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HomeMy WebLinkAbout0059 OLD POST ROAD (CENT.) - Health (2) 59 Old Post Road Centerville A = 209 066 vtc Y�FaCoy� llll SiLi� �'PC 12543 'o.53LOR ,c��T•CO�Sv� I.ASTINGS,IIN No. G k`/7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: . PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitatlon for Misposal &pstem Construttion Permit Application for a Permit to Construct( ) Repair(&4 Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No S'g o tD Posi Rol. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 209 G(, �.e e�c l +{ . Al rn EE Gmr4k cc- Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 9 a'C.3 V.H.A 550C . So8-8 33.00 y I -rcm.5c_rc*4 LrJ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Rc S i jr_(NA i w No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) y y0 gpd Design flow provided Plan Date -p f in Number of sheets Z Revision Date Title Size of Septic Tank /00 0 Via• Type of S.A.S. SQQ 9o-1 Lj G �3� Description of Soil Nature of Repairs or Alterations(Answer when applicable) D OC)X - 3`5009v.1 L f C Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions 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. Sign Date M21 Application Approved by Date 2 Y "`7 Application Disapproved by Date for the following reasons Permit No. �a r f Date Issued Fee.% ; !Jc' Entered in'I o uteri THE COMMONWEALTH OF,MASSACHVSETTS p Yes PUBLIC HEALTH DIVISION TOWWOF BARNSTABLE, MASSACHUSETTS a 2pYiration for Misposar 6pstem Construction 3permit M' Application for a Permit to Construct( ) Repai5( Upgrade( ) Abandon( ) ❑Complete System ndividual Components Locahon,Address or Lot No.Slj O L.D QO Sj Owner's Name,Address,and Tel.No. ;" - F L ASmEE Gar-1L. ce. Assessor's MapTarcel Z09 L�, '��,-"c r � Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. '9 C3 Ex ca� -�(ate V.N.A 550C . SO$-g 33 00 y 1 Type of Building: Dwelling No.of Bedrooms `7 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) y LID gpd Design flow provided Plan Date (�o Number of sheets 'Z Revision Date Title f \ Size of Septic Tank /00 0 Type of S.A.S. S_ LT 3 1 Description of Soil Nature of Repairs or Alterations(Answer when applicable) D 0nX - 3 SOO 9 a Lk— Date }.� r Date last inspected: Agreement: f 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. Signe/ Date /y Z 1) )`7 Application Approved by v�,, Z I / Date Application Disapproved by Date for the following reasons Permit No. c ( `7 -- 0 Date Issued 2 "7 - -:---------—-----------------.--- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(64 Upgraded( ) Abandoned( )by _8 �e 9 F_x Za,v aA; 0 A at , :9 OL.0 -Pbs I JU has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ) a (�Adated Installer Designer #bedrooms q Approved design flow % 7 U and The issuance of th perrt>t shall not be construed as a guarantee that the system ill fun tion4 designe . n� Date f / Inspector - - _ -- _- - - - -- ---- Z� f ?' !C ------- --------------------Fee----/�-� No. I I _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction 3permit Permission is hereby granted to Construct( ) Repair(,Jf Upgrade( ) .. _..Abandon'( ) System located at 579 nL p Ras 4 Qo( 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:Construction must be completed within three years of the date of this permit. n /� Date �2.Z�/ Approved by Town of Barnstable Regulatory Services Richard V. Scali,Interim Director BARMnaIA �MAM Public Health Division i639. A�0 Fp _ Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# ,) Assessor's Map\Parcel 20'7 6-fol Designer: �� ASO�/e/cL-f Installer: Address: -5� 6 ("o` lij/ /.o,&l Address: �o On was issued a permit to install a (date) (installer) septic system at �7 ��� // f�� based on a design drawn by (address) / dated (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. Strip out (if required) was in ected and the soils were found satisfactory. fs c : � Q� / APT C Al,`s'b* 4/V 1f--�0 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. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms 6f thel 7A approval letters(if applicable) / I j"A Or°rsf o� AW (Installer's Signature) o VON yLNE '3 v 9 #1068 6�' o m CrSTE�' 9��1TA �Pa (Designer's Signature) (Affix DesikMM&mp 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. . QASeptic\Designer Certification Form Rev 8-14-13.doc TOWN OF BARNSTABLE 1p LOCATION S9 OLD 4)c);s4 1` J -< SEWAGE VILLAGE ec-n-J,—r ASSESSOR'S MAP&PARCEL 209 I GG INSTALLER'S NAME&PHONE NO. EXC'.QV(aA;o y\ SEPTIC TANK CAPACITY /00 0 9oJ LEACHING FACILITY: (type),SOO go.J Li c, 3) (size) I3 x 33 x Z NO.OF BEDROOMS y OWNER CL hG PERMIT DATE: G- ZZ- 1'7 COMPLIANCE DATE: 4 -b-3. 