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HomeMy WebLinkAbout1157 OLD STAGE ROAD - Health 1157 Old Stage Road Centerville A= 173 —087 f S M EAD No.H183OR UPC 10259 smead.com • Made in USA oix- TOWN OF BARNSTABLE LOCATION �J �� f��� �� SEWAGE#-:2 t'VILLAGE ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. - SEPTIC TANK CAPACITY�Xi.�'�'%'�' LEACHING FACILITY:(type (size) NO.OF BEDROOMS OWNER ��c�'��/ PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: e Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on` site or within 200 feet of leaching facility),,: Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) _ / / Feet FURNISHED BY '. S , /7 mac'./,S'cr'dLs a N l 3. e No. 1 1 Fee A10 'r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS applitation for Misposal 6pBtem Construction vermit Application for a Permit to Construct( ) Repair(eUpgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.�/3",7 9�,�j,�Tj��.,��d Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 3— cps Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building —� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank �Ti� /o®ea457 `-'Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) J'C`0'e* 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. �j t Signed Date / J Application Approved by 14 Date Application Disapproved by Date for the following reasons Permit No. ��� Date Issued L 7147NO. •a f r Fee G t) THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer:_ - Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS fiplitation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.f/r 7 O�.f !'T/Q a Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ZJ J Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 07 Type of Building: Dwelling No.of Bedrooms 3 I' Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3, © gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size'of Septic Tank G` ✓'T��" ��o ! ype of S.A.S. 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. Signed Date Application Approved by r Date C Application Disapproved by Date for the following reasons r 1 Permit No. 1 c1 V- 067 Date Issued l/ L/ / C Th E COMMONWEALTH OF MASSACHUSETTS _ BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( 4 Upgraded( ) Abandoned( )by Sl r� G G��GG�l/ S e���c at../�J_ 7 C?46 has been constructed in accordance t/ i with the provisions of Title 5 and the for Disposal System Construction Permit No. UI '1-01 7 dated Installer�!/yj �C` 4�l//F` 1'G`�1'� ,�diL �esigner A Z Z4 � O•v Q-1', #bedrooms Approved design flow L) / gpd The issuance of this a its 11 not be construed as a guarantee that the syste .ction as designed �. �/ d 0 Date Inspector , . r y v No. 2 6 w— 0 3 - Fee 7a THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(j4< Upgrade( ) Abandon( ) System located at ��r� 0 '�� ✓���lr �d C�f�''7' 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. i Provided:Constriction must be completed within three years of the date of this permit. r Date C f( Approved by ( i i Town of Barnstable Regulatory Services A } Richard V. Scab Interim Director sasysrABLY- ,�, = /k, Public Health Division \ a1 Thomas .MeKean,Dirarror 200'MIain Street,Hyannis,hLk 4D-601 Office: 508-862-4644 Fax: 508;90-630-` Installer& Designer Cerfzcation Form Date: ��/�' Sewage PernaitT���� oy �issessor,-s MapTarcel -E Ides:finer: t � -� 1 Installer: - 'i' °, ��. ✓.1 Address: JE• 1 � Address: Cn 7 y� i . was issued a perrui to iota a a ate) (installer) septic system at ;5 7 D---P r based on a desi-&aw-n by ("address' ��b�c'tL'p� � • � e�y� CatBd � � �� (designer). 1/ I certify tiat the septic system referenced above was i .,alled ssbstan ally accordin- to the design, which may include minor approved changes such as lateral relocation of the dis:-ibution box and/or septic tank. Strip cut (if required) was ins-pected and the soils were sound satisfactory. I certify that .he septic system referenced above was insta_led with major cha-1-ges (i.e. seater than 10' lateral relocation of t:*,(.