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HomeMy WebLinkAbout0277 PLEASANT PINES AVE 277 Pleasant Pines/Lakevie� 214-041. W01 West Barnstable 214-041 .TO Centerville llll �RfCYCIF°C ,Dmead,, l/ll UPC 12543 No.63LOR �,7C0N5Ja HASTINGS, MN ;l Commonwealth of Massachusetts - Title 5 Official= Inspection Form �= r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 277 Pleasant Pines Ave Property Address SWANSON, LYLE A& CYNTHIA R Owner Owner's Name information is _C_enteryille ✓ Ma 02632 4/11/2 required for every •` page. Cityrrown' State .Zip Code Date of Inspection L 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. Inspector Information on the computer, use only the tab Michael DiBuono key to move your Name of Inspector �'• cursor-do not DiBuono Sewer And Drain t use the return Company Name key. 35 Content Lane Company Address Cotuit Ma 02635 City/Town State Zip Code 508-364-9587 S113522 _ Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails ._�11 6120 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection.If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. " Please note: This report only describes conditions at the time of inspection!and under the conditions of use at that time.This inspection does not address how_ the"system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 277 Pleasant Pines Ave `V Property Address SWANSON, LYLE A& CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 Gallon septic tank as well as a concrete distribution box and a field of pipe in stone. Distribution box shows no signs off pushback or failure. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 1-- 14,311, Commonwealth of Massachusetts Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 277 Pleasant Pines Ave Property Address SWANSON, LYLE A&CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.1/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 277 Pleasant Pines Ave Property Address SWANSON, LYLE A& CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 277 Pleasant Pines Ave Property Address SWANSON, LYLE A& CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,0,00 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts ,iA Title 5 Official Inspection Form I;la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 277 Pleasant Pines Ave Property Address SWANSON, LYLE A& CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 277 Pleasant Pines Ave V Property Address SWANSON, LYLE A& CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Approximately g ( y g (gp ))' 284 GPD Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts �7 :. r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 277 Pleasant Pines Ave Property Address SWANSON, LYLE A&CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped at time of inspection Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u% 277 Pleasant Pines Ave Property Address SWANSON, LYLE A& CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 6/13/2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts ,, Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 277 Pleasant Pines Ave Property Address SWANSON, LYLE A&CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): 811 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? / Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts IP Title 5 Official Inspection Form I. to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 277 Pleasant Pines Ave Property Address SWANSON, LYLE A& CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. City/Town State Zip Code Date of Inspection D. System Information (cont) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 c Commonwealth of Massachusetts _ Title 5 Official Inspection Form I1. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 277 Pleasant Pines Ave Property Address SWANSON, LYLE A& CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level and at normal level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form I iia Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V � 277 Pleasant Pines Ave Property Address SWANSON, LYLE A&CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 App 50' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form 1a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 277 Pleasant Pines Ave Property Address SWANSON, LYLE A& CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Dry at time of inspection 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 277 Pleasant Pines Ave Property Address SWANSON, LYLE A& CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts �- ,p Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 277 Pleasant Pines Ave V� Property Address SWANSON, LYLE A& CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 16 of 18 4/16/2020 Assessing As-Built Cards TOWN OF 13ARNSTABLE �C LOCATION r� ��f�Nl I'�F' FIA)t_S' SEWAGE# VILLAGE ASSESSOR'S MAP&LOT '2 INSTALLER'S NAME&PHONE NO. XI-9 041UC-0 77 5--r SEPTIC TANK CAPACITY �//9�� LEACHING FACIL=: (type) leAC�tI'Idd �--fUs .