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HomeMy WebLinkAbout0271 PHINNEY'S LANE - Health (2) 271 :Phinney's Lane ' ,Centerv,l;- P A .= Y3 ,008: Igo. 4210 1/3 ORA LM �7 eta 10% C O a a TOWN OF B/ARNSTABLE f l LOCATION �� l -4 I w)&YY5 (-AAJe SEWAGE# l �� VILLAGE C6&R&P,V1Cfi,C ASSESSOR'S MAAPP&PARCEL ;130 002 INSTALLER'S NAME&PHONE NOCA?G(JyV t &U-CERMS-cS SEPTIC TANK CAPACITY ( ®U GALL 0 0 LEACHING FACILITY:(type) 'X 500 (size) 12 % ;L5 NO.OF BEDROOMS �. nn,,,�,, OWNER C—AR1S'i[�I` 4EP �i PAW; PERMIT DATE: -7-aO-0201J COMPLIANCE DATE: g--1 —ad 17 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility tqA Feet Private Water Supply Well and Leaching Facility(If any wells exist on / site or within 200 feet of leaching facility) NIA A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �,Q—s+��nn ��^ �" Feet FURNISHED BY CAPewt-oi E0 `G1-c ISE- k 1S o a A ^ 3 41 .5 A R LA Lk5. 3� o � QA2 - 2 ► � o a 21.4 o I�_� Z; 3` i 11/17/2017 R. Anderson daily log 271Phinney's Lane Centerville— R230-003 Reported to site with David (Health) to investigate allegations of people living in 2 RVs. Found power to one RV but no sewer line. No one responded to knock on RV entry. Found owner's wife at home in the dwelling. She called her husband, Headly Bowen who spoke to David. Owner stated that no one is living in camper; he is cleaning and working on it. His wife admitted us to the RV for a quick inspection. Found the bathroom to be winterized, there were no personal effects noted, no creature comforts. The beds were not prepared for sleeping, no pillows. We did not ask to see inside the other unit as there was no power to it at all. Dave advised Mr. Bowen on unreg MV ordinance. Said PD may follow up with them. He also advised owner to register or shrink wrap both RVs in order to avoid additional investigation. Owner will shrink wrap roof of RV (to avoid leaks) and maybe cover doors as well. That will be acceptable as no one will be able to enter units for living purposes without disrupting shrink wrap. No C%% Fee /0�9 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for �Digo!5a[ *potem Con.5tructiou hermit Application for a Permit to Construct( ) Repair( upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. �-71 PWAJAJey� 4..JW , Owner's Name,Address,and Tel.No. Assessor's Map/Parcel OZ 30/00 2 1 0 I JOV-r c-4 1''LAIM S'7- l3P-6Lf J'l49 C..n(MA s'�g-�7� -Fg Installer's Name,Address,and Tel.No. -7-7 Designer's Name,Address and Tel.No. sod- X73- ®377 C,APEi 1&)1 aC- Z e e�u CT4_16EW.1 0Cc 7"C.. Type of Building: Dwelling No.of Bedrooms Lot Size (0,0j')t.f sq. ft. Garbage Grinder ( ) Other Type of Building P GS1b4W T1 A-C_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 34914 gpd Plan Date Z O 04 1 1 c-:t d 17 Number of sheets Revision Date Title 471 AHt CV�,S LA)Jj— Size of Septic Tank I IC9Qp C— C,:,0R/S Type of S.A.S. �o�� �5 Co C-,4,. C,rj C44AI-Ii$dLS Description of Soil M a i fd ort S A-,)j5 !1�?, ga" SC6 pCA AJ Nature of Repairs or Alterations(Answer when applicable) V SC- CXQ —T(AJ& 1 j UOD C4-L-C 0V Sl�—T-Tt T*O-k IL= �J fie.' ® -13¢K lJD ('g SOL) &A4- z iy Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date ti� Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued Be � as � No .12 . 5 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for tg oga gterrt Cowaruction Permit Application for a Permit to Construct( ) Repair A QgTmde `� Abandon ��{{ P Pg 1 ('� ( ) ❑ Complete System LlJ Individual Components Location Address or Lot No. 171 P41NAI 5 Lr(R/ Downer's Name,Address,and Tel.No. Ca&r169-VfL/ C"Xt STQPHCV- AADA0l5 Assessor's Map/Parcel ;Z 30/00 g 1 Q tvoe,-r(4 144w 5-r 13P'1144F(,642)t MA S02-(f7'1 -�8Z`1 5oS- X73 - 0377 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. CAPF,kv'Dl� 6-LrrWQ/_1S6,5 JG FNC�fiV tr.�Cr�7JG_ 15 Co G�l 5z M�S6Fo�' �g5�4 C�4x� N w IE , Ws4eZl.�t f Type of Building: / Dwelling No.of Bedrooms Lot Size j O(Q'I f sq. ft. Garbage Grinder ( ) f Other Type of Building RCStbC1JTI 4L No.of Persons Showers( ) Cafeteria( ) t Other Fixtures r• Design Flow(min.required) gpd Design flow provided 3<4q,4 gpd Plan Date UcA 17 t AO 17 Number of sheets f Revision Date Title �2, /I AN1V1VC /`S (,ME' 0EVTLXV1L&G Size of.Septic Tank 1000 (ScA.4,(,0&j5 Type of S.A.S. (;X) 500 C:z4-c. orj GL�R/�t$025 i Description of Soil N�{o 1 V w 5 AA-A) qP ql r Sty Pr- Q N; Nature of Repairs or Alterations(Answer when applicable) <I SF C XlSTI k) U a C— 4C. oxj SCAT!C.. T34"0 K. 11-� 06110 D -t3 y KTZ) ESoD Cw4 0?-J C 45-b t>F t 1./& 5-4,0+,U A c7GC ��' OF S URA us.-a f1v G-- " Date:last inspected: i - Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in w--,accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. - Signed Date r r Application Approved by Date T A lication Disapproved b �- PP PP Y� Date for the following reasons - Permit No. Date Issued f` THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( x) Upgraded ( ) Abandoned( )by CAP Ew t D C 'xriE�Qj7Q(Sj=j at 17 1 PH ri11 U EY �s L#r J C Ul C.L has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.c/7 dated Installer �,4piE sUjt66 &y74A Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the syste wild fu cfi n s s ed. Date I / Inspecto � }/^ � .� _------------Fee �f✓� --- -- --- ' No 143 -` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Digoml *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( X) Upgrade ( ) Abandon ( ) System located at P 4IA)ICJ `� L-f4 AJF (' C wmt /f CL6 t 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 of this permit. Date Approved by rvi IV uVOC[L1ViltJY #5603 P.001/,001 Town of Barnstable Regulatory Services Rielhard V.Scali enax®rA6[.iG a ,Interim Director ' Public Health DiVisiom Thomas McKean,Director 700 Main Street,Hyannis,MA 02601 MOO', s08-062-4644 Fax 508-790-6304! Installer& be%I ner Cerfifl Lion Fnrro Date; ±847 sewage permit# ac't'l —a3 g Assessors 11 OPTarcel 0 J Designer: �G. � Z�a�'cn Installer: Ca '.wide. Z in•E�rprf se-s Address: 2 S 51 aln }}j h wA Address: 15 3 Ca vr►m crc i o I ca5k a•ek►am KA e253 Hask�,.eLNtk o2 iA —3 On '1'a0-01®1• Cape►�idc k �1s�S (date) — Was issued a permit to install a (tnstalter) Jino at_,,,. 7( , based on a design drawn by (addre s)tn�cg er) dated 6*v17 lyZdl7 taeW.( : '7�Z(-/y ) (desig er) 'ify that he septic system referenced above was installed s bsign, w ich may Include minor approved changes such as!teral�relocation of the to ution b xand/or septic tank. Strip out (iF required) was inspected and the soils founds tisfactory,fy that the septic system referenced above was installed with major changes (i.e. r than 1 ' lateral relocation of the SAS or any vertical relocation o£any component septic ystem) but in accordance with Stte cos Dotal Regulations, Plan revision or ed d s iit by designer to follow. Strip out(if required)was inspected and the soils were found s tisfaatory. _...,,_ I certi that he system referenced above was constr Of the I1,�'ap roval letters (if applicable) ue Pti H ce with the terms G (I stalle ' Signat 8) 1PNuR N ILL4.1 .o N .oft 7 Pew,p e s signer's Signtt (Affix igne s St mp Here)'"— PL ASE RETU TQ BARNS'I'ABI,E PUBLIC I )EA OF COMPLIANC i?VI1;L lyOT $E ISSUED U IL OT N• CERTIFICATE XI.T CA$lID ItY';CEIVEDB T ARIVSTA►SLE PU C S ir'URM Ag, T ` YOU. ALTH DIVISION. QilSapnclDcalgncr Ccranc t(on Form Rev a•14.13.doe ,i i Town of Barnstable P# l Department of Regulatory Services , i F Public Reafth Division Date ' S • MAU �ejy. 200 Main Street,Hyannis MA 02601 rEtt ti � Time a.