECTI4N �'(3R�i PaRT a CERTIFTCATIO�T(con�:ued} Property Address: �ek-I olS 4-4 Wa ems► ✓'d'i e� /�/� Owner: ��'Gr rl✓� Date of Inspection. o? D 6, V ther Evaluation is Required by the Board of Health: onditions exist which require ftut_her evaluation by the Board or?iealth it order to deg ., .:r?_is faiiintr to protect public health, safety or the ea zronr=ens - 1. System will pass unless Board of Health determines in accordance with 3I€1 CNIR 15-303(.)(bl that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet ofa surface water Cesspool or privy is whin 50 feet of borderins vegetated w-edazd or a salt marsh ?. System will fail unless the Board of health(and Public Water Supplier.if arty)determines that the system is functioning in a manner that protects the public health,safety and eaviro nt: The system has a septic tank and sot absorption system(SA.S)and he SAS�� 1 00 feet or surface water supply or-butary to a surface water supply. The system has a septic tank and SAS and ye SAS is w t1 a Zone i of a 7p, Lc vate: ? ry — The system has a septic tank and SAS and the SAS c .; is�,a: - _ The system has a septic tank and SASS and the SAS is'_ess>� 11C feet but ;10 eet or mom sQ-a private water supply Weil"*.Method used to determine�`ctar his system ce tsle passes if well water analvsjs nerpt�t, iILU sac era z :l r ved a'a�21 e abc-atc��, Seri co=?=o u vox4L: e Ofgan.ic co'-mmounds ies that` - dS inCiCa' � ell iS e presence of a7nrnor,ia nitro 3 TQrar �tC'_it. geu'�and r..zate nitrogen is equal to or less 1, ,z— ai ure criteria are 'asereci A p e the aanalys s must be an ched to dHs fQ �. 'ther: p2Ee? of l? OFFICIAL ENSPECTION FORtiI—\OT FOR VOLUNTARY ASSESStiI 1'I c SL 73SLR" FA- � CE SEWAGE DISPQSL SY_S-I-E-M INSPECTION FORM P_4RT A CERTIFICATION(cont;nnued) Property Address: Owner: /fie g r .,� Date of inspection: D. System Failure Criteria applicable to all systems: You must indicate `yes"or"no"to each Of the followine for all;',zpectioru;: Yes N o �ckup of Sewage L.to facility Or system component due to overloaded or clogg J S or ceS y00 Discharge or ponding of e fluent to the surface ofthe ground or sarface'•4ater'S cue to an overloade or ogged SAS or cesspool Static liquid level in the distribution box above outlet invert,due to an overloaded or c7o�Ged S- S,,-�sspooi , — v §uid depth in cesspool is less than 6'below invert or available vo_hLe is Tess than day=3QG Required pumping l�es purnped more than 4 times in the last yea- �OT due to clog-ed or acsL:c-ted pipe( ). � r0, 11 Of the SAS,cesspool or privy is below himGTOund water ele aeon � Y Poriion of cesspool or p by is within 100 feet of a surface eaters ly Oa �u ry to a s-=ce water supply. - - _ Any portion of a Cesspool or privy is within a Zone I of a public well. ricy y portion of a cessgooI or p is within0 feet of a private wMter srgly wey y portion of a cesspool or privy is less than 100 feet but greate than 50 feer=cm a aliv e w=t�-supply well with no ace - Ta - zble water .. eP cttalitr arai-sue syst performed at a DEP certified laboratory,for colifo bacteria anem d volatile tihor�e comnattuciss, indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or Iess than S ppn4 provided that no other failure criteria are triggered.A copy of the analysis must be attached to this fbr€n.l The system fails.I have determined that one or ire of-ire abQv :; _ described in 310 0YM 15.303.therefore the system f �' v`�L`e "`ems eYui as ails. t �=e ss2C 3_L OLm.L":}e *3J�uQ Ji Health to determine what will be necessary to correct the fail-tze. .E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10.000 to iS.JO{} gpd. ou must indicate either"yes"or"�o"to each of the following: The fOilOW'iZlg Criiez'1a aTply z,0 large systemas in addi'or to the c t--is above) _c :he syste.