- SAS or any vertical relocation of any component of the septic system) but in accordance with State 3e Local Regalations. Plan revision or ce:�afied as-built by 'esier to follow. Slip oit (if required•) was inspe-ed and the sots were found satisfactora. I certify that the system_referenced above was contracted in cosh ante N `1 the terms.of the I',A approval letters (if applicable) r C), � �taller's Si att e) i fiA�S� mo.10 sign i�nature) (Affix Dest _p Here) PLEASE RETURN TO BAPUNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NO T BE ISSUED UNTIL BOTE TIBS.FOR�YIAS- �6� BUMT CARD ARE RE+CE-VEED B`i THE BARNS TABLE• PUBLIC H.EAI,TH DIVISION. TILA.NK YOU. Q:\SepticTes.gner Cerrficator,F3r.m Rev 8-14-13.doe ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1157 Old Stage Road r,y Property Address r Alfred Bleau '" Owner Owner's Name information is : required for every Centerville/ Ma 02632 5/21/2019 ► 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. Imngoutf rms A. Inspector Information �� /8gc1 f filling out forms on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. Company Lane Co Company Address Centerville Ma 02632 City/Town State Zip Code 508-658-3456, 774-248-4850 SI 4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 5/21/2019 Inspector's Signature Date The system inspector shall su m�copyy this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1157 Old Stage Road Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 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 dwelling located at 1157 Old Stage Road Centerville is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and a 2 lateral perforated pipe leach field. The system was found to be in proper working condition at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"'or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1157 Old Stage Road Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form jo Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1157 Old Stage Road Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. CityTTown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form !� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1157 Old Stage Road Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form M�a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1157 Old Stage Road Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? • ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1157 Old Stage Road Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form j° Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1157 Old Stage Road Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �. 1157 Old Stage Road u Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system.(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: system repaired 4-10-2014 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leaks or blockages. Vented through roof t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1157 Old Stage Road Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 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 gallons 101, Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 2.5 Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank should be cleaned soon and again every 2 years for proper maintenance. Outlet tee was intact, tank was structurally sound. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form lio Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1157 Old Stage Road Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 14*1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 1157 Old Stage Road Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was level and in good condition with no rot. Water level was even with outlet inverts with no signs of past backup. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1157 Old Stage Road Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 39'x12'x6" ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1157 Old Stage Road Property Address Alfred Bleau Owner Owners Name information is required for every Centerville Ma 02632 5/21/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): s.a.s. consists of a 2 lateral leach field 39'x12'x6". Both lines were video inspected from d-box and found clean with no signs of past overloading. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments l; 1157 Old Stage Road Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 i Commonwealth of Massachusetts . Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1157 Old Stage Road Property Address Alfred Bleau Owner Owner's Name information is Centerville Ma 02632 5/21/2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately i O 0 3 Z t i 5r A-2 28 Qz 1'7 '43 Z0`Y �33 30 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts ra Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 1157 Old Stage Road u Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10 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: 4-1-14 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: Design plan dated 4-1-14 states that groundwater was observed at 10'and system is designed to have 4' seperation between bottom of s.a.s. and adjusted groundwater elevation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 " Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1157 Old Stage Road Property Address Alfred Bleau Owner Owner's Name information is required for every Centerville Ma 02632 5/21/2019 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 i Town of Barnstable Ul the lq,, P#—/� Department of Regulatory Services 1 seatvaTAst.e. : Public Health Division Date .. '� RAss' t639 ,e 200 Main Street,Hy nis MA 02601 CFO MA'I 1, Date Scheduled'. / r Tune Fee Pd. "Oil Suitability Assessment for Se e i o a Performed By: Witnessed By: �f LOCATION& GENERAL INFORMATION Location Address �/S`� Owner's Name Address,::� zqz� Assessor's Map/Parcel: �3, Engineer's Name NEW COiYSTRUCTION REPAIR z /��j Y � Telephone# Land Use' Slopes(%) - Surface Stones' Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line —__ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) c - C C) 11";I`0 i= a ) t".J Y'C7 Parent material(geologic) �� Iw �T Depth to Bedrock (/ Depth to Groundwater. Standing Water in Hole: Weeping from Pit Pace Estimated Seasonal High Groundwater Method Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE Depth Observed standing in obs.hole: in. Depth to soil mottle$: Depth to weeping from side_of obs.hole:. in, Groundwater Adjustment fn r. `Index Well ' ' 'Reading Date: Index Well level Adj.factor AdJ,Groundwater level, 1 PERCOLATION TEST b>lta . Thne 10 Observation Hole# Time at 4" Depth of Pere Time at 6" Start Pre-soak Time @ 1 Time(9"V) End Pre-soak Rate Min./Inch 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:4S EPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# [Surface epth from Soil Horizon Soil Texture Soil Color Soil Other (in.) I, (USDA) (Munsell) Mottling (Structure.,Stones;Boulders. Cons istriLc Gravell b -Z a0 Z �� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil �()ther Surface(in.) (USDA) (Munsell) Mottling (Structure,:,tones,Boulders. Consistency.�n,�ravell DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulder:. o f to c o Gravel) DEEP OBSERVATION HOLE LOG Bole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, I Flood Insurance Rate-Map: +/ Above 500 year flood boundary No Yes V Within 500 year boundary No es Y rY Within 100 year flood boundary No" Yes . Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi s m terial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pery ous material? "�__ Certification n I certify that on I L/ (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with . the required training,experti and ex en n e described in 310 CMR 15.0117. Signatur Date l * 10� Q:ISEPTIC\PERCFORM.DOC J:�3,P-r s LOCATION SEWAGE PERMIT NO. 0-T o`Z O tot Q y ae— VILLAGEI Lam' ' tom INS A lL R'S NAME ADDRESS b A B U I L D E R R OR OWNER 4 v DATE PERMIT ISSUED DATE COMPLIANCE ISSUED \ � I Lb Fro n 3� 15 a • - , R g �� Fizz . ............ THE COMMONWEALTH OF MASSACHUSETTS SOAR® /qF HEALT ............................... Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System t��t ....... Location• ess o t No. // ...... �� � L�'�-� � . •................•........ ..... L t...v.. ......oc< ._ e.Cg,d1--' ----------- O ner Address a ........... Installer Address Type of Building Size Lot/q a .7......Sq. feet U Dwelling—No. of Bedrooms........ _. .___.Expansion Attic (a?.G.9) Garbage Grinder (,f aOther—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) G4 Other fixtures --•••................................. . W Design Flow..........�____...............gallons per person per day. Total daily flow.........S.,.TO.................. WSeptic Tank—Liquid capacity/jl1OO.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...... ft' Z Other Distribution box ( ) Dosing t 31k ) Percolation Test Results Performed by.... __ . :_�/_. �f�<'�! _ Date.._...._-! •_... . �}' --- ,`�a Test Pit No. _�j......minutes per inch Depth of est Pit-___� Dept�'i to ground water.____ __.... f=, Test Pit No. �?ha9 __minutes per inch Depth of Test Pit____________________ Depth to ground water-----_l.L............. (-- -----------------------------------j --------------------------- ---------------------------------- •----------------- Description il oo -------0 :--............. --- ---•----•••-----••••--••-----•------•-••--•-----------•--•••--•••-••................ f-v w •••••............................"_ = sae d �!! l sPr .__Scs�tc -----•-••------------•--••-••-•--•--............ VNature of Repairs or Alterations—Answer when applicaJ............................................................................................. ...-•-•--••-•-••••••••••••••--•--•---•••------•------•••-•••--•--•-----•...........................•-•-•-••-•-----------------•---•-•-•-••----•-----••-•••--....---........:._.. ..................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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 byAtherd of health. Application Approved By-------- .. --- .._....... ... Date Application Disapproved for the following reasons:--- .........................-•----•-••------------•-•••--•-•--•-----------•-•-----•-••--...•-•.............._ ------•----------••----•-•......................•---•-•-••......•-------.....-••••------........••-••------.._.............-------------------------•-••--•------••-------------••---------------------- Date PermitNo......................................................... Issued....................................................... Date 4 Application is hereby made for a Permit to Construct (*"<r Repair an Individual Sewage Dis�osal THE COMMONWEALTH OF MASSACHUSETTS �2��L '11114 , , z Other Distribution box Dosin!� Percolation Test Results Performed by. Date...... Test Pit No. minutes per inch Depth of est Pi Dept�to ground water.... ... Nature of Repairs or Alterations—Answer when appi. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T LE 5 of the State Sanitary Code—The undersigned further agrees not to place the s tem in YS operation until a Certificate of Compliance has been_Lssued by th"rd of heal�h.o�. (f sst.k, . --Ir Application Approved Date Date Date THE COMMONWEALTH OF MASSACHUSETTS T,UIS-IS TO GIWTIFY, Thatjthe Individual Sewage Disposal System constructed or Repaired / ------- ...... --------e, ---------- has been installed in accordance with the pro sions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------ ... dated_.4- ------------------ A GU R-A THE THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED,AS eT, E' SYSTEM WILL FUNCTION SATISFACTORY. In THE COMMONWEALTH OF MASSACHUSETTS Permission ii�,hereby granted......510 an Ind' I Sew Dispo al Sy t Street as shown,on the application for Disposal Works Construction PerTnit N -..7, FORM 1255 A. M. SULKIN, INC., BOSTON � / r ' | q9 ' ;a t k� TA �.. �ou,✓p. � 5 �. a 61 X_at N F hrr � LG`7' -71ai o q 6 446 41") 0 :r Z 0 6 iTJ7f/ lei q.:� OF��q sc N pfY��s�� =` ALBERT G ROBERT GJ k, tJ 1✓ `y A. o B. G� MORSE, ELDREC7GE',: ti � . C H A V6 C'P 7U Ac r p No.1095`�p xv No. ifl367 �p f �} ,�} r,. fir- lJ 1Vp:,,-f r�1; �'T IT S e rGl' ct. ADO �C/5 7 E� \v r c�,r f61STE��� c ��r.1_rP ' �r a s a! lOZ L E Q E EXISTING "SPOT ELEVATfON 0,01. EXI>�TING CONTOUR --= 0 CERTIFIED PLOT PLAN " FINISHED SPOT: ELEVATION s t.07- ,2,2 I*INiSMED, CONTOUR 0 CE Al NOTE: ."The location :of any existing unde, r and sewerage, wells;. or other utilities shown on this plan is. approx-_ IN imate only-as determined from records and/or verbal 'information: The contractor is 'responsible'; for the ' 'V" 'w .Z, g' verification of`the exisfin locations in the fle 4i. Y $ SCALE,,. 