� Date Scheduled Fee Pd._ Soil S�urtabzfity Assessment for Se e Disposal ' Performed.Hy:Mtc a ! 't M 4e I FIT C S E Witnessed By: LOCATION&.GENERAL INFORMATION Locatlon Addross a7 1 'PH1 h)NC t i.AIJC—. Owner's Name i{ :�4� t$YS C Qt5?C,pI (t Address O �`OiLZ tl IK8� 1$T 0 a l tV::-f C'A Assessor's Map/Parcel: X30 / O© C o�GFtvtD� ��i�1 D&(5aLs' t 1 Engineer's Name ETC C��l pJ�T�t:J.•tA.(y Z � NEW CONSTRUCTION REPAIR _ Tale hone# S p t�'1 i 7 rrSOYQ-23-P377 Land Uso' eS� '(, er4,,Q' S10 ae 96 3% ,(f A P ( ) Surfaco Sconce �1 �5� Distancoa Etna: Open Water Body —Oft 1'osalblc Wet Area ft Dr(tddng Watcr Wall 7 ft � i Dralhago Way d ft Property Una ft Other ft SKETCH:;(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands-in pmximity to holes) See CPC.Ch e • )an Parent material(geologic)v j '��n Depth t r o 34, '✓ `' 5I r Depth to Groundwater. Standing Water In Hole:_ Weeping froth Plt Paoa K Estimated Seasonal High Groundwater t3 DET RM[NAVON FOR SEASONAL•IIIGD WATER TABLE Method Used: t"tC. gQf N0� n h De th Observed standing In obs.hole: oZ la, Depth to soil Mott �J 3 2 In, . Do�th to weeping from side of obs.holes > la, Groundwater Adjusttttent ih. (ndox Wall-# Roading Dato, index Wall lava[ Adj,-hotbr.,,,._.�,,,_Adj.d iutldwater•La al PERCOLATION TEST bale zjo ''rime are Observation i Hole# Time at 9" Depth of Peru —GV Timc at 6" Stsrt Pro-soak Time • GWl Time(9"411) End Pro-soak �I:IGOVA i Rate Min./Inoh i Site Suitability Assessment: Slid Passed Site Palled: Additional Testing Needed(YIN) AI Original: Public Health Division Observation Hole Data To Be Completed on Sack— ***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conselrvation Division at least one(1)week prior to beginning. Q:ISEPTICU'ERCPORM.DOC DEEP.OBSERVATION HOLE LOG Hole# �_ Depth from Sall Horizon Sall Texture Shcl Color Sall. Other Surfaeo(in.) (USDA) (Munsell) Mottling (Stnuetum,Stonei;Boulders. • , taletency.96'aravall • 0— 1g L&IK Yand 10 Yr 3/1 1�- (J) 9 Lorzp-'y San d 10Y�( 5 6 ; LO- ID C Mej«, sonj Z5 Y" 61 — — DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soli Texture Soil Color Soil Other Surfaee,(lo.) ► (USDA) (Munsell) Mottling (Structuro,Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sall Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. DEEP OBSERVATION HOLE LOG Hole# Depth atom Sall Horizon Sall Texture Solt Color 81311 Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stapes;Boulders, Flood Insurance Rate Man: Above 500 year flood boundary No Yes , Within 500 year boundary No 7, Yes„_,,. Within 100 year flood boundary No.V Yes Death of Naturally occurrine Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorption system? If not,what Ig the depth of haturally occurring pervious material? Cer'tlfication I�-17- � ' 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 training,exportise J experience described In 10 CMR 15.017. Signature Date �y�7 ' g . Q;xsalrrlCkPBRCPORM.DOC Commonwealth of Massachusetts ago-609 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 271 Phinney's Ln. Property Address VQ > Adams Owner's Name / Centerville 1✓ MA 02632 5/26/17 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. A. General Information sl* 0740 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityfrown State Zip Code 508.272.6433 Telephone 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 az1votf 5/26/17 Inspector ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 271 Phinney's Ln•03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 15 40nd (I t 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 271 Phinney's Ln. Property Address Adams Owner's Name Centerville MA 02632 5/26/17 Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ 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. ND Explain: n/a ❑ 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 271 Phinney's Ln•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts VTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 271 Phinney's Ln. Property Address Adams Owners Name Centerville MA 02632 5/26/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ 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: n/a 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. 271 Phinney's Ln•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 271 Phinney's Ln. Property Address Adams Owner's Name Centerville MA 02632 5/26/17 City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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: n/a 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 %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. 271 Phinney's Ln•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 271 Phinney's Ln. Property Address Adams Owner's Name Centerville MA 02632 5/26/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® 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 ❑ El 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. 271 Phinney's Ln•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 271 Phinney's Ln. Property Address Adams Owner's Name Centerville MA 02632 5/26/17 City/Town 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)] 271 Phinneys Ln-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M y 271 Phinney's Ln. Property Address Adams Owner's Name Centerville MA 02632 5/26/17 City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: n/a 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: Last date of occupancy/use: Date Other(describe): n/a 271 Phinney's Ln-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,•''� 271 Phinney's Ln. Property Address Adams Owner's Name Centerville MA 02632 5/26/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Pumped 5/1/17 per owner 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): No D-Box Approximate age of all components, date installed (if known)and source of information: unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No 271 Phinney's Ln•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I 271 Phinney's Ln. Property Address Adams Owner's Name Centerville MA 02632 5/26/17 CityTrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 6"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: 1000g Sludge depth: trace Distance from top of sludge to bottom of outlet tee or baffle >12 11 Scum thickness trace Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? Measured 271 Phinney's Ln•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 271 Phinney's Ln. Property Address Adams Owner's Name Centerville MA 02632 5/26/17 Cityrrown 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.