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HomeMy WebLinkAbout0141 MONOMOY CIRCLE - Health � x l r-, 4G's Monornoy Circle A= 191, -206 Centerville 5 M EAD® No.2413m UPC 12M sm"d.com • Made In USA mq,N I Town of Barnstable Barnstable Inspectional Servicescacft IIAFiNSMXSLE, 9� ,�� Public Health Division Arfi°�hD� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7657 May 1, 2019 CARROLL, CINDY LOU 141 MONOMOY CIRCLE CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 141 Monomoy Circle, Centerville, MA was inspected on 04/22/2019 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 THE BOARD OF HEALTH 6Z M Thomas cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mai ling\Failed or Needs Further Evaluation Letters\141 Monomoy Circle Centerville.doc Town of Barnstable s a � s • BARNSPABL.E, 9� Regulatory Services Department '°rFa r�u►�°' Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scah,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 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 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 driveway due to H-10 components, etc) eaching 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 c Commonwealth of Massachusetts �T Title 5 Official Inspection Form �= .0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Monomoy Circle "* Property Address s + Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 l:_'A required for every page. City/Town State Zip Code Date of Inspection i'' 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, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 Q Company Address Sandwich Ma 02563 City/Town State Zip Code _ (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: 1 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 Brett Hickey "°� °�°""�" 4-22-19 -- Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System--Page 1 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form 1; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Monomoy Circle V Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 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: 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Monomoy Circle u Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 ,f Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Monomoy Circle V Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 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 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 O ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ El Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Monomoy Circle V� Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 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 ❑ ❑ 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 '/z 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. ❑ O Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ El Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ID 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� Ely cesspool serving a faculty with a design flow of 2000 gpd- 10,000 gpd. a ❑ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Monomoy Circle V Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 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 Q ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 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? ❑ ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ 0 Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? El ❑ 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? Was the facility owner(and occupants if different from owner) provided with El El information on the maintenance of subsurface sewage disposal systems? proper 9 P Y The size and location of the Soil Absorption System(SAS)on the site has been determined based on: El ❑ Existing information. For example, a plan at the Board of Health. ❑ a 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.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 cam, Commonwealth of Massachusetts �. Title 5 Official Inspection Form n! Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Monomoy Circle Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 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): 425/GPD Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes 0 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 El No Seasonal use? ❑ Yes (E No Water meter readings, if available(last 2 years usage(gpd)): See below Detail: 2018- 32,000gallons 2017- 32,000gallons Sump pump? ❑ Yes M No Last date of occupancy: currentDate t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Monomo Circle .