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HomeMy WebLinkAbout0230 OAK STREET (CENT./W.BARN) - Health (2) 230 OAK ST Centerville A = 173 — 049 SMEAD Na Z+10WR UPC IUM �a..aAan • wd.ln ua �a„a.j Commonwealth of Massachusetts Title 5 Official Inspection Form i%l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r• rd � Property Address le- Owner Owner's Name information is � r required for every page. CityfTown State Zip Code Date of I pec n Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector InlMtion filling out forms on the computer, use only the tab key to move your Name of Inspector cursor-do not v use the return key. Company Name //0 Q Company Address VQ L 42.5 City/Town( Q��O `/� O State / � x P Zip Code Telephone Number! License Number B. Certification i certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintena of on-site sewage disposal systems.After conducting this inspection I have determined that the s em: 1. Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Inspector Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10.000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. We 5 Vidal.r.spenon rcc S�Csur,'ace sewage omposai system-Page of is t5insp.doc•rev.7/26/2018 Commonwealth of Massachusetts �: Title 5 Official Inspection Form 9. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,mod Property Address le, Owner Owner's Name information is l_ �)/ ?� 9/ required for every �/�N�G✓y� �- 41,4OJ4 J page. City Frown State Zip Code Date of In ecti C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of and 6. 1) System P s: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass' section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes'. "no" or"not determined" (Y, N, ND)for the following statements. If"not determined,' please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑I N ❑ ND (Explain below): t5insp.Coc•rev.7/26/2016 -me 5 otiiaa mspecuor,Form..Suos❑race sewage Disposa System•?age 2 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 0 Property Address Owner Owner's Name �j Q information is �� required for every AU (( page. CityTFown State Zip Code Date of Ins otio C. Inspection Summary (cons.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 'times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health. ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.dcc•rev.7/25/2018 -itle 5 officiai insoecticn com-:subsurface sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address // r"00 l2 Owner Owners Name information is required for every page. City/Town State Zip Code Date of Inspettion C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well'. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ❑ B up 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 7itfe 5 Offidai 1ns�ectl0n Far:Subsurface sewage Disposal System•Page 4 of 18 t5insp.00c•rev.7262018 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments J3 o 06; .5 Property Address Owner Owner's Name information is required for every Ce-64 page. City/Town State Zip Code Date nsp Bon C. inspection Summary (cons.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded - � or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than'/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. Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal eoliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000 gpd- �� 10;000 gpd. r The system fails. I have determined that one or more of the above failure J criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes' or'no-tO each of the following, in addition to the questions in Section CA. Yes No I� ❑ the system is within 400 feet of a surface drinking water supply 7 I the system is within 200 feet of a tributary to a surface drinking water supply u the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well �e 5 V`Cs Inspe or,=or:Subsu-ace Sewage Dis. sa)system•Page 5 of 18 5insp.Goc•2v.72620t8 f c Commonwealth of Massachusetts 11_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a Property Address e Owner Owner's Name information is required for every page. City/Town State Zip Code Date o In ecti C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section 0.4 above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: Yr11llere ping information was provided by the owner, occupant, or Board of Health any of the system components pumped out in the previous two weeks? ❑ s 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)] Tine 5 of`cei inspection=or,:Suos.rface sewage Disposal Systems•Page 6 of 1a t5insp.doc•rev.7126/2018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments cp OG 4, S Property Address 00 4- Owner Owner's Name I� ' information is O d-6y, 3 required for every page. City/Town State Zip Code Date of Ins ction D. System Information .1. Residential Flow Conditions: 3 r f bedrooms (design): Number of bedrooms (actual). Number o 33� DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: / /ON � C !� 6-t� C.y / 43 ���/70 -It' O� pZ W 6 G O r1 o'vti► f S 'L.Q,, Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes No If yes, discharges to: Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Ye No Seasonaluse? Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: 0 Sump pump? Last date of occupancy Vidal:nspecaon=cm.Sccsu'ace Sewage Dispcsai System,Page 7 of 18 t6insp.doc rev.7126t2018 i Commonwealth of Massachusetts P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c 2 3 v► S�— Property Address Owner Owner's Name information is 3 required for every (// D page. City/Town State Zip Code Date of In ecti D. System Information (cost.) 2. CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day d P Y�9P ) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below). 3. Pumping Records: .tea/f Source of information. Was system pumped as part of the inspection? ❑ Yes o If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7f26/20118 -itle 5 offiaai insce=on.=om:sut)sufiace Sewage Disposai System-?age s of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments lkp� _I �- Property Address 00 Owner Owners Name information is iQ `6 e 9 required for every page. City/Town State Zip Code Date of I spec' n D. System Information (cont.) 4. Type of stem: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy [} Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components: date installed (if known) and sourc�f inf awn: o2ol Were sewage odors detected when arriving at the site? ❑ Yes ''Ly��o 5. Building Sewer(locate on site plan): �I Depth below grade: Jet Material of construction: ❑cast iron 40 PVC ❑ other (explain): �( p well or suction line: o Distance from private water supply feet Comments (on condition of joints, venting, evidence of leakage, etc.): 3 C`cai inspzcdcr,Fo,.sutsur,,ace sewage Disposal system•Page 9 of 18 t5insp.doc•rev.7/26/2018 Commonwealth of Massachusetts Title 5 Official Inspection Form 00 , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 �-- Property Address Owner Owner's Name information is �� v/ 6�vZ 3 / required for every page. City/Town State Zip Code Date of Ins ctio D. System Information (coot.) 6. Septic Tank (locate on site plan): Depth below grade: feet Material onstruction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy or certificate Yes ❑ No Dimensions: ,� v Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Gum 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 - v L How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): r . . �O J-6,Z-hp K tue 5 Ot',cai inspecuon=o-n.suosurace sewage Disposal System•?age 10 of 18 L5insp.doc•rev.7/2 61201 8 i Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ©� Property Address 4o rJ� � Owner Owner's Name e W�l information is (��4m G WX 42— 3 required for every page. City/Town State Zip Code Date of fnspe6tion D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition: structural,integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete {_I metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day ^ue 5 if`aat jnspe=on Form:secsu.-face sewage Disposal system•?age 7 5 of 18 t5insp.doc•rev.7126i2058 i Commonwealth of Massachusetts Title 5 Official inspection Form 51 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name �yG 9- information is (� required for every page. City/Town State Zip Code :Date of I pec' n D. System Information (cons.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): o� eve Ile-If �c� 6cs oi5cai nsoectron Form.s:.os::rface sewage Disposal System•?age 12 of 18 t5insp.doc•rev.7252018 _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address 00 -e Owner Owner's Name information is / required for every page. City/Town State Zip Code Date of Inspe on D. System Information (cost.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No; Alarms in working order: ❑ Yes ❑ No' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.).- if pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: 1 I^'1boo G�� oh CA f `-XS4oa-v'-_,' ❑ leaching pits number: ❑ leaching chambers number: leaching galleries number: ❑ eaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativeialtemative system Type/name of technology: -me 5 :nspe.:Jon For.:suos�,sce sewage oisposai system•?age 13 of 18 Sinsp.joc•rev.'/26/2058 i 4'\ Commonwealth of Massachusetts Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments / c23c) Property Address Owner Owners Name information is �ytj /V O•Zi u_ 3 required for every page. City/Town State Zip Code Date of I/speelion D. System Information (cont.) 11. Soil Absorption System (SAS) (cost.