HomeMy WebLinkAbout0073 OXNER ROAD - Health 73 OXNER ROAD
CENTERVILLE
A= 193- 127
IN SMEAD
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KEEPING YOU ORGANIZED
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No. 12534
2-153LOR
SUSTAINABLE FORESTRY MIN.RECYCLED
INITIATIVE CONTENT 10%
CeNfied Fiber Sourcing POST-CONSUMER
www.sflprogram.org
S"1270
MADE IN USA
GET ORGANIZED AT SMEAD.COM
TOWN OF BARNSTABLE
LOCATION -7- 0,k_A 1Z!-__A2S_ SEWAGE# 1f( - e+-7--t-
VILLAGE ASSESSOR'S MAP&PARCEL (13.
INSTALLER'S NAME&PHONE NO. _Z8- -7-t1 613 �
SEPTIC TANK CAPACITY _,,,Ia_.
LEACHING FACILITY:(type) -;rJrZ,py— { (size) 'jX�: n_3
NO.OF BEDROOMS 0/�" U4
OWNER
PERMIT DATE: COMPLIANCE DATE: -2 /.Yo
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility #- Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) ( Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facilityy)- ft Feet
FURNISHED BY �dsyi/ L yQf �hrr wr•�..�.
u
YE Q 0 0
C � ,
R<,��a�L
I �—
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppYitation for ]Disposal 6pstem Construction Permit
Application for a Permit to Construct( ) Repair l ) Upgrade( ) Abandon( ) [Complete System ❑Individual Components
Location Address or Lot No.r 3 0 X n er / Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel &-40 �I E' Zm U_),� -)3 uX Dar a�
Instal er's e,Q�ddress and el.No. U�-7°j/- jQ� Designer's Name,Address,and Tel.No. SU9-3Co2' J
E�OV fG� �=C�i15�0q a�4nC P.O.( OX t)D(/ ,c rzrl 9_tr? /vaz," Sf
14 O G Oa S
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size ��U_3 !L sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 30 gpd Design flow provided 3 3& gpd
Plan Date Hove m, ergo, 'n p g Number of sheets / Revision Date
Title %% �+t`� t�2 X h 1e
a
Size of Septic T c � /�/U Type of S.A.S. - ?�1 D Sim ���C
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 not place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. /
Signed Date
Application Approved by Date ��'��► �,�G/
Application Disapproved by Date
for the following reasons
Permit No. gO L U(1 qfq Date Issued
No. O' l g Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTHDIVISION - TOWN OF'BARNSTABLE, MASSACHUSETTS Yes
01ppfieation for Misposal bpstern toustruction Permit
w Application for a Permit to Construct( ) Repair(✓� Upgrade( ) Abandon( ) Pi/Complete System ❑Individual Components
Location Address or Lot No.r) 3 6 Y(c)e Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 3 e`` C-0 i tic "_O" l c)ie 7 3 0X r)re r-PO
r
Installer's Name,Address,and Tel.No.sG� �? _ 93 F9 Designer's Name,Address and Tel.No. � .-��-�SVI
1444/10:6—
�c�►,s(rclG�tl��,�r,c rev lox boy(
Type of Building•. / 2 -
Dwelling No.of Bedrooms 3 Lot Size / sq.ft. Garbage Grinder( )
!
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required)
�� 3 3o gpd Design flow provided .7 3& gpd
Plan. Date A1o0,,,n2js6'r -)a, ab l�14' Number of sheets Revision Date
Title ; q C lef Ir,41 614- �7 oxnief
t r
Size of Septic/Tank 1 4:Z,3—gip tf( 4) Type of S.A.S. � !1 r f� � 111V,1yII,A :1/1'1,e �
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`oPplace the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
y Signed Date /
Application Approved by ""�^ _ Date —
Application Disapproved by Date
for the following reasons »- '
Permit No. . p(9 -- Date Issued
-------- ----------------------------------------- ------------------------------ = --------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the�On-site Sewage Disposal system Constructed( ) Repaired(✓� /Upgraded( )
Abandoned( )by
at lox� T��. , (� s�I,'/jQ has been constructed in accordance
a �
with the provisions of Title 5 and the for Disposal System Construction Permit No.�(�1 qt dated
Installer i
�..i D
,.7`1`� x�.. .� (.r, r' � !..�. esgner
J i
J_
#bedrooms _ Approved design flow gpd
The issuance of this ermit shall not be construed as a guarantee that the system will'' ct fdesig ed. " .
