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HomeMy WebLinkAbout0020 OUTPOST LANE - Health 20 Outpost Lane , Centerville A= a E No. 42101/3 ORA n � � ESSELTE 10% U& ® @ m O TOWN OF BARNSTABLE . LOCATION 04,�-,R1 f L¢.k c SEWAGE# ;t®10-q- I SIC VILLAGE f2/,���� ASSESSOR'S MAP&PARCEL /7sZ�/Z 0 INSTALLER'S NAME&PHONE NO. A� 6 SEPTIC TANK CAPACITY l000 ff/0 � f` LEACHING FACILITY.(type) J'Z I r® 'J+ (size) _ (9 3 NO.OF BEDROOMS _ 3 OWNER 144-AgA C PERMIT DATE: l 0 q COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility &0 toi 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 ri 5, 5 �.��- 1 f IQ� 8•� atii31 s`s•6 �.a Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Outpost Lane M Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:when A. General Information filling out forms on the computer, use only the tab 1. Inspector: v key to move your cursor-do not Richard M. Capen use the return Name of Inspector key. Capewide Enterprises, LLC r� Company Name 153 Commercial Street Company Address Mashpee MA 02649 Cit !Town State Zip Code Y p '508-477-8877 S113385 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that',the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance''of on;ste sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15?340�gj Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/25/2012 Inspector ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the.system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 'ZD I t5ins•11/10 Title 5 cial nspection Form:Subsurface'Sawage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4n4 20 Outpost Lane Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check.the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 20 Outpost Lane Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N . ❑ ND (Explain below): ❑ obstruction is removed . ❑ Y ❑ N ❑ ND (Explaiin below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 20 Outpost Lane Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has aseptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified Laboratory, for fecal coliform bacteria indicates absent and,the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El ® 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 20 Outpost Lane Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ z The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form m; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 20 Outpost Lane Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components; excluding the SAS, located on site?. E ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the-site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined.in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design):. 3 Number of bedrooms.(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Outpost Lane Property.Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage.grinder? ❑ Yes ® No Is laundry on a separate sewage system? [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)): Detail: 20t 1 _ Lj Z o00 0 Sump pump? ❑ Yes ® No Last date of occupancy: October 18"' 2011 Commercial/Industrial Flow Conditions: Type of Establishment Design flow(based on 310 CMR 15.203): . Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑. No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 20 Outpost Lane M Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? El Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins c 11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 20 Outpost Lane Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. City[Town State Zip Code Date of Inspection D. System Information (cont:) Approximate age of all components, date installed (if known) and source of information: Upgrade using existing tank completed 8/17/2009 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1811 Depth below grade: feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Pipeing 4" PVC SCH 40 Septic Tank(locate on site plan): 10" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, Fist age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal Precast 1" Sludge depth: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 20 Outpost Lane H Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. City/Town State Zip Code Date of Inspection D. System_Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness 1 8" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 17° . How were dimensions determined? Plan/tape sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level with inlet and outlet tees. 