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HomeMy WebLinkAbout0346 OLD STAGE ROAD - Health 346 OLD STAGE RD., CENTERVILLE A = lll ® �J�Rtcvet�4�� lIII UPC 92534 � No. 2153LOR HASTINGS. HN J No. W tnlf Fee�— THE COWONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es application for 3k5pozat 6p$tem Con.5truction Permit Application for a Permit to Construct( ) Repair(i, Upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No. 7(O (/� `�� Owner's Name,Address,and Tel.No.-/�1_ks 1FA ST 461 R�® CTV Assessor's Map/Parcel J O Installer's Name,Address,and Tel.No.GO 1Ll..i4M PINOE� Designer's Name,Address and Tel.No. ,���/��� �& apt rT' �y� ynas� : o r' `� �; T, 0LV6t4- / Type of Building: Dwelling No.of Bedrooms Lot Size �/, �g f sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)��b �i�gpd Design flow provided �3 y, q�6�1� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank ��00 Type of S.A.S.3_amoaa:s�J i1Z Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 igned Date 0 Application Approved by DateVj ­ C/ Application Disapproved by: Date for the following reasons ——— — Permit No. V�Q��Q Date Issued o 0 K No. Q ):it .,. �.. Fee�— THE CO�II�OIt tALTH OF MASSACHUSEfTTS Entered in computer: / J s PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for 0i5pool 6p5tem Congtruction Permit � Application for a Permit to Construct( ) Repair(W--.Upgrade( ) Abandon( ) ryComolete System ❑Individual Components Location Address or Lot No. / ��Z 0ST E I�-D Owner's Name,Address;and Tel.No. �r��/7I!{S /�i<} C c=U 1 Assessor's Map/Parcel D /Installer's Name,Address,and Tel.No. LV 1I-k-M m D 1 A)C_r Q, Designer's Name,Address and Tel.No. ,TWICE 11 J17 j5 d� (DoNf-1.46 5-7- fly/L, pw5l.5, Type of Building: ;r;'C)U 1`V TAIAI Dwelling No.of Bedrooms / Lot Size '�/., D9� sq.ft. Garbage Grinder ( ) 1 Other Type of Building .�%`'S No.of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow(min.required) 7 C) Q0 gpd Deign flow provided � ��, 9<j 6 PID gpd Plan Date Number+,of f sheets Revision Date Title Size of Septic Tank UD ( Type of S.A.S. , Description of Soil Nature of Repairs or Alterations(Answer when, pplicabl) i 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. Signed w> .f%(i \ Date OY { Application Approved by ;' Date Application Disapproved by: Date for the following reasons Permit No. )00 0-r- Date Issued f o.Z Q THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (X Upgraded ( ) Abandoned( )by W lk L/A W 'i D/AhO G,t I: at -3 D gTAC(- QD C— V 1 1 T has been constructed in accordance with the provisi ons of Title 5 and the for Disposal System Construction Permit No. 2tJ1),r_D as'' dated I/? Installer 6i ? f / Designer #bedrooms k,�} 1�y�, Approved design flow V I gpd. The issuance of this permit shall o Abe o strued as a guarantee that the system w' fu cti .on as designe U Date Inspector i -�) No.,�! J rT Fee l 6 THE COMMONWEALTH OF MASSACHUSETTS ` PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS li5po5al *p5tem Con6truction Permit Permission is hereby granted to Construct ( ) Repair (( Upgrade ( ) Abandon ( ) System located at -may a/-P 1j T Gr_— L2b (a/- u �J)i'j..4= and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. fj Provided: Cohstraction must be completed within three years of the date of xhrs errhit. , Date f J 2•//dy Approved by -a/- - Town of Barnstable °AWE Regulatory Services Thomas F. Geiler, Director MAMaea,Ysr�Bi.s. r�pl1639. '`eg Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 503-862-4644 Fax: 503-790-6304 Installer_& Designer Certification Form f Date:01• U Sewage Permit# o?0b Q rb©rssessor's Map\Parcel cl) Designer--Pf'/4zeA Installer: Address: PD , -BD)( 9po1 Address: 4 o253*1 On (date) (installer) was issued a permit to install a septic system at 34� OLD STAGC ROA-O based on a design drawn by (address) �:)kP-Re^ 14. Ale y e R S dated 0/• Qo`Z �� (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. V 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. RE EN . o (Installer's Signature) _ _ 1 No. 1140 \ 'AEG/STEM p SqN I TAR\I'� 01 W-L O D(Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORNI AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU Q:Health/Septic/Designer Certification Form 3-26-0,:.doc m TOWN OF BARNSTABLE _ LOCATION , "5' 0 OLD S rAO- /Q—O SEWAGE VILLAGE� 'Jl�`T��V/4L.P ASSESSOR'S MAP&PARCELJ)1 /1/0 —"� INSTALLERS NAME&PHONE NO. ���,� SEPTIC TANK CAPACITY LEACHING FACILITY: e ©�(tYP �a—v G C (size) NO.OF BEDROOMS OWNER 'A /"7 7 .. PERMIT DATE: IIA91 kZ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BYi" %G � 1� A 3 R-3 QWN 0 STABLE LOCATION SEWAGE # ASSESSOR'S MAP & LOT O -�0 J v 1,J1f � SEPTIC TANK CAPACITY 1�J � 0 LEACHING FACILITY: (type) �Wc S� ) NO.OF BEDROOMS _i MDER OR�OUWNER A 7'E: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by - �4c j Mo A O PA Commonwealth of Massachusetts Title 5 Official Inspection Form - Not for Voluntary Assessments d Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification Important: 30 When filling out 1. Property Information: O�� forms on the a Road 346 Old Stage � computer,use 9 only the tab key Property Address to move your Today Real Estate V cursor-do not use the return Owner's Name key. 1533 Falmouth Road Owner's Address Centerville MA 02632 City/Town State Zip Code Ili Date of Inspection: 10/27/07 Date 2. Inspector: MR. ROBERT A. DRAKE Name of Inspector KCJ ENGINEERING Company Name 66 GREENVILLE DRIVE Company Address FORESTDALE MA 02644 Cityrrown State Zip Code 508-477-5048 Telephone Number ' S Certification Statement: t ,, 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 Sel i 1 340 of Title 5(310 CMR 15.000).The system: ZN OF Mess ❑ Passes ® Conditionally Passes 9 ❑ ROBERTA. DRAKE ❑ Needs Further Evaluation by the Local Approving Authority o CIVIL 2 - A i 9 No.41642 Q in Inspector's Signature Dates/ONALEN��� The system inspector shall submit a copy of this inspection report to the Approving t rity(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 346 Old Stage Road-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 T Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 346 Old Stage Road Property Address Centerville MA 02632 Cityrrown State Zip Code Today Real Estate 10/27/07 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND)in the❑for the following statements. If"not determined," please explain. ® The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: First Cesspool is made of 6'x 6' block and showing signs of exfiltration.Water level is approximately 2.5' below the invert of the out going pipe. The cesspool needs to be replalced with a new septic tank. 346 Old Stage Road-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 346 Old Stage Road Property Address Centerville MA 02632 City/Town State Zip Code Today Real Estate 10/27/07 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 346 Old Stage Road-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form ' M A. Certification (cont.) 346 Old Stage Road Property Address Centerville MA 02632 City/Town State Zip Code Today Real Estate 10/27/07 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 346 Old Stage Road-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 346 Old Stage Road Property Address Centerville MA 02632 Cityrrown State ZipCode Today Real Estate 10/27/07 Owner's Name Date of Inspection D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than'/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes No ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 346 Old Stage Road-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5of16 I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'G M A. Certification (cont.) 346 Old Stage Road Property Address Centerville MA 02632 Cityrrown State Zip Code Today Real Estate 10/27/07 Owner's Name Date of Inspection 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 El ❑ 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. 346 Old Stage Road-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist 346 Old Stage Road Property Address Centerville MA 02632 Citylrown State Zip Code Today Real Estate 10/27/07 Owner's Name Date of Inspection Check if the following have been done. You must indicate"yes"or"no"as to each of the following: YES NO ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection?, ❑ ® Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 346 Old Stage Road-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 346 Old Stage Road Property Address Centerville MA 02632 Citylrown State Zip Code Today Real Estate 10/27/07 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): �O°� I I�, 279 gpd Sump pump? ❑ Yes ® No Last date of occupancy: a couple of months ago. Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 346 Old Stage Road-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M C. System Information (cont.) 346 Old Stage Road Property Address Centerville MA 02632 Cityrrown State Zip Code Today Real Estate 10/27/07 Owner's Name Date of Inspection General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/A gallons How was quantity pumped determined? N/A Reason for pumping: N/A Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Cesspool with an overflow cesspool. Approximate age of all components, date installed (if known)and source of information: House built in 1950. Assume first cesspool installed at that time. Were sewage odors detected when arriving at the site? ❑ Yes ® No 346 Old Stage Road-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M C. System Information (cont.) 346 Old Stage Road Property Address Centerville MA 02632 Cityrrown State Zip Code Today Real Estate 10/27/07 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: approx. 2' feet Material of construction: ❑ cast iron ❑ 40 PVC ® other(explain): Orangerburg Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear to be structurally sound, no signs of leakage. Septic Tank(locate on site plan): Depth below grade: 0.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 6'x 6'concrete block, there are no tees or baffle in tank. If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance?(attach a copy of ❑ Yes ❑ No certificate) Dimensions: 6'x 6'concrete block Sludge depth: approx. 2.5 feet Distance from top of sludge to bottom of outlet tee or baffle approx. 3.5 feet to pipe invert Scum thickness approx. 4 inches Distance from top of scum to top of outlet tee or baffle approx. 2.2 feet to pipe invert Distance from bottom of scum to bottom of outlet tee or baffle approx. 2.8 feet to pipe invert How were dimensions determined? MEASURED IN FIELD 346 Old Stage Road-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 f Commonwealth of Massachusetts L Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 346 Old Stage Road Property Address 346 Old Stage Road MA 02632 City/Town State Zip Code Today Real Estate 10/27/07 Owner's Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): In the first cesspool shows signs of leakage, no tees or baffles present. Cesspool should be repalce with new septic tank. Grease Trap(locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): 346 Old Stage Road-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 346 Old Stage Road Property Address Centerville MA 02632 City/Town State Zip Code Today Real Estate 10/27/07 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: N/A 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.): Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert N/A Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 346 Old Stage Road-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 346 Old Stage Road Property Address Centerville MA 02632 City/Town State Zip Code Today Real Estate 10/27/07 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ 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.): Overflow cesspool was dry at the time of inspection. Approximately 7.5 feet from bottom of cesspool to invert of pipe. 346 Old Stage Road-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13of16 Commonwealth of Massachusetts Title 5 Official Inspection Form aS Not for Voluntary Assessments �M SVB Subsurface Sewage Disposal System Form C. System Information (cont.) 346 Old Stage Road Property Address Centerville MA 02632 Cityrrown State Zip Code Today Real Estate 10/27/07 Owner's Name Date of Inspection Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan):. Materials of construction: N/A Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 346 Old Stage Road-T51NSP.DOC.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M C. System Information (cont.) 346 Old Stage Road Property Address Centerville MA 02632 City/Town State Zip Code Today Real Estate 10/27/07 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. aI U a� ® A - -70 6 A �ISeks.�C�ve�s R1 6KAu 346 Old Stage Road-T51NSP.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 346 Old Stage Road Property Address Centerville MA 02632 City/Town State Zip Code Today Real Estate 10/27/07 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 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: Barnstable GIS Groundwater Maps indicate high groundwater elevation is at approx. = 27.0', GIS Contour Maps indicate ground elevation is at approx. 60.0', Cesspool bottom approx. 8' below grade therefore bottom elevation is at approx. = 52'. Approximately 25'separation. 346 Old Stage Road-T51NSP.DOC.