� Y Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 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- last pumped 4-10-18 Was system pumped as part of the inspection? ❑ Yes M 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 �m Title 5 Official Inspection Form11 , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Monomoy Circle Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) I ❑ 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: 1-3-78 per COC Were arriving sewage odors detected when i g g at the site?. El Yes ❑■ No 5. Building Sewer(locate on site plan): 2'6" Depth below grade: feet Material of construction: ❑cast iron 40 PVC ❑other(explain): Distance from private water supply well or suction line: Town waterfeet 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 �n Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form Not for Voluntary Assessments 141 Monomoy Circle V Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 116" Depth below grade: feet Material of construction: 0 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 1 Dimensions: 000gallons 611 Sludge depth: 28111# Distance from top of sludge to bottom of outlet tee or baffle 411 Scum thickness 6„ 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 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Monomoy Circle Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form I' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Monomoy Circle Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 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): offDepth 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Monomoy Circle V Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 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: El leaching pits number: (1) 61x6' pit ❑ 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 Commonwealth o f Massachusetts Title 5 Official Inspection Form Ia Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Monomoy Circle u� Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 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. Pit was full to 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 +m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Monomoy Circle u� Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA 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 —IN Commonwealth of Massachusetts - Title 5 Official Inspection Form ,m Subsurface Sewage Disposal System Form Not for Voluntary Assessments I u 141 Monomoy Circle Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 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 Sun A B Room 0 0 o--_. 0 A1.20' B1.50' A2-28' B2-32' A3-42' B3.29' t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 i Commonwealth of Massachusetts �m Title 5 Official Inspection Form io Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 141 Monomoy Circle Property Address Cindy Lou Carroll Owner Owners Name information is Centerville Ma 02632 4-22-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: FEW Check Slope Surface water Check cellar Shallow wells Estimated depth to high ground water: NoGW@12'feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record 12-28-77 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 at the local Board of Health was used to determine high groundwater. 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 �s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 141 Monomoy Circle u Property Address Cindy Lou Carroll Owner Owner's Name information is Centerville Ma 02632 4-22-19 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. 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 TOWN OF BARNSTABLE i LOCATION 141 JnonGynou C,rcic SEWAGE#20 19 - 1$1, VILLAGE Ccnrlcr,,;J G ASSESSOR'S MAP&PARCEL 191- ZOG INSTALLER'S NAME&PHONE NO. G 4. r3 rXCc3tX3_, 1'0i\ 4`7-1-OJ S3- SEPTIC TANK CAPACITY .1000 LEACHING FACILITY.(type) S009_m) C (2"') (size) 13 x ZS X NO.OF BEDROOMS .03 OWNER C,n.k4 Carroll PERMIT DATE: .S-25/- %Q COMPLIANCE DATE: S-30. 19 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Al - Zoy" Az- Zl ' A L:l Bz• sy 63.3$ � �y - y2G " � C�r�le �. No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 01ppliLAtion for Bisposal *pstrm ConstrUrtion 3pPrmit Application for a Permit to Construct( ) Repair.(114upgrade( ) Abandon( ) ❑Complete System ndividual Components Lo lion address r of No. y f Q/1pmp Owner's Name,Address and Tel.No. p� � y L�o�o l.ov ��oil 7n�--3,�- ► yy A ssbr's Map/Parcel _ILA aPIC11 �,O- Z 0 / Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 84B &C0VCtfia,j -308- 47-7 01o53 :r1aheey-y j�Nv ),?q- qq q-ii &j� Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _�.3 �� gpd Design flow provided gpd Plan Date ��a�� 9 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 i Zp cl-bny (23 r r 2D g00 pnj Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of alth. ( r Si Date SI 1 Application Approved byul. Date Application Disapproved by Date for the following reasons Permit No. ® — ! Date Issued ----------------------------------------------- _' ' No. — 1!D Fee- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN,OF BARNSTAB,LE, MASSACHUSETTS 01-ptlflcatlon for Disposal *pstem ConstrUction.Vermit Yr Application for a Permit to Construct Repair U ade Abandon _.,a" "* PP ( ) p ( pgr ( ) ( ) Complete System dividual Components r Location Address or Lot No. Owner's Name,Address,and Tel.No. f l � ©r7amoy &l-. A(s onSM piP 1 19 f 0rr7r�y env �z r1oIl v ZD Installer's Name,Address,and Tel.No. 4 Designer's Name,Address,and Tel.No. 8.48 (+XCP' vadto/I i30,9- )477-0to53 :r1oheet �Alv qaq-/t 61� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 4- Design Flow(min.required) ") gpd Design flow provided gpd Plan Date as Lj V Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 2 o eA -heox (2) 2.D "- 1 4 k �S ' S 1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of a th. Si - Date S �3 Application Approved by Date Application Disapproved by Date for the?following reasons �r Permit No. �� f Date Issued t I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance ; THIS IS TO CERTTIIjFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by at 14-i 1 r�!