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0061 PARK AVENUE - Health
61 Park Ave Centerville A= 208-008 SMEAD No.2-153LOR UPC 12LU a w 4aom - Yob In us& Ir11�N9�lImURut SFI OFM VI TOWN OF BARNSTABLE LOCATION,y,\ SEWAGE# VILLAGE CcAeC\t\e ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. ��'vp� � �o Ae_ re( - $7 a�sao SEPTIC TANK CAPACITY LEACHING FACILITY:(type) y 3 3 ,K 1-7 V'X Z NO.OF BEDROOMS 7 OWNER �` u c/i' od! • PERMIT DATE: 4Z ZZ/Y COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 7 /O 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(Ifany wetlands exist within 300 feet of leaching facili Feet FURNISHED BY ct�� 6/`�oi7iis7 14 Ile, 000 3 - — — — — - — — — � y , o 0 0 .r Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments +61 Park Ave , v Property Address Garfiel P and Phyllis C Blightf Owner Owner's Nameinformat required l for on levery Centerville Ma 02632 ass; 5/15/19 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. Inspector Information /3 S filling out forms on the computer, use only the tab Michael DiBuono key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Lane � Company Address Cotuit Ma 02635 City/Town State Zip Code 508-364-9587 S113522 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 Ahority 4. ❑ Fails 5/15/19 Inspector's Signature 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. l5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts - p Title 5 Official Inspection Form J Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 Park Ave Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is required for every Centerville Ma 02632 5/15/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 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 contains a 1500 Gallon septic tank as well as a concrete distribution box and 3 500 Gallon H2O Chambers in stone. 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•Pa4e 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 61 Park Ave Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is required for every Centerville Ma 02632 5/15/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 61 Park Ave Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is required for every Centerville Ma 02632 5/15/19 page. Citylrown 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 asses if the well water analysis, performed at a DEP y p certified laboratory, for fecal Y P ry, coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u � 61 Park Ave Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is required for every Centerville Ma 02632 5/15/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 61 Park Ave Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is required for every Centerville Ma 02632 5/15/19 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 Y g 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)] l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts ;to Title 5 Official Inspection Form I,. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 Park Ave " Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is required for every Centerville Ma 02632 5/15/19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 205 Gpd Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 61 Park Ave Property Address Garfiel P and Phyllis C Blight Owner Owner's Name required for is every Centerville required for eve Ma 02632 5/15/19 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: Not Provided 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 A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4�a 61 Park Ave Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is required for every Centerville Ma 02632 5/15/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Installed 12/31/13 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2 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.): System is vented at the roof line as well as the field. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �Z 194 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 Park Ave V Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is required for every Centerville Ma 02632 5/15/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 H2O If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24 11 Scum thickness 3„ Distance from top of scum to top of outlet tee or baffle 411 Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 61 Park Ave `J Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is required for every Centerville Ma 02632 5/15/19 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form = la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 Park Ave Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is required for every Centerville Ma 02632 5/15/19 page. Citylrown 