-.1n s )._thin 400 feet Oi a surface dnaking:rater suj ... JlTJ _ j .he Sys e�_s 'N_thin 2100_ et Of a butary t u o a surface sil:;{i; - rhe SySte P 1S located;n a nitrOgea, se:lsllly e area rote:Lm 44'�Ii1es�P_r Zone ?l of a pue1=C water sDgpiy welt Jou have ansvve.- - e0 yeS 10 ariv Gsze -'u,S Ou ` _ _ -C• _, .\a/`zoo, D abo-ve .Le . 1�t JecLVn ilia.J�J!eu,��vV:ia11L\.L L.v G - or,7, - r -stem "as _leg. ! Oi e*Gr --. rh ear Order SeCPOII F - -- D" ato - - ed a ^^'= "sr- o- fa'1 ::Eder Secto s all ;�,a^ I-T v'.:a,-r Should Co - UPL-ad,, c-yr=r ` _ BTaC.else apgrODTla zi eora' re r �: o__isce of = aC• �_'_ _�� -- y' ;J e -- - -- ?age of 11 OFFICI_AL INSPECTION FORM—NOT FOR VOLL--'N'T_A.RY SS SS VIE TS SUBSURF_4CE SEWAGE DFSPOS_AiL SYS'TE�ILtiSPEC-rj-SC)FS SSYfO VI1 PART B CHECKLIST Property_ Address: C�- AlQ'/Ne T 4 /G? ,! - Owner C:�4 r, yr n Date of Inspection: / ag 0-(, Check if rile 'O iC':v',^v gave 'o en done.You must nldlcaie`�,es7'or;`;i0'2S`C caC J >0�0 v=tc _ �P'-!=! o in_or a on'.vas Dio4.dedby'?e OC4�1er;OC^ 'anT__ Or 02rCOf e?= Were any of The system c0=onents punned our=in the prei ious - o:v=ess ? - y as -he sv,tem received nor=nal`lows in the previous two weelk period? rave large volumes of mazer been introduced to the sv5_ern re-cen-J e_as pa_z v_=-�-;z.�C�O `,'v ere as'built plans of he system cotai�ed and examined?(T z! . were nat a-a-_ahte=ere as N_1) Was the facility or dwelling inspected for signs of sewage back dp? ✓— Was the site inspected for signs of break out? Were all system components; excluding he SAS,located on site? Were the septic tank manholes uncovered.opened,and the .tetic_ ��e k _wee_.�>or-fie c T r OI r, a ] 5 _ o f_OL or Ldmaterialies or zees. material OI Coustruc30n. dirnenSions,dep-h of.Lqu;�de iH of SI=3d e` epth Of X�= c/"a Was the facility ouT.er(ant? occupants if di�'erent LeW O lei);,04 3ed-_"h . _tv --Cr��on on`tee-:C v = maintenance of subswface sewage disposal systems? i' e size and location of the Soil Absorption System(S ASS,}on-fie site has eL deter- hem on. :es0 ucn cis se,a plan at the Hoard of Health. Determined ill he field(if anl'Of the faille Ciiena related t0 P=ii C S s-�_de aDD -^'0- _s unacceLtabie) i 0 Cti1R 15.302(;)(b)j --- Faze 5 of I l OFFICIAL, I\TSPECTION FORM_tiOT FOR VOLUNT: rE SUBSURFACE SEWAGE DrSPos_aL sYsr tir r SpE -flS SS ��S P_4RT C ''77 SYSTEM n'TORAATION Property Address: c� l -XiPr, cj,99, Owner:_ Date of Inspection: RESIDEtiTIAL FLOW CONDITIONS �4��rti y dumber of beCrCO_^1 (CeS:QT I:37 nbei Oi be liot ms,.ae:u2lt. �3v '� DESIGN`low based cr: = 0 C `_R 15.203 (for exa* Ie: 110 pd x_of bedrooms): dumber of c,�*-ent reside^ts: 0 - Does residence tea-:e a ?a-ba_e Winder r,•ves or no): Is laundry on a separare sev.ace-sYsterr?(yes or no):.. 1W iif yes separate:'sr'ec�on r �e^ ed Laundry syste. respected(yes or no): Seasonal use: (yes or no): Qf — Water meter readungs_ if available(Iasi 2 years usage(gpd)): St1ITlp pump (yes 0--_ '. AV Last date of occupancy: CO NtNTERC1ALil_D L STRI_A,L 1 yroe Of estabiishmen-t: Design flow-(based on 3l0 CtiLR 1�-20�): a,d Basis of design flow(seals persons/sgftetc.): Grease trap present(yes or no):— Industrial waste holding tank present(yes or no):— on-sanitary waste discharged to the Title; Sys,em(yes or no):— Water_Teter readings, if available: Last date of occupancymse: OTHER'describe): GENERALr�TORNAATION Pumping Records Source of information: ,vas system pumped as par of die insp tion(yes or no): /(IV If yes, volume pumped:-gallons--How was o'aanftty ed �L Reason fortlint}ing: TYV�'T SYSTEM di.st_rib_tiC-',- sod abs^ d + vier on system Single cesspool _Overfow cesspool _Privy Shared SVSien1 l JeS Or no'j (if veS, aiaCP previous?n'ST)ecLton reCOrfS, ant`).nu o/ative;:AIte naiive Technology. Attach a copy of e can-em eneraden and_ �;�_.