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HomeMy WebLinkAbout0307 PHINNEY'S LANE - Health (2) 307 Phinney's Lane Centerville F/R A = 230 012 1 No. 4210 1/3 ORA Pwgmndaflex 10% Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 307 PHINNYS LANE ------------------------------- —------------ ------------------------------- Property Address MAME MELESKI Owner &1in Owner's Name- information is required for every CENTERVILLE MA 02632 07/23/2018 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information S 1 13�a__1- on the computer, use only the tab 1. Inspector: key to move your cursor-do not JOHN GRACI use the return Name of Inspector key. GRACI SEPTIC INSPECTIONS, Company Name PO BOX 2119 Company Address TEATICKET MA 02536 CityfTown State Zip Code 508-641-6694 S1468 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: 0 Passes M Conditionally Passes El Fails El Needs Further Evalua by the Local Approving Authority 07/23/2018 -Inspector's­ -§7ij-n'a'—tu-—re Date The system inspectors submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within days of completing this inspection. If the system is a shared system or 0 has a design flow of 10, gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER 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. f5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 307 PHINNYS LANE Property Address MAME MELESKI Owner Owner's Name ---- information is CENTERVILLE MA 02632 07/23/2018 required for every _ page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSES TITLE V INSPECTION SYSTEM APPEARS TO BE STRUCTUARLLY SOUND AND FUCTIONING PROPERLY AT TIME OF INSPECTION. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): NA -- -- - -- ..-.----- ---- ----- __-.--.-..-... ----- - ---- -- t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts =W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 307 PHINNYS LANE _ Property Address MAME MELESKI Owner Owner's Name - information is CENTERVILLE MA 02632 07/23/2018 required for every - page. City(rown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): NA ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): NA C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 307 PHINNYS LANE Property Address MAME MELESKI Owner Owner's Name information is CENTERVILLE MA 02632 07/23/2018 required for every -- page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: NA 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 '/2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 307 PHINNYS LANE Property Address MAME MELESKI _ Owner Owner's Name — — information is CENTERVILLE MA 02632 07/23/2018 required for every - ------..-- — -----.—. _=_-- — -------- page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threai under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 307 PHINNYS LANE Property Address MAME MELESKI Owner Owner's Name information is CENTERVILLE MA 02632 07/23/2018 required for 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? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): ND - --- Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): ND I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 P 9 P Y 9 Commonwealth of Massachusetts N-_ Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 307 PHINNYS LANE Property Address MAME MELESKI Owner Owner's Name information is CENTERVILLE MA 02632 07/23/2018 required for every _....__. — -._.-- ---- .-._.-- page. City/Town State Zip Code Date of Inspection D. System Information Description: 1500 GALLON SEPTIC TANK DISTRIBUTION BOX AND 2-500 GALLON LEACH CHAMBERS Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): TOWN Detail --..--------. ---- - Sump pump? ❑ Yes ® No Last date of occupancy: OCCUPIED Date Commercial/industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): NA Gallons per aay(gpdj Basis of design flow(seats/persons/sq.ft., etc.): NA 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: NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 o n 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 307 PHINNYS LANE Property Address MAME MELESKI Owner - ------- ----- -- Owner's Name __.. --- ---- -- - --- -- information is required for every CENTERVILLE MA 02632 07/23/2018 ----------------- page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): NA General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: NA gallons How was quantity pumped determined? -NA Reason for pumping: NA -_ __ 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): NA t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts - v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 307 PHINNYS LANE Property Address MAME MELESKI Owner ----- Owner's Name information is CENTERVILLE MA 02632 07/23/2018 required for every _-----...