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): n/a 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.): n/a 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): n/a 271 Phinney's Ln-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 271 Phinney's Ln. Property Address Adams Owner's Name Centerville MA 02632 5/26/17 CityTrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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.): n/a "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No D-Box Pump Chamber(locate on site plan): ,Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 271 Phinneys Ln•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 271 Phinney's Ln. Property Address Adams Owner's Name Centerville MA 02632 5/26/17 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit is full above the inlet invert at this time 271 Phinney's Ln•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 271 Phinney's Ln. Property Address Adams Owners Name Centerville MA 02632 5/26/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): n/a 271 Phinney's Ln•03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 271 Phinney's Ln. Property Address Adams Owner's Name Centerville MA 02632 5/26/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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. O � 271 Phinney's Ln•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 271 Phinney's Ln. Property Address Adams Owner's Name Centerville MA 02632 5/26/17 CitylTown 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: 12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: 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: US topo maps You must describe how you established the high ground water elevation: Home is on 44' contour and nearby surface water is at 32' 271 Phinney's Ln-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 CGM 271 Phinneys Lane ` c)n Property Address Grace Buckler Owner Owner's Name information is Centerville Ma. 02632 1/4/2008' required for every 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 rerun City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number l rhs B. Certification I certify that I have personally inspected the sewage disposal system at this addrqs--� and that.the information reported below is true, accurate and complete as of the time of the inCObction. T-4e insp;ection was performed based on my training and experience in the proper function and naa ntenance of on;site sewage disposal systems. I am a DEP approved system inspector pursuant t� ection 1=5.340-'-of Title 5 (310 CMR 15.000). The system: = ' M CD r-. ® Passes ❑ Conditionally Passes ❑ Fail � M ❑ Needs Further Evalua 'on by the Local Approving Authority 1/4/2008 Insp or' Slg ure 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. 271 phinneys lane•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 CI Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 271 Phinneys Lane Property Address Grace Buckler Owner Owner's Name information is required for Centerville Ma. 02632 1/4/2008 every 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 riot evaluated are indicated below. Comments: The,septic system is in proper working order at the present time. 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. Answer yes, no or not determined (Y, N, ND) in the ❑ 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. 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 271 phinneys lane-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 271 Phinneys Lane Property Address Grace Buckler Owner Owner's Name information is required for Centerville Ma. 02632 1/4/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: 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. 271 phinneys lane•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 271 Phinneys Lane Property Address Grace Buckler Owner Owner's Name information is required for Centerville Ma. 02632 1/4/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 El ® 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 Y2 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. 271 phinneys lane•12107 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wMks271 Phinneys Lane Property Address Grace Buckler Owner Owner's Name information is required for Centerville Ma. 02632 1/4/2008' every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable,to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is withina 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. Forllarge 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 El ❑ 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. 271 piinneys lane•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 271 Phinneys Lane Property Address Grace Buckler Owner Owner's Name information is required for Centerville Ma. 02632 1/4/2008 every page. City/Town 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)] 271 phinneys lane-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 271 Phinneys Lane Property Address Grace Buckler Owner Owner's Name requiratifor Centerville Ma. 02632 1/4/2008 required for every page. City/Town State Zip Code Date of Inspection D. System Information, Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 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 ears usage (gpd)): 2006:15,000 g ( y 9 2007:31,000 Sump pump? ❑ Yes ® No Last date of occupancy: 1/4/2008 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.): i 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: Last date of occupancy/use: Date Other(describe): 271 phinneys lane-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 271 Phinneys Lane Property Address Grace Buckler Owner Owner's Name information is required for Centerville Ma. 02632 1/4/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection.? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No 271 phinneys lane•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 271 Phinneys Lane Property Address Grace Buckler Owner Owner's Name information is required for Centerville Ma. 02632 `1/4/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 1' Depth below grade- feet Material of construction: ❑ cast iron ® 40 PVC ' ❑ other(explain): Distance from private water supply well or suction line: 20'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 gallon 2„ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness 1 6" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured 271 phinneys lane•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 271 Phinneys Lane Property Address Grace Buckler Owner Owner's Name information is required for Centerville Ma. 02632 1/4/2008 every 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.): Pump tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. 