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HomeMy WebLinkAbout0074 MONOMOY CIRCLE - Health 74 Monomoy Circle Centerville P A = 190 196 ford, NO. 1521/3 ORA 10% Commonwealth of Massachusetts 190-1% Title 5 Official Inspection Form _ <iI' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Monomoy Circle Property Address �. Wantuil Mariano Owner Owner's Name information is required for every Centerville V, MA 02632 04/14/2020 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 A. Inspector Information gLygf filling out forms �� on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Q Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 04-15-2020 In pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. CityTrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Please read the bottom of the first page of this report. This statement is from the MA. DEP. This home was inspected under the MA. DEP and The Town of Hyannis' guidelines. This 3 bedroom home has an H-10 1000 gallon septic tank with a H-10 D-Box feeding 2 leaching chambers. At the time of the inpection the leaching was dry but there is very heavy staining. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): 0 ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic.tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts e Title 5 Official Inspection Form �I4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ............. !% 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 I Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. City/Town State Zip Code Date of Inspection. C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of breakout? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form aI e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 plus GPD Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d town water 9 ( Y 9 (gp ))� Detail: In 2019-80,000 gallons were used and in 2018-65,000 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: Fall 2019Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts e Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts e Title 5 Official Inspection Form '~ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 18"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: H-10 1000 gallon Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 4" 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 13" 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.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form - FIo Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle .Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form �1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form + il; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection the leacing was dry but they has seen heavy use. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts . Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form t i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle V� Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within.100 feet. Locate where public water supply enters the'building. Check one of the boxes below: ® hand-sketch in the area below E3—&awing attached separately �f t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 a 0 A B A B 1 25' 49'8" ❑3 2 30' 51'6" 3 31'6" 52'9" O O 4 36'6" 5316" 5 44'9" 42' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 11 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole to 11'to show 4 plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts lip Title 5 Official Inspection Form '- Ili Subsurface/Sewage Disposal System Form - Not for Voluntary Assessments .V 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is required for every Centerville MA 02632 04/14/2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 „ t Town of Barnstable Inspectional Services Department ABARNS Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 1371 December 31, 2019 MARIANO, WANTUIL S 74 MONOMOY CIRCLE CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 74 Monomoy Circle, Centerville,MA was inspected on 12/03/2019 by Brett Hickey, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails” under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF E BOARD OF HEALTH cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\74 Monomoy Circle Centerville.doc ° Town of Barnstable + BA"STABLE, MASSa 039. Inspectional Services Department pTFD MA'S� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts 1, Title 5 Official Inspection Form r/lig1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments {, 74 Monomoy Circle r e; Property Address r t, Wantuil Mariano Owner Owner's Name information is required for every Centerville Ma 02632 12-3-19 I 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. Inspector Information on the computer, use only the tab Brett Hickey key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 &I Company Address Sandwich Ma 02563 I At City/Town State Zip Code (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑■ Fails D�pnmy eremn eYamm Nzkq Brett Hickey o�: �.���•o•W.�,r•m��, .�.