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 I nit"'a l 5 2440 TowN®� L HfgU1♦��pTA�E �,�.,, COMMONWEALTH OF MASACHUSETTS �- EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 346 OLD STAGE RD. CENTERVILLE CENTERVILLE, MA MAP 190 PAR 104 02 Name of Owner STEPHEN SMITH Address of Owner: 340 OLD STAGE RD.CENTERVILLE MA.02632 Date of Inspection: 2/1/00 Name of Inspector: JOHN GRACI I am a DEP approved system Inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET MA.02536 Telephone Number: 508-664-6813 FAX 508-664-7270 CERTIFICATION STATEMENT I certify that I have personalty Inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of Inspection.The Inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evaluati By the Local Approving Authority Fails Inspector's Signature: Date:2/5/00 The System Inspector shall s mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life:" THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND REPLACING COVER ON FIRST CESSPOOL.RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. 3 revised 9098 Page 1 of 11 i 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 346 OLD STAGE RD. CENTERVILLE CENTERVILLE, MA MAP 190 PAR 104 02 Name of Owner STEPHEN SMITH Date of Inspection: 2/1/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are Indicated below. 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all Instances.If"not determined",explain why not. n& The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance attached)indicating that the tank was Installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. n& Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass Inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced p(g The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if (with approval of the Board of Heath): _broken pipe(s)are replaced _obstruction is removed revised 9/2/98 Page 2 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 346 OLD STAGE RD. CENTERVILLE CENTERVILLE, MA MAP 190 PAR 104 02 Name of Owner STEPHEN SMITH Date of Inspection: 211/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system Is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy Is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS Is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds Indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance Wa(approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 346 OLD STAGE RD. CENTERVILLE CENTERVILLE, MA MAP 190 PAR 104 02 Name of Owner STEPHEN SMITH Date of Inspection: 2/1100 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage Into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level In the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below Invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times In the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Q. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No - X the system Is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply - X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system In accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further Information. f revised 9/2198 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 346 OLD STAGE RD. CENTERVILLE CENTERVILLE, MA MAP 190 PAR 104 02 Name of Owner: STEPHEN SMITH Date of Inspection: VI/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health. X - None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was Inspected for signs of sewage back-up. X - The system does not receive non-sanitary or industrial waste flow. X _ The site was Inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X - The septic tank manholes were uncovered,opened,and the interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing Information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)] X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 346 OLD STAGE RD. CENTERVILLE CENTERVILLE, MA MAP 190 PAR 104 02 Name of Owner STEPHEN SMITH Date of Inspection: 2/1/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 0 Number of bedrooms(actual): Total DESIGN flow: n/a Number of current residents:n/a Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate Inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: 1/15/00 COM M ERCIALlINDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of Information: THE SYSTEM HAS NOT BEEN PUMPED IN THE LAST YEAR. System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous Inspection records,if any) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: THE SYSTEM IS OVER 30 YEARS OLD. Sewage odors detected when arriving at the site:(yes or no): NO revised 9/2198 