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.): 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): 271 phinneys lane-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 f ' Commonwealth of Massachusetts { Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 271 Phinneys Lane Property Address Grace Buckler Owner Owner's Name information is required for Centerville Ma. 02632 1/4/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert D-Box not present. 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(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No 271 phinneys lane•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 271 Phinneys Lane Property Address Grace Buckler Owner Owner's Name information is required for Centerville Ma. 02632 1/4/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ® leaching pits number: 1-1000gl. ❑ 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.): Sandy dry soil.No signs of hydraulic failure.Leaching pit water to invert was 50" at time of inspection.Stainline visible 42" below invert. 271 phinneys lane•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W " Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments (° 271 Phinneys Lane M Property Address Grace Buckler Owner Owner's Name information is required for Centerville Ma. 02632 1/4/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 y 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.): 271 phinneys lane•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ® Zoom Out J In clrt, f, r t'\ ! Z a• n 6 , 0 13 Feet r2 a ..8 � set scale 1" = 13 I Aerial Photos rn—rinht 9nnF_9nn7 rn,.,n of P-netohio MA All rinh+c—coon http://www.town.bamstabl6.ma.us/arcims/appgeoapp/map.aspx?propertyID=230008&mapp... 1/8/2008 Commonwealth of Massachusetts W Title .5 Official Inspection Form Subsurface Sewage Disposal'System Form - Not for Voluntary Assessments 271 Phinneys Lane Property Address Grace Buckler Owner Owner's Name information is required for Centerville Ma. 02632 1/4/2008 every 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: Bottom of LP 15' 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: As-Built Card ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Used:Gaherty& Miller model 12/16/94 ground water elevations.USED:USGS Observation well .data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of ground water elevations. 271 phinneys lane-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 r Town of Barnstable . �QFtHE Tp� Regulatory Services ,,,STABLE ; Thomas F. Geiler,Director 9 Mass. g'prE16.39. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system in report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division vision agree with an y y technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. i DATE: 8/2/02 271 Phinne PROPERTY ADDRESS: ys Lane RECEIVE® _-Centerville , Mass -------- AUG 8 2002 02632 TOWN OF BARNSTABLE HEALTH DEPT. On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1-1000 gallon septic tank . MAP 23 0 2 . 1-1000 gallon precast leaching pit . ( 6 ' X9 ' ) PARCEL ' 0 6`6 Based on my inspection, I certify the following conditions: LOT 3 . This is a title five septic system . ( 78 Code ) 4 . The septic system is in proper working order at the present time . 5 . Pumped the septic tank at time of inspection . Heavy scum amd solids layers were present . 6 . Waste water is 39" Below the invert pipe of the leaching pit . SIGNATUR Name:— J.—P. —Macomber—Jr . -- -- ------- ------- CoMpany:Joseer, P._ Macomber & Son, Inc. Address: Box 66 -------------------- __ Cen�arv_ille�_�I��_Q2632-0066 Phone:- 508-775-3338 -------------------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 f r� 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:271 Phinneys Lane Centerville .Mass . Owner's NameSandra Ross Owner's Address:Same Date of Inspection: - g/g f n g Name of Inspector: (please print) Joseph P. Macomber Jr. Company Name: Joseph P_ Maccmhp & Son, Inc. Mailing Address: gnx hF -rent-erN7i 1 1 ey MA — 02632-0066 Telephone Number508-775-3338 CERTIFICATION STATEMENT 1 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 ,6pproved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ZPasses _ Conditionally Passes Needs Funher Evaluation by the Local Approving Authority Fails Inspector's Signature:, J Date: The system inspector shall mit 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. 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 I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 271 Phinneys Lane entervi e , ass . Owner:Sandra Ross Date of Inspection: 8 2 02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. =SystemPasses-: I have not found any inform�Anyy hick indicates that any of the failure criteria described in 310 CMR 15.303 or in 1 .304 exisailure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time . B. System Conditionally Passes: AUO 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. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If"not determined" please explain. P 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: A)04/6 Observation of sewage backup or break out or high static water level in the 'stribution boy ue 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: 4V 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 f Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propern Address: 271 Phinneys Lane Centervi e , ass . Owner: Sandra Ross Date of Inspection: 8/2/02 C. Further Evaluation is Required by the Board of Health: V0 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. I. S,stem Hill 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: ko 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. S,stem ,sill 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 s,vstem has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or rTibutary to a surface water supply. /" The system has a septic tank and SAS and the SAS is within a Zone I of a public water supple 4X 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 eater 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 facilir- and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are rTiggered. A copy of the analysis must be anached to this form. 3. Other: 3 Page : of I I, OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Properry Address: 271 Phinneys Lane Centerville .Mass , Owner: Sandra Ross Date of Inspection: g/o /1L2 D. System Failure Criteria applicable to all systems: You must indicate 'yes" or "no" to each of the following for all inspections: Yes No� ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge or pondmg of c lucnt to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution;bo>xbove outlet invert due to an overloaded or clogged SAS or / cesspool ��LP�/Qy0 6 X _ d Liquid depth in.ccupoal is less than 6" below invert or available volume is less than 'A day now Rcquved pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number — / of times pumped ). �/ y ponion of the SAS, cesspool or privy is below high ground water elevation. �y