-)/)r�-n a, / r"�t ��Q _ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 0 - dated l d 4 Installer /� � _� �� Designer fl #bedrooms Approved design ow gpd The issuance of this permit shall n t be construed as a guarantee that the system willcti n designed. Date. /'+, _ Inspector No. � � � Fee �/�✓" THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstrm Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) . System located at 1 CA � ��� e and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructii n mustf be completed within three years of the date of this permit. Date 1d101 Approved by t Town of Barnstable °pV.E r Regulatory Services Thomas F. Geiler, Director ' &ARNSTABLE. = _ Public Health Division . A � Thomas McKean, Director prEO MA'S 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 5-30.1Q Sewage Permit# Zol9- 1$6 Assessor's.Map/Parcel 1-206 Installer & Designer Certification Form Designer: 09!,ae BOAINerIM Installer: 13 EXeca0A0,r", Address: p -0 X 331 14arwick Address: lqF`i'eaSesc'c�. �.►� On S-Zy- 19 3 4 G 6xerayaA i on was issued a permit to install a (date) (installer) septic system at I to I {rho na rn oc1 C;rc1 based on a design drawn by (address) �aue alner�et dated 5.ZZ- 19 (designer) S( I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils were found satisfactory. DAVID D. S staller' i�ems— HERTY,JR. No. 1211 . (Designer' Signatu , (Affix Desig u p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.. THANK YOU. q:\office forms\designercertification form.doc i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Lyz 0 C 1 ✓` Property Address / 4-� OC ON ner ON ner's Name 3a information is ( �CY�! /1� required for every State Zip Code Date of spect n page. Ckyfrown 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. Ifnpoftnt: ^1en A. General Information (� filling out forms \ ' on the computer, use only the tab 1. Inspector key to move your , cursor-do not R✓ Kh e, l use the return of Inspects -mac key. ��// O 'Company Name /�O� Company Address 00( Tot G f -- GtylTown Soe ^�. 1 /, State Zip Code Telephone Nu r / `T License Number B. Certification 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 16.340 of Title 5(310 CMR 16.000). The system; ;;�Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority aJS A. - Inspect is Signature Date The stem 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. Title 5015elal InspaetlonFarrrt SuDeurlaee$ewdpeDl*paael SyOm•Pape 10117 One•3M 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �f l / "119P1 0►-10 (,! r Property Address Owner Owner's Name Information is C—e 0 ' � ool 6-aZ 41ns ✓(i ( //required for every page. 5t /Town state Zip Code Datetion B. Certification (coat.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System saes: 7I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ one or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND) for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not)Is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): One,Y13 Title 60ff1dW Inspecdon F arm Subsurface Sewage Disposal System-Pape 2 of 17 Commonwealth of Massachusetts 19 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments / [!J A1000 ►N/0 C "/' Property Address 77 Cw nor Orr ner's Name �,�( information is . I e j�%72a3 a �3 required for every page. Cityrrown State Zip Code Date of I spectbn B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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. J. 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 mannerwhich 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 Ore,3f13 Tile 6ofaelel Ire pecaonForm subsulme SevM9Dlepaael System•Pape 3of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments Z / A/W 0 V417 0 Property Address ellpG4-- ON nor ON ner's Name Information Is required for every l/ pectbn page. Cilyfrown State Zip Code Date of In B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier,If any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate --Yes" or"No" to each of the following for all Inspections: Yes No ❑ 2 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ g/• Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ �/ tatic 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'/z day flow ire,W 3 Tide 501ftal impecdon F am Subsurface Sewage Disposal system-Page 4017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �`f l A/0✓r V woo Property Address 0C-�- CY IInnformation Is Oau ner's Name / ✓✓! / required for every ("�Q✓► ` State Zip Code Da et of spect page. City/Tow n B. Certification (cont.) Yes No 0 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. ❑ p' Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ (�>ny 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.] ❑ Te system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd.he system fill$. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system falls.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems. To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well If you have answered"yes'to any question In Section E the system is considered a significant threat, or answered "yes"In Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system In accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Or*-3M3 Mo OOfA01d Inspecdon F am substowe sewage Dlspaed system-Page b of V r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments / 0 VI?49(-) C Property Address �o�l✓ ON nor Cw nw's Name Information Is required for every / ��Cpd� ! Ile- 1 yd-C -7.L S o? page. City/Town State Zip Code Date of Insp6ctlon C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes o ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as NIA) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? 