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ' ?age t4 of 18 5 iae 5 flcai inspac'�cn=om.sursuRace sewage asposai system• t5insp.00c•.'ev.726,2018 Commonwealth of Massachusetts Title- 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r A20 _ ©cl-4• S1 Property Address Oo le Owner Owners Name / /� information is eN� // /'fl 6?d f required for every �/�L ✓ page. City/town State Zip Code Date of insfectiof D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): True 5'�aa msoecoon=ortn.Scosurrace sewage asposai system•?age 15 of 18 5insp.doc•rev.7126,2018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i d 4 Property Address Q l e Owner Owner's Name information is 4en Me � 0. required for every ''�++'��JJ'�� page. City/Town State Zip Code Date of lnspecflffn D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the buildi Check one of the boxes below: and-sketch in the area below ❑ drawing attached separately A I I �n°O CT�IIoh Sep�t� a rtG.M I I i (ma's�.,✓lP � I i-3 Of���y i G IQ , ^ 19 i 5 C3 -e? 1103 cat i •Page 16 of 18 t6insp.doc•rev.7126/2018 -iue 5 o fl cu ,m C?J frspeon=o sucsurface sewage oisposal system Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 4 S7� Property Address / Owner Owners Name C Ile, information is H / required for every 1_�"4 '?h page. City/Town State Zip Code Date o nv ecti D. System Information (cons.) 15. Site Exam: �J Check Slope ❑ Surface water 71 Check cellar Shallow wells f f. 1pori Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design pians'on record If checked, date or design plan reviewed: Date erved site (abutting property/observation hole within 150 feet of SAS) Checked with local Boarc�j Health - explain: Xel ', S� vl�S Checked with local excavators; installers- (attach documentation) Accessed USGS database- explain.- You must de e how you established the high ground water eie/C� n: 4HCGN � /�l/0 _ 10f�4 de .5 Before71fiiing Is Inspection Report, please see Report Completeness Checklist on next page. 5insp.doc•rev.72&2018 `Ue 5 JrSca:;rspa=on=c :Suosuface Sewage Disposal System•?age tl of i8 Y Commonwealth of Massachusetts - , Title 5 Official Inspection Form 0. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments S)L Property Address Owner Owners Name �J /, information is N �` required for every page. City/Town State Zip Code Date of In/pect on E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: <lnspector Information: Complete all fields in this section. certification: Signed & Dated and 1, 2, 3, or 4 checked C. inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 allure Criteria)and 6 (Checklist)completed D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included ve 5 of ioaa!nspe=on=o-::Suos-,—Sewage Disposal System'=age 1 8 of 1 8 t6insvloc•rev.7126/2018 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS plitation for Disposal *pstrm Coustrurtion J)ermit Application for a Permit to Construct( ) Repair( ) Upgrade( an ( Complete System ❑Individual Components Location Address or Lot No. 230 ner ddresss/s,,and Tel.No. Assessor's Map/Parcel � l_73 , k6 f Li 9 Pnc� wUl- Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. el'je )(6 4 vc-fi on -q-77-&53 _7510hee7_ C-1) v 9f7 4 - 9Q y - /1 Type of Building: Dwelling No.of Bedrooms �3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures F� Design Flow(min.required) gpd Design flow provided gpd Plan Date j 7 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 093 K 20 d b OX (Z) N 2 0 ,3 C t 1Lt f11 I N S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued b this Board o alth. j i ed ' Date J I��1 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �01 Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Miap f a 4pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( a o ( Complete System ❑Individual Components Location Address or Lot No. 230 s ner s ,Address,and Tel.No. Assessor's Map/Parcel ✓vl V 73 1 40 f y 7 Q ark D-2► C Col it installer ame, - ess,and Tel.No. 509 — Designer's Name,Address,and Tel.No. t 4VGL.fton ���-c 3 "/cheer fin ✓ 9qq - 99Y Type of Building: Dwelling'Zt o,.of Bedrooms s3 Lot Size sq.ft. Garbage Grinder( ) Other hype of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 () gpd Design flow provided gpd Plan Date 1 f-j 7 Number of sheets O� Revision Date Title rt) Size of Septic Tank Type of S.A.S. Description of Soil K.2 �� i L_ Nature of Repairs or Alterations(Answer when applicable) ID 93 K 20 C1 b Z\OX � 1 H 2 Q 5� C` 1U M I Date last inspected: x Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in f . accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of 41 Compliance has been issuer/S)ned this Board o alth. // Date I3d T r Application Approved by �G� , Date Application Disapproved by Date ¢' for the following reasons r Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY,that t n-site Sewage/Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by ��.�/�-03 at 23 U Oak- _54—( t 1— has been con"* ac to with the pfov'��i-lons of Title 5 and he forDisposa System Construction Permit Noed Installer y �� /� /� v Designer ?� /y� .-n y,l�)n�Y1Pd._llc l #bedrooms —3 Approved design flow �U gpd The issuance of this permit shall no be cqnstrued as a guarantee that the system will nction �ned. Date Inspector -- --Yv� ---------------------------------------------------------------------------------------------------------- No. , Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction permit Permission is hereby granted to Construct ,,( ) Repair( ) Upgrade( ) {/ Abandon( ) System located at U ( /'[�(..