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0034 MIZZENTOP LANE - Health
34 Mizzentop Lane Cen'terville .r 247-059 F� L„ S M E A D No.H163OR UPC 10259 smead.com • Made in USA �J TOWN OF BARNSTABLE !/ LOCATION I-ZZNTOP EWAGE# `'y�LAGE ASSESSOR'S PARCE INSTALLER'S NAME&PHONE NO. G SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) 3 NO.OF BEDROOMS OWNER d w PERMIT DATE: COMPLIANCE DATE: 3 6ZI 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 an wetlands exist within 300 feet of leaching facili Feet FURNISHED BY Al' TOWN OF IBARNSTABLE LOCATIONMIVIU:�W �qff SEWAGE # VIL,LAG SSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER w PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1 ` 44 AD U .A �G y �1 ,/ TOWN OF BARNSTABLE ,OCATION 37 AAz ze4, 7�v Z N SEWAGE # Tf1rI.AGE / _�_,___ASSESSOR'S MAP&LOT NSTALI-ER'S NAME&PHONE NO. ;Els'I'%C TANK CAPACITY Ce SS Qp .EACH NG PACILITY- (qV) Ce ss v0 / (size) L x f 10.OF'BEDROOMS_ 3_.._.......r....,., MILDER OR OVvTWLR 'EIMATDATL. ' _ COWLIANCE DATE: leparation Distance Between the: Aaximum Adjusted Groundwater Table to tht;Bottom of beaching Facility �. sell 'Nate Water Supply Well sand Leachir7g l:,acility (9f asiy+�clls exist on site or within 200 feet of leaching facility) idge of Weeland and L.eaclting Facility(If any wetlands exist within 300 feet of i acting facility) cot U,urnishcd by .� � �`��, :�lru � ; ... f O � e 30 6 " I` � No. Fee �® „fT Entered in computer: TT THE COMMONWEALTH �bF MASSACHUSE S Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYitation for Mispozal *pstrm Construction Vermit Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address gr Lot No.3Y /z e Owner's Name,Address,and Tel.No. Assessor s 1GIap/Parcel Installer's-hlame�rA;ddress,and Tel N . /�/�tt) esi nN�yA,ddr�ss,and Tel. o ✓ �I �OD'�/<O G Gi / ''�(. 9�-6/0�/� �,1� Tc�^ iEJrc 71 Type of Building: Dwelling No.of Bedrooms Lot Size _20Y7;� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .�� gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title �- (� Size of Septic Tank ��/�?9d / 7>f kpe of S.A.S. j —ARC ��g ;�o•�J Description of Soil Nature of Repairs or Alterations(Answer when applicable) lS 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 bC of Health. .. - Date ----�— 3 Application Approved by Date Application Disapproved by Date for the following reasons Permit No._ Q/ ri, "'� Sp Date Issued No. �� 0 Ll Y Fee CJQ THE COMMONW9 F MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppYication for Bispo� stem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade Abandon( ) ❑Complete System ❑Individual Components s` Location Address r Lot No. 7 /&WMi� 1 F Owner's Name,Address,and Tel.No.�-�f s C) I g Assessor'=Zrcel r/r Installer's-Name,Address and Tel.N . / t& J Desi n N e Address and Tel. o a26 7o��71 c 's 7`- �� d' /a�j , o a/-�' dNu��� r la �53 Type of Building: C! Dwelling No.of Bedrooms Lot Size 7 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures x Design Flow(min.required) � gpd Design flow provided �(� gpd 7� Plan Date Number of sheets Revision Date Title Size of Septic Tank 7 Type of S.A.S. 5 Description of Soil Nature of Repairs or Alterations(Answer when applicable) = D� ®G — lS t i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. 3 igned j > Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ���` 3 {o Date Issued THE COMMONWEALTH OF MASSACHUSETTS i� BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site�,S�ge Disposal system Constructed( ) Repaired Upgraded f ) Abandoned( )by (E- ./ I at Z — o E> has been constructed in accordance h with the provisions of Title 5 and heJ�Disposal y$em Construction Permit No�C/ 3� �-�ydated o` /7 3 � Installer ./;�/,�,�,���" �� �,�-' 4--Q_ Designer #bedrooms �� Approved design flow gpd The issuance of this permit shall of b construed as a guarantee that the syste( wil de ig d. Date /r• ) Inspectoi - - -------------------------------------------------------------------------------------------------------------------------------------------- No. Fee /Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem (Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade System located at 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 omplete within three years of the date of this ermit. Date 2 Z; Approved by MAR/04/2013/MCN 03:32 FM SandwichTownOffices FAX No, 1 5C8 833 OC18 P. 001/031 Tow of Barnstable °¢' ' 'i• Regulatory Services Thomas F.Geller,Director 1639. Public Health Division Thomas Mi cKean,Director 200 plain Street,Hyannis,NIA N601 OiTicc: SOS-362-46� Fax: 508490-6304 Installer & Desi net Certification Form Date: 14'-3 Sewage Permit# An /3--o��,ssessor's 1171ap1Pareel -7�Qj Designer: ` g ner: �� Installer: i Address: P6 &}( C Address: ;Vz/ CP, / 4as issued a permit to instal: a (date) (installer) y septic system at v"�� �1 -'""�� based on a design crav/n by (address) - _ dated 1' (designer) 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved cnaages such as lateral re octtticn o:the distribution box and,'or septic tank. I certify that the septic system referenced above was installed with major chancres (i.e, greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic systenn) but in accordance with State &Local Regulations. Plan revision cr certified as-built by cesigZer to follow. OF DAR N n j y (Installer's $ wri re) °? o. 1140 15fE � PNITAIt�a� tI1 esigner's S'inure) (Affix Designer's Stamp Mere) PLEASE RETURN TO RA.RINSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COiti MANCE WIL BUILT CARD ARE DECEIVED BY THE SAKNST.kBLE PUBLIC IfIEALTIR DIVISION! THANK YOU Q:14calt;Scpric/Dasi;ner Certification Form 3-16-4doc • Town of Barnstable Barnstable �P�ppTHe Tp A6fimericaCity Regulatory Services Department , 1 • lABNIMABLE, MASS. Public Health Division 0 9- 2007 PTEo µA+° 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2843 1853 January 3, 2013 David Holt Today Real Estate 1533 Falmouth Road/Rte 28 Centerville, MA 02632 • RE: 34 Mizzentop Lane, Centerville, MA ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 34 Mizzentop Lane, Centerville, MA was last inspected on Shawn McElroy, a certified septic inspector for the State of 12/19/2012 b S p p Y Y Massachusetts. The inspection of the septic system showed that the system"Fails"under the guidelines . of the 1995 TITLE 5 (310 CMR 15.00) due to the following: 0 System is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system with the deadline period will result in future enforcement,action. PER ORDER OF THE B ARD OF HEALTH • Thomas McKean, R.S., CHO. Agent of the Board of Health I I l Q:\SEPTIC\L.etters Septic Inspection Failures or Future Eva1\34.Mizzentop Ln.Jan 2013.doc I I Commonwealth of Massachusetts ``` W Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form --Not for Voluntary Assessments S 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) - -- Owner Owner's Name required for every rt _a— information is C� �r J�I�/ MA 02601 , 12-19-14 � �� •-n page. City/Town State Zip Code Date of Inspection 4= - '�. Inspection results must be submitted on this form. Inspection forms may not be alteredl n any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: • U Shawn Mcelroy ' Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification . •1 certify that I have personally inspected the sewage disposal system at this address and that the ' information reported below is true, accurate and complete,as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 12-19-12. Inspector's Signature Date The system inspector shall submit a copy'of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspe F r :Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official InspectionForm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt G Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every W. Hyannisport L MA 02601 12-19-12 page. City/Town 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 the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if-the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): - I t5ins•11/10 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 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every y p W. H annis ort MA 02601 12-19-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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): f ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11/10 Tide 5 Official Inspection Form: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 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name required for is every W. H annis oft required for eve y p MA 02601 12-19-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-11f10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every y p W. H annis ort MA 02601 12-19-12 page. CitylTown 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- 1 0,000g pd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every y p W. H annis ort MA 02601 12-19-12 page. CitylTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms). 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official ,Inspection. Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every y p W. H annis ort MA 02601 12-19-12 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 12-2012 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•11110 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 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every W. Hyannisport MA 02601 12-19-12 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: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a'copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every y p W. H annis ort MA 02601 12-19-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) _ Approximate age of all components, date installed (if known) and source of information: 1965 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.): 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: Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every y p W. H annis ort MA 02601 12-19-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 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.): 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form iA Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)- Owner Owner's Name information is required for every W. y p H annis ort MA 02601 12-19-12 page. City/Town State Zip Code Date of Inspection D. System Information (cant.) . I A I . Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): - t 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official. Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every yannp W. H is ort MA 02601 12-19-12 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 N/A Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11f10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts b W Title 5 Official Inspection Form - �; - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every yannp W. H is ort MA 02601 12-19-12 page. Citytrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1-6x8 ❑ innovative/alternative system Type/name of technology: .a Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Overflow cesspool empty at inspection with stain line at Inlet invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2-Inline Depth—top of liquid to inlet invert N/A - Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool 6x8 Materials of construction Block Indication of groundwater inflow ❑ Yes ® No t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts V Title 5 Official inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments- ;M 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every W. y p H annis ort MA 02601 12-19-12 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.): Cesspools were empty at inspection with stain lines at inlet invert in overflow. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Y Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every W. Hyannisport MA 02601 12-19-12 page. City/Town 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 13c,c k r O L R t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form' s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is W. H annis required for every y p ort MA 02601 12-19-12 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: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 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 °M 34 Mizzentop Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is H required for every Hyannis port p MA 02601 12-19-12 page. City/Town 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Town of BA11astable. P# of� Department of Regulatory Services/ Public Health Division Bate 1639. �e� 200 Main Street:Hyannis MA 02601 Date Scheduled Time_ Fee Pd. Soil Suitability Assessj?ieni fog- Se e tspo a - Performed By: ! Witnessed By: i LOCATION & G-ENE_ RAL INFORMATION Location Address/3� Mt 2 --D 1P b A,J Owner's Name CC►.tTn-v bt�� {+�/�f I Address /�A Assessor's MapjP4rcel: 'L��/Q I Engineer's Name Dom,VY-e,n NEW CONMIZU#ION REPAIR _ Telephone# 1 N�� Land Use y t�, Slopes(%) Surface Stones Distances from: Open Water Body ?�. ft Possible Wet Area� L� ft Drinking Water Well ��J ft i Drainage Way G ft PropcM Line `4) ft Other ft SIETCH:(Street name,dimcnsiods'of lot,exact locations of test hales&pert tests,locate wetlands in proximity to holes) 1,3 le,ct I • i I F • i Parent material(geglogic) Depth t4 Bedrock Depth to Groundwater Standing Water in Hole:' ,�! It Weeping from Pit Ftiee Estimated SeasonaliHigh Groundwater DtTERNUNATION FOR SEASONAL HIGH WATER TALE Method used: I : In. Depth Qbperved standing in obs.hole: —_in. Depth to spli tztottles: in, ©roundwnter Adjustment Depth toiweeping from side of obs-hole: Ar1j,Groundwatertevel..,,,e. Index Well# Reading Date: Index Well.level AdJ,Actor"^��" I PERCOLATION TFS'Z' Dnte.,��. 'Citue Observation ,, Time at 9" - -- - -- Hole# Time at G" Depth of Perc Z ! ►© Time.(9„-6,�) Start Pre-soak Time.@ , p i End Pre-soak ' • Rate MinJlnch Additional Testing Needed(YIN) Site Suitability Assessment Site Passed ' Site Failed: Originak,Public,. edlth Division Observation Hole Data To Be Completed on Back— ***If percolation test is to be conductedwitbin 100' of wetland,you must first notify the Barnstable Coriservation Division at least one (1) week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel sll 3St, SSA rg2`I C:. M-Ci,��� c DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel i0 ►i rl �^ti A �I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel I I I i 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, Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pery ous material exist.in all areas observed throughout the area proposed for the soil absorption system? �.c If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department� Environmental Protection and that the above analysis was performed by me consistent with the required trat in xpertis d experience described in 3,10 CMR 15.017 Signature `---- �—` Date t Q:\.SEPTIC\PERCFORM.DOC r f COMMONWEALTH OF MASSACHUSETTS r EXECUTIVE OFFICE OF ENVIRONME,,N-TAL AFFAIRS } a DEPARTMENT OF ENVIRONMENTAL PROTECTION A/ yV�y TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 3q t A h%t Owner's Name: Owner's Address: 63�t- Date of Inspection: 16 t %yL Name of Inspector:^(pl�a-se print) k Company Name:"Cork vInUAWL4 Mailing Address: gG3b '� fhA 80U%(( Telephone Number: '6 OS CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails —� Inspector's Signature: Date: � Q 