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 360 feet of leaching facility) Feet FURNISHED BY Al - 1-7'1. AV Zzfg 82. 2z A3.31 $3. 11w ' M " y� ' A 13 13y 23' 2 3 i „w a 1 (5-15�t t-,-r---5 Town of Barnstable -- P# .the . . 31 Department of Regulatory Services Public Health Division DateKAM bs9 200 Main Street,Hyannis MA 02601 - ; t� tT1 F / l IA5 Date Scheduled l� <`.� Time Fee Pd. ROOD Soil Suitability Assessment for S ge Disposal / c Performed By: �/S t°/!G _ J- Witnessed By: LOCATIIO,LNn&GENERAL INFORMATION Location Address 5 Q Ial 1®5/ -Z a Owner's Name Xl�*e 0j : ek*ee 1� ci' /k d0,11e Address Assessor's Map/ParceL Q'�/��� Engineer's Name NEW CONSTRUCTION REPAIR _J Telephone# oo /� L C/ Land Use /�P E-WeIy/ Slopes(%) .Z� Surface Stones /20 Distances from: Open Water Body ft Possible Wet Area — ft Drinking Water Well ft Drainage Way ft Property Line [eft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 07 Parent material(geologic) � �� Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face /Ie1f`" Estimated Seasonal High Groundwater l DETERMINATION FOR SEA ONAL HIGH WATER TABLE Method Used Depth Observed standing in obs.hole: 1A in. Depth to soil mottles: in: Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index ell level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Date g l .Time /K9Q Observation Hole# l Time at 9" Depth of Pert Time at 6" Start Pre-soak Time @ Time(9"761 End Pre-soak Rate MinAnch 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 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. Q:\SEPTIC1PERCFORM.DOC DEEP OBSERVATION HOLE LOG' ' Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munseli) Mottling (Structure,Stones,Boulders. d Consistency.%(iravell Id YA3 L r a79 /D L o f 1 , DEEP OBSERVATION HULE`LOG Hole+# 7, Depth from Soil Horizon Soil Texture Soil Color Soil I Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. _ Consistency.%(travel) o v z 3 NO DEEP OBSERVATION HOLE.LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. ' P DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consigema,%Gravel) J Flood Insurance Rate Mao: Above 500 year flood boundary No_ Yes Within 500 year boundary No •� Yes Within 100 year flood boundary No Yes Death of Naturally¢ccarrtne Pervious Material Does at least four feet of naturally occurring pervious rpatcrt'al exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervj4us material? Ce ketion I certify that on fZ' l`D (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the`required training,expertise and experience described in 310 CMR 15.017. Signature Date v1 7 Q.ISEPTICIPERCFORM.DOC r t s Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 59 Old Post Rd. Property Address Marilyn L.Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 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. Important: A. General Information QI When filling out E%0&J 2 forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 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: ICJ' ® Passes El Conditionally Passes ❑ Fails` G*wwy e ❑ Needs Furt er Eval ion by the Local Approving Authority a . N 9/17/2009 Inspector's Sign re L> Date . The system inspector shall submit a copy of this inspection report to the Approving Authority(hard 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. i ****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. b l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewa Disposal System•Page 1 of 17 c. 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Old Post Rd. M Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632. 9/17/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r i t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 59 Old Post Rd. Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board'of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 t Commonwealth of Massachusetts 4 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 59 Old Post Rd. M Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 every 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. ❑ 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 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 El ® or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 59 Old Post Rd. Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 _ every 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- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 59 Old Post Rd. Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® El 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): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 59 Old Post Rd. Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 every page. City[Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon septic tank,distribution box and leaching pit. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2007:38,000 9 ( Y 9 (gP )) 2008:29,000 Detail: 2007:104gpd 2008:79gpd Sump pump? ❑ Yes ® No Last date of occupancy: 9/17/2009 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 every 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: Capewide Enterprises,LLC. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? measured Reason for pumping: Maintenance Type of System: Septic tank distribution box soil absorption system p p Y ❑ 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): L15ins-109/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 59 Old Post Rd. Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 every 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: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10'+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 59 Old Post Rd. Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 every 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 24" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every two.Years.lnlet and outlet tees are in place.No evidence of leakage.Tank appears structurally sound. 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 l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ 'Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts V W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 every 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 No 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.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 59 Old Post Rd. Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 6'x6'with 2' stone ❑ 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.): Sandy dry soil.No signs of hydraulic failure.Water level was 5' below invert at time of inspection.Stain line is 4' below invert. 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 1 Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 every 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ® Zoom Out ,In i is ♦ t ♦ u O ♦ ♦ ♦ i r :.t. :.... =.:.. 1 � ' i M �f f,a' C1 21� Fe' n� 1 Set Scale 1" = 20 ( Aerial Photos I MAP DISCLAIMER ............................ ..... ..,... .. y.' r—,rinh4 9Mr.-9nnO Tnum of Q.—O.W. AAA All rinh}c rocone httn.//www.town.ha.rnsta.hie.ma..us/arcimg/a.nnPeoann/man.asnx?nronertvlT)=?.09(66k.man... 9/1900119 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 59 Old Post Rd. Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LP 21' 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: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'M 59 Old Post Rd. Property Address Marilyn L. Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 N L IF ,c N 2 _ _ - . i +A�woA 0f o� ,LAMEST MORE No 33253 01 T F/fir - ' 41,0-- G:>^/=i. 09/19/2009 11:10 FAX 5084283928 CAPEWIDE @ 001/017 4 Commonwealth of Massachusetts MEN Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L.Williams Owner Owner's Name Informrequired tion is Centerville Ma. 02632 9/17/2009 required for every page. Cityrrown 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. 'mp°ftft When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterpdses,U.C. Company Name Q P.O.Box 763 Company Address Centerville Ma. 02632 ,ate Cityrrown State Zip Code ' (508)28-4028 Si4454 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 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/17/2009 in s Sig re 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 perforrn In the future under the same or different conditions of use. tshm•OM Title 5 Of W Inspea on Fmm:Subsurface Sewage Disposal System•Page 1 of 17 09/19/2009 11:10 FAX 5084283928 CAPEWIDE IM002/017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L.Williams owner Owners Flame Infou a d d for is req Centerville Ma. 02632 9/17/2009 9"rypage. own state Zip Code Date of Inspection every B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/afways 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: The septic system is in proper working order at the present time. ®) 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 extiitration 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): twns•09= Title 6 OWW W InspeWw Farm:Subsurface Swap DIVO W 8 o1 yWen,•�Z 17 09/19/2009 11:11 FAX 5084283928 CAPEWIDE Q 003/017 f M h Commonwealth o Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L.Williams Owner Owners Name requmavired for on Is Centerville Ma. 02632 9/17/2009 required every page. Cityfrown Slate Mp Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cunt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation Is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 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 Wns•MW Us S OBl W heron