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HomeMy WebLinkAbout0063 OCEAN AVENUE - Health 63 Ocean Avenue Centerville A= 226 - 149 i S M E A D No.H1630R UPC 10259 smead.com • Made in USA i� '�sr Sep 25 2019 2128 HP Fax page 20 aac�-Iy 9 Commonwealth of Massachusetts Title 5 Official Inspection Form .i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y � 63 Ocean Ave ? ' Property Address Johanna Buffington K F Owner Owner's Name information is required Centerville MA 02632 9-17-19 requiredd for 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. Please see completeness checklist at the end of the form. \\\Itlfllllffq�r�/ firlingout fomsen A. Inspector Informationq3 ,,04 ssq�-,,, on the computer, 3 per': .ns_y use only the tab James D.Sears s JAMES _ key to move your Name of Inspector s3 SEARS cursor-do not Ca ewide Enterprises use the return key. Company Name �TI�\ 153 Commercial Street `�5 �/flh► 11 Company Address nmt+m ICI Mashpee MA 02649 CitylTown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification certify that; I am a DEP approved system Inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection;and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system; 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 9-19-19 pectoris 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. 15insp.doc•rev.712612016 Title 5 Omcial Inspection Farm:Subsurface Sewage Disposal System•Page 1 of 18 Sep 25 2019 2129 HP Fax page 21 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Ocean Ave u- Property Address Johanna Buffington Owner Owner's Name information is required for every Centerville MA 02632 9-17-19 page. QtyfTown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gel,Tank D Box and 11 Chamber's. 2) System Conditionally Passes. ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old'or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ NO (Explain below): i t5insp.doc rev.7126Mill Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 16 Sep 25 2019 2129 HP Fax page 22 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not For Voluntary Assessments 63 Ocean Ave Property Address Johanna Buffington Owner Owner's Name Information Is required for every Centerville MA 02632 9-17-19 page. CitylTown State Zip Code Da:e of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation Is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: 15insp.doc•rev.728J2018 Title 5 Of ial Inspectlon Form:Subsurface Sewage Disposal System-Page 3 of 18 Sep 25 2019 21:30 HP Fax page 23 Commonwealth of Massachusetts ,pip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Ocean Ave Property Address Johanna Buffington Owner Owner's Name information s Centerville MA 02632 9-17-19 required for every page. City/Town State Zip Code Da:e of Inspection C. Inspection Summary (cons) ❑ 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 ooliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered, A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5lnsp.dCc•rev.712612018 Tide 5 Mdal Inspection Forth:Subsurface Sewage Disposal System•Page 4 of IS Sep 25 2019 21:30 HP Fax page 24 s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 63 Ocean Ave Property Address Johanna Buffington Owner Owner's Name information Is Centerville MA 02632 9-17-19 required for every page, Cityrrown State Zip Code Dale of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in amwpwi is less than 6" below invert or available volume is less than %day flow .4 6,4 00'/w 6E ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply, ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure, 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA, Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone 1.1 of a public water supply well tsinsp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Sep 25 2019 2131 HP Fax page 25 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Ocean Ave Property Address Johanna Buffington Owner Owner's Name information is required for every Centerville MA 02632 9-17-19 page. City(Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed, The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no" for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of 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 lees, 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)] tsinsp.doc•rev.V2612018 Title 5 Othdal Inspection Fo.�r:Subsurface Sewage Disposal System•Page 6 of 18 Sep 25 2019 21:31 HP Fax page 26 Commonwealth of Massachusetts Title 5 Official Inspection Form C° Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments F ,.� 63 Ocean Ave Property Address Johanna Buffington Owner Owner's Name information is Centerville MA 02632 9-17-19 required for every page, cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 Description: 1500 Gal.Tank D Box and 11 Chamber's. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2017-5,000 Gal's2018-2,000 Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date 15insp.doe•rev.7/ZB72018 Tille 5 Ofildal Inspectlon Form:Subsurface Sewage Disposal System-Page 7 of 18 Sep 25 2019 21:31 HP Fax page 27 Commonwealth of Massachusetts - Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Ocean Ave Property Address Johanna Buffington Owner Owner's Name information is required for every Centerville MA 02632 9-17-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15,203): Gallons per day(gpd) Basis of design flow (seets/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 15inspAoc•rev.712612016 Title 5 Official Inspection Form,Subsurface Sewage Disposal system-Page 8 of 16 Sep 25 2019 21:32 HP Fax page 28 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Ocean Ave Property Address Johanna Buffington Owner Owners Name information is required for every Centerville MA 02632 9-17-19 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the UA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components,date installed (if known)and source of information: 2007 Permit # 07- 118. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 37 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.): Pipeing is 4" PVC SCH-40. 15lnsp.doc•rev,712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Sep 25 2019 2132 HP Fax page 29 Commonwealth of Massachusetts Title 5 Official Inspection Form �A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments vw63 Ocean Ave Property Address Johanna Buffington Owner Ownees Name information is Centerville MA 02632 9-17-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 27"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: yews Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10 Sludge depth: 1 Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness oil- Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18 How were dimensions determined? Asbuilt-Plan -Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tank at working level. Tank at 27"below grade w/both cover's at 5". In and outlet tees. No sign of leakage or over loading. 151nsp.doc-rev.7126/2018 Title 5 C"dal Inspecllon Form:Subsurface Sewage Disposal syss6sm-Page 10 of 18 Sep 25 2019 21:32 HP Fax page 30 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Ocean Ave Property Address Johanna Buffington Owner owner's Name information is required for every Centerville MA 02632 9-17-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day tsinsp.doc•rev.M612018 Title 5 Official Inspedlon Form:Subsurftue Sewage Disposal System-Pape 11 of 18 Sep 25 2019 21:32 HP Fax page 31 Commonwealth of Massachusetts Title 5 Official Inspection Form • Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Ocean Ave Property Address Johanna Buffington Owner Owners Name information is required for every Centerville MA 02532 9-17-19 page. City[Town State Zip Code Date of Inspection D. System Information (cunt.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-32"below grade w/cover at 1'. Box is clean and solid w/5 line's out. No sign of over loading or solid carry over. l5insp doc•rev.7126/2018 TiBe 5 Official Inspection Forth:Subsurface Sewage Disposal system•Page 12 of 18 Sep 25 2019 21:32 HP Fax page 32 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Ocean Ave Property Address Johanna Buffington Owner Owner's.Name information is required for every Centerville MA 02632 9-17-19 page. 6ty[Town State Zip Code Date of Inspection D. System Information (cant.) 10. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms In working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 11 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system , Type/name of technology: t5lnsp.doc•rev.712612018 Title 5 C icial Inspection Form:Uhsurface Sewage Disposal System•Page 13 of 18 Sep 25 2019 21:33 HP Fax page 33 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c' 63 Ocean Ave Property Address Johanna Buffington Owner Owner's Name information is required forevery Centerville MA 02632 9-17-19 page; City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 11 500 Gal, dry well chambers. Chamber's 46" below grade w/cover at grade,vent and jnspection port. Chambers are clean and dry.Chambers are like new. 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 1 ❑ .Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15insp.doc-ray.7/26/2018 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 14 of 16 Sep 25 2019 21:33 HP Fax page 34 \\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Ocean Ave Property Address Johanna Buffington Owner Owners Name information is required for every Centerville MA 02632 9-17-19 page. CltylTown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5lnsp.doc-rev.V2612018 718e 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 or 18 Sep 25 2019 21:33 HP Fax page 35 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �r 63 Ocean Ave Property Address Johanna Buffington Owner Owner's Name Information Is required for every Centerville MA 02632 9-17-19 page. City/Tom State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately rRoPr 8 sP 3 r 1z'7•� t5lnsp.doc•rev.M612018 Title 5 Official Inspection Dorm:Subsurface Sewage Disposal System•Page 16 of 18 Sep 25 2019 21:33 HP Fax page 36 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Ocean Ave Property Address Johanna Buffington _ Owner Owner's Name information is required for every Centerville MA 02632 9-17-19 page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N6 10, Estimated depth tofFiigh ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 8-22-06 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: T.H.on Design plan 8-22-06 10'no G.W.. Bottom of leaching at 4'-4"below grade. Bottom of leaching at 5'-6"above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5lnsp.doc•rev.7t28/2018 