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Home My WebLink About0127 PHEASANT WAY - Health 7 Pheasant Way Centerville ,f A = 228 131 AN 'Am- 11l! UPC 12543 No.53LOR �o- HASTINGS,UN c Y (� 1 \ V , J ` Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 127 Pheasant Way i* Property Address Ocwen Loan Servicing LLC M~; Owner Owner's Name —, information is required for every Centerville MA 02632 05/11/2017 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 Jason Haskell use the return. Name of Inspector key. All Clear Septic&Wastewater Services Company Name 102 West Main Street Company Address Norton MA 02766 City/Town State Zip Code 508-763-4431 S113520 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Qo•� �/9 5/18/2017 Insp tor'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 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. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Septic tank, distribution box, SAS. Septic tank and all related components are in working order. SYSTEM PASSES. 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has 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: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® 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.doc-rev.6/16 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 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 page. Cityfrown 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? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 GPD provided t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 127 Pheasant Way Property Address Ocwen Loan Servicing.LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holdingtank resent? Yes No p ❑ ❑ Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 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 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 page. CitylTown 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): l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known) and source of information: 6/28/2006 per design plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 19"feet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints good, no signs of leakage, system vented. Septic Tank(locate on site plan): Depth below grade: 33" feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ® polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'3 x 5'x 5' (1500 gallons) Sludge depth: 4" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 5 Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Rod&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.): Pumping not required at this time. Inlet and outlet tees are good. Liquid level is at outlet invert. No evidence of leakage. Recommend an effluent filter and risers to grade for proper maintenance. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc:): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA. 02632 05/11/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is good and level. One outlet. Minor solid carryover. No evidence of leakage. Recommend a riser to grade for proper maintenance. 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil and vegetation normal. No signs of hydraulic failure. 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 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 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: >54" 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: 6/28/2006 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: High ground water elevation obtained from system design plans for this property. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 127 Pheasant Way Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centerville MA 02632 05/11/2017 page. City/Town 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 All-Clear Septic Wastewater Services AL 0i , . 9. ► k ► I VC SHE -you TM *t# ►Q 0 ' t e � * 1 ! B i r 6 � � HUU�1Cj NI. 'z MM AD �.�;�,,, .�.� -� s C.�� .