(size) SD.x NO.OF BEDROOMS r B DER OR OWNER IT DATE: .S 6 COMPLIANCE DATE: 60 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (1f any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i �LCAMAI—PLAF5 8 -----a https://www.townofbarnstable.us/Departments/Assessing/Property_Values/HMMddisplay.asp?mappar=214041 T01&seq=1 1/2 4/16/2020 Assessing As-Built Cards LA ram- 1 1 https://www.townofbarnstable.us/Departments/Assessing/Property_Values/HMdisplay.asp?mappar=214041 T01&seq=1 2/2 Commonwealth of Massachusetts 1p Title 5 Official Inspection Form �4 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 277 Pleasant Pines Ave Property Address SWANSON, LYLE A& CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 6'feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 6/13/04 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole data on plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 277 Pleasant Pines Ave Property Address SWANSON, LYLE A& CYNTHIA R Owner Owner's Name information is required for every Centerville Ma 02632 4/11/2 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑ A. Inspector Information: Complete all fields in this section. ❑ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ❑ D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 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: 277 Pleasant Pines Centerville Owner's Name: David Baker / Owner's Address: Date of Inspection: 0-7 Name of Inspector:(please print) Sean Jones,, - . Company Name: William E: ' Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: (5081 775-8776 S rw CERTIFICATION STATEMENT t I certify that I have personally inspected the sewage disposal system at this address and that the informatiog44 ported 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 functio and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to ection 15340 of Title 5(310 CMR 15.000). The system: -r Passes Conditionally Passes Needs Further Evaluation by the Local Approving Au ioritya Fails Inspector's Signature: Date: The system inspector shall submit a copy of this'tnspectior report to the Approving Authority(Board of Neatth*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 seat to the system owner and copies sent to the buyer,if applicable,and the approving authority. Sc, c Sy%k-- . uS Aoec, e-x o< 4l3J - fld s,5 Notes and Comments a/Ar,4ACc 's rora.4el 0 g..'S ""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 r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 277 Pleasant Pines Centerville Owner: David Baker Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Syst Passes: 71 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: V One or more system components as described in the"C onditional Pass section need C or repaired.The system,upon completion of the replacement or repair,as approved b the Board be replaced 11 PP Y 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 e indicating that the tank is less than 20 years old is available. leaking and if a Certificate of Compliance ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to-broken or obstructed pipes)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 obrnected pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is rcmovod ND explain: I t Pag:3 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 277 Pleasant Pines Centerville Owner. David Baker Date of Inspection: a C. Further Evaluation is Required by the Board of Health: Aj Conditions exist which require further evaluation by the Board o 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 I 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 front 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 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART A CERTIFICATION(continued) Property Address: 277 Pleasant Pines Centerville Owner: David Baker Date of Inspection: ..7 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 ponding of effluent to the surface of the ground or surface waters due to an overloaded or JcloggcdrSAS or cesspool _ Static liquid level in the distribution box above.outlet invert due to an overloaded or clogged SAS or /cesspool ,V✓ Liquid depth in cesspool is less than 6"below invert or.available volume is less than%day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number /of times pumped _ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100.feet of a surface water supply or tributary to a surface / water supply. _✓/Any portion of a cesspool or:p/Anrivy is within a Zone I of a.public well. 5 y 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.] � " (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 Systems: ./ V J To be considered a large system the system must serve a facility with a'design-flow of f 0,000 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 Y g Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a sipificant threat,or answered . "yes"in Section D above the large system has failed.The or%mcr or operator of arty 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 Pages of II OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 277 Pleasant Pines Centerville Owner: David Baker Date of inspection: 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 v 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 inspect.ed for the conditio of the battles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? n 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)j 5 Page 6 of 1 I , OFFICIAL INSPEC TION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 277 Pleasant Pines Centerville Owner: David Baker Date of Inspection: CD- FL W CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x H of bedrooms): ql/,0 6,Pb Number of current residents:_ Does residence have a garbage grinder(yes or no): AOO Is laundry on a separate sewage system(yes or no):/vO [if yes separate inspection required] Laundry system inspected(yes or no): A,, 'A Seasonal use:(yes or no):_ALO Water meter readings,if available(last 2 years usage(gpd)): N/A Sump pump(yes or no): &to Last date of occupancy: Gurftmt COMMERCIAL/INDUSTRIAL Type of establishment: 1-\I)A Design flow(based on 310 CUR 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 S system_(yes or no):_ Water meter readings,if available: Last date of.occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: NSw S e ph !9,S4r,- (0 0o�`f Was system pumped as part of the inspection yes or no):_ If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYpt 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) _lnnovative/Altemative 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 or no):A-0 6 i Will: 7 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSL:SSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F0101 PART C SYSTEM INFORMATION (continued) Property Address: 277 Pleasant Pines Centervi e Otrncr: David Baker Dale or Inspecllon: p'> BUILDING 5EWElt(locate oil site )lan) Depth below grade: r �CI0w j d�� hlalerials of consIruc(iofc_cast iron _✓00 PVC_Other(explain): Distance bons private water supply well or suction line:_ Conunertts(oil condition of juutts,Venting,cvidcncc of leakage,Etc.): 5rr1JcvlP�44 (e leaIC SEPTIC TANK: ✓(locale on site plan) Dcpth below grade: , Material of constructive:_+/concrete �,CiaI fiberglass pul)-cthylcnc _ulhct(cxplain) If tank is metal list age:_ Is agc (unfirmed•by a Cerlificale of Cunrpliance (ycs or nu):_(attach a cvl�� of . certificate) Ditnensions: /SDO G1-804r Sludge depth: got Distance bons lull of sludge to bullum of oulict Ice ut bafllc: 3-S r Sewn thickness: I er Distance from toll of scull,to top of oullcl Ice or bafllc: Gor Distance Gom butivm of scum to bo(jonr of outlet tee or Wile: I low'-Ncre dimensions dctcnnincd: oPt'nc caves Cumntcnts fun pumping rccoeuncnJatiuns,inlet and oullct Ice or bafllc cundilicn, struclwal inlcgrity,IiyuiJ Ic.•cls as related to oullcl utven,cvidcncc of leakage,etc.): 11Jr�c a.r rev Ca JGj. �•�,• ��nIC- i..�cS` ✓rl,.ro�. $urn a,J Na9— jt'u/ 7 GREASE TRAP:�dntc on site plan) Depth below grade:_ Malcrialofconstruction:`cuecrcle ntclal fibctglass_pul)-clhylcnc _other (explain): — Dinncnsions: Scum Ihickrncss: Distance from lop of scum to top of oullcl Icc or bafllc:_ Distance bout bollum of scum to boltunt of oullcl ice or bafllc: Dale of last pumping: Cununcnts(oil pumping Icconuttcndallulls, inlcl and uullct ice ur bafllc cundiliu:t, sttuctelal inlcgilly, liquid Ict.cls as rclalcd to oullcl ins•crt,ctidcn(c of Icakarc,cic.): 7 ]'age 8 of I I ' OFFICIAL INSIDEM ION FORM NOT FOR VOLUNTAIIY ASSL;SS111L;N"1•S SUUSUILI'AC1;SENVAGI'_ DISPOSAL SYSTL61 INSI11,,C'1'I0N FO1(�1 PART C SYSTBI INFORMATION(cunlinucd) Property Address:277 Pleasant Pines c_'enterville Owner: fix, Uatc of lospcctloo. a ©7 TIGHT or IIOLDING TANK: /V Y, _(tank must be pumtpcd at time of inspection)(lucale on site plan) Depth below grade: hlatelial of construction:_—concrete_m►etal_fiberglass t)ulyelliylene ollrer(explain): Uimcnsivns: Capacil). ralluns Ucsign glow: gallurts/dap Alarm present()•es or no): Alarm level: Alann in svurkin urdcr Date of last pumping: 6 (J'cs or nu):_ Cununcnts(condition of alarm and float switches,c►c.): DISTRIBUTION BOX: ✓ (if lttescnt must be o►cncJ to I )( cafe on sUc plan) Depth of liquid level above oullcr invert: r I Conut►uns(note if box is level amd distribution Icaagento or out of bux,ctc.): tv outlets equal,any evidence of solids catr)over,any evidence of i 00 I All'CHAMBER: .