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 Level and at Normal level 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 61 Park Ave Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is Centerville Ma 02632 5/15/19 required for every 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: ® leaching chambers number: 3 H2O 500 gallon ❑ 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 ,lp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 61 Park Ave u Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is required for every Centerville Ma 02632 5/15/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching field functioning as designed 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 Park Ave Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is required for every Centerville Ma 02632 5/15/19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 61 Park Ave Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is required for every Centerville Ma 02632 5/15/19 page. Citylrown 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 5/15/2019 Assessing As-Built Cards TOWN OF BARNSTABLE LOCATION gk5 t SEWAGE# G/ — ©/O VILLAGE CPcrc&Q E ASSESSOR'S MAP&PARCEL .76C' ZF INSTALLER'S NAME&PHONE NO. t Lbg4e f —�8•�15�atsao � SEPTIC TANK CAPACITY /S Ci d LEACHING FACILITY:(type) s Co /��,,�r,r(size) ? /1 Xx Z NO.OF BEDROOMS OWNER 4Ck,774 , a cliii a r1 PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility Of any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility Of.any wetlands exist within 300 feet of leaching facili //� Feet FURNISHED BY of ,�/oi7 irk 1 3i z may_ �737 000 3 - - - - - - - - Y 0 0 0 https://townofbarnstabIe.us/Departments/Assessing/Property_Values/HMdisplay.asp?mappar=208008&seq=2 1/2 Commonwealth of Massachusetts -, Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 61 Park Ave �u Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information is required for every Centerville Ma 02632 5/15/19 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: 10+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 12/31/13 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: Test Hole data on plan 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 p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 61 Park Ave Property Address Garfiel P and Phyllis C Blight Owner Owner's Name information isequired for every Centerville Ma 02632 5/15/19 page. Cityrrown 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 checked ❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Town.of Barnstable Regulatory Services Richard V. Scali,Interim Director * MUMSTABM # M^ML Public Health Division iOrFn 9. & Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Desi ner Certification Form11 Q� Date: I" Sewage Permit# %3"50 Assessor's Map\Parcel���U Designer: THONW M CUU-AAJ P E, Installer: / ,f3 6 Address: g0X I 3 Address: E. V Et\w 5 MA 026LA r On � � was issued a permit to install a date (inst filer) septic system at �i PAP K A\/c, C Etv JZVI 0GU based on a design drawn by (address) T f le Mfi� M C LEU.n-v RE, dated ! Z-23 1 3 (designer) v I certifythat the septic stem referenced above was installed substantially according to P Y Y g the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in co!E liance with the terms f the I\A approval letters(if applicable) 4 '� t# J. OVIL (Ins is S nature) 9 $ t (Designers S• nature) (Affix Desijf eT sS amp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION,. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS'jFORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc i FROM :HUTCHINSON FAX NO. :508-790-1104 , Dec. 31 2013 09:22AM P1 December 31,2013 Commonwealth of Massachusetts Town.of Barnstable Massachusetts Board of Health Hyannis,MA Dear Barnstable Board of Health, The septic system design for 61 Park Avenue,Centerville,MA 02632 by Bass River Engineering dated December 23,2013 is consistent with the existing property and the way it has remained and been used for the last twenty one years. Respectfully/ hinso Co-owne w�:th Ca�roly:nM. HutchinsonCynthia la. H�itc n, , 61 Park Avenue Centerville,MA 02632 508 7901104 No. g0 3"' � r Fee 1 l/V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Vsposar 6pstem Construction Vermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �� �l9 /p� Owner's Name,Address,and Tel.No. qsgsre-s sYTlap�iP`arcei�— 0m8 / �cj�� ��/l! � �lliV c5 d>✓ Ins ler's Name,Address an Tel No. Designer's Name,Address,and Tel.No.73;,-v07(�4�ZT Type of Building: sCi Dwelling No.of Bedrooms�� Lot Size�� �J / sq.ft. Garbage Grinder(�6 Other Type of Building j\L 101t?l'!fl C7iL No.of Persons Showers( ) Cafeteria( ) Other Fixtures /1 Design Flow(min.required) 7 �� gpd Design flow provided 4<53y_ gpd