�. �s 12-3-19 ''�Oete:3p18.1].11 pB:t0:3-0SYIO Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Ins ection Form w1 p I;l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system was in hydraulic failure at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle L Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The se system has a tic tank and SAS and the SAS is less than 100 feet but 50 feet or Y p more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: .4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of.the following for all inspections: Yes No El El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �T Title 5 Official Inspection Form �= " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle V Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ E 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: ❑ E] Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ Q 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.] ❑ a The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. El ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 r , c Commonwealth of Massachusetts Title 5 Official Inspection Form r� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle u Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No it ❑ El Pumping information was provided by the owner, occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? ❑ El 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? 0 ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ El Was the facility or dwelling inspected for signs of sewage back up? 0 ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? El ❑ 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? ❑ O 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. ❑ 0 Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 i Commonwealth of Massachusetts �M Title 5 Official Inspection Form �= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle v� Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 3 Number of bedrooms(design): Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330/GPD Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes [E No Does residence have a water treatment unit? ❑ Yes ❑. No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 91 No information in this report.) Laundry system inspected? ❑ Yes El No Seasonaluse? ❑ Yes [E No Water meter readings, if available(last 2 years usage(gpd)): See below Detail: 2018- 65,000gallons 2017- 80,000gallons Sump pump? ❑ Yes ❑■ No Last date of occupancy: Current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts in ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Monomo 74 Circle � Y V� Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner- date of last pump is unknown Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �= F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r; 74 Monomoy Circle V� Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: 0 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 ElOt a (describe): Approximate age of all components, date installed (if known)and source of information: 2003 per Asbuilt Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 21611 Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑ other(explain): Town water Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 c Commonwealth of Massachusetts ,p Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code - Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 11611 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: 1000gallons .. 1211 Sludge depth: 2411 Distance from top of sludge to bottom of outlet tee or baffle 411 Scum thickness 611 Distance from top of scum to top of outlet tee or baffle 1311 Distance from bottom of scum to bottom of outlet tee or baffle measured 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.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 I Commonwealth of Massachusetts rb Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA Depth below grade: feet Material of construction. ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness. Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: • Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): NA Depth below grade: Material.of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form + � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 0" 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.): The d-box was in poor condition at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form i, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l; 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working"order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: (2)500 gallon chambers 0 leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle u— Property Address Wantuil Mariano f Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in hydraulic failure at the time of inspection. Chambers were full over inlet invert when viewed. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle V� Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form I;o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ■❑ hand-sketch in the area below ❑ drawing attached separately TOWN 0F"BAR:NSTABLE LOCATION SEWAGE VILLAGE ASSESSOR'S MAP ,r: LOT INSTALLER'S NAME & PRONE NO: E..t: :• , ._ SEPTIC TANK CAPACITY LEACHING FACILrry., (type) f~2 z x r w I NO. OF BEDROOMS ? BUILDER OR OWNER —_-.