�z ��..gga. `•'Y� t:' � py x to + �z �S x 1 2 A 29.0' 21.0' B 26.0' 46.7 102 W. Main St. Norton, MA 02766 Office: (508) 763-4431 Fax: (508) 763-4168 www.aliclearseptic.com TOWN OF BARNSTABLE LOCATION SEWAGE# VIIrLAGE ASSESSOO' 41AP&PARCEL �-q t� 1 INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS 7 OWNER G-K._--- PERMIT DATE: 1 hml- ANCE DATE: 7 Lo . Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY L t 3 �. I � •, o l �TOWN`OF BARNSTABLE LOCATION PA $4�► ®�! VIL LATE (�,Q.��rv�� ASSESSOR'S MAP & LOTOV - /3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY CESSpW LE CHING FACILITY: (type) �X�� Po-r (size) �00?J cIn NO OF BEDROOMS vZ BUILDER OR OWNER Ac-JqM MAre Ae.Gy PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leac ng facility) Feet Furnished by 1 el.Wc 0n 77 FOiC1 I r - G,arAIt- Q t t 3 � a Al S r a 97 3 3b 3y No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppfication for Zie;ponf *p$tem Congtruction. Permit Application for a Permit to Construct( )Repair )Upgrade( )Abandon( ) mplete System ElIndividual Components X.o Location Address or Lot No. 1,�- � ( J Owner's Name,and Tel.No. � —�c-� Assessor's Map/Parcel /j k,s,camI C r i � Installer's Name,Address,and Tel.No. Designer's Name,Address el.N,o. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( Cafetena(� Other Fixtures '� Stt1 Design Flow �?_)p gallon per day. Calculated daily flow gallons. Plan Date &). t0t Number of sheets Revision Date Title Size of Septic Tank J Type of S.A.S. X o2 Description of Soil rPlCd1 3—CVI-kc 5` Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has be lb oj Health. Si a Date. Application Approved b Date Application Disapproved for the following reasons Permit No. Date Issued No. 4 dCJ "" —( . •fi 4t Fee I THE-COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS r 2pprication for Miopaal *poem Con!Wuction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) X mplete System 0 Individual Components Location Address or Lot No. ' a - '� W Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and-T 1.No. SJ2 C Sevcs, SAS �►�V. seJcS. Type of Building: i Dwelling No.of Bedrooms— 2 Lot Size 10, '�O sq.ft. Garbage Grinder Other Type of Building No. of Persons Showers( afeteria Other Fixtures S Design Flow gallons er day. Calculated daily flow -gallons. t Plan Date e3 a OZ. Number of sheets Revision Date Title- J; �. Size of Sepiic Tank ---Type of S.A.S. I C 1a Description of Soil _ �`�t1 s ? . } Nature of Repairs or Alterations(Answer when applicable) Date last inspected: t r is✓ Agreement: ` '' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system 'P in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has b,eeoe==n,issued by this B d of fiealth. Si hed Date '��! D�o Application Approved bb Date Application Disapproved for the fo lowing reasons Permit No,�i� aZ 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 k c- at ,C �'r-r vI has been constructed in accordance with the provisions oat oaA 5 and the for Disposal System onstruction Permit No. ated� Installer — d 0.,.Z�6 Designer The issuance of this permit shall nb)constr u as a guarantee that the sys em wit une on as esigned. Date Inspector i NR�-��(� r�� --------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migpog, [ *p$tem Con!5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at l —2_ 2 iNg�. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructi must I completed within three years of the d e`of this pe Date: Approve y 10/13/2016 00:48 FAX 1a 002/002. Town of Barnstable t Regulatory Services Thomas F. Geiler,Director M ,}' Public health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508.790-6304 Installer& Designer Certification Forma Date: 7-17-06 Designer: Shay Environmental Services, Inc. Installer: Robert Septic Services. Address: F.O.Box 627 East Falmouth Address: 5 Trenton Street MA 02536 Yarmouth MA On 5-27-06 Robert Septic Service was issued a permit to install a (date) (installer) septic system at 127 Pheasant'trir'ay, Centerville,MA based on a design drawn by (address) Shay Environmental Services.Inc. dated 5/24/06 (designer) XX I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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. ` H of MASS o CARMEN let re) U SHAY N No. 1181 +P��lSTER�G � SANITAM signer's Signature) (Affix Designer's Stamp Isere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF OMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY TIME BARNSTABLE PUUBLIC HEALTH DIVISION. THANK YOU, Q:HealWgeptie/Designer Certification Form ,,oF1HE Ta,. Town of Barnstable Regulatory Services BAMSrABM v MASS. g Thomas F. Geiler,Director s639. nee.+ Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 7/9/03 To: Karen & Adam Machado 127 Pleasant Way Centerville, MA 02632 The septic inspection for your property as stated above; was submitted by James M Ford on 7/1/03. The status of the inspection when submitted was (NFE) needs further evaluation. Single cesspools by local regulations are not permitted in the town of Barnstable. The status of the inspection has been changed to Failed. A system that fails needs to be put into compliance within two years of the failure. Therefore you have two years from 7/1/03 to come in to compliance with this local regulation. Sincerely yours, Thomas A. McKean, R.S., C.H.O. ,7 Agent of the Board of Health Town of Barnstable Enclosures: JJd: 0 Qm-imr.ymWd�lgfh-d-d- / Town of Barnstable �0.FTHE Tp�y y�P o� Regulatory Services BARNSrAF3LE. » Thomas F. Geiler,Director y MASS. $ 1639• Public Health Division ArFb MAC A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 December 17, 2008 Attn: C.O.M.M. Fire Health Inspector Jaime A. Cabot, R.S. conducted a rental inspection in accordance with Chapter 170 of the Town of Barnstable Code. In accordance with the State Sanitary Code, 105 CMR 410.482, the Health Department is required to notify the Fire Department if there is a smoke detector violation, or possible smoke detector violation. The following property had possible smoke detector(and\or CO detector) violation(s): 127 Pheasant Way, Centerville, Assessors Map-Parcel: (228/131) - Carbon monoxide detector not provided for bedrooms. IZ•S. J e A. Cabot, R. S. Health Inspector Q:\Order letters\Housing violations\Rental ordinanceUire ViolationsTIRE TEMPLATE.doc °fVETay. Town of Barnstable ,ARr,srnsLe. : Regulatory Services y4, ' 39. �� Thomas F. Geiler,Director pIFD MA'S� Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 u js DATE: 4 2 13 1LD O NiI1VS� R OT F GL TO FOLLOW-; 1 TO; FROM: �AL"C 1*l �N S Ec.t per. PHONE: PHON v (508)86246 r FAX PH FAX PHONE: (508)790-6304 cc: NOTES/COMMENTS: TC7 NA'4Kdu S Ica Cc> % S�4 1 O£'C f-L;r e' from. 2.— 0 A o Z 1 N K VQ A.L,K W A (_ 73a1MIL Co QAFax Form.doc Aon,ovod:_ 6 TOWN OF BARNSTABLE --� 21"/Ic 1Jn c,,..T lviu)Cert: 2 - aa- L BOARD OF HEALTH ,J;q-,o e c_,�e�� ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION -f Date 2 13 O Time: In :30 Out I .' q _( Owner Tenant i S L e•j r- Address. (p 1 C eA-N Sj( jLg,!!:j L AN t- Address 12 '� � �-1 aA S A.U Z �y,A Nam! iS dJe�c.'� 11A L' f� ►,�ZEA. � 1LL-c t',AAr • �32�g2 L Z S Compliance Remarks or Regulation# Yes fiO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities }�jA'(�k1Z A LL'-S -Y CILiL;�, 4. Water Supply --Cow ✓ 9-to S f a i V-4 5. Hot Water Facilities 6. Heating Facilities % 7. Lighting and Electrical Facilities N 0 Gb La-t uZ: c"`'' S1 8. Ventilation �'-- n 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements -OL�,C. 14. Insects and Rodents (� A.I✓►e.C�L.n 15. Garbage and Rubbish Storage and Disposal 2, H��i ,� I S o 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed 9 PART 11 37. Placarding of Condemned Dwelling; f Removal of Occupants; Demolition µ %—c kkv SF u Number of Bedrooms Z- t S� Number of Vehicles Allowed (max) 3 Number of Persons Allowed (max)_ 4 Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here ^� y No. J —�� 3 � r 1 V Fee THE COMMONWEALTH OF ASSACH� ETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Mg;poe;aY *p5tem Con!5truction Permit Application for a Permit to Construct( )Repair( , )Upgrade( )Abandon V_�, ❑Complete System ❑Individual Components _^J 7 Location Address or Lot No. 