✓" (locate on sift plan) 1'ulnps in wurking order(ycs or mu): Alarms ill'Volk'm g order(),es or no). Conunc -- nls n utc Condition ondition r of l ump Chantbcr,cundt(iun of pumps and appurtcnanccs,uc.): f 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: 277 Pleasant Pines Centervi e Owner: David Baker Date of Inspection: L'-z I p- SOIL ABSORPTION SYSTEM(SAS): ✓ (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: R �" t ,, r,�¢crr)g overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding, etc damp soil,condition of vegetation, .); -- o'I — �OCG,'hanR inr�¢4 rW Seen1' 0lr ?x.�`K� r7�r�endt [ CESSPOOLS: �Jlcesspool 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): IV 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.): 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: 277 Pleasant Pines Centerville Owner: David d B k Date of Inspection: -tq D 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 s 3 1 FpOrt i�. 3 (Poo 10-6 41 A-a r SAS A-3 5?0` 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: 277 Pleasant pines Centerville Owner: David BAker Date.of Inspection:_ 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: ' RM`f 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: Gnu✓ d jw. , z s e�S b pi aCcas 1 n QISI 4AJ Pl.m aN �9Ic at- iD...., wc4/J�, 11 TOWN OF BARNSTABLE U 'ATION All l''lb*A�I— ��4ycL SEWAGE Y- �(� # VILLAGE EOTE VyrLLE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.. Xk9 Q40C-D -77 5--, O SEPTIC TANK CAPACITY /6 6D g9Afr r `j 'LEACHING FACILITY: (type) 1e��'�e/¢" (size) 5-b o X f &i, rNO. OF BEDROOMS Ali UII.,DER OR OWNER 1s"i� RMITDATE: 5 d COMPLIANCE DATE: r Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet. Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by a h . . GARke � 1"L,CODA Arr'ptAI.C,5 � - ----- 1. � f '' i lu No. �" — G Fee r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1/�/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for Mizponl 6potem Construction Permit Application fora Permit to Constntct( )Repair(✓rpgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No.a 7 1t Q Sen t i h CS /44 caner' Name,Addyfss and Tel.No. _ STec/e UAn2 Assessor's Map/Parcel a �� v y ( 10 w Installer's Name,Address,;Ad&&cCANC0 Designer's Name,Address and Tel.No. _ eaAAnr\ 350 Main Street elef W. Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1496 gallons per day. Calculated daily flow 1'(Y 0 gallons. Plan Date d O— (Y Number of sheets •1 Revision Date Title S Y — P 14 Size of Septic Tank %v)4 ido D Type of S.A.S. 6 " e'4e�1 e Description of Soil A Nature of Repairs or Alterations(Answer when applicable) Per- P l.� 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 B 1 of Signed Date Application Approved by DESIG NG ENGINEER MUST SUPERITI�E Application Disapproved for the following reasons INSTALLATION AND CERTIFY W WRITING THE SYSTEM WAS INSTALLED'IN STRICT r ACCORDANCE TO PLAN_ Permit No. Date Issued No. ." 2 ;x 4 •y . • c y f Fee �U ' :-THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migpool *pgtem Congtruction Permit Application for a Permit to Construct( , )Repair(v-Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a plC cr Je"i f i e S k0wner's Name,Address and Tel.No. JA��2 Assessor's Map/Parcel a L� v L' Installer's Name,AddressAA TIVUNCA Designer's Name,Address and Tel.No. CG'^^�^ 350 Main Street fi Ieyer F�c, W. Yarmoui ; M 36d - a 9 /a- Type of Building: Dwelling No.of Bedrooms i Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures DesignFlow � �� O gallons per day. Calculated daily flow 1 y U gallons. Plan Date Y -0 v - Cl Number of sheets I Revision Date Title .Si f sr "'A 10/A.-) Size of Septic Tank f%� iU oo Type of S.A.S. 6 " /ns Description of Soil r /'/A/I W E Nature of Repairs or Alterations(Answer when applicable) her Y 4 f-7 i 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 Bo of e-54h. Signed I \ ( .l,Gf Date Application Approved by Date Application Disapproved for the following reasons Permit No. 