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 CM 15.302(5)J D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): One•3M3 Title 50ftldal inspectlon Form Subsurface Sewage Disposal system•Page 6 of 17 i Commonwealth of Massachusetts Titlo 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments / W AoOno C� ►� Property AddressO. nor ON ner's Name Inf P (i //� d� `�o� _.....Z o� 9, �3 Intormation is required for every page. i5y/rown state Zip Code Date of I ectiorf D. System Information Description: �0 DO l�o h sp 4 4 h �✓ �lJ�/i Jvr�lD Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes 2 No Information in this report.) Laundry system inspected? Cl Yes No Seasonal use? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yea No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM R 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: Mrs-W3 Tltle 80fAde1 lropeclon Fort Subsurface Sewage Dlepoeel System-Page 7 of 17 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface sewage Disposal System Form -Not for Voluntary Assessments OBI o✓'10 I ✓' Property Address Owner Oav ner's Name / informatlon Is e✓f•�✓//!�le / / ' required for every State Zo Code Date of Ins cti0n page. Cilyfrown D. System Information (coot.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: O �N1 01�✓ Source of information:Was system pumped as part of the Inspection? ❑ Yes a"No 9yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of S m: 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/Altemative 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 VA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Title 60flidd Irapection F orm Subsurface Sewepe Dlsposel System•P19e 6 of 17 Ons•3M 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I T 1 '/P/0✓1 O kv10 Cf ✓' Roperty Address / ' /o G A/ iInnformstlon Is ner's Name o I 'InsrequiredforeveryCe 19 State Zip Code Date of page. CNyRownctan D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information?: Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan), Depth below grade: feet Material of constructi;-40 ❑ cast iron PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet / Material onstruction: 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: C;?;,— Sludge depth: t5ine-3M3 Title6Offi dInspecdonFarmSubeulaceSewageplepaeelSPfem•Page9Of17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System F orm •Not for Voluntary Assessments l0 v'!o V CfY, Property Address ' / Wro rr 4/ ON norner's Name informrrn A oa 6 3� a Y- ation Is h��y/ Ile_ required for every page. City/Town State Zip Code Date offfispectloff D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle / !/ Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): ko 1-Qq, 1'j. 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 Toro.3113 Title 5 01Add Ins peotlan Form SubsWace Sewage Disposal System Pepe 10 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 /y/ 14100 0 Wo!::� 1��, y" Property Address // � O G h/ // Vinf ner Ory ner's Name /` 0afo requiratfo is / e� .�rf` e P9eUedforevery Cityrrown ,y„� State Zip Code Date&I pectl D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural Integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): must be pumped at time of Inspection) (locate on site plan): Tight or Holding Tank(tank p p p� ) g Dept h bel ow g ra de: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in worWng 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 fin,3N3 Tile 5011dei lnspectlanForm SubsWw9 SewapeDlepoe9 SyaMm•Page 11 of V i Commonwealth of Massachusetts 19 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /W �O40V110 V ✓' Property Address /O G� Ow nor Owner's Name Information Is H ►ti! Qa �� 6 g requ� �ed for every page pyre Otalo alp Oodv Daly�f I iopoolbn D. System Information (cost.) Distribution Box (if present must be opened) (locate on site4gan): z-- 4--ek-7 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.): o >/, Ge✓�/ l� so/ NS �n L4e-C-- 41s Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No" Alarms in working order. ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): if SAS not located, explain why: Mine.3 M 3 Tile 6 Official ine pactlon F orm Subsurface Sewage Dispood SWWM•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 19 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �000w10 Cyr property Address ,- h O G / �w nor C w ner's Name C information Is G e,,,- rv<A, OP 6� rr 9uiiredforevery Cilyfrown State Zip Cade Oate of t spection D. System Information (cost.) 'x Type: 0 leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/aitemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): t vl v'Q /v O s o cr w /i'C -7<1 11,11Y Pe 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 C] Yes ❑ No Tile8010det irepeotlonForm Subeurteoe SewaOeDiepeeel System•Pape 13 or 17 Wire 3H 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /WON Owo 6✓' . Property Address /OG� lnf ner Oerner's Name Ce I ✓v�/ Qo�6�0� 9 �3 inforrrretbn is -}� i_'.L required for every page. Citytrown State Zip Code Date of I spectbn D. System Information (corn.) 