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HomeMy WebLinkAbout0155 MONOMOY CIRCLE - Health 155 Monomoy Circle Centerville F/R A = 191 207 AY O'CRO t R UPC 12543 e-4a HASTINGS, MN T J V) s t QL - t Commonwealth of Massachusetts Title 5 -official ,Inspection -'Form. Subsurface Sewage Dispbsal$yStem Fbrm,-$Not for•Voluntary Assessments: 155 Monomoy Circle -- Property,Address Florence Williamson Owner Owner's Name information is required for every Centerville. Ma 02632 717/201,1 page. City/Town State Zip Code Date of inspection Esespe�tit ae..reselts.i +test re,snb itteta on..thi�fo f i. Wspection fotlns`rua ii'iot.be-alter&d if "a y. -way.'Piease see completeness checklist at the,end of the form. es s ian t fisitrT9-Oi}Z 10tCri5' -''- -- on the computer, use only the tab 1 Inspector: )U key to move your FF��Kfflll �/ cursor-do not Sean M.Jones use the return Name of Inspector ,key. SM:Jones Title V Septic Inspection Company Name, 74 Beldan Ln. Company Address Centerville Ma 02632 Cityi town State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 Telephone Number 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 was performed based on my training and experience in the proper function and rna f ltenance`aff on s 'sewage disposal systems. I am a DEP approved system inspector pursuant t& ection 09340 et` Title 5 1310.CMR 15.000).The system: Passes F1 conditionally Passes Fails t Needs Further fvaluation by the Loc:al'Approving Authority i w v '7/7/2011 Inspector's Signature Date The system'inspectbr 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,shag e. ayl. is vi has a design flow of 1.0,00.0.gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional. office of the DEP. The d!(U tsvPiezi-aen&to the buyer,•if applicable,-and--the-approving.authority. ***� ;�� f4 �°pibtss co>dr±lo s°at t time of-inspection and under the conditions of use - z4_that i ?e_This A!edG a sFai63 the same or different conditions of use. Lt t5ins�'U9708 We 5 Officialinspection Forin:SOiSsuriare sewage iiisposai sin•c age W 47 !0ommonwealthof Massachusetts V 5 Official Inspection Forrr� E - al - sra a.-'.ew wFr.t$:-.rYrF"aahcnlri:-i•Arcca•cr+sc.hMxt: Subsurface Sewage Ms—it ire.,... 1 vv talon may vie vie. h mpegy Address Florence Williamson Owner Owner's Name information is Centerville Ma 02632 7/(/�Q11 required for every page. Citylrown -state Zip Code. Date of Inspection. .. Certification (cunt) :Inspection-Summary: Check A;B.C;D'or E all ays eonaplete.all of.:Section D A) -System Passes: 1 have not found any information which indicates that any of'the failure c'riteria describ-d, in 310 CMR 15.303 or in 31'0 CMR 15.304 exist.Any failure criteria not evaluated'are indicated below. ,',Comm e its: 13) System Conditionally Passes: E] One or more system components as described in the'Conditional Pas-,-'wvv� n ad.c replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. nariic the nnx€ rani' or-no c# fiarzrtan�stj" (y N,'ND)for the`followln, statements. If"not :determined," please explain. The fitic lnsc 9s°rhta9:antl'tiver 20 yeaYs`i7ld}fir the septic teak(whether metal or not)is structurally unsound, exhibits:substantlai infiltration or exfinration or tank failure is imminent. System will pass inspection if the-existing tank is replaced witli a complying septic tank as approved by the Board of 1 981tF . A rnp7ai sQnfir'i-2nk a.a l na e ir-.-zn5-rfinn,if4f is�rrara aradv Win, nn t��us� �rar..a E__�rzrrtr�r�*-.rf Compliance.indicating that theaank:is less han.20.years:old is-.available. u Ink, Lj, v.D.(Expi�in;betoinij orris o91oe Title 5 Official hispec5on Form:Subsurface Sewage Disposal system..Page 2 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal,System F m 4ot far Junta;y;:ssessr:3 r is 155 Monomoy'Circle Property Address Florence Williamson Owner owner's Name information i is Centerville Ma 02632 7/7/2011 required.for every page. City£rown State Zip Code Date of Inspection -B. Certification (cunt.) -B) P m-Cohditionaily-Passes(cont.): E] 'Observation of sewag'ebackup or break out or highstatic water level in the distribution box due to broken or obstructed pipe(s).or due to a bm—e . pass inspection if(with,approval of Board of Health)_ -M hrnken ninP(-,Vnrr-rerrlac,Pri 1-1 Y (-1 N f_1 N fF-61aEn t etoxo [ obstruction isr removed Y N Q 'ND(Explain below): [] distribution.box is leveled or:replaced Q Y El N O ND(Explain below,)'. Q 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)•arerreplaced El. °Y E1 4N Q-ND{Explain below): �] obstruction is'removed [] Y fl `N '0 AID(Explain below): C} Further Evaluation is Required-by theBoard of-h6altai: [} 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. I. System will;pass unless Board.of:Health-determines in accordance.with 310 CMR ° V`'"M that the system is not functioning:in,a manner which wilt'protect public health, F:9.9 8.9i i Y 1 Cesspool.or privy is.wi`thin 60.;eet cif d_surface.orate;. Cesspool or,privy is within-50 feet of a bordering vegetated wetland or.a salt marsh t5ins.=09708 TMe S offidW,fttVecfion Forth:Subsurface Sewage Disposal System-Page 3 of 17' Commonwealth of Massachusetts Title 5 Official Inspection Form I. Subsuaface Sewage Pasposal-System Foil -Not for-Vountaiy Assessments 1,55 Monomoy Circle u property 6 ddiess -_ - Florence Williamson Owner Owners Name inforriiation is required for every Centerville Ma- 02632 71712011- page- City/Town state Zip Code Date of Inspection. B. Certification (cont.,) �uee'ec'm."mm�aevs�Malls'9';�a.fli9 Public Water.`$uppher,if any) determines that the system-is functioning'in a manner that protects the.public health, -safety,snd environment, .,...,.J- ..,r.,.,.i.r a ZJZi:...,aaiiPL ...,... e.c.;.s3..T:• s ,s�3:�:. :��r,..�� ulo .9.. ... i 100 feet of a surface water supply or tributary to a surface water supply_ V Ave -L he system a sq---isai tiC:lifE iU `viRtV RI R.P'L9-iG v!'lV is ev.eit iii a :vi�.ic. i ire'cap�rw c>cii;.rai.-',i`ewr �.._ The system has a septic tank and SAS and the SAS is within 50 feet of a private water C�J ;iet �n� .C`CC r+.a l)` Sfi4' c 1�c ati, enn _a i_ a cn s e s06te;f;`;has sep is a i{ - , ,.. „� :� 4 w .,,,. h.� r,. :at; more from a private water sppfily weir. Method used to deternt"sne distance: =-=-6.at l .•r-ertiified laboratory,.for-coliform k�acteria=indicates absent-and4h.e presenceW.ammDnia nitrogen and nitrate.nitrogen is equal to or rrh>ded thst no ether failtire r_riterin are triggered- A copy of be analysis must'be 3 lei". ,D) -System.Failure:Criteria-Applicable to-All Systems: You must-indicate"Yes"or".No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool l isdharge•or.ponding.of.efuent°tothe-_surface.of the ground or surface waters due<to-an overloaded or,dogged SAS or cesspool v1141 iaiw Hni the distrei-a lion°b x above outlet ItlVelt-'duetoi�n. verload8d U N or clogged SAS or cesspool . 