Date Inspector
No. -* Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal Opstent Construction 3permit
Permission is hereby granted to Construct( ) Repair(/ Upgrade( ) Abandon( )
System located at ;, 1 1!2
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 f Approved by
r
JAN-10-2020 02:04 From: To:15087906304 Paee:1,'1
Town ®f Barnstable
Regulatory Services
Thomas F.Ceiler,Director
MAM 1PubUc Health]Division
Thomas McKKean,Director
2001v1Wiu Street,Hymuzis,MA 02601 �
Office: 50-i&4644 Fwc: $08-790-6304
JustaHm&IDesi ne r Certitisatiog Form
Dab: 4 aoa0 sewage� �a 9- 9 y Assessor'®Map)Parcel 9 3 2�`-
7—
Designer. PDOUN Nfg&fiJMMJJC, Installer:
Addiros: Address: -
�Ru-�ul PLOITF ih 02fa7 y MAWN4 MIt--6;, W 02146
on /dA i 9 �r ' l/» 7' stall issued a permit to in a
•(date) installer) '
septic system Q Gen ery i l 4.- based on a design drawn by
(a ess)
an i,el A - ,0 i wl a. , 96 dated WOv. 2- T LO lq
I certify that the septic system referenced above was installed substantially according to
the demgc6 which may=lude minor approved changes such as lateral relocation of the
disc Au ion box and/or.sTdc lank
I certify that the septic system referenced above was installed with major changes (i.e.
greater Plum 10'lateral relocation of the SAS or any vertical relocation of any component
of the-septic system)but in accordance with State&Loeg Regulations. Plm revision or
certified ag built by desigi=to follow.
OF AM fn
DANIELA. N
OJALA
CIVIL "`
(Instaner's toatuIe) No.46502
a-
°� F018Tea 11;
ONAL �
(Designer's Signature) (Affix Designer's-Stamp Here)
PLE", RETURN TO B "LE C MAIMy® CIUM CAT_E Oil.
VgMF'L&CB MUh NOT BE MM UNM )3QIg TMS PQRM AND .ASAMT CARD ARE
3=RI ED 19N M B"NSTAB�E XOLIC EMALT9 DI MS10% IWANK YOU
Q:Health SopWDdperOmiMcationFo=3 26.04.doe
l0C /AJION/ / SEWAGE P RMIT NO.
oe .dl
VI:,LLAGE
INSTA LLER'.S ' NAME i ADDRESS
GUILDER -OR OWNER
DATE .PERMIT ISSUED &Zz �,, 8 �
DAT E COM'PLIANCE ISSUED
7.3 bxner
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L`c T I N y SEW& PERMIT U O.
11�1ST&LLERS E DD U&M �11 ASS
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BUILDER 5 Q &V AF- �. ADDRESS
DATE PERMIT ISSUED '� � ze
DATE COMPLI AtdCE ISSUED : V?
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No.8�- G7 9 Fima.......D..J.....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
w.�..►..0................. �'C�1.-��� .........................
Appliration for Bi_qpniiFal Works C�onstrurtion rrmit
Application is hereby made for a Permit to Construct (ko� or Repair ( ) an Individual Sewage Disposal
System at:
.............O Xr,i u.,...... .. .......................................... ............................� - -
Location-Address or Lot No.
4'.1.dp . Q '�e��.�-� - =-1'�._. ► .._...�1. (.....-----•... .......--
Owner Address
........... -....... [�/.1� -------••--------------------------•--•---•-- -----•-------- al_,�.......................................