ponion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface /water supply. iV Any ponion of a cesspool or privy is within a Zone I of a public well. .any ponion of a cesspool or pries is within 50 feet of a private water supply well. Y Any ponion 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. jTbis system passes if the well water analysis,, performed at a DEP cenified 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 forma /VV (YesrNo) The system fails. I have determined that one or more of the above failure criteria exist as ,escribed in 310 CMR 15 303. therefore the system fails. The system owner should contact the Boar, 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 now of 10,000 gpd to 15,000 gpd You must indicate cithef"yes" or"no" to each of the following: (??te 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 (In(erim Wellhead Protection Area — I WPA) or a mapped Zone 11 of a public water supply well you nave answered "yes" to any question in Section E the system is considered a significant threat, or answered es" in Section D above the large system has failed. The owner or operator of any large system considered a s:gn!!;cant threat under Section E or failed under Section D shall upgrade the system in accordance with )10 CMR 5 10- The syssem owner should contact the appropriate regional office of the Department. 4 Page 5 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:271 Phinneys Lane eenterville ,Mass . Owner: Sandra Ross Date of Iospectioo: _8/2/02 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 4x'ere any of the system components pumped out in the previous two weeks H-as 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 faciliry or dwelling inspected for signs of sewage back up _ Was the site inspected for signs of break out ? Were all system components, rcicluding the SAS, located on site ? Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condit.on 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)er) 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: l'es�no _✓ — Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Pan C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)j 5 Page 6 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 271 Phinneys Lane Centervil e , Mass . Owner: Sandra Ross Date of Inspection: 8/2/0 2 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual): DESIGN now based on 310 Cj 15.203 (for example: 110 gpd x k of bedrooms).,X1�(11.6='. .Fe7', -' Number of current residents: Does residence have a garbage grinder (yes or no): .U4 Is laundry on a separate sewage system yes or no):;i7d (if yes separate inspection required) Laundry system inspected (yes or no): Seasonal use: (yes or no): .(� Water meter readings, if available (last 2 years usage (gpd)):2000-32 , 000 gallons=87/68 GPD Sump pump(yes or no): 6 2� — — allons=109 . 59 GPD Last date of occupancy:A"t COMM ERCLAL.JINDUSTRIA L Type of establishment: Design now (based on 310 CM-R 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present (yes or no):,& Industrial waste holding tank present (yes or no);L Non-sanitary waste discharged to the Title 5 system (yes or no),,J Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: -/G Was system pumped as pan of the inspection (yes or no): If yes, volume pumped:iGeid gallons •• How was quartury pumped delermin d? Reason for pumping: Tank—onl�t. Heavy scum & solids Ala were present . TYP OF SYSTEM 2Septic tank, soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no)(if yes, attach previous inspection records, if any) B Innovative/Altemative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank �O Attach a copy of the DEP approval ,Other(describe): Ap oxtmate aee of�all�ccomponen s, date insta. d�i ) arj4 source of information: Were sewage odors detected when arriving at the site (yes or no)4 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 271 Phinneys Lane Centerville ,Mass . Owner: Sandra Ross Date of Inspection: 8/2/0 2 BUILDING SEWER(locate on site plan) Depth below grader Materials of construction: cast iron 40 PVC A/Ather(explain): 414 Distance from private water supply well or suction line: /bit Comments (on condition ofjoints, venting, evidence of leakage, etc.): Joints appear tight . No evidenee of leakage . The system is vented throug h the house vents . SEPTIC TANK: on site plan) <ero#46lS Depth below grade: h4 Material of conlstruct7ion Zconcrete4o metal, i fiberglass4f49olyethylene ifi�other(explain) 40 If tank is metal list age:,�00 Is age confirmed by a Certificate of Compliance (yes or no):,(ld(attach a copy of certificate) J Dimensions: L'�rfp '�/�/ �" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: J Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments (on pumping recommendation , inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inven, evidence of leakage, etc.): .Pump__rhhe gepLic tank every 2 3 years Inlet & outlet tees are inplace . The tank is structurally sound and shows no evidence of leakage . GREASE TRA$[&,,V(locate on site plan) Depth below grade: 1i9 Material of construction;,Wconcrett-4metaLe&�,4 fiberglass,! olyethylene,&/ebther (explain):_ i11i9 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: _ 'f 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 is not present . 7 Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 271 Phi nneys Lane Centervi7ie , Mass/ . Owner: Sandra Ross Date of Inspection: 8/2/02 TIGHT or HOLDING TANK(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: 150 Material of construct ion:;fAconcrete 460 metal&�7 fiberglass199 Polyethylene 4e14 other(explain): w1r4 Dimensions _ AM Capacity: AA gallons Desien FloA: gallons/day Alarm present (yes or no): _Al2 Alarm level: �11,4 Alarm in working order(yes or no): Date of last pumping: _ O Comments (condition of alarm and float switches, etc.): I'ight or hoiding tanKS a , I DISTRIBUTION BOXq,&g,(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: df� Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box is not present . PUMP CHAMBEF� (locate on site plan) Pumps in working order(yes or no):d� Alarms in working order(yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): ump c am er is not present . 8 r Page 9 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 271 Phinneys Lane Centervi e , ass . / Owner:Sandra Ross Date of Inspection: 8 2 02 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) 1-1000 gallon precast leaching pit . 6 ' X9 ' If SAS not located explain why: Located see page 10 Tvp leaching pits, number: 1 A10 leaching chambers, number: (� DI eaching galleries, number: Q leaching trenches, number, length: Q 920 leaching fields, number, dimensions: z7 Q overflow cesspool, number: Q _ innovative/alternative system Type/name of technology: /")I-k, Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Loamy sand to medium fine sand . No signs of hydraulic failure or ponding . Soils are ry , egeta ion is no Waste water is 39" below the invert pipe . CESSPOOL$IbA�f (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 0 Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: MDimensionst Materials oof cesspool: : ,Uq�_ Materials of construction: Indication of groundwater inflow(yes or no): d� Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspools are not present P R I VYXjj2Vf_(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.): Privy is not present . 