[ 51 ( y eta e')p n leu yi and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constru i n i st b ompjeted within three years of the date of this permit. Date 07 Approved by / 7 r . Town of Barnstable Regulatory Services • Richard V.Scali,Interim Director snnxsrastie: ,` Public Health Division A'FD1"°�p Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: I.9.1`7 Sewage Permit# f - f pk Assessor's MaplParcel_M It9 Designer: PaV119U 2 Installer: Q 4 B LcXG'myaaiOn Address: B-0}Z Address: ILI �'occc�do,.lc d Z�� On S•3)•isl Q>E f3 ExcXaV i'o,n was issued a permit to install a (date) (installer) septic system at 230 ST based on.a design drawn by (address) l� dated T Z 9 - 1,1 (designer) I certify that the septic system referenced above was installed substantiallyaccording t the design, which ma ude minor a l g ° g � incl y. approved changes such.as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 1.0' 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. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed i ce with the terms of the I\A approval letters(if applicable) H OF 4f4 s �� DAVID ��yG L(D taller's Si e) " FLAHERTY, 7R, No. 1211 � a TE�E t S4NUAW e igner's igna e f ( Designer tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASepfi6Designer Certification Form Rev 8-14-13.doc Rim Town of Barnstable Pa � cS t $ Department of Regulatory Services- ? Public Health Division Date 206 Main Street,Hyannis MA 02601 IAFt� FaA. �1 Date Scheduled Time Fee Pd. {+ Soil Suitability Assessment for Se e Disposal :. Performed By: Witnessed By: t° LOCATIONNNJ-/y&.GENERAL INFORMATION Location Address�� Owner's Name . Address 15V^IItVY-C- Assessor s Map/Percel: 13//.f. Engineer's Name NEW CONSTRUCnON REPAIR Telephone d Land Use Slopes(%) Surface Stones :Distances from: Open Water Body �s Lft Possible Wet Area/ Drinking Water Well�R _ Drainage Way _fl Property Line,(.V ft Other fl - �l� SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests locate wetlands in proximity.to h es) C_.ref-Z Parent material(geologic) d_" "4k Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR.SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. .Depth to soil mottles: in, Depth to weeping from side of obs.bole: in. Groundwater Adjustment ft. Index Well k Reading Date: Index Well level. Adj..factor Adj.Groundwater Level_ PERCOLATION TEST Dateme Observation Hole k Time at 9" " fl Depth of Pen; 1 Time at 6" N . Start Pre-soak Time© fryy Tim c(V-6") N End Pre-soak :/L Rata.Min.Anch Site Suitability Assessment:-Site Passed- Site Failed: Additional Testing Needed(Y/N) Original:Public Health Division Observation Hole Data To Be Completed on Back---___ "°°If percolation testis to be conducted within 1.00'of wetland;you must first notify the Barnstable Conservation Division at.least one(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC f r_1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil. Other Surface(in.). (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency,8/6 Gravel) 0 - 0 S 0 z. o ! i DEEP OBSERVATION HOLE LOG Hole# .Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency,%GrAvOl © Z yr S / r DEEP OBSERVATION HOLE LOG Hole# Depth from .Soil Horizon ..Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in:) (USDA), (Munsell) Mottling (Structure,Stones,Boulders. Consistency_%Graven Flood Insurance Rate Mao: Above 500year flood boundary No Yes Within 500 year boundary: - No— 'Yes Within 100 year Flood boundary No k Yes- Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervl us Inaterial exist in all areas observed throughout the area proposed for the soil absorption system? t If not,what is the depth of naturally occurring per4ous material? Certification I certify that on Aronenta—lProtection �.(date)I have passed the soil evaluator examination approved by the Department of E and.that the above analysis was performed by me consistent With the required trai expertise an rienc descri d in 310 CMR 15.017. f Signature Date. � i I Q1SEPnCIPERCFORMDOC i~ ro -17 Lsk ��.._ �_... Vito LP ..- t R mil__ D_ __ ( _ • i_._ _ r 1 .�__1..� V�'M/' __7 xe l ! 1 {Imam -cl i� 60 .. { -.:..._� -- ' .T_; t '-.-�- _ I i�f- I "---1,.-•--''•---, ^...-tom-7--•.��_ � _���_.ai _. � � �. , ' Town of Barnstable Barnstable Regulatory Services Department AFAme'ca�j IA�NSfABM 9 , MASS. ,0� Public Health Division �fD Mrs A 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2847 9008 October 4, 2016 MULLALY, JOHN T JR&ETHEL T 3900 WISCONSIN AVE NW WASHINGTON, DC 20016 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 230 Oak Street, Centerville, MA was inspected on 09/21/2016 by Shawn Meelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Stain lines showing system failure. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\230 Oak Street Centerville.doe �y°f THE T��• • Town of Barnstable • w • IARNSTAHLE, 6� Regulatory Services Department ''rfa ram'' Public Health Division 200 Main Street,Hyannis MA'02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED .SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA. ❑ Static liquid level in the distribution.box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) .OTHER J GPiA livle �o�i� S Svc Jv� Repair deadline: Nears Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc i Commonwealth of Massachusetts 0 :+ Title 5 Official Inspection Form ;W Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Oak St Property Address W Bank Owned Owner Owner's Name ~ a information is required for every Centerville MA 02632 9-21-16 = page. City/Town State Zip Code Date of Inspection m SJ1 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information sly /189� 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 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 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 9-21-16 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form f Subsurface Sewage Disposal System Form Not for Voluntary Assessments 9 230 Oak St Property Address Bank Owned Owner Owner's Name information is Centerville MA 02632 9-21-16 required for every t — page. City/Town State Zip Code Date of Inspection tw B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts a=1 Title 5 Official Inspection Form lR i�I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �_s¢ 230 Oak St Y Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) I ` ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C Further Evaluation is Required b the Board of Health: q Y ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth f o Massachusetts , Ir+ f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a% 230 Oak St Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. I . ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged,SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Pill Title 5 Official Inspection Form .A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Oak St Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ' ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form i -� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Oak St Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 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)] D. System Information Residential Flow Conditions: 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form �1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Oak St Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? - ❑ Yes ® No Last date of occupancy: UnknownDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow seats/ ersons/s .ft. etc.): 9 ( p q ) 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts a=1 Title 5 Official Inspection Form 'i�-1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Oak St Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I • Commonwealth of Massachusetts as Title 5 Official Inspection Form f ' I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 230 Oak St _ Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1981 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 10"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: 2"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) f F 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: 12" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not.for Voluntary Assessments {?, 230 Oak St � J Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" 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 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 is in good condition with baffles installed. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form -'I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o` 230 Oak St Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 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.): 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts 9Title 5 Official Inspection Form �f'I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �:LC,F 230 Oak St Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 page. City/Town 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 empty at inspection with stain lines above outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 r Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form I.l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Oak St Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 . page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was empty at inspection with stain lines above inlet invert and into d-box. 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Oak St Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form isi�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �.4f! 230 Oak St Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately { Ac) L 6' -" - 113 r E• •r t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts �al Title 5 Official Inspection Form 1A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments } � la 230 Oak St Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: ,USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 230 Oak St Property Address Bank Owned Owner Owner's Name information is required for every Centerville MA 02632 9-21-16 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Finc...O..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 10W.4...............OF...... Appliration for llhipooal Works Tomitrurtion ramit Application is hereby made for a Permit to Construct (V) or Repair an Individual Sewage Disposal System at 0 ..................OA4 ....... .......Cbmfigz-f ........................................... ..........................I............... .. Locati 07, 0 fix '4�4 14 1,(2 7A--*Y�'......... ...... .. . .... -----------­...... Address ............. ...... ................................................................................................... Insta r Z46� Address Type of Building Size Lot._.