Form:Subsurface Sewage fJiepoael 8yatem•Page 3 of I? 09/19/2009 11:11 FAX 5084283928 CAPEWIDE IM 004/017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L.Williams Owner Owrm's Name requ a6on is Centerville Ma. 02632 9/17/2009 every very page. age. � wn fro state ap Code Date of Inspection e P B. Certification (cunt.) 2. System will fall 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 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 ❑ to Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged 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 t5kw•OWN TWO 5 OfRO W mpeouon iamw subswrae*aewese oaf s •POP 4 of 17 09/19/2009 11:11 FAX 5084283928 CAPEWIDE Q 005/017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L.Williams Owner Owner's Name inform9on is required for Centerville Ma. 02632 9/17/2009 - .req every page. Citylrown 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 conform bacteria Indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system falls.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"nob 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 "yes" If you have answered es to an question in y y y q es on 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 WAR-00= T61e 6 Of ckA Inspection Fomc subsurface Sewage Mpwd System-Pepe 6 of 17 09/19/2009 11:12 FA% 5084283928 CAPEWIDE IM 006/017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L.Williams Owner Owners Name ImbrrnaregWre fb is Centerville Ma. 02632 9/17/2009 wry paw Clty/rown state Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate°yes°or"rW 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 NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ Were all system components,excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing Information. For example,a plan at the Board of Health. ❑ ® Determined In the field(If any of the failure criteria related to Part C is at Issue approximation of distance is unacceptable)1310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 `-----JNumber of bedrooms(actual): 4 - DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t51�•o8/oF1 Tale 6 Of6oW In" d-Fav i SuF uA—Gw-p Mpml&Sftm•PW 6 of 17 09/19/2009 11:12 FAX 5084253928 CAPEWIDE IA 007/017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L.Williams Owner Owner's Name Iftyination reciuk dfo Is Centerville Ma. 02632 9/17/2009 every page. City/Town state Zip Cade Date of Inspedon D. System Information Descriptlon: The septic system consists of a 1000 gallon septic tank,distribution box and leaching pit. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] [J Yes No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings,if available last 2 years usa a 2007:38,000 9 Y 9 t9Pd)) 2008:29 000 Detail: _2007:1,04gpd 2008:79gpd Sump pump? ❑ Yes ® No Last date of occupancy: 9/17/2009 Date CommerclaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes (] No Industrial waste holding tank present? ❑ Yes ❑ Np Non-sanitary waste discharged to the Title 5 system? 0 Yes ❑ No Water meter readings,if available: fte•00= T*6 6 MW 1""dim Fwn&"wf**seWve Vbpmd 8yslem•Page 7 of 17 09/19/2009 11:13 FAX 5084283928 CAPEWIDE Q 008/017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Old Past Rd. Property Address Marilyn L.Williams Owner Owner's Name requinfamia retion is Centerville Ma. 02632 9/17/2009 required for every page. cityrrown 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: Capewide Enterprises,LLC. Was system pumped as part of the inspection? ®Yes ❑ No If yes,volume pumped: 1000gallons How was quantity pumped determined? measured Reason for pumping: Maintenance 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): Ohs•09108 Tide 6 Official Inspection Fomc Subsurface Sewage Disposal System•Page 8 of 17 09/19/2009 11:13 FAX 5084283928 CAPEWIDE 9 009/017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Old Post Rd. Property Address Marilyn L.Williams Owner Owners Name information is required for Centerville Ma. 02632 9/17/2009 every page. Gtylrown Zip Code Date of inspection D. System Information (cunt.) Approximate age of all components,date installed(if known)and source of Information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16" feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from primate water supply well or suction One: 10'+ feet Comments(on condition of joints,venting,evidence of leakage,etc.): Joints appear tight.No evidence of leakage.System vented through the house vents. Septic Tank(locate on site plan): 1' Depth below grade: teat Material of construction: ®concrete ❑metal [J fiberglass ❑polyethylene ❑other(explain) It tank is metal,list age: Is age confirmed by a Certificate of Compliance?