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 346 OLD STAGE RD. CENTERVILLE CENTERVILLE, MA MAP 190 PAR 104 02 Name of Owner STEPHEN SMITH Date of Inspection: 2/1/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 12" Material of construction: _ cast iron _ 40 Pvc X other(explain) Distance from private water supply well or suction line: 0" Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) THERE IS TOWN WATER;THE SEWER LINE IS ORANGERBURG SEPTIC TANK: X (locate on site plan) Depth below grade: 1" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank Is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 6'X6'BLOCK CESSPOOL NOT TIGHT" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 24" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) MAIN CESSPOOL AND ALL COMPONENT ARE STRUCTURALLY SOUND.RECOMMEND REPLACING COVER,AND MAINTAINING EVERY ONE TO TWO YEARS. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a ` Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in reation to outlet invert,structural integrity,evidence of leakage, etc.) n/a revised 9/2/98 Page 7 of 11 r i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 346 OLD STAGE RD. CENTERVILLE CENTERVILLE, MA MAP 190 PAR 104 02 Name of Owner STEPHEN SMITH Date of Inspection: 2/1100 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,Inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:n/a Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet Invert: n/a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage Into or out of box,etc.) n/a PUMP CHAMBER: _ (locate on site plan) Pumps In working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 346 OLD STAGE RD. CENTERVILLE CENTERVILLE, MA MAP 190 PAR 104 02 Name of Owner STEPHEN SMITH Date of Inspection: 2/1/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,If possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)6 XT BLOCKCESSPOOL leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE OVERFLOW CESSPOOL IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE PIT WAS EMPTY,AND HAS NOT HAD MORE THAN 2'OF WATER IN IT. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet Invert: n/a Depth of solids layer: n/a Depth of scum layer. Na Dimensions of cesspool: n/a Materials of construction: nla Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: Na Dimensions: Na Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2/98 Pa e 9 of 11 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 346 OLD STAGE RD. CENTERVILLE CENTERVILLE, MA MAP 190 PAR 104 02 Name of Owner STEPHEN SMITH Date of Inspection: 2/1100 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes Into house) q d A'4 3a r revised 9/2198 Page 10 of 11 x Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 346 OLD STAGE RD. CENTERVILLE CENTERVILLE, MA MAP 190 PAR 104 02 Name of Owner STEPHEN SMITH Date of Inspection: 2/1/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow— Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 10 Feet Please indicate all the methods used to determine High Groundwater Elevation: NQ Obtained from Design Plans on record No Observed Site(Abutting property,observation hole,basement sump etc.) NQ Determined from local conditions NQ Checked with local Board of health NQ Checked FEMA Maps KQ Checked pumping records �Q Checked local excavators,Installers Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-10+FEET revised 9/2198 Page 11 of 11 ,4 ,T BENCH MARK N ILIA �R RUN t TOP OF CONC BOUND LEGEND. z N y R o4 ELEVATION = 57. 48 PROPOSED CONTOUR 2 L 93.00 ft 61\ �' ARI\JSTABLE GIS DATUM r - - - ------- - - - - - - - - - - - - - ------- - - - - -1 - - ___ B 9 PROPOSED SPOT GRADE �PA� zGR _ 68.91 Q¢ �T RD aRs �� Q ft _ - 59 __ 98 __ EXISTING CONTOUR ���• �s�8 9/y _ 74 + 96.52 EXISTING SPOT GRADE / Q�V C�9O m ! ft \ \ \ W— EXISTING WATER SERVICES�SOterUl `oJ TEST PIT R Q o a m ! O 0 10 f t \ \\ \ \\ j `�' o Q `� Shopping o ' I \ \ \ i 58 D ! �� � �� \ \ \ �. chwos T fV _ \ \ [ _.