'Owners Name,Address and Tel.No. �•- Assessor's Map/Parcel 'Z t � Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �^ / Type of S.A.S. Description of Soil J°i , Nature o?__4?6b epairs or Alterations(Answer when applicable) %d 100�t d o y �1 P iCl aL- 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 th n ' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been' s jedth' o of e . Signe Date 4 /® Application Approved by Date Z Iq o Application Disapproved for the following reasons L --------------------- Permit No. �00 3 —-30 3 Date Issued 7)g O 3 No. r-�-^✓ J _, ("G�nQt`� U � LITTS NFee/0(� THE COMMONWEALTH OF ASSACHU Entered in computer: • Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Zi5po.5ar *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon Y N ❑Complete System ❑Individual Components Location Address or Lot No. /3wners O ' Name,Address and Tel.No. �a g .o/ �f Assessor's Map/Parcel 'Z 7— ph eA s�1L C�+� 'a� -e 4 5 C A l A.1 Cr 4P^4 C. r Ha— V MqC Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. TA v A O� tic 5 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures • a Design Flow gallons per day. Calculated daily flow gallons. M Plan Date Number of sheets Revision Date Title Size of Septic Tank r Type of S.A.S. Description of Soil Nature of epairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the con truction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the/Env�ironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued th' oar of e Ilt. Signe Date d /� Application Approved by Date q Application Disapproved for the following reasons Permit No. oG 3 '3U 3 Date Issued 7 3 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) ,Abandoned( b_ at � P'Kvo BQ-A has been construct d accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.Zoo 3-%3 dated 9 3 Installer Designer The issuance of this pefTmt hall not be construed as a guarantee that the syste w' f si d. w Date I I N �03 Inspector c N 3 ------------------------------- No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi.5pogar *pgtem Con5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon System located at ��-� koq Cam, �- Le and as described in the above Application for Disposal System Construction Permit.The applicant recognizes 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 f this erm'.t. Date:_ 7 9 to 3 Approved by 4 i ra> �. 3 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 127 Pheasant Way DRECEcr.- Centerville,le, MA 02632 Owner's Name: Karen&Adam Machado Owner's Address: Date of Inspection: June 28, 2003 Name of Inspector: (Please Print)James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Map:228 Osterville,MA 02655-0049 Parcel: 131 Telephone Number: (508) 862-9400 Lot: 3 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes ✓ Needs Further Evaluation by the Local Approving Authority Fail Inspector's Signatur\sub Date: July 1, 2003 The system inspector sa 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 127 Pheasant Way Centerville, MA Owner: Karen&Adam Machado Date of Inspection: June 28, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. h following tatements. If"not determined" lease Answer yes,no or not determined(I',N,ND)m the for the s ,p explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 127 Pheasant Way Centerville, MA Owner: Karen&Adam Machado Date of Inspection: June 28, 2003 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 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Laundry goes to a single cesspool in the driveway. Cesspool is not H-20 and is at risk of collapse. 