3 0 DATE -DREDGE ENGINEERING Z 1N CLIENT rr V 'CERTIFY THAT THE, PROPOSED EmISTERE REOISTHRED JOB NO S` BUILDING SHOWN ON THIS PLAN` CtViL - ` LAND.'_ � '� CONFORMS TO THE ,ZONING ;LAWS DR.8Y ENO NEER RV OF BARNSTABLE , .MAS 112 MAIN STREET CH. By ' ,�%� `k a HYA'NN I S; 'MAB.S. 9HEET;,.L.'OF A E REG. LAND SURVEYOR ZOfT. MlN:. . NOrE !F TNF SEPTIC T.4�!/�{ /� MORE THAN /2 11VCHES 8,6E-0GA/ GRADE, A 24 INCH DIAMETER CONC?ETE CO(iER Sf/AL4 ' 4"PVC OtPE BE BROUGHT To G.?AOE �AN .EXTRA AIEAVY /o2S CagCRFTF M1N. P/TGH CAST IRON COYER._5{IALL OE USED !F JN COVERS ••PER FT. DR/VCkV'AAl r--�( FLON�4/FFUSOR O O/? r.� f 2.� M/!�'• GRADE e0UIYALE1V7,GAlURRIE5 SER/ES AT EiYD �'' LlQUIO.LL'VEL _ , AL SCHEDULE 40 _� a o c c� c �, .tf i/ ,TD 4 P_V.C. RI PE .lam. GAL cs� Q L1 G1 �?J� O/SGHATGE L =� M!/V.P/TCH .SaPT/C TA NK �'•` -�• sue. p '-' 4:; ;r�?�`_ grv,o t rro.n . `' BOX 6" "PER FT. a��— G 9�. iPr LEACfftKG GAa` LEVY B WASHED STONE •o� �,way: •' • '• _ _ SECTION OF GROUND l�YA-rzRTA9LE .P,o. . gorra�n:!5z_K/.o = po SEWA(gE DISPOSAL S`YSTE.M �_ TA,641LA7'/D/� TeTRt: CAPACITY° ��� GRID•: x D/MENslolti Q ZS FT. .S'CAI- K4 D/MEKSlCI1f B�FT. i D/MErvS/ON C FT /FT 4 ol: - DA-rE OF SQlL- TEST Soli- 7E�'r #t SO/L 7-E5T eft 2 RESULTS/YIT/V.--SS'ED BT �c 6r�r=oa*� El EY. `n 7 ELEV. �RCOLAT/O/`l RATS At I. PE/QC0LA7-10H RATE W z mlmllNCX $L/35o it T Nb CLElfN .LAYER of 4N/G 357Z 3 .� ,SA/!o 5/Pvj-Y-,rvyY--,V-1 KUM®Er� OF ®EORooMS .mayc=1 � /� ' aARBASrE D/SPOSAL tJK/T• d' "slot L', orl c7 �=; IaA L��STONE EST/hlATgO F40l1/ 33� GAL�DAY � �°�Fg�L" jtE�bCXMG .� .je.•:'.=,.;�w�..r S/DELEACN/N4 AREA BOTTO/�4 LEACJ,//NG AREA /S� SSJ.FT. r e-v. go.Z 70 TA L AREA ZSZ SQ,FT SECTION X—X RESERVE AREA Z�Z SQ.FT. -v, f�9,7 SCALE.` �4~= �`� O r Q 71/O GROUND 1OVATER ENCDUNTA=,TZP ELE'VAT�ONE USGROUNO WATL.R AT EL EY. INVERT _ OF ; ' S�o ALBERT /h/6iE/PT AT QU/LD/N6 /OO,o FT i A. ,'> /NGET SEPTIC TANX 45:3 FT, C-�"�✓% „/i t c-� s S MORSE ; y [ DOTL•ET ..SFP7/C TANS g8 P7, �vo;ios5r o � L©R OGE ENG//dEERl1VG:C0: /NC, G I/YLET /STR/BUT/O/V QQX g� FT . hcZi t4 ` �" \O,cFs IsT �• OuTLET:O,�g7R'18UTJON,(3QX- g7.7 FT7/2 IV/A/N ST.�, NYANhf,/S, IKIAS S. 0!1 1 f/ C�Lt t.� C. ''i'gib_ /NLEr J°LOWDIFJ=USo i� 7, Fr. EN r OATL� tz CLI Comp leted. by FI I GII GROUND-WAT ER LEVCL COMPUTAT I ON S.ia,e .Loc,ai ion: .�Lf� � '� Lot .No. ZZ. Owner: Address. Contractor: p Address: --- .. Notes: STEP I Measure depth to watertable q s to nearest 1/10 ft. . . . . . !/Zs/8y date STEP 2 . Using Water-Level Range .Zone CCSw�53� and Index Well Map locate site and determine: A) Appropriate index we1.1 B) Water-level range :zone* G STEP 3, Using monthly report 'Current Water Resources Conditions" determine current depth to ,ys y%S water. level for. index well mo yr STEP . 4 Using Table of Water-level Adjustments for index well I-N ,Z. STEP 2A current depth to A water level for index .well (STEP 3) , and water-level -- zone (STEP 2.6) determine ��o water-level adjustment - STEP 5 Estimate depth to high—water - —^-- — -^- -- by subtracting the water- 00 - level adjustment (STEP 4) r-- from measured depth to water level at site (STEP I) . . 0 °'°* . _i► Completed by HIGH GROUND-WAIER LLVLL COMPUTAtIOtd -74 Site Locat ion: 7FC �i�y Lot No. Owner: Add.r.ess: I!?.. Contractor; — Address: — Notes: STEP I Measure depth to water table _QS to nearest 1/,10- ft. . . . . . . :. . . ��Zs/8 �.//_—� .. date STEP 2 Using Water-Level Range ,Zone z spw s3 and. Index Well Map locate site and determine: Fj/ �✓ SD4i Z53 . A) Appropriate index well . . . . . Z3� B) Water-Ievel 'range zone , . . . . . STEP `3' Using monthly report"Current Water Resources. Cond i tions" . . determine current depth- to water level for index well . . . . . 9/a mo 'yr STEP. 4 Using Table of Water-level _ Adjustments for index well l-y STEP 2AY , current .depth to water level for index well ' .