1=rtiar�i t-nth ih f-"- k(dbn) ifi$P��than'fi"6 Plr:w invi?rt ns siw ilY hkz_vniomp is Iris U than M day flow tsb,.(IM ride 5 olfiddi hispectiam form:SubmMme Sv*4p Xsp6sW'System-`Pagea'o 17 Commonwealth of Massachusetts Title-5 Official Inspection Form Subsurface Sewage Disposal System form =Not for Voluntary Assessments 155 Monomoy Circle Property Address Florence Williamson Owner owner's Name information is e required for every Centerville Ma 02632 7f7/201.1 page. City/rown State Zip Code Date of Inspection B. Certification (cont.). Yes No Q Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El 0 Any portion of the SAS,cesspool or privy is below high ground water elevation. U Any portion of cesspool or privy is within 100 feet of a surface water su ply or tributary to a surface water supply. - Z Any portion of a cesspool or privy is within a Zone-1 6f a.pdblic kavell. n Z Any portion of a cesspool or privy is within 50 feet of a private water supply well. 0 Any portion.of a.cesspool or privy is Tess than 100 feet but greater than 50 feet G .<<K- vi er°sdappl;�°���e'. with o acceptable water quatity:anatysia. [This system passes if the well water analysis,-performed-at-a DEP certified. _nates absent and the presence Vs«re e 'er a �sa i� f..9. a s>t... a ..:..... provided that no other failure criteria are triggered.A copy of the analysis i ���a•f7�in si�psack�tr eswai�4 6a�'Q}?1nl±4ar6 4n 4�sc f!4>ccg.l- �. - _ _ .-. .. �.:he.system.:;s a cesspool serving a facility with a des;!;, iwvv yr vvis _- I V,vvO9pd. Th , ucg.� fal t m mr, of ha; a'I IY r � ' � td criteria-edsI'as _ described in S 10�MIRkvgi�.u I~5 sus s'+'sca a qv' system"owner should contact the Board of Health to determine what will be necessary to correct the failure. E t sF T reonsidered alai �sys ;t�e�systesn ust Ise a46CHs$y=vrs;4 deaign flow,of 10;000-gAd_to 15,000 gpd. or"n0°:to:eacl7 f3f,the:f£311o.wing;..;i£,addition.to::the questions in.Section D_ Yes No the�y-temzis-:,ithin 00-feet-of-a;surfiace,dnnking.water=supply Q Q the system aswithin 200 feet of a:tributary to:a surface drinking water supply o the system is located in a nitrogeni sensitive Area—iWPA)or a mapped Zone l l of a public water supply well l (311 ha1/£3fta3ilTLrGd"yES O an?�{�ldGStIQT1 1n v Ct3G3Tt tt7I Yy tel is;(XIIISM'i UU u J.Vi' MIUI0i Ul U or answered yes" in:SeaJon 0 above the large systerrl.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 e-appropriate regional office of the:Department mim5.MW Tdt 5 0tficr kMPeCfiM FOM SubstdaW.S8MP Di PMW System•Page 5 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 155 Monomoy Circle Property Address Florence Williamson Owner Owner's Name information is required for every Centerville Ma 02632 7/7/2011 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant., or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? i ] Has'the system received normal flows in the previous two week period? C 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 siteinspected for signs of break out? ❑ Were ail system components, excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered, opened and the interior of the tank wspected for the:condition.of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge,and depth of scum? . occupants if different from owner}provided with Information on theproper maintenance of subsurface:sewage disposal systerins? The size and location of the.Soil Absorption System (SAS)on the site has been determined based on: 1411 Lj Existing information.°For-example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to-Part Cis at issue . 'caNYivriiricA.-aivi vi uiowuu..iv LIICllstr\.a'/LGLItr�iV `v 'vrii• iv.vv�Cat'1. " O st C.J. �y'�cem Irtfo@'l:'l ation 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 9pd t5ins%09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 155 Monomoy Circle Property Address Florence Williamson Owner Owners Name information is required for every Centerville Ma 02632 7/7/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 155 Monomoy Circle Property Address Florence Williamson Owner Owner's Name information is Centerville Ma 02632 7/7/2011 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information 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: 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/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 I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-091D8 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 155 Monomoy Circle Property Address Florence Williamson Owner Owner's Name information is required for every Centerville Ma 02632 7/7/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed(if known)and source of information: system repaired 2004 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 4 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): Depth below grade: 3 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gallons Sludge depth: 3" t5ins-09f09 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 155 Monomoy Circle Property Address Florence Williamson Owner owner's Name information is Centerville Ma 02632 7/7/2011 required for every page. CityfTown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers and tookmeasurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank should be cleaned soon and again every 2 years as maintenance.Tank should be cleaned from larger center cover. Water level was ok, no leakage, tank was structurally sound and not leaking. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 155 Monomoy Circle Property Address Florence Williamson Owner Owner's Name information is Centerville Ma 02632 7/7/2011 required for every page. CityrFown State Zip Code Date of Inspection D. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 155 Monomoy Circle Property Address Florence Williamson Owner Owner's Name information is required for every Centerville Ma 02632 7/7/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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.): D-box was functioning as intended. 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.): I Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•091D8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foam-Not for Voluntary Assessments 155 Monomoy Circle Property Address Florence Williamson Owner Owner's Name information is required for every Centerville Ma 02632 7/7/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Type: ❑ leaching pits number: ® leaching chambers number: 5 hi cap infiltrators ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): s.a.s.was inspected through the vent with a camera and was found to have 1"of standinng water with no signs of past hydraulic overloading. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 N Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 155 Monomoy Circle Property Address Florence Williamson Owner Owner's Name information is Centerville Ma 02632 7/7/2011 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•0901 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form-Plot for Voluntary Assessments 155 Monomoy Circle Property Address Florence Williamson Owner Owner's Blame information is required for every Centerville Ma 02632 7/7/2011 page. Citylrown State Zip Code Date of Inspection De System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two.permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Re- NA—Tome' A,7 ' t� ,y 3 A-7 - - f tsi»t..Dom Title 5 Oftidal Inspection Foam Subsurface Sewage Disposal System•Page 15 0117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 155 Monomoy Circle Property Address Florence Williamson Owner Owner's Name information is required for every Centerville Ma 02632 7/7/2011 page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water. 20+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour maps. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-09/08 Tdle 6 Official Inspection Forth:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 155 Monomoy Circle Property Address Florence Williamson Owner Owner's Name information is required for every Centerville Ma 02632 7/7/2011 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09= Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 OfNh,�-( Fo o . 14 WDK 12 12 14 .�.. �54 16 110 BASF BMT 2 14 ' 3 r 12 . GARS r 0 20 40 14 t l /• // � '/'.i'/" '// /:i/��%/% 6i gy„ r t,�s£tsst t:t3s•tE•s•ittf£9 . .! '!�r.6.'.Gl/%6%u< :rG.l .uS'. •i:;" w:�I£�ft£:£fff£££ff�<s££„&�?:::.{: FAZE® INSPECTION L COMMONWEALTH OF MASSACHUSETTS 1!7 coF, y F: l R rf1 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Z w DEPARTMENT OF ENVIRONMENTAL PROTECTION u F RECEIVED '�M 5�•�° OCT 1 9 2004 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS t SUBSURFACE SEWAGE DISPOSAL SYSTEM FORMP PART A PARCEL CERTIFICATION LOB` ; Property Address: 155 MONOMOY CIRCLE CENTERVILLE,MA 02632 Owner's Name: MARY SULLIVAN Owner's Address: 155 MONOMOY CIRCLE CENTERVILLE,MA 02632 Date of Inspection: 9/28/04 Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: j _ Passes _ Conditionally ses _ Needs Furt valuation by the Local Approving Authority X Fails Inspector's Signature: Date: 9/28/04 The system inspector shall submit opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspecti n. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner sha l 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. Notes and Comments SYSTEM FAILED TITLE V INSPECTION.THERE IS NO EFFECTIVE LEACHING LEFT IN LEACH.PIT.LIQUID LEVEL IS FULL OVER PIPE. ****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. Titles 5 Tncnartinn Fnrm A/15/M00 1 Page 2 of 11 OFFIC IAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 155 MONOMOY CIRCLE CENTERVILLE,MA 02632 Owner: MARY SULLIVAN Date of Inspection: 9/28/04 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: SYSTEM FAILED TITLE V INSPECTION.THERE IS NO EFFECTIVE LEACHING LEFT IN LEACH PIT. LIQUID LEVEL IS FULL OVER PIPE. 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. n/a 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: n/a n/a 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: n/a n/a 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: n/a Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 155 MONOMOY CIRCLE CENTERVILLE,MA 02632 Owner: MARY SULLIVAN Date of Inspection: 9/28/04 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 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 n/a "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: n/a I Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSME NTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 155 MONOMOY CIRCLE CENTERVILLE,MA 02632 Owner: MARY SULLIVAN Date of Inspection: 9/28/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X , _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply X 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. d I Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 155 MONOMOY CIRCLE CENTERVILLE,MA 02632 Owner: MARY SULLIVAN Date of Inspection: 9/28/04 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health _ X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period? _ X Have large volumes of water been introduced to the system recently or as part of this inspection? _ X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? \ X _ 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? X _ 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 p y (SAS) s been determined based on: Yes no X _ Existing information.For example,a plan at the Board of Health. X _ 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)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 155 MONOMOY CIRCLE CENTERVILLE,MA 02632 Owner: MARY SULLIVAN Date of Inspection: 9/28/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 1 Does residence have a garbage grinder(yes or no):NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings,if available(last 2 years usage(gpd));:Ww �3 _ Sump pump(yes or no): NO 0� 'b®o Last date of occupancy: n/a � COMMERCIALANDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no):NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X 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): n/a Approximate age of all components,date installed(if known)and source of information: 28 YRS.PER OWNER Were sewage odors detected when arriving at the site(yes or no): NO i Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY`ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 155 MONOMOY CIRCLE CENTERVILLE,MA 02632 Owner: MARY SULLIVAN Date of Inspection: 9/28/04 BUILDING SEWER(locate on site plan) Depth below grade:36" Materials of construction:_cast iron =40 PVC Xother(explain):20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade:30" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: H 10'6" H 5' 7" W 5' 8"" Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle:31" Scum thickness:3" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 15" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below;grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 iPage8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 155 MONOMOY CIRCLE CENTERVILLE,MA 02632 Owner: MARY SULLIVAN Date of Inspection: 9/28/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): NONE PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 155 MONOMOY CIRCLE CENTERVILLE,MA 