Plan Date Z Z Number of sheets l Revision Date Title Size of Septic Tank 0 Type of S.A.S. Description of Soil y/Tj 7s i p_ Nature of Repairs or Alterations(Answer when applicable) 1S-dD72 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B ar Health. Si Date/2` '"f� Application Approved by Date Application Disapproved by Date for the following reasons Permit No. go 1�o Date Issued 1 r 3 No. a 013- 9� 3,. ' Fee I&D THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes RpOYication for Disposal 6pstem Construction Permit 1 E Application for a:Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �� �j9/1/� /91/ Owner's Name,Address,and Tel.No. Installer's Name,Address,and Tel No. Designer's Name,Address,and Tel.No.7F,,v 147 eZ, 9 A./ r Type of Building: Dwelling No.of Bedrooms Lot Size l� � sq.ft. Garbage Grinder V P6 Other Type of Building g /����,Pm�j r7 L No.of Persons Showers( Cafeteria( ) '� Other Fixtures Design Flow(min.required) t�L�Q gpd Design flow provided 4e/m• gpd Plan. Date- 42—.a I ' Number of sheets /Revision Date Title�� l,_� Size of Septic Tank Type of S.A.S. Description of Soil � Nature of Repairs for Alterations(Answer when applicable) i v Date last inspected: Agreement: { j The undersigned agrees to ensure the construction and .maintenance of the afore described on-site sewage disp6sal 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 Boar Health. Signe Ll/jam/S Date Application Approved by / Date �� - 3(- f Application Disapproved by U Date for the following reasons s 2 Permit No._�_Q a- Date Issued Th F,COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by l _ c5 at has been constructed in accordance s with the provisions of Title 5 and the for Disposal System Construction Permit No. '9 015 Sedated 1, -- 3/-1 3 Installer esigner0<5 JL1r-� �-1 Li / d #bedrooms Approved design flow gp The issuance of this permits:all not be construed as a guarantee that the system will-function as ddesigned. l4' Date Inspector --------------------- ---- --- ------------- ------- --- ------------ _------------------------------------ No. 3 Q 13 5'6 1 Fee y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at /� ��'1j jjgl- �/ � T �f�� ZW/ 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 _ 3 Approved by J I; I LH-1 I Ell RELI ILL4 PROPOSED BATHROOM ADDITION RIGHT SIDE ELEVATION c 3/16 1' ) 10'-0" BATHROOM ADDITION PROVIDE 30" x 30" CR AWL WL SP ACE CE AC CESS E S S a O . .E 66" "� o a vanity NEW O BATH NEW the _ a ih m 36" x 54" / I tile shower � O w/ glass enclosure y1 616 00 existing O window NEW existing window to be LINEN to be replaced removed ° w/ NEW 34 x % 6—panel PINE Dr. EXISTIr -V X FULL BASEME EXISTING BEDROOM ED ADDITION I FLOOR r Barnstable Town of Barnstable .�. Regulatory Services Department j eficaC j 9 ,"�: ��� Public Health Division m F°'gyp 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 - Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2850 7732 May 8; 2013 Cynthia& Carolyn Hutchinson 61 Park Avenue Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 61 Park Avenue, Centerville, MA was last inspected on • 4/16/2013,by Darrell Stone, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Needs further Evaluation" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • The septic system is in hydraulic failure Also, due to the fact that the leaching area is located underneath the driveway,the new leaching pit must either be H-20 load bearing or relocated to an area outside the driveway. The septic system must be repaired within sixty(60) days 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 OARD OF HEALTH T om s McKean, R.S., CHO Agent of the Board of Health • I Q:\SEPTIC\conditionally passed\61 Park Ave Cent May 2013.doc WWI) -��,, d- i • Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 61 Park Ave. Property Address Cynthia&Carolyn Hutchinson Owner Owner's Name information is required for every Centerville MA 02632 4-16-13 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 filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Darrell Stone t use the return Name of Inspector key. Cape Cod Septic Inspection r� Company Name PO Box 1466 Company Address Harwich MA 02645 City/Town State Zip Code 508-240-2500 S14995 Telephone Number, License Number Q � B. Certification 's �= `tl I certify that I have personally inspected the sewage disposal system at this address and that'th'eU. _ information reported below is true, accurate and complete as of the time of the insp tion. The�nspodvon was performed based on my training and experience in the proper function and maintenance nt on situ sewage disposal systems. I am a DEP approved system inspector pursuant to ection 1".. 