- 7�,, .....Sq. feet U —No. of Bedrooms................ Expansion Attic Garbage Grinder Dwelling k................... Other—Type of Building ............................ No. of persons..........--......_......... Showers Cafeteria Other fixture ..............................................................................................I s Design Flow................5.1!r. '.. 'Zgallons per person per day. Total daily flow............ ....... ................gallons. Septic Tank—Liquid capacity .gallons Length................ Width................ Diameter.---.--.-------- Depth..............-- Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. f t. Seepage Pit No.........I ------ --- DiameterR.'.Ir---- Depth below inlet......../—V..I.... Total leaching area....XAVA9..sq. ft. z Other Distribution box Dosing_tank 5_1 Percolation Test Results Performed by.,dAX7ZZ_.. ......... .Date---. 11.01 ................ Test Pit No. I......./P.....minutes per inch Depth of Test Pit-------1.5...... Depth to ground water........=.......... fro Test Pit No. 2................minutes per inch Depth of Test Pit.......k.V.... Depth to ground water------7.............. 9 ........................................................................................................................................ ------------ 0 Description of Soil... ose 61"D ........... .. . ...... .................3&z.0e.4_).... .......2-W.t4 es��...... ....*-------------------------------------------------------------------------------------------------------------------------------------------------------- .......................----------- 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'L I A'U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issue y.t bo d of health. Signed.. .......... . ........... Date Application Approved By................... .4... ... .. ........... .......... V---------- ate Application Disapproved for the following reasons:.............................................................-----------_.................................. ......................................................................................................................................................................................................... Date PermitNo........................................................... Issued....................................................... Daft No.. 8/ .._....... F�s....�. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 awllj...............0F......./�` .f. ' � <f .................................... Appliratiou for Disposal Works Toustxnr#iun 1hrutit Application is hereby made for a Permit to Construct (1<) or Repair ( ) an Individual Sewage Disposal System at: 61144 �c�ciT ✓�c e- ................_...---•--....�. ...•-•--.....-----....--•--•--------------------........... .................................................................................................. o anon- ddc o I.ot N -- ......:..r� .ru....... . '..._�� �2�t �-. ........... ....... d� ...... ...�ae.�°T�:�ut: �1 D . Owner Address --�.. Installer Address d Type of Building Size Lot...:-'--Ze 5 .....Sq. feet Dwelling—No. of Bedrooms............................._______Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtur W Design Flow.................. .....................gallons per person per day. Total daily flow............... "�'d:...............gallons. WSeptic Tank—Liquid"capacityA gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width--..__....:....... Total Length......._..._.__..j_. Total leaching area-__..r_._.....____sq. ft. Seepage Pit No........../........ Diameter r�.�. ... Depth below inlet.........Z_...... Total leaching area...._s . ft. Z Other Distribution box ( ) Do ing tank ( ) � '`" Percolation Test Results Performed bf'J�/= __ `'. !'� __:.. ..�lS._.._._. =/��l � W . Date_.... W Test Pit No. I.......b.....minutes per inch Depth of Test Pit.........�?....... Depth to ground water.........."........... Test Pit No. 2................minutes per inch Depth of Test Pit------- Depth to ground water...................... Pd Description of Soil-•t- ? T, AeCiJ i cl e�/,v ,c'c /�il{>!/ C.. G ----s'� . .j-------f �id1 v •-••--•----------- Gain- .l� iz .......c SS_`. ^-r�-•---� %✓...........................- W -------------------------------------------•---•-••----••-•--------•------••---••--•-•-•---------- ------------.....-------•---...----•-------------•-•-•----••••••---••••••......---•----•----••---•-- U Nature of Repairs or Alterations—Answer when applicable.............................•.____............_._.........___..................._............. -•--------------------------•--------------------------------------------------••--•-------••------••-----•-...••-••••---•-••--•-•--•---•-------••---•--•-- ........................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T IT.IS 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health Signed..................................................