Installer Address
d Type of Building Size Lot_V"'_ �._..Sq. feet
Dwelling—No. of Bedrooms._�-�.......................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures __________________________________
W Design Flow....................... .-5�. .........__gallons per person per day. Total daily flow................... � ...........gallons.
W I it
Septic Tank—Liquid capacity.kO-00-gallons Length. ".�..._. Width4_- .0. Diameter________________ Depth..5.'_'%..
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No....1------______---- Diameter..e°__5�__.._.. Depth below inlet.... Total leaching area. .-sq. ft.
Other Distribution box (✓f Dosing tank ( )
'-' Percolation Test Results Performed b ':P�A,QK .���._b tom.._-. Date...1.0/3-0/#.1.............
Y �-r,
aTest Pit No. 1................minutes per inch Depth of Test Pit- .....2•. Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit_6__'7. ... Depth to ground water........................
(Yi ------•---•••-•------ ...6a a P ±� '�.._.i.es xa' ...............................•-------- ....._...
O Description of Soil........... .............
"7= ®!.•---- ------ %Y '" s �-�sAj` ��s
--.....
U ------------------------------------------------------------------------------
•-••---•----••�s..•1' ---•G�' ,e�,t`5 M. 9.1_1.1r ' .�
W -------•-•----- ----------- ----•---•------••--•------••---•--•------•-•...../� " " ---- ---
�xj Nature of Repairs or Alterations—Answer when appl�ble,_,. _.._
----------------------------------------------------------•----------------....----.,mod........ . --- ---------------------------•------------------------_.---------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of L i:''.`
p 5 of the State Sanitary Code—The undersigned furtl; agrees not to place the system in
operation until a Certificate of Compliance has bee s d by th bo/�
Signed •---- z---•..... ° �
/ Date
Application Approved BY >.�-- � =.•-- .... .. 4l/ z"D �f
ate
Application Disapproved for the following reasons:..............................................................................................................
....•--••-•-••••-•-----•-•--•---••-••----•--•------•--••----•••-••------•--•------••-•-•••-••••-----•-•--•---.......-•-•--•---•---------•-•------•----•--•--•-------•----•--•---....•---•-----------•---
Date
PermitNo......................................................... Issued.......................................................
Date
r °*
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.::' o vJ.�...................OF.. .a,.� �w1.. .I�.ra ....„----........-•--------
Applira#ion for Uhipo','al Works (fig ,itrnrfion permit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
,3.
.... n .............................................. 4? C... ......................................................
Location-Address or Lot No.
Owner Address
..4-19r. •----•--•-------•............................•. .............. .
Installer Address
d Type of Building Size -----Sq. feet
Dwelling—No. of Bedrooms.. ........................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building --- --------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures .._..._.. - ......................................................
Design Flow......................5_5 -----------gallons per person per day. Total daily flow-___--___----_-_."33_Q......._....gallons.
WSeptic Tank—Liquid capacity.`D.0 .gallons Length_f3'_.w_..__ Width g..'.CO__ Diameter................ Depth..?_-.' ..'
x Disposal Trench—No..................... Width.................... Total Length................_..___ Total leaching area...; _ _____....sq. ft.
3 Seepage Pit No....I................ Diarnelter--8.)L,5_..... Depth below inlet....G........... Total leaching area... .:j.sq ft.
Z Other Distribution box („-•) Dosing tank
'-' Percolation Test Results Performed'by. _-.-:-"y—v TT-' 1.)k Date....� !_ ±�� .............
W
1.4 Test Pit No. 1---_______------minutes per inch Depth of Test Pit--------------- Depth to ground water--- _-__-----_---__--.
4T Test Pit No. 2...............minutes per inch Depth of Test Depth to ground water........................
O ---------------- .----
W
VNature of Repairs or Alterations—Answer he livable.ee ..____.�/ ___. .___.,----------------------y____....._._____.____ _ ,.______.__._.__.___.