40 ofq Title 5(310 CMR 15.000).The system: -- El Passes ❑ Conditionally Passes ❑ Fails Z Nee urth r Evaluation by the p g Authority 4-18-13 In ctoes Signature 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. ['6 q 119 3 t5ins•11/10 Title 5 OffiaInedtion Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form =- Subsurface Sewage Disposal System'Form-Not for Voluntary Assessments wM 61 Park Ave. Property Address Cynthia &Carolyn Hutchinson Owner Owner's Name information is Centerville MA 02632 4-16-13 required for every page. CitylFown 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: t 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 f • Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 61 Park Ave. Property Address Cynthia&Carolyn Hutchinson Owner Owner's Name information is required for every Centerville MA 02632 4-16-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health):, ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced- ❑'Y ❑ N ❑ ND (Explain below): i ❑ 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): s I 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts a . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments 61 Park Ave. Property Address Cynthia&Carolyn Hutchinson Owner Owner's Name information is Centerville MA 02632 4-16-13 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ - The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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: The(6x6)' H-101each pit is under the driveway. The`current ponding level in the leach pit is 6"from the inlet pipe.With previous staining around 2" higer. 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 ❑ ® Liquid depth in cesspool is less than 6° below invert or available volume is less than '/a day flow t5ins•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Park Ave. Property Address Cynthia& Carolyn Hutchinson Owner Owner's Name information is Centerville MA 02632 4-16-13 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain.of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: .To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the. questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to,a surface drinking water supply .❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection _Form = Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Park Ave. Property Address Cynthia&Carolyn Hutchinson Owner Owner's Name information is Centerville MA 02632 4-16-13 required for every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ' ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes'uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® El information 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 ® El approximation of distance is unacceptable)[310 CMR 15.302(5)] D.-System Information Residential Flow Conditions: Number of bedrooms(design1. Na Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 i t5ins•11%10 " Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 II I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Park Ave. Property Address Cynthia& Carolyn Hutchinson Owner Owners Name information is Centerville MA 02632 4-16-13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 3 Bedroom residential dwelling Number of current residents: 1 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: Sump pump? ® Yes ❑ No Last date of occupancy: 4-2013 Date Commercial/IndustrialFlow 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 _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Park Ave. Property Address Cynthia&Carolyn Hutchinson Owner Owner's Name information is MA 02632 4-16-13 required for every Centerville page. Cityrrown State Zip Code Date of Inspection . D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Unknown Was system pumped as part of the inspection? ❑ 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Park Ave. Property Address Cynthia &Carolyn Hutchinson Owner Owner's Name information is required for every Centerville MA 02632 4-16-13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1979 Per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 23"+/- 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.): Apparent good condition Septic Tank(locate on site plan): Depth below grade: feet P Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•11110 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Park Ave. Property Address Cynthia&Carolyn Hutchinson Owner Owner's Name information is Centerville MA 02632 4-16-13 required for every page. CityrFown 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 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.): 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 t5ins•11r10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments µ„ 61 Park Ave. Property Address Cynthia&Carolyn