(attach a copy of certifficate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 8" MW•09= Title 6 OftW InsPWW Form:Submufaoe Sewmge Obi syAwn•Page 9 of 17 09/19/2009 11:13 FAX 5084283928 CAPEWIDE Q 010/017 ,44 Commonwealth of Massachusetts Title 5 Official Inspection Form WE'D la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L.Williams Owner Owner's Name intbrmrequired is Centerville Ma. 02632 9/17/2009 required for every page. Chyfrown State Zlp Code Date of Inspection D. System Information (cont.) Septic Tank(coat.) Distance from top of sludge to bottom of outlet tee or baffle 24p Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Pump septic tank every two.Years.inlet and outlet tees are in place.No evidence of leakage.Tank appears structurally sound. 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 t6bla•OOM Tide 5 001cW inapecdon Form:Subawface Sewage Disposal System•Page 10 of 17 09/19/2009 11:14 FAX 5084283928 CAPEWIDE 11011/017 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L.Williams Owner Owners Name i"f0"naltor'is uired for Centerville Ma. 02632 9117/2009 e,y pop- CRY/Town We Zip Code Date of lnspectlon 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' geHons Design Flow: gafbns 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 t6ina•"M T$b 6 Oflidal InapeOW Form;Suba wfew Sewape Disposal System•Pape 11 of 17 f 09/19/2009 11:14 FAX 5084283928 CAPEWIDE a 012/017 Commonwealth of Massachusetts Mamf Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L.Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 every page. cityfrown 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 No 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.): Box is Ievel.Box has one outlet Iateral.No evidence of solids caryover.No evidence of leakage. 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.): Soil Absorption System.(SAS)(locate on site plan, excavation not required): If SAS not located,explain why: Wrns•09= Tills 6 Ofrwial Inspection Form:SuWurfwe Sewage Disposal System.Page 12 of 17 09/19/2009 11:14 FAX 5084283928 CAPEWIDE Q 013/017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L.Williams Owner Owners Name inforniregWre fo is Centerville Ma. 02632 9/1712009 required for every page, CityNown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number. 106 with 2' stone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number,length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/aftemative system Type/name of technology: Comments(note condition of sal,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): Sandy dry soil.No signs of hydraulic fallure.Water level was 5'below invert at time of inspection.Stain line is 4'below invert. 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 term•OWU Tpte 5 offiew bmpamn Fonts 8ubewfbW Bewape DispoW System•Page 13 or 17 09/19/2009 11:14 FAX 5084283928 CAPEWIDE R 014/017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L.Williams Owner Owner's Name information is required for Centerville Ma. 02632 9/17/2009 r every page. C+hRom 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.): tam•09M Me 6 Official Inspectlon Form:Subsurface Sewage Disposal System•Page 14 of 17 09/19/2009 11:15 FAX 5084283928 CAPEWIDE Q 015/017 Map Page 1 of 2 Town of Barnstable Geographic Information System Parea Viewer I Custom—Ma—p7l Abutters Map Size . Zoom Out!III 11111in } A ♦ is \. y A... n. o ♦ A w. C yap \ \ \ M \ 1 .1 Y a 4 Ch _ c� , Set Scale 1" _ 0 Aerial Photos I MAP DISCLAIMER r nn.mso 7M14_7Mo Town of Rarnalaw. a4A am viAhoa mem http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=209066&map...' 9/19/2009 09/19/2009 11:17 FAX 5084283928 CAPEWIDE Q 016/017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L.Williams Owner Owner's Name information IS Centerville Ma. 02632 9/17/2009 required for every page. C-HyRown State Zip Code Date of InVecWn D. System Information (cunt.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LP 21' 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: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report,please see Report Completeness Checklist on next page. 16ins•09/08 Title 5 Official Inspection Form:Subsurface Savage Disposal System-Page 16 of 17 09/19/2009 11:17 FAX 5084283928 CAPEWIDE Q017/017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Old Post Rd. Property Address Marilyn L.Williams Owner Owner's Name inforrriationrequired Is Centerville Ma. 02632 9/17/2009 required for every page. CRY/Town side 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 15ins•09108 Title 6 OHtcial Iampedbn Foam:Subsurface Sewage Oir{weal Sydam•Page 17 of 17 f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 5 ..........................................OF...................................................................................... Trrtgrirat� of TIaurptiattrr THIS IS TO C FY, That the Individual Sewage Disposal System constructed ( ) or Repaired by------------------- --•-•-......