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,ands-the approving authority. Y r Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address low the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I f Page 2 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: -3 nt ��{- Kh✓►�ic�er Owner: e` Date of Inspectio�: 3 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"secti eed to be replaced or repaired.The system,upon completion of the replacementZfolling ove the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the fatements.If"not determined"please explain. The septic tank is metal and over 20 years old*orether metal or not)is structurally unsound,exhibits substantial infiltration or enfiltration tanaureinent.System will pass inspection if the existing tank is replaced with a complying septic `approved by the Board of Health. *A metal septic tank will pass inspection if it is s turally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old' available. ND explain: Observation of sewage backu or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a brok ,settled or uneven distribution box. System will pass inspection if(with. approval of Board of Health): broken pipes}am.replared obstruction is.zemoved distribution box is leveled or replaced ND explain: The sys In required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass Inspectio if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: j y ffl4-zz-e&%fb0 w Owner: W6`�t Date of Inspection: Ob 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 ` e system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 31 MR 15.303(1)(b)that the system is not functioning in a manner which will protect public health fety 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 etland or a salt marsh 2. System will fail unless the Board of Health(an ublic Water Supplier,if any)determines that the system is functioning in a manner that protects t public health,safety and environment: _ The system has a septic tank and soil a orption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surf a water supply. The system has aseptic tank and AS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank d SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic t and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". ethod used to determine distance "This system passes if th well water analysis,performed at a D.EP certified laboratory, for coliform bacteria and volatile org is compounds indicates that the well is free from pollution from that facility and the presence of ammom nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are trig red. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM d PART' A: CERTIFICATION(continued) Property Address: ( 1 Z t Owner: W a% e Date of Inspection: � 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 T 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 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. _ VMV 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. o Any portion of a cesspool or privy is less than 1-00 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 colifo m bacteria and volatile organic.compownds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is.equahtwor less than 5.ppm,provided that no other:.f"ure criteria n, are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must ea facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to ea of the following: (The following criteria apply to large sys in.addition to the criteria above) yes no the system is within 4 feet of a surface drinking water supply _ — the system is wit ' 200 feet of a tributary to a surface drinking water supply the system is cated in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone H of public water supply well If you have answ ed"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Sectio above the large system has failed.The owner or operator of any large system considered a. significant thr t under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The stem owner should contact the appropriate regional office of the Department. n Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST , Property Address: i /. i Owner: d ke Date of Inspection: 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? _ r 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 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 o the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? 