Hutchinson Owner Owner's Name information is required for every Centerville MA 02632 4-16-13 page. CityfTown 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 fiberglasspolyethylene ❑other(explain): ❑ ❑ ❑ 9 ❑ 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 a - W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °wM 61 Park Ave. Property Address Cynthia&Carolyn Hutchinson Owner Owner's Name information is required for every Centerville MA 02632 4-16-13 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 Comments(note if box is level n distribution to outlets equal, any evidence of solids carryover, an y evidence of leakage into or out of box, etc.): PumpChamber locate on site plan): ( P ) 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Park Ave. Property Address Cynthia&Carolyn Hutchinson Owner Owner's Name information is required for every Centerville MA 02632 4-16-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leachin 9"pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: `�❑ 7 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.): 1 H-10 (6x6') pit with 1'stone Grade to pit 24" Bottom 104" Pondin 63" Staining 2" higher Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Depth—top of liquid to inlet invert 511 Depth of solids layer 13" Depth of scum layer Dimensions of cesspool (6x5') Materials of construction Cesspool block Indication of groundwater inflow ❑ Yes ® No t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System Page 13 of 17 P Ys • 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Park Ave. Property Address Cynthia &Carolyn Hutchinson Owner Owner's Name information is required for every Centerville MA 02632 4-16-13 page. Cityrrown 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.): Grade to cover 3" Normal liquid level SCH 40 outlet tee Recommended next maintenance pumping within 1 year Recommended maintenance pumping yearly 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 61 Park Ave. Property Address Cynthia&Carolyn Hutchinson Owner Owner's Name information is required for every Centerville MA 02632 4-16-13 page. Citylrown 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 all wells within 100 feet. Locate where public water supply enters the building. Check n f p pp y g c one o the boxes below: ® hand-sketch in the area below ❑ drawing attached separately e � l t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 J f, Commonwealth of Massachusetts . Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 61 Park Ave. Property Address Cynthia&Carolyn Hutchinson Owner Owner's Name information is required for every Centerville MA 02632 4-16-13 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: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: See below You must describe how you established the high ground water elevation: Elevations from USGS maps Approx. Property ELV. 50.0-46.0 Approx. Bottom of Main cesspool ELV. 39.59-43.59 Approx. Bottom of SAS ELV. 37.34-41.34 Approx. GW ELV. 36.0 Separation >1" 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 61 Park Ave. Property Address Cynthia&Carolyn Hutchinson Owner Owner's Name information is required for every Centerville MA 02632 4-16-13 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Town of Barnstable P# ' Departinent of Regulatory Services Public Health Division DMAMate09,200 Main Street,Hyannis MA 02601 Date Scheduled ,A+ Time Fee Pd. —/ Soil Suitability ,A.ssessmentfor Se;' e Disposal � THO A f M G_e_�,uA/ Pe 4 Performed By: Witnessed By: Q/ _ �tJ LOCATION& GENERAL INFORMATION / Location Address p �g/ /t J Owner's Namc C=�J�J'r}11 f� I'I�i�e, i 3r !!c.1/ �7�1 AddressTj Assessor's Map/Parcel:/ V Engineer's Namc J'L.) 1 NEW CONSTRUCTION 1 9 REPAIR Telephone#,��C:�' 3J3S, 3qZZ ,, Land Use IC4^.� Slopes(96) _ Surface Stones N0 A/ Distance's from: Open Water Body _g possible Wet Area_/�b g Drinking Water Well Drainage Way 1 g Y ft Property Une �_ft Other ft SIM'TCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands 1n proximity to holes) BUM pS R 1 VfIL (Lo Q c I " ' t CD Pa --i • � Opp � t-- vt rr, Tr -r1l-z 06 Parent material(geologic) dU�w/Q J�� Depth to Sedrock Depth to Oroundwater. Standing Water in Hole:_�P0/V _ Weeping from Pit Fnee Estimated Seasonal High Groundwater N/" DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: I4. Depth td soll mottles: 1tL Depth to weeping hum side of obs.hole: In, Groundwater Adjustment ft. • Lid x:✓e[i{I Reading Date: index Wet[icVsi _ Aqj.factor- Adj.UtnundWawr L.evei „P- PERCOLATION TEST bate 11�13-1hitne" Observation Hole# I _ Time at 9" t Depth of Pero Tlme at G" Start Pre-soak Time @ SwA7�2 GONG /1J Time(9"G") End Pre-soak m I N �5Rate Min./Inch •. ' Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N), Original: Public Health Division Observation Hole Data To Be Completed on Back--- --- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at Ieast one(1)week prior to beginning, Q:SEPT[C\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil. Other Surface(in.) (USDA) (Munsell • ) Mottling (Structure, Stones;Boulders, i ten'y,9% ravel) A 1,5 Io 5 z 24 B �-S loH2r 6 3° G mS 2-�l 716 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, - -C-011slstency.