9 Pagc 10 0( 11 OFFICLAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSA—L SYSTEM INSPECTION FORM PART C SYSTEM INFORJvtATION (coniinvcd) ➢toPcrty Aoorciim 271 Phinneys Lane Centervilie ,Mass . ONocr: Sandra o s ottc of Intpcccioo: SKETCH OF SEWACE DISPOSAL SYSTEM P1oioc c ck(ich of chc )(wit( dilmll iy)tcm inclvd(ng ticf to it Icast two Pcrmancnt rc(crcncc Ia�Cmtrkc o,pincr�nvki lo<iic cu . cllc ..;th;n too (m. Locm whcrc Pvblic wiccr tvpPly cnccrs chc bviloin6. i 10 i Page I I of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Sandra Ross 271 Phinneys Lane Owner: 271 Phinneys Lane Date of Inspection: 8/2/0 2 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 90 feet Please indicate (check) all methods used to determine the high ground water elevation: NO Obtained from system design plans on record - if checked, date of design plan reviewed: N A YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: NA YRS Checked with local excavators, installers- (attach documentation) YF.4 AccessedUSGSdatabase-explain: httP : //town . barnstable .ma . us . You must describe how you established the hi h round water elevation: g Used ; Gahrety & Miller Mode-1 . 12/16M Ground water elevations above sea level . 'USED ; USES . Observation w 11 data. June 1992 Used ; USC)2-000-1 Plat-_p #2 Annual ranges of ground n water e ut evations . Leaching Pit 0'b ;eet `I " Groundwatdi. rcet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Thercfore, the vertical separation distance between the bottom Of the leaching pit and the adjusted groundwater table is .5--�. feet. 11 I rrr,rrr-n .•r.--rr� -rr.—mnr..'rrnr..-r.•T.:rr.:-.�*-rvrr:-irrerrr�rre�u*ra-+rrcr.r� .• .. ��! k. Barnstable T•.� r•r— - TO" OF BOARD OF HEALTH 1 0 - T -- .-SUIISURFACF 9E naF DISPOSAL SYsTFM INSPECTION FORM - PART D - CERTIFICATION `fI �T^'T� ,'smn-'mrrtrzra-.rrr..rrtr.•.—.rrrr•._. ._. A —TYPE OR PRINT CLEARLY— PROPERTY INSPECTED STREET ADDRESS 271 Phinneys Lane Centerville ,Mass . ASSESSORS MAP , BLOCK AND PARCEL # OWNER ' s NAME Sandra Ross PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P .Macomber Jr . COMPANY NAME J. P .Macomber & Son Inc, • ' COMPANY ADDRESSBox 66 Centerville , Mass . 02632 Street Town or City Stet• ZIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (508 790 _1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of .-inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of site sewage disposal systems . Check one : -�y System PARSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or Lhe. environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have conducted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature ` Date 01ne copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF )JEALTIi. * If the inspection FAILED , the owner or" 'P* er'ator shall upgrade ' the eyetem within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 ChiR 15 , 305 . partd . doc TOWN OF BARN;$TABLE LOCATION SEWAGE # ®� VILLAGE ASSESSOR'S MAP & INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY �Pd !mod LEACHING FACILITY: (type)/- , -,�b � f (size) NO. OF BEDROOMS BUILDER OR OWNER Ce 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 ac ' g Facility (If an wetlands exist within 300 feet o e �24z�y) Feet Furnished y \` r ., �/ �� � � _ � E .. " � � � � Z� Y/' oZ7 TOWN OF BARNSTABLE LOCATION ���li�le y5,1-a:%>cf. SEWAGE # VILLAGE °�?�7I?1�61��1c ASSESSOR'S MAP & LOT 330 -Dam INSTALLER'S NAME & PHONE NO. P SEPTIC TANK CAPACITY 4 LEACHING FACILITYAtype) A, (size) NO. OF BEDROOMS_ PRIVATE WELL OR UBLIC WATE BUILDER OR OWNER PH PATE PERMIT ISSUED: g /D- DATE COMPLIANCE ISSUED_ / 3 ' VARIANCE GRANTED: Yes No i/ _ ;, �, t �� � _ �� `_ ti ` c` � ��ill �►��// ,� '� "� `� /a o �° � . � � .. a� N y............... 20 00 o.. ... Fps•••........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --.............Town ..........OF...............Barnstable ---- --- -----------------------•----•----------------- Applir4tiun for Binpuuaf Workii Tanntrnrtiun Vanfit Application is hereby made for a Permit to Construct ( ) or Repair 0[X) an Individual Sewage Disposal System at: .............J ani c e -Phi l l iPs........................................... ...._............................................................................................._ Location.Address or Lot No. 271 Phinneys lane Centerville:_ ...................... _...----.---•- .................................................................................................. Owner Address W J .P.Macomber Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling X-No. of Bedrooms..........a...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building No. of persons............................ Showers P� yP g •-••-•-•-•-•---------------- P ( ) — Cafeteria- ( ) a' Other 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-----.-..-.--_-..-----.. (i Test Pit No. 2................minutes per inch Depth of Test Pit--.................. Depth to ground water----..........--....--.. Q+' •-•••--••-•--•••••............................•--••-•••--------.....--------.........-------•----•--......................................................... 0 Description of Soil........................Sand...&...G.ramP_L........................................................................................................... W U ....------••--•---••---•--••-••-------•----•-•--•--•--•-------•---•--•-••-----••---•-----------•••-•--•---•••-•-•••-•-•.._..--••-•--•••••-•----•-----••-•-----•--•--•---•-••-•----•----••--••-•---••---- w V Nature of Repairs or Alterations—Answer when applicable-------------------1--1000__.gallon Pit . ...................................................... •------------------------------------------•---------------------------------------.......--------------------------------...-----------------------•--------------•--------------------••--•-•-----•_.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT?E 5 of the State Sanitary Code— The undersigned further grees not to place the system in operation until a Certificate of Compliance has b en issue by ebrd of h th. Sign L---•• 8 1 $8 .......__... Date Application Approved By-••--•-•-•-•... •--- •-• <H.-- s -------------------------- ----------------------..---------------- ' Date Application Disapproved for the following reasons:-------•---------------------------------•--------------------------------..................................... ..•-•--•-•--•-••••---------•-•-•-•---•••............•----•--------••-••....••---------•---...