--.___-- --------. __Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 212" feet Material of construction: ❑ cast iron ®40 PVC 40 PVC — ❑ other(explain): Distance from private water supply well or suction line: GREATER THAN 10+ FEET feet Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK IS FUNCTIONING PROPERLY AT TIME OF INSPECTION Septic Tank(locate on site plan): Depth below grade: 10 INCHES feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: NA years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1500 GALLON Dimensions: ......---.5" _ _ Sludge depth: ----- t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 � Commonwealth of Massachusetts W Title 5 Official Inspection Form -- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 307 PHINNYS LANE _ Property Address MAME MELESKI Owner ---------.__-- Owner's Name ------------ - .....__ --- information is CENTERVILLE MA 02632 07/23/2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" ---------- ---------- 11. Scum thickness 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 -- -- --- ----- - -- How were dimensions determined? MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): SEPTIC TANK APPEARS TO BE STRUCTUARLLY SOUND AND FUNCTIONING PROPERLYAT TIME OF INSPECTION . RECOMMEND PUMPING NOW AND EVERY 2-3 YEARS DEPENDING ON USAGE. Grease Trap(locate on site plan): Depth below grade: NA - feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: NA Scum thickness NA — Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA Date of last pumping: NA Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form -- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °�, ,•''< 307 PHINNYS LANE Property Address -___...-------_.--__--- - _ — MAME MELESKI Owner Owner's Name - --- -—___ __..__...------ -------- ---- ----- information is CENTERVILLE MA_ 02632 07/23/2018 required for 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.): NA Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: NA ----------- Capacity: NA gallons Design Flow: NA gallons per day Alarm present: ❑ Yes ❑ No Alarm level: NA ----- --- Alarm in working order: ❑ Yes ❑ No Date of last pumping: NA Date Comments (condition of alarm and float switches, etc.): NA *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 c Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 307 PHINNYS LANE — ----- --- ..- -..... ...- --- Property Address MAME MELESKI Owner _...._.._____...._._.-- Owners Name information is CENTERVILLE MA 02632 07/23/2018 required for every ___.._ __— page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert BOTTOM OF PIPE 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 APPEARS TO BE STRUCTULLY SOUND AND FUNCTIONING PROPERLY Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NA -------------- --- t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts m_ w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 307 PHINNYS LANE Property Address MAME MELESKI Owner .._._ _._._._...---.-... --- Owner's Name information is CENTERVILLE MA 02632 07/23/2018 required for every __._.. �__---- _--.----.---__- ___ page. Clty/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: NA ® leaching chambers number: 2-500 ❑ leaching galleries number: NA — ❑ leaching trenches number, length: NA _ ❑ leaching fields number, dimensions: NA_ ❑ overflow cesspool number: NA ❑ innovative/alternative system Type/name of technology: NA Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 2-500 GALLON LEACH CHAMBERS: BOTTOM 5' NO VISABLE STAIN LINES EMPTY AT TIME OF INSPECTION. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert NA Depth of solids layer NA Depth of scum layer NA Dimensions of cesspool NA Materials of construction NA Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposat System-Page 13 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 307 PHINNYS LANE ---A- r---.-._. -- --- —._._. - Property ddress MAME MELESKI Owner Owner's Name information is required for every CENTERVILLE MA 02632 07/23/2018 --- ---..__......-- ---_.