%O e Cf . (,S loq�, 6Z 13S G MS Z•5�( ?. . DEEP OBSERVATION HOLE LOG Hole#. Depth from Soil Horizon Soil Texture Soil Color Soil Other' Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulders. Co i to c Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (structure,Slopes;Boulders. Consistency y Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No._ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perviou aterial exist in all areas observed throughout the area proposed for the soil absorption system? J If not,what is the depth of naturally occurring pervious matarial? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tra' ing,expertise an, exp ience described in�10 CMR 15.017. ? Signature Data 12' Zff- i J QAS.EPTICIPERCFORM.DOC 17' L0CA`.TION SEWAGE PERMIT NO. 41 '4,e - VILLAGE INSTA LLER'S NAME i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �� �� \� N� �f ?. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ..............T.o.w.n.....OF_,....Barnstable .... .. ... ................................................................................. Appliration for Uispaaal Works Toustrurtion "amit Application is hereby made for a Permit to Construct or Repair ( X) an Individual Sewage Disposal System at: 6.L.1'ark.-Ave........C.ent.ex.ville....._Q26.32.... .................................................................................................. Location-Address or Lot No. Paul Hutchinson .............. 2.0---L.eny--- jM Q.652.0. ---------------------- W A 4 B Cesspool 0 r Address 8 128 Bishops Te .,...11YAPAIP.......02�!21............................. ------------------------------------.. ..............Bishops__................. 0.4 Address Type of Building Size Lot--- --------- ---------Sq. feet U Dwelling—No. of Bedrooms.................................._.__.._..Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons.... ..................... Showers Cafeteria Pa Other fixtures .............................................................................................................................................I........ Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter-_-____-.__..... Depth................ Disposal Trench—No..................... Width............._...... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter............___._._. Depth below inlet.................... Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 14 1 4 Percolation Test Results Performed by.......................................................................... Date........................................ 14 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_.__..__._.._........__. �_q 1 44 Test Pit No. 2................minutes per inch Depth of Test Pit..._._.............. Depth to ground water........._........__.___ P4 ............................................................................................................................................................ 0 Description of Soil........Sancl...&...Gramel.......................................................................................................................... U ......................................................................................................................................................................................................... ...................................................................................................................... ................................................................................ U Nature of Repairs or Alterations—Answer when applicable------_--------Instal_1at.izn----ot...a---1,OD-0...gall on stane---packed...leach---p1t....................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersig I � _VA further agrees not to place the system in operation until a Certificate of Compliance has been issued t e bo�", alth. ze,�,Z_ ,;e:e, Signed. ........................ ............ ......... 51._71_79........... D te, ApplicationApproved By...........................................................................o...................... .........5./! 