Loading...
HomeMy WebLinkAbout0463 NOTTINGHAM DRIVE - Health 46I Nottingham Drive Centerville P �A = 147 033 1 TOWN OF SARNSTABLE ,// /,/ ) LOCATION `tG 3/— /Tin �u �y f, SEWAGE# YII..L'AGE Cen*ert).II-4-0 ASSESSOR'S MAP&LOT �7 0 3 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY - 1006 C)G l ' LEACHING FACILITY: (type) lv l e ld (size) 3 7� NO.OF BEDROOMS— 3 BUILDER OR OWNER PERMIT DATE: - COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) < / Feet Furnished by M-66i2::4 of N Q -�- J 4 } t t tn f D 6 UO r h,0, A 36- I E— 37 6" 0 a a TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO,OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY I_ f 5MIO1 NOTICEThis Form Is To Be Used'For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOLL EVALUATION EMIPTION FORM : I, 6, Je14NlQN hereby certify -ufy that the engineered plan-signed by me dated concerning the property located at 4 b 3 ?-r-MlrMq•, �104 t r E Le-Ai7?7&Y meets all of the following criteria:: — • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. i t F • The soil is classified as CLASS I and the percolation iaie is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may m conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. I i • The bottom of the proposed leaching facility will not be located less than fourteen (I4) feet above the maximum adjusted groundwater table elevation. (Adjust the { groundwater table using the Frimptor method when applicable]' +. Please complete the following: 1 A) Top of Ground Surface)HIevation (using GIS information) S� B) G.W. Elevation 3X . ;adjustment for high G.W. DU ERE`tCE BETWEEN A and B 1 t S IGiVED � DATE: 3l�y�a`l NOTICE Based upon the above information, a repair permit wiII be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. a q:hclth folder pe xmp f Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 463 Nottingham Dr Cl� Property Address `� Nationwide REO Brokers Owner Owner's Name information is Centerville MA 02632 1-25-08 required for every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form.inspection forms may not be altered in any way. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Shawn Mcelroy Enterprises Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City lrown State Zip Code 1-508-495-0905 S13971 Telephone Number license Number B. Certification I certify that I have personalty inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authoritty 1-25-08 ._.s :n nspector's Signature Date he system inspector shall submit a copy of this inspection report to the Approving Authority(Board ealth or DEP)within 30 days of completing this inspection. If the system is a shared system or w o a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the �,er�psc rt to the appropriate regional office of the DEP. The original should be sent to the system owner Y �>�copies sent to the buyer, if applicable, and the approving authority. ****Tiis 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. t5ucsp'OM6 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 463 Nottingham Dr Property Address Nationwide REO Brokers Owner Owner's Name information is required for Centerville MA 02632 1-25-08 every page. City/Town state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/ahvays 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 is in good working order with no sign of back-up. B) System Conditionally Passes: ❑ One or more system components as described in the'Conditional Pass'section need to be replaced or repaired.The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND)in the❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ 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 t5ins •08/06 p Tine 5 Official fnspecfion Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 463 Nottingham Dr Property Address Nationwide REO Brokers Owner Owner's Name information is required for Centerville MA 02632 1-25-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fait 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. t5insp•OWN Tide 5 Official Urspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 463 Nottingham Dr Property Address Nationwide REO Brokers Owner Owner's Name information is required for Centerville MA 02632 1-25-08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) C Further Evaluation is Required b the Board of Health (cont.): I a Y ( ) ❑ 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*"`. P PP Y Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6°below invert or available volume is less than'/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. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t5insp•08/06 Title 5 Official inspection Forth_Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 463 Nottingham Dr Property Address Nationwide REO Brokers Owner Owner's Name information is required for Centerville MA 02632 1-25-08 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cunt.) D) System Failure Criteria Applicable to All Systems (Cont): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either`yres'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. t5insp•OWN Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 463 Nottingham Dr Property Address Nationwide REO Brokers Owner Owner's Name information is required for Centerville MA 02632 1-25-08 every page. Cityl-rown state Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"non as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the maintenance of subsurface proper u sewage disposal systems. The size and location of the Soil Absorption System (SAS)on the site has been determined based on- ® ❑ Existing information. For example,a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp-08/06 Title 5Official inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 463 Nottingham Dr Property Address Nationwide REO Brokers Owner Owner's Name information is required for Centerville MA 02632 1-25-08 every page. Cityfrown state Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 12-07Dd e Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp-08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 463 Nottingham Dr Property Address Nationwide REO Brokers Owner Owner's(dame information is required for Centerville MA 02632 1-25-08 every page. City/Town state Zip Code Date of Inspection D. System Information (cunt.) General Information Pumping Records: Source of information: WA Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gall 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) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (d known)and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 463 Nottingham Dr Property Address Nationwide REO Brokers Owner Owner's Flame information is required for Centerville MA 02632 1-25-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Building Sewer(locate on site plan): Depth below grade: 22"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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 Gal Sludge depth: 8a Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 1° 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? Tape t5insp•08/06 Title 5 Ofrraat Inspection Form:Subsurface Sewn I S Sewage Disposal yslErn•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 463 Nottingham Dr Property Address Nationwide REO Brokers Owner Owner's Name information is required for Centerville MA 02632 1-25-08 every page. Cityfrown 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.): Tank in good condition with tees in place. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): t5insp-08/06 Title 5 official inspection Form_Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 463 Nottingham Dr Property Address Nationwide REO Brokers Owner Owner's Name information is required for Centerville MA 02632 1-25-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 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.): Good condition. Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp-08/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 463 Nottingham Dr Property Address Nationwide REO Brokers Owner Owner's Name information is required for Centerville MA 02632 1-25-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) pocate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number. ❑ leaching trenches number, length: ® leaching fields number,dimensions: 38'x12'x6" ❑ overflow cesspool number. ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leach field in good condition with no sign of back-up. t5insp-08106 Title 5Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 I\� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 463 Nottingham Dr Property Address Nationwide REO Brokers Owner Owner's Name information is required for Centerville MA 02632 1-25-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): M t5insp-0=6 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 463 Nottingham Dr Property Address Nationwide REO Brokers Owner Owner's Name information is required for Centerville MA 02632 1-25-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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. ' t a b C. 19- 35 zfe F- 3 T6 � 3f' t5lnsp-08W rfle 5 official trmpedon Form:Subsurface sewage Disposal System-Page 14 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 463 Nottingham Dr Property Address Nationwide REO Brokers Owner Owner's Name information is required for Centerville MA 02632 1-25-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water. 30' 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: Perc test on file shows no groundwater at 10'. t5ins 08108 P• Trtte S Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 I ' Town of Barnstable OF THE Tp� Regulatory Services BARNST,ABLE Thomas F. Geiler, Director, yQ MASS, `�� •�rf039. Public Health .Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is required for Centerville MA 02632 October 29 2007 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key —1 I to move your David D. Coughanowr cursor-do not Name of Inspector use the return key. Eco-Tech Environmental ® � Company Name �e 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State ? Zip Code 508 364-0894 1328 Telephone Number License Number d B. Certification r� .4- 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.T.he inspection was performed based on my training and experience in the proper function and maintenance of on,site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10,J 't, a, P—S October 29, 2007 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5-2815.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is required for Centerville MA 02632 October 29, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ forthe following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ 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 t5-2815.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is Centerville MA 02632 October 29, 2007 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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. t5-2815.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is required for Centerville MA 02632 October 29, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: '* This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® 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. t5-2815.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is required for Centerville MA 02632 October 29 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5-2815.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is required for Centerville MA 02632 October 29 2007 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5-2815.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is required for Centerville MA 02632 October 29 2007 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Number of current residents: 3 Does residence have a garbage grinder? Removal of grinder is recommended ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 129 gpd 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5-2815.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts L W Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is required for Centerville MA 02632 October 29, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Owner's agent Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age: 3+years. Certificate of Compliance issued 419104(Board of Health permit#2004-147) Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2815.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is required for Centerville MA 02632 October 29 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2feet 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.): No evidence of leakage or backup into dwelling was observed. Septic Tank (locate on site plan): 1 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5 ft x 5 ft x 5 ft(1000 gallon) Sludge depth: 6 in Distance from top of sludge to bottom of outlet tee or baffle 28 in Scum thickness 2 in Distance from top of scum to top of outlet tee or baffle 9 in Distance from bottom of scum to bottom of outlet tee or baffle 13 in How were dimensions determined? As built card t5-2815.