__— page. Cltyrrown State Zip Code Date of Inspection ._ - — D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA --------------- Privy(locate on site plan): Materials of construction: NA Dimensions NA Depth of solids NA Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •�' 307 PHINNYS LANE Property Address MAME MELESKI Owner Owner's Name information is CENTERVILLE MA 02632 07/23/2018 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 42-300 16 -30 83- t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts u —_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 307 PHINNYS LANE _.._... __--- — - ------ -- - Property Address MAME MELESKI Owner Owner's Name -- information is CENTERVILLE 07 required for every —._ —_ MA 02632 /23/2018 own Cit R ------- page. y 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: GREATER THAN 10+ FEET 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: You must describe how you established the high ground water elevation: HAND AUGER ------------ Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts u — W Title 5 Official Inspection Form 's Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 307 PHINNYS LANE Property Address MAME MELESKI Owner Owner's Name --...-— - ----- -- - --- —- information is required for every CENTERVILLE— — MA 02632 07 23 2018 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information- Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION 302 Iti s SEWAGE # .3a VILLAGE ( 0 ASSESSOR'S MAP & LOTZZ a / `�INSTALLER'S NAME&PHONE NO. 4i—O o� C�z ha sx SEPTIC TANK CAPACITY 1, 5O-0 LEACHING FACMITY: (type) W (size) X NO.OF BEDROOMS BUILDER 0 WNE PERMITDATE: o COMPLIANCE DATE: ii "/ d L- Separation Distance Between the: `' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leac ng facility) Feet Furnished by rt - -lip 5 TOWN OF BARNSTABLE LOCATION 160� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT E � INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY &Aea e li LEACHING FACILITY: (type) size) NO. OF BEDROOMS BUILDER OR OWNER 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 L ac 'ng Facility(If an wetlands exist within 300 t ty) Feet Furnished b c -1-138 6 0 \� 4p OA q�,a�ed(ir.e � Qo i l - .=t No 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: jYe t/ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zfppliration for Migpogal bpgtem Congtrurtion Permit Application for a Permit to Construct( )Repair( . upgrade(Vrbandon( ) R-omplete System ❑Individual Components Location Address or Lot No. �n p`,�„/s ,(„(t!LL Owner's Name,Address and Tel.No. v6'*.�71 Assessor's Ma /Parcel e-en fer Y►'l/e,. !1 J n - G YGl'/y To y cw_ p Q rce,� ®1 0 7 iVhJ n n ey 3 AP, 0_et?&rrj//C_� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. D ya�-33 y 7 AZI-11e r /U , Type of Building: Dwelling No.of Bedrooms Lot Size 0. 02.2 � � Garbage Grinder(l�i9 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date /V Title /dovseot LL 0 7 84,il I-Ce kl Ce n v%�e ,/n4ud. Size of Septic Tank / 00 oa-ili-q�_ Type of S.A.S. kaQ hr'/x Description of Soil l Nature of Repairs or Alterations(Answer.when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b is Board of H alth. ) i Signe ..cue % 1 a`Date_ Application Approved by Date Application Disapproved for the following reasolO F_(�7 Permit No. Date Issued ---------------------------- ---------- o. ./ �� Fe N ed THE COMMONWEALTH"OF MASSACHUSETTS Entered in computer: e PUBLIC HEALTH DIVISIAN,O gOWN OF BARNSTABLE., MASSACHUSETTS l ZIpplicatfon for ;Df5pool *p$tem Cow6truction Permit -'' Application for a Permit to Construct( . )Repair( w4pgrade(t,Abandon( ) E Complete System O Individual Components Location Address or Lot No,/� �L�/i j' �, / LQ /Le- Owners Name,Address and Tel.No. Assessor's Map/Parcel eri r V,'l�P� M O • .�0,7 /�hYcriy��C�� i�(:. ��at . c/, cCj D��, C 0Jitrj.iiCi)?q Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,��� 5v1/,✓a h !`s�� ,r�.c r�� �i/G �U� `y.�E•33y Type of Building: -DwellingNo.of Bedrooms � Lot Size �. o�.Z AGr� -sq-<ft: Garbage Grinder(Iv? Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r'=� Design Flow gallons per day. Calculated daily flow gallons. Plan Date 200,'� Number of sheets Revision Date Title PfdAl2,red 2; 1� G1.P ri' r Q� 3017 r i'7Jr�a�f y1i / Size of Septic Tank IeOO N�' � Type of S.A.S. /�� 7��z'i ChA/7760, "' d<Q)'70 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: ' /' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by-this Board of Health. i o t Signed,`r-\ � ,r a -\-,c-*... /1 n t Date_ Application Approved by 4'' ''�.fl '%`1 =�l /l�a'f i,,��' f .✓ Datei i Application Disapproved for the following reasons`' / I Permit No. r"� -� Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired Upgraded Abandoned( )by at_�� n x»4 't L Q'il-, P r7 k=4 vi%!a- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a ,� -.5 7 dated 11 1 a 0/0 3 Installer Designer The issuance of this permit shall not be construed as a guarantee that the sr,!stem`wilt function as designed. Date (; 1 Inspector � .'XT` 42 f c �- No.