-C obtained from system cwrerl _ -o- ct; c= -,an- AiaCII a COD'v Of fye DEP 2Dproval Oise*;desc-^.be): 'alli "i Gne^t LISLaHeC(II:LT1C'.i^1 i aitG�O i'CP^' = _12 at a:e S, or Page _of OFFICIAL INSPECTION FORE-NOT FOR VOLL.��N-T�2��ss�s SL�SLRFACE SEWAGE DISPOS�iI, S�'STEYl SpECTION FORM PART C SYSTEM LIFO VI TION Property address: p7 Owner: Date of Inspectio a 8 0 BUJLDrtiG SEWER{loca te n zite play,) Depth below grade: A Materials of consturucao t ion �o PV C Distance fro _other(exg±air,)_ m pr: ate warer surpiy well or suction line: Comments (on co^cition of Joints, venrng,evidence of lealtage-etc.)_ SEPTIC Roccf}ate�on site plan) Dervh bellow grade: /0 � vtarerial of construction: 'concrete metal 15"—'1ass i„ other(explain) — — ---diylene " tank is metal list age Is age con5irtned by a Ce certificate) ` — rticate of CarmT?arce"vas or no): (aL_ach a cen--o; Dimensions: S x — Sludge depth: Distance from top of sludge to botton of outlet Scum thickness: tea or bali`1e; �_ Distance from top of scum tO top of outlet tee or bade: Distance from bottom of scum to bottom of Dull *ter'or ba HOw were dimensions determined: ,ale Comments on �q --r ( pumping recommendations.filet ou let aS related t0 Otttlei invert. evidence Ofleakage_ -Lee Or 72�_e COLA=OL ^�''► �✓ G;... �S, etc.): `r t GREASE TR p: �<care on site plan) Depth below grade: -aatenai of conQL-Lcticn: concrere petal rQ (explain): _ Dimensions: - Jcuna chickness:_ Distance ". r0 p Of scum tO LOp of Cutlet teae or ba_le: Ds ante from bo tom of scum to boLton of outlet tee cr b—ji Jane ofast p„rnping: �> Comrre nrz (on pumo n¢�r ecorrrLeLdarons. n'et and o rle-tee 0-L.�tMe as related ro cutlet r<ve t, evidence of?eakage,etc.): Page 8 of I I OFFICIAL, INSPECTION FORM-NOT FOR tiOLUNT-ARY ASSESS N�IS SL'$SL RFACE SEWAGE DISPOSAL Sy:-- ,T€-NfL15F'ECZIE3 FORIj PART C SYSTEMINFORNLATION(coutnued) Property Address: 12 - ✓t Owner: Dare of Inspection: Q( TIGHT or HOLDING T�,NK:/I�(t- n o r ist u�ec at�e ar insn.�natl(z^care on s__-r;T_~) Depth below-grade: Mate al of con stacron: :onc-ete metal tfoergassg-= Dimensions: Capacity: -allors Design Flow: gallons day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float svv-tches• etc.): DISTRIBUTION BOX: C (if oreseLt atilt be opened)(locate on site ply) Depth of liquid level above outlet invent k1Q.-Vl1 y Comments (Hate if box is level and distribution to outlets equal_anv e-v?dence of- ds c - `<;_� r,;e_-`y_c leakage into out of box, etc_`: - ' e o o Zee/ - /rio S'd PUNIP CHAMBER: eoo cate on site plan) Pumps in working order(yes or no): Alarms inworkin_2 order lyes or nod Corrments (note condition of pun rp chaTnber.condition or-pumps and a�n; Page 9 of 11 OFFICI_AL INSPECTION FOR VI—NOT FOR VOL.L7-,N-,T�2Y SSESSA.IENTS SUBSL'22FACE SEu%AGE DISPOSAL. S�'ST'E�r�s��;E-�-�©� ����� PART C SYSTEM I\/FORVLaTION scan-n_�d} Property Address � Cep ��, • P, /��¢ Od��� Owner: o•�I bq Date of Inspection 0 b SOIL ABSORPTIO-N SYSTEM (SaS):_(locate on site plan,excavation not required) if SAS n of located e:Kc.lain, hv: Type �- leacnins pits, rum,ber: leaching cha.nbers. =--nber: ieachmg galleries, r_urnber. �/� syc leaching -tenches, rurriber, length: leaching nelds, nuriber, dimensions: overflow cessr_.pol, -illmber: mnovai,veialternarive system l ypeInane of tecanology Commenrs (note condition of soil, signs of hydraulic failure,level of pon d- g, i ii da�^p soL,c..