�sa Cvitn. �' z r— \ \I \ j LOCUS MAP N.T.S. 0 Z O z J z \� A�ANDONE TER LINE _ - _ . — . \\ \ r KOI �59 GENERAL NOTES: co Io W A \ I 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL POND BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS \ OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE \ I TH-1 \ Oj LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. j 0 �`s�TH-2 \ \ �I 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN AOp T ENGINEER BEFORE CONSTRUCTION CONTINUES. V- ___c7�r n � I 6 C 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. ID U ) \0 I 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF \'T}1 3 r \ rp HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. `\ 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED j TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 1 TFI-4 �� 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY qoD I �� THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING I __ �� I fr it 61 CONSTRUCTION. I + 2 ft I 10. EXISTING LEACH PITf TO BE PUMPED CRUSHED AND REMOVED 1 T I / 1 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION / I I 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY / I AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 62 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING 14. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPECIFIED OTHERWISE) 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW I FOR THE USE OF A GARBAGE GRINDER LOT — A 1 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING d 1 17. PROPERTY IS NOT LOCATED IN A ZONE OF CONTRIBUTION. / AREA = 21 ,097 sif O - 6 2 cv I It I '' C 10 of I o D RVN t PROPOSED SEPTIC SYSTEM UPGRADE PLAN U NO 1 Ro y # ; 346 OLD STAGE ROAD, CENTERVILLE, MA Prepared for: Bartlett 'AFC/siE � ;', MAP. f90 Engineering by: Surveying by: SCALE DRAWN JOB. NO. SURVEY REFERENCE: MNITA \ LOT. 104 DARRENM.MEYER,R.S. Eco-Tech Environmenta! 1"=20- DMM PLAN OF LAND BY BAXTER & NYE, INC. u DEED BOOK.•# 12944 Po Box 981 (508) 364-0894 DATED: MARCH 10, 1982 �f( �Z •Q V - DEED PAGE.•#203 EAST SANDWICH,MA 02537 DATE: CHECKED SHEET NO. V 508-362-2922 01/02/08 DMM 1 Of 2 ELEV. TOP - FOUNDATION * " (Existing) FINISH GRADE= 61.0 62.73 F.G.EL: 61.5 F.G.EL: 61.0 F.G. EL: 61.25 fMAINTAIN 2% MIN SLOPE OVER LEACHING AREA COVERS TO WITHIN 6 OF GRADE 76" INSPECTION PORTL - 25 FINISH GRADE 4" SCH 40 PVCL = 5'1o"I o a o 0 0 0oao o a a (MIN.) ® S= 1% (MIN.) e- 0 S= 1% (MIN.) TEE'S ARE TO BE 14 4' SCH 40 PVC IN V.59.38 INV.59.13 0 0 o a , 0 0 0 0 0 o a INV.58.96 GAS PROPOSED DB-3 C GOn,no 101,1010 EXISTING OUTLET BAFFLE INV. 59.99 H:. -10 DISTRIBUTION BOX 25,Alm A'm INV. 59.63 PROPOSED 1500 GALLON SEPTIC TANK NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR TO CONSTRUCTION ft«FABRI 9 MIN. 2) D-BOX SHALL BE SET LEVEL AND TRUE TO PER T1 TLE 5 GRADE ON A MECHANICALL COMPACTED SIX OF MgsS' INCH CRUSHED STONE BASE, AS SPECIFIED IN BREAKOUT EL = 58.5 �Q l' 310 CMR 15.221(2) INV. ELEv.=58.0 DA M. 3) INSTALL INLET & OUTLET TEES AS REQUIRED J�4-_ �_,�• 24 30 5 o. 114 "' o«iecE WASNID SnwE INVERT 1 ciTE ° SEPTIC SYSTEM PROFILE BOTTOM EL.= 56.0 V8" so" 8" SANITAR�aa U I 146" _ I O SEPARATION 5.50 FT. BOTTOM OF TH-1 EL: 50.5 SOIL ABSORPTION SYSTEM (SECTION) SOIL LOGS P#: 12059 DESIGN CRITERIA NUMBER OF BEDROOMS: 2 BEDROOM ACTUAL/ 3 BEDROOMM DESIGN (not in zone 11) DATE: DECEMBER 28, 2007 SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) SOIL EVALUATOR: DARREN MEYER, R.S., CSE DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONNA MIORANDI, BARNS. BOH DAILY FLOW: 110 G.P.D. r DESIGN FLOW: 330 G.P.D. Elev. TH-1 Depth Elev. TH-2 Depth Elev. TH-3 Depth Elev. TH-4 Depth GARBAGE GRINDER: NO (not designed for garbage grinder) q 60.5 0" 60.5 A 0" 61.3 0" 61.25 0" SEPTIC TANK: 330 gpd x 2 = 660 gpd USE NEW 1,500 GALLON SEPTIC TANK LOAMY SAND LOAMY SAND A A LOAMY SAND LOAMY SAND (330) = 445.94 S.F. 10YR 3/2 10YR 3/2 10YR 3/2 10YR 3/2 LEACHING AREA REQUIRED: 60.17 4" 60.17 4" 60.97 74 4" :60.92 4" B LOAMY SAND B LOAMY SAND B LOAMY SAND B USE THREE (3) INFILTRATOR 3050 UNITS WITH 4 FT. STONE IOYR 5/8 10YR 5/8 10YR 5/8 LOAMY SAND ON THE SIDES & 1.3 FT. STONE ON ENDS: 25' L x 12.16' W x 2'D 58.0 30" 5&0 30" 10YR 5/S 58.8 30" -�59.75 30" BOTTOM AREA: 25 x 12.16 = 304 SF Ct C1 Ct C1 � SIDE AREA: (25 + 12.16) X 2 X 2 = 148.64 SF TOTAL SQUARE FEET PROVIDED = 452.6 vs. 445.94 REQ'D + MEDIUM MEDIUM• SAND PERC 0 56.25 SAND SAND MEDIUM PERC ®56.3 MEDIUM DESIGN FLOW PROVIDED: 0.74(452.6 S.F.) = 334.95 G.P.D. vs. 330 G.P.D. req'd SAND 2.5 Y 7/4 2.5 Y 7/4 2.5 Y 7/4 2.5 Y 7/4 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 346 OLD STAGE ROAD, CENTERVILLE, MA Prepared for: Bartlett 50.5 120" 50.5 120" 51 14 122" Engineering by: Surveying by: SCALE DRAWN JOB. NO. 51.25 120" DARRENM.MEYER,R.S. EI•co-Tech Environmental N.T.S. DMM PERC RATE <5 MIN/IN. ("Cl" HORIZON) PERC RATE <5 MIN/IN. ("Cl" HORIZON) Po BOX981 (508) 364-0894 NO GROUNDWATER OBSERVED NO GROUNDWATER OBSERVED E4STSANDWICH,MA02537 DATE CHECKED SHEET NO. 508-362-2922 01/02/08 DMM 2 of 2