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( )`�✓q �9h/t Abandoned( )by/ c'" C c n r at (-)Y) P,,jn c A Ug C,,. <t,u;l t P has been constructed in accordance ws with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer A A The issuance�°f this permit shall not be construed as a guarantee that the sy a will,function as�designed. Date Ifn l 31 h L� Inspector t�,.. t - ------------------------ - --------------- No. Nf 'Z Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS lwigpoga[ *pgtem Construction Permit Permission is hereby granted to Conskruct( )Repair( Upgrade( )Abandon( ) �j System located at uxo- sm�r_ . 9-<romes O/G,14b& h-e and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to I- hip 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: A7�t�zl Approved by i Town of Barnstable •.°�s"E'` �: Regulatory Services P Thomas F.Geiler,Director • saxivsrnBrs. Public Health Division i639, ♦0 rEp `°i Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: J ki e 2CO4 Designer: ()A; Installer: A-f 6 C Address: . Po 13 oX 0(�,( Address: 3 Sa Pot d Si OZ03 On was issued a permit to install a (date) (installer) septic system at FLEASPror p(Na5 AVe - based on a design drawn by pp�� ��pp (address) Uq V /� G� Z,S dated (designer ^T I certify that the Septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component .of the septic system)but in accordance with State&Local ations. Plan revision or certified as-built by designer to follow. X�H OF nays 9c s DARREN o� M EY (Installer's Signature) U o 11 0 ®� o GISTS N i Q s'9NITAR\N V (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. TRANK YOU. Q:Health/Septic/Designer Certification Form r TOWN OF BARNSTABLE �C LOCATION I � SEWAGE # VILLAGE CaMYNILLE ASSESSOR'S MAP & LOTS L 'oil I—I�I INSTALLER'S NAME&PHONE NO.. �LS G�6O 77 S�-rt c-60 SEPTIC TANK CAPAC= LEACHING FACILITY: (type��� ir'►+=/�F �3'��rfS (size) 6b.!x G NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 0716v COMPLIANCE DATE:. Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by L ICEVIEW A. GAW , 1"LC'A5Antl— lNE .. . l u f Tow&-of Barnstable Board of Health P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MS Wayne Miller,M.D. May 13, 2004 Mr. Steve Dane 277 Pleasant Pines Centerville, MA 02632 and Mr. Richard Cannon 350 Main Street West Yarmouth, MA 77 Pleasan ��..Pin `� Cnterv�IeFaedeptic S>ystg� .;rrt � r�'::�§#• .,.va.,r.,,� ��w. m womi. a .:��.., ksu._u,w....r.°-.w' ,��,P. _�� iEs� a4„' Dear Mr. Dane and Mr. Cannon, You are granted temporary approval to continue to utilize the existing "failed" septic system at 277 Pleasant Pines, Centerville. This temporary approval is granted with the following conditions: (1) The lawn area located above the failed leaching facility component shall be visually inspected for any signs of sewage over-flow on a monthly basis. (2) The system shall be pumped immediately by a licensed septage hauler as soon as there is any back-up of sewage into the home or as soon as there is any overflow of sewage onto the ground. (3) Once such a back-up or overflow event occurs, the owner of the property shall report the incident to the Health Agent in writing within seven days of the event. (4) Once such a back-up or overflow event occurs, the property owner is responsible for keeping the system pumped, daily if necessary, to ensure there is no additional back-up or overflow of sewage onto the ground. (5) This approval may be revoked anytime unsanitary conditions are observed in regards to overflowing sewage from the failed leaching component. (6) In two years, on or before May 11, 2006, the new property owner will be required to apply to the Board of Health in writing for a variance or for an extension for an additiona-I-two-years-or-greater. (7) In five years, on or before May 11, 2009, the new property owner will have the following options: (a) install a replacement soil absorption system, (b) connect the home to town sewer if public sewer is available at that time, or (c) apply to the Board of Health for a variance or for an additional extension of time. (8) The potential buyer must be fully informed of the conditions listed above. (9) The potential buyer shall provide a letter to the Board that he or she is in agreement with the conditions of this approval letter. This temporary approval is granted because the Department of Public Works has informed us that public sewer lines are planned to be installed along Pleasant Pines Road sometime in the near future. Funds have already been expended for designing engineering plans for this purpose. The applicant testified that the "failed' system has not caused any back-ups into the building or any overflows of sewage onto the ground in the past. It has not been a public health hazard or nuisance to date. It is