-�ron c= AI D CESSPOOLS: k(cesspool=ust be pumped as par of inspzcdorl(1_ocate on site-oi Number and conTiffuration: Depth-top of liquid to inlet invert: Depth o'solids layer: Depth of scum laver: Dir tensions of cesspool: Materials of constr uc-ion: uidlCauon of grour_dwater inflow fives or not: Cetnmens (note condiron of soil, signs of ll'ulic failure,lLLei of-pr ding,coed-io r- et0 _ o PRIVY:klocare on site plan) Maier a?s o`cons-goon: Dimensions: Depth of solids. ._ts !^Ot2 -o_r_r ir:c of so , of C a� _ ._ 01 or'CLLr ^r �' CQ _ = -- _ _ _ Page 10 of 11 OFFICIaI- I�SPECTIO\FORM-'NOT FOR VOL:L-'T_�RY ASSES .fE TS SUBSURFACE SEWAGE DISPOSAL SYS�E � sPc�ror�z� PART C SYSTEM LNI TORTNZATION(ca,�r ue Property address: dB/-4 Ge.- ,-viIle, /lam/f Owner: Fe-e;ik��C�fDate of Inspection: ,6 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the se`L'aze disDosal systern Lcludin_ties to at least two perm: =eii _ =Ce c_ ..Li o_ benchmarks. Locate all .% i 00 feet Locate where public water s-u=!y n=e=S V- oZ I f - �3L /27 `f 3 9 page 11 of i 1 OFFICIAL INSPECTION FORM—VOT FOR VOLUNTARY ASSESS_NIENTS SUPStiRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM E FORD'LATION(cc } property Address: C12 �' �� �-4 t"�,_ p-vvner: i�rt Date of Inspection: of 6 0'6 SITE Slope Surface water Check cellar '' nn V%/ Q Shal!w., we11c Estimated deLtr to •_-ro�ud w-zter / / met Please indicate(check) all methods used to determine he nigh c-om_d water ele.a=ou: Obt ed j om system design plans on record-If checked.date of des ar?plan re 1e ed: served site(abutting property/observation hole wi 150 feet of SAS)Checked w-itn local Board of Health-exolain: N' o`� � /� �o/[7/ Checked ::'4r1'1oral excavators;installers- atEach documenta on) Accessed USGS database-explain: You must desc be b you established the Wgh sound water elevation: I 0C . T10 , 1 ` w SEW CE P.ERM T NO-N I 1 LL �G 1 I6SjA L.L_E.. 'S NAME i ADDRESS c� R I L D E R 0WNEX.. DATE PERMIT 9SSUED: DAT E COMPLIrANCE ! ISSUED � � �► CtVit. '1 ►�o % -� i t a i � 4 1 w _ No...... . . `7811 f - Fss D ..... THE COMMONWEALTH OF MASSACHUSETTS �� �►+a q EOAR® 'OF HEALTH OB ,� o- ..................O ' -----------•--------------- F. G 5 1 ppliration for Elhipoii al IVnrkii Tomitrnrtinat Vantit o G tion is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal .. ...........1_111.0 ...MIX_......._.... N..o. Location- essLot 0 r. Owner Address •--- --••---••--....-- Installer Address Q Type of Building Size Lot------- ..Sq. feet Dwelling—No. of Bedrooms............. ..........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ... W Design Flow.................! ................... per person"p9 4r day. Total daily flow................a 3-0...............gallons. WSeptic Tank—Liquid capacity".gallons Lengthb'!-�6___" Width. =�16__ Diameter---------------- Depth--er)1-=/&./' x Disposal Trench—No..................... Width.................... Total Length........... Total leaching area....................sq. ft. Al Seepage Pit No------/----------- Diameter__��'__6_._._. Depth below inlet..6_.=0.._._._ Total leaching area._I . '. 49 Z Other Distribution box ( �� Dosing tank (- ) '-' Percolation Test Results Performed b�L i `! '*�� VC............. Date.1 6_4 Zf�'.V. �� Test;Pit No. 1-----Z.......minutes per inch Depth of Test Pit.-f .___.__ Depth to ground water ✓o%"t_� f✓.�v.�.r. y�,� 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ - ------- x Description of Soil.... ---..-2$_......... �' .