(STEP 3) , and water-level zone (STEP 2B). determine water-level adjustment STEP' 5 Estinate depth to high water by subtracting the water- le:vel adjustment (STEP 4) from measured depth to water 7, `r level at site (STEP 1 ) . ... . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . I _ President: Member ot: ROBERT BRUCE ELDREDGE,R.L.S. CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS ELDREDGE ENGINEERING MASS.ASSOC.OF LAND SURVEYORS Associates: AND CIVIL ENGINEERS ALBERT A.MORSE,P.E.,R.L.S. COMPANY INC. PHILIP WEINBERG,P.E.,R.L.S. AMERICAN CONGRESS ON SURVEYING AND MAPPING AMERICAN SOCIETY FOR n LSE£z£d -`e C L1t£z£a TESTING AND MATERIALS .land Civil 712 MAIN STREET csuzv£e�ozs °ky 3 & in££za HYANNIS,MASS.02601 TEL.(617)775-2244 Board of Health RE: Lot 22 Town of Barnstable Old Stage Road 367 Main Street Centerville, Ma. Hyannis, Ma, Job # 84076 Greenbrier Devel. Cprp., June 27, 1985 Dear Sirs: Grades were set by this office before the sewerage installation and were checked on June 25, 1985 after installation by the contractor as follows: Distance from flow diffusors to foundation: 21 feet (20' min.) Distance from septic tank to foundation: . 1fil"feet (10°min.) Invert elevation at inlet of flowdiffusor: 97.51 (97.5-min.). Elevation bottom of flowdiffuson: 96.37 (96.0 min.) E In conclusion, I certify that to the best of my knowledge the sewerage system has been installed in accordance with our plan dated April 22, 1985. Sincerely: Robert B. Eldredge, R. L. S. Eldredge Engineering Company, Inc. RBE/j ne ! I i ASSESSORS MAP :_,___,�1� �► ' TEST HOLE LOGS � PARCEL : � � _ ,. . . " O 1) The installation shall corni.,, will, 1 ille V and Town of5► ,bard oL. FLOOD ZONE: /(./C)� SOIL EVALUA"roll : � N/1,0 11�l 6�6 health Regulations. REFERENCE ! -- _ WITNESS : l Ir-IQ V-) 1/t._- _ CC�C..a G ✓�;�"° l 1�-� 2) The installer shall verily the location of ulilitics, sewer inverts and septic � � DATE: �C. l components prior to installation and setting base elevations. -------- 77,c/ PERCOLAT ON RATE- ,G Z 1M! ► , 3) Al l gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first � .- -- two feet out of the d-box to the leaching shall be level. _ �t] 4) This plan is not to be utilized for property line determination nor any other }7 H- 1 /7 �g �/ Z "—' TH-2 purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over 1110 septic components. Z -0 ( l l o 7) The property is bounded by property corners and property lines. LOCATION MAP 8) The property owner shall review design considerations to approve of total lA 1 \ design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed A p Y p approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall QD ` be removed along with contaminated soil and replaced with clean sand per i,;�? VWQ91 W4' e t Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossing the / water line shall be sleeved with 4 inch SCI140 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service i line. The line is to be sleeved as aforementioned and maintained in place. SEPT IC SYSTEM ! DES I G N 11) If a garbage grinder exists it is to be removed and is the responsibility of the oZ,coca - � owner to ensure such. 12)The installer is to take caution in excavation around the gas line if such FLOW ESTIMATE exists. 13)The installer shall verify the location, quantity and elevation of the sewer BEDROOMS AT GAL/DAY/BEDROOM GAL/DAY lines exiting the dwelling"prior to the installation. N P T 14)This plan is representative only that a system can fit on a property meeting SE PTIC I C TANK Title V requirements. I � O ,' \ ` ��I _.' i - � ✓ GAL/DAY x 2 DAYS GAL _ - ,0 USE GALLON SEPTIC TANKL• ! TIfl `' S 0 TL A B S O R P T)ON SY T EM :At IA.?Iye � D��� �DAV►D9c���. Y Imo. �I� a SIDE AREA: � ! BOTTOM AREA: / , €t ,c SO-61 � I' - --� SEPTIC SYSTEM SECTION to \�(A I ovl- 0166 k0� GAL SD),55 � - ' ► — — —� SEPTIC TANK X 30 OTiL l� lT1 53, 1 �►���l�i SITE AND SEWAGE PLAN j LOCATION : ID �- i PREPARED FOR : .�► r G %( � SCALE: W DBC I MASON DATE: ENV IRO RO ' Zol NMENTAL DESIGNS W EAST SANDWICH . MA Z DATE I . HEALTH AGENT ( 508 ) 833- 2 177