the opinion of this Board that it would not be cost effective and would not be reasonable to require the applicant to install a new septic system at this time in view of the fact that public sewer lines are planned to be installed at this location in the near future. Sincerely yours, wa.umb ML W Miller, M.D. BOARD OF HEALTH TOWN OF BARNSTABLE Cc: Robert Burgmann James Daley Peter Doyle �FtNE T DATE: FEE: RAMSTABLE. y MASS. gj i639• ��� REC. BY Town of Barnstable 1 SCHED. DATE: Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862.4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION 1 Property Address: C/K i V c� _j E�• 1 ti�v> \ �_ Assessor's Map and Parcel Number: 1`i — Ll J Size of Lot: Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: 5 ` Phone �- ? i Z Did the owner of the property authorize you to represent him or her? Yes x, No PROPERTY OWNER'S NAME CONTACT PERSON Name: Name: Address: X V-1 Address:Phone: Phone: VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) NATURE OF WORK: House Addition ❑❑❑❑❑❑ House Renovation ❑ Repair of Failed Septic System ❑ Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only). Full menu submitted(for grease trap variance requests only) Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same oWmer/leasee only], outside dining variance renewals [same owner/leasee only], and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne A.Miller,M.D.Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Susan G.Rask,RS. Q:\HEALTH\Application Forms\VARIREQ.DOC i ;4> s Page:CERTIFICATE OF ANALYSIS 1 Barnstable County Health Laboratory Report Prepared For: Report Dated: 4/23/2004 Kinlin Grover GMAC Real Estate Order Number: G0424886 Karen Steel 95 Route 6A Sandwich, MA 02563 Laboratory ID#: 0424886-01 Description: Water-Drinking Water Sample#: 24886 Sampling Location: 277 Pleasant Pines Centerville MA Collected 4/22/2004 collected by: Customer Received 4/22/2004 Routine ITEM _ RESULT UNITS _MDL MCL Method# Tested LAB IC Lab Nitrates .5.7 ; mg/L 0.1 10 EPA 300.0 4/22/2004 LAB: Metals Copper 0.1 mg/L 0.1 1.3 SM 3111 B 4/22/2004 Iron <0.1 mJL 0.1 0.3 SM 3111B 4/22/2004 Sodium 12 mg/L 1.0 20 SM3111B 4/22/2004 LAB: Microbiology Total Coliform Absent P/A 0 Absent 309 4/22/2004 LAB: Physical Chemistry Conductance 250 umohs/cm 1 EPA 120.1 4/22/2004 pH 6.8 pH-units 0 EPA 150.1 4/22/2004 Note: Water sample meets the recommended limits for drinking water of all the above tested parameters.Sample has higher than average levels of Nitrates.Monitoring is recommended(2-3 times per year)to establish any upward trends. ' Approved By:--,-,*'- ( Dire`[o RECEIVED APR 2 8 2004 ;TOWN OF BARNSTABLE, HEALTH DEPT. Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 RECEIVED MAY 18 2004 Town of Barnstabl OF BARNSTABLE DEPT. Board of Health P.O. Box 534,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MS Wayne Miller,M.D. May 13, 2004 Mr. Steve Dane 277 Pleasant Pines Centerville, MA 02632 and MAP PARCE4 4 1 W Mr. Richard Cannon 350 Main Street SOT - - West Yarmouth, MA �"T FleastF'in s� enfieEvtlle Fa IedSe1c,5 sfiem � „ y� � . .,.,>„ .. ,�..:, ac�� sE; .xitals �.��� �3-- .���r .,•xe..�aa .��v�aSvx..wxn,-R.....bx�c. �} .,,�z,`'��..> Dear Mr. Dane and Mr. Cannon, You are granted temporary approval to continue to utilize the existing "failed" septic system at 277 Pleasant Pines, Centerville. This temporary approval is granted with the following conditions: (1) The lawn area located above the failed leaching facility component shall be visually inspected for any signs of sewage over-flow on a monthly basis. (2) The system shall be pumped immediately by a licensed septage hauler as soon as there is any back-up of sewage into the home or as soon as there is any overflow of sewage onto the ground. (3) Once such a back-up or overflow event occurs, the owner of the property shall report the incident to the Health Agent in writing within seven days of the event. (4) Once such a back-up or overflow event occurs, the property owner is responsible for keeping the system pumped, daily if necessary, to ensure there is no additional back-up or overflow of sewage onto the ground. (5) This approval may be revoked anytime unsanitary conditions are observed in regards to overflowing sewage from the failed leaching component. (6) In two years, on or before May 11, 2006, the new property owner will be required to apply to the Board of Health in writing for a variance or for an extension-for an add-itional--two-yea-rs-or-greater: (7) In five years, on or before May 11, 2009, the new property owner will have the following options: (a) install a replacement soil