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is required for Centerville MA 02632 October 29 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time but maintenance pumping is recommended within and every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): t5-2815.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is required for Centerville MA 02632 October 29 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert At outlet inverts Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box appears structurally sound with no evidence of leakage in or out. Few solids in sump. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2815.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is required for Centerville MA 02632 October 29, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1—38 ft x 12 ft ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils above leaching field appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A bucket of water was poured into the distribution box and was observed to pass through in a rapid and unobstructed manner. i t5-2815.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is required for Centerville MA 02632 October 29 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): f t5-2815.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is required for Centerville MA 02632 October 29, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. U NOT TO SCALE EXISTING U DWELLING CY U B AS- WA ER LINE ENTERS HERE/ SEPTIC ° LOCATIONS El TANK o CY z A B LEACHING 3 I 10.5 FL 33 FE FIELO 0 D-BOX 2 16 FE 35.5 FE z 3 2B FE 33.5 FE W � m NOTTINGHM DRIVE t5-2815.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 463 Nottingham Drive Property Address Zilton Prates Owner Owner's Name information is required for Centerville MA 02632 October 29 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to 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: Barnstable GIS Department records You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is 20 feet above groundwater table. t5-2815.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 tHE Town of Barnstable �p Tp� d Regulatory Services BARNSTABLE ; Thomas F. Geiler,Director y MASS. 1659. Public Health .Division pTEp�,�A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 11 1 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. NO.(/1-- �! THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH OF L APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade Abandon ( ) - ❑Complete System [.Individual Components 4'63 FA9-11 fi I tCL`" GL%�rZ'lt /LL �A wl l &/0 fc 6, ,4 O Phtion © Owner's Name I � t"e) Map/Parcel# Address 9,)-' - 4t y3 Lot# Telephone# (1141 6- �i`17t1/CC— —)ca( �✓S�rt Installer's Name Desigr'sne Name 13 Address \ Address bsoe Telephone# Telephone# Type of Building: !LS(cgCly 7-(4 L Lot Size Sq.feet Dwelling—No.of Bedrooms .3 C W is% Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) 73 0 gpd Calculated design flow gpd Design flow provided�r37 gpd Plan: Date 3�/��� 9 Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator J,7 d--J n— Date of Evaluation-A:--Z- 0 3 DESCRIPTION OF REPAIRS OR ALTERATIONS c � e,'�1��KG C�coo 6 4 1— ft'_`! The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and fu grees not to place the system in ration until a Certificate of Compliance has been issued by the Board of Health. Signed Date Q Inspections11 �WO� FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH 7),*6 Lr I/ 10(2jf--'� 0 F e,.j rvo-v 1 LL L.) APPLICATION FOR DISPOSALSYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct Repair Upgrade (K-,) Abandon Complete System Individual Components Al --f 63 lu-7-rf m F 44,-,," %41 e-614rZ91V11-" 6�1 0 ft-&^1V P� tion O Owner's Name 7 - '�� Owner'sMa�/Parcel ff Address 411 If( 9 3 Lot to 4,+IVIM T:�415OA:vfo 01V lnstaller's Name 460Y D 613 0ner's ;mle-e O.L 43-r 4 ,vt 4 Address Address �L-%—1.9 of Telephone# Telephone# Type of Building: A_eSId tre-4 7- 4 L Lot Size Sq.feet Dwelling—No.of Bedrooms 3 't.13 7- Garbage Grinder- Other—Type