-l Y'r'` ✓ PERMT I DATE: I _L OMI'L:IANCE DATE: C-- Separation Distance Between the: Maximum Adjusted Gi-oundwater Table.to the Bo.ttotn of.1-,aching Facility Feet Private:Water Supply Welland Leaching Facility (If any wells exist on site or within 200 feet of teaching:facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I t J - L ''' F77, _. l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form °l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 74 Monomoy Circle u Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this section. Q■ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 c , Commonwealth of Massachusetts Title 5 Official Inspection Form �= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ■❑ Check Slope ■❑ Surface water ❑N Check cellar ❑■ Shallow wells Estimated depth to high ground water: No GW @ 132"feet Please indicate all methods used to determine the high ground water elevation: F] Obtained from system design plans on record Oct-13-08 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: A plan on file was used to determine high groundwater. ' i Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts �M p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Monomoy Circle V� Property Address Wantuil Mariano Owner Owner's Name information is Centerville Ma 02632 12-3-19 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ■W A. Inspector Information: Complete all fields in this section. ❑■ B. Certification: Signed& Dated and 1, 2, 3, or 4 checked ❑■ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ■0 D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 q 1) - t�(P Commonwealth of Massachusetts �i2 Title 5 Official In .����on- LormRM - b3 C I 1.-Y W'. 4a• w $• � o Not for Voluntary Assessments � ��-- Subsurface Sewage Disposal Systeril, R 20 Phi 12: 24 �M Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be..altje-lCed_in_an.K.W,► Y. — A. Certification U44#V i;,IUN Important: When filling out 1.. Property Information: forms on the computer,use 74 Monomoy Circle- Centerville only the tab key Property Address to move your Irwin and Grace Moy cursor-do not use the return Owner's Name key. 96 Foxglove Road Owner's Address Centerville MA Q02632 City/Town State Zip Code Date of Inspection: April 18, 2005 Date 2. Inspector: David D. Coughanowr, R.S. Name of Inspector Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364 0894 Telephone Number 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 1.5.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails Needs Further Evaluation by the Local Approving Authority j %QRVX- � April 19, 2005 Inspector's Signat re 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. t5-1997.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 74 Monomoy Circle Property Address Centerville MA 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 Owner's Name Date of Inspection 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: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: t5-1997.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 41M A. Certification (cont.) 74 Monomoy Circle Property Address Centerville MA 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 . Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 t5-1997.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 3of16 Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'GSM A. Certification (cont.) 74 Monomoy Circle Property Address Centerville MA 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: t5-1997.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M A. Certification (cont.) 74 Monomoy Circle Property Address Centerville MA 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 Owner's Name 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 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. ❑ ® 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes 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. t5-1997.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 5of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M A. Certification (cont.) 74 Monomoy Circle Property Address Centerville MA 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 Owner's Name Date of Inspection . 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. t5-1997.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form B. Checklist 74 Monomoy Circle Property Address Centerville MA 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 Owner's Name 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? Z ❑ 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(3)(b)] t5-1997.doc• 11/2004 _ Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 74 Monomoy Circle Property Address Centerville MA 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 Owner's Name Date of Inspection 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 gpd Number of current residents: 3 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)): 395 gpd Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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: Last date of occupancy/use: Date Other(describe): t5-1997.