Title 5 Official Inspection Foma Subsurface Sevwege Disposal System•Page 17 of 18 Sep 25 2019 21:33 HP Fax page 37 Commonwealth of Massachusetts Title 5 Official Inspection Form k l op Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, 63 Ocean Ave Property Address Johanna Buffington Owner Owner's Name information is required for every Centerville MA 02632 9-17-19 page. City/Town State Zip Code Date of inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed& Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria) and 6(Checklist)completed ® D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included CRA3 7f N n 10 N° G. w, t5insp.doc-rev.7/2612016 Title 5 OKcial Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No. Dw_77 l O $,1 0 0 .0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye ZIPPYicatton for dig ogar 6 gtem Cougtructfon Permit Application for a Permit to Construct( ) Repair()§ Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 21 2—2 8 8-5 0 4 5 63 Ocean Ave, Craigville Pete- Buffington Assessor's Map/Parcel 2 2 6/14 9 25 E End Ave, New York, NY Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 2 7,—0 3 7 7 Wm E Robinson Sr Septic JC Engineering Inc PO Box 1069 . Cerlterville 2854 Cranberry Hwy, E ?,,I' "rsh m Type of Building: Dwelling No.of Bedrooms 6 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 septic system to plans of JC Engineering Inc, #1066 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. pt S' ned i Date �J` Application Approved b Date (J C9'—f Application Disapproved by: Date for the following reasons Permit No.-` -7 Date Issued f�� P. -h 10 0.0 0 No. Fee '� � Entered in com THE COMMONWEALTH OF uteri 1 p PUBLIC HEALTH DIVISION,- TOWN OF BARNSTABLE, MASSACHUSETTS Ye i ZIppricatiou for Migpogaf *pgtem Cott�. tructiou Permit Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components e Location Address or Lot No. Owner's Name,Address,and Tel.No. 21 2—2 8 8—5 0 4 5 63 Ocean Ave, Craigville Peter Buffington Assessor's Map/Parcel 2 2 6/14 9 -2 5 E End Ave,, New Bdyck, NY._, Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Des gner's Name,Address and Tel.No. 2 7 3—0 3 7 7," Wm E Robinson Sr Septic ! JC Engineering Inc PO Box 1089, Cenlnrville 2854 Cranberry Hwy, E WAreham Type of Building: Dwelling No.of Bedrooms 6 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building .No.of Persons Showers( ) Cafeteria( ) . Other Fixtures Design Flow(min.required) gpd Design flow•provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil r f Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 septic system to plans of JC Engineering Inc, #1066 i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S' Tied Date 'f O ✓ Application Approved b� Date 3 0'l A lication Disapproved b ` PP pP Y Date ; for the following reasons f � Permit No, Date Issued _3 3CZ c-2 - -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS Buffington BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired �K"*�•)N1 Upgraded ( ) Abandoned( )by Wm E Robinson Sr Septic at 63 Ocean Avenue, Craigville has been constructed in accordance ` with the provisions o�ff Title 5 and the for Disposal System Construction Permit No. ;�)Cc,7 /I t dated 3/JO �/7 Installer Designer #bedrooms (0 Approved design flow `� �j 6,C� gpd The issuance of this�ermit,sshall not be construed as a guarantee that the system 1 i�functijon aas designed. �j/0� Q ' Date !J 7 Inspectors ------------- -- 100.00 ---- THE COMMONWEALTH OF MASSACHUSETTS Bu71AILttNEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 'Wi5po5al *p! tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( X) Upgrade ( ) Abandon ( ) System located at 63 Ocean Avenue, Craigville and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions.-- Provided: Construction must/fie completed within three years of the date/of this pe j Date / / Approved by Town of Barnstable °FIME'°rt o Regulatory Services Thomas F. Geiler,Director ` r * BARNSTABLE, y MASS. Public Health Division t63.9' �0 ArEo '�°i Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Designer: JC Engineeri.ng__Inc Installer: Wm E Robi_nson Sr Semitic Address: 2854 Cranberry Hwy Address: PO Box 1089 E. Wareham Centerville On Wm E=:Robinson Sr: Septiwas issued apermit to install a (date) (installer) septic system at 63 Ocean Ave, Craigville based on a design drawn by (address) JC Engineering dated 09-1 5-06 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. THE JOHN L. �io 0 CHURCHILL (Installer's Signature) JR. CIVIL 41807 (Designer's Si "ature) ( �lix Desi 's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC IPEALTH 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/Desiper Certification Form f Gk _ 21-7 49 PsP21 s C-6888 02-02-2007 a 1(_-1 a 19ca DEED RESTRICTRK'1 .05S s 106 01-30-2007 9.14 BARNSTABLE LAND COURT REGISTRY WHEREAS,James Buffington III,Peter I)uMngton and Andrew Buffington,Trustees of Buffington Nominee Trust,u/d/t dated August 12,1988 being Document No.467,406,and having a mailing address of 25 East End Ave,New York,New York 10028 are the owners of the land together with the buildings and improvements thereon situated at 63 Ocean Avenue,Crafgvtlle,Barnstable County, Massachusetts,02632,(a.k.a.Parcel 249 on the Town of Barnstable's Assessor's Map 226)and more particularly described in Deed Book 6429,Page 129(ace Plan Book 194,Page 41)and Land