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 127 Pheasant Way Centerville, MA Owner: Karen&Adam Machado Date of Inspection: June 28, 2003 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 127 Pheasant Way Centerville, MA Owner: Karen&Adam Machado Date of Inspection: June 28, 2003 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner, occupant, or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 127 Pheasant Way Centerville, MA Owner: Karen&Adam Machado Date of Inspection: June 28, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 3 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): Yes [if yes separate inspection required] Laundry system inspected(yes or no): Yes Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): 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 (laundry) ✓ Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: A pit was added on July 24189-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 127 Pheasant Way Centerville, MA Owner: Karen&Adam Machado Date of Inspection: June 28, 2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage, etc.): SEPTIC TANK: ✓ (locate on site plan) (Cesspool acting as a septic tank) Depth below grade: To grade Material of construction: concrete _metal _fiberglass _polyethylene ✓ other(explain) Cesspool block If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: S'W x 7'T x 9'6"bottom to grade Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: -- Scum thickness: 2" 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: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Liquid was up to the outlet tee. The cover was to grade. Recommend pumping every year for maintenance. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 127 Pheasant Way Centerville, MA Owner: Karen&Adam Machado Date of Inspection: June 28, 2003 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (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.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 127 Pheasant Way Centerville, MA Owner: Karen&Adam Machado Date of Inspection: June 28, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 4'x 6'(600 gal.) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): The pit had l'ofwater on the bottom. The scum line was T up from the bottom. There were no signs of failure. The cover was 2"below grade and the bottom to grade was 6. CESSPOOLS: ✓ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 1 single for laundry Depth-top of liquid to inlet invert: -- Depth of solids layer: lot Depth of scum layer: 0" Dimensions of cesspool: S'W x 4'T x 6'bottom to grade Materials of construction: cesspool block Indication of groundwater inflow(yes or no): No Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): The cesspool had Y of water on the bottom. The cesspool was in the driveway and is not H-20 rated. Recommend piping laundry to main system and filling the cesspool. PRIVY: None (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.): 9 • Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 127 Pheasant Way Centerville, MA Owner: Karen&Adam Machado Date of Inspection: June 28, 2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. I GArA I t. Q � vnGle.r I 04 3 � a r 3 ,36 3y 10 • •• Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C q SYSTEM INFORMATION (continued) Property Address: 127 Pheasant Way Centerville, MA Owner: Karen&Adam Machado Date of Inspection: June 28, 2003. SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25' +1- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 25'+/-to ground water at this site. This report has been prepared and the system inspected and in need of further evaluation by the Local Approving Authority as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system the inspection and/or this report. 11 TOWN OF BARNSTABLE C/ .LOCATION e14.5 � SEWAGE #1;1 VILLAGE ASSESSOR'S MAP & LOT INS?<IALLER'S NAME & PHONE NO:?5 � SUS SEP^"IC TANK CAPACITY LEACHING FACILITY:(type) (size) D�� /// NO. OF BEDROOMS oZ PRIVATE WELL OR PUBLIC WATER/`,.W, C. BUILDER OR OWNER , r DATE PERMIT ISSUED: -- —b H DATE COLiPLIANCE ISSUED: 'I 2 VARIANCE GRANTED: Yes No c 1 e195l��l� lXJ THE COMAMONNWEALTH OFUMASSACHUSETTS " J_ Appliratiuu for Biupusal Works Towitrurtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: !le ... ......�e��e�v� .....................•--------- --...------------ ......--------- Locatio -Address , or Lot N , /!e!t? ........,(,(„.r...1. .-- ------------------------------------------ .....11l .......,!?7��e� ........Ode p Y..!_Im caner 0 Address i W . ...-•- aN.s... .r...