02632 Owner: MARY SULLIVAN Date of Inspection: 9/28/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LIQUID LEVEL IS FULL OVER PIPE IN LEACH PIT.PIT HAS NO EFFECTIVE LEACHING LEFT IN IT. BOTTOM IS AT 9 FT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 4 Page,,10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 155 MONOMOY CIRCLE CENTERVILLE,MA 02632 Owner: MARY SULLIVAN Date of Inspection: 9/28/04 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. Vv a Z2 in Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 155 MONOMOY CIRCLE CENTERVILLE,MA 02632 Owner: MARY SULLIVAN Date of Inspection: 9/28/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. tt No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes y PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zfppriratiott for Mioponl bpztem QCom5truction 3permit Application for a Permit to Construct( , )Repair Upgrade( )Abandon( ) El Complete System Xindividual Components Location Address or Lot No. H ap{mp G r Owner's Name,Address and Tel.No. MP&Y SQCLIVAt) Assessor's Map/Parcel �srLl�cu��� 1 Installer's Name,Address,and Tel.No. �^-- Designer's Name,Address and Tel.No. (OUS 53\O 5 301 -7- Type of Building: Dwelling No.of Bedrooms_�� Lot Size l.S sq.ft. Garbage Grinder(AJ� Other Type of Building �� No.of Persons 3 Showers( P Cafeteria Other Fixtures v bAlm,jr,- Design Flow gallons per day. Calculated daily flow gallons. Plan Date o4 Number of sheets ' Revision Date Title �-;R& �o c, St X&nc, U!Q ,C-MdQ Size of Septic Tank �K ►�Q.^t . I Sinn ACZ` Type of S.A.S. 10 x3a 1..�!�c'2an6, Description of Soil; i�Q S4,ar *0 j�t kac, Nature of Repairs or Alterations(Answer when applicable) as Q N­fl © c 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 f Title 5 of the Environm tal Code and not to place the system in operation until a Certifi- cate of Compliance has been issue this B and of Healt . Signed Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued Fee „ �.. 't ' THE COMMONWEALTH OF MASSACHUSETTS,,, Entered in computer: Yes > � PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for 30igogal *pgtem Construction Permit Application for a Permit to Construct( . )Repair)Upgrade( )Abandon( ) ❑Complete System AIndividual Components Location Address or Lot No. CC*M C) C•r, Owner'"s,Name;Address and Tel.No. �-t ,�� r� MaQY Sv�t_�vAN Assessor's Map/Paz Co ` SflM.E Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �3 se�-"C SRcu\CQ jk�Pt`� re r�U n Q� JJC Type of Building: Dwelling No..of Bedrooms Lot Size-1-5 5-M sq.ft. Garbage Grinder(�teria Other Type of Building �0-ip,jZ_ No.of Persons Showers(� Caf ( �' ,,Other Fixtures poa Vap Design Flow gallons per day. Calculated daily flow gallons. Plan Date 11) 1 1( Number of sheets 1 Revision Date — Titlen�C pr�:- 9x Size of Septic Tank �' Type of S.A.S. Description of Soil _ `�.o �Szr -�n �-,1 S R Nature of Repairs or Alterations(Answer when applicable) a .. f Date last inspected: Agreement: The unde'r''signed agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance wiih-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 issue y this Board of Health Signed /7 Date w �i Application Approved by Date l/ Application Disapproved for the following reasons V �� Permit No. Date Issued _ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CE.XIFY, that the Op-site Sewage Disposal System Constructed( )Repaired ( )Upgraded) Abandoned( )by -k at D f // has been constructed in accordance with the pro visiions oaf Title 5 a d e oor ispo a ystem Construction Permi o. dated 1/A.e �2.� (�l S Installer �.C1 �/�. Designer �. YizW The issuance of this permit shall not be construed as a guarantee that the system wt1.11un ation as designed. Date /lS; �r.J 24 Inspector �� - -� ------------------------------ _ No. Fee c THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS v, Migaar *pgtem Con5truction Permit Y Permission is hereby granted to Construct( )Repai ( �)Upgrade.�)Abandon System located at I 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:ConstrtIction m.st be c mpleted within three years of the date of t `s� erm'. ry Date: Approved by v� i � ✓ -_ Town of Barnstable OFtHE ley, Regulatory Services O Thomas F. Geiler, Director * BARNSTABLE, 9� 1639.MASS. ��� Public Health Division ArFO3,�s Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 10/25/04 Designer: Shay Environmental Services, Inc. Installer: Robert Septic Services. Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street MA 02536 Yarmouth, MA On 10/20/04 Robert Septic Service was issued a permit to install a (date) (installer) septic system at #155 Monomoy Circle, Centerville, MA based on a design drawn by (address) Shay Environmental Services, Inc. dated 10/15/04 (designer) XX 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. 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. VjH OF MgSo. (In a 1 s tg moo`' CARMEN �yGN o E, SHAY No. 118,1 Go_�1� P_ -<_ (Designer's Signature) (Affix D ere) NITAR\ PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIV 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:Health/Septic/Designer Certification Form .TOWN OF BARNSTABLE LOCATION �/ . SEWAGE # VILLAGE C `�,� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY t' Nk MID LEACHING FACILITY: (type) - 6L (size)��(le- NO,OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet i 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,, o a . �-r All e S���Cv� fJ�s any Of THE COMMONWEALTH OF MASSACHUSETTS /�/ BOARD F HEALTH � Appliratiuu -fur 43itipuittl urkg Tuuitrurtiuu Vaulit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: . ----------------- Ass ---_ ...... ................ ................. ie Lot N. ................................... Owner X Address W .......... ...... .. .............. -------••------ ----•- ✓,�,,�'........... Installer Address Q Type of Building Size - ___________Sq. feet U Dwelling—No. of Bedrooms..------------- -----.__.•-----------------Expansion Attic ( ) Garb e Grinder ( ) per-, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -•----------•------------•-----•----------•-------------------------------- •-----------------------..._.........---•--..........._...............--- W Design Flow............................................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-------------------- Depth below 'nlet......__ Total leaching�area--_---.-.-._.-____sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0,(� —. Z 7'3d— 7, Percolation Test Results Performed bY---------------------------------------------------------------------- . Date------------------------------------ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..-.-_-_.-.---_--------- �Xq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_.