of Building No.of persons C'Sho'wers Cafeteria 'Other fixtures Design Flow(min.required) 73 0 gpd Calculated design flow gpd Design flow provided�U> gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator e.Ve Ja IYRI-A 10" Date of Evaluation Q 3 DESCRIPTION OF REPAIRS OR ALTERATIONS r,"Ae The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 cm�d fu her not to place the system 1"eration until a Certificate of Compliance has been Issued by the Board of Health. Signed /Xi Date io Inspections Aie- V V Z FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 ---------------------------------------- --------- N.. A —/ITHE-COMMON EALTH OF MASSACHUSETTS FEE fAf',^t� EL( BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: E] Individual Component(s) E]Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed Repaired Upgraded Abandoned by: qb_3 hl, at has been installed in a cordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.,2 UWNY? dated Y45-100 Approved Design Flow—(gpd) Installer A Designer: Inspector r IC. Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 ------------------ NA0 THE COMMONWEALTH OF MASSACHUSETTS FEE 2--AkABOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is her b ted to Const uct r ) Re air ( , Upgrade ( ) Aba-adon WEi�individual sewage disposal system, UP Xmy-)Dye I i Y�7 QE�A s desc ilbed 4 in the application for Disposal System Construction Permit No. dated Provided: �Uonstr ction shall be completed within three years of the date of this mi .A�1/10a7l ditioo usl�be met. Date r, Board of Health Ik 0 FORM 2 DSCP DEP APPROVED FORM 5/96 'FORM 1255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS- BOSTON 1-J TOWN OF BARNSTABLE EC q,J LOCATION yG� /✓Q�t'rNcA SEWAGE #.-2 i 7 ! VILLAG �lle ASSESSOR'S MAP & LOTA7 INSTALLER'S NAME&PHONE NO. -IZ&W N SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: O � COMPLIANCE DATE: 0 N Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Lea ng Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by 1:�'i 14WSe A A L ec e h Field 2�— 14If �3-37.S'_ ^3f3 r a Town of Barnstable Regulatory Services 059. ' Thomas F.' Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office%508-8624644 Fax: 508-790-6304 Designer Certification Form Date: Designer: 12,qi g/el- S JP f.\l Sa"l-i Address: X 0. On was issued a permit to install a (date) (installer) septic system at 463 ^o�,71rm,(& � 61en TC�VILILLgbased on a design I drew, (address) dated I certify that the septic system referenced above was installed substantially according to the design. I certify that the septic system referenced above was installed with changes but in accordance with State & Local Regulations. Revision or certified as-built by designer to follow. OOAM F 4; 8 JQtd NO."G77 (De igner's Signature) ( ix tamp Here)` PLEASE RETURN TO 13ARNSTABLE 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:Health/Septic/Designer Certification Form Commonwealth of Mosmichusetts John Grad Executive Office of ErMrormiefttal Affairs D.E.P. Title V Septic Inspector Department of P.O. Box 2119 Environmental Protection Teaticket,MA 02536 D 3 1 � A d SUBSURFACE SEWAGE DISPPOSAASYSTEM INSPECTION FO r✓ g fo CERTIFICATION t� Tp •C � w'' Property Address: 463 Nottingham Dr. Centerville Address of Owner: OPNsl 199, Date of Inspection:712147 (If different) �FPTgeIF ��r Name of Inspector:John Gracl Noonan Company Name,Address and Telephone Number: Z 1 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes This Inspection Is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs F 1her aluation B the Local Approving Authority performinn at the time of the Inspection.My Inspection does — y pp g not Imply any warranty or nuarantee of the lonnevtly of the — Fails septic system and any of Its components useful life. Inspector's Signature: / Date: 712197 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B.C, or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined(Y, N,or ND). Describe basis of determination in all instances, If "not determined", explain why not.) The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street . Boston,Massachusetts 02108 e FAX(617)556-1049 . Telephone(617)292-5500 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 453 Notdngham Dr.Centerville Owner: Noonan Date of Inspection:712197 _ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four 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 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 11/15195) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 463 Nottingham Dr.Centerville Owner: Noonan Date of Inspection:712197 D] SYSTEM FAILS(continued) Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further Information. (revised 11115195) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 463 Nottingham Dr.Centerville Owner: Noonan Date of Inspection:712197 Check if the following have been done: x Pumping information was requested of the owner,occupant, and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. n1aAs built plans have been obtained and examined. Note if they are not available with N/A. x The facility or dwelling was inspected for signs of sewage back-up. x The system does not receive non-sanitary or industrial waste flow. x The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered,opened, and the Interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. x The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115195) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Add ress: 463 Nottingham Dr.Centerville Owner: Noonan Date of Inspection:712197 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 gallons Number of bedrooms: 3 Number of current residents: U Garbage grinder(yes or no): Yes Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available: n1a Last date of occupancy: 1 year ago. COMMERCIAL/INDUSTRIAL Type of establishment: n1a Design flow:u gallons/day 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: n1a Last date of occupancy: n1a OTHER: (Describe) n1a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last year. System pumped as part of inspection:(yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: n1a TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source information: 1074 Sewage odors detected when arriving at the site:(yes or no) No (revised 11115195) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 453 Nottingham Dr.Centerville Owner: Noonan Date of Inspection:712197 SEPTIC TANK: x (locate on site plan) Depth below grade: 1' Material of construction:X concreate_metal_FRP_other(explain) Dimensions: L 8'6"H 5'7"W 4'10- Sludge depth:5" Distance from top of sludge to bottom of outlet tee or baffle: 22' Scum thickness:3- Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: IV Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Septic tank and all components are structurally sound.Recommend pumping system now and then maintained every year. GREASE TRAP:_ (locate on site plan) Depth below grade: n1a Material of construction: _concrete_metal_FRP_other(explain) Dimensions: n1a Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:n1a Distance from bottom of scum to bottom of outlet tee or baffle:n1a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet Invert,structural integrity, evidence of leakage,etc.) n1a (revised 11115195) 6 , f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 463 Nottingham Dr.Centerville Owner: Noonan Date of Inspection:712197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: nla Material of con struction:_concrete_metal_FRP_other(explaIn) Dimensions: n1a Capacity: n1a gallons Design flow: n1a gallons/day Alarm level: Na Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nla DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) n1a PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) n1a (revised 11115195) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 463 Nottingham Dr.Centerville Owner: Noonan Date of Inspection:712197 SOIL ABSORPTION SYSTEM (SAS):X (locate on site plan,if possible: excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Na Type: leaching pits,number: 1,000 gallon leach pit leaching chambers,number:n1a leaching galleries,number: n1a leaching trenches,number,length: Iva leaching fields,number, dimensions:Na overflow cesspool,number:n1a Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) The overflow is structurally sound and functioning properiy.lt was empty at the time of the Inspectlon.Pit has not had more than 3'of water In It. CESSPOOLS:_ (locate on site plan) Number and configuration: n1a Depth-top of liquid to inlet invert: n1a Depth of