Court Certificate No.115363(see L.C.Plan#17609-C&L.C.Plan#17609-G)recorded at the Barnstable (Lot F & Lot32) County Registry of Daads. Said parcel coataWng 83 acres of land,more or less,according to said Plan Book 194,Page 41;and WHEREAS,We,as owners of said Parcel 149 have agreed with the Town of Barnstable Board of Health to a restriction on the number of bedrooms that can be included in any home now existing or hereafter constructed on said parcel as a condition to obtaining a disposal works constriction permit for the on-site septic system repair/replacement/installation on said parcel pursuant to State Environmental Code,Title V, 310 CMR 15,000 et.seq.;and WHEREAS,the Town of Barnstable Board of Health as a condition to granting the disposal works construction permit is requiring that the agreement to restrict the number of bedrooms in any home now existing or hereafter constructed on the parcel be put on record with the Barnstable County Registry of Deeds by recording this document; NOW,THEREFORE,We do hereby place the following restriction on the above referenced parcel in accordance with the Town of Barnstable Board of Health,which restriction shall run with the land and be binding upon all successors in title: 1. Any home now existing or hereafter constructed on the above-referenced Parcel 149 shall contain no more than six(6)bedrooms. We agree that this shall be a permanent deed restriction affecting the above-referenced Parcel 149 also known as 63 Ocean Avenue,Creigvlle,Barnstable County,Massachusetts,02632 as described in Deed Book 6428,Page 129(see Plan Book 194,Page 41)and Land Court Certificate No.11S365(see L.C. Plan#17609-C&L.C.Plan#17609-G)recorded in the Barnstable County Registry of Deeds. This restriction may be released by the Town of Barnstable's Board of Health should regulations change or sewer become available. For our title see Deed recorded at the Barnstable County Registry of Deeds in Deed Book 6428,Page 129 (see Plan Book 194,Page 41)and Land Court Certificate No.115365(see L.C.Plan#17609-C&L.C. Plan#17609-G). Executed as a sealed instrument this_LLth day of r>xlun ,2007 a Buffington,Ili, ste f Buffington Nominee T /ll 9�1od i lass Omit Notary Public State of New York Expire 10/2V2007 t9 Peter Buffington,Trustee of Bufflngton Nominee Trust Reg OICA0100670 Andrew Buffington,Trust f Bu tngton Nominee Trust ELEVATION ANO NOTIFY _`"�_ 'S E l I G I AN K F KU t- l L t- (Dimes: ENGINEER IF DIFFERENT 1; NOT TO SCALE Corp., I �i / WET 11 / ET 1-2— ` 0 \ET 10� Lt T '13 v M) v� I , SET�� L 8.3 WEB WET 1 1 .4y � 4 / W ET 16 / g / PROPOSED CLEAN TO GRADE (TYP. / WET 17 / ' / / �24 \ ._ W ETA 18 ® >o r' '� NN `� EXISTING 6� `jvdT)J I 4y 6 BEDROOM DWEL ING F 2 I I I 6 TOE= 19.0''±' 1 ! 264.1'± IRON PIPE• � 4"PVC - ( 11 ,isN Pl'P ® Z2-INSPECTION i PORT 0, ���� OPOSED 11 - d TP 3 PR 18x00 TP 4 _ Fro _ -- I I Town of Barnstable 4 w RAiYNb"TAB ,. ' Board of Health '�o ►n 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Sumner Kaufman,MSPH Paul J.Canniff,D.M.D. January 10, 2007 Mr. John L. Churchill, Jr., P.E. JC Engineering, Inc. 2854 Cranberry Highway East Wareham, MA 02538 RE 63 Ocean Avenue, pGenteruiile,. Dear Mr. Churchill, You are granted multiple conditional variances on behalf of your client, James III and P&A Buffington Trust, to construct a replacement sewage disposal system at 63 Ocean Avenue, Centerville, Massachusetts. The variances granted are as follows: Section 360-1: The leaching facility will be located 86.5 feet away from the bordering vegetated wetland, in lieu of the minimum 100 feet setback separation distance required. Section 360-1: The septic tank will be located 91 feet away from the bordering vegetated wetland , in lieu of the 100 feet setback separation distance required. 310 CMR 15.211: The leaching facility will be located six (6) feet away from the foundation wall in lieu of the minimum twenty (20) feet separation distance required. 310 CMR 15.221: Five feet of cover (soils) will be over the top of the leaching facility, in lieu of the maximum three feet allowed. These variances are granted with the following conditions: (1) No more than six (6) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and Q:WP/ChurchillBuffington07 IL similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting -the property to six (6) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) The septic system shall be installed in substantial compliance with the engineered plans dated September 15, 2006 (4) The professional engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the engineered plans dated September 15, 2005. (5) The new septic system shall be installed within eight months, on or before August 5, 2007. Failure to replace the septic system before the deadline date will automatically result in a hearing at the August 7, 2007 public meeting of the Board of Health. These variances are granted because the physical constraints at the site severely restrict the location of the soil absorption system due to its close proximity to wetlands bordering three sides of this lot. The proposed plan appears to meet the maximum feasible compliance standards contained within the State Environmental Code, Title 5. Sinc ely yours, Wayne/Miller, M.D. Chairman Q:WP/ChurchillBuffmgton07 IIKE T�ti DATE: x Q, FEE: BARNgmBm mass. 039. �� REC. BY /!