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.): +ers•ana M96014ds Inspecdo,Formc subarface Sewegeoieposel System-Page U a» Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments AX 671— Property Address IOGh/ Ow nor Ow ner's Name Information is Cyr, ✓�// Ile �� Oa 6 Z.) o�} requireduiredfor ovary page. Cky/Town State Zip Code Mte of Yispectldh D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, Including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where c water supply enters the building. Check one of the boxes below. hand-sketch in the area below ❑ drawing attached separately 4- sRod., / Sd a9 da 3� A.7 - a 9 Ans•310 Tltle 60tAdel Inspecton F am SubeuAew Sewage Dlsposel System-Page 16 d 17 Commonwealth of Massachusetts 19 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /�Z/ -- 1q0 Pi a W 0 !, C/ Y" ' Property Address roc � Cw ner Ow ner's Name _ �/! / Information is /�✓ required for every CPv►y page. City1rown State Zip Code Date of In pection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells /C�Ovtf---- Estimated depth to high ground water feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: pate ❑—/ Observed site(abutting propertylobservation hole within 160 feet of SAS) L7 Checke th local Board of Health-explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must desc a how you established the high 2rou/nd water elevation: r LI p u ✓l d(r-.�-t� Before filing this Inspection Report, please see Report Completeness Checklist on next page. Ons•a13 TiVe$Ofidd InepeogonForm Subsurface SewegeDlspoed System•Page led» 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments N/ AC20 0 VV(P 2�z Property Address Cw ner Cw s Name // requinatbn is Ce,-4-k✓o ` `c- /L,� O��2 � qrequiredforevery _L page, Cityfrown State Zip Code Date of Ins ction E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked Inspection Summary D(System Failure Criteria Applicable to All Systems)completed Ifd�Sys m Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate fie Wine.3H 3 Title B Offidd Ire peclon F am Subsurface Sewage Disposal System-Page 17 d 17 to GAr �.E bI�1 . Ladl Lam( FLow s 1Io rc 3 t ��b G.P.D. Op.of �EF'T-I G T'41.1 K = 330,E f r o °y, 4-C15 6.p D. PDSAL PIT I...�SE IC�oc� G,� • 1� IS Id2� i IC�o �8a r'ro�vt AeQ .P D. F' _ 0 TOT,&L TV E 16KI ■ L1> > d25 G,P.D. qNk TbTQ 'val U-( FLOW PC�RGDI,.D,T10t.J 0ATE s I"II.J 'Ltit l u' o¢ LpSS. OF ;,o�.4z� n�0�Np�, ALAN RCHARD A. 2a 3 '�"1 '� •�3 m2ooW1 22; i y •, BAXTER No.2'04t3 �4N�STJ�,�`� ' ,, '• 5 i ,�";�':,�t. �oi�2 �=-17. 1 7 : . i 'mot, i A Dsu T ua lI l'LZ,�•�•7 hTC6"v., Fwo �e►o.e.,_ 4. 4=")C) 74 4'PPe� �.��e IOoo UN. �� luv• �,b °", t_i Iw. G,o,L. 167 . L -, f '8ox qG 7Lk -4 � Iwv ►JV. G PITi- 'A i Z• .: M wASNw CE Q.T t F 1 ED p LC'T' j�L Q 1J r LOCATlot,J l G G IZ T 1 1= T J-4 A T T 1-4 C-- 'DW ELL„I N G 5"0%4j►J P L.A.►.! R 1='C >~►.•i G E �C: t_�IJ Cc pL�S W 1'1"F•1 TWG. I ws or Ae-IG i~cqulrZEMck4TS �o w C�5-0. ' ,, • Bh.x-rct� �,. uYt� IaJG. aCGls ttl7E-D 1,AI.IG SurzVEYor S TI-415 t�L,AI-I l a 4•JoT L',A�>Cp Utr..J AaJ OSTEJZVI�1 o �,(A5 :r�uc�wr ;uc .n_Y , Yla� vFl�air, S1 rGw.,w ` 13r-_ u5tc� .•ru . b�'1 GeM1►JC:. ...l.D a,PPL CA.ti.JT,. • �ffvcq 1?7.7-3 f(1 error Cam. � °3• Fsa...............•L THE COMMONWEALTH OF MASSACHUSETTS l �-- BOARD F HEA H szj , Fly /7/�e . 1 q Applixtt#ion-for 3Rispinial arks Tons#rur#ion Pernti# 7 Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: eA ocatfo dms -o Lot o. •••• .•...._...... ..................` . ..........................._......-•-........ ........__ u: :. ... ................................. nor 'dress W /..---.._... .. ..._ -------------•-... :.........ram. k ..A.--•••:.......................................... Installer Address UType wilding Size Lot............................Sq.�feet a Dwelling—No. of Bedrooms........1,3...........................Expansion Attic ( ) Garbage Grinder vv�d GOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other Irktur W Design Flow.... xirr --lions per person per day. Total daily flow....._.. a g g. P P P Y. y ...................... gallons. 04 Septic '1':mk—Liquid capacity.1_663gallons Length................Width................ Diameter................Depd-................ x Disposal Trench—No................ .......Widtli... ..... ......_.Total Length....................Total leaching area....................sq. ft. Seepage Pit No.. . Diameter..`,2..�8 Depth below.inlet....................Total leaching area..................sq. ft. 2 Other Distribution box ( ) Dosing tank .2 L- 77 Percolation Test Results Performed by.....-Z �........r.......IL Y i-'*AV.......... Date..,t.2..' _ ._'.�.7......... MTest Pit No. I................minutes per inch Dep�of Pest Pit.................... Depth to ground water.........-....-.-....... G, Test Pit No. 2................minutasper inch Depth of Test Pit.................... Depth to ground water........................ 2........ .... ... ........ ..._...... ...../7............._.....yT / �¢ Description of Soil........................,- 3� / elP.�..� .'. `.4 _ W .........................................................................................................................._......... U Nature of Repairs or Alterations—Answer when applicable........... /1�.... C� .