------------------------ :......--•--•----------•------•----------•----•-----........j
Agreement: /� e�a�.j
The undersigned agrees to install the afbr described Individual Sewage Disposal System in accordance with-
the provisions of:i T
p 5 of the State Sanitary Code—The undersigned fur e agrees not to place the system in
operation until a Certificate of Compliance has been is "ytheandSigned . ---------------------------•---••---•-....._ ................................
Date
Application Approved By.............
.....�.a . . .. ate
Application Disapproved for the following reasons:.._._____
Date
PermitNo........................................................ Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........ �...................O F............... ... ... ................
10 rdifiratr n aam rltttnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by------------------------------------------......................................................--••----•-------------•----....------------------•--......---•••---------------•--••-••-•----------
Installer
at-----•------------- ....... - - .r r� �5► ----------------------•---------------------------------------
has been inst'iTl�d'in ideEordance wItII�e provisions o1T I 1 LE f) of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No--------- ...... dated--_............................................
THE ISSUANCE OF THIS-CERTIFICATE SHALL NOT BE CO STRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTIOP SATISFACTORY.
. t
DATI4t-•,.__...•- ........ - /Ylv------------------------------ Inspector.............. , .�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....°/oiv A+...............OF....:/J..191 .................................
No... ------------- FEE--3p..-----•_--••-
Rapnoa1 Work.5 TwOnxitr ion an it
PermissiorL s,.hereby granted........C!---------.i�.;12 '`r- --------------------------------------------------•-------•--•----....--•---•-----....
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
at No. Gar 0. .1>/,C f A- "itl L...----------------------------------------------------------
�,�,Street
as shown on the application for Disposal Works-Construction Permit No.................. Dated..........................................
DATE..------....
Z Board of Health
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
Town of Barnstable
Inspectional Services Department
NAM
19. Public Health Division
E0""�s 200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7015 1730 0001 4988 0923
October 8, 2019
WATTLES, MARY R TR
73 OXNER ROAD
CENTERVILLE, MA 02632
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 73 Oxner Road, Centerville, MA was inspected on
09/25/2019 by Frank Nunes III, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the guidelines
of 1995 TITLE V (310 CMR 15.00) due to the following:
• Leaching facility with standing liquid level at or above the invert pipe (per
Town Code 360—20h).
You are ordered to repair or replace the septic system within two (2)years from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE B ARD OF HEALTH
hB e n, R. ., CHO
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\73 Oxner Road Centerville.doc
Town of Barnstable
a
BARNSfABLE.
�A 6 9 ,�� Inspectional Services Department
rfD MA'S�
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 4/26/19
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000)
An"x" marked in the ❑ is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA
❑ Discharge or ponding of effluent to the surface of the ground
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
❑ Structurally unsound septic tank or SAS
ONE (1) YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
❑ Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2) YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation
of a driveway due to H-10 components, etc)
/Leaching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline:
Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
C
Commonwealth of Massachusetts
ro Tithe 5 Official Inspection Farm
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments {
73 Oxner Rd.
Property Address
Wattles 'e r,
Owner information is Owner's Name
required for every Centerville MA 02632 9/25/19 t
page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
A. Inspector Information
Frahk Nunes III
Name of Inspector
saa
Company Name
Box 841
Company Address
East Falmouth MA 02536
Cityrrown State Zip Code
508.272.6433 13010
Telephone Number 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
911�A2V,r
9/25/19
Inspect igna ure kfi Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
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
�e
u 73 Oxner Rd.
Property Address
Wattles
Owner Owner's Name
information is
required for every Centerville MA 02632 9/25/19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
System Fails
Observed backup at the leach pit
Septic tank is leaking
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
4
Commonwealth of Massachusetts
�. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
73 Oxner Rd.
Property Address
Wattles
Owner Owner's Name
information is
required for every Centerville MA 02632 9/25/19
page. City/Town 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
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
73 Oxner Rd.
Property Address
Wattles
Owner Owner's Name
information is
required for every Centerville MA 02632 9125/19
page. Cityrrown 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
f
Commonwealth of Massachusetts
,ip Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
u 73 Oxner Rd.