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: bate t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Outpost Lane Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow gallons per day Alarm present: ❑ Yes ❑ No Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cwM 20 Outpost Lane Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. City/Town State Zip Code Date of Inspection . D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 3 Hole distribution box replaced 2009 as part of upgrade Pump Chamber(locate on site plan): Pumps in working order: ❑. Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If.SAS not located,explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G„M 20 Outpost Lane Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. Cityfrown State Zip Code Date of Inspection D. System Information-(cont:) Type ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2, 2.875x30 ❑ teaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): dry 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 l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 20 Outpost Lane Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. City/Town State Zip Code- Date of Inspection D. System Information (cont.) Comments (note condition of soil,.signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 f . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Outpost Lane Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate al 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 IG i 1 2 r r� t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 20 Outpost Lane Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: no h2o at 11' per perc test 8/11/2009 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 8/14/2009 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: plan dated 8/13/2009 perc log Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Outpost Lane Property Address Vanessa Lencewicz Owner Owner's Name information is required for every Centerville MA 02632 09/25/2012 page. CityTTown - State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed E System Information Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No. Fee v f/ cJ THE COMMONWEALTH OF MASSACHUSETTS - Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftPfication for bis oral bpstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. -,h o u,Po%T A-,< Owners Name,Address,and Tel.No.'s ' q.r►ice Le-,c RvJ;r.-z te�% 38�o sE 7'� Assessor's Map/Parcel 1"7 12 o S v✓w✓+wLArn Installer's Name,Address,and Tel.No. ✓a�p�w: E'Lt fcslar sej Designer's Name,Address,and Tel.No. Q L-Z a 13 2R S'f C �a e/✓� �4 i.d yr cU ��►va yh i41 s6 Type of Building: Dwelling No.of Bedrooms Lot Size (� O } sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 0 gpd Design flow provided 3 y(�. gpd Plan Date 9-9 - 2QoS Number of sheets Revision Date Title Zo o.►rn�� Size of Septic Tank (k�t¢Z @� �tt�c Type of S.A.S. Z !,/?JL�2�e5s LJ( Pt Description of Soil o (e7Z> 7u Nature of Repairs or Alterations(Answer when applicable) C<6 t)'4 iA*,k 7b N.w ® '(- C Q 3(- t4 c Date last inspected: 'Z00c) 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. Si Date ^�� Application Approved by Date Application Disapproved by Date for the following reasons Permit No. J Date Issued G ..*.^'4..., r 4.fi'1;r•+..,.—..r+.�....,y-..,.•-Yr'-ti", �"._m .�-,:-.""'r .,_. .,---, ;�,.'vw'+•v-` ,,,.'^.d-......).r-.....-.:...,,,sv-,.,...K..v^n....�` - .. . . . I No• Fee L THE COMMONWEALTH OF MASSACHUS;EE.7 w:4; Entered in computer: Yes PUBLIC HEALTH DIVISION is OF BARNSTABLE, MASSACHUSETTS 1 . 2ppIitation for isposal-Opstem Construction !Permit Application for a Permit to Construct( ) Repair(>4 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �,p o VT PoST L Owner's Name,Address,and Tel.No.T4-, Assessor's Map/Parcel 1-7 20 "���� 3�� 5'E Installer's Name,Address,and Tel.No.C n p-ew;4. 611 kip;'S�� Designer's Name,Address,and Tel.No. 1' o tjaa?bT Z,fSY �lt+h�iil✓-� y�,� 1� L C � i�Lc, ( -e.-,,l-V .1:•• y �A'c emu, dY�y Type of Building: Dwelling No.of Bedrooms Lot Size () O 3 sq.ft. Garbage Grinder( ) Other Type of Building 5 i K S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 O gpd Design flow provided -3 (o . gpd Plan Date S -( 3 - 2 doC Number of sheets Revision Date Title_ Z o Size of Septic Tank /.Coo Sol ex,-,I Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Ext 5 i 9-, i-lA-v..i 7b tQ W 2� ST (e--�s TY-<,i,7c�,Y o G � Q -3( .a c 7-w L Date last inspected: -200'y 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 e� .