solids layer: n1a Depth of scum layer: n1a Dimensions of cesspool: n1a Materials of construction: nra Indication of groundwater: n1a inflow(cesspool must be pumped as part of inspection) Na Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Na PRIVY:_ (locate on site plan) Materials of construction: n1a Dimensions: n1a Depth of solids: n1a Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n1a (revised 11115195) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 463 Nottingham Dr.Centerville Owner: Noonan Date of Inspection:712197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' I � A �A 3� 314 DEPTH TO GROUNDWATER Depth to.groundwater:12 feet method of determination or approximation: USGS Maps and Charts (revised 11115195) 9 • TOWN OF BARNSTABLE LOCATION Ala#42eJCb&,-- SEWAGE# 100 q'"ly-7 VII.I.:AGE (� Ze ASSESSOR'S MAP & LOT , INSTALLER'S NAME&PHONE NO. lzjle s /�iorr N SEPTIC TANK CAPACITY OAD 4 LEACHING FACILITY: (type) (size) lee G 4, NO.OF BEDROOMS BUILDER OR OWNER ^l / PERMITDATE: y COMPLIANCE DATE: 0 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 t i400se - 3 A Al O A :s-3D ED A 4-22 • G�eG�h fiel(J � 3 ,�1 �Z �— x Q Y� 38x �2X 0.S �3-37.5' 38, i ` TOWN OF BARNSTABLE LOCATi0N WOT11116HA-M DR we SEWAGE # VIL AGECEI.IILRY1LLC ASSESSOR'S MAP & LOT 147-3� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1 OU d G 4 L LEACHING FACILITY: (type) I E(-17 (size) NO.OF BEDROOMS 7 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ECO -- T1eCW - Th5 eC 011 '*1/07 W NOT TO SCALE EXISTING U DWELLING E CY I, U a A WA TER LINE ENTERS HERE/ ❑ SEPTIC LOCATIONS TANK o ry 2 A B F�FIELO CHING 3 1 10.5 FE 33 f t 0 o-eox 2 16 F E 35.5 FL Z 3 26 f E 33.5 FE W m NOTTINGHAM DRIVE D D 3 1b 2 w 'o a m 1 o 0 co IJ O m V m 2 o 24' M o a D --------- --- ---- ---- ---- --- - 77 -------------------------------------------------------------------- t1 X a� y�� ts• 2e I I I N s e 8 I . < ------------------------------------------------------------------------- tC Z s.t I . ____ __ ______ ______ ______ � I ------ �mZ x NM I r I I � ----- D _ a a f7 �I ' S v o•. I I I �I l a - O Z I N � � I i , � � A i N O 1� s � `6° 0 x LIZ- 15 410 ge ( yt yw, dY j�7T, I N � fKJA � t � .s Vi CD 3 tUw y lU ,z�j 4 stC Ali r° - 1.'� E� CD m � I C n O I o — -------------------------------------------------------------------- CD A-5 1 Project Garage & Breezeway Addition Chris Ellis - 3D Computer Home Design A-2 for Ann & Harold Graham P.O. Box 146, Brewster, MA 02631 Overview 463 Nottingham Drive, Centerville, MA 02632 phone: 774-212-6625 longpondl@mac.com NO. OF ACTUAL DISTRIBUTION LINES:2 l LENGTH OF LEACHING LINE:38' LEACHING FIELD TEST PIT DATA END"CROSS SECTION LEACHING FIELD DIMENSIONS: 38'LX12'WX0.5'H Performed By: Daniel B. Johnson FINAL GRADE TO BE STABILOED SCALE - NONE 97 0 Witnessed By: N/A \ /--EL. FINISHED GRADE(SLOPE # 02)= — 4"SCH 40 PVC PIPE �� � i � � ( = I C I — FIZ'IMINJ Date: December 5, 2003 ! EL -94e Z'LAYER1/8"•1/Z'DOUBLE i (BREAKOUT) 4 WASHED STONE NO OFF GRADING FOR fig, EL -=93.71 (END] ORIFACE DIA. 6- 3/4"-1 1/Z'DOUBLE WASHE "�f - 14„ A/Fill Loamy sand BREAKOUT REQUIRED FOR o 'Q STONE 14 - 31 Bwb, 5R5/8 Loamy sand Q ((( 1r 3i" -108" Cl, 2 . 5Y8/2 Fine-med. sand No Observed ESHWT EL -93`1 No Observed Groundwater ENO OF DISTRIBUTION LINES TO LEACHING FIELD TO MEET BE CAPPED,UNLESS VENTED. 5' REQUIREMENTS OF 310 (REF.PLAN AND PROFILE) CMR 15.252. TP-2 (EL. 96.1) ESHWT EL. =91.5 9b �` 0" - 4" 0/A Loamy sand 4" - 18" Bwb, 5R5/8 Loamy sand 1 18" -108" Cl, 2 . 5Y8/2 Fine-med. sand DISTRIBUTION BOX 9�t 9 H 20 � �� � 1 � ! '7 � _ REMOVABL_F No Observed ESHWT COVER , , 4"SCH 40 OUTLET LATERALS � ai,7Dt>oo r,,Q 98+° No Observed Groundwater v Dc DISTRIBUTION BOX TO MEET SHALL BE SET LEVEL FOR A � I i V -'•- -J- _ L__— M _ __ _.___�_ ' PERCOLATION TEST DATA I REQUIREMENTS OF 310 CMR ` MINIMUM OF-THE FIRST T1+d0 f 1 15.232(WATERTIGHTNESS, FEET AND CONNECTED TO f E�rSTlrvb o ,;G g Date: December 5, 2003 r CONSTRUCTION.ETC). zI EACH DISTRIBUTION LINE WITH SOLID SCH 40 PVC PIPE Soil Class: Class 1 (0. 74 G/SF) NO. OFOUTLETS: 2 EL. =94.10 EL a9393 Q ' fiE' ro�,6t 4"SCH 40� 1 � i � Yo•F, = 99,bt Oo 0 6"(MIN) 0 0 STONE MECHANICALLY D ASHED Perc Rate: < 2 MPI (TP-1, TP-2) } STABLE LEVEL BASE tjj (-VA Vj -` 77A c r 98*9 _ _99 Depth of Perc Test • 31" _ 49" (TP-1) 1 b" (—2'_._._-___-.