--f V -------------------------------- ---------------------------- •-------------------------------------------------------------------------- •--------------- ------------ •------------------- ---------------W 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 Movisions I I of HE 5 of the State Sanitary Code— The undersigned further a e not to plat e ystem in oper on until Cer to of Com lia as heem issue b)Lthe board of hea • ,,�te A ication Approved By.......... --- . '- : ._..._... ....... 2�i ° ............ --Date Application Disapproved for the following reasons:--•••--••---••----•---•----•-----••------...---•---------•---•--•--••-----------••-••.........................•- ----------------- --------- •------------------------------------- ---------- ------------------- Date Permit No............ J� 2 ............... Issued....................................................... Date Date w THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..o........ ......................OF....... �!'.✓ �,�'..6.e........................... Cwrrtifiratr of ToutpliFaurr THIS IS TO CERTIFY; That the Individ al Sewage Disposal System constructed ( ) or Repaired ( ) by.................................. ............................................. Ic '�(��Nl------------------------------------------------------•----.-----..------------ Instal ler at.................................................................................................................................................................. has been installed in accordance with the provisions of Tit . .. ,oi The State Sanit-sry Cod . as described in the application for Disposal Works Construction Permit No........ _ ` �`...... __. dated = . ,/ era "' THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. t DATE...................................... /`;r'_ .............. Inspector-----------.-•- -•---••---------- - ' ... .:_.::�..............- ��.1. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �^ � ✓ rZ '� " ....................... No.--- ............ FEE..-..a„:. - ,,- ( -= .Permission >.s hereby granted...----=—J=-----------•..............•-••-•-----�------------------...----------------�� -------...._...........-•------- to Construe (4 or Repair ( ) an Individual Se =age Disposal System o�- Ce ._V w. at No......... --•••--••-•----•--•--••---------•-•---••--•..�� .._ - Street � Z as shown on the application for Disposal Works Construction Perma No''`.. �� " Dated.._ 2���__... :., Board of Health DATE............. — = ---...... .� FORM 1255 HOB S & WARREN. INC.. PUBLISHERS Fims.::- ............... THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH R ...........OF..... &UZ4 �. : a pfiration for BWVviia1 Works Lu�ts�r�s�tuu rruti� tion"is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal ................ . ............................. ----------......---------'�- -------- ................................................... d' Location-A [ r ..9�✓,!. . el .. ........................... �f'� �ld f�^b°s �' r E�'. /77„�//,!`�✓. i! _/�!,C � W Owner Address / •--••----...-•------•--•................ Installer Address d Type of Building Size Lot-------�.��_..�.��._�..Sq. feet Dwelling—No. of Bedrooms..............3..........................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .......................... Design Flow..................55..................gallons per person per day. Total day flow................ ...............gallons. Septic Tank—Liquid capacity/4 h .gallons Lengt .-_&_ Width--4_--/4.. Diameter_______________ De th..S.Aa_..Ie Disposal Trench—No. .................... Width_. Total Length_........o........ Total leaching area-___.----____-------sq. ft. Seepage Pit No....../----------- Diameter../1r�. -a _. Depth below inlet__..__....... Total leaching area..