--- = ---------- ------Fee- IM2 ✓" ;�M2 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mizpozar *pgtem Congtructfon Permit Permission is hereby granted to Construct( )Repair Upgrade(//J'Abandon( ) System located at 0 IV h', 0 n F,. /)s. /Ld � P I?��"v 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: Z Approved by TOWN OF BARNSTABLE LOCATION 6-) SEWAGE # o 3�tS"f7 7 VILLAGE e n,.x*-v-re, � ASSESSOR'S MAP 8c LO'I INSTALLER'S NAME&PHONE NO. - i&NA-0 vs SEPTIC TANK CAPACITY 1, LEACHING FACILITY: (type) S (size) X ~ NO, OF BEDROOMS BUILDER O VVrhtE PERMITDATE: 0 /03COMPLIANCE DATE: JO t' Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leac ing facility) Feet Furnished by r / r sac, } )b t o Y COMMONWEALTH OF MASSACHUSETTS ulpEXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL 7HEALTH FAILED INSPECTION TITLE 5 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 307 Phinney's Lane Centerville, MA 02632 Owner's Name: Beverly Joyce MAP Owner's Address: t 1 PARCEL, Date of Inspection: October 9. 2003 LOT Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on m P Y 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 N Further Evaluation by the Local Approving Authority ✓ Fail Inspector's Signature: Date: October 14, 2003 The system inspector shall subm' 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 11 , OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 307 Phinney's Lane Centerville, AM Owner: Beverly Joyce Date of Inspection: October 9, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. 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 distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 307 Phinney's Lane Centerville, AM Owner: Beverly Joyce Date of Inspection: October 9, 2003 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone l of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 4 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 307 Phinney's Lane Centerville, MA Owner: Beverly Joyce Date of Inspection: October 9, 2003 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day now ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] NOTE: Single cesspools automatically jail in the Town of Barnstable. Yes (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 307 Phinney's Lane Centerville, M9 Owner: Beverly Joyce Date of Inspection: October 9, 2003 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓. Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 307 Phinney's Lane Centerville, MA Owner: Beverly Joyce Date of Inspection: October 9, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a Number of current residents: I Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system ✓ Single cesspool 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: Approximately 1950s-per owner Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 307 Phinney's Lane Centerville, MA Owner: Beverly Joyce Date of Inspection: October 9, 2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: None (locate on.site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 307 Phinney's Lane Centerville, MA Owner: Beverly Joyce Date of Inspection: October 9, 2003 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: allons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on.site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 307 Phinney's Lane Centerville, MA Owner: Beverly Joyce Date of Inspection: October 9, 2003 SOIL ABSORPTION SYSTEM(SAS): None (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: 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.): CESSPOOLS: ✓ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 1 single Depth-top of liquid to inlet invert: Even Depth of solids layer: 6" Depth of scum layer: 2" Dimensions of cesspool: 5'Wx 4'Tx 7' bottom to grade Materials of construction: Cesspool block Indication of groundwater inflow(yes or no): None Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Liquid was up to the inlet pipes. A single cesspool automatically fails in the Town ofBarnstable. The cover was 9"below grade. PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 • Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 307 Phinney's Lane Centerville, MA Owner: Beverly Joyce Date of Inspection: October 9, 2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. �AL�, 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 307 Phinney's Lane Centerville, MA. Owner: Beverly Joyce Date of Inspection: October 9, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and water contours map the maps are showing approximately 10'+/- to ground water at this site. This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 i 1-1 ayes Ij Little Connect Exist.House Sewers rI/ Great Pt� "F•/ I F.G.44.0 to Septic Tank. / Pt / F G. 44.0 In n a /• / 1 �ZZ_ i \�! /i /� 11�•.