4 _ 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: Y no 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 i unacceptable) [310 CMR 15.302(3)(b)) 5 Page 6 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ��qq SYSTEM INFORMATION A Property Address: 3Y i - Owner: D t Date of Inspectio LaI66, FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):�3 Number of bedrooms(actual):_ DESIGN flow based on 310 CMS 15.203 (for example: 110 gpd x# of bedrooms): Number of current residents: d Does residence have a garbage grinder(yes or no): A10 Is laundry on a separate sewage system(yes or no):tJ[if yes separate inspection required] Laundry system inspected(yes or no): A)O Seasonal use: (yes or no):00 Water meter readings, if available(Iast 2 years usage(gpd)): Sump pump(yes or no):;��! Last date of occupancy: ' �/'tf� COMM ERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 C 5.203): . gpd Basis of design flow(seats/ sons/sgft,etc.): Grease trap present(y or no):_ Industrial waste ho ng tank present(yes or no):_ Non-sanitary w e discharged to the Title 5 system(yes or no):— Water meter r adings,if available: Last date o ccupancy/use: OTHE (describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):AP If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _Septic tank,distribution box, soil absorption system _Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all,gomporients,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): 6 Page 7 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3 t �,,� Owner: Date of Inspectio : BUILDING SEWER(locate on site plan) u . Depth below grade: Materials of construction: cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints;venting, evidence of leakage, etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction:,concrete_metal_fiberglass ethylene —other(explain) If tank is metal list age:_ Is age confirmed by a ertificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sluXebof outlet tee or baffle: Scum thickness: Distance from top of scutlet tee or baffle: Distance from bottom om of outlet tee or baffle:. How were dimensions Comments(on pump' g recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet . vert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grader Material of construction:_concrete etal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness/vert,evidence Distance from tof outlet tee or baffle: Distance from b bottom of outlet tee or baffle: Date of last pum Comments(on endations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to oute of leakage,etc.): 7 1 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: C 6 Owner: Date of Inspectio TIGHT or HOLDING TANK: (tank must be pumpe at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete Infiberglass_polyethylene other(explain): Dimensions: Capacity: g ons Design Flow: allonslday Alarm present(yes or no): Alarm level: Al in working order(yes or no): Date of last pumping: Comments(condition f alarm and float switches,etc.): DISTRIBUTIO/BOX: esent must be opened)(locate on site plan) Depth of liquid linvertComments(noted distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or o PUMP CHAMBER: 0- a on site plan) Pumps in working o r(yes or no):. Alarms in work' order(yes or no): Comme s( e condition of pump chamber,condition of pumps and appurtenances,etc): 8 Page 9 of 11 OFFICIAL. INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: st( Owner � Date of Inspe ion SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: e overflow cesspool,number: t 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.): ttJarae A(�Iwnt_( �d A� K 1 CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: :.Lj.'%j%,cNmM Depth of solids layer: �{u Depth of scum layer: a.h ' Dimensions of cesspool: Materials of construction: I tf w'& ( iG Indication of groundwater inflow(ye o): I 0 Comments mote condition of soil,signs of hydraulic f 'iure, level of po ding,condition of vegetation,etc.): -�&AAA.. PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note conditio of soil,signs of hydraulic failure;level of ponding, condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: zr er* e Owner: Date of Inspecti n: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. 37 Page I I of 11 OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.. SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3 t Owner: p� ` Date of Inspection: SITE EXAM Slope VQU. Surface water 0-0 Check cellar 144 Shallow wells 100 Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date,of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) 0�_Accessed USGS database-explain: .You must describe how you established the high grouirid water elevation: 11 COMMON-WEALTH OF 1 ASSACHUSE 'S ExECL;TTVE OFFICE OF ENTVIRONTNf iNuAL A FF-A.IRS DEPARTMENT OF ENVIRONMENTAL PROTECTION pSSESS�RSM� 1' PAR�ELN�. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: X 41 te;_kq Owner's Name: Owner's Address: LAW&>b ��OZ a3n13� �onspection: / Name of Inspector: (please print) k"Ae-H Company Name: 44tcj A 6n,i;&Arne,n+aj Jwpe,,fons Mailing Address: / .0, Sw, S &aaf pen.�:s A o26Y/ Telephone Number: SO$•3AS ZAog CERTIFICATION STATEMENT I certify that I have personally inspected the,sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails yy Inspector's Signature: �i,�� Date: lellp c_/ -- 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_ V Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/152000 page I Page 2 of 1 I OFFICIAL INSPECTION FORD—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 3y pt,ez�vt `� � urn%s ®weer- Wo• l Date of Inspection: 7 O Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: v 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 reply or repaired.The system,upon completion of the replacement or repair,as approved by the Board of th,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following stateme .If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic (whether metal.or not)is structurally unsound,exhibits substantial infiltration or exfltration or tank is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as ved by the Board of Health. *A metal septic tank will pass inspection if it is strut sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is a le. ND explain: Observation of sewage backup break out or High statir.water level in the distribution box due to broken or obstructed pipe(s)or due to a bro settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)anr zeplaced obsmu tkm is.removed distn on box is Ierteled or replaced ND explain: The s m required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspe ' n if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 i Page 3 of 1 I OFFICIAL, INSPECTION FORM-NOT FOR YOLLTNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PANT A CERTIFICATION(continued) Property Address: i rZenrt4p Lo,-Q a rrn� Owner: pt Date of Inspectio : 7/ p C. Further.Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order o 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 w' 310 CMR 15303(l)(b)that the system is not functioning in a manner which will protect public h th,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 vegeta wetland or a salt marsh 2. System will fail unless the Board of Health( d Public Water Supplier,if any)determines that the system is functioning in a manner that protec the public health,safety and environment: _ The system has a septic tank and so' absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a s ce water supply. — The system has a septic tank d SAS and the SAS is within a Zone 1 of a public water supply. — The system has a septic and SAS and the SAS is within 50 feet of a private water supply well. The system has a se p' 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• the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile rganic compounds indicates that the well is free from pollution from that facility and the presence of onia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria triggered.A copy of the analysis must be attached to this form. 3. Othe . 3 Page 4 of l l OFFICIAL INSPECTION FORM—NOT-FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE D SYSTEM INSPECTION FORM PART.A CERTIFICATION(continued) Property Address: 3 7 lvizred Lo" Owner: WO` Date of Inspectio : 710 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 _ X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/2 day flow a—� Required pumping more than 4 tunes 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 tnbutary 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. -9— 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 ealMorm bacteria and volatile organic,cotes 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 SPpm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] �(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: ~� To be considered a large system the system must serves facility wi design now of 10,000 gpd to 15,000 gpd. .s You must indicate either"yes"or"no"to each of the follo D (The following criteria apply to large systems in additi the criteria above) yes no — _ the system is within 400 feet of ce drinking water supply _ — the system is within 200 t of a tributary to a surface drinlang water supply the system is loci in a nitrogen sensitive area(Interim Wellhead Protection Area—1WPA)or a mapped Zone 11 of a pu 'c water supply well If you have answer es"to any question in Section E the system is considered a significant threat,or answered "yes"in Sectio above the large system has failed The owner or operator of any large system considered a. significant eat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL.INSPECTION FORD-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: c Owner: Wo G Date of Inspection: o Check if the following have been done You must indicate`yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(if they were not available note as N/A) — Was the facility or dwelling inspected for signs of sewage back up? — Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? — Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no — Existing information_For example,a plan at the Board of Health. — Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable)[310 CTvM 15302(3)(b)] . 5 Page 6 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: .39, N exxo*,Hy -� r� It r7 r-$ Owner: Date of Inspe� `7 1 d 4 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR IS 203(for example: 110 gpd x#of bedrooms): Number of current residents: J Does residence have a garbage grinder(yes or no): /JO Is laundry on a separate sewage system(yes or no):-jZ f if yes separate inspection required] Laundry system inspected(yes or no):A�o Seasonal use:(yes or no): A/67 Water meter readings,if available(last 2 years usage(gpd)): D a IF 6,�(��f Sump pump(yes or no)�6! Last date of occupancy: C vriKr&* COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CNIR 1 5.203): apd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present or no):_ Non-sanitary waste discharged to Title 5 system(yes