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 8 of 16 L Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form O�y C. System Information (cont.) 74 Monomoy Circle Property Address Centerville MA 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 Owner's Name Date of Inspection General Information Pumping Records: Source of information: owner 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age: 2 years. Certificate of Compliance issued April 28, 2003 (Permit#2003-101) Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-1997.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 74 Monomoy Circle Property Address Centerville MA 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 2 feet. Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line. 20+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer appears structurally sound with no evidence of backup or leakage into dwelling Septic Tank (locate on site plan): 1 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 El Yes ❑ No certificate) Dimensions: 8.5 ft x 5 ft x 5 ft (1000 gallon) Sludge depth: 5 inches Distance from top of sludge to bottom of outlet tee or baffle 29 inches Scum thickness 6 inches Distance from top of scum to top of outlet tee or baffle 6 inches Distance from bottom of scum to bottom of outlet tee or baffle 12 inches How were dimensions determined? Probe to top of tank t5-1997.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form G'1Ti Svey`' C. System Information (cont.) 74 Monomoy Circle Property Address Centerville Ma 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping recommended within 1 year and maintenance pumping is recommended every two years. Tank and tees appears structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): t5-1997.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 74 Monomoy Circle Property Address Centerville MA 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 Owner's Name Date of Inspection Tight or Holding Tank (cont.) 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.): Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert At outlet inverts 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.): D-box appears structurally sound with no evidence of leakage in or out. Few solids in sump. Pump Chamber(locate on site plan): Pumps in working order:` ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-1997.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments ,M Subsurface Sewage Disposal System Form C. System Information (cont.) 74 Monomoy Circle Property Address Centerville MA 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 Owner's Name Date of Inspection 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: Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ 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.): Soils above leaching gallery appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. 5 gallons of water was poured into D-box and could be heard splashing down loudly into both drywell units. t5-1997.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M C. System Information (cont.) 74 Monomoy Circle Property Address Centerville MA 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): t5-1997.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ,M Subsurface Sewage Disposal System Form C. System Information (cont.) 74 Monomoy Circle Property Address Centerville MA 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 Owner's Name Date of Inspection 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. LEACHIN0 os YG GALLE LOCATIONS A B 20 D-BOX 1 50 f t 25 f t 2 53 ft 33 Ft SEPTIC a 3 54 f t 37 Ft TANK o A g EXISTING DWELLING # 74 W Z J C W Q 3 MONOMOY CIRCLE NOT TO SCALE t5-1997.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form C. System Information (cont.) 74 Monomoy Circle Property Address Centerville MA 02632 City/Town State Zip Code Irwin and Grace Moy April 18, 2005 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 15+ 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: March 13, 2003 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: Design plan shows bottom of system to be 9.6 feet above the adjusted high groundwater table t5-1997.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 16 of 16 TOWN OF BARNSTABLE LOCATION SEWAGE # 9003 IDj VILLAGE O-en 4 ASSESSOR'S MAP & LOT INST,'iLLER'S NA &PHONE NO. AD 6 i'n 5 0n 5�0 c- 7 '�77 ME SEPTIC TANK CAPACITY 1 QOO G a I LEACHING FACILITY: (type) o'l_5D®�/'t I G / I (size) o2 .�u a a )N0. OF BEDROOMS �J r BUILDER OR OWNER jj by PERMIT DATE: -25 - 13-03 COMPLIANCE DATE: 41 o r?Y'03 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 OF CU �t. �i o TOWN OF BARNSTABLE LOCATION 24 �4 012 OY 61*r SEWAGE # VILLAGE ���`�h�'/'yr.�t� ASSESSOR'S MAP & LOT i90119 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ��y LEACHING FACILITY: (type) 0211f'ry (size) NO.Of BEDROOMS BUILDER OR OWNER X?"