--•-•-•••-•--•---•-•---------------------- ---------------•----------•--------------•--..........._..........-----•......----•-.. IMPller at-.............%5. `..------- --1 C.. -_ -------------------•----------------------- --- has been installed in accordance with the provisions nI % `?'` J j of"The S e Sanitary Code as described in the application for Disposal Works Construction Permite,'o- % .-Z?f..... dated...........................................A.. THE ISSUANCE OF THIS CERTIFICAT SMALL NOT BE C014STRUED AS,.,A-GUARANTEE THAT TH! :, SYSTEM WILL FUNCTION SATISFACTOR DATE -.. Inspector..... �� � E J �P h � ��- dam'• � �.� ---._---___ U J No.. I ....._....... Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................... ...............OF.......................................------------......---------..........._......----• Appliration for Dispaii al Works Toustrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal .. System at: Loc tion-Address or Lot No. •----.-••••-•-••-••.-•--••--.------•-s-.. - . c , caner --------•---•...................Address a .6al....�- x.e ..---•-•....................•---.............................. ........... .----------------------•--------------••--- / Installer Address dType of Building Size Lot..............•---•-••---,..Sq. feet U Dwelling—No. of Bedrooms..��_................... ..__.Expansion Attic ( ) Garbage Grinder ( ) U — aOther—Type of Building ............................ No. of persons__ i�.................. Showers ( 1 ) Cafeteria ( ) QOther fixtures ................................. • W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1----------------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........................ ...........................•------...-•---•--•-•------•----------•..........................................•-----•---------•-------•-•••...............-•-- ODescription of Soil.....................................................•------•-------------------------------------------------------•------------------•----------------........._-•---- V W ••-----------------• •-•••-•---------------•----••------•-••----•----•---------•---••-•----••-•------------ ------------------------------------------•----•--•--• - UNature,of Repairs or Alterations—Answer when applicable_.__ . iq.. I........e.e ms n------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI'i l-E 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, Q�,... C... _�„�C„Y.L -- -------•................... Da e Application Approved BY 1492 A - , &.......... ate >ca on D' approved for the following reasons---------------------------------------------------------------•----------------•---------------••-------••..._- .. ..................:�-•�---•----.........._..-•-•-----------•----------•--.....------------------------------------------•-•----•-•--------•---•-•-•-----Date ------------ PermitNo.........•--••-••-••...-••••-•-••••••-••....-•--------_. Issued----------_------ ---------------------------•---- I Dattee � V THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................ ------..........OF.............-......................... ApplirFa#ion for Dispas al Works Tonotrurtion jJamit Application is herebyymade for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................•-•-^------.......--•-------•-------•-^---•----••-------....---............---•- Location•Address } . or Lot No. ....... -•--•-••--- .............................................. wner Address a c y Installer Address U ------------------------------------------.........................----••.. --------------------------•---------------------------•---------------------------••__-----•-••--- Type of Building Size Lot............................Sq. feet 12 -, Dwelling—No, of Bedrooms_. .._.._..-_•---•_••_--__•-__.•__-__•_Expansion Attic ( ) Garbage Grinder" ( ) Other—Type of Building ............................ No. of persons_._:_..__._...........___... Showers (I ) — Cafeteria ( ) Otherfixtures .----•------------------------------•-•--•--•---•---...--•-------••------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter-----------_.... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... " 0 P4 ----•••••-----------------------•-----•-•••••••--•---•••....•-•••---•-••••...-•-•--•----•-•----•---•...-------•---••---......... -------------------- Description of Soil........................................................................................................................................... ....