` '•.. .......... .......................................................................................................................... .... i ... .. { Agreement: {� 1 The undersigned agrees to install the aforedescribed Individual ewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The unders g ed further agrees not to p e the system in operation until a Certificate of Compliance has bee ed by boa • of heal . Signec1• = _ . . ...................................... ._...._..... Application Approved By._---•--• ,..4;.c�rr¢.•-�c, •••����-LG!1�. ............ .lnFvi. �_...... 'Date ' Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................._.-----...._...._.................-----..._............_..................................._.. Date PermitNo......................................................... Issued.... -7............................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH .y�...........O F....... ..f...'v..�...v...~-::.................................. tthe rfif ira#le of Tomplittnrle THI IS 0 CB Y, Individual Sewage Disposal System constructed ( or Repaired ( ) by..... ... • ..................... _................._..............-----_... ................ �/ Installer at......... ... .. .......7(-.......{ d?�7 ?� �....'.. ' t ... . ..................................................... has been installed in accordance with the pro 41ons of ' e XI of The State Sanitary as described in he application for Disposal Works Construction Permit N ..._�.................... dated.... �n..,3...-.Zc�k-... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM.WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector................................................ ............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH s, /`..i r ...oF............ ...Aa I............................................... -d d 0.........5......... �is�u�ttl ii���. eP ermission ' ereby granted.....,.f . -to Construct r Repair an Individual ..Dii osal/System at No....e... . . ',7- . .....��ldh?� g�h�:. street as shown on the application for Disposal Works Construction Pe Nof;... ..... Dated......1.- ......... - Board of Health FORM 1255 House 9 wARREN.JNNC.. PUBL19HERB L ATIOIv' I SEWAGE PERMIT NO. V L L A G E INSTA LLER'S NAME & ADDRESS B U I'L D E R OR OWNER ' DATE PERMIT ISSUED :,, OAT E. COMPLIANCE . ISSUED j; ���- i 4 '�� O s - 1 � r 1 ._.. . _� _..___. � _ ' i � � s �...... ..._.__,___._ a _ _____.: 77 1113 , .............................. THE COMMONWEALTH OF MASSACHUSETTS ®l" BOARD F HE94 H I ... --....O F..... ... . ................ .. - . ---.........................---- a Appliration -for Uhipaoal Workii Towitrnrtiun Vrruiff 7/7/�op Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• ����9'", ' r..___- _ 7 --.•----_--- Locatio dress o-Lot r.. a. ----• • .............-................... ..................... ----------- -• - .......--- ---------- ................................... 0 nor Address Installer Address Q Type uilding Size Lot............................Sq. feet V Dwelling—No. of Bedrooms..______.. Expansion Attic ( ) Garbage Grinder WVJd �-� ------------------------ p`.,., Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other t W Design Flow.......... .. ___gallons per person per day. Total daily _ (y Septic Tank—Liquid capacity_J_ alions Length................ Width................ Diameter................ Depth-------- ....... W x Disposal Trench—No...................... VVidtlt___ __._. ..:_____ Total Length------------_----_ Total leaching area--------------------sq. ft. Seepage Pit No... Diameter_. � Depth below inlet____________________ Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( 0 ,�' %,R - a �- 7 7 '~ Percolation Test Results Performed by.___--. � ------- _____� � Cqf.. Date__%_g•... ---.... �.1 Test Pit No. 1________________minutes per inch Dep of Test Pit----------- ______.. Depth to ground water-------------.-.__.____- r=. Test Pit No. 2................minutes per inch Depth of "Test Pit.................... Depth to ground water-_---._--_---_--__-_---- r / -•--•---•-------•-- ----- ----•------- Description of Soil '-� 8._ ..0 ^J �" '. C s=13 x c, ---------------------------•-----------•-•---..__._._.-•••--••--•-•--•••-•--•-- W ------- --•-------------- -- UNature of Repairs or Alterations—Answer when applicable._...______ -___._ _._ __.,,,--- _.____.. . Agreement The undersigned agrees to install the aforedescribed Individual Aewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The unders•g ed further agrees )tope the system in operation until a Certificate of Compliance has bee • ed by t boa of healt Signed_ ,� J --------------------------------- ---••-Dace---••--------- Application Approved By--------/,, .. ate Application Disapproved for the following reasons:--•-••--- ----------------------•--•---•---•-----__-____-----•-•--••---••-----------•••-----•------------------- --••_-_---------•--•----_•------•------------------•-•-------------------•-••---•-------------------------------------------------------------•------•---•-------------------••----------------•-•----- • Date PermitNo......................................................... Issued___..�_V...'_.7_ .................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O)j HEALTH ............ .:...OF. ............................................... .3N5......... FEE Di-spviial lu , kii n trurtion V trutit Permission ereby granted-------- ------ I. ......................................................................................... to Construct r Repair an Individual ewage Di posal,Syste ---------------- -- 4 -0/-------------------------- at No...,-.