absorption system, (b) connect the home to town sewer if public sewer is available at that time, or (c) apply to the Board of Health for a variance or for an additional extension of time. (8) The potential buyer must be fully informed of the conditions listed above. (9) The potential buyer shall provide a letter to the Board that he or she is in agreement with the conditions of this approval letter. This temporary approval is granted because the Department of Public Works has informed us that public sewer lines are planned to be installed along Pleasant Pines Road sometime in the near future. Funds have already been expended for designing engineering plans for this purpose. The applicant testified that the "failed' system has not caused any back-ups into the building or any overflows of sewage onto the ground in the past. It has not been a public health hazard or nuisance to date. It is the opinion of this Board that it would not be cost effective and would not be reasonable to require the applicant to install a new septic system at.this time in view of the fact that public sewer lines are planned to be installed at this location in the near future. Sincerely yours, v6a* m 4e W Miller, M.D. BOARD OF HEALTH TOWN OF BARNSTABLE Cc: Robert Burgmann James Daley Peter Doyle LOCATION S WAGE ITvg N VILLAGE i �� INSTA LLER'S NAME i ADDRESS J. CRAIG MEDEIROSs Tracking V BiRldRing 342 Corrpocoiinn Skeet / 7�Q Qr. = OWYvt - ' ydH Mass. 775-0828 7csr 5�D n ni nvcS7 \ DATE PERMIT ISSUED - ' } '�,\,- DAT E COMPLIANCE ISSUED e S a tiT' dplvyua /v odoz�rfi � U No.:r:7... .......... FES......... ........... .. � THE COMMONWEALTH OF MASSACHUSETTS Rrl BOARD OF HEALTH aL ® l 7-0 . Ty Applgration for Dispa ii al Workii Ctantitrurtion rawit `application is hereby made for a Permit to Construct ( ) Dr Repair ( ) an Individual Sewage Disposal System at: JPIKAJrzt,%.... __ -.....-••----•--•_..... ................ •-"" =------------------------------- ocation-Address or Lot N -�-•-H .pla-•--• a �1-4-- __.................... ... ......c u_4 .......................... Owner Address a ^._... ._..... \ Installer Address Type of Building Size Lot___:�&t j5?'._1.!!Z...Sq. feet .-, Dwelling—No. of Bedrooms............ _-__•--------------------Expansion Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building Vead.....J.S- o. of persons........................:.. Showers (-,e4 — Cafeteria ( ) Q' Other fixtures ................ --...-.__-_---•-----•--------------------- •-•.------------- W Design.Flow._----------3_30...6_1P,.Qgallons per person per day. Total daily flow.......�_�.�----1...._0..gallons. WSeptic Tank—Liquid capacityAl-M.gallons Length---------------- Width---------------- Diameter---------------- Depth_--_---__--_ xDisposal Trench—No. .................... Widt Y -_-_-___-_--- Total Length.;___........_::_... Total leaching area--------------------sq. ft. Seepage Pit No.__--_Z......__... Diameter___�...�____ Depth below inlet.:_.__...•....._.... Total leaching area------------------sq. ft. Z Other Distribution box (X ) Dosing tank ( ) / �" Percolation Test Results Performed by..._A;CAAWF.... A Kr,CA,................ Date.......... d_-� / - +------. Test Pit No. 1----------2!.minutes per inch Depth of Test Pit____________________ Depth to ground water------------------------ 4q Test Pit No. 2................minutes per inch Depth of Test Pit-_._-_..__.._._____- Depth to ground water................... 9 ........................................................=.................................................................................................... 0 Description of Soil----------------------------------------•••-- ep.__.....__o _ '-`----``---------j--------------�- ------ - �- - u-!� .---=-------- ------------ -- W t,-C6t l(/ 1 � .:..1'Gf�` ' v_/��1__..-SoJ?i�-y �����G� AZte-1.e 0t44e c. .�+ ------------------•--------------............................... U Naturc.,of Repairs or Alterations—Answer when applicable.-_-_/ICE CfG` J-_' 3 afoKl�S - X ---------------------- ....................................... --••-••-"••-•-••-••••••-••-•----••--••--........-"•---"--•--•---•--••••••-••----••----•--•--•--•••••-•••------•---•-----•---•-•---•••-•...----•---"----"-"•_.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary Code— The undersigned f rther agrees not to place the system in operation until a Certificate of Compliance has been iss by the b ealth. Ap�plicatioDApproved Signe --a-� . -------•---------------•---••-----••---- ---B Date Application Disapproved for the following reasons:-------------•----____-_____•-_-•---____-_-___-_-.._._-----_-_-_-._____-____--_ ...