-' h G PGr[e M ij I'ER MITDATE: 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 ErR ' teC� �'✓�V i'pHYh��'3�( —$gS,pCc�-o LEACHING GALLERY Z° °-BOX LOCATIONS SEPTIC A `g - TANK n 1 50 ft 25 ft 2 53 ft 33 ft - 3 54 ft 37 ft A B EXISTING DWELLING # 74 Z NOT TO SCALE J C WI3 MONOMOY CIRCLE No. ZOQ 3 ^ t W ° ' Fee So. 0� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Mtopoml Opotem Construction Permit Application for a Permit to Construct( . )Repair(X)upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No:74 mOn O/N O /I`G Owner's Name,Address and Tel.No. C e,n7'e+^vt 11 er :rr tvt n m o y Assessor's Map/Parcel if pe'r y/OVA �v I �� J Installer's Name,AAddress,and Tel.No. Designer's Name,AdjJress and Tel.No. W.E fLObt�SGn 5tyttC-, Eeo -Ile,cn Po JSCA, ;0Ir cen rv1 477S, 7 ,yg Try yt� ct"e—, S�nD4ir Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(nG� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(A swer when applicable) !'fZt✓ u� �2_�e./► S'dS 754 M 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 Certifi- cate of Compliance has been i by this o of Health. Signed Date Application Approved by Date 3 6 3 Application Disapproved for the following reasons Permit No. 2-0 to 3— (6) Date Issued 3 3 3 No. Z(0�3 — k.b� 5o. a� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .. . Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Misspoof 6potem Construction Permit Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.7 U /'1 an o m a/ Circle— Owner's Name,Address and Tel.No. C2 n7ercli//� -fPW1 ki m o y Assessor's Map/Parcel 0 �,� r0�, /VEJC�. Q 9 Installer's ame,{address,and Tel.No. Designer's Name,Address and Tel.No. W. A-o ir►SGn 5�e ptc Eco - -re,C-h Cent:erUI �/3 rr14Hy1C_ 77S=�S7"7/o Type of Building: j.Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building !� No.of Persons Showers( ) Cafeteria( ) F Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title i Size of Septic Tank Type of S.A.S. Description of Soil t11 1 � / Nature of Repairs or Alterations(Answer when applicable) le 2 c �m -IrlJ P1,9 n_S ter/ a - T c y 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, nvironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i e by this o d of Health. A, Signed Date Application Approved by LX Date 3 3 0 3 Application Disapproved for the following reasons - Permit No. 2003 ' 16 Date Issued 3 3 U 3 THE COMMONWEALTH OF MASSACHUSETTS M 0 `/ BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-sit,Sewage Disposal System Constructed( )Repaired(�Upgraded( ) Abandoned( )by W. F. R O b w s oi9 S-e,Of�i Jl✓-U/G e- at G �Ci r CQ � has been constructed i accordance with the provisions of Title 5 Ad the for Disposal System Construction Permit No. 200 3-/o( dated 3 0 3 Installer Desi aye The issuance of s pe t shall not be construed as a guarantee at t e s • e ill ction as designed. Date LJ � C2 3 Inspec i No. 2.a 3 — (Ol Fee,50.00 old / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS &5po!gar bpgtem Congtruction Permit Permission is hereby granted to Construct( )Repair(,t")Upgrade( )Abandon( ) System located at 7 4/ fn(In&n 0 t/ CirGl e1 C 12✓,�`� _ (ir//ell and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Cons ctio must be completed within three years of the date of this Date: 3 (3 o 3 Approved by t LOCATION T SEWAGE PERMIT NO. _J LOT 38 Monomoy Circle . 79-74.9 / C� VILLAGE Centerville, MA. INSTA VLER'S NAME A ADDRESS Alfred Fuller 995 Cotuit Rd. Marstons Mills, MA. • UILDER OR OWNER Alan E. Small Box 536 Centerville, MA. 02632 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r _. J� , �. �'` � �, � �l �` �� � � � i ,TOWN OF BARNSTABLE I LOCATION L/ �t vr,n 7 C 1 SEWAGE # aCX�3= fD j VILLAG Ge n 4 ASSESSOR'S MAP &LOT INSTALLER'S`NAME&PHONE NO. A66� I5OC 'S92 f' �- 7 77 b SEPTIC TANK CAPACITY /OOO c, LEACHING FACILITY: (type) ,9 500 er F►i e iV(size) 02�T NO.OF BEDROOMS BUILDER OR OWNER M b 'PERMIT DATE: �3-D3 COMPLIANCE DATE: `� e��'O3 1Separation 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 U Ul, �a TOWN OF BARNSTABLE LOCATION SEWAGE # .200 3- 10). VILLAGE 0—e 04 ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. 606 r' I56n 5Q L c-- 7� SEPTIC TANK CAPACITY 1000 c,a I LEACHING FACILITY: (type) 9 500 Q/}f Qc&I L9 (size) 02 fJ' �* !a h V va NO.OF BEDROOMS BUILDER OR OWNER m a�/ PERMITDATE: ,13-0 COMPLIANCE DATE: `I " �'03 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 L . �t O P: w- 4 No.- ..:7` ` .... Fps............................. . THEBOAR®ALT F FHEAC T ErrS � � - r � Appliratinn for Uiipniiai Works Tomitrnr#ion Famit Application is hereby made forrapa�� Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at: ........./ �!�! J /�..•••• J.. . � - ................ Location-Address A or Lot No. r •- ,... ............... ......................... ......... -=L•• .................. ..... Owner /. Address Installer AddressPq ,--- U Type of Building Size ....Sq. feet Dwelling—No. of Bedrooms..:.............:...........................Expansion Attic ( ) Garbage Grinder ( )Y� aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures a;......•--••---••-•--•-•-......----•----•••......••.-----••••--•-•----•--•-•-•-•--•---•--••----.....•-•-------------•....•--•-•........------_----- W Design Flow........ Q _ _ ti................gallons per person per day. Total daily flow------ ._ ...................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width..........._.... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter. .r _ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by...................................................y............--....... Date........................................ Test Pit No. 1..Z. L..minutes per inch Depth of Test Pit...e._Z........ Depth to ground water.//0&ti� .__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 .---------•• ---•••......••-•••-••-•---------- ------------•-----•-......--••---•---•---•--............--•---•.....................---•--------•---•----- ------- 1ArE /Z � 1Descr>ption of Soil...... .......Z- 5�1 ?�.----_ ._.. V W VNature of Repairs or Alterations—Answer when applicable............................................................................................... -•------------------------------•--••------•----------------------------•--•--•----------..........-----•-----------------------------------•--•-------•------------•-•----------------....•----•-----•. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed = 91. •-�l=- 9 -- Date Application Approved By............... ..' ..._ Date Application Disapproved for the ollowing reasons-------------•-------------------------------------------------•--------------------.....---.....-•---....._..... ................................................•--•------........-----------------...---------w-----------•--•------•-•-•---•-----•••----•---••••-•--•-•--••---•--•--•••------•------•••-----......_.. Date S� PermitNo......................................................... Issued... /x .. ._.----------------- Date Zr r'7 7'e No......... .....:�...... FEB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F H EA T- k ,. ------------------- Appliration for R-4pnii al Works Tont•rurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys at: ................ ... .... .x: : ° .... -------- .. .......... i Location-Address r Lot No. - •=' ........................................ ........ t :?t * .............-•-----•--•----•--...._._......._------ Owner Address 1.4 .._.. ;.::f. ^w......---•.......................•-------.............-------- ....-------• ., ' ;�" l.�......................................................... a ............. Installer Address Type of Building Size Lot.. . _....Sq. feet aU Dwelling No. of Bedrooms......................... .Ex anion Attic g (,,ogo g— --•--------------- p ( ) Garbage Grinder p-, Other—Type of Building ............................ No. of persons........................--.. Showers ( ) Cafeteria dOther fixtures W Design Flow.........el-. .... ::..............gallons per person per day. Total daily flow.......`.,;._..: ..................gallons. WSeptic Tank—Liquid capacity.....--.....gallons Length................ Width................ Diameter.........--..... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. r.Seepage Pit No-----------_------- Diamete ./.e'��+1. . Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by........... •------------,.... _ Date------•------------•-----•.............- Test Pit No. L.Z .Z---.minutes per inch Depth of Test Pit...Z-Z.-•-•--•-- Depth to ground water. '...... G>~ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......--............---. a ••---•-•------••------•--•-•--•------•-•-----•........................�y--..�...---• . O Description of Soil-•-•--Q.: ...1..Y..S-•-•-- ...:.,.. ..�..... ?�1r -2.�9t 5 �Z.�...J''1�:1?�t��'1 U ......V-D................................................................................................................................................................................... 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 provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issuedjby the board of health. Signed.. : $ -•--•-----•-••-------••---•--...--•-----.... - - - - ...-- j Application Approved BY ; Date .... ..-•---•----••----...-•--••--•-••-•--•--------•-----------------------•--- ----•---....--••-------•---------....... Date Application Disapproved for the following reasons:................................................................................................................ .............•--••-----•-----•-........--------•----•...------•-•---------•----•-------•- •....---------•-------•--- & Date PermitNo......................................................... Issued_..... ........................... .... � .............• Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ZGti.. ..............OF........7.1k./...S..1/4. '.L..F............................... Trrtifiratr of Tontplitanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (�) or Repaired ( ) by - ...........,'��..�...t=. .....-----•--------------------------------------------••------------........---------...--------------...----------------............------------ _ t� y� Installer at.... U .......-YES........ 1 r?/!.h_/Lf ........... !11.r_C..c -----••--- '/l_.._r_j.t_ii• , has been installed in accordance with the provisions ofTI�_ of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ............ dated.-.. ////� ......................... � - -- THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. .`. :-. ._... .... Inspector. -- ..--L 44.i --. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C �� c� .............OF........7 'h�: �.<.. /sr... .......... j No............ .1�.... FEE...����1........... Disposal Works Tonotrnrtion antit Permission is hereby granted....,_......... �11.,_. ........... to Construct or Repair ( ) an Individual Sewage Disposal System at No..t..t l.