� ,�. ------7 Street as shown on the application for Disposal Works"ConStruction Peg* No Dated...... X7 2e ................................ Board of Health H�eait�DATE------' -------------------------------------- FORM 1255 HOBBS. & WARR PUBLISHERSI F" Nib.......... ....... Fs>m.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE:ALTH Appliratiun -fur Digpniat Works Tunitrnrtiun Vrrntit Application is hereby'made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: I --- �= `°!', --------------------------------- /y Location Address or Lot Iho. I y p !�� ./,✓' 1�•�,-4_ � f \'"'9P'�v",.Fs �a''` .ni. ir'�.,r/..r/" k � W O' d" } Address Installer Address Q Type of*Building Size Lot_-------------------------Sq. feet Dwelling—No. of Bedrooms---------- --------------- -------------Expansion Attic ( ) Garbage Grinder VV0 aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q Other fixtures ......................................................---------------••------------------•--..._.. ----- W Design Flow.....................'...-___-------_---._gallons per person per day. Total daily flow....... ' _` '_._�^-.._-_--.....-_-gallons. WSeptic T:.nk—Liquid capacity j_('r�lallons Length---------------- Width................ Diameter__-.--_------- Depth.__._---_.----- xDisposal Trench—No-.------------------ Width......... -------- Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No.... Diameter__&_-k ,,a Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( Q 0 /yles C. 7'7 W Percolation Test Results Performed by.----. c.....4. •le .......... Date--`—;!_ ..... Test Pit No. 1................minutes per inch Dept i of Test Pit..----_____-_-___-. Depth to ground water........................ fS, Test Pit No. 2----------------minutes per inch Depth of Test Pit...---.-_-______--_- Depth to ground water--.-.--..-_--_-._--.._.. P; --•----• r.... -- ® Description of-Soil d . . _ '._ ra :- ....... ..'� ` .': dic�t ------------ - --------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- -• ----------•--•---------------- U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------- --------------•---•----•----------•-----------•----------•--•-------------•--------------- Agreement The undersigned agrees to install the aforedescribed Individual ewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The unders ied further agrees not to pla e the system in operation until a Certificate of Compliance has bee is •ed.by t boa .`of health. SignedQ --' ---------••------------•-•-•--- ... '- .... Da A A Application PP rovedB Y--.... =-1: k1---£.r�'--.-� ���-- -� ---•----------------- -- - ' Ye�`�''�---�� 'Date Applicati'o"approved for the following reasons--------------------------------------------------------------------- --------------_ --------....... ;. Date PermitNo................................-----••---•---•--------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS B0-ARD O HEALTH OF....... .:.... n/ ! ~` ................................... rr. ifirab of IT.'am ffitgtre THI IS .,O CE �'Y, 1 the Individual Sewage Disposal System constructed (. or Repaired ( ) by -- f�/ W"' ), ................ at ..r- .� ...--! ,-•--- r has been installed in accordance with the,•pro �I ions ofI of The State Sanitary C as described in #he application for Disposal Works Construction Permit N �-------------------- dated THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM,,-WILL FUNCTION SATISFACTORY. DATE. ;.. Inspector------------------------------------------------------- Cal= -Y"l r 1."► Z-��1-1�.. �•IaJGL� SLIMILY �;�"?� W��►��L�C_M .-a. - _.__ ►moo G,Arrx.�.i✓ er�l�r��z. _ ._ radl LY >`Low : I lv .c 3 z 33d G.P•D. F• (Op.p� �._ - �EP't-i 330.E (S o % • 4S9 ri 6.P.o. 14. ! 171�Po5AL PIT IJSI= Iooe SUeIA/ALL A EA = 15o -.- . 04IPI •�.er�-ram 37S G.P.D. ST. _ft-d So Sri. SO ,S TOTrdL IZ>G6j6W • d2S Q.P.D. LIN AMA , ' -.,t,•; } Tr>TQ L ba1 Lam( FLG1W • 330 6,w. P-WG0L&T10U 04TE ' � tl.l ZMIIJ OQ LESFs. €,.' ICJ OF ALAN lti �4C .ARD •� P nZ V'I A. kt BAXTER �,p fc�, 70 r Vl,,,)rj gip. i No,2'.04E) 4 cis,-%�� I �� � �,72' 1�=g39s , woo 1414/- OMV ' . �7Top• .. 7Tlr�i./.�. 5 , ♦ . . .....,,, P..... u Lo A wi ' ,d''P�� -� I ' ••Y i i r �y (` � i � �pe (bGp lfN � �� tIJV`. 1l•b i jri';.J ' f- Z• SJo►S/IC.. f,- ! 4" PPEs D�aT IW CGA.I f r f VG� CIwv- (000 x i Qti I ITAIJK t t INV 11lV t i GAL. t i L• l ' sj SAy�, ' LAN 77 PIT , , t j } .1 I - •.� � '�. J J.. r ` M� WASWED 5To f I i I f a .. .. wi E i y.' _ - SAS!� �o G.o' �o ----- _:. _' _i____-. � _ -'• 1- 12 8�:0 LOCATIol-4 t h u o Sca`+ TE(LI/It I t� o "role✓ ATC— WE4.INL Slaaw►J I Pt 4.t.1 . w1/IPL�(S W 1'i'I-1 T►-1` �j1 D�..LI1JEs ; -� f .� I s r,i Aua SEYOACIC �cgvIQGAAE!WTS o� r►�+:. , '.. �T ��+ 'Tow,•.] o� ' 4I r BI�)(TCu, u* , 9ZG61S'(z{ZED LA wo ! lueva o,qs "1'1-115 6LAt-1 .1e, WOT BA-1.Gv 014 ; p�,l _ OSTE2VIl..LL= o,. k(ASe,# ` ' h tJSrIc�MC`_i.1T ul �/�zY Tilt UFI=;r--T"d' .5140WLj> u`� 1�1 ' • - - A.P P t1 G tJ ti•Iv'r �C �t� Z"C�- .�1 C�M t"wl 1.:. t_"..1..D`r'..-.-1_o I-1��,,._ A -f".+._i ,�1'1{� , � /� /.. � � r s COVERS TO BE WATERTIGHT AND TOP OF FOUNDATION SEPTIC SYSTEM PROFILE c e)BROUGHT TO WITHIN 6"OF FINAL GRADE Flaherty Environmental Services EL. 60.0' EL. 58.0' (not to sal INSP. PORT W 13" OF GRADE CLEAN SAND P.O. Box 331 2"of."to z" DOUBLE WASHED PROP. EL. 58.0' FILTER FABRIC Harwich, MA 02645 4" CAST IRON or EQUIVALENT PEASTONCOR GEOTEX TILE --cam MIN. PITCH 1/4" PER FOOT 774.994. 