��••,�i " 2- `.0 1500 Gal ion 41.0 p •Y: .o 41 9 e To E1.42.0 ` Septic 41.65 0 •� I ;i 'u Bot.El. 39.0 _ \ / - 41.4 5 41.2 m :.<s Bedding asBM• N I _ Per Title 5 L x 3s*-T\C TANK �- 1 _,,. il' 'pond m ,� / ° ' DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM 9 CONK<CT ? 1.ST: I`.._2S M\N. , Not to Scale HOUSE .5E'.NER5 T OO r ♦ .tll, n I SaPT1 C TAN\G � ` Z— Pv l�n r� d- RE,MovE ��• �\\,. D �; In ' DESIGN DATA LOCUS PLAN EX\ST, �ESSPOOI Finish W �y Grade Single Family- 2 Bedroom No Garbage Grinder �r r DEC\� f Filler ' Scale I =2000 Septic Tank:12020 gpd x2 00 /o= 440 gpd Assessors Map 230 -m n Fabric� Compacted FIII o Use a 1 500 Gallon Septic Tank. Parcel 012 Pen Stone LEACHING AREA 1�li W 220 gpd/0.74= 298 s.f.Required Leaching Sidewalk 2(12'+25' )2= 148 s.f. aX I S-T 2. 3.Ft. c Chamber 3i4"-I vz"Double Bottom Area: 12'x 25' = 300 s.f. G -� 4 Washed Q 448 s.f.?otal Provided. 100 LEACHING CHAMBER DESIGN Al I Pipes to be Schedule 40 PVC. Use 2 j { - 500 Gallon Leaching Chambers in a 0 CROSS ,SECTION OF CHAMBER 12'x 25' Washed Stone Field as Shown. PO RGH / n J J NOT TO SCALE 6' Q I / i S NOTES, I 1> I. Water Supply For This Lot is Municipal Water. LOT AtZcx. - ( 2.Location of Utilities Shown on This Plan Are Approx. At Least 72 Hours Prior to Any Excavation For This }` Project The Contractor Shall Make The Required Notificationto DIG SAFE- 1-888-344-7233. I ( _ 3.The Contractor is Required to Secure Appropriate t — j v �gez�rZo•'E yL o`r \ Permits From Town Agencies For Construction Defined by This Plan. 4.Install Risers as Required to Within 12"of Finished Grade. t,Q 5.All S'sructures Buried Four Feet (4') or More or Subject to Vehicular to be H-20 Loading. c PH/NNEYS LANE 6.Septic System to be Installed in Accordance With 1NOF 310 CMR 15.00 Latest Revision And The Town of �`�• PUER PLAN V ll!EW Barnstable Board of Health Regulations. � SULLIVAU 7 All Piping tobe Sch. 40 PVC. O t:O•2�]�� Scale I lr= 20' r�'J!L L Ee O r• PROPOSED SEPTIC UPGRADE AT 1 307 PHINNEY'S LANE CENTERVILLE , MASS. FOR BEVERLY JOYCE SCALE: AS SHOWN DATE: NOVEMBER 3,2003 SULLIVAN ENGINEERING INC. OSTERVILLE MASS L.�. C) _ I Mayes Pt - �' Little Connect Exist.House Sewers it, Great Pt�- / F.G.44.0 to Septic Tank. / Pt :C, _ I 41.0 S' u� 5��2H 1500 Gal Ion Top El. 42.0 o r' ��1� - uz.ti+' Z Q 41 9 I Septic Tank i 41.65 l dye o o v ' •: �' ;1 IV h'J �•� Bot.El. 39.0 � ,•��• ,I ,. \ 41,45 41.2 i o °� j �: ' �•S -Sox —� �•'_ ;-, a a wE'S. ii W. Bedding as -;, ,_ u.'•' r. BM (� Per Title S \`�. TANK 1 ++ Pond m ° DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM 0a ;;' �.-•o�g ,=Z � 1 / COSJNtCT EXJ.ST'. /�- 2"S +N• Not to Scale j - 4-LOUSE 3E.wCRS '+'4 O I I F / •�� •'o D -i� S=p»,c. r'a'NK ! LOCUS PLAN G DESIGN DATA o�de Family- 2 Bedroom Single No Garbage Grinder Scale : I "=2000' 7 FiNer '� Daily Flow: 110 x 2 = 220 gpd t s m Fabric Campaded Fill Septic Tank: 220 gpd x 200'a/o= 440 gpd Assessors Map 230 = A N Use a 1500 Gallon Septic Tank. Parcel 012 � c Pea'Stone LEACHING AREA rj 220 gpd/0.74= 298 s.f.Required 'a Leaching Sidewalk 2(12'+25' )2= 148 s.f. EX I S-r.. a. 3.R. w/1= owt Ll iIVC. a Chamber . Wash-II/2"Double BottomArea: 12 x25 =300 s.f. waenea p P 448 s.f.7otal Provided. '2 '-0 I LEACHING CHAMBER DESIGN iW — All Pipes to be Schedule 40 PVC. Use 2 CROSS SECTION OF CHAMBER - 500 Gallon Leaching Chambers in a 0 NOT TO SCALE 12'x 25' Washed Stone Field as Shown. T Q / s NOTES J. 1 I. Water Supply For This Lot is Municipal Water. l/ OT A,�cz� 1 I 2.Locgrlon of Utilities Shown on This Plan Are Approx.At Least 72 Hours Prior to Any Excavation For This I Projct The Contractor Shall Make The Required �l Notification to DIG SAFE-I-B88-344-7233. 3.The ;"ontractor is Required to Secure Appropriate � $a'z6'2o"e v�.o`' _� Permits From Town Agencies For Construction --- Defined by This Plan. 4.Insto:l Risers as Required to Within 12"of Finished Grade. 5.All Structures Buried Four Feet (4') or More or _ �9w.v, Subjsct to Vehicular robe H-20 Loading. -z PH/NNEY'S LANE 6 Septic System to be Instal led in Accordance With PATER tt 310 CMR 15.00 Latest Revision And The Town of SULLIVA11 PLAN VIEW EVU Barn,toble Board of Health Regulations. o GO.29a33 ,r 7 All Piping tobe Sch. 40 PVC o f=;VIL Scale l = 20 •e+; S> 0 PROPOSED SEPTIC UPGRADE AT 307 PHINNEY'S LANE CENTERVILLE , MASS. FOR BEVERLY JOYCE SCALE: AS SHOWN DATE: NOVEMBER 3,2003 s SULLIVAN ENGINEERING INC. I OSTERVILLE MASS I