--._._-_.-_--_-.----. � >, fo -.--- ---------�- ----------------------- --Descripton o Sol------ -.... ----- _ U Nature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------------------------_________________-- •••-----------------------------•-•-------------•--•---••------•---------.-------------••------•-------•------------------------•-----•-----•----•-•-------•-------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewa e Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigne rther agrees not to place P system in operation until a Certificate of Compliance has been . ue by the d of ealth. 76 J0 Date Application Approved By.-- -�- --- -• •••-- • -- --- •..... '--- - - — 7 Qr Da'fe Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------•-•-••-••--•--•••-••----•--...-•-•-••--•----------------------------------------------------------------------------------- Date PermitNo........................................................ Issued---- - ..... --•-•---- Date ------------------------------------------------------------------------------------->----------- --- ------ ------------ - r No......... °? Fus..........-.. _..... _-._ . . THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH Alipfirtttinn -fur Ii.4pgottl narks Tonstrnrtimn Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at* 7� / �f �"�I 7 ------------------- --------------------- --- ------- •--------- ---------------------•----------- . . Location•Address or,Lot No.t",.- W Owner Address �} ---- -•--- -- ----------------•- Installer Address Q Type of Building .0 Size Lot..;�_:7.................Sq. feet Dwelling—No. of Bedrooms--._--_-_.-_�_=.......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures -----------••----------•-••_--••---•------•----•----- W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. 9 Septic Tunk—Liquid capacity------------gallons Length-------_------ Widtli................ Diameter.......--------- Depth.__.._-__------- xDisposal Trench—No_ ____________________ Width-------------------- Total Length___-_____--__.___... Total leaching area-------------.------sq. ft. Seepage Pit No..................... Diameter.................... Depth below i let----_._______...... Total leachingg area---_.-._-_ ___-__ scl. it. Z Other Distribution box ( ) Dosing tank ��L 3d 71� aPercolation Test Results Performed bY-------------------------------------------------------------------------- Date--- a Test Pit No. 1________________minutes per inch Depth of Test Pit--------------...... Depth to ground Water_.__--.--..-..---.---- 1:14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water......------------------ G ---------------------------------e---------------------------------------y -••--••------•---- Description of Soil ..•_.C�_-y. �'z �p - _ ----- _ __d_____ _.. �` -1 __.-________--_--__--..-__. ---•-----------------------•--•-------... ------------••----------_____------------- ------------__-------------------•------------•-•---------------------••---------------•--••-•--_------ 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 Article XI of the State Sanitary Code—The undersigned4urther agrees not to place the system in operation until a Certificate of Compliance has been issued by th board of health. %7 g n e ed � r' Y Application Approved B �� 111.� ate _G7 Date Application Disapproved for the following reasons----------------•--•••----•-----------••----•----------------•---•-------___.._._•--- -------------•••-•--- ------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF . ALTH .......... .......42... o ..x�F................ .... ................................................ Tatifirtttr of 10.1nmplittnrr THIS J T IIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) s , by - --- ----------------- -----------&1alie - °= ------------------------------------- has been installed in accordance with the pr vi -ons of Artic of, The State Sanitary Cwe as xlescribed i the application for Disposal Works Construction ermit No._.'_________.__ ._ '-------- dated.._-_L_ ._�_ ____lL._'_...�.. --- THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. o DATE_.......le c. ........... .............. Inspector- ------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF flEALTH �j� ........../ ..OF.............. No. /_. G_._.. //'' i �ttl k Lan >lttrtinttrrmtt • Permission is he y granted•_• �__ to Cons�ru,t' Repal/� ) an Individual Sewage Disposal System at No. f 3 � li_�__I- ''t -- -------Street. as shown on the application for Disposal Works Construction f� - - Board of Health / DATE-------------------------------------------------------------------------------- _ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS t 3 .7 ± :. "' �f \ V\� O rf` ,.C.CA,T t 0tq 4 £tAT'E. y li_F- MA55. ��ytHQy SC A, DATE RicHARD 2► A. i flA)CTER PLAN QE.FERENC.E. ! W.24M PL. Q3Y,, a72 PAGE 58 7,.�1o1 7' 7NZ . ✓noel vv 4 714�,V T3 ABC T R KY V-r I N C .HOW/V AI 7b ::bra F R EG i ST ERZ� LAND SURYF,YOR S 2"0,VI A,e 1,4W-f <5 Fc ?fs",E TvW l :P, As.LP.N S MP,>_L 1 MC.. TOWN OF BARNSTABLE LOCATION c D(/✓Df�L � SEWAGE # VILLAGE ��� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. cje� d SEPTIC TANK CAPACITY b-Z t 52�h -. Off) C3*\ LJ l LEACHING FACILITY: (type) 1 . c, Ltt� LTi9Z-6'1 (size) �C NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 7� LO T I O 5EW W:, E PERMIT U O. VILLA — — — 1NSTl� R5 IJ E ADD ESS - - BUILD tJ /�I�l DDRES ' MOTE PERNAiT 155UED DATE COMPLIL Kic*E ISSUED : � 1 rt 2 ­'� , 1.­ I . r " � � � ,-,,, .11�I 1.�, , ,� I I I e I 1 ,,, , 11 .. I I�7���' .1� - �� � ..'�. � -.�,, , I i �!, -1 I I�, I I � I .I I 1 I � ,,,, ­.­­'�­N­',',4� . �,� _4 , , , . -,r­.�r�, � �,-�1�' �--;.�Ill, ;,I� -;-��. 1,1*�, ,. ,. -, 1,,V .r. I , , , . , . I . I � I � .1,. ., �,-��-`��,,'�i,I:-. ;-"I:��.F ," � , � ,�f. 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I ,I le� . , , 11 � . I 11 _" 1. :: I I ; � I A, - , r, , i / 1, �, . . I 11 ,"­ � � N - , I � � , � 1� I I �, .11 - I I : I I I � � . , . I I- I I _. �­,�,',V' . � ':I, ,* - A-LL PIPES I'll �. I"I I ,� � I ., ,, , , , ._ � - , I I �, , : � orn ,�_ ' ALL'OUlLET PM FROM TW r� . . , �-, 1. � . ' 1� � "I I ,, I I �� I a I � I ,4 : �', fr 24 Inches tall) I I I �, - ., . .'� ,�4 �� . � I � � . I I I ­ ". � ­ I -1 I i � , . I I �11­ " " MWOUTIMI SOX SHALL BE I a F i- - � - I'— � : , PROFILE VIEW OF�ADDirm I A I - I , I � 11� VENT PIPE�16'L..',i ' ' ,� , ­_ / I I " , , I I I " 1- "' :1, , ­ � " I , -� � ,, , , " _', -, , � 1'' I ' SECTIONA ,-A ­1 - _ -1 , I 1. . I � I I � , ,,- ­ " , I ,- 11 " %, , -, ­ _ . I I ; .11­1 , , ,,,, 14 � 1­, %4 . I 'i . 't �, ,, , ,." , ­ � I 1, 1, ,C_�,`,' ': ,� , , I �I ,��,,,,1� , I �,4 1�'.I ,; I , .1 11"I_`, �,;:��.,.