---...•....... . . ..........i........ '�. � 1 , Date Application Approved BY ---------• - '''le � /D ---------- Application Disapproved for the following reasons------------------•---------------•----------------------------••--------•---•----------•---••--•----•-----•..... -----------•-•--•--•------------------------------------•----•-•-•----------------•---•---••-------••-------------------------------------------------------------------•-----•----------------•----•-- 1 Date 1 PermitNo......................................................... Issued....................................................... 1 Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD 0= HEALTH �?tv�Cl..........oF.............W111k&11_i&F..... ................................. (Intifiratr of Tuntpliatta IS CERTIFY, Th t the Indiv>dual Sewage Disposal System constructed ( ) or Repaired ( ) b v r) O r ' , , taller / ✓ at ............................................................... ----•-..... ..... '--••-----•----•---------------•-••---------------------------------------------------- has been installed in accordance with the provisions of '" "I 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N ��r ._ lJ: .................. dated-__.____-_...--____--_______-_-_................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. u 11 DATE....................................... k Inspector...................... ............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (GCJ1J.......OF......._..lee`-'/1�%i� C+r !�3a L ................. . :...................••-•-•---•--..........--•--•......... ........................ F '.t�;t:' ...... Disposal n� s �uttstr ion ramit Permissio�is hereby granted ------ -- =- ---.-----.Azez ......----•----------------------•-•-•-•-----..................-----.. to Construct,,( or R,e�Pair ) an Individual Sewage Disposal System atNo...__..._...% !`' '------•---•�... --------------------------------------------•--•--------•--•----.----.-.-------- Street as shown on the application for Disposal Works ConstructA-••'Cermit No..................... Dated.......................................... ----------------------------------------------- g > and DATE.:..... 1 of Health • • --•-FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - TOWN OF BARNSTABLE LOCATION Z3o OAK $"T SEWAGE# ZO 1 TI- 11.9 `VILLAGE CC-Mcr V i 11 G ASSESSOR'S MAP&PARCEL 113149 INSTALLER'S NAME&PHONE NO. $ £Xca%/aLJ i Ow-, 4' e) - 0453 SEPTIC TANK CAPACITY f OoO LEACHING FACILITY: (type) 5OOQC,,,1 Llc t!Z) (size) 13 x 2S xZ NO. OF BEDROOMS 3 OWNER i ' PERMIT DATE: 5-31- )7) 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 Al� zo'3 A AV Z/, QZ. 19,E -93- LI'L ' C3-$3 O From 3q- w79 Cy- 93' ❑ 3 'T 'tAl1�i IFLBARNSTABLE LOC�,.'I'IaN, VYI LRGE C� S5E5SOR'S MAW'+&LOT - INSTeL)e�'S NAIVIL p1QI+lB Nd Sfi1EsZ'IC �'A1 Itti CAtPAG1Tk 6 o, 100 f' LIrAi�IiIPiG>~+,I�CI'I°Y: {tea) t {sszc) -- -� I3 1p,I�QR O, PIE: IU{I'TI Gt3NI}bl.Il�i�Tt� D/�TE, :._.._.. ._... .�..� Snp arataan 0 tm &twten�Se Maximum l�ctlusfnd.Gspuild tdjTa to to the Battarn ai) s;siGhsn�i"suititY PAlvatc. CA:r Su lyJclt atst!I,eaaitsistg k?ac�kt easy wells exist ot�astG ac within' 4p feet tri'leatxi�ig fslGsttt}') " .`.�. Eclat.af~WV�:t4 M said lLeacfl�Intq!?acslity{Yg stsiy w�tlancl5 exsst es: +rltlassa:pp Wt 0 ! pl-W61ACO // sWon C 1Purn{sbes!try (.'s �,��' C!� /v?�•l� I7 a � � 0 aid `' El -Y- 11.3 �gC on— CO C•A T AN SEWAGE PERMIT NO. V-ILIACE IN=T �R'S A i ADDRESS OR OWNER f 0 GATE PERMIT ISSUED DAT E COMPLIANCE ISSUED A p ` 41 r, �4 i i.. I .r,�T�('t G _t_��e<. = 3�,O,r (�-iG °/'o " A�'(S 6•N:7. �� � � 22 ro'C- P Lvvn-rotilk h ,�2e 113 sIG. � •� l t om. A .7l To-r.��. -��;l�•,u - 55 �,.pz�. � Q r4Ak ro7/ i it y��'*c, •�� ':�^' _ �: .,� y�•�•7:N�•.� '� �'�.7��• • P,3 Ill 97 ti •fU© OAV, 313 ZG` t �1 r pc= }Tj7trjT "� I . 6-AL. 99 r ..: ;N4ma �j w--- --Sox49 SEf"C Awby �t/r I)v _._.�J 7-AkV- A S,auay STc���c� J?7 CSZ'T11P ary T-ILOT _____---, I so sh q ol Aln wAMM P,-LO 05 el.> .F, 'Meru SLt.ia 4 5 c lc>�v►J PL A t`! R L �.RE:►�:c_ I U u, I-l'-�Cr ��*•!� :!v"!-�.'.�:!': .'i:G3t.�1�(_.��-I.1�',y � 'C'1-iC-;,' ,� Q '' 1 So S P, q RCGtS'rC_ci_c� L�ti i '�U�.*�'s•':� -�•!�� ,%t_ ��i-I t_!c>r L',r:sCty: c�aS fiCA-1 os-f�t�vtt.t_Cz o ' ieaS�L':.i.•�iC��--I ; •����.. :<<� •�- ..re1C: u�c' r�a �t•� !lt?I:,t_t C.A.l-.lT_, r COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM"PROFILE TOP OF FOUNDATION BROUGHT TO WITHIN 6" OF FINAL GRADE Flaherty Environmental Services EL. 56.0' EL. 54.0' (not to scale) INSP. PORT W I 3" OF GRADE CLEAN SAND P.O. BOX 81 2" of 8" to b" DOUBLE WASHEDPEAST EL. 48.0' Yarmouth Port, MA 02675 4." CAST IRON or EQUIVALENT FILTER FABRIC GEOTEXTILE —�� FILTER FABRIC 774.994.1 166 MIN. PITCH 1/4" PER FOOT 4" SCHEDULE 40 PVC PIPE •�%��. �����-� •' 4"SCHEDULE 40 PVC PIPE FLOW LINE VENT IF REQUIRED (first 2'to be level) —► 56' 13% —� 5' Jo o. EL.45.0't '.r.'•: LEXISTING 0 14" -- °o o° 000 0 0 ° ° .•C :�C=.p ,-.yy'O: e 'C�'�Oaa7000- c ; EL.EXISTING —� 000000° ° °o°o° o o .'