or no):— Water meter readings,if avai e: Last date of occupancy/u OTHER(descri GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped:,_gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool OC 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 ob_tained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: r Were sewage odors detected when arriving at the site(yes or no): A� 6 f Page 7 of l I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM[ INFORMATION(continued) Property Address: 3y�t t zen k Ate? n RS Owner: �r C Date of Inspection: 7 y O BUILDING SEWER(locate on site plan) _ it Depth below grade: /8 Materials of construction:Xcast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:`(locate on site plan) Depth below grade: Material of construction:`concrete metal_ ergiasspolyethylene _other(explain) If tank is metal list age:_ Is age confuate y a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bo m of outlet tee or baffle: Scum thickness: Distance from top of scum to op of outlet tee or baffle: Distance from bottom of s to bottom of outlet tee or baffle: How were dimensions ermined: Comments(on pump• g recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet vert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction: concret _metal`fiberglass_____polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scu to top of outlet tee or baffle: Distance from bottom scum to bottom of outlet tee or baffle: Date of last pumpin Comments(on pu ing recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to out t invert,evidence of leakage,etc.): 7 i Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3 A ZX-ex- Owner- O Date of Inspection: 7o TIGHT or HOLDING TANK: (tank must be pumped time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete me fiberglass_polyethylene other(explain): Dimensions: Capacity: yno): lDesign Flow: ons/dayAlarm present(yAlarm level: ing order(yes or no): Date of last pumpComments(condoat switches,etc.): DISTRIBUTION BOX: (if pr ent must be opened)(kocate on site plan) Depth of liquid level above tlet invert: Comments(note if box' evel and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out o ox,etc.): PUMP CHAMBER: (lcat site plan) Pumps in woTkmg order es or no):. Alarms in working o er(yes or no): Comments(note ndition of pump chamber,condition of pumps and appurtenances,etc.): . 8 I Page 9 of I I OFF ICL4L INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PANT C SYSTEM INFORIVIATION(continued) Property Address: S Owner: 14)oic Date of Inspection: -7/ SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number- leaching chambers,number:. leaching galleries,number: leaching trenches,number,length: 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.): S 'mil • a /!o r`c, o e CESSPOOLS:/(cesspool must be pumped as part of inspection)(iocate on site plan) Number and configuration:_ ? / Gt f okk Depth—top of liquid to inlet i vert S Depth of solids layer:t3� Depth of scum layer: a Dimensions of cesspool: S-,X�.--r— Materials of construction: 0 ye �QG�C Indication of groundwater inflow(yes or no): Comments note condition of soil,signs of hydraulic failure t Iev 1 of ponding,condition of vegetation,etc.): *64ew ha-5GL yr/JC e e 0— PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition o i1,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 71 9 i Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: r c� r'1 r5 Owner: p ` Date of Inspection: O SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within.l 00 feet.Locate where public water supply enters the building. �C4.- a f Page I I of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION_(continued) ]Property Address: .:!r •Z� t(O� �.�-•-( Owner �(— Date of Inspection: SITE E))M,,,, Slope Surface water it Check cellar -1 V" Shallow wells a Estimated depth to ground water o2S f t Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: U S 42�,S Map C,,,.e.le D 04A 11 1 LEGEND I CENTERVILLE gg PROPOSED CONTOUR > Ln 98 PROPOSED SPOT GRADE 7 w Mq�N -- gg -- EXISTING CONTOUR PINE ST rr + 96.52 EXISTING SPOT GRADE p ,c W— EXISTING WATER SERVICE AT I k TEST PIT lv LOCUS: APO Q- 34 MIZZENTOP W' r PROP. 1 ,500 GAL LANE LOT 41 SEPTIC TANK GAP 0 AIGVILtE ACH ROAD j LOT 42 _ � � f0• 9g.9) BE AREA-7497t S.F. 39.10 ° LOCUS MAP 1 1 39.5 = _ � BLHO o _ _ 10'OAK LOCUS INFORMATION PLAN REF: 103/127 39.20 TITLE REF: 26554/26 PARCEL ID: MAP 247 PAR. 59 ZONING: "RB" #34 _ FLOOD ZONE: "C" _ 10'OAK COMMUNITY PANEL: 250001-0008—D DATED:07/02/92 40. -- - e� 39.20 39.70 j °° 2_ _ , �' _- ° y � LOT 49 SEPTIC SYSTEM REPAIR PLAN LOCATED AT: - - 39.70 - ; EXIST. CESSPOOLS 34 MIZZENTOP LANE GENERAL NOTES: _ oa Y =_ tnsp Ports 3 j (SEE NOTE 10) CENTERVILLE MA. 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL c/ `' io•oAK'� PREPARED FOR BOARD OF HEALTH AND THE .DESIGN ENGINEER. FEDERAL NATIONAL 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 0E __ ( ; OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 39.70 4 90 ;I MORTGAGE ASSOCIATION LOCAL RULES AND REGULATIONS. T -� `h y9 b 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 9896 TH 2 sh"D FEBRUARY 05, 2013 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE e90 DESIGN ENGINEER. , LOT 48 }, LOT 43 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN OF ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF j M R THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. N 1"140 7. PROPERTY IS SERVICED BY TOWN WATER. 