Property Address
Wattles
Owner Owner's Name
information is
required for every Centerville MA 02632 9/25/19
page. Cityrrown 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 Y 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 11 of a public water supply well
t5insp.doc•rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
73 Oxner Rd.
Property Address
Wattles
Owner Owner's Name
information is
required for every Centerville MA 02632 9/25/19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no"for each of the following for all inspections:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or 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.7/2 612 01 8 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
73 Oxner Rd.
Property Address
Wattles
Owner Owner's Name
information is
required for every Centerville MA 02632 9/25/19
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): n/a Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms). 330
Description:
No engineering on file
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 301 GPD
g ( Y 9 (gp ))�
Detail:
Sump pump? ® Yes ❑ No
Last date of occupancy: Occupied
Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
,p Title 5 Official Inspection Form
- Subsurface Sewage Disposal System'Form -Not for Voluntary Assessments
73 Oxner Rd.
Property Address
Wattles
Owner Owners Name
information is
required for every Centerville MA 02632 9/25/19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(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:
Pumped reguarly per owner, about 1 yr ago
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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
in r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
73 Oxner Rd.
Property Address
Wattles
Owner Owner's Name
information is
required for every Centerville MA 02632 9/25/19
page. City/Town 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:
1982 per record
Were sewage odors detected when arriving at the site? ❑ Yes ❑ No
5. Building Sewer(locate on site plan):
Depth below grade: 12"feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: >10'
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
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
73 Oxner Rd.
Property Address
Wattles
Owner Owner's Name
information is
required for every Centerville MA 02632 9/25/19
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
6"
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
H-10 tank has 8" of effluent in it at this time, effluent level is 40" below the invert at the outlet, the tank
is not tight
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000g
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
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
How were dimensions determined?
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
i
Commonwealth of Massachusetts
�. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,.
•�, 73 Oxnef Rd.
Property Address
Wattles
Owner Owner s Name
information is
required for every Centerville MA 02632 9/25/19
page. Cityrrown 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.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
ip Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�a 73 Oxner Rd.
Property Address
Wattles
Owner Owner's Name
information is
required for every Centerville MA 02632 9/25/19
page. City/Town 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
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D-box was video inspected and is dry at this time
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
I
Commonwealth of Massachusetts
,p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
•� 73 Oxner Rd.
V�
Property Address
Wattles
Owner Owner's Name
information is
required for every Centerville MA 02632 9/25/19
page. City/Town 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:
1
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ 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
u
73 Oxner Rd.
Property Address
Wattles
Owner Owner's Name
information is
required for every Centerville MA 02632 9/25/19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Pit was excavated and there is obvious signs of backup with muck up and over the invert, piping from
the d-box to the pit is also heavily mucked, carryover in pit, pit is 2' below grade
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.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Fo
c Commonwealth of Massachusetts
�= Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
•� 73 Oxner Rd.
Property Address
Wattles
Owner Owner's Name
information is
required for every Centerville MA 02632 9/25/19
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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
A
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
� 73 Oxner Rd.
Property Address
Wattles
Owner Owner's Name
information is
required for every Centerville MA 02632 9/25/19
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
I
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18
L
• a........Ilaurwew EeluveFR�R[ISQ�T�C.l1.S� Ct'�.BS�A$8SCSS![C���....r«
AN
E CA Itfu SEWAGE IT72
1f0-
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LLACE
INSTA LLEN•S NAME i ADDRESS
iIIILDEEI OR - OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUES
ys
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Commonwealth of Massachusetts
(o Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
73 Oxner Rd.
Property Address
Wattles
Owner Owner's Name
information is
required for every Centerville MA 02632 9/25/19
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: >12'
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: n/a
Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
4' seperation per compliance on file
❑ Checked with local excavators, installers-(attach documentation)
® Accessed USGS database-explain:
TOPO mapping puts the site at 60'msl and nearby surface water at 44'msl
You must describe how you established the high ground water elevation:
see above
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
,F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
73 Oxner Rd.
Property Address
Wattles
Owner Owners Name
information is
required for every Centerville MA 02632 9/25/19
page. City(rown 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.7/2 6120 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
� .