•--••--••---•-••••--•-----••--••-•••-------•---•----••-••--------------•-----••••-•----••••--------•--...._ Date PermitNo......$.6-------- ........................ Issued....................................................... Date .e, No..- :.. � Fps`...... , ?C.... C THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ton Barnstable _---------------- .. - --- ----------OF.........................--------..... ------------------------------.......---------- Apli irFation for Uhipaii al Workii Tnmuurtiott Vantit Application is hereby made for a Permit to Construct ( ) or Repair Z�X) an Individual Sewage Disposal System at: Janice P?hilli1?s .............••......---•--------------------......---------........_............._..---•--....... ....------•....----.......•••••.......--•---••--------------•----............----•-......--•••••-- Locatio -Address or Lot 231_Pbinney_.s ' ane Centervi.Z?. 2. o. ----------------- ----------------- •..................... .---------- •------------ •.......... .-------------------- Owner Address W .P.Macomber Installer Address Q Type of Building Size Lot--------------_--_---_--•Sq. feet U Dwelling X-No. of Bedrooms..........3...............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria f-4 Other fixtures ---------------------•--•---...-----•--•---------.....•-••••......-•-----•--•--•--•---- W 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 ( ) Percolation Test Results Performed by...............................................:.......................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit---...........-----. Depth to ground water--......--..........-... Test Pit No. 2................minutes per inch Depth of Test Pit...--......---...... Depth to ground water------------------------ .......................................................................................................-•--•--------------------•---•-•-••-•••••••••--••--••-•••----•-•-•-•••...........-----------••••.......................................................... 0 Description of Soil........................ '_nd & Grave- . W - - --------- ----- - --- --------- ------ U Nature of Repairs or Alterations—Answer when applicable........................ i . - �� .................................... �...................... ------------------------------------------------------------- -••••...............•-••--••-•••.....•-••-.......•-•-•••-•••-•••••••-•-•••......-•-.....--------••--••••-••••••-••.-•------••-----------•-••-------••-•-•--•--•--•••••---•-•••---••------------•---•••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T?TLE 5 of the State Sanitary Code—The undersigned furti:er a rees not to place the system in operation until a Certificate of Compliance has be n issued�by tAe board of heafth. Signed:-�t-gt_aa�;f�ar -_ � t"' Ilfi `' /I 0Al 88 .- Application Approved By--•---•---.1�� ....�. :�: �...................:... ............••.... Date-----. Date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------------- •-•-•-•--•--•-•-•••-•--••----•••---•-•••............•---•---------••---••-....•-•.....-----•-•••-••••••••-•••-•••--••••---•••••••-•-•••••-••-••••••---•---••••---•---•••--------•-•--•••---•••••-------- Date Permit No.......F1-------5-al------------------------ Issued.--------••------------ Dste THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ..........................................OF............................................................. .................... �rr�if irtt#r`laf ft�a�nt�r�taanr�e q.,, TH S IS TO CE.RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired( , } P.Macom er by................................................................................................................................................................................................... 271 PI-Anneys Lane Centervi 1 1 CInstaller at..............................--••••-•-••••----•------••-••--•-•-••••••---••••••--•-•--•-••---•----•----•-•••-•---••-••-----••-•••---•-•••••----••-•--•-•-•-•••-••-•-••......------••. has been installed in accordance with the provisions of TIT' 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......- ig...... f....... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable No... .. /. OF.............................................. .................................... FEE........................0 Disposal Vorlkli Ton#rudion rrntit Permission is hereby grad........ •...--tt►.. nmk..e�'..-----••-•------------------------•----••-----------........---------••-------..................... to Consl�ti( PA.or Repair � andn i en i�dl giSley&e Disposal System at No........................nne S a e Street as shown on the application for Disposal Works Construction Permit No.-FF_.���,�1Dated.......................................... ............................... DATE.................. �. • --•............................... Board of Health •-- -fy.'.g FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS T.O.F. EL.= 48.0t FINISH GRADE OVER D-BOX= 44.6'f FINISH GRADE OVER CHAMBERS = 44.3' - 44.6' GENERAL NOTES f PROVIDE EXTENSION RISER SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO NE T DOUBLE WASHED REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE- 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& RISER TO WITHIN 6" OF FINISHED GRADE 4" SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS FINISH GRADE OUTLET TO WITHIN 6" OF F.G. 0 2" OF 1/8"TO 1/2" DOUBLE WASHED METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL 46.5'f F.G. OVER TANK EL. = 45.3'f 5" DIA. OUTLET(S) MIN SLOPE 1 /o BOX TO F.G. (SEE NOTE 21) STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES. @ FND. EL.= _ 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE PLACE RISERS ON ALL DESIGN ENGINEER. EXISTING 4" PROPOSED 4" 9" MIN. " TOP of SAS = 41 .63'� CHAMBERS WITH 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWERR PIPE - - SEWER PIPE SCH. PVC 4" PVC TEE 36�� MAX. 4O.SO' 36" MAX. BREAKOUT EL= 41 .301 FINISHED GRADEINLET PIPES TO 6" OF SYSTEM UNLESS OTHERWISE NOTED. \ 6" 3 3" DROP MAX 3„ 9„ L-2Q'f 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2 DROP MIN MIN.SLOPE@ 1% PROVIDE WATERTIGHT o o ELEVATION = 41.30' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 13" 4" PVC IN FROM JOINTS (TYP.) 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 14" *43.5' SEPTIC TANK 4" PVC OUT TO 0 O 0 0 0 0 O 0 C� o Q THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE LEACHING FACILITY o0 0 0 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN oo = = = 0 = = = INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL OUTLET TEE 41 .17' MIN 6 41 QQ' o0 0 0 0 ! 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZEN OF 48 VERIFY CONDITION OF 2 0 0 00 = = = = = oo 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND EXISTING SEPTIC AND REPLACE AS EXISTING TEES GAS BAFFLE 6 CRUSHED STONE o \ 0 0 0 oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS OVER MECHANICALLY o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 4.0' I I 4.0' AND DESIGN ENGINEER. 