77.19........... Date Application Disapproved for the following reasons:............................................................................................... .......... ...................................................................................................................................................................................................... Date Permit No---------------79-.-............................ IssuedL.....V...1/7.9................................. .......... Date t No 7°=,� 4': Fps 5.j ......._ THE COMMONWEALTH OF MASSACHUSETTS BOARD"O'F ' HEALTH . . ...................-.. ..T©yn.....OF.......PArnstabl@....................... tt ; ; pphration for Dispasal vrk�i Tnntrnr#inn iY a.0 Apphctio ,;is hereby made or Permit to.Construct ( ) or Repair ( X) an Individual Sewage Disposal Systear,,it -----------------------=--------•--------------------- ••- ---.. .....---• - +Ls< tc} v b Location Address or Lot No. s M ......................................... �A :: (�-Ea2ja f «kq3 j vg , Owner Address i a Aa' `eao ,. x'Y ¢.................................. 2$._.BshQpc�-- erx.. Yaan � f � C� Installer Address r r. W - U Type ofoBuildsrig Size Lot____ Sq. feet Dwelling- No: ,of Bedrooms................... ..............._.......Expansion Attic ( ) Garbage Grinder ( ) Other,—wT-• e -of -Buildin No. of ersons____z_____________________ Showers a z YP g P ( ) —•-Cafeteria (. ) fixtures .----•--------------------------------•---------•----•-••-•--------------•---•--------•------•---------.........-•••----_._. . W Deslgn ' ` :.......................gallons per person per day. Total daily flow....... .....gallons. WSeptic 17`an "`1✓Iquid capacity___.._..____gallons Length________________ Width...._...___.__._ Diameter._.... llep"th................ x Disposal''Txej i3 Vo_____________________ Width.................... Total Length.....................Total leaching area_;_; .......sq. ft. Seepag"-._' t o Diameter.................... Depth"below inlet.................... Total leaching area.................... sq. ft. Z Other Di'gtfibution box--( ) Dosing tank �' Percolation Test Results;: Performed by %---............................................................. Date............................ ,_.__..__.._..----. a Test,Pit;No._I................minutes per inch Depth of Test'Pit.................... Depth to ground water....:................... Pit:,No.:2................minutes per inch Depth of Test Pit.................... Depth to ground water ............... 1 kr ......••---- Descr>p`t on''of:Soil- - .? fG� 2:7F� --••••••••.............••--....---••-••..•-- V r '= ......... . '---------------- ----------------- • ....................................................... U Naturel- Repairs`or Alterations—Answer when applicable................Tn tJ..,on... TKr?!!?._gallon Aee y G E 1 34 i,.................................•---..__...---------------------..... •-•---------. -- ._. gr rent .,.:. ,. , .• .... �' .,. TWjiin.ersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with Carr s . the pro,pip is,of j114 LE 5 of the State Sanitary Code—The undersig further agrees not to place'#e system in operation,until:a'Certificate of Compliance has been issued he bo ealth. U. Signed,A rD e ApphcafionApproved By:_..-•---------------------•-----....---------------.....--•--•-•---•------•-•----•-_.._.......-- .... .., Date Application Disapproved-for the following reasons--------------•--•---------------------------------•--•--•--••-•-----•----•---- . •------•••--•-- .............'' _. ..................................................._......._..........__......__....... {fa _�. r - ............. �� } Date t`lPermit No --•---. •S -----•-•-• - :.: Issued.------ 1. 7 ---- Y� Date - } r�11 0 '744 a 5 lh J. \1 ya trk_,ts,• "' "' THE COMMONWEALTH OF MASSACHUSETTS` '� a• BOARD OF' HEALTH . .TC3Viin....OF........•Baryl.Ektabl.f.'............... r' �t¢ Tnt first a of ( ompliatta y THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed '( or Re aired X b A..s Q�e s ±1?.._ :x�: :;.._� ... _ h errs, e ..... My ..Ia. . ................. a xa-xs �� In^all r r at £a1.' '" a a .- �'s «1..__v293? Pa ill tI�tta-h 8On r has been znst.�lled in accordance with the provisions of TI" IE 5 of The State Sanitary Cole a dgscribed in the application for Disposal,.Works Construction Permit No..-? .._..._�.�: ........ dated_._,..................�+// ;................ THE ISSUANCE OF THIS CERTIFICATE tSHA"AL, BE CONST UE® AS A G RANTEE THAT THE SYSTEM WILL, FUNCTION SATISFACTORY. DATE " ; ~ ...• ••--- Inspector .. .. ....... THE COMMONWEALTH OF MASSACHUSETTS - kr� BOARD OF • HEALTH No 7 ¢ - ................T.oi�1n.......OF........Bad'datable.........----............................... FEE 00 .r 5. a ------••••..... � .$� �.� . .. �i��rr,sttl �rk� ��at����rtilan' anti#• - • ` � . Per'snissaon-tis•,hereby granted._-A ._$-,CeSSIDOOL Service- 12£i B �Y�O�iS 2'�z', Hyannis .s ---_.... ....._ .. A°4 ..