� Date o- Application Approved by Date irApplication Disapproved by ~ Date for the following reasons y t t Permit No. 7� ^— Q`� (v Date Issued G q ------------------------ ----------- --- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Urtificate of Contpfiante THIS IS TO CE,�tTIFY,that the On-site Se age Disposal system Constructed( ) Repaired(�) Upgraded( ) Abandoned( )by �/1r (k r,�,(�P E-")a d✓r L(..c- at Z O O v�'�o>T (,,� ,� �,., l<<• has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.o'bV(m ated `7l Q Installer .,e►A r.,,& E oj1 -J e✓t <-1 Designer 5. c r 11{�c,'h #bedrooms ?, Approved design flow (o_ and The issuance of this y errm�it shall not be construed as a guarantee that the system will rnction as/designed. { -� Date �f / �� Inspector jr J �J ------ ------------- - --- - - Noee,q CJ'SG( Fee�V V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Misposal *pstrm Construction i3ermit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at 7iD 0 cJ 1 Qp5 1 fr,p.� o Le,�„4.{,« c and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date 1 y ��1"1 Approve by I Wn of Barnstable Barnstable Regulatory Services Department MAmedcaChy BA.RNSfABLE. M" Public Health Division ArED""°�p 200 Main Street, Hyannis MA 02601 2007 Zv Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 , A A.9 C CG f, O N 1 12 c{ 1 pt� Thomas A.McKean,CHO CERTTIFIED MAIL 7007 3020 0001 3429 8332 July 15, 2009 Janice H.Lencewicz 3840 SE 167th Place Summerfield, FL 34491 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE AND THE BARNSTABLE CODE: On July 1, 2009 Health Inspector Jaime A. Cabot, R. S. investigated a complaint at the property owned by you located at 20 Outpost Lane, Centerville. The following violations of 310 CMR 15.00, the State Environmental Code, and Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, the State Sanitary Code and the Town of Barnstable Code were observed: 310 CMR 15.303 (2): Septic system is in hydraulic failure. Sewage was observed at the outlet of the septic tank over the top of the tank. 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements: Stairway to cellar bulkhead is damaged, rot was observed on windowsills. 105 CMR 410.351 (A): Owner's Installation and Maintenance Responsibilities: Water supply line to the bathtub leaks, the discharge to the clothes washing machine is not connected to the septic system. 105CMR 410.550 (A) -Extermination of Insects, Rodents and Skunks: Evidence of rodent activity, mice droppings were observed in the kitchen draws. 105CMR 410.550 (D) -Extermination of Insects,Rodents and Skunks: Rodent harborage; stored property in basement has attracted rodents. 105CMR 410.552: Screens for Doors: Sliding door has a hole in the screen. Town of Barnstable Code & 353-9: Discharge of sewage onto the ground was observed. Town of Barnstable Code & 170-4: Certificate of Registration: Rental Property is not registered with the Town of Barnstable. (1) You are directed to keep the on-site sewage disposal system pumped as many times as necessary(daily if needed) to keep it from overflowing onto the ground. (2) You are ordered to obtain a septic design engineer to design the repair plans for the failed septic system at said location and apply for a septic permit with the Health Division within thirty(30) days of your receipt of this letter. (3) The septic system shall be installed in strict accordance with the approved engineered plans within sixty(60) days of your receipt of this letter. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by repairing the damaged screen, connecting the clothes' washer discharge according to applicable codes, repairing the rotting sills, removing the stored property in the basement so as to eliminate the rodent harborage, repairing the leaking water supply line and registering the rental property with the Town of Barnstable Health Department. The tenant is directed to take action to eliminate the rodent activity within twenty- four (24) hours of receipt of this notice. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division- d ask to speak with the inspector who performed the inspection. O THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable ° FORM30 C,W Ho8Bs&WARREN'" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN o DEPARTMENT ADDRESS IL 2!