� e..QA-2..................... .....11.f ....../ ��.ar.._..5 � Installer T Address d Type of Building Size Lot............................Sq. feet V DwellingNo. of Bedrooms........... .. .Ex a ' n Attic Garbage Grinder aOther—Type of Building i_t!511�...,____... No. of persons !'.0�_______ Showers ( ) — Cafeteria ( ) P4Other` fixtures ---------------------•--- -----•-•----------....------...------------------------------------------------------------------------------............... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r3� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix .........-•-----------------•-----------...------........------......-•------...........-•--•-------......................................................... ODescription of Soil.......•....------------•....-......---....•--•---...•---•-----------•.......----------------------- x c., w x -•-•-------•--- ------------------•--------•--••-•-------•-----••-••--•-----------•---------------•---•- �j - ---------------- s ........... V Nature of Repairs or Alterations—Answer when applicable..__. dl�.n� -----_._Ante---_-___ d!,.. �.��d,C� ..__.___- --------------------------•------------------------------------------- ------------ �_.. --------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI LE, 5 of the State Sanitary Code—The undersigned furt'Ver agrees not to place the system in operation until a Certificate of Compliance has n 'ssue boar f h Sign •-----• ---- --- --------- �- �_�3^. 9 Date ApplicationApproved By----. •-- . ''.. . -•------- ........................................ Date Application Disapproved for the following re ons:--•-•---------•---•------•-•--•----•----••----•---------------------------------------------------------------•- Date Permit No...... ..- C,� f ------------------ Issued........ Date X No.. ._._... 1. F :�../.4�_ ....... THE COMMONWEALTH COFUMASSACHUSETTS ARD......7�a)Xp...OF. . ............. Appliratiun for Diinuuttl Works Ton,strurtion runfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .._ . ._..... :��?...kemS.�u�......Why...... ....�':.�e....................................... ......................................... Location- ddress , or Lot .D- .... ............................ ...•.. caner Add re sJ at QJ ±.L?.I .td.cl. Z. .......................... ��lr lit�.Jat_... _3?.r 1 4� Installer Address dType of Building Size Lot............................Sq. feet U Dwelling=No. of Bedrooms.,....... .....Expa o Attic ( ) Garbage Grinder ( ) - = ( ) — ) Other—Type of Building.,Vk Ie__.......... No. of Persons___ .r_e.�"________ Showers Cafeteria ( Otherfixtures ........................................................... -•--•-•-•------•-••--------------•--•••••••••--•••-•••-•-•-•............--••-••-••••--•••- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area_-____-_--_-----•-sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit---------........... Depth--to-ground water______._-__-_-_-_-___-_. (X, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._______--_____-----_--- P4 --••••---•••-•.............................................••-••••••-•......-••-•--•......-----_............................................................. 0 Description of Soil.......................r--............................................................................................................................................... x -----------------------•---------------------........------------------.....................•.................. ..................• r U Natur of Repairs or Alterations—Answer when applicable.__.__ _..se1_ _.......14�cd____.___�! ,._1tl.QNRl......_.... t��-------------------------•------•---------------------•--•-------------•--...........------------------...------.....--•-------------------------------------------------•------••--- eement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned fur t er agrees not to place the system in operation until a Certificate of Compliance ha en 'ssu boar f h h. % Sign •. .... . --- :42.----•--- ��-�^-Gt••� .� Date Application Approved By...._. _.._....._ �_;.. .._ !