� � , _ I I � I . , I 11 . I . I A� 0 FAILM704a � ,-��1�,, _,�,,. , �A� �:, � ,­,, � ,Ak�� ���, I'� I � ��:�, ,� ,,;,:"-" ":1.Irl 1, � � , ,-,, , I � � � .. I. . � I I " I ,;*,,,1,_,,_Y,,_"I .�r. . I., �, �. . 11 I _ . I -* OTE 10 BE 4 .SCHEDULE 40 P,V.Cl ' " "' , . - - ,- , , w , , ­ " I "- 1, I � --- - � . 1-1 ,. . � .I � , I" _ , ,6, inin. � / I ,I � - al, - I ,-, � I ..� I , . . :* 4 �z � , ,,�. ,',, ,,. _x4fn'g,Foun'elation' ,-� �� house Ao septic tank ,, : �,,',7�f�4,. :, � I I � I - I . - _� I ...,.TO LEACHING SYSTEM , - , " , , , I I I - ���, - , I , I "" '�, �2 z ,�: . I� �"I �. � '. I ,. ' ,$chedule.4 PVC w/Charcod,Odor "ter '.., I .,. I �I I, I 1. - I - - I l'i, � P.,I,' ", 1r; . r� . Ar 0 . 11 I I ��-A I ,,,� V�� ,� , - I ,; ,'-.��­ " ,1�'t �r'��'­ '_ -, ,'.." I 11 1". I � ,I I:_ " , . . . , . , ,"�SET LEWL FOR AT LEAST 2 FT. . . � F CONMTE COWR" . .r/��- i . ,. , - '- � I � � . . . "a,._, � � . , ­ I I I I ' ., . . . ­ ': , ,,, 1, . I, I I � ,� , I . I �. I I . � '�� �,��-�,, I � ."I. . . ;;, . : I � � 1, .�,�'�,�',, " . . ed Pocet ' r '� .. , , '­ ' , 1, ,� _JOO.06'(A�,,Urnj� t-k ca"m must be , I ­,,, I 'I - 1. 11 - . � 1�_�,�_'" , I I -r - 1/2*,,Wash -: ... I� 1. � I '. I � 11 I I . , . TOP - se� ., , - .1, " ­ ,,,,,, I I � I � ,�� -," I . I , .�, .I � I ,I � , - I I,_, , ,,OF�,rOUNDATiON �.,ELEV, , ,ithk, � '" ' �i 1. .,�%�_ � . , " ,t, I .I , I I �., 3" of.1/8', , I , � ' , I � 11�- ­ . I I . , , , , I I ,� " kl� 11 � I I 11. I 1; "I , - . ,�" - " � -� .. , , . I 1, _' , .1 S7 0_\ \Ir � �` I . i_",'3-Af I --I-,-,_�-:,t � ,,�,I,: � � �� .I . I :5 . I - q; �� I . 1. 1�,�,,. I , I I � : -11 :r I I I � 1 4 .. r OLITLET-1-1 r 11:t�1� , 4 - I ,­,� . . � a I 1.-1 " I I , .�v , . .,�r�,O � I�, , I.. � . , � � I . � . , I I , I � ,,,-�,, . .11 I �, - , X11=01.113 -.- � , ,: " �� � . - , � �I . L . . . , I � �. I 11 % . 1 ,4 L, 1 � :, I I 1.I , � . ,I I � - 11 = I. '14, ­ - I , f I �I ', - , � � . �,,, , ,, ", -( I , � -,�, �I 1 11 ,:1. "��,,�,,�_ I �:1 4 , .1 � I "I 1, ,� , , ­ I . .:. �';, ., I I- : L , I I , I � 1.1 ,�.,' �I I / I ,� " ' !,�,, 1. � I I I , � � - � . , - 4, 14Y , . I 1, � I � " ­ I �� ', 1. I -'' ' I I I - I � '' '. ,�." �:�, , . � .1 , I I I I I 1. I ; -4 , , I I*1 , , . I � �,_,�,- , 1: . ", 1, : �'�:" -1 11. �I . � , 4 1 1 ti, I I, ­ ­ � ,., , 6 In.'bf finished gnide � � -:�--- , ,��:,r I� ,, , I I�_! I� - ,: I , �i, I �. �, I . I Septic ank- 98.00,i,'� � � ­1 I�~D-Sox-9&06 "� .. . SAS;�-i9m to,9�&00 I � . /4*,Itc�I 1�2,'*asllhed,'Cr�sheci , . I - -, -, , / .�,�/, .. � , 741 � . ,�, : ­1. ; ,. , 2 'r, -� , 11� '� � ­ �- � Ora&ow ':��" 11 � v -�. -,� 1. I � .I�r� ,�'�"� , r, �� �, � � ,. '. - I , � . �1,1 lv." �. -, 7- � , 7 - I 4, �. L I - - -I I �1� "�­�­ '.' I - �� I �, I L' 1 . I ,d - ,� r. ', I , . I � I - ", . I , - � , I � : I I , . � 11 � � .) , �,, : r , -, I ,.�_ - ," I I � 11 I �, . - . �'. I I , ,; r I r . - �', - I _ - . "I I I I " �� - I I � I�I 1� � __- 11 , , , . _I I �T- 1- 7r I ��I�,,,,, �, � , � . � I " , � ,�', I �I�',-,,.'� I �.1,I� � - - *r7 � : -15.5, - 12' IWET . '4' . V ­'� ,; , � ,� ,I _ 4L I ,;.. , , I 1. " , I I , I � . " . . . I W �, , . I 10 � I 1 ,, , I� � � � , I OUTLET 11 I I . � I I I J I . I .. , ; I � '' ", " *_ , ."-;. � I � .." I 11 _� : I _ ., � � I� � � �, ., � ., ­ � I - 7, 1 TLET � .1 I i 14 / I ,� � S �� I I 1�. � I I .1 I . , I -, ­ � tes . I 11 � , 11 � I I, , I I 1 0.02 �� ' , ,I I - � �� , * %, - � .''�"-1 I" :11 � , , I �� � r .. . ,�� ­11 I I - . I 11 � � " � �. . 1, I I . 3 14OLE H-10 � ,". � � ". I ; �', 13. 1 - I I - I I "il 11, I I -I � , , , �_ , ,� I - op LoW �E*v. -95.25 1 � � I ", I 1_� ., .,:,I-1 � \ o;. .. : , if - I .. Ir , I I I, , it- � -.1 ._ _ , 1 , I " , I � - - ,_ '''. i� , -"- �- IF- 4 � , - - I - I .1 ­ 11 _7 L�, .�,, .1 , "106 iC` "I T %_11 .I I I L ­ I ; I I �. _-�_�� � I . 'A-_TV I" -, , Z�,, I If J *01 � I., �.- , I ! DIS'L Box , ,� _ r',, ;r , MUM co�44,i I :Oke�l �': � I 11 I � I I - ., :, I". , , I I - .� -� .1�­ L.': ,,,�, i I"�.� A , ,I . _;,L". ,:1. le. I � ", ,_ EXIST.- � ''I'll'' 111� S-O.m -Grooter I . 11. ,� � �� I I ��:., ,-, ,� I � I , �', - v - I t''11111 I - � � � I I, ­ ­4 I V-�,Z-, ,. � I I � - , , - �, rl in I CK I � .�,', � 1, I - , 11 - j '_ - � � � . "- I I I ;,,L, � '�,� ","1. � ML�Lil�F_L�� In - I � �'0 11,500 CAL,,- I � . , .1 �1 I ­ �' .1 ., , I ,� I I I I I I� . ' . /_.�t.�01�4 0 , , , _ SM. '46 Tee I 1, � _/ lr_ ,__j _4 'r . 1 - � 'T, , - � ", - S- 0.01'PW foot I I -, - � .11 I I � I - I r L I tl�� . ,,, I .-15.51 - / / I I -,�k' '�` ''FROM'EXIST,FULVMTM�", � - , " ! � -1: 4 I I 211 I I . �,,�I� � ­40" , 1, , � I . �� . ..., . ,,, I I . . 4 I - ''. 4 . 1-1 � � � ,� � -�'J , I Li , , t 8 ''��` ­ ,: � , , V Effectlw Depth " � I.rr i ' I I . - -- � -1 " ;SEPTIC�TANK, I � , .1 � Ir".. � ,� ,";, , 1, - "�, ,� "I . ,� 1, , 30, , -� I I . . I I ­ � .� I � � � I - I , � I . ,,,,.,.,, I . I"�L ­ �� ' I �,� / . !." Z, � ��­to H-10 ­ - 6 , . I ,_ . , 1(0 ,_ ,� I I 11, ". --- I . . ,:,I . ' �,I�-L / . .-, ,�, I _ I ' I I . �, . .L .' � I 1 14M I �1, I I I � Ln I 1110 I � I '1� I I �. ­ ,, PLAN' SECTION � � CROSS-5 CTION I I _' * - 11 � - ­�,:, ; _ ,� - , . . - I '�­ L I - ,�� , , I - ,� i C, � I ,� L 'I - I_ , "I , I I .,� . .� 6 I I I !, 1 _5 Units @ 6,25' .- , . � , , , ,, I ­ 1, " I ,� ­ I � 1. . I L _ . . , " -��'. '�L, I - I " I I I " � I _. I. I I I , I �O�� , , ,�, '' �, "I" � ,", :," . I 0 - � I ,� I � I q �_� . i - I � . 7 t­ , I I I L L, - I I I IL I , . >' �11 M FWNM70+--1 , I �, I ­ 11 I � 1 I L I`__ . . 0 I - . A � I , ,I .'��'," . ,- I L I / / I �1­I J­�­ II , I . 0 _ � r, _ � r 3* ,.�11�, L 31 1: - I I I I I ' I 11 I f L - I � I .T L I :P; I , I . . � I 0) . -* 0.83',(1 0 inches) I . ­ I I . I 4� �.ft . L , � �� , I -1 a) �' .11, I �v -, �b � __� h I .. I - , , L� I - � . .1 � �`I I , �_t I t."'.1-- , � ; - _ 11 I., � � 'V .6- � r" '�,; , � ,I 0) I L . I I , 11� � , , L � --I- -31.25 I -.1 I � l,r I � I . 1. I ­­,� I 1.,� I M, - I I . , , �, � I I , . r ­ L � , . � - .. r I � " I � 14" % - � .. . I I I � 1+ I _­ L L _.,�� � , J� 9 " 11 , I � I I: .1, I ,I, _ . . �_ , , L� �� -1 I',- � - - I- � 3 HOLE t4-1 b DISTRIBUTION BOX , 'III I *. I ,go#- , ,I I " ' L' I SYSTEM P - - ,6 In.of 3/4'-1 1 1 . r 1 I I I ,; - 1; � I I L. I I. , I L - -17 P54" �� " I '��, ' ' - i , �', L , I I � 0i � I" - �, 'i,�` I -,- - I I . ;- x ", , -�� - RonLE - . � . . . - \ I IL � I I � - I 4) L :­ ." 11 . . I �­ I I, . �, I.' � I I -L�,�, I . I . I L :, I I . A ,,, I . I I I , " I I . I I "R�el - I I :, Not to swle I , :�,, L -0 1, I . . I ­;.. � , � -'I . . , I I 11 L S I, I � $ 1 `W___­1 - I . I ,_ I Ef f ective Length " � I I I I - I I � � �,* Ccn)pocted Stone' , ' . L I L L . ' - � , I I " � " '., � > - 4) 1 1 . . , 'i,; a) ,� � I , ,, NOT,TO SCALE I ' i' 11-1 I.i?