� 0 T P �51 TELEPHONE Address C�N� �tt.yc "A, 0'Z Occupan �L� F% LE Floor Apartment No. No.of Occupants �C�S .., S GJ C�9 2S 1 No. of Habitable Rooms cc No. Sleeping Rooms _ J TO O�✓�i No.dwelling or rooming units \ No.Stories k a.i�.r A..A ti e Name and address of owner A La l� " pt-V_ 0 G'�-W S� I a p4"Ah gLACFt.. �c� Q.�f^��l iA r—L v, —4 Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish S -t rJ Containers: tzA uL; k u Drainage Q F- IV­.ALA& W Infestation Rats or other: -k- STRUCTURE EXT. Steps,Stairs, Porches: j� Dual Egress:and Obst'n se- a t- SS ❑ B ❑ F ❑ M Doors,Windows: -4 U A Na vv � � Roof t3,.i L,, Lc JV0 Gutters, Drains: Walls: Foundation: (� ►'`? Chimney: BASEMENT Gen.Sanitation: L a ( CIL 13 AAA,-j � Dampness: CvN tr fit:- Sr STk Stairs: }3 T,®i�$ vwa Li htin : STRUCTURE INT. Hall,Stairwa : K-&. � 0 Obst'n.: S p cx_ Hall, Floor,Wall,Ceilin : g-T (L cr �LZ Hall Lighting: Hall Windows: N- ,o v C,,, (2 J2 1 G 4tI� zoo S o CA, ) C HEATING Chimneys: J Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: l.L1n�r �-.r_ -c ❑ MS ❑ ST ❑ P Waste Line: V, H.W.Tanks Safety and Ve s ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom —Pantry Den —Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted S'f ,v A4 1110 41 Locks on Doors: TH 'T kk -To wN A 2v ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF ERJURY.", T ' INSPECTOR E •S, TITLE "S f DATE r TIME �(� P.M. A.M. THE NEXT SCHEDULED REINSPECTION T,&A P.M. J 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included.in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required,by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. r vi safe supply (E) Failure to provide a s o pp y of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or .other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 4.10.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. l Barnstable Assessing Search Results Page 1 of 1 2009 Assessed Values: LENCEWICZ, JANICE H 20 OUTPOST LANE Appraised Value Assessed Value Map/Parcel/Parcel Extension Building Value: $ 113,400 $ 113,400 172 / 120/ Extra Features: $ 11,200 $ 11,200 Outbuildings: $ 0 $ 0 Mailing Address Land Value: $ 143,200 $ 143,200 LENCEWICZ, JANICE H Totals $ 267,800 $ 267,800 3840 SE 167TH PLACE SUMMERFIELD, FL. 34491 2009 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Community Preservation Act Tax $ 55.43 Fire District Rates Town Residenti Barnstable FD - All Classes $2.37 $6.90 C.O.M.M. - All Classes $1.08 Town Commeri C.O.M.M. FD Tax (Residential) $ 289.22 Cotuit FD - All Classes $1.43 $6.12 Hyannis - Residential $1.78 Town Tax (Residential) $ 1,847.82 Hyannis - Commercial $2.77 W Barnstable - All Classes $2.11 Community Pres Total: $ 2,192.47 http://www.town.bamstable.ma.us/assessing/2009/displayparcelO9map.asp?mappar=172120 7/7/2009 r Town of Barnstable P#_ �/2 e y!� oF�� , Department of Regulatory Services ? BAM HASS, Public Health Division Date 1639 ,6� 200 Main� Street,Hyannis MA 02601'OTFO IAA A , Date Scheduled Time Fee Pd. /(Jc) Soil Suitability.Assessment for Sewa e Disposal t� Performed By: �Oh'n �. Dr�il( i1C, e•C• P C.S, Witnessed By: LOCATION& GENERAL INFORMATION Location Address j �ta f�t�GwC Owner's Name �. .v.a`� Address Zo OL*e sk,Z.O&Z I ceolleru4t t 1d.A Assessor's Map/Parcel: Engineer's Name 'Sc t:NgfA¢ui�nS frnC i NEW CONSTRUCTION REPAIR Telephone# 506,2173-6377 T Land Use S.prle �Qoj(r /rea(degjja1 !Slopes 30 tt p ( ) 1-2- Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well '- ft Drainage Way ft Property Line �10 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Se zt aga`CA o041 Parent material(geologic) 006wa5v) Depth to.Bedrock 7 (32 (OS S Depth to Groundwater. Standing Water in Hole: 7 1 3 2 u s Weeping from Pit Face 132S Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Dwec)c 60sarvat- Depth Observed standingm obs.hole: ''t 3 L in. Depth to soil mottles: Depth to weeping from side of obs.hole: i 3 2 in. ©roundwater AdJties: — ft. Index Well# _ Reading Date: Index Well level AdJ,factor Adj.Clroundwater Level R Observation PERCOLATION TEST bate t�-11-0 9-0 9 Time 10 n Hole# 1 Time at 4" - Depth of Perc 36-Vb -Time at 6" Start Pre-soak Time @ i w i 2 An Time(9"•6") v End Pre-soak 1 U:2,0 hh - Rate Min✓Inch 4�- 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:\S EPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. on istencGravel) A (o-2 y hj L S 10 it alb G- F- 5`1 / Z W- 9� Cs 2. ` � 25/e o o.