-. Z Other Distribution box ( A-�r— Dosing tank ( ) aPercolation Test Results Performed byr 4 `_. _5� . Test Pit No. 1-----2_......minutes per inch Depth of Test Pit---1,04-__`--- Depth to ground water/ # .e✓✓Chi .c rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit................_... Depth to ground water....................... a //------------e-i-------------- -'•-------•- . it / r.... . '3 ODescription of Soil..... .� -- .. x �^ (� ..................•....... ----------- -------------••---•--•-•------•-•-------------••----•---•-------•-•----•--•--------•--------'-----.....---•••------...--•- W x ......................... r--•--------------------- ................................................. V 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 iITLZ 5 of.the State Sanitary Code— The undersigned further a .r'e not to plat he ystem in operation until a Certificate of Compliance has been issued by the board of Ilea Signed ------------•-------••----- ----------- ' .... Date Application Approved By '`-..._.. ..._ ... .� -....................................... ...........d....._.. ..-'w1............. Date Application Disapproved for the following reasons:-----•-------------------------------•------ --------------------------------------•--•. ......-••---•-•--'• ............................-............................................................................I---••--------•-------•--•--------------•----•-----••••---------••----•-•------•--•----•------•- Date PermitNo. ..`.�� --------------- Issued_..........--------•--------•......-•-......-----'•..... Date APPLICATION FOR P'E/RCOLATION TEST AND OBSERVATION PITS ,J �CAI�ION �Q� 9�GI�,�/D�z►,tj�v — NO. �]84- _ I LLAG E Pf111619 _ DATE 1)PLICANT 0"*Y%&1-0a1dL"5 4'E• n 71- f7 FEE__ !)DRESS/G¢7�V,9W07# 44v <4-9ea) �l I&AI1S• TELEPHONE NO. 71i�-� (Non-refundable) ?GINEER ,&W/ Ale. TELEPHONE NO. . 440-d 3 7\TE SCHEDULED AkY -?,- 8 _ (Applicant' s signature ) • . . . . . o . . . . . . o . o o . 0 0 0 . o o . . . o . 0 . o . . . . . . . . o . . . o . . . . . . . . . o . . . . . . . . . o . o . . . o . . o . . . . . . SOIL LOG l � 'JB-DIVISION NAME O&S-51 DATE /i/M Z7i ��� TIME 0.',361 ::PANS ION ARE YES NO _ � rJ)(/ �/6i,�/� C 1,V C. ENGINEER ,)WN WATER `� PRIVATE WELL ,�Q BOARD OF HEALTH ,CbQ(�jQ1Ji¢T/Q,ZJ EXCAVATOR I:ETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in -proximity to test holes ) NOTES : l0L'k/l'ET11 WA 7� 15 /ao 36 O /OU "'RCOLATION RATE: Z ,Q 1.:ST HOLE NO: ELEVATION:— - - TEST HOLE NO: ELEVATION:' To YC 1 2 suasoi� zy,, 2 3 3 — 4 - --- 4 ----- 5 /11F-AiVM 5 6 5&j D 6 ---- --- 7 7 _ 8 8 10 - 10 11 -------- 11 12 ►�4„ 12 13 - ND Wl3TR 13 --- 14 14 15 15 16 16 I.IITABLE FOR SUB-SURFACE SEWAGE : LEACHING FIELD LEACHING PITS LEACHING TRENCHES '/!SUITABLE FOR SUB-SURFACE SEWAGE . REASONS: ')TE : ENGINEE'RING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ::1GINAL: COMPLETED IN ENTIRETY BY P . E . AND RETURNED TO BOARD OF HEALTH ;PY: RETAINED BY APPLICANT rs ' l LEGEND N Ra Rd Ced<ic \,°td EXISTING CONTOUR ® �� x 98.93 EXISTING SPOT GRADE ecinct Ra pce���Gc Ra -P° �� d PROPOSED CONTOUR �� N• pf 5 %�o re°{Eet R W EXISTING WATER SERVICE H� cinct o -�.H.Imo— OVERHEAD WIRES ^� 5 p`e LOCUS 5� TEST PIT BENCHMARK erlaeh O M osemory \-o ef� f R - o ° DU^cO� A a LOCUS MAP NOT TO SCALE x 102.70 N 60149'46" E x 101,2 1 d0.00' 0.00 F %P x 101,93 102,02 x 102.54 �J J LOT 6 \ MBLU 148-154 16,962 ±SF \ I \ x 101.6 I x 10 2.2 9 SHED \ � N O � N _.. -..... - o _. .,_ .,.. - -_:•,. � c0 102,86- 102 47'- 102,30 .DECK- . STG. � .- . .. � N x O O Z N II 103,08 x mI - EXISTING HOUSE(#21) TOF=103.81 x 102.75 x \ 102,72 U 1 Benchmark Set `� " B3.55 M Cl- OUTSIDE CDR./BOTT. STEP EL.