SECTION — SEWAGE
\,x
l
.-SEPTIC TANK - - "D" BOX - - LEACH..L . f
T OF+OOF(Q�F�Dj?N/� ,Iti:, I'1•l' +'F° `'.
YVASHE I7 STi)NE 1
1 C IN OUT - i 1 -
IN OUT IN
j u::D
u
3Z 3TANK '�
ELEV. \0
ELCV. ELEV.
ELEV.
ELEV. ELEV,
No E. RfffrpovE AL._ VN5U1TAt3LE MATEf,-(M..
TESL" HOLE LO
X
TEST BY
3 . } �}C '( y}5c.
�,�}`:. .'..✓C) _�.,.
WITNESS
TEST DATE - 30 DESIGN
1 ' _ _BEDROOM ifOUSE
T.H. # 1 T.H. # 2 �, __-.
b(,
�7_�_yt FLE �_._ �. EV. NO ` r r j
f d-d. Z DISPOSER 4)w444&r•+x
T
I LL PERC RATE ____._._ _MIN/IN. r �.
rl _5Q.Q� �1 FLOW RATE 330 (GAL./DAY)
Z-SEPTICTANK tD 1i 5 7, _ .• _ ` - �x
- - - ) r
/ �� -� avC7 .I 1* ! - / iC� r_ + .�, ,. ....
-REO'D SEPTIC TANK SIZE
�'f LEACH FACILITY
SIDE WALL !1 I *1 .+� �
�" 'ft •��— s'o (z, ) >!n + G E7 i 0 W i,( '` .'� Zit'�• - . ..
f�1.� BOTTOM _._.715% - f -- — (l,f> ) - .! G U
'€`' # #LJ�iya TOTAL g57r {/_'
f Ce fit,
,+ to 6KAV~t..
13 .tl 4 " iZ (•r USE: _ ___ OL`�! -. LEACHING _ _ .. . �_
� / d E7b t .. _ ... >
_ `�_Ser—___WATER ENCOUNTERED --- -
NOTES: (UNLESS OTHERWISE NOTED)' r ,
�
n
I DATUM(MSL) 'TAKEN FROM -- ----.--AVAILABLE
,. PIPE PITCH: '4 PER FOOT _ ° 1--060ANK
4.DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO-__.,,:.SS �4✓ -44 iVU .'(,,If I.
5. MFN,GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. Q DISTANCE AS CERTIFIED ^^ r
6. PIPE JOINTS SHALL BE MADE WATER TIGHT r+ �
7 CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS.STATE ENVIRONMENTAL CODE TITLES I HEREBY CERTIFY THAT THE BUILDING SITE PL N'
SHOWN ON THIS PLAN IS LOCATED ON THE ,.�-� tom! 1 t,� I A-f
' GROUND AS SHOWN-HEREON &THAT IT—_—. LOCUS:._L L _f i Ct � T
CONFORM TO THE ZONING BY LAWS OF THE {f
ram ' TOWN OF --- — E�_TE(ZIL 11A.
REG. PROFESSIONAL ENGINE F +a S.S � `� Q WHEN CONSTRUCTED. DATE REF: _l F96& t ?—
_
down cape en0p►ineering PREPARED FOR: C>u91zt- 35�
CIVIL ENGINEERS CAe'�3 � ��akl s
LAND SURVEYORS - - -u—�-"—
BOARD OF HEAL1 H REG. LAND SURVEYOR r _
CONTOURS (ExISTING) --------- ---- I Q
(PROPOSED)—0--0-0-0— APPROVED -------DATE. __ ___.__ MA � Yarmouth &Orleans,MA SCALE Fq
i— i?-is
.�.�—_..._ 111 DA E
ALL SHALL
TEM
SYSTEM PROFILE MARK DS WITHC MAGNETIC TTAPE ORBE NOTES
PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS NAVD 88
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 2. MUNICIPAL WATER IS EXISTING
2" PEASTONE OR GEOTEXTILE Route 6 e Rd.