______ �... ' NOTE S >EP ` `1).� /Dap SCHEDULE OF ELEVATIONS 1 Ali construction methods shall con1orrrl to the Titie v (310 �ELocATE6 ���°' `�`�'------ ,�/{T.►NK LO A T Elt. Y�l �� CMR 15) and the Barnstable Board of Health Regulations. Inv. Out Founcat:l,on ,existing) 96. 0 There are no Known private Or , �. ra �1_-- _ .l '�,� prrE� ^' Inv. In Septic Tank (existing) 94 . 5 T "� � --.,��* 150 ''rr"4 ► Inv. Out Septic Tank (existing) 94 . 3 ; feet/400 feet, respectively,1' - --- -3s' sA Inv. In Distribution Box 94 . 10 e public wells within leaching p y, of the proposed leaching area. There is no wetland within 100 feet of the proposed leaching �l ¢�aaq� -• Inv. Out Distribution Box 93. 93 area, nor is the proposed leaching area within 200 feet of a Inv. Begin of Leaching Field 93. 90 riverfr-ont . os,00, _ �� Inv. End of Leaching Field 93 . 71. 9I� ;" - _ Bottom of Leaching Field 93 . 21 3. Existing SAS to be pumped and removed prior to installing _ `__ - 9i No Observed ESHWT/GW (Bot tor TP-1 • 88 .2 the new leaching area. 6A,rc J jEA6HjNb IFICLb ' C�*);riivb 'sr� Bks r �9 -* rzw r N �qT6L u�� 6�Pix ox) .- --�-- - --- ----- 4 No changes are to be made in the field without the approval of the Board of Health and the design engineer. �orri^/r�t�,�.�1 'Die "it 5. Proposed leaching field is not designed for use with LEGEND garbage disposal . Existing Contour - - - 98 - ) 6. Contractor to notify Dig Safe 72 hours prior to Proposed Contour construction. (8 00) 3 4 4-7 2 3 3 . 98 7. Property line information taken from deed, Book 17583, Pace Test Fir ; 3R, referenrfe Lot E7 nNn r "Lumbert Mills" in Centerville, MA, Peter Sheaffer, dated Finished Floor Elevation FFE May 28, 1971 . The septic plan is not to be used as a ( property line survey. Basement Floor Elevation BFE I Water Line W 9. Contractor shall verify all plumbing from existing structure Gas Line Gwill be connected to the new septic system prior to construction. If any existing plumbing exiting the loz y OF Cable C structure is found to be different the that shown on the h5 Srbwnl approved septic system plan, the contractor shall notify the Over Head Wire OH6a designer. All internal plumbing shall be connected to new FFE° ruo,b+. i septic system, unless otherwise specified. (0° _ _ CALCULATIONS: e 3 Bedrooms (existing) 110 GPD/Bedroom X 3 Bedrooms s 330 GPD Dt,4 1ziSE-JI 9d A,rc co�r-ws TICP;� os�� ��' rf �4 M Q ; Percolation Rate - < 2 MPI (TP-1 ) a ? r Soil Class : Class I' 0 . 74 G/SF) .° Co a c. ty r r" ! W NA PROPOSED LEACHING AREA: LA t� sr+UDAE o„ Leaching Field: 3F3' x 4 ` ; x 0. 5• c� * Pr t c v ti} �E4" N 0 4- c� ` N,D R y y Z CA2ARUS I ti Bottom Area: 456 p6. ,s 0. 74 G/SP jjj GPD 0 ! i i [OVFLC RD w i ~ a i3OW�11�Rl 11.4a�:hing Ca(pacalty: N_rw 33'7 GPD f }.� z � N _ '� f9FN SM��>a AR � j S uy�AS A t S 1 OILCHIT N LSohr1_. ENE.` <4 N O 4r �'-- S +v t'pP `� + h "" W000�A`` - r -- /0 r +*os yPf �`} cv r(Eai �nciS ti a7£If A hsL£ RO ? AA 40� —V K jS,OI _ .—_n_. °� �} ?Oc4 OP o Ctcsbry r p c.gcL[*ov aA 54 ` �._. .. _.__.:_ � _�"' I/A �` t p 0 Ro r p S r° I ' ! 94.3; r 9 jGNgfl IEIGf, pti�• —_--' — -= / . SE' sf pMES `` 6aCAT G13.f �3,7/ r O C�rJ V- 1 } 1. Q N M+ 0 c n i f �r tyo t p i vAr �g�CP J� p RSrI rjr(r __-__._ _ _ o a P" z s. LA a o� d}� �4. t +r a O i x 3.9 W X D r 9a D r'�riL1&/ �r1014 �/!au Q o P°o FLP°NO y C�L Md GAL a cr �F ♦ F h + t-4es aLISON f•S f,p, ? S ° !v4 wpER r� Ot' �O O C Ec„ uR �►�E r� CRPf �^ �Y t" G a0 it tARA 'v C E A)T r �.'s e ? it Y t 0 C'�'`. `mac r 0`� v . Gfn1EROB�1. • VIL. L LA E7<rST/Nc' oury Ap o y L,a sy .� L^+ 28 /000 i�,4 LL Q�J CON �S o frRC • ANOLEA ra ^4 �?C t WESTMrNSrER ✓Sf/N NEO .��'\_ ogp► S LA 5errle_ T*Al i +_ abe i O aA Et'S Oq QkvO far�.� 'a� P icLfa �' r4vr4 OL r0 /,v i r�L L a o 8� NE 4' PVL TEE E>Iiw ' EL. = 38.: LTP-f ,4s^ta zq DEL f�L rE�+. IN OJTLET a�7 0t00 otlo 0+.10 Of To p440 p}So D+bo p+)0 ot3�► dr9n ltoo t�0 �n �0--�®� r SUBSURFACE SEWAGE DISPOSAL SYSTEM E11Z 463 Nottingham Drive, Centerville APPROVED BY: r � y L SCALE: DRAWN BY Y DATE: 3/12/04 Daniel S Johnson REVISED Prepared Darn Giordano (508) 420-4193 For: 463 Nottingham Drive, Centerville, SEA 02632 �f�t�'i'4 a .y. Prepared DQESTIC SEPTIC DESIGN, INC. (508) 420-1904 DRAWING NUMBER 1 I Bv: P.O. Box 643, 03terville, Ma. 02655 J-1046