=103 55 x x 1 i 10 OA O EXISTING SEPTIC TANK 02.20 .` A '^ ..4 �;:.. 8 TOP OF TANK, EL.=101.68 O IN (OU 1)=100.35f x 01.84 EXISTING LEACH PIT TP-2 TO BE PUMPED, FILLED + WITH SAND & ABANDONED CB 101, x x 1 .64 I 101.09 100.98 100.00' "Y00:08'", 100.40 S-60'49'46''W— — ja$- — 7CB - R0 100.10 99.96 99.63 99.42 edge of pavement 99,25 99.00 MERIDETH WAY o f MAs�q�ti .. o PETER McENTEE PROPOSED SEPTIC SYSTEM UPGRADE PLAN CIVIL N No. 35109 21 MERIDETH WAY, CENTERVILLE, MA REGISi- Prepared for: Lisa Cozeault, 21 Merideth Way, Centerville, MA ,oP ES EN6 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. / CAZEALLT, DONALD & LISA M Engineering Works, Inc. 1"=20' P.T.M. 132-15 21 MERIDETH WAY 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. CENTERVILLE, MA 02632 (50$) 477-5313 4/10/15 P.T.M. 1 of 2 a .r 0 • 4 a N �r a NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:99.5 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BOX PROVIDE TWO ACCESS MANHOLES TO WITHIN 3" OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & COVER pF FINISH GRADE FOR INSPECTION PURPOSES T.O.F.=103.8t SET TO 6" OF GRADE F.G. EL.=102.6t F.G. EL.=102.8(MAX.)t F.G. EL.=102.Ot F.G. EL.=102.5f /MAINTAIN 2% GRADE (MIN.) OVER S.A.S. ts2714iCH J L = 16' 5' S=1% (MIN.) % (MIN.) 4"SCH40 PVC 40 PVC 6" 10"I " as A 6a 14" 9B8a689 EXISTING 48" LIQUID INV.=100.35t aaaaaaa LEVEL4' 4.8' 4' GAS eaE INV.=99.27 INV.=99.10 PROPOSED D-BOX EFFECTIVE WIDTH = 12.8' INV.=99.00 EXISTNG SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-10 RATED 3" LAYER OF 1/8" TO 1/2" DOUBLE WASHED STONE TOP CONC. ELEV.=99.8t (OR APPROVED FILTER FABRIC) NOTES: BREAKOUT ELEV.=99.50ftmmmmmmm Al , INV. ELEV.=99.00 mmum criaBaB 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE aaaBa aaaae INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=97.00 ° 2) D-BOX SHALL BE SET LEVEL & TRUE TO 4' 8.5' 4' GRADE ON A MECHANICALLY COMPACTED SIX 4' OF NATURALLY OCCURRING VARIES-REFER TO SKETCH INCH CRUSHED STONE BASE, AS SPECIFIED IN PERVIOUS MATERIAL 310 CMR 15.221(2). 5' MIN. SEPARATION TO G.W. t 4" TO 1-1/2" DOUBLEN 3) INSTALL INLET & OUTLET TEES AS REQUIRED. NO G.W. EL.=88.2 - LEACHING SYSTEM SECTIO 3/ WASHED STONE 1 4) O OUTLET TEE. SEPTIC INSTALL A GAS BAFFLE ON THE SEPTIC SYSTEM PROFILE ;1 GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL ,EXISTING BOARD OF HEALTH AND THE DESIGN ENGINEER. HOUSE#21) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS TOF=1O3.81 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR = TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE C� DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING n/ N FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN (0' �p ENGINEER.,BEFORE-CONSTRUCTION CONTINUES.- 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 0? P 55.3' 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF d N THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 60g '51 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 1 PROPOSED 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. I I 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS A.S. AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. - -- 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY S.A.S.LAYOUT THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND SOIL LOG REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. DATE: APRIL 6, 2015 (P#14,652) 14. THE ENGINEERING IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SOIL EVALUATOR: PETER McENTEE PE(SE#1542) SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. WITNESS: DAVID STANTON R.S. HEALTH AGENT ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH 102.4 A 0" 102.8 A 0" SANDY LOAM SANDY LOAM 101.7 10YR 4/2 102.1 10YR 4/2 8.. 