__._.t _...... ._...y to Construct tr ) or Repair ( an Individual Sews a Dish. stein at No }- �............................................. en terville, 'a. €� -- �' 4 1 T patch n�nN air --------•----•------------ ;4,�, a; -�, .k - .................••-- Street ................. r ................. as shown on the application for Disposal Works Construction P . it No -__,___ Dated_._.5� T�ry�_________________ 7 Boar ofcHealth�y� DATE. FORM 12.554 HOBBS WARREN, INC., PUBLISHERS S � AsBuilt Page 1 of 1 LOCATION SEWAGE PERMIT NO. G> P�,-f< VILLAGE INSTA LLER'S NAME i ADDRESS BUILDER OR OWNER Q .� DATE PERMIT ISSUED OAT E COMPLIANCE ISSUED :\10 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=208008&seq=1 5/21/2012 KEY: LOCUS-- EXISTING CONTOUR:---- SEPTIC SYSTEM DESIGN SEPTIC SYSTEM SECTION -71 PROPOSED CONTOUR:............. 2"PEASTONE OR FILTER FABRIC EXISTING SPOT ELEVATION: 25.5 FLOW ESTIMATE: COVERS WITHIN 6" 3/4"-1 1/2" PROPOSED SPOT ELEVATION: 25.5 100.72 WASHED STONE 0 4 BEDROOMS AT 110 GAL/DAY= 440 GAL/DAY OF FINISHED GRAD RIVER RD A TEST HOLE:* TOPBUMPS T D m, m INSPECTION PORT UTILITY POLE:-� FOUNDATION �^ � ,�-,a�� � CTIO SEPTIC TANK: " � ELEV.=97.5 FENCE LINE: �' N w Q�C� HYDRANT:�j 440 GAL/DAY x 2 DAYS= 880 GAL 3'Mom' Q ����<G RETAINING WALL:o USE 1500 GALLON SEPTIC TANK 97.86 4 �=h /8 (1�M NR Y p ELEV. 97.1 � e; 4 ELEV. a LEACHING AREA: . . . . . . . . . 97.06 96.89 USE 3-500 GALLON CHAMBERS(8.5'x 4.8'x 2'EFF.DEPTH)WITH 97.35 ELEV. ELEV. 94.5 LOCATION MAP Q ELEV. D-BOX 4 4 ELEV. PARCEL 8 (10,059 SF) 4'OF STONE ALL AROUND (33.5'x 12.8'x 2'DEEP) 1500 GAL (6"STONE UNDER) < 33.5'x 12.8' ASSESSORS MAP:208 PARCEL:8 SEPTIC TANK DEED BOOK:26550, PAGE:327 SIDE AREA: (33.5'+ 12.8')x 2 x 2=185 SF (0.74)= 137 GAL/DAY 3 500 GALLON CHAMBERS WITH (6"OF STONE UNDER OR 96.5 4'OF STONE ALL AROUND BOTTOM AREA: 33.5'x 12.8'=429 SF (0.74)=317 GAL/DAY MECHANICALLY COMPACTED) ELEV. (33.5'x 1(( VENTED2.8'x)) CAPACITY=454 GAL/DAY 2'DEEP) TEE SIZES: GAS BAFFLE INLET:6"UP, 13"DOWN AT OUTLET TEE (TO BEH ) OUTLET:6"UP, 14"DOWN N REQUIRED VARIANCES FROM TITLE FIVE: 1.SECTION 15.211 (1):LEACH AREA TO BE LESS THAN 20'FROM CELLAR WALL(VARIANCE OF T). TH-1 100.0 TH-2 100.0 2.SECTION 15.211 (1):LEACH AREA TO BE LESS THAN 10'FROM GARAGE(VARIANCE OF T). I TEST HOLE LOGS O/A HORIZON ELEV. O/A HORIZON ELEV. 3.SECTION 15.211 (1):SEPTIC TANK TO BE LESS THAN 10'FROM CELLAR WALL(VARIANCE OF 2'). ENGINEER: THOMAS McLELLAN,P.E. LOAMY SAND LOAMY SAND 4.SECTION 15.211 (1):SEPTIC TANK TO BE LESS THAN 10'FROM GARAGE(VARIANCE OF T). BED 10" 10YR 5/2 99.2 9" 10YR 5/2 99.3 ROOM WITNESS: DONNA MIORANDi,R.S. B HORIZON B HORIZON DATE: 12-3-13 LOAMY SAND LOAMY SAND 24' 10YR 6/8 98.0 26° 10YR 6/8 97.8 : BATH I PERCOLATION RATE: <2 MIN/IN .--{ C HORIZON C HORIZON Fd e n P#14196 2 5 D 7/6 SAND 2.5Y MEDI7/6 UM SAND 97 �8e Of pay �""/A• BED BED ROOM ROOM 138" 88.5 138"1 1 88.5 97 �� 2nd FLOOR NO GROUND WATER ENCOUNTERED n / Stpc \ MUD m�LE NOTES: 98 / aaa F 98 c'ace \9� ROOM `\ $3 _ 1.VERTICAL DATUM: ASSUMED G KITCHEN 2. MUNICAPAL WATER IS AVAILABLE. Q BATH BED a ROOM 3.SCHEDULE 40-4"PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. * �A 98 4.ALL PRECAST UNITS SUBJECT TO TRAFFIC LOADS TO CONFORM WITH AASHTO H-20 SPECIFICATIONS. O - 99 O MCP. DINING ' 5.PIPE PITCH= 1/8"&1/4" PER FOOT(UNLESS NOTED OTHERWISE). C AREA 6. FIRST 2'OF PIPE OUT OF D-BOX TO BE SET LEVEL. T LIVING l f SUN ROOM 7.THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE USE OF A GARBAGE DISPOSAL. 0 BF�RtVG hydrant PORCH 8.ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE STATE OF MASS. ENVIRONMENTAL 4� tpp fn�t/NG 44 CODE(TITLE FIVE)AND LOCAL HEALTH REGULATIONS. 10 ;�2 E / 1st FLOOR 9.CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. 10.GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO EXCEED 3'. Co cP �n�ert a / EXISTING FLOOR PLAN 11. FIELD SURVEY PROVIDED BY TERRY A.WARNER,P.L.S.,HARWICH,MA. Y� 9�86 36"oak j r BENCHMARK AT RIGHT CORNER 12.THIS PLAN REQUIRES THE REVIEW AND APPROVAL OF ONE OR MORE TOWN DEPARTMENTS AND BOTTOM STEP IS SUBJECT TO CHANGE UNTIL SUCH TIME. 10, ELEVATION=100.23 � 13. EXISTING CESS POOL AND LEACH PIT ARE TO BE PUMPED AND FILLED WITH SAND OR REMOVED. mn / cP BRi� 12"willow 14.D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. 99 Wq�k x� 99 Ae q GF i P 100 / 4 J SITE PLAN `\ � � Z EXISTING DRAIN /o th_1 cedars TO BE REMOVED th \ , LOCATION: 86. 2 sTr / of 61 PARK AVE. CENTERVILLE MA �Ylve \ mom l4$J. PREPARED FOR: molt c4v& CYNTHIA HUTCHINSON 100 SCALE: 1"-20' I e�_� DATE: 12-23-13 - � � BASS RIVER ENGINEERING 100 2nd BENCHMARK AA AA AT MAG NAIL ELEVATION= 100.0 THOMAS J. McLELLAN, P.E. P.O. BOX 385- EAST508-36DENNIS,MA 02641 508-385-3426 OR 508-364-9048 M 13-40