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED IST F � TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 'S481 TO,\P� 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY " ll THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 10. EXISTING CESSPOOLS TO BE PUMPED, CRUSHED AND REMOVED. REPLACE-WITH CLEAN MEDIUM SAND PER TITLE 5 SPECS. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 1 MEYER BC SONS, INC. {�r 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY P.O. BOX 9 81 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING 14. ,ALL P1P-,E TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE) 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW . . . Y EAST SANDWICH, M A. 02537 FOR THE USE OF A GARBAGE GRINDER 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING (5 0 8)3 6 2— 2 9 2 2 17. PROPERTY IS WITHIN A GROUNDWATER PROTECTION DISTRICT ' SHEET 1 OF 2 J#1509 a NOTE: TO PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:36.81 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. T.O.F. EL.=40.0 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER fa" OUTLET AND SET TO 6' OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. INSTALLED F.G. EL.=39.80t F.G. EL.=39.80f F.G. EL: 39.50t F.G. EL: 39.50(MAX.) LENGTH ���� pF MAss9 DARR,�N�M G 9" MIN COVER/ MFfF L = 25't 36" MAX COVER '' L = 10' L = 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) ` O. 1140 ® S=1% (MIN.) EL. = 38.0 ® S=1% (MIN.) ® S=1% (MIN.) 12.37" 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 10• • '�G/STENO 1a• 6' 10.75" ToNITAR\P� INVERT ��{I�l INV.=37.0 ae"uow0 1INV.= 36.75 INV.= 36.35 LEVELPROPOSED COUPLER DETAIL GAS BAFFLE D-BOX71NV.=36.45 3 ROWS OF 6 UNITS 0 5'/UNIT + 1 COUPLERS 0 1.16'/UNIT = 31.16'/ROW INV.=36.6DB- SOIL ABSORPTION SYSTEM (PROFILE) PROPOSED 1.500 GALLON SEPTIC TANK EXISTING SEWER OUTLET RESTORE VEGETATIVE COVER INV.=37.80 BACKFILL WITH CLEAN PERC SAND TO TOP OF CHAMBERS 60" ---�{ I BREAKOUT=TOP ELEV.=36.81 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING INV. ELEV.= 36.35 PIPE INVERTS PRIOR TO CONSTRUCTION 2) TANK AND D-BOX SHALL BE SET LEVEL AND BOTTOM ELEV.= 35.48 EXISTING SUITABLE TRUE To GRADE ON A MECHANICALLY COMPACTED 2.88' } MATERIAL SIX INCH CRUSHED STONE BASE, AS SPECIFIED 5' MIN. ABOVE BOTTOM OF - IN 310 CMR 15.221(2) T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 31x 2.88' = 8.64' (6.68' PROVIDED) USE 3 ROWS OF 6-ADS ARC 36HC 3) INSTALL INLET & OUTLET TEES W/ ADJ. GROUNDWATER EL.=28.80 = (H20) UNITS - N0;STONE W/ 1 COUPLERS GAS BAFFLE AS REQUIRED IN EACH ROW SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S. N.T.S. 16" SOIL LOG P#:13868 DESIGN CRITERIA DATE: FEBRUARY 5, 2013 • NUMBER OF BEDROOMS: 3 BEDROOM DESIGN SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE #1614 SECTION 10.75" SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONALD DESMARAIS, BARNSTABLE BOH HEIGHT END CAP DAILY FLOW: 110 G.P.D/BR. DESIGN FLOW: 330 G.P.D. Elev. TP-1 Depth Elev. TP-2 Depth ADS - ARC 36HC CHAMBER H2O LOAD GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 39.80 A LOAMY SAND 011 39.80 0" 10YR 3/2 A LOAMY SAND MODEL ARC 36HC SEPTIC TANK: 330 gpd x 200% = 660 gpd USE NEW 1,500 GALLON SEPTIC TANK 39.13 8" 39.13 8" B B LENGTH 63" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT LOAMY SAND 10YR 5/8 LOAMY SAND TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY 10YR 5/B EFFECTIVE LENGTH 60" LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. 36.89 C 35" 36.89 C 35" SIDE WALL HEIGHT 10 " DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. DISTRIBUTION BOX: 3 OUTLETS (MINIMUM) OVERALL HEIGHT 16" PRIMARY S.A.S. PERC ® 35.47 MEDIUM-COARSE MEDIUM-COARSE 4640 TRUEMAN BLVD SAND OVERALL WIDTH 34.5 SAND 10.7 CFgrow* HILLIARD, OHlO 43026 USE 3 ROWS OF 6 - ADS ARCHC 3616 H2O UNITS-NO STONE 2.5Y 5/4 2.5Y 5/4 CAPACITY _AND EXTENDED 1.16' W/ COUPLER IN EACH ROW 80.0 GAL ADVANCED DRAINAGE SYSTEMS INC. �r BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF CHAMBER) PROPOSED SEPTIC SYSTEM/SITE PLAN (CHAMBERS: 6/ROW)18 UNITS x 5.0 LF x 4.80 SF/LF = 432.00 SF 28.80 132" 28.80 132" 34 M I Z Z E NTO P LANE C ENTERVI LLE, MA (COUPLER: 1/ROW) 3 UNITS x 1.16 LF x 4.80 SF/LF = 16.70 SF } TOTAL AREA 448.70 SF PERC RATE <2 MIN/IN. (*Cl" HORIZON) Prepared for: Dedecko/FNMA DESIGN FLOW PROVIDED: 0.74GPD/SF(448.70SF) = 332.03 GPD > 330 GPD req'd NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN DATE: Meyer&Sons,Inc. MacDougall Survey NTS D.M.M. 02/05/13 • 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pO BOX 981 (508) 419-1086 to conduct soil evaluations and that the above analysis has been performed by me consistent with the REV. DATE: CHECKED. SHEET NO. requirements of 310 CMR 15.017. 1 further certify that 1 have passed the Soil Eval. Exam in October, 1999. EASTSANDWlCH,MA02537 508-362-2922 D.M.M. 2 of 2