�aLJa �.IJ�O ° REQUIRED: 5 SOIL REMOVAL EL. 51.6' 0 0 0 0 C f• EL,44.33' °o°o° o o°o°o°o° [_ Ef 0 0 0 1 O ® [ c LATERALLY AND BENEATH EL.44.5' o 0000°0000000 �� �0���� c 2.0' GAS BAFFLE HH=20 ? EL.44.3' °000000000°000000 00[� �QE'PQ O Q c— PROPOSED SAS TO ELEV. 40,0't D-BOX °0°0°0°°0°° O°O°O° o.d ' ' c (C2 HORIZON) "a. r e': EL.42.3' STALL INLET TEE (; SOIL ABSORPTION SYSTEM i 6"CRUSHED STONE OR 1"ABOVE OUTLET INVERT" •g' •' �' " MECHANICALLY COMPACTED 1000 GALLON SEPTIC TANK (2) 500 GALLON H-20 CHAMBERS (DATUM: ASSUMED) (EXISTING) { WITH 4'STONE AROUND IN A 6.3' 4" t�il-," DOUBLE WASHED STONE 12.83'X 25'X 2' CONFIGURATION j EL. 36.0' BOTTOM OF TEST HOLE EL, 36.0' LOCATIONMAP USGS ADJUSTMENT: N/A GROUNDWATER ELEV: N/A N TH o LOCUS f,l N �W cl m ENCHMARK. - QaK$t• OP OF TANK t EL.52.0' Race Z p DECK c o O/a`S�ge iqQ, 56 '� o M EXIST. S.T. " EXISTING 54 i 9 BR SHED DWELLING NTS 52OFss / 43,5/ S� D q D S0 s2 O 5' REMOVAL O Y'. / i 7.1 / DRIVEWAY J 50 F / RHO .^ S T E `SgNITAR N TH / f ' / MAP 173 LOT 49 DATE.•512912017 REVISED: / / i 37,500 SFt EXIST. LP SITE AND SEWAGE PLAN FOR B & B EXCAVATION INC./ _ STREET BRIAN COOLS 230 OAK ET OAK SCALE : 1 = 40' CENTERVILLEEMA REF.PB 305 PG 69 PAGE 1 OF2 { ..................................................................................................................................................................................................................................'...................... ..................................................................................... - -r GENERAL NOTES DESIGN CALCULATIONS SYSTEM DETAIL Flaherty Environmental Services P. 0. Box 81 1. ALL PRECAST COMPONENTS TO BE H-10 M Yarmouth Port, MA 02675 RATED UNLESS OTHERWISE SPECIFIED. NUMBER OFACTUAL BEDROOMS 3 774.994.1166 DISTRIBUTION BOX(ES)AND ANY COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO VEHICULAR TRAFFIC TO BE H-20 RATED. { 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW , ALLOW FOR THE USE OFA GARBAGE (110GAL/BR/DAYX3BR) 330 GAL./DAY 5' REMOVAL GRINDER. 3. MUNICIPAL WATER IS AVAILABLE. REQUIRED SEPTIC TANK CAPACITY ' 660 GAL. 4. ALL CONSTRUCTION TO CONFORM WITH { SIZE OF SEPTIC TANK 1000 GAL. (EX/STING) 310 CMR 15.000 AND ALL OTHER t APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION CODES AND REGULATIONS. 5. INSTALLERICONTRACTOR TO REVIEW& DESIGN PERCOLATION RATE 2 MIN./INCH VERIFY ALL ELEVATIONS AND DETAILS EFFLUENT LOADING RATE 0.74 GAL./DAY/FTC O O 12,83' AND REPORT ANY DISCREPANCIES TO — :• DESIGNER PRIOR TO CONSTRUCTION OR ' L" ASSUME ALL RESPONSIBILITY. LEACHING AREA (2)x(25.0'+ 12.83)(2) = 151 SF 6. INSTALLER/CONTRACTOR IS 25.0'x 12.83' =320 SF I RESPONSIBLE FOR MAINTAINING SAFE 471 SF 0.74 =348 GPD WORK AREA, VERIFYING ALL UTILITIES AND NOTIFYING "DIG SAFE" USE(2)500 GALLON H-20 CHAMBERS WITH 4'STONE 25, (1-888-344-7233) 72 HOURS PRIOR TO /N A 12.83'X 25'CONFIGURATION AS DIAGRAMMED CONSTRUCTION, 7. ANY CHANGES TO OR DEVIATIONS FROM RESERVE LEACHING CAPACITY N/A THIS PLAN MUST BE APPROVED IN WRITING BY FLAHERTY ENVIRONMENTAL SERVICES AND LOCAL BOARD OF HEALTH. 8. FINISH COVER OVER COMPONENTS IS f NOT TO EXCEED 3'PER 310 CMR 15.000 (NTS) UNLESS SHOWN PER PLAN. i 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION FILLED WITH CLEAN SAND OR REMOVED rEsrHOLE#1 P#15359 TEST HOLE#2 P#15359 AND REPLACED WITH CLEAN SAND. Evaluator., David D.Flaherty Jr.,RS,REHS Evaluator: David D.Flaherty Jr.,RS,REHS 10.ALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755 BOH Witness: Don Desmarais,RS BOH Witness: Don Desmarais,RS jN OF lygs WITH WATERTIGHT ACCESS PORTS Date: May 16,2017 Date: May 16,2017 sqf' WITHIN 6" OF FINISH GRADE. 11.ALL SEPTIC TANKS, DISTRIBUTION TH-1 ELEV.48.0' TH-1 ELEV.48.0' BOXES AND PIPING TO BE INSTALLED WATERTIGHT. 0%10" A SL 10YR212 01-10" A SL 1OYR212 1 12.NO KNOWN WETLANDS OR WELLS 5%Cobb/es ti 5%cobbles �FG/s r Rio WITHIN 100 FEET OF PROPOSED 10"-28" B LS 10YR 516 10"-28" B LS 10YR 516 Sq LEACHING. 5%Cobb/es 5%cobbles 13.THIS IS NOT A CERTIFIED PLOT PLAN AND UNDER NO CIRCUMSTANCES IS THIS 28"-96" C1 VFS 2.5Y615 28"-96" C1 VFS 2.5Y6/5 PLAN TO BE USED FOR ZONING OR trace°fsut p trace ofsnt UNSUITABLE UNSUITABLE SITE AND SEWAGE PLAN BUILDING PURPOSES. FOR 14.LOT IS SHOWN AS ASSESSOR'S MAP 173 7 certify that on November 12,2002, have passed B & B EXCAVATION, INC./ LOT 49. 96"-144" C2 MCS 10YR 614 96"-144" C2 MCS 10YR 614 the examination approved by the Department of 15.LOCUS PROPERTY IS NOT LOCATED Environmental Protection and that the above analysis BRIAN COOLE WITHIN AN A UIFER PROTECTION has been performed by me consistent with the 230 OAK STREET Q G.W.ELEV.N/A G.W.ELEV.,NIA required training,expertise,and experience described DISTRICT(ZONE II). in 310 CMR 15.018(2)." CENTERVILLE, MA BOTTOM TH-2 ELEV. 36.0' BOTTOM T*2 ELEV. 36.0' r PAGE 2 OF2 ................................................._.........................................................._................. .........._......._............_.-............................................................_........................_................................................................................:................._.............._..................... .......................................................................................