8.,B B SANDY LOAM SANDY LOAM cJ' 10YR 5/8 10YR 5/8 -I�-12.g� $ 99.9 C 30" 100.1 C 32" _ DESIGN CRITERIA 1 r 3.7 -FT PERC `n 1BOTTOM AREA -F NUMBER OF BEDROOMS: 3 BEDROOMS SOIL TEXTURAL CLASS: CLASS 1 1 320.0 S.F. 1 N M-C SAND M-C SAND L- - -J ! 2.5Y 6/6 2.5Y 6/6 DESIGN PERCOLATION RATE: <2 MIN/IN 1 DAILY FLOW: 330 GPD 1-21.3'--1 DESIGN FLOW: 330 GPD PERIMETER=75.6' GARBAGE GRINDER: NO SAS DIMENSIONS 91.9 126" 91.3 138" EXISITNG SEPTIC TANK: 1000 GALLON CAPACITY SKETCH PERC RATE <2 MIN/IN. ("C" HORIZON) PERC RATE ON RECORD 10/24/84 (IN SAND) LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF NO GROUNDWATER ENCOUNTERED .74 GPD/SF PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 2-500 GALLON LEACHING CHAMBERS IN SERIES SURROUNDED BY 4' DOUBLE WASHED STONE-ALL SIDES 21 MERIDETH WAY, CENTERVILLE, MA SIDEWALL AREA: 76.4'(PERIMETER LENGTH) x 2'(EFF. DEPTH) = 151.2 SF Prepared for: Lisa CaZeaUlt, 21 Merideth Way, Centerville, MA BOTTOM AREA:............................................................................ = 320.0 SF Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:.................................................................................... 471.2 SF Engineering Works, Inc. N.T.S. P.T.M. 132-15 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 4/10/15 P.T.M. 2 of 2 > i.+..• , -t. d. - -.n - '=v .am,.'Srn.n..� (F, w:::f..N er vs-.kw...�a,r.. aed...,,. y,...,lYx�•+.#41. wcu.'.:vey"Y�.-s'•� cw +pU,.1.,....•^,4 5.. eti•.*.�o,.'tk. �.^J'.,r. . t w , ..J. . x?Aa.� ..t ,, .,. twnrv:: - ...+.tY...rl- t.:. , ..n.. „, d..a a.4,„,.w:pe. .d.,!a idEa45.. .n.xY. W .kin: eti...ti•W R�•».^'A X •.,.1 .. •I s.rw..,ov .» unr.•.+.ww,..a✓.`...a,. .,�:ar, r..s.... e e .. 'wx.•Aar+•,�y;q,.a...m+Nsw..-n,. a:Y+..a'. '. .,,..: ,^.WaWllxn wer=+r�;e,..,••+as,r.�*r:�.,'...wswm.,Yw:r.<•,.�a..-,•,w•::M•exw R-::;.,»�*n�.r-..y..:,v."nxcae. a.r 'v�. ,x-,iu•.3�..dn,:Aw-.x...u...y,r:+.,.,+n,.,v.•q�:�wy*>N,.us-✓....,...a.,+tta,v)rr.,fY,on, +.%v�.o,u....+•+uNgwmh,+ns..r..�M^a�ro^+'WMI m+Hlrw ?:Aaa.dfu +wa• .w=.rsm r.�W.k r wf �1a se• 41'� - - 'a , t t- J T y+5o f ,4,3L0 0,447 41 f 44 � � r ,.._. �"�rq{r�^ �/' s,!- � ,yr+r�t �/mow �Y ' AJJ� •Y1/t"TT`t�`', a�z r��"4�� 1'"X.� �3+•4ayt'^��I�i,.*'J�F�a.�. ,t' 3 / � /�/fj r�/�rvrY tFJ sri� •»�•,+v. �,�w„-.+�'a. rr.:q,. .... �.,., „ 1400 •���flv;dt�' ..e.....a.. �.. Y� :.oaf �"'•4,,, k { L .�- ,�, �,+Y � .�4 �� '+ l �• , V; _. .kt. 2,0 �19 -a..1+_-.,�'t b,a&.. - �•�.. ,� :r." .SA. •t, -.5' -� ,�:. !f ,. A�J.� ;,�� �/0. - ' _ i.* ^ //ii '��,��*// •'•��j /j� [/'�Q j� �7'."T- ti.` , �: _ - - A.k'�'.��. ..J�k1.� r?"'i�" „ vi. .,r,, �.'C:. r!'.. "" �,y.. �•fl r'.Y_.. A. r. 3 _ rir..-HV�.+...{� �'f l /�l!/l JJ .. �"�or'�` �,•- •i� C �"� � ,s :y r�a .t ip^ )�.� .,. �.,,;,,;, Y. 1 "•.,,� ♦,.f,.y yy„ f .i::.l.J�.. .r'7. 4'f, `� - i3 .r !' ,i) N �,: , � ri2re� M' } kt'n`•. " '. '. A, l "' ' 9. ,. .... .N. ,. '..r •$'; .. ,r .,. .•V' _ - - Y,( _ !,r d'x faT a1.. 1 ,. NOV 27 1984 r 1 �����. ��&�. �' X �-cfhi ri,r a. 'F .�; ) '`s:. A•' 'J fj.t,s",� lY�•1 r f i r- i.. x .. fL--)4I(1 a...� . Aevcw ,� - 4 �l H -- ri�erl Fad �" I� s , 4" �o , k a.r....,+..,°..r�—� t - f r {+�s ��,{•JA•'r�' 5y� y-• A' , {:�'J, K t.t.• 7 ..rr r y,I �'--- '� ^�� j s! ,.r' A r'' /r ,�„1 .`f,�{� .,,ice' ,�4• �' �"'r� '� r�,.,{� �.'�4+I.•��r {,/�'� � : �" a 001, 3 6-9 OF i �' '-,�1.�.�,,. .Nw..dAlk`4!.N`,i.r✓.aR bAiMN-+�Y�,.,1,:.y,. 1�to . r 4 ie r J'^ X P '�• d._ .J I �y:t A 3 1�•-�}W} j�+• �'�" ,> j�f ,-•�,`. - _ _ '. , ... Y,• \ - ,sr•. ,r'� w.', .4 ,by ,r.... �.nt-t;-4 .:r,;r;:- ...T i ,,t'r r:"_ G V - . tic • � � Ns) { 27r 5X� A* � 3 f .