TOP FOUND. EL. 62.9' FILTER FABRIC OVER STONE II II II 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. Se Ic
' W W W _
58.5 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 58.0-59.7 4. DESIGN LOADING FOR ALL PROPOSED PRECAST
=
• PRECAST H-10 MORTAR ALL BLOCKS OR UNITS TO BE AASHO H-M
a
RISERS (TYP.) PRECAST RISERS
2'0 4"OSCH40 PVC COMPONENTS , 5. PIPE JOINTS TO BE MADE WATERTIGHT. Oak Street
H-10
6" MIN. SUMP PIPES LEVEL 1ST 2' 4, 5' INV'S EL. 55.9'
12" MIN. INT. DIM. �BET. (nP•) SIDES1500 GAL H-10 ENDS56.73' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE Locus
\57.0.�'* 10„ o WITH 310 CMR 15.000 (TITLE 5.)
SEPTIC TANK 14" y=.ye•y o yee�e... °
TEE a' LIQ. LEVEL TEE 000°b°o° O. Q:'. r. - aQo °oo°o°O 0� s
56.63' 56.38 ° o ° 0®�® ®®®® oo°��c ®®®® --®®®® °°o°°°o° Three Wequaquet
ACME OR EQUAL °°o°°°oo°o°o WATERTEST D'BOX o°o°o°o° ®®®®�®���®® oo°o°� ®®®����®®0� ;o°o°o°o° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND
0 0 0 -0-0
0 o O > o 0 0 0 00°0°0 O O O O O O o°o°o°o° _
GAS BAFFLE..,' ° ° ° ° FOR LEVELNESS °°°°°°°° ®®���0�®�® ��®�0��®000 ° NOT TO BE USED FOR LOT LINE STAKING OR ANY Lake
°°� N °o°a°o°o ®D��OD®�®®® 00000C ®®EnM[I ®®® �00000000 OTHER PURPOSE. �°
0 0 0 o O O O O o0 o c O O o 0 0 0 Z
56.32' S6.15' °o°°°o°° °°°° °°°°°°°° 53.9
°°°°°°°° °^°° ° ° ° ° 8. PIPE FOR SEPTIC SYSTEM TO SCH 40 4" PVC.MIN. SUMP /•o
o
00000000a00000000000000000a000000000000000000 12" MIN. INT. DIM. 1 Q p
'0000000go°o°o°o°o0 V?nono„o�,o'o°o°o. H-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. g. COMPONENTS NOT TO BE BACKFILLED OR
" DOUBLE WASHED STONE-1 2"-1 3 4 (2) UNITS REQUIRED OF
/ / CONCEALED WITHOUT INSPECTION BY BOARD •` yoke �1
CONNECT PIPE FROM PROPOSED SEPTIC 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30' X 9.83' HEALTH AND PERMISSION OBTAINED FROM BOARD
TANK TO EXISTING PIPE FROM DWELLING COMPACTION. (15.221 [2]) OF HEALTH.
AFTER PATIO (IF SUITABLE) 00
10. CONTRACTOR SHALL BE RESPONSIBLE FOR
( 2.5% SLOPE) ( 2 % SLOPE) (1 .7 % SLOPE) CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP
LEACHING VERIFYING THE LOCATION OF ALL UNDERGROUND &
FOUNDATION- 15' SEPTIC TANK 3' D' BOX 17' OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF
FACILITY 45.5' BOTTOM TH-1 T WORK. SCALE 1"=2000'f
*THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL NO GROUNDWATER FOUND
11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 193 PARCEL 127
UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS BE REMOVED BENEATH AND 5' AROUND THE
PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM v v PROPOSED LEACHING FACILITY.