/fU— �ArE°,tea Town of Barnstable ... .. SCHED. DATE: / fB Board of Health N� 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE RE UEST FORM LOCATION een�w Property Address: e. t �<<' Assessor's Map and Parcel Number: 22 6 � )ytj Size of Lot: 0.3 Acre,5 Wetlands Within 300 Ft. Yes X Business Name: No Subdivision Name: APPLICANT'S NAME: John L. CM�c�1i11 , 3c., �,r. Phone SafS 273"�'377 Did the owner of the property authorize you to represent him or her? Yes No QQQQQ PROPERTY OWNER'S NAME CONTACT PERSON au,kk— fo—Au),�4z4 I Name: Sames lit and Q tt R avCjut5k,, Trjs� Name: Soht, [_ GlauacJA,(l J i Address: 25 eas{ eot Ptuwve_ Address: 26.54 ciroA.Ou cr New ';osr, u: &nsk war2Ham , ►4A1 ,0.26-;8 Phone: Phone: 50g,273.03 77 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) C'v 3(0 CfiQ (5, 221 (Max corer overcoyn�"el {a ceduee- y-je- C6,43es ; fuss. rev, wotks c vtsw&4s 3 1 o c m 9, 15, 2 t t (Leaclh, to gar.E+n 5Qoca{wu-% frovn w ett-4 s Acklcle l ,seeor► 3bU k ( ►5 b weticr+6S) s;le censtebunl5', sot? 1 covtds better frx Qrea 4ck,e\e l , Secho,% 360- l (s.,, ko u-el%&A45) •1,a ouritcA CA dnem er tcicqAe. GMan�eS NATURE OF WORK House Addition 0 ????? House Renovation 0 Repa of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) C:\Documents and Settings\decollik\Local Settings\Temporary Internet Fi1es\0LK3\VARIREQ.D0C I EXISTING FLOOR PLANS FOR 63 OCEAN AVE PREPARED BY: JC ENGINEERING, INC 2854 CRANBERRY HIGHWAY SCALE: NOT TO SCALE EAST WAREHAM, MA 02538 DATE: SEPTEMBER 15, 2006 OFFICE # 508-273-0377 SLIDING DOORS TO PORCH 11.1' BATH 9.6' fV BEDROOM ROOM m BEDROOM #2 7.5' #3 ? CL v a 15.6' 2.6 15.33' iV CL CL v BEDROOM o HALL #1 CHI LIVING L6 a a � ROOM CL 4 a, DOOR TO PORCH CL 6.0 .9 TO DECK 4.8' A 5.0' PANTRY CL Cn a THto r anTH N BEDROOM BEDROOIV #4 #5 BEDROOM KITCHEN #6 DINING 10.5' 6.8' 10.5' ROOM 17.3' 21.5' 2ND FLOOR 1 ST FLOOR P. 13.' 2006 4.31 PM fro, 611$ P, 1/1 Jaynes III and P&A Buffington Trust 25 Last End Avenue New York,NY 10028 September i 2,2006 Board of Health Town of Barnstable 200 Main Street Hyannis,MA 02601 Re: Declaration of Authorization Dear Members of the Board: Let it be known that I, Peter Buffington,do hereby autborize JC Engineering,Inc.of East Wareham,MA 02538 to represent the Trust's interests regarding the upgrade of the sewage disposal system located at 63 Ocean Ave,Craigv7lle,MA in meetings both public and private. I cc , Peter Buffington N On Behalf of the d€anes IA and P& A Buffington Trust Coocumcm mid 5eitin�>T ter BuffitigtottlLocal SCtti[I mcmporwy Intemet fi OOLKIRWhorization 1,cttcr.duc Town of Barnstable P# 3 - N�ypFTHE Tpk p Department of Regulatory Services i Public Health Division Date satuvsrwerx. j, MASS. ♦p 200 Main Street,Hyannis MA 02601 i639' �� v . . Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Dis sal Performed By: H(64ael kk~kZ.k I E TTi C SE Witnessed By: ' LOCATION & GENERAL INFORMATION Location Address McLn ��Q-- n QY Le e_ ll,, t � � 1i �}j 111 1�1�'�� AP M s cceC n Av.e.,r1, c Assessor's Map/Parcel: �q��/�y 9 USG En eer's Name k�ulC�i i NEW CONSTRUCTION REPAIR _ Telep lone# , Land Use lsy4e 6"Zly / fe5(LAeo4i-k Slopes(%) Surface Stones a Distances from: Open Water Body i0o t Possible Wet Area 1(20 t3 Drinking Water Well _ tt Drainage Way ft, ,Property Line > /0 ft Other _ ft t� SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to,holes) See- u{(Gc�ee� Qpc��sec` 5p��iC 's�skwt (j f y-Je- &✓t "SC ���5if1e2: t�1S t '�cnC. ` �ckJ Sg0k-" it (5t 206(0 it (Gl 0lwoS�n ?"I20 3(rS Parent material(geologic) Depth to Bedrock Depth to Groundwater Standing Water in Hole: i20' Q�(rS Weeping from Pit Face 7 (20 6&S Estimated Seasonal High Groundwater .2 126` DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: 7 (Z 0 in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment R• Index Well H Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date f3-22-040 Time l6 AM Observation _ Hole# Z Time at 9" Depth of Perc 3(0' Time at 6" Start Pre-soak Time a JD:U y /0:11 Time(9"-6") End Pre-soak 10:0 L 2 MPi G 2wf, Rate Min./Inch , Site Suitability Assessment: Site Passed t/ Site Failed: Additional Testing esting Needed(Y/N)_ Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. i Q:HEALTH/WP/PERCFORM DEEP OBSERVATION HOLE LOG Hole # 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(ht.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. _ - ......... __...... . Cansistt;ncv.•0laf3ravel)... .._._. /0 - fo-3� i3 L5 16 ir516 _ 36-128 G M S 2. Y Alta �- c 510 3"Q"d DEEP OBSERVATION HOLE LOG Hole # y Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) o>y - - •- Gider y lO (�_ LS 16 Yr 312 10 Yr 36'i20 C IIS �, l 6Ib L .57a gfp�c` �ODS� DEEP OBSERVATION HOLE LOG Hole# 5 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) o- y - � - - •�oPs�i� _ 312- - r L5 Io'Y: - 3y- 120 G MS DEEP'OBSERVATION HOLE LOG Hole# 0 .Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) •toQSoi l _ y-8 A L5 10 r 31-2- _ - 8 -3Y . FD L5 �oYr SAY - - TP s H4 cond-rued a,A 7-17-OG Flood Insurance Rate Man: were_ aloe onecl due_ -o �c,Ea�ocable Above 500 year flood boundary No_ Yes Soi\ Coe lboY�S �OJyl�cted• PJuQ. S&5 Within 500 year I boundary No_ Yes kocje8 ck 1eO5 3 t ".0/ Within 100 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? yes If not,what is the depth of naturally occurring pervious material? Certificatior. I certify that on bGk Zit i9l. (date)I have passed the soil evaluator examination approved by the Department of Environmental Protecf and that the above analysis was performed by me consistent with the required training,expert se and rience described in 310 CMR 1.5.017. G Date 1./5 o6 Signature — Q a-1 EALTH/W P/PERCF0.RM L� PO AMC 15.220: Pienarauon of Plans and Soecifications ,41e V 1, 4;,e jI/fAr-cA /q 9s— The plans and specifications>for every on-site system shall be prepared.as follows: (1) -Every system shall be designed by a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian provided that such Sanitarian shall not design a (Q system designed to discharge more than 2,000 gallons per day pursuant to 310 CMR 15.203. / Any other agent of the owner.,may prepare plans for the repair of a system.designed to discharge not more than than 2,000 gallons per day pursuant to 310 CMR 15.203 provided 1/ they are reviewed by a Massachusetts Registered Sanitarian and.approved by the approving authority: (2) Every.plan submitted for approval must be dated and bear the stamp and signature of the designer, (3) Every plan for a new system or plan for the upgrade or expansion of an existing system l� which requires a variance to a property line setback distance;'must.also reference a plan Jwhich bears the stamp and signature of a Massachusetts- Licensed Land Surveyor in accordance with M.d.L. e: 112, § 81D; / (4) Every plan for a system shall be of suitable scale-(one inch=40 feet or fewer for plot / plans and one inch = 20 feet or fewer for details of system components) rind shall include depiction of: (a) the legal boundaries of the facility to be served; (b) the holder and location of any easements appurtenant to or which could impact the . ' sy.stem; (c) the location of the all dwelling(s)or building(s)existing and proposed on the facility _and identification of those to be served by the system; '(d) ••the"Iccation of existing or proposed impervious areas, including driveways and parking areas; (e) location and dimensions of the system (including reserve area); (f). system design calculations,including design daily sewage flow, septic tank capacity (required and provided); soil absorption system capacity (required and provided); and !/ whether system is designed for garbage grinder, (g) North arrow and existing and proposed contours; (h) • location and log of deep-observation hole tests including the date of test, existing grade elevations marked on each test, and the names of the representative of the ^approving authority and soil evaluator; . / (i) location and results of percolation tests including the Gate of test and the names of V 'the.representative of the approving authority and soil evaluator, G} name and certification number of the Soil Evaluator of record; (k) location of every water supply,public and private, 1. within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply wells, 2• within 250 feet of the proposed system location in the case;of tubular public water supply wells, and 3. within 150 feet of the,proposed system location inthe case of private water supply wells; location of any surface waters of the Commonwealth, rivers, bordering vegetated wetlands, salt marshes, inland or coastal banks, regulatory floodway, velocity zone, surface water supplies,tributaries to surface water supplies,certified vernal pools,private water supplies or suction lines, gravel packed or tubular public water.supply wells, subsurface drains, leaching catch basins, or dry wells; and the location of any nitrogen sensitive area identified'in 310 CMR 15.215 within which portions of the proposed _Z— stem are located. m) location of water lines and other subsurface utilities on the facility; (n) observed and adjusted ground-water elevation in the vicinity of the system; a complete profile of the system; (p) -a note on the plan listing all variances to the provisions of 310 CMR 15.000 sought in conjunction with the plan; the location and.elevation of one benchmark.within 50 to 75 feet of the facility to' which is not stibjcct to dislocation or loss.during construction on the facility; (r) when dosing is-proposed, complete design a'fid specification of the dosing system proposed including but hot limited to dosing chamber capacity (required and provided), ump curves and specifications,number cf dosing cycles and depth per cycle; w �/ (s) when a Recirculating Sand Filter or equivalent alternative technology is required or !/ proposed,a complete plan and specification for the system,including a hydraulic profile; _(t) a locus plain to show the location of the facility including the nearest existing street; u the street number and lot number,if any, of the facility; and v) the materials of construcOon.and the specifications of the system. ROVIDE PRECAST CONCRETE EXTENSION FINISH GRADE OVER D-BOX= 18.4r ± TOP OF FOUNDATION - 25.12 RISER OVER INLET&OUTLET COVER TO FINISH GRADE OVER CHAMBERS = 16.00' - 20.08' UTILITY BOX AT GRADE PVC VENT PIPE WITH GENERAL NOTES WITHIN 6"OF FINISHED GRADE REMOVABLE CONCRETE COVER SLOPE @ 2% MIN. OVER SYSTEM CHARCOAL FILTER 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION TO WITHIN 6"OF FINISHED GRADE 4" PERFORATED PVC PIPE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE FINISHED GRADE � - � �� 4" SCHEDULE 40 PVC MIN SLOPE 1% WITH SCREW TYPE CAP TO 3/4"TO 1-1/2" DOUBLE WASHED FINISH GRADE OVER TANK EL.