�' I ,,'A I ' I I .I I . I , I m I I k L "" : " '6 1 ,,� . I � ­ I I . I r . I I I I . I � .. a L Zg"'� I I - " " � - . ; . LL�, L F . I � � , , 5 4* 1� L' - . I -A13§dRPT1 -SYSTEM (SAS) � . �' �, I I . . I , f""MyrM I i . - I %L I I K .,.­� 0 I . I .. I � L �, I I I ­ I e I I'll I I :.; .E -C I.: _2 ' LL , 4 I_ I .I I I : , SO L ON _. ,- ,. I _. . --- I I,—" I I .� _­ � ,, I . , 'r, � I I'll I r� , 11 . I I - . . . I I I - ! . 1� I i ,. - 1 .5 , :; � I � I I I I I 1. � I � - " " � � ­ . L I � --I � I I S i--, I � , I ' - I I . I ,� I - I , '' 4 �L r _ I., � I� �_ L � I I 101, 4) - � , -.1 1. �L , I � I . I L 'r� L. I I I . ` (H-20 'LI]ADING)/ GEORGE O'BRIEN I I L � : L�, , - r �,L" "i , . 6 tn.of 3/4'-1 'a , I -Z I ,. L:�, ,� � , _ �:��t�,,�t I"I,, I L 4:_. I � - - - I�, . I . I I 11:r I 2 m I � I . I� I'.' ' ,,r,, .,INFILTATR[IR H1dH �16A'PACITY� . I L L ,, GENERAL LNOTES ' ' " L' .1 I I , r � _ " , , . I . I ,I,,;1 �� ., I . . I compacted *tone � .� L,Effec" Wth I ..; I I . '- I : 11�I I . L I I � - : I ,_ 11 �.I I I 1� r" .: I , , , 0 I I (OR EQUrVALDM Not to. Scale I I I I �-I I I 1. Contractor is roSp6nstlble for Digsafe notification I I I , � �� I I L, � ­ I I � - ­ I ---, NOTE- -ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE �­` I '� Pottm'af Test N�e 1141.�'.�W.�o ,� in . 11 I ,", I I ,, I - I , I -1. I - ' ' I I �` 1 �- , I _ I - . " � . .. I L I r ;,";,,I I� I 11'.I, � ­ I I 1. . I � I 1 I ­ . I I I . I I I I I No&=mdwatw Obser,mid 0 132'- � t � I . NOTE. �, OVERALL HEIGHT-OF wriLTRAT60'is 18* /EFFECTIVE HEIGHT IS 10"", ,' ,, . , I 1, I 'and protection L Of'all underground 'utilities and pipes. I L , , ­ ,- I ,- I . � I - I " I I I I , I �,� I I I . - � ­ I , . I I . r " , �­ � � I�" .- � ,;,� ''. I . _ -I. - � � 'i,I I ,r I I I . I ,. I 1; ­ '� � L., - . . � . � - . � ,_ I - .1 I I . I . � I . . - 2. The'septic tank,and 'distribution 4 box shall, be I.set I I A, , -,.,; �, ,-� ., I ,, � - ­�LL � . I I �" -L . I I � r L I I� I L-,L L .1 .1 I . I. I.", I , I I'� I I IL level ,on 6".of L 3/4%r 1 1/2' stone-L - ,.L . ,� I I . I �'i I ,L I � ,I � . "I I � I -1 1 1 � I , � � . I L L I .- I , , . . I I L �: � . �I , , - I I I I 1, . . I I _ ., , I ". ��, . I . � . I 11 should,be.clean sand * , I. 1, L� . � , I I I I 1 I - . - � . � � , I I L '.. �, � � I I . _ , - I 1:1.1 , I I 'L, I I �, I- - __� . � , . � I I ,, , . , . ­ . L ,. I I I L . I I 1 3. Bockf i .-or gravel'with no , I �I . -_ - - -_ - , I . 11 V 3",in 'size.-., I L I I , " I A � . I I L - I I. � " � I . I I 11 stones a 4r , . �'. � ' L I I ,� . - I I 11 I I , L - r I I I � " I I .11 I - I . � I I I. � ; , I I ­ I I I I I ,, I I . . � . I . . -1, � I I I . L 1. L . 4 .� I I . I . . . 1 4. This system is'subject to inspection during installation . . I ,I - . I . I '. ` � ' 11 - 1. . L I I ­1. - L . � I I I I I�, I I . . . I I_ -11, . "'- "'L L� I I I � I - . L � I � � , r 1, , I by Cormen'­El� Shay,— Environmental Services, Inc. . �!�, , ,� ; � 1, I I I I I I .1 I I I -, I . I L � I r 1� , . ,­� 1. . I . I ­ . . . L I . 1._. L � , 11, LOT,459 I L L I . -11, I I � 5. The contractor shall install this system in .accordance I ! I .. . I . I L �,_ , �L :L,:,�,,� I � , L I I I . I I L I I I � �, .1 . I .11 !I . � �� 'with Title V of'the Massachusetts State code, the approved plan I ' I L . I , : ,� .L ,,, LPERCOLATIQW�TEST L 11 . 11 Q3 I " I . . . I I I ­ I I ; ,"r,! , , , �, .1 . I I ­ . I I . I I � . I . � I . I I L � 1 arid L6cat.Regutations. � . � - ­ I 1. N rj$ �11 .1 1. " I ba, ", �1� f , � ,. � - I � I C.) , : �b , QP- � ,00 I r � L . I I - I I I . L I � I , � L : � I ' I I I N% . � f% 'L NI ' N -1 . � . 6. If, during installation the contractor encounters any I L I I I ,��I te -of�Percolation Test:' OCT. L14, 2004 I I � . . - . I �� � . . I I .. _/ . I/ 0 'L 1 �/N ,/,CJ - 11 I . L I I . 1. _: I 1 1. NL . , I . ' / I - . I soil conditions or site conditions that are different 1� � Test 'Performed By. CARME E. SHAY, 'R.S., C.S.F_ I I , 11 I I / I I fL _ " // i 11 /I . 11 11 I� I L I I L . - from those shown on the soil log or in our design I � L '_ "Pesults W`itnessed,B)� VAIVER ( per Barnstable B.O.H.) I I I .11 I I I - .1 .1 I / , " // - / le � L . L L I L, � ` I �i, I 1, - --- ________ I "T -_ ____ - / / / - � I I I : I ., .,EXCAVATOR:' UNKNOWN ' . . I . I I '­ � I � I J I" - // L L I/ I / , /- �' I . LL I I installation must halt & immediate notification be . I - _ , / / I L ". � I . - - nvironmentol Services,I Inc. � L-Percolation Rate: , Less,T�on 2 MPI 0 24" ' ' 1 76.3 7'L , �L/ ,� , Failed . I L � I made ,to Carmen E.�Shay .' L E I I I � ­17 1 1 ,/ - / I � � L . I L I ' . I � I I- . . I I 11 . I � ,� L I I I I / // 'Leach,Pit I . LOT #76 'k � -1 '. , - ,f� ,,,, . I / , - �� , / Ir 1, . L . 1 7.. No vehicle�or 'heavy-friachinery shall drive over the L, � � L 'L �L I � . I I �� I / �. / �L k �,/ . I I . I I I � -20 septic components. . I , ,�I ; L�: I I �1. I . 1, I . I I / ,. I . I ,, i'septic system unless�noted as H r �,,��_ �111 1, I I I I , / - J , 7.45 4"IP 11 I I I i - - � � 8.'Install Tuf-Tite gas baffles or equals on all outlet tee ends. � I 'L,, I I I I A* . . � I , I I I � . I .� 1, .1 IL .1 I I ,�Zzt I � I VENT I ­ .I I , I - I . I / .- �L I I I I I Lk�.. ... 1.6 I . 9. All Distribution .Unes shall, be 4" diameter Schedule 40 NSF PVC pipes. L .-1 .I I I . . I I � "'- , �. L I I . I 'L I I - I I I i.� I I I L I I / 7I. - . -. .. �. I . I � I 0. All' solid piping, tees & fittings,sholl be 4"-diameter , . . � ,Test Hole ,, : I / ;�f dw . . U ,I TES .L 1 �' .. , � . .I I --., - I I I , / I .. . . . - L .1 '41 1 L I I . , . I , . , I _� L I , / I . , , ELEV.= 98.00 Schedule 40 NSr PVC pipes with water 'tight joints. -1 I _ No. 1 :; I I . - , , �,, ' -` ' - � � �, 11 � . � I 'r " L / . � I I � . I -DEPTH SOILS ELEV. L I I I It L � 1� TOP OF FOUNDATION I 1 1.' Municipal,Water is Connected to ALL OF The Residence and Abutting . 11 . I / L I I L . � I, I I . 1 I / , I f � ­- % ,D-00)( � I'll S. . ­ I . I .4 . L, �. I 0 . 98.00 I L / ELEV. = 100.00 (Assumed) I 11 I - I . � - . I � I �, \ . I - .Propertles'Within 150 Feet, , , ," L!�', 'L 'L I I / / .1 / \ I I .*, _ 0�, " -.- I���- I � 1, .L I / L\ I L �,, i j � , , I y \ L'� . . I I I ' L I ' I ; � I 11 iird I / / / 11 \ L 0 . . I , 1,� , . .L� I I 1, . - . I I., , �I., � � L . : I I // / - I . , THE PROPERTY LJNES ARE 'APPROXIMATE AND , , ,11 . � I L I I I .� / I / / EXIST. 1500 gla\l. - . ' � .� , !'