� ,�,.. Date Application Disapproved for the following r ons:.......................................... -------•---------------------------------------------------------- r Da te Permit No ....r... �. t .... Issued_......•.4ADate�46•. ................ THE COMMONWEALTH OF MASSACHUSETTS ?OARD O:F}�HE LT �4�I ..................'..1.... .OF....% �:'.\ .. �. ) y6�n ...-•................. TO rdifiratr of Toutphatta THIS,4 TO�C RT Y, Tha the In' idual Sewage Disposal System constructe or Repaired ( ) by � `" =/ J� �_ '.�A° �- ----f - J.. --- ------------------ ------•-•----------._......-- ----..._ at ... _... ' VY nst er 1 7 has been installed in accordance with the pr sions o rT7r. 5 of T ej$tate Sanitarye;A as de ri in the application for Disposal Works Construction Permit No Y�_V/..... dated.. .... .. .. ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A TEE HAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..::.....:...:... •-"-... ............................ Inspector---------.........•�Jtpz................................................ THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH 76 ....................fQAOF.. is ...................................... �' No. 4...... .. FEE..I ( Diunusa ArAll Tonutrw$ ...................... ='••• .....--•---....-------••••-......••.............. ,t'r � m to Construct or Repair ( ) a I divid al ew Di s S at No.. Street c}l / as shown on the applic tion fo Disposal ��Works Construction rmit Nof)--.�.... __ ?/Dat,�d___ ..�_. .�.............. DATE_ Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. SECTION A -A , 10' min. from ALL OUTLET P1PES FROM THE BE t Existing Foundation )house to septic tank PROFILE VIE DTRBUTQH BOX SHALL W OF LEACHING SYSTEM SET LEVEL FOR AT LEAST 2 FT. 127 CONCRE1E COVER Septic tank covers must be D-BOX cover must be y TOP OF FOUNDATION = ELEV. 100.00 (Assumed) within 6 in. of finished grade Not to Scale Within 6 in. of finished grade `. Grade over Septic Tank-91LOO Grade over D-Box- 95.00 over SAS- 84.00 to 91.00 _ 3-5'OUTLET KHMOUTS 1 \: # s /4" to f t/l " I/aeMd GraWhed atoms 5.e OUTLET a : 12, RA.ET S - 0.02 3 HOLE H-10 V PVC(CAPPED)INSPECTION PORT TO 8E %, 0 20' NEW soot or Greater ST. BOX 3' V..imam Cover Top OF System- Elev. -86-75 INSTALLED AND TO BE wITwN s•of GRADE 2' PaF ae " EXIST.PIPE 1,500 GAL. s- 0.01' 4 15.5' 4" - SCH. 40 To- ` tU N O 20' Per foot FROMI Exlsr. F1AlMDATIIIN SEPTIC TANK t, PLAN SECTION CROSS-SECTION CONCRETE FULL FOLaTaN-� N H-10 0.soft rn N Cd 5 Effective Depth 24 Sdewai� ' > II OD� � _ _ - ,. > Co 3 Units @ 7' - �21' �SYSTEM PROFILE 6 In.of 3/4"-1 ,/2- 4. 4, 4� , 1' , 3 HOLE H-10 DISTRIBUTION BOX c compacted stone y CO NOT TO SCALE �k Not to Scale - c N aovm, > 12' II 5�-- iav, Ttd 5 Effective Width m Effective Length 6 in.of 3/4•-1 1/2• GENERAL NOTES compacted stone SOIL ABSORPTION SYSTEM (SAS) NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE m INFILTRATOR MODEL 3050 CH-20 LOADING)/ SUMNER & DUNBAR 1. Contractor is responsible for Digsofe notification, Verification of Utilities and protection of all underground utilities and pipes. Bottom of Test Hole 1 Oev=81.00 (OR EQUIVALENT) 2. The septic tank and distribution box shall be set Groundwater observed- NONE OBSERVED level on 6" of 3/4"-1 1/2 stone. NOTE: OVERALL HEIGHT OF INFILTRATOR IS 30" /EFFECTIVE HEIGHT IS 24" 3. Backfill should be clean sand or gravel with no stones over 3" in size. PERCOLATION TEST 4. This system is subject to inspection during installation b Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance Date of Percolation Test:JUNE 28, 2006 with Title V of the Massachusetts state code, the approved plan Test Performed By. CARMEN E. SHAY, R.S., C.S.E. and Local Regulations. Results Witnessed By. DONALD DESMARAIS (Barnstable B.O.H.) 6. If, during installation the contractor encounters any EXCAVATOR: Shay Env. Svcs. soil conditions or site conditions that are different Percolation Rate: Less Than 2 MPI ® 30" from those shown on the soil log or in our design installation must haft & immediate notification be Test Hole Test Hole made to Carmen E. Shay - Environmental Services, Inc. No. 1 No. 2 7. No vehicle or heavy machinery shall drive over the DEPTH SOILS ELEV. DEPTH SOILS ELEV. septic system unless noted as H-20 septic components. 