__..... V ------------------•----•---•---------••--------...-----------.....-•------.........--••---------------...------•-----.......------...-----•-----•-••----••-•---•-•--•---•------...........---••-_.--•-•- W x -••------•••------------••-•-----••-•----••-----••. -•••---------------•----•---••---•-••-- U Nature of Repairs or Alterations Answer when applicable $ ," ' -- ............... . ► == t 4� C�. I. ...."" _fir+. ... ' ....... t ''' t "` "' - `------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iiTv✓ 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., ... ._ :1 ^'+>s: "'- ................. Alication Approved By_ Date Ire jA7pli&tion//6ipP o�ed for the following reasons:........................................................ .- ----------------------------------------- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........ (9rdifiratp of Tautplitturr THIS I, T CZaTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ) b y .......................................... ---------•----------•-•--------•-------•----•-----• ----•-----•---•----•----------- Installer at S l �•--.�.............. .............. '----------�---�✓ & t,- -----•---•---•-•-----•-----------------•-------•......------•. -----•--•--•---------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N .49'__3kIK................ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... .l.l (-.--------••------__---- Inspector........ t_A�-•-•-••••------••----••----------- ---- THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH N �� � ............................................` ..OF.....-- :`..�...✓..." �-.d .' ............. FEE......_-----•.......... Dts noal k � at irttr irrn rr ti# Permission is hereby g ed.......... _? ._._ to Construct ( ) or Repair ( ) an-44dividual S�ewaff�oe Disposal SysterrY Street as shown on the application for Disposal Works Construction Permit No..................... D ted_......................................... - B ar of Health DATE------•-•---------------••-----•------••---------------•--.....--------........ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS CD da L 0 C.A T ION SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS f B-U IL DER OR OWNER DATE PERMIT ISSUED -Z3 DATE COMPLIANCE ISSUED i l �� i �4- 0 GENERAL NOTES: NOTE: Pump and backfill 1. VERTICAL DATUM: __ASSUMED -------- failed leach pit. Re—use 2. MUNICIPAL WATER _ IS _ AVAILABLE. existing 1000 gal septic tank. ---- �, wotert"a�n 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT SYSTEM UNLESS OTHERWISE NOTED. 4. ALL PRECAST UNITS TO CONFORM TO t Road AASHTO: _ U_10 & 20 P QS 5• PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. 0`d 6. ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE 53.22 WITH MA ENVIR. CODE (TITLE 5) AND LOCAL 29 REGULATIONS. 16" 3.26 3 53.12 •18 7• CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES 3� .;`\ PRIOR TO CONSTRUCTION. Oak .06 ..SZ95=..'< ,k 524 x 5�.21/k.75 4 LEGEND: v' 57 ` B W5 5 17 G°rden f ` enchmark: Use Top of �— 99�- PROPOSED CONTOUR �- 51• 2.44 Bottom Step at El. 53.9' 99 PROPOSED SPOT GRADE /�Stn; 51 99 52.2 — 40 EXISTING CONTOUR 75 32 6� vCn9 / x 52.5�LP C 51.31 X 30.23 EXISTING SPOT GRADE ��• ;wy so TEST PIT 51 x 5 . —1 p EXISTING WATER SERVICE z" arty —L�� n 9. 4vb 51.3Y ;." .` % LEACH DETAIL: E T 2 0 p 0 X o WORK LIMIT LINE fl 1 7� El 0 x V, Pr. l x 3 w B 51p5 50. 29.$3' y I 12 24 Porch 52. `8 �11 M -,,i = 50.96 50.60 OF p19ffq� 93 50.88 Q AMY L. y� 731 1x 51.49 96 Fnd� 0 cV VON HONE L ti SI Exist. Dwelling c�0 17' No. 1068 25 4" O�k Top of Fndn. = 12 83' '� STFR�� Elev. 54.3' ,f P� Q Deck / /x51. 0 — to ASSESSOR'S MAP: 209 �p PARCEL: 66 NOTE: This plan is to be used for septic REFERENCE: PL. BK. 558 PG. 73 system purposes only and is not to be PL. BK. 315 PG. 21 used for any other purpose. FLOOD ZONE: X Town of Barnstable 00 25001CO563J(07 16/14) moo. 59 OLD POST ROAD Falmo th Rd Route 28ocus goo°° CEN TER VI LLE, MA 0 associates PREPARED Sylvia Ln °- Use 40 ml Liner for Setback Variance FOR: B & B Excavation TEM cn od op EL. 50.4, Bottom EL. 47.0 Q R° SEPTIC SYS DESIGNS 320 Cotuit Road Septic placed 3' off closest edge of stone. p System and tQ _ Sandwich, MA 02563 `D 0\a P Maximum Feasible Compliance: �� d ��H� / ( (0) 508.833.0041 Site Plan Aimee Garthee (`s p I Al o f r el V4f e p (c) 508.274.0074 y Title 5, 15.405: I- f�{,, 6 1 y 59 Old Post Road 7' variance, proposed 13' `�� ��``'(/ a'1�'sr°" T got 1i^s�u/f, , Surveying Centerville, MA 02632 separation between leach facility n"h`�f:���J Cw,�I'r14 rrr�, Jitr� � AHOjalaSurveying and foundation / ArneH. 0jala,P.L.S. �o ���/[7 REVISION: 06/21/17 211 Maple Street DATE REVISED SCALE SHEET NO. Leach Configuration, Variances west Barn 2017 stable, MA 02668 . / / / / 1" = 20' 1 of 2 LOCUS MAP N.T. . 