--...3W....--- !��J/1 Via. 1-:_' �---.....(.4.4'f._z_s!= (�f- , "�_ I, _ C .. Street as shown on the application for Disposal Works Construction Permit No..................... Dated..-! 7 .............. ............................•-----------•-------------•-•----•-••-••...-•-------....----......_.._....._ Board of Health DATE-- -/. � ` ,;.................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS llC� G�A(..'�.al. � d(Lt tiJt.>t�.I�, "✓�•�� `� _ T` - I r�r.+L� F-LC,�n/ a ►IU .c G.P•T7. 1 49`i 6.RD. loon (G&A--. T30-T-T-04A aze4l r C.o ST-. TOTAL -C>ES16" = 42S Li. . �-7 ToTQ L Gh I L�f (`LU�.I/ = 33D 6.PD. p '"''("" •-- rr ��QT'E ; CIQ 2MIu' oe t�SS. TA p ZQ PIT i y TOP FNo ti' >C'.ta 4'�/Ofs DISf IIN. 2 r -Box 1&1, SeprIC I►V. 'rA r e+e -- p 000 �� iwv. INV• �cC. s• u 7- 9G LAN •� FIT 5 wtTu •� w.as►+ea L-E- LoCAT101-1 Ti4AT' TOG- 7ljW,!�-n St-to�ul.} Pti talJt 2t=t-�t� �.1cE 1-1C.E,1=L�►.1 C"C-•�/lE't-�(�i Vll tTF-1 �'4-1� : �jI DE t-l►_l� _ 07 •rcww G1✓- �.� `iT�� ' � � f � Lc'�•I.�t ' � :tea �A'�E� �C ! / �f Ct�� _ � t ��.•,w B,4 7C� (;tiZ. {.`;. lJY C:. t``"�G- REGiS CZ:_�i=1� iJs.l�1C� Sl)2v4-`{vl-'• TMts t�I_ntit t 6. oT ?- Al;I-kl!-J,*^ �i�?�-`/t-`�' X +{i;: c�FtT�t C i il•lGt.14D A.F�t*t_lCt�.taT_� LL t f' U•,l_� + T'i.� i�r.l'��►�Mi►-�L: �b'Y" E_IF.lt,�•.,a _'_ ��(�,� L //�i�lt _ .. c ♦ \ CENTERVILLE. MA z M PLAN REFERENCE CONTOURS m PLAN BOOK 272 PAGE 58 EXISTING - - - - - - 50 Z _ ASSESSOR'S MAP: 190 MINIMAL GRADING PROPOSED 4 �W LOT: 196 N s O �O N ' O<w { CZ H1N Hw� _ LOCUS \Z T O mNH wh I STONEY CLFF F w; �to AO,lD M � LOCUS MAP NOT TO SCALE U-z �. o 00 ° W N Cv 50 < (� N v J_ J Z N c�y� 450,00 n N V UJ J > U cr. QJo J w PAVED DRIVE AY : z w ry LEGEND � J O av¢ 14 ft x C5 ft x 1 ff � EX�STAIG Ur t O I (� O 0 2 r LEACHNG GALLERY 50 SEPTIC GALLON ° SEPTIC TANK O D-SOX w��x� a I?Q J +n O zwse WA I k � W �� a o' P� TEST PIT Li 0 ' c O r W1 Q �d 50 EXISTNG U b� LEACH PIT O LL LL - w c U W zo O 1 o UTLITY POLE $ Lu .s �< LOT 38 l n DRAIN go Q� AREA - 15640 sf © ^ HYDRANT O TREE Q To N ` 50 J o-o�K nnaeE v-v� z v I �7o r, 1/ v . so Lu PL�1 N z w w O z BENCH MARK 3LL z J SCALE: 1 in v 30 ft E ATis5" SEWAGE DISPOSAL SYSTEM PLAN OLL m � 0 U I USGS DATUM ASSUM® 0 Q I� X o -TO SERVE EXISTING DWELLING o M wow IRWIN AND GRACE MOY O cn - �ps9 74 MONOMOY CIRCLE CENTERVILLE. MA < � — o Q QAD�D ECO-TECH ENVIRONMENTAL 0 0 `; y o Co#jogs R 43 TRIANGLE CIRCLE SANDWICH MA 0256 —J w H CL x W 9F �P�a 508 364-0894 o W w sgNys� P`P ETE-1363 I MARCH 5. 2003 A 172 I � THIS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT BEARS THE STAMP AND SIGNATURE OF THE DESIGN ENGINEER 0 ORIGINAL INTENDED FOR AL TO THE OF HEALTH WILL BE SIGNED IN BLUE T BOARD AND STAMPED IN RE . TEST: FEBRUAY 3. 2002 j` SOIL TEST LOG SSOILEEOVALUATOR: DA VID DR COUGHANOWR. RS DESIGN CALCULATIONS WITNESSED REQUIREMENT WAIVED - NO VARIANCES SOUGHT NO GROUNDWATER TEST PIT PARENT MATERIAL: E ROGLACIALDOUTWASH DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD ELEVATION - 50.50 +_ PERC AT 62 in 2 MIN/INCH IN C SOILS SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS DEPTH SOIL USDA SOIL SOL COLOR SOL OTHER USE EXISTING 1000 GALLON SEPTIC TANK IF IS SOUND STRUCTURAL (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) 0-10 A LOAMY SAND 10 YR 3/2 NONE FRIABLE 10-40 B LOAMY SAND 10 YR 5/6 NONE FRIABLE DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 40-132 C MEDPJM SAND 10 YR 6/4 NONE LOOSE. 5% STONES SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 ft x 2 ft LEACHING GALLERY CAN LEACH Abot - ( 24 x 12.5 ) - 300 sf Asdw - ( 24 + 24 12.5 - 12.5 ) x 2 - 146 sf Atot - 446 sf Vt 0.74 x 446 - 330.04 GPD USE A 24 ft x 12.5 ft x 2 ft GALLERY. Vt - 330.04 GPD > 330 GPD REQUIRED GROUNDWATER ADJUSTMENT EXISTING GROUNDWATER LEVEL BASED ON BARNSTABLE GIS DEPARTMENT RECORDS LEACHING GALLERY OBSERVED GW: 32.0 INDEX WELL: SDW-252 CONSTRUCTION DETAIL ZONE: D READING: FEB 2003 DRYWELL UNIT STONE -LEVEL: 47.2 8'-6-= 4•-10'X 2'-P* ADJUSTMENT: 3.3 f t 2 ft EFF. DEPTH ADJUSTED GW: 35.3 24.0 ft o M o NOTES N_ o I) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN 2.5' 8.5' 2 fr 8:5' 2.5' 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. NOT To 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 24.0 ft SCALE OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) , 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM, 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX-*TO RUN LEVEL FOR 2'-0" BEFORE PITCHING DOWN - SEWAGE DISPOSAL SYSTEM PLAN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES AND APPLIANCES. AND BIANNUAL PUMPING OF, THE SEPTIC TANK -TO SERVE EXISTING DWELLING 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT - PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. . ;. IRWIN AND GRACE MOY 10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 74 MONOMOY CIRCLE CENTERVILLE. MA II) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY 'COMPACTED AND ON TO WHICH ECO-TECH ENVIRONMENTAL SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING =? 12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED 43 TRIANGLE CIRCLE SANDWICH MA 02563 k FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE, ETE-1363 MARCH 5. 2003 2/2 4