- STONE TO CROWN OF PIPE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. @ FOUNDATION = VARIES = 19.5 18.0 5 DIA. OUTLET(S) - WITHIN 3"OF FINISHED GRADE -\ '--- __ 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD - 2"OF 1/8"TO 1/2" DOUBLE OF HEALTH AND THE DESIGN ENGINEER. 20"MIN. ACCESS COVER 12"�lN. i � WASHED STONE (TYPICAL FOR 3) 36" MAX. TOP OF SAS = 15.08 PLACE RISERS ON 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL 36"MAX. , 9" MIN. CHAMBERS W/PIPED BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. PROPOSED 4" 12"MIN. 14.25 36"MAX. BREAKOUT EL = 14.75� INLETS TO 6"OF 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN SCHEDULE 40 PVC PROPOSED 4" FINISHED GRADE 1 ELEVATION = 14.75' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS SCHEDULE 40 PVC A 40 MIL GEOMEMBRANE LINER IS PLACED AT LEAST FIVE FEET FROM S.A.S. AND THE TOP MIN.SLOPE @ 1% 6" 3" 3" 9° - -- 3" DROP MIN. MwSLOPE @,% PROVIDE WATERTIGHT �4,p OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 10° 14„ f r 4" PVC IN FROM JOINTS (TYP.) O = = O 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. *19 6' 7 15.50 SEPTIC TANK O 4" PVC OUT TO 1, po 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. LEACHING FACILITY o 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO 15.75' � 0 0 CD 0 00 0 0 0 o pp BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR 48" OUTLET TEE 14.77� WHIN. 14. ' o0000 0 00 0 0 0 oo p po o �o oo o0 0 0 0 000 0o po a' INSPECTION. SYSTEM IS NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING 60 + op ap o o oo ap oo APPROVAL FROM BOARD OF HEALTH AND DESIGN ENGINEER. 22"ZABEL FILTER , MODEL#A1801-4x22 6" CRUSHED STONE 2.5' 2.5' 8. ELEVATIONS BASED ON NGVD 1929 DATUM OF 10.40' ESTABLISHED ON BFE = OVER MECHANICALLY 6.1- (TYP) 2•5� 3 0, 2•5- A NAIL IN PAVEMENT ON OCEAN AVENUE AS SHOWN ON PLAN. 19.0'±* COMPACTED BASE VARIES (SEE PLAN) (NP,) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION 6" CRUSHED STONE 5 OUTLET DISTRIBUTION BOX GROUND WATER ELEV.- 6.17� 8.0' THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE 12.25 AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY 4h*01W COMPACTED BASE BASE. FIRST TWO FEET OF OUTLET 5'MIN. DISCREPANCIES TO THE DESIGN ENGINEER. PIPES TO BE LAID LEVEL. 11 - LC-6 CHAMBERS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE PROPOSED 1500 GALLON CONCRETE SEPTIC TANK *CONTRACTOR TO VERIFY LENGTH 10•5' WIDTH 5.67' DEPTH 5.67' CROSS SECTION VIEW STRUCTURES SHALL BE MADE WATERTIGHT. SEPTIC TANK PROFILE ( DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE CHAMBER DETAILS CHAMBER END VIEW 11. NO DETERMINATION ETER II ATIOIOHASBEENM DEASTOCISTO COMPLIANCE DEEDED OR ELEVATION AND NOTIFY Dimensions per Wiggins Precast ENGINEER IF DIFFERENT NOT TO SCALE Corp., Pocasset, Massachusetts) NOT TO SCALE DETERMINATION FROM APPROPRIATE AUTHORITY. \ TEST PIT DATA TEST PIT DATA TEST PIT DATA 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE \ ++ f• lie . • I THEY SHALL WITHSTAND H-20 LOADING. 0/ \ • ` INSPECTOR: Donald Desmarais 0 INSPECTOR: Donald Desmarais INSPECTOR: Donald Desmarais 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND ♦ �' +�' f 1 w� W, SOIL EVALUATOR: Michael Pimentel, E.LT.; SOIL EVALUATOR: Michael Pimentel, E.I.T.i SOIL EVALUATOR: Michael Pimentel, E.I.T. FINES. DATE: July 17, 2006 DATE: July 17, 2006 i DATE: August 22, 2006 / WET 11 • 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF / _, _. _---•--" '-� MAP 226 '• •. "' TEST PIT#: 1 TEST PIT#: 2 I TEST PIT#: 3 LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN WET - LOT 75-001 ELEV TOP= 12.00' ELEV TOP= 10.00' ELEV TOP= 18.00' COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN N/F MCCAW ,r • + w w ACCORDANCE WITH 310 CMR 15.255(3). w • ELEV WATER= <6.1 T ! ELEV WATER= 6.1 T ELEV WATER= <8.00' `WET 10� I + + PERC RATE = N/A PERC RATE = N/A PERC RATE _ <2 MIN/IN 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN /`b \ �\ / - WET s f "" SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. \ 4 ' T 13 \ / WET 2 • : DEPTH OF PERC = N/A DEPTH OF PERC = N/A DEPTH OF PERC = 36"-54" 16. PROPOSED PROJECT IS LOCATED WITHIN: I \ \ / // / \ • • �" I ASSESSORS MAP 226 PARCEL 149 MAP 226 , / / • TEXTURAL CLASS: N/A TEXTURAL CLASS: 4 TEXTURAL CLASS: 1 ^� ET 9\, \ LOT 149 / / (, • * i OWNER OF RECORD: JAMES III AND P&A BUFFINGTON TRUST / WET • • 0" 12.00' 0" 10.00' 0" 18.00' ADDRESS: 25 EAST END AVENUE 8.3 ACRES± �-- _...� ��, � WE�8 \ \ ��, . • +z Topsoil Topsoil Litter NEW YORK, NY 10028 WET 1 \ -WET 6 // / '' _ - ' a ++ . 16" 10.6T 10" 9.1 T 4" 17.6T FEMA FLOOD ZONE C, B, &A10 (EL 11) \ T 7- _ _ \\ _, , ,� ++ +++ *4 q Loamy Sand AS SHOWN ON COMMUNITY PANEL# 250001 0008 D �2 /L •It. Coarse Sand 10" 17.1T �_,/ 10% Gravel 17. PLAN REFERENCE: • • Fill ( ) g Loamy Sand \ 1 WET 4 • Cry �ll • # •` 1. L.C. PLAN# 17609G &C E�5 / 1 \ •••• /r 10YR 5/6 ? + • "` •�r �� ' 15.00' 18. DEED REFERENCE: • •.•`� : �!: ►f ! 46" Mottlin 46' 6; 17' 36 1. L.C.C. # 115365 �--- EXISTING CESSPOOL TO BE - �' � +� g @ o �-�:- / / \ PUMPED AND FILLED WITH CLEAN • . • , • "" 10 YR 5/8 Perc _- `14 SAND AND ABANDONED. r , ,� • 11 + 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. / c� \1• Coarse Sand48 6.00' 13.50LTQ " III • • • �� Fill 10% Gravel 20. PROPERTY LINE INFORMATION IS APPROXIMATE, ONLY. THIS PLAN IS TO BE USED ONLY /� �6\ \ PRO IDE 18 MIN Pil Ville a • ( ) FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY / PR POSED CLEAN OUT �( 0 SEPARATION BETWEEN ,..