�eA ' So c.oik lei C-Z H S 2.517/y DEEP OBSERVATION HOLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsisten %Gravel 6-2Y i3 LS /Oyr -r/e -, F-05 2.5 YVy °/E$,ra.'r'i ° 5% COW r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%G vei DEEP OBSERVATION HOLE LOG Hole# 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 Within 500 year boundary No YesT Within 100 year flood boundary No✓ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Ylt3 If not, what is the depth of naturally occurring pervious material? Certification ` I certify that on 1�i� ee (date)I have pa the soil aluator examination approved by the Department of Environmen 1 nd t e ab ysis was performed by me consistent with . the required training,ex se d scrib 10 CMR 15.017. Signature Date / Vo Q:\S-PTICxPERCFORM.DOC Town of Barnstable Regulatory Services , �` "R•�, Thomas F. Geller, Director 9ARNBTAH�R. Public Health Division MAHB. Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Off k;e: 508-862-4644 Fax: Date: ci-1 " 0 9 Sewage Permit# 9o®g•2S(6 Assessor's Map/Parcel Installer & Designer_Certification Doris Designer: Installer: Gra���w,r4� G�1Fcr�risr . Address: 1 I C(or,V;,e .i g�w�� Address: �c� l3oX tl)U'r[.Vl wWl r'l U Z 3�41_..... pia tt 2 c7 3 p�.1 l .. -- ---- On is . . e) was issued a permit to i,istall a ?0... _...__...- ._..........._... - - (dt+tc)-•• -- (installe:r) septic system �c> u�,r at _....._...._ .._._.....,...._......._::_'n�- based on a design drawn by (address) dated Au) uS1 1.3 2,001 I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as larerd relocation of the distribution box and/or Septic tank, Stripout (if' rectuired) was inspected and the soils were found satisttaetory. ............_... I cortify that the septic system referenced above was installed with r:ajor Changes (ix.greater than 1 U' lateral relocation of the SAS or any vertical relocation d any component of'the septic system) but in accordance; with State & l..,ocal Regulation:;. Plan revision or certified as-built by designer to fallow, Stripout (if required) is ectod and the stril: were found satisfactory, CW J L. CHURCURCHl1,.L JR. � n Icr�s .41�;rlfltl.trc") rVti. �ti60 .� __..... ..q.... ... ..r ....wu..u.........-____.....__.__ ..__.._................ est ynet, s Signature (Af•fix Cie gn I1eic) P :ASIi; .RETURN TO ARNSTAI3LE PUBLIC HEAL' I DIVISION (:ERTIFICATE OF 'MRIJANCV, WILT. NOT BE I,. SUED UNTIL BOTH T1F1.IS�e()RM AND AS- QUILT C;AIID ARE; RECEIVED BY THE BARNffABLE PUBLIC FIIt;A.LT.H UIV1Si()N. T . A YOU, ti\nt'hcc lion'.(l tLkilciccrritit::ntun roim tioc T0 'd Z920 riZZ 809 8NI2133NI8N38r Wd ST : tiO 600Z—b0—d3S V00- TROY WILLIAMS SEPTIC INSPECTIONS t. Certified by MA Department of Environmental Protection r�� � (5'08) 760-1819 40 Old Bass River Road a e South Dennis,MA 02660 JAR -6 Commonweafth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection clo om F.Wald Trudy Coxe Arw Paul Celluccl hs u.Cv&nff x David B.Struhs Commhabner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A _ CERTIFICATION Property Address:.20 6,j+-,041 S� Lam. Ile- Address of Owner. 7 cr E5 Date of Inspection: 5 /a7/9(- (If different) ej Name of Inspector.�Oy (�J f �, c4 f Company Name,Address ad Telephone Number. /�� O . i34x 6 O I.GN�e✓ CERTIFICATION STATEMENT O�z 3� 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 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: se V Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature' s r 1 Date 8 /a ) /GG The System Inspector shall submit a copy of this inspection report to the Approving Authority withinthirty(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. INSPECTION SUMMARY: Check A, B, C,or D: A r A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. BI SYSTEM CONDITIONALLY PASSES: N/4 One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair, passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal, 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 conforming septic tank as approved by the Board of Health (revised 11/03/95) 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A r� CERTIFICATION (continued) Property Addrem a b U u TL/pc,s Owner. /-tv 6 i v�y c Date of Inspection: g /a / 4 /- B] SYSTEM CONDITIONALLY PASSES (continued) 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 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 Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: A///7 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 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 a 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and 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. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: o2 D 0 v o SOL Owner. /-A.) Date of Inspection: D1 SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to failure. determine what will be necessary to correct the Backup of sewage into facility or system component due to an 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 boa 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 IN 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water.analysis for ooliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: A114 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: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address U u + u y A— Owner. fhj h B✓ Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. _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. Nl9 As built plans have been obtained and examined. Note if they are not available with N/A The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow /The site was inspected for signs of breakout. V All system components, excluding the Soil Absorption System, have been located on the site. 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 existing information or approximated by non-intrusive methods. C) The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. `k (revised✓11/03/95) 4 t ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: v�0 4'j 4-'V g -- Owner. �� v Date of Inspection: RESIDENTIALFLOW CONDITIONS Design flow: 3�gallons Number of bedrooms:Y Number of current residents: 0 Garbage grinder(yes or no): Laundry Connected to system(yes or no):—j�c-5 Seasonal use(yes or no):_11 0 Water meter readings, if available: 6 _ ,Z oo�� �./yak I Last date of occupancy: V C,4 - IS— W n p L C u.s,04,r, v S e- �! COMMERCIAL/INDUSTRIAL• AI�19 Type of establishment: Design flow: ...gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER (Describe) Last date of occupancy: C GENERAL INFORMATION PUMPING RECORDS and source of information: /`l° AP IJK, �•H h i� ava �0.6 (c �. /�6rr� s �z-S /� �chty.,��. �- /���►� . System pumped as part of inspection: (yes or no) A/D. If yea,volume pumped: gallons Reason for pumping: TYPE QF SYSTEM li Septic tank/dis�.baz/soil absorption system Single cesspool { Overflow cesspool Privy { Shared system(yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 6r-I r/ H Sewage odors detected when arriving at the-site: (yea or no)/Vv �s fi_. (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1 SYSTEM INFORMATION(continued) Property Address: 02 d a U ` p o S f - Owner. /7�'V � �•✓ Date of Inspection: SEPTIC TANK:_ (locate on site plan) Depth below grader Material of construction: ✓concrete_metal_FRP—other(explain) Dimensions: .5 k 9 'X / 6 0 0 s (�o Sludge depth:- Distance from top of sludge to bottom of outlet tee or baffle: 07 Scum thickness: NOA1 Distance from top of scum to top of outlet tee or baffle: /V O S 4- Distance from bottom of scum to bottom of outlet tee or baffle: /(/O S Comments: (recommendation for pumping, condition of inlet and outlet or baffles, depth of liquid level in relatio to ou invert,structural integrity, evl ce of leakage, etc.) C6 a c.sr v�t ^�'C•� O J'L IQ, /�/l J d( ,&_7 t sue' l t� d✓ �- u r +.z O r V" •1 a v. d. �0 u.� -' c�y al 7 i S GREASE TRAP:A//4 s- (locate on site plan) Depth below grade: Material of construction: _concrete_metal_FRP—other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: fs Distance from bottom of scum to bottom of outlet tee or baffle: 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 leafage, etc.) G• r d (revised 11/03/95) 1 1 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: 07 d d cl �" 5 Owner. 40 (✓.',N `r Date of Inspection: TIGHT OR HOLDING TANK N�iJ (locate on site plan) Depth below grade: Material of construction: concrete_metal_FRP—other(explain) Dimensions: Capacity:_ ¢allons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX�//,4 ^ (locate on site plan) (j Depth of liquid level above outlet invert: G�> Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box,etc.) wtJ i 'n "D C't— 6 a.r g PUMP CHAMBER:�/4 (locate on site plan) f Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) �} r ,revised 11/03/95) 7 rj i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: p2 Owner. Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: D'x � ' ' L �� C, �-�* w'� � � 5 ham , leaching chambers,number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of n 5 . � S�� `l ponding, condition of vegeQ tion,etc) a c✓ S �►✓ti 1 CJ�4� yG G� ✓i o � � o o �✓ � ��. f- $o[M 4 L Grs-r. a✓cr AV CESSPOOLS: M (locate on site plan) Number and configuration: _ d • . DePth-top of liquid to inlet invert: ` L Depth of solids layer- Depth of scum layer: 1 `� Dimensions of cesspool: J v Materials of construction: Indication of groundwater: f inflow(cesspool must be pumped as part of inspection) ` ✓3 Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Y PRIVY: IV/4 (locate on site plan) ; Materials of construction: Dimensions: Depth of solids: Comments (ao a"condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) / (revised 11/03/95) 8 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: V. a v +�o Si- L�^ Owner. Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM:- include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' )36- 1� . I O l • �, J1 f 1 e �f��� r' 1 I ' Y 'Po` f 1� y1` 1 , o?�S:T�kc .--� DEPTH TO GRO{UNDWATER Depthr . L 4groundwater: feet — adjusted high groundwater level method, of,determination'or approximation: 1Ai4l.fit Lr ��✓� 6 /.. S c., o✓t-e f c, • W c.. S / 4, O YO G f �•.c Ind�i L 9 PROVIDE PRECAST CONCRETE GENERAL NOTE S T.O.F. EL.= 63.7'± EXTENSION RISER WITH CONCRETE INISH GRADE OVER D-BOX= 61 .4'± COVER TO WITHIN 6"OF F.G. OVER 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE OVER DIFFUSERS = 61 .5' - 61 .8' INLET AND OUTLET COVERS. REMOVABLE WATER-TIGHT COVER OVER SLOPE @ 2% MIN. 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION RISER TO WITHIN 6"OF FINISHED GRADE INSPECTION PORT WITH ACCESS BOX H) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE , WITHIN 3"OF F.G. (ONE PER TRENCH) CODE AND ANY APPLICABLE LOCAL RULES. @ END. EL.= 62.0 '±' FINISHED GRADE OVER TANK EL. = 61 ,5 ± �5" DIA. OUTLET(S) 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE ---� - i DESIGN ENGINEER. i EXISTING 4" PROPOSED 4" 9"MIN. " 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL _ ---- -- r� PVC SEWER PIPE 36 MAX. 9 MIN. SEWER PIPE ' 36"MAX. TOP OF SAS/B.O. = rj9,33' SYSTEM UNLESS OTHERWISE NOTED. 6" 3" 3"DROP MAX PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2" DROP MIN 3 9 MIN.SLOPE @ 1% JOINTS (TYP.) ELEVATION = 59.33' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 10" 4 PVC IN FROM 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF _I�- -14" ��* '{ SEPTIC TANK 4" PVC OUT TO 1.33' n1jTYP THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. --- 9.4 . LEACHING FACILITY 0.90, (TYP.) 6 TYP 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. CONTRACTOR CONTRACTOR SHALL � l 12" 6" � I dd 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 59.17 f MIN. 59.00 58.90' 58.0' (LAID FLAT) 2.875'(34.5") 5.75'� 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES 22"ZABEL FILTER 6" CRUSHED STONE 0. (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS 5 EXISTING SEPTIC AND REPLACE AS MODEL#A1801-4x22 OVER MECHANICALLY (TYP.) 11. NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY (GAS BAFFLE ON BOT.) COMPACTED BASE 5'MIN. AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX 30.0' (TYP FOR BOTH TRENCHES) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 63.00' ESTABLISHED --` TO BE INSTALLED ON A LEVEL STABLE ON A NAIL SET IN A OAK TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 50.50' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW BIODIFFUSER (PROFILE) BIODIFFUSER (END VIEW) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES 'CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL 12 - ARC 36HC (#3616BD) BIODIFFUSERS TO THE DESIGN ENGINEER.TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING . �, '^` !`"` �� , • TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM PERC NO. 12648 APPROPRIATE AUTHORITY. �' / INSPECTOR: Don Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS o EVALUATOR: John L. Churchill Jr. PLS,PE LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. APPROX. LOC. OF EXIS? _ ��'� w++ , - `" ss C.S.E.APPROVAL DATE: Nov. 1997 MAP 173 LEACH. PIT TO BE PUMPED & MAP 173 ' • +0 C DATE: August 11, 2009 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. FILLED WITH CLEAN COARSE SAND & ABANDONED PARCEL 31 r TEST PIT : 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE PARCEL 30 •, . ES # ran berry + + ' d ELEV TOP= 61.5' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. PROPOSED DISTRIBUTION BOX o. * R • REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, * �•+ ; + .