0 91.00 0 92.00 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. Loamy Y Loam 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. Sand 10 YR 3/2 10 YR d 10. All solid piping, tees & fittings shall be 4" diameter Schedule 40 NSF PVC pipes with water tight joints. 0"-6" As 90.50 0"-6" A, 91.50 11. Municipal Water is Connected to ALL OF The Residence and Abutting Loamy Sand Loamy Sand Properties Within 150 Feet. 10 YR 5/6 10 YR 5/6 Bw 88.00 6"-3s" B� s.00 THE PROPERTY LINES ARE APPROXIMATE AND COMPILED FROM THE SURVEY PLAN GENERATED BY ED -Coarse MED-Coarse BARNSTABLE SURVEY CONSULTANTS. OF YARMOUTH, MA Sand Sand Co CO d• N ENTITLED " PLAN OF LAND OF LOT 3 PHEASANT WAY, CENT., MA, 2.5 Y 7/4 2.5 Y 7/4 1 1 1 DATED FEBRUARY 17, 1968 36"- 12o C, 81.00 36"- 120 C, 82.00 I I I AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 100.00 r i r IT SHOULD BE USED FOR NO PURPOSE OTHER THAN j 12 5' 1 4" PVC THE SEPTIC SYSTEM INSTALLATION. I I Egled Ven�j SHED I DrtBox ,�C spool r EXISTING CESSPOOLS TO BE PUMPED OUT& REMOVED �---- IO O O I _� I TEST HOLE #1 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE - I A fir. r• tr;-d _ 0' ELEV.= 91.00 FROM THE EXISTING CESSPOOLS TO BE DISPOSED I I `'' '� = � • • t OF AS PER BOARD OF HEALTH SPECIFICATIONS. PROJECT BENCH MARK TOP OF FOUNDATION Fail d Perc #1 ELEV. = 100.00 (Assumed) Ce pool WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY Depth to Perc: 36" to 54" � ------- ASSESSORS MAP 228 PARCEL 131 Perc Rate= 2 MPI Groundwater Not Observed DECKi i ; LEGEND N D No Observed ESHWT ADJUSTED H2O Elev. = None TEST HOLE #2 X_Q ; ELEv.= 92.00 I F DENOTES PROPOSED 3-24'oIAM ACCESS MAN#WLES o #1z7 ; 0 104X1 SPOT GRADE `� o I o EXISTING oo DENOTES EXISTING 7-_ _•, �•- 2 BEDROOH ___ i A X 104.46 SPOT GRADE _ : ;: �� HOUSE ---- - �\ t = \\\ pl PROPERTY LINE #&4XUT _Emm� 1) CC) I _01- WLET `/ `/ ` / =� T \\ 3s` 96P PROPOSED CONTOUR ` THE ACCESS COVERS FOR THE SEPTIC TANK, \ I J Q I DISTRIBUTION BOX AND LEACHING COMPONENT \ SHALL BE RAISED TO WITHIN 6" OF �� _ _ , I - -- -- -97 EXISTING CONTOUR FINISHED GRADE. �\ �. � ! U)� I ~ STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITE GAS BAFFLES OR EQUALS ��` LOT #3 PLAN VIEW ON ALL OUTLET TEE ENDS 10,000 Square Feet +/- I r DEEP TEST HOLE & 3-24"REMOVABLE COVERS ----- ------------------- ; ; PERCOLATION TEST LOCATION � 5' RETAINING WALL 6 FOOT STOCKADE FENCE 100.00' J min clearance ts' east 1 1 1 1 1 1 MET a mtn-T�2'mtn Wet to outlet e.� 1 � m 1 1 I NNLE 10'min ---Lkluid level_r - OUTLET __ ________*___ _-_____________________ PLOT PLAN > E 4'-0"min. 1 \ 1 \ i c a e•.exe. - liquid depth 1 1 \ 1 OF PROPOSED SEPTIC SYSTEM UPGRADE �,o-o• 5' -B' � � PREPARED FOR CROSS SECTION END-SECTION MR. SAM U E L_ TRAYW I C K TYPICAL (H-10 LOADING) 1500 GALLON SEPTIC TANK NOT TO SCALE # 127 PHEASANT WAY May Substitute with 1500 gallon H-10 Polyethylene Tank-George O'Brien Co. CENTERVILLE, MA Design Calculations jH OF Mq PREPARED BY: Number G Bedrooms: 2 Equivalent to 220 Gal./Day (330 Gal./Day Min. per Title V) E. ,�H�4 Y Garbage Grinder. No �1 itN Li y g Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) o Septic Tank : - 2 x 330 Gal./Day = 660 USE NEW 1,500 GAL. Septic Tank. �' p` ENVIRONMENTAL SERVICES, INC. SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch 0 20 40 50 Bottom Area: 0.74 gal/sq. ft. x 300sq. ft. = 222.00 gallons �c �k° P.O. BOX 627 Sidewall Area: 0.74 gal./sq. ft. x 148 sq. ft. = 109.50 gallons c1sTti EAST FALMOUTH, MA 02536 Providing: = 331.50 gallons SANITAR\P� TEL/FAX : 508-539-7966 Use: (3) 3050 H-20 INFILTRATOR CHAMBERS, HAVING A 2' EFFECTIVE DEPTH, SCALE: 1"=20' SCALE: 1"=20' DRAWN BY: CES DATE: JUNE 28, 2006 (4' W x 7' L) TO BE USED WITH 4' OF WASHED STONE ON THE SIDES AND 2' OF WASHED STONE ON THE ENDS. PROJECT#SD937 FILENAME: SD937PP.DWG SHEET 1 OF 1