� T L 11 10 Y 4/2 � I . .. . I I I / 1 1 Septic Tank \ I COMPILED FROM THE SURVEY PLAN GENERATED BY I - . L � . I _ I 11 1,I I � O*_6" A, 98.50 . I // // // I I I I BAXTER & NYE, INC. OF OSTERVILLE, MA ENTITLED . I . . � / . I N i ,v I 1, - I . I'll . I I I � - I I /. / / \\ I L I I - I ., I . � �,,., I I . , I � / / / .1 I I CERTIFIED 'PLOT PLAN OF,LOT #75 MONOMOY CIRCLE, CENTERVILLE, MA .I I I � � �; I.. I .I � LOOMY , ��"I . I I I , ,/ / � I I L I I I I- : 'L I L Smd I / / / / -0�1 I ,, 1976 1 1 . . , I � L �: - . . L I�, :� �11 1, -1 I 10,YR 5/6 , L 11 r I I / // I/ � L ..� . � I . .;�). I � AND IS NOT INTENDED TO ,BE A SURVEY PLOT PLAN , L 11 I . I L I / / / �­! I I , I I I � 'I, 'THAN I 1 6 -- 24 O' I I I . . � I I .11 . 1 . It..BW 96. 0 / I I -, I IT SHOULD BE USED FOR NO PURPOSE OTHER . ". �', I . I 11�� I I � I Med. - . I I - / // / , DECK � . �I., ".: - . I THE SEPTIC SYSTEM INSTALLATION_ , . . . I I L . I / . ., I EXISTINC . I I I � -' Sand ,. I / / :, . I I L , �7�� . I I , � , 1 I I I . 11, � I I " / � I I f . ,� 2 BEDROOM i � I . I " " I I I ",� I IL I I . . - I .1 I I 1. I 1 2.5 Y 6/4 1 . I I I I . I I I I I � I . - 1. L "I 11 1. '. I -138' C, 86.50 ,�. 1. LOT #74 1 . I I I . I �� ,� �.. 11 t . I L , EXISnNG LEACH PIT TO BE PUMPED OUT,AND . I "�����L '. " 24' � I I/ I I � I ' I , � 11 - ;­ !, ., I �IL I , I I � I I -111 ,,_ I � I L.-11,L - I I . HO�USE I I L 11 1�I I . I I I . . REMOVED-TO,FACILITATE NEW SEPTIC SYSTEM INSTALLATION � � , , I , . I I I . I . . I . ,, I .i , . 11 11 ,� I q . - I I , 'L ,� .1� � L,; �­ L J , . , , -" � . 11, I I I � I . I I , I % -1', , � . � 11 �I � ,I . . . . G . .. .I I I I : I LOT #75 "I 11 I I NOTE: ' ANY STRIPPED OUT SOIL.CONTAININ i"� �' *' L ' .I I . I - I I I - i . .1 #165 , . .1 I I . ", I I . . LEACHATE I �I 1. . I I I I .1 I I I I I I \ '"' , . I I � I I I I ' 1, A. . �1� I 0 I ._1 1. �I I .1 . I I k I I - I '' k I 11 I I I I �, I I , \\ L I I\ 15,500 Square Feet +/_ . I 1 I FROM THE EXISTING LEACH PIT TO BE DISPOSED ' . � I ,­ I 11 .- . . I I I \ - .1 . 11 - \ , - _ . 11 11 ­1 � � '�_L I - . .I � L- I _ - ­ - -_ __ --- - ­ -_ % I - I \ , - - L' - - I \ . ­- I L R EALTH SPECIFICATIONS. I . ­'. 1 I � , 11 L �__s I I L- - -_- -_ - - - I � -1. ____ � I �, � I � I . I ,_I ­ % \ 'L "' I L . I 1, I L I I . I \ 11 I I \ V I . . - � I. I I . � i 6 I I . \ I \ I � I L L I I I � -I I L . I \ \ (0 I I I I 1, L �L�` � "I " . . ,.NO'WETLANDS ARE PRESENT WITHIN 200' V, ", , I 11 I � I I I I I . � I \ CARA GE . � \ . � . . 'LOF THE PROPERTY ­1 I I � I . I . � (�) I , \ I I. I I � I I - , . I I I I "I I t I "t I I 11 \ � ; '. I . \ S 11 ASSESSORS MAP 191, -PARCEL207 � , . ( " . " �, I \ I . ."� I I � ., I I . .� � . I 1.��,. 1, . � I I 11 � I I � I 0 I . i L . 11"... I L%I \ . I \ L' _ - ,�, � .I .9 I \ ,� I I 11 I - ,, L 1, I � I I .� ��' � I , I � L I . � , 11 �­ I� I I � I _ , L � - , ., L I I I I \ \ L, . I I I I I L ," " , �, ,- I , \ , I L , -� , 11 I I \ , I L I . ." 'L L I I I I I � . I 1 . 1 _ � I I . 11 I I % L I I. .I I I _ii t� ­ 11 ' 'I I ." . , L I I I , LEGEND I , ,, - I . I ., ,� I _, , I �_ I A , \ \ - % � ' , . 1 ­ . . I . �' ­ I � I �, ._ , � 11 I I � \ __ I I -* I I . L L I -_, , I I I L �', I I 1�1 11 - L I A I \ \ I I � I . - i I . I I ��., I'_ I - 1 . . I � I I I 1. C #1 �, . I �, I . L . b.11 :. \ .\ , L \1 1. � .1 I . � t � I I ,�,. . L I I . I �1�" - � .L:�, , . ,, ,�', L t _ . L - \ . �\ I I % � I , I 11 � � _'j�_' , ,,, L '� 4 Per �, . ; . 04 .I % , \ I \ I I ­\ I 1 14 \' , � I 1. . �� I I I ,. 10 . I '­ . ; .�L I I ­_ " . 1 . I . ., .L, ,_ " I I I I � I I * I I k \ I � \� -, I �' . I I - - . , I .1 1�- , 11 ' L � I I L,\ 1, \ L \ I I L - I L.�& I I I Ir � : L ,DENOTES- PROPOSED :,4 , �� �­., � I Depth to Perc: 28"�Ao' 46* . . . I � 11 ". \ I k � \ ­ I\ I I - A L .1 L . - I . : 11 04X 1 ' L, I , � .A t_ I I .1 I '' L '� I I I' \ \ L \ \ I I 11 \ � � L I I : , " L I � 1, . 11 Perc Rate- Less Tho 2 MPI Z I I I I I I , I I ,�I I L� 1. I . . �1_ , 1, ' I I 11 \ \ \ \ 11 \ " L . I I , . I I I SPOT GRADU ' I I I I . L . L Groundwater Not bbserved , . I � I I. I I I I � .L� 1�111 I I . . � � A .. 1., , .. L, �� I I \ \ \ � \ \ I I �, , \ , / . I � % I � I -1 L� , �,I I I ,:, I 1. � L,L I L' I �, I L J I �, I I ­ ­ I I I I I � . 11 , " � . I . I I .1 I . I I I � I ,� . I I I, , , L . I I . I I . I , 1 I , I I \ / ­ I I L-� ­ I I - I I � .X 1 04.46 1, ,� ' '� , TEs -EXISTING I I � 1. , . I . I No Observed ESHWT - I � . ,� " I � . I �;�%\, \ , \ I ­ \N \ , , Lr I �i 1��k \L I I . r. " .. I I I � \ \ I \ \\ / DENO '... I I - I �L ADJUSTED H20 Elev. - None ­ I '' \ I \ \ � : 1, I L "I L ,, � \ 1\ \ � 0 / � � I I �Ii�, � , I � ­ I . I . I I I� �� I L I. I., 11 il L % , \ \ , L I \ P i i / , . A - .qe\. . I I L I I . �, ; SPOT GRADE - � ; r . ". 11 I I I . L . L. . 1. I I I 1. 1� L L I r I I \ I \ , , \ \ 10� \ / I � I � . �, - . L 1. .'L I , I I 1­,-,r-),, , I ,-_�' 1, 1; . 1-11 � � � . I L 11 I \ 'I, \ I I\ , � \ \ ,� \ I I . � . . o I . I I �, 11 I I � I I I - ,� , . , . � I .. I LL 1. 1% ,,, \ \ � \ I: .L / I � I I , . I I . . I � ,, I I­ 1� I I�- . I I � I 11. I I I . i.l ,�-I I I � -1 ­ I � \ . \ 11 '� A , L PL . I . . I I r 14 � , �, I I � . . . ­ � I . I � I I . � , ,, I 1\\ I \ \ I \ I \ I . \ , /I I - \ � � , PROPERTY LINE - I . . 7 , I I I ...,- I .1 I � L I : L � I I 1� ,1_ ­L - I . , \ ' \ " I � I I , 11 I " ­� I I— - 1 1. :­ 1­ .0 I�� ;. I I'll . , \ \ L , 1 \ . I 0 1 I L I - . 'L � L L __ , . I . , f \ - . - .\ f� . " . �, ­o � .r I -11, I . ,f­.1 I I 1. 11 1 I . . ­,r. . I % r \ , \L I ' , , 'L I ". �I L I . I . L I L I I I I .1 I �� I I . 1� , ,L , , I I - 11 I I , , \ " � . L ,� L L . I . 7%"� ,-, �' L I 11. L I. �. I If I �, . r I ­ ", I 1. �- - \ I . �\ \ I . \ I I .L. � I I I . I I � 11 I "�.i,.:� , L' I� r, I 11 �. I I I . . I r . ,I I I I I I , , � � \ I \\ \ I I \ I \ I .- ,� I � L " I a � I I.,11� . I -L 11 I L -- I 96P , I ONTOUR I I I ",:, , � I I I � I 1­ , I I I I . � . I 1. I I- I \ I \\ I I . ,V .1 P, . 1. I , 11 . I ,, I . . I . 1 ; L . 11 I �,I '': r . I I . . I I L -L I I I / - I % \\ , I\ .\ , �� I .I I"N I. ,. � 1. � . . I I i. "I I I I I I I I I I I I t, _­ � I . I I _� . I 1, I 11 � I I . . 1 4 , I I I I ,. � I f . ' ' ' I � I EXISTING . CONTOUR �, -,�. I I I I F . I I \ I I, ... � I .1 I , 11 I r . I I � I t ­�_, � I I L I ­ e i �� I 11 1, I 11 \\ - \ L \ - I , I (b . *1 I I � I -- - --.'-97 . ,. I��,�, . , I I, I I � I ­ � I - L ' 11 I ,� f I I . L I . '' I !,�!-.�,-:­ , L ,,,r,. . I . .1 . . � I I 1. L I .1 //. . . . I .� I � ,� L\ " L\\ ­1 \ I \ . C� I I � " ,."i L- I I L 'L . .� ­1 .1 ? I I 11� .0 L I L %" � lil- � I .. i �� " . I �, ; � 1, - � I I I .1 .1 I I . I i \ \ � . �: \ , . ­ Cl r' , � I IL . . I , I �, . I I 1 I I . .i - �, .Z / \ ' � ,, � , I I I ., � 1.1. . . 'Ir L . . - - �/ � , , I I . I I . ,� L . I , , . 11 . 11, 11 I . ; .", .. I L 'L I \ I � � I . I I I I L I . , , " I I I . I I : I I �L i-_,"..I'll I �, 1-24" OM.�ACCESS MANHOLES ' .. ,,, 1� . 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