• f.'r 0 + ELEV WATER= <50.5' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). m "' • • 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN �., + t • PERC RATE _ < 2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. l Benchmark 's • z EXISTING 1000 GALLON SEPTIC Nail Set in Tree ;« LO w • ' + DEPTH OF PERC = 30"-48" a Elev. =63.00 a TANK TO BE UTILIZED AS PART ` ` N75o3 . M• « • A • 16• PROPOSED PROJECT IS LOCATED WITHIN: OF THIS DESIGN o"W Approx. M.S.L. • • �►� .• , ��, . to • ` + • . ' TEXTURAL CLASS: 1 ASSESSOR'S MAP 172 PARCEL 120 _--�\� 126•62, MAP 173 _ ' OWNER OF RECORD: JANICE H. LENCEWICZ er PARCEL 32 * • : �� ' « • « w ADDRESS: 3840 SE 167TH PLACE `� *• • + * + s* w ,` ; • •• • ' + A 0,. Sandy Loam 61.50' SUMMERFIELD, FL 34491 •�, * ; * •# ' 10Yr 3/2 61.00' `1 TP 1 / .* ,+ 4 r • • ' LP 61.5'TP 2� a -62 SHED FEMA FLOOD ZONE C • • . ' `. „ • • + MAP 173 61.5 / Loam y Sand • . • • * • B COMMUNITY PANEL# 250001 0015 C PARCEL 48 PROP. TOTAL 12 ARC 36HC BIODIFFUSERS ++f * ,' • ' • 10Yr 5/6 (6 BIODIFFUSERS EACH TRENCH) •+ 24„ 59.50' 17. DEED REFERENCE: CERTIFICATE# 156451 � ,� � „ • ' � � r/p '�� ° \ / « i! # • « « w'� w + 18. PLAN REFERENCE: LAND COURT PLAN 32851-B co nr o 30 h . /� "' tiN 0 ^ ` -- / PROPOSED INSPECTION PORT WITH ACCESS * w � ' 30„ y F-C Sand 59.00' 19 ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. N / BOX TO GRADE (TYP OF 2) �r • « ; • 2.5Yrav ) 20 PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY DECK %� / , •, �� • • « w Perc _, (25% ravel #20 `k- 294, * " • ' 48" _ (5%cobbibs) 57 .50' FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSOME ANY LIABILITY r • + FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. EXISTING 62 // y , �� ; ' « • 53.50' 3-BEDROOM // fi 96" DWELLING I / ' 11 _ • « •_ TOF = 63.7'± / /o1a�a / Medium Sand '�� p0 'Al MAP 172 LOCUS PLAN C-2 2.5Y7/4 ° RAN e �ry PARCEL 119 /b SCALE: 1"= 1000' GRAVEL // No Mottling, Standing or Weeping Observed (0 �c3� 3 DRIVE / DESIGN DATA PERC TE�ST PIT LEGEND \ /L/3 / / INSPECTOR: Don Desmarais, R.S. 50xO EXISTING SPOT GRADE 3-'6 3 / NUMBER OF BEDROOMS (DESIGN) 3 0 EVALUATOR: John L. Churchill Jr. PLSPE 3 / � -- -- 50 - EXISTING CONTOUR o� 66- 3 MAP 172 / DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E. APPROVAL DATE: Nov. 1997 PARCEL 120 TOTAL DESIGN FLOW 330 GAL/DAY DATE: August 11, 2009 r� PROPOSED CONTOUR o� � � 00• / / 3 AREA=10,038 S.F.± / DESIGN FLOW X 200 % = 660 GAL/DAY TEST PIT#: 1 E/T/C EXISTING UNDERGROUND UTILITIES USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP 61.5' ❑/H/W EXISTING OVERHEAD UTILITIES ELEV WATER= < 50.5' (40'�iOF-rpOST PERC RATE - GAS EXISTING GAS LINE �985'110 q�F INSTALL 12 - ARC 36HC #3616BD BIODIFFUSERS �'! W-- EXISTING WATER LINE N DEPTH OF PERC= �9 yo�T) TEXTURAL CLASS: 1 � TEST PIT LOCATION SYSTEM CAPACITY FO PP �3) -. --- EXISTING 1,000 GALLON SEPTIC TANK C�OFA (TOTAL L.F. OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD , V� (60.0')(7.8 SF/LF)(0.74 GAUSQ.FT.)= 346.3 GAL. LEACHING!DAY 0 61.50 PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE Mac �4) A Sandy Loam NT 0', 0 6�. 10Yr 3/2 o 61.00' ❑ PROPOSED DISTRIBUTION BOX HC1 0 ;! TOTALS: 0 B 10Yr 5/6 Loamy Sand PROPOSED ARC 36HC (#3616BD) BIODIFFUSER DECK (2) TOTAL NUMBER OF BIODIFFUSERS: 12 #20 TOTAL NUMBER OF COUPLINGS: 0 24„ 59.50' EXISTING TOTAL LEACHING AREA: 468.0 SQ.FT. 3-BEDROOM HC2 TOTAL LEACHING CAPACITY: 346.3 GAL./DAY C-1 R� DATE BY APP'D. DESCRIPTION F-C Sand -------- ----�.. - - -- -DESCRIPTION DWELLING 2.5Y6/4 PROPOSED SEPTIC SYSTEM UPGRADE TOF = 63.7'± (25%gravel) (5% cobbles) PREPARED FOR: NOTE: 96• 53.50' CAPEWIDE ENTERPRISES EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER LOCATED AT "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO Medium Sand ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST C-2 2.5Y 7/4 20 OUTPOST LANE MODIFIED OCTOBER 30, 2008). TRANSMITTAL NUMBER=W000052. CENTERVILLE, MA 02632 SWING-TIES SCALE: 1"=20' 132" 50.50' SCALE: 1 INCH = 20 FT. DATE:AUGUST 13, 2009 DESCRIPTION HC1 HC2 No Mottling, Standing or Weeping Observed FEET 0 10 20 40 80 BIODIFFUSER CORNER(1) 37.3' 26.1' PREPARED BY: RESERVED FOR BOARD OF HEALTH USE o CNURCHILL `� JC NOTE: Jo R HN L 285 CRANIBERRY HIGHWAY BIODIFFUSER CORNER(2) 63.8' 28.5' I w 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE BIODIFFUSER CORNER(3) 45.3' 36.6' cM�L No. 4 3►� TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. EAST WAREHAM, MA 02538 SITE PLAN BIODIFFUSER CORNER(4) 68.8' 38.3' 508.273.0377 SCALE: 1"=20' f' Drawn By: JLC Designed By:JLC Checked By:JLC JOB No.1670