--�`"-•-�-LL-�--�., ��- � ' •!! I( � Medium Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 18-- TO GRADE (TYP. OF 3) PROPO D SEWER PIPE AND -"r - - \ jfj ! 04 t� Standing Water @ 54"0 \ i \ 3 -� � a 11 ! 54" - 5.50' C o 2.5 Y 6/6 21. IN ACCORDANCE WITH 310 CMR 15.401 - 15.405, THE FOLLOWING LOCAL UPGRADE EXISTING WATER LINE. --o N \ i� \ 9ti (< 5/o Gravel; Loose) APPROVALS ARE REQUESTED FROM 310 CMR 15.211 &310 CMR 15.221: o , o ^ ) Silt Clay 1.)A 2.0 (3.0 -5.0)VARIANCE FOR MAX COVER OVER THE PROPOSED LEACHING FACILITY. -- y � 2.)A 14.0' (20.0 -6.0')VARIANCE FOR THE SETBACK FROM THE PROPOSED LEACHING FACILITY / / ^� � _ _ _.._.---•- � ` �, � - ------- ---- ------ '` TO THE EXISTING GARAGE FOUNDATION / WET�17/ / / r i / \24�\ \ \ \ ® ` 21. THE FOLLOWING LOCAL VARIANCES ARE REQUESTED FROM ARTICLE 1 SECTION 360-1: I / ( !! ( /2 OR 70" 6.17' 1 72" 4.00' 120" 8.00' 1.)A 13.5' (100.0-86.5')VARIANCE FOR THE SETBACK FROM THE PROPOSED LEACHING P \ \ LOCUS PLAN- FACILITY TO THE WETLANDS. \ - No Standing, Mottling, No Standing, Mottling, 2.)A 9.0' (100-91.0')VARIANCE FOR THE SETBACK FROM THE PROPOSED SEPTIC TANK TO ' \ rn ocv J 3 Q \ o MAP 226 SCALE. 1 - 1000 or Weeping Observed or Weeping Observed THE WETLANDS. I o�' CNN N ( ` \ _ EXI TING mn j \ a ` LOT 80 1�V�TJ1� J I 6 BEDM�OOM N /r N/F TEST PIT DATA TEST PIT DATA TEST PIT DATA DWELLING FV S i -_ - DRISCOLL LEGEND ��" / TOF= 2 .12' BP gP 1 WE 2 I Donald Desmarais Donald Desmarais Donald Desmarais ( } / 1 BFE = 19`.0 t BM ' 1 PROPOSED 1500 GALLON DESIGN DATA INSPECTOR: INSPECTOR: k INSPECTOR: - --100 - EXISTING CONTOURS SEPTIC TANK SOIL EVALUATOR: Michael Pimentel, E.I.T. SOIL EVALUATOR: Michael Pimentel, E.I.T.(; SOIL EVALUATOR: Michael Pimentel, E.I.T. EXISTING WALKWAYS August 22, 2006 August 22, 2006 August 22, 2006 102 PROPOSED CONTOURS O DISTURBED DURING DATE: 9 DATE: 9 DATE: 9 GS !CONSTRUCTION SHALL BE NUMBER OF BEDROOMS DESIGN 6 TEST PIT#: 4 TEST PIT#: 5 TEST PIT#: 6 102 PROPOSED SPOT GRADE 4" PVC REPLACED IN KIND (DESIGN) 264.1'± IRON PIPE �. '" DESIGN FLOW 110 GAUDAY/BEDROOM ELEV TOP= 19.00, ELEV TOP= 18.00' i ELEV TOP= 16.00' 1 1 -INSPECTION / O (dist/fnd) --22 _- T ❑/H/W -- EXISTING OVERHEAD WIRES PORT - TP 5 P 6 1T2 UU `710xo2 TOTAL DESIGN FLOW 660 GAUDAY ELEV WATER= <9.00' ELEV WATER= < 8.00' ELEV WATER= <6.00' O JP 6 S DESIGN FLOW X 200 % = 1320 GAUDAY U, O �� / / PERC RATE = PERC RATE _ <2 MIN/IN I PERC RATE _ �/ ---- EXISTING WATERLINE USE PROPOSED 1500-GALLON SEPTIC TANK DEPTH OF PERC - DEPTH OF PERC = 34"-52" DEPTH OF PERC = 4g 14' - TEST PIT LOCATION PROPOSED 11 - TP 3 a f TEXTURAL CLASS: 1 TEXTURAL CLASS: 1 i TEXTURAL CLASS: 1 LC-6 LEACHING 18x00 �� O' 6.0 TP 4 CHAMBERS 19x00 I �\ Benchmark O O O PROPOSED 1500 GALLON SEPTIC TANK ___-18-� INSTALL 11 - LC-6 CHAMBERS 0" 19.00, o" 18.00' 0" 16.00' ,, , O r. PROPOSED 5-OUTLET Nail in Pavement MAP 226 5� / Litter Topsoil Topsoil PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE OFF / - � GARAGE � DISTRIBUTION BOX �K N.G.V.D.G V.D.01929 LOT 36 �-P�p/ ' ONG QP` , pP�,,M SIDEWALL CAPACITY 4" 18.67' 4" 17.67' 4" 15.67' N/F IRELAND ( G EDGE OF �pF \ q Loamy Sand q Loamy Sand q Loamy Sand PROPOSED DISTRIBUTION BOX TRUSTEES �5 i `� TRAVELLED Wt6 O \, (PERIMETER) 2' HIGH 0.74 GPD/S.F.) = GAUDAY 10YR 3/2 10YR 3/2 10YR 3/2 ❑ DRIVEWAY UP 159/4 160.2' ) ( 2' ) ( 0.74 GPD/S.F. = 237.1 GAUDAY 10" 18.17' 8" 17.33' 8" 15.33' _ ( ) ( ) ( ) g Loamy Sand g Loamy Sand g Loamy Sand �Q PROPOSED LC-6 LEACHING CHAMBER 10YR 5/6 10YR 5/4 10YR 5/4 REMOVE&REPLACE UNSUITABLE ( / oz5N0 `NV` 36" - 16.00' 34" _ , 15.1T 34" 13.1T MATERIAL TO C-SOILS WITH CLEAN COARSE SAND, IF NECESSARY ©O� - p0~ w` I^v BOTTOM CAPACITY Perc P� UP 190/1 aA• `P`v = �- Perc OG 54 ' 14.50' ` 52" 3 13.6T 10� PROPOSED VENT- EXACT ( BOTTOM AREA ) (.74 GPD/S.F.) = GAL/DAY LOCATION TO BE DETERMINED (576.8 S.F.) (.74 GPD/S.F.) = 426.8 GAUDAY -•''� BY OWNER REV. DATE BY APP'D. _ DESCRIPTION _ Medium Sand PROPOSED IMPERVIOUS 40 MIL C 2.5 Y 6/6 C Medium Sand C Medium Sand PROPOSED SEPTIC SYSTEM UPGRADE TOTALS• 2.5 Y 6/4 2.5 Y 6/4 ( (Loose) (Loose) PREPARED FOR: GEOMEMBRANE LINER HC 2 � <5% Gavel) He 1 PETER BUFFINGTON SWING TIES & DIMENSIONS I TOTAL NUMBER OF CHAMBERS: 11 3 1 TOTAL LEACHING AREA: 897.2 SQ.F7. LOCATED AT ASSESSORS BUILDING CODES DESCRIPTION HC 1 HC 2 GC 1 GC 2 � O TOTAL LEACHING CAPACITY: 663.9 GAL.IDAY 120" 9.00, 120" 8.00' 120" 6.00' - - .. .0 2 63 OCEAN AVENUE CODE DESCRIPTION SEPTIC TANK(1) 37.1' 14.1' - - 6a ___ o No Standing, Mottling, No Standing, Mottling, No Standing, Mottling, CRAIGVILLE, MA 02632 SEPTIC TANK(2) 30.0 18.5' O or Weeping Observed or Weeping Observed or Weeping Observed BAS FIRST FLOOR � _ _ - 4 BMT BASEMENT AREA _ _ O ___ LEACHING CORNER(3) 21.4' 24.T I � <- .,r- RESERVED FOR BOARD OF HEALTH USE SCALE: 1 INCH = 20 FT. DATE: SEPTEMBER 15, 2006 O O_ a a 0 10 20 40 80 FEET FUS UPPER STORY LEACHING CORNER(4) 26.9' 28.7' O Fl�SH or Mq LEACHING CORNER(5) 37.7' - 8.5' - PREPARED BY: 5 -GC 1 I JC ENGINEERING, INC. LEACHING CORNER(6) - - 11.1' 12.4' w e; 2854 CRANBERRY HIGHWAY O SITE PLAN LEACHING CORNER(7) - - 16.8' 17.7' Gc 2 EAST WAREHAM, MA 02538 508.273.0377 _ SCALE: 1" =20' LEACHING CORNER(8) 41.5' - 19.8' - 7 SCALE: 1" =20' Drawn By: BSM Designed By:MCP Checked By: JLC JOB No. 1066