166 4"SCHEDU E 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE ; FLOW LINE l VENT IF REQUIRED r1is1 2•to be fever ., . �• —► �''• ` L.EXIST. 14" ®� . 4i p °°0°o0o°c 0 0 0 0 EL EXI • —� °o°o°o°o°o° ° {t�j 000°o°o°c L.55.6 0000000 0 0 0°0° r�J o 0 0 o e 0 0 0 0 0 0 0 0 0 0 0 EL.54.73' 0° °0O°O°°°°°O � ,000000oc ' L.54.9' O 0°0°000°0°0°0 •� 0000o0o0c 2_0 r GAS BAFFLE EL 54.T 0090900000 000000 ®L���.. ® 00000000� .....�• 000000000° Oo°p0o aO a w 0000°o°OC EL.52.T (H-20 D-BOX) 6"CRUSHED STONE OR SOIL ABSORPTION SYSTEM 1' '' �` •' •'' MECHANICALLY COMPACTED 500 GALLON H-20 CHAMBERS 1000 GALLON SEPTIC TANK 2( 6.71 (DATUM: ASSUMED) (EXISTING) 311 1„ WITH 4'STONE AROUND IN A n—to 1, DOUBLE WASHED STONE 12.83'X 25'X 2'CONFIGURATION BOTTOM OF TEST HOLE EL. 46.0' EL. 46.0' USGS ADJUSTMENT: N/A LOCATIONMAP LOT 74 GROUNDWATER ELEV: N/A 15,142 SFt BENCHMARK: N TH O� MAP 191 LOT 206 TOP OF FNDN �� 58 EL. 60.0' a. 58 O� 56 O 00 EXIST. S.T. �TH-2 9 VL ,O T 1� LOCUS .BYO ••''� 29.4' r f 0 33.6' NTS EXISTING SH 3 BR DWELLING DA ti 32.3' D LA E PORCH PATIO 010 /STEM NBa EXACT LOCATION OS SAS M' / �aAilTAlt) MAY BE ADJUSTED TO ACCOMMODATE GARAGE \ /01 �� / O Ai. V/ (ry EXISTING PLANTINGS \ QJy `7 IVEWAY -, 1SS1', IN, �O O,4TE.•&2"19 REVISED.• LEGEND SITE AND SEWAGE PLAN FOR B& B EXCAVATION, INC./ w 6 6 6 GAS LINE / CINDY LOU CARROLL - 1I—�:—�W- WATER LINE 56 / -6 E—€—E E EXIST, ELECTRIC 141 MONOMOY CIRCLE / (CENTERMLE) BARNSTABLE, 99 EXIST. CONTOURS SCALE ■ 1 = 30 MA ————— 99 PROP. CONTOURS } EXIST, FENCE ■ �� REF.PS272 PG 88 F2 PAGE 1 OF2 . t ..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... .................................................................................................................................................................................. GENERAL NOTES DESIGN CAL CULA TIONS S YS TEM DETAIL Flaherty Environmental Services A 0. Box 331 1 ALL PRECAST COMPONENTS TO BE H-1 0 Harwich, MA 02645 RATED UNLESS OTHERWISE SPECIFIED. NUMBER OFACTUAL BEDROOMS 3 774.994.1166 DISTRIBUTION BOX(ES)AND ANY COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO VEHICULAR TRAFFIC TO BE H-20 RATED. 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL EST/MATED FLOW (110 GALIBRIDA YX 3 BR) 330 GAL./DAY ALLOW FOR THE USE OF A GARBAGE GRINDER. 3. MUNICIPAL WATER IS AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 660 GAL. - 4. ALL CONSTRUCTION TO CONFORM WITH 25' SIZE OF SEPTIC TANK 1000 GAL. (EXISTING) 310 CMR 15.000 AND ALL OTHER APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION —CODES AND REGULATIONS. ------------- 5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLATION RATE <2 MIN./INCHVERIFY ALL ELEVATIONS AND DETAILS EFFLUENT LOADING RATE 0.74 GAL./DAY/FTCAND REPORT ANY DISCREPANCIES TO DESIGNER PRIOR TO CONSTRUCTION OR 12,83' LE4CHINGARE4 ASSUME ALL RESPONSIBILITY. (2)X(25.0'+ 12.83)(2) = 151SF 6. INSTALLER/CONTRACTOR IS 25.0'x 12.83' =320 SF RESPONSIBLE FOR MAINTAINING SAFE 471 SFx 0.74 =348 GPD WORK AREA, VERIFYING ALL U77Lr77E5 AND NOTIFYING "DIG SAFE" USE(2)500 GALLON H-20 CHAMBERS WITH 4'STONE (1-888-344-7233) 72 HOURS PRIOR TO INA 12.83'X25'CONFIGUR4TIONASDIAGRAMMED CONSTRUCTION. Z ANY CHANGES TO OR DEVIATIONS FROM RESERVE LEACHING CAPACITY NIA GPD THIS PLAN MUST BE APPROVED IN WRITING BY FLAHERTY ENVIRONMENTAL SERVICES AND LOCAL BOARD OF HEALTH. 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED 3'PER 310 CMR 15.000 (NTS) UNLESS SHOWN PER PLAN 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND SOIL EVALUATION FILLED WITH CLEAN SAND OR REMOVED TEST HOLE#1 P#19-„2A TESTHOLEV AND REPLACED WITH CLEAN SAND. Evaluator David D.Flaherty Jr.,RS,REHS Evaluator David D.Flaherty Jr. 7SREHS 10,ALL COMPONENTS TO BE PROVIDED SE#2755 j SE#2755 OF BOH Witness: David Stanton,RS WITH WATERTIGHT ACCESS PORTS BOH Witness: David Stanton,RS Date. May 9,2019 Date: May2,2019 WITHIN 6"OF FINISH GRADE. 11.ALL SEPTIC TANKS, DISTRIBUTION TH-I ELEV.58.0' ft"A E" -R TH-2 ELEV.58.o, BOXES AND PIPING TO BE INSTALLED 0. 21 WA TER TIGHT. 0'-1 P A SL 10YR&2 01-it" A A 10YR 32 12.NO KNOWN WETLANDS OR WELLS /STE WITHIN 100 FEET OF PROPOSED 11 34' B SL 10YR 516 11"-34' B SL 10YR 516 LEACHING, 13.THIS IS NOT A CERTIFIED PLOT PLAN AND UNDER NO CIRCUMSTANCES IS THIS (68 Pero 7 cer*that on November 12,2002, have passed PLAN TO BE USED FOR ZONING OR ) SITE AND SEWAGE PLAN the examination approved by the Department of BUILDING PURPOSES. Environmental Protection and that the above analysis FOR 14-LOT IS SHOWN AS ASSESSOR'S MAP 191 has been performed by me consistant with the 346- B & 8 EXCAVATZON, INC. 2.5Y 615 34"-120" C CMS 2.5Y615 required expertise and LOT 206. 144- C MS In 310 CMR 15.018(2).' CZNDY LOU CARROLL 15.LOCUS PROPERTY IS NOT LOCATED 141 MONOMOY CIRCLE WITHIN AN AQUIFER PROTECTION DISTRICT(ZONE 11). G.W ELEV.NIACENTERMLE) G.W.G.W El EV NIA BARNSTABLE, MA BOTTOM TH-IELEV. 46.0,1 BOTTOM 7-H-2ELEV. 48.0'1 PAGE20F2 .......................................................................................................................................... ................................................................................................................................... ................. ................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................