5 - 8.5' (NP) 4.0' 4.83' 4.0' OUTLET DISTRIBUTION BOX .�P ) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 45.00, TO BE INSTALLED ON A LEVEL STABLE 25.0' ( ESTABLISHED ON A NAIL IN A FENCE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET Z':8 8O' GROUND WATER ELEV.= < 33.50' 12 83' I 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. ' MIN. � THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 5 EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK CROSS SECTION VIEW 2 - 500 GALLON CHAMBERS CHAMBER END VIE1 v 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. ELEVATION I RI TO VERIFY EXISTING SEPTIC TANK DISTRIBUTION BOX DL � AI L CHAMBER DETAILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. ELEVATION PRIOR TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE -- - 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING on TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM /Y Pt PERC NO. 15405 APPROPRIATE AUTHORITY. i� a \ Hayes - t.! INSPECTOR: Donald Desmarais 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED \ I UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR EVALUATOR: Michael Pimentel, E.I.T. TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. �i Uttlo C.S.E. APPROVAL DATE: Oct. 1999 MAP 230 I'i 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. EXISTING 1,000 GALLON LOT 142 \f ' ,t. '$(/ Ire'a t Pit ., DATE: July 10, 2017 - - . SEPTIC TANK TO BE UTILIZED \ �+ + / ~ TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE • t MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. IN THIS DESIGN • •. - 1 �i\;; \ " , ' �' �'• ':;� • , k. �`- ,_ _.,_ �� ELEV TOP = 44.50' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, ELEV WATER = < 33.50' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). , ` w / •:.� r • = • �\ 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN 28' MAPLE `�� - \ '"� , ���` PERC RATE _ < 2 MIN/IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. EXISTING LEACHING PIT ,� \ . . • : • •. • LO TO BE PUMPED AND /� `"'{-- 45- \ '~'r " • • LOCUS • `•.• v��! ' vim • w��~ DEPTH OF PERC = 42"-60" 16. PROPOSED PROJECT IS LOCATED WITHIN: 04 r FILLED WITH CLEAN SAND ��' O . • •C� /�' ' �'A� 'D' • + '"+. .• •«�• • • a «11 Il TEXTURAL CLASS: 1 ASSESSORS, MAP 230 LOT 8 d MAP 230 LOT 141 --� �' c., ,�� X44.4 ' ..w • • , •�• • + . � . 11 _ - �� •. « • + + OWNER OF RECORD: CHRISTOPHER D. ADAMS rt , \ 8" CHERRY \ 0 0 �• ••+ #- 0" 44.50' ADDRESS: 10 NORTH MAIN STREET MAP 230 0 :y Loamy Sand \ / • •Q' " ��` BRIMFIELD, MA 01010 LOT 9 M• �+'+' : 18" 43.00' FEMA FLOOD ZONE X •�i� • • �• �•f, '.� COMMUNITY PANEL# 25001CO562J X44. X44.3 2 5 �o � �� • Loamy Sand itB 10Yr 5/6 17. DEED REFERENCE: BOOK 23550, PAGE 177 45 MAPLE • t�i \ q i {` + 18. PLAN REFERENCE: PLAN BOOK 121, PAGE 125 \ 3eechwood �\ _.. 0 fir Ii • / '� x , 42" 41.00' PROPOSED .0 2 O �' \ W.e • • ,�• 5tA , ) • Perc 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. DISTRIBUTION BOX (3) \ : • «'`-'� J/' � • • • ��'. ' • • ,. % ' •'f! 60" 39.50' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY _ y FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY P 2 / *'' ••• /!�' • . : j i FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. PROPOSED 2-500 / j LP co s���O #27 \ • ►`• ` !/ • .. '` # • Medium Sand GALLON LEACHING h 0� ,p / r • • ' C 2.5Y 6/6 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A b x X44�5 44x �, EXISTING �l • i '1• f ~ -v _ '« / .� \; �� A DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3" OF FINISH GRADE. A CHAMBERS REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. 1 ;'` 2-BEDROOM Q HC-1 DWELLING 16" HOLLY/ TOF = 48.0'± \ 22. OWNER/APPLICANT/ CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL l REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. Benchmark �Xl X-� � ' cn � Q LOCUS PLAN Nail in Fence -44 0 " Elev. = 45.00 " If \ 21.0 � N .� MAP 230 SCALE: 1" = 1000' 132" 33.50' Approx. M.S.L. \ LOT 8 No Mottling, Standing or Weeping Observed T I 1 \ Cvs O 6�\�Q 10,072± S.F. PROPOSED ( ) \ HC-2 DESIGN DATA T P I?� DATA INSPECTION PORT - 44x5 44x C LEGEND .., y� PERC NO. 15405 11.8 12.g /\ . INSPECTOR: Donald Desmarais 50xO' EXISTING SPOT GRADE NUMBER OF BEDROOMS 2 (3 MIN DESIGN PER TITLE 5) RHODODENDROh� (4) O� i EVALUATOR: Michael Pimentel, E.I.T. - - - 50 - - - EXISTING CONTOUR DESIGN FLOW 110 GAL/DAY/BEDROOM ��j 9►` C.S.E. APPROVAL DATE: Oct. 1999 TOTAL DESIGN FLOW 220 GAL/DAY Z 50 PROPOSED CONTOUR DATE: July 10, 2017 Cyr \ J DESIGN FLOW x 200 % = 660 GAL/DAY TEST PIT#: 1 50 PROPOSED SPOT GRADE X 44.2 ' 5" OAK \ � � \ USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP = 44.50' GAS EXISTING GAS LINE ELEV WATER = < 33.50' - ❑/H/W EXISTING OVERHEAD UTILITIES MAP 230 J 1' LOT 7 �' Qs � � g5�` �O� J��� PERC RATE = W - EXISTING WATER LINE \ \4 / INSTALL 2 - 500 GAL. CHAMBERS w/ AGGREGATE \ \ S\ 17" MAPLE \ = Cyr, \ �OFQ DEPTH OF PERC = \ Ate\ \ \ o �pG SIDEWALL CAPACITY TEXTURAL CLASS:_ 1 TEST PIT LOCATION \ / (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAL/DAY � ' (25.0' + 12.83') (2 ) ( 2' ) ( 0.74 GPD/ S.F.) = 112.0 GAL/DAY O O EXISTING 1,000 GALLON SEPTIC TANK 11 'fz ri �J&1 BOTTOM CAPACITY 0 44.50' PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE o \ , \ / cs ' �,��.\'P (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAL/DAY Loamy Sand \ �"� �O� 10Yr 3/1 ❑ PROPOSED DISTRIBUTION BOX o \ \ i ���� (25.0 x 12.83) (0.74 GPD/S.F.) - 237.4 GAL/DAY 18„ 43.00 90 Q O PROPOSED 500 GALLON LEACHING CHAMBER C EX. CBN R' \ Loamy d RIM EL. = 45.0'± J TOTALS: B 10Yr 5/6 1 1 7-21-17 MCP JLC Design flow data (3 bedrooms to 2 bedrooms) \ \ TOTAL NUMBER OF CHAMBERS 2 TOTAL LEACHING AREA 472.2 SQ.FT. 42" 41.00' REV. DATE BY APP'D. DESCRIPTION _ 3 / TOTAL LEACHING CAPACITY 349.4 GAL./DAY R P OPOSED SEPTIC SYSTEM UPGRADE PREPARED FOR: Z ' C Medium Sand CAPEWIDE ENTERPRISES \ 3 2.5Y 6/6 i i LOCATED AT I a i 271 PHINNEY'S LANE CENTERVILLE, MA 02632 NOTES: 3 SWING-TIES - �/ r 132" 33.50' SCALE: 1 INCH = 10 FT. DATE: JULY 17, 2017 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF DESCRIPTION HC-1 HC-2 0 5 10 20 40 FEET EACH SEPTIC SYSTEM COMPONENT. / ' CORNER OF STONE (1) 22.5 25.5 No Mottling, Standing or Weeping Observed %SH OF _ o JO N L �� PREPARED BY: 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF \ 3 CORNER OF STONE (2) 27.0' 36.6' RESERVED FOR BOARD OF HEALTH USE CHUR ILLJR. m JC ENGINEERING INC. THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST \ ' r o NO. 1�7 c PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL CORNER OF STONE (3) 37.9 46.4' 2854 CRANBERRY HIGHWAY BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. EAST WAREHAM MA 02538 I SITE PLAN CORNER OF STONE (4) 34.8' 38.3' •��`�`' s N � ' 3.) PROPERTY IS NOT LOCATED WITHIN A DEP APPROVED ZONE 2 BUT IS 3 r 508.273.0377 � SCALE: 1" = 10' - - " WITHIN THE ESTUARINE ZONE WATERSHED. i` Drawn By: SJI Designed By:SJI Checked By: MCP JOB No.3869