LOCUS IS WITHIN FEMA FLOOD ZONE X
66 12. EXISTING LEACHING FACILITY SHALL BE PUMPED (AREA OF MINIMAL FLOOD HAZARD) AS
AND REMOVED OR PUMPED AND FILLED WITH CLEAN SHOWN ON COMMUNITY PANEL #25001CO561J
SAND. DATED 7/16/2014
LEGEND
99- EXISTING CONTOUR
X 99•1 EXIST. SPOT ELEV.
6s 6111, Off.
-[99]- PROPOSED CONTOUR /i T
(98.4] PROPOSED SPOT EL.
5.00 SYSTEM DESIGN:
TH 1
TEST HOLE 65 \ Ssp� O GARBAGE DISPOSER IS NOT ALLOWED
2% SLOPE OF GROUND �6. F DESIGN FLOW: 3 BEDROOMS Ca? 110 GPD = 330 GPD
C-Q-) UTILITY POLE O �� Oh � USE A 330 GPD DESIGN FLOW
FIiRE HYDRANT J �Q �`�1 \ SEPTIC TANK: 330 GPD (2) = 660
NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING _.__
,p�1Sp USE A 1500 GAL. SEPTIC TANK
O \?St8•p0 O
PAVED 'S) LEACHING:
CENTER BASIN 15,203 S.F.t TEST HOLE LOGS BENCHMARK: DRIVE LOT AREA SIDES: 2 (30 + 9.83) 2 (.74) = 118 GPD
`�/� �-�
EL.=63.5' 63 BOTTOM 30 x 9.83 (.74) = 218 GPD
ENGINEER: DANIEL E. GONSALVES, SE #13587
1`O 3 TOTAL: 454 S.F. 336 GPD
WITNESS: DAVID W. STA ON RSA
DATE: 11/14/15 0 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL)
EXISTING �� WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5'
PERC. RATE _ < 2 / w l 3 3_- c DOWFLLIN62 9 �
MIN BETWEEN UNITS
CLASS I SOILS P# 19-193 61 CONNECT TO
N �,� EXISTING PIPE IF
ELEV. ELEV. • h� PATIO SUITABLE
00p 59.0' p" 59.5' 6/TH \� 0 61 APPROVED DATE BOARD OF HEALTH MA
TH 00 \
FILL FILL
26 30" 6° TITLE 5 SITE PLAN
B B �R \ 0 \ z OF
SL SL 6 7 65 \ \\��\ 58 5g .h^
„ 10YR 5/6 5/6 #73 OXNER ROAD
10YR
52 54.7 50 55.3 CENTERVILLE MA
C1 C1 ti PREPARED FOR
5' REMOVAL OF UNSUITABLE SOIL REQUIRED
FSL FSL AROUND PERIMETER OF LEACHING FACILITY, 1� OA S9
DOWN TO SUITABLE SOIL LAYER. REPLACE s9 6� BORTOLOTTI CONSTRUCTION/
WITH CLEAN MED. SAND, TO MEET WATTLES
72" 2.5Y 7/1 53.0' 68" 2.5Y 7/1 53 8' SPECIFICATIONS OF 310 CMR 15.255(3) 62
C2 C2 �I- A A4,1 s �N°F`�ss�c DATE: NOVEMBER 20, 2019
DANIELA. ti� `� AN �G
SIEVE M/CS M/CS 66 65 U OJALA
A. off 508-362-4541
O,i ,1 CIVIL �4 l fax 508-362-9880
2.5Y 6/4 2.5Y 6/4 �\P �No.465020 �� �i �NYu. 4J980P �+� I downcape.com
IST
10% GRAVEL 10% GRAVEL )NA L Fti,G�R', down cope engineering, //!C
162 45.5 162 46.0 69 °" N a civil engineers
Scale: 1"- 20' -moo -, land Surveyors
NO GROUNDWATER ENCOUNTERED - I '1-20 ',C ,
939 Main Street ( Rte 6A)
0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675
D CE # ' 9-3 7J 19-375 BASE.DWG