5W-362-Gs34 06 20 2017 06 21 1 I T.O.F. (Full) Provide Riser over D-box NOTE: All components to be marked with NOTE: To prevent breakout, final EL. 54.3 to within 6" of final grade magnetic tape or similar prior to final cover. grade of EL. 50.4 to be carried (Cover to be watertight) out a minimum 15' beyond edge F.G. EL: 51.0-53.0 f-F.G. EL: 53.0 F.G. EL: 53.0 Maintain Min. 2% slope over leach facility to of leach focility.(Existing grade Existin prevent onding F.G. EL: 52.0-53.0 meets breakout.) Install risers w/covers over inlet and Min. 2" of 1/8" - 3/4" Washed Stone or •Irr§ ection Port within 6" to grade outlet to�L=10' (Access Covers min. 20 final diamr per Code) _ z „ade Geote�xtile Fabric Exist. invert 4' SCH 40 P . - " L=10 L=20' 3/4 - 1 1/2 Double Washed Stone Installer to 4 SCH 40 PVC a 4" SCH ' PVC Top of Peastone or Geotextile Fabric EL. 50.4 @S= 2�v1IN confirm 10' 14• �5=2.5% as ®a " elevation as s- ®S=4.6% 0.5%MlN a®®�a®a 24 Eff. Depth EL. 50.75f aalaaaaa needed. Install Gas Baffle EL. 50.5 EL. 50.33 47.4 EL. 51.0± PROPOSED DB-3 EL. 49.4 Use 3 - 500 Gallon Precast Chambers H-20 DISTRIBUTION BOX (H-10) with Double Washed Stone 5 87' Watertest for levelness in "L" Configuration (Install PVC Inlet & Outlet Tees) SEPTIC SYSTEM PROFILE EXISTING 1000 GALLON if more than one H-10 SEPTIC TANK outlet EL. 41.53 N.T.S. Bottom of TH-2 SOIL LOG ADDITIONAL NOTES DESIGN CRITERIA Number of Bedrooms:Existing 4 Bedrooms SOIL EVALUATOR: MARK POLSELLI, S.E. #2912 1 Contractor to confim soil suitability prior to installation. Contact BOH and INSPECTOR: JUNALD DE5+t 11:0 R.S., BOH Design Sanitarian in the event of varying soils from original soil test. Soil Type: Class I DATE: JUNE 15, 11:00 AM g � gPercolation Rate: <2 min PERMIT: #15383 ?©(? Inch/ PERCOLATION ,RATE:<2 MIN/INCH IN Cl 2. Any contaminated materials within 5' of proposed Leach Facility to be removed. Replace with clean fill per Title 5 specifications. Daily Flow: 110 G.P.D./Bedrm x 4=440 G.P.D. TH - 1 TH - 2 Design Flow: 440 G.P.D. (Min. Required) 3. Water line to be sleeved at any sewerline crossings and within 10' of any EL. 51.7 EL. 52.0 septic components, as needed, per Water Department requirements. Garbage Grinder: Not Allowed A Contractor to verify location of water line prior to construction. Loamy Sand Loamy Sand Leaching Area (440)/0.74 = 594.59 S.F. 10YR3/2 10YR3/2 4. Distribution Box to be placed on 6" crushed stone or compacted, level Required: loll 50.87 10" 51.17 base. Septic Tank Required: 440 G.P.D. x 200% = 880 G.P.D Loam Sand Y Loamy Sand Minimum 1000 Gallon (Existing) B B 10YR5 4 27" / 49.45 27" 10YR5/4 49.75 Use 3 - 500 Gallon Precast Chambers H-10 with Cl Cl SEPTIC TIES Double Washed Stone in "L" Configuration Medium Sand Perc Medium Sand 29g3 � 10YR6/3 ® 1oYRs/3 � Sidewall Area:2(29.83'+12.83'+17'+3.67'+12.83'+16.5')= 185.32 S.F. 61" Bottom O o Bottom Area: (17'x12.83')+(12.83'x16.5')= 429.80 S.F. O o Total Area: 615.12 S.F. O ' 'o Design Flow Provided: 0.74(615.12 S.F.)= 455.19 G.P.D. to 3' poach _ 59 OLD POST ROAD Fnd� CENTERVILLE MA associates PREPARED Exist. Dwelling sync srsTEn1 oE�cris FOR: B & B Excavation 122" 41.53 122" 41.83 Top of Fndn. _ No Groundwater Observed No Groundwater Observed Elev. 54.3' 320 Cotuit Rood Septic System and Sandwich, MA 02563 Site Plan (0) 508.833.0041 Aimee G a r t h e e <9 @ 8:01 min. PERC RATE: <2 MIN/INCH C1 Horizon De ck (C) 508.274.0074 59 Old Post Road I, Mark Polselli, S.E., hereby certify that I am currently approved by the C'� Su^ey^9 by: Centerville, MA 02632 DEP pursuant to 310 CMR 15.017 to conduct soil evaluations and that AHOjala Surveying the above analysis has been performed by me consistent with the REVISION: 06/21/17 Arne 2H. 0ja1s,P..L.S. DATE REVISED SCALE SHEET N0. requirements of 310 CMR 15.017. 1 further certify that I have West 8amM e able. Mn ozsse successfully passed the Soil Evaluator's Exam on December 14, 2004 Leach Configuration, Variances 509_362_0934 06/20/2017 06/21/2017 1" = 20' 2 of 2 _ % , �... . . . . . . - - ..... f f' . .. . �'(� x . . . . 1 .. r \ '�+ cG :T� . , . r . _..r r €o : .. - _.. . , . , :. i 1.,; �j Iv 1 f.:1 .:.. �- . �. ,. , _.,_ . 4 ,-' E) 4 "::`. .. . .•. . _ L. , ... .. .. .. .. �i lam" — - . , a a � YA I . . - f . . : - rl` . . . _, ..,. .,. . . r , :. , .. . 1. , .-., i . j _ :-:r - t : ,-- _ .. -: _: i .- .g .,. .... - , �S . ., .. . : �`: _. - k % is .. ,- • : . - ... ' . - 1. ; . -,_. . . _ .: , .,,:' ..::...Y.'. .Y- t .'> _ . f. ".+. : "- _ a I: { . .. - t 1- 1 . . :;m i 1 i 6 : . . .;' .: . % .�. - qq - _ 441 .1 :. u_ W . r:. " I ,_ =. .. -: .. .., .. 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