--•--------------------------------•-•••-----••--••••-••.................................................................... Permit No.___ :3_-_16O | 00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �F-'----------- ------------ | . / � �~°= ' �� . �����«�ww � Disposal Works ��u������N� ��� l � - u� � ' is hereby made for u Permit to Construct ( ) or Repair ( ) an Individual Scwu8o Disposal ^ °x" � � ,� -------------------. �z�---��....................................... � �. x r Lot No. Wrier Address Installer Address Type of Building Size -----Sq. feet Dwelling—No. of Bedrooms............3............................Expansion Attic Garbage Grinder ( ) Other--Type of Building of persons............................ Showers +2�') -- Cafeteria ( ) ^� Other fixtures -.-------'..-............................................................................................................................ ' Design Flow'-- ---'3130' per person per day. Total daily flow----------03-1-0....��'JoQ^~noos. Septic Tank—Liquid --gallons Loucdz--__'- Width................ I)iao`cter-----. Dent6-------. Disposal Tcench--lVo. .................... Width ....... Total Length.................... Total lcmc6io0 area....................sq. ft. Seepage Pit No......,~.��.--. Diaozdcr--.<i'... Depth bc{mmiolet---------- Iotu leaching area.-.------'sg. ft. Z Other Distribution box Dosing ) ~~ Percolu600Test B ` I,erforzucdbv---.tti^w4-'A'A�`,c ........... Du1e-'- -------- Test Pit No. 11 ....;Z*minutcv per inch Depth of Test Pit----_.-'- Depth toground water---------- 44 .� �= Test Pit No. 3................minutes per inch Depth of Test Pit-.- ........... Depth toground water........................ � � ��� �= [) '~ ��''-����(��x''-��������--'7~�'-p'--'�- -~--'.-"---zs*r��+-�-----'----------'- | Description of Sol---------------'-_-_--------------------.----__-____.-________________________. /Z.-K-1�-----Jbw+Mi'-''F' **z+........ --', ........��^�'r~......................... ''----------'-�.-----'- '�` ---'-'----'��� �''--''z� �^/�-��''���+��'~��^��~> U Nature of ' ---'-'--'----'---'--'----------------'--''------'----'-'--'--'-------'------'------ Ayrneozcot: The undersigned agrees to install the uforc6cacribc6 Individual Sewage Disposal,System in accordance with the provisions of T ME i 5 of the State Sanitary Code _Tb-c undersi I- t to place the system in 21 It Date Applicatio�Approved By.......... .................................................................................. ........................................ Date THE COMMONWEALTH OF MASSACHUSETTS n* BOARD OF HEALTH Wal Sewage Disposal S stem constructed or Repaired 1-1�ts been installed in accordance with the provisions of. TIT� _5 9f 'Lhe Sia�4;�Sailif�i�y C6&.:��s ';�F'jbpd the THE ISSYA .,NCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT THE SYSTEM W FUNCTION SATISFACTORY. THE COMMONWEALTH, OF.MASSACHUSETTS BOARD OF 'HEALTH to Construct �*)� or Repair an Individual Sewye Disposal System Street as shown on the applicatioli for Disposal Works Congtfucti-o'n Permit No...................... Dated.j---;? z�............... Board of Health INC., PUBLISHERS � gEpRooM SiN� ��P.MI�"Y - 3 11J.0 GAD5AGE ,CjCU Worn IZ aNIL�Y F%.ow 110 x 3 = 3306-Pv. 5EPT1G TAKJK = a30xl5o% °A95G-RQ- u51= %000 GAS.•. ot5Po5A� PIT V'SE 1 o o 0 &At-. S%p%WAU" Av-SA I 150 5.1. X a-S BOTTOM AQFAr .. lro it Z 'FOZ� 1,50 5.F �x I. o 0,o P o' G. -T oR•A>_ 0 6.516N = .g-2 5 G.P 0. 'ToTAt.. �A 11-Y Ft..otr! - 33o G.Po. CEN'S`ER-ti/I L LS- PER.GOLATION RATE] 1"HO 2MIN 01`LeSS r• Ojj,111,.,,E ALAN ,;;7,. RICHARDA. "r RAXTER JOKES ,�► No.240484 571 Z510� i ��G1STEp4 O4 S r /T a P Z.o3 'Ara ToP FWD='d$ TE tl'r Imo. EN SE 1000 I14%1- l1rc�D DIST. vGay. MCK1.'C B01A LIQ ScvTlG Q�,p 100o I1�� TANK • . , ti dO�`41. PIT I�"EAGN NV. 'lu. W I T W A4-j 39 Z WAS"SO 6TaN6 t GE7_TIFIS0 PLoT PLAN eoNY GRAVl31. PROFILE l.oL4"T1olJ C E NTE.�.�✓I I.c.._� � �Z No• 5GP.L 50_ ALMASNdTaZ �/41$3 NO WA'tre-1'� QLAPJ REP62ENGE 3/ 30/el 1 Gsr-L-r Y -tNAT THrcPRo1? rbUND. SKovYN L0'T 1 N6'Q-r=0At GOMPt..`(5 �n11TlaZHtr Sicr LIN Awe ,,.C- GK tL6QutR.EM�NT•� oF 't1-►� �L�H 'p�K Z14- ~PC. . �.3 'To W N O F I.OGATEfl •WITN11�1 TN•6 GLooD P�A1N • r-7 G;D'►.AN-5 u Q.v�Yoe�s REG � �3TE2VILLFr • Mi�'ss• 71A15 PLQN I fi NdT 4�5�D ca Ail , I •lu5.r-R•uMEN'� SugvG--Y -THE ot=VSE'r5 6uouO No-r DC- V��OTc+ n+=T�.z•.�1Nc t_or �II.1G�, aPPt_►�A`�,F'N,��E�oT��Rs J. F bG-VEL0PE2S Av C t o �A �. 1_- Irk N r AO • �(j39• � QD VROPOSL t> FoUA►bA°rl�f1 � � ��'ry ' 1 G 4, M LA GARACvf- �- V0.vPo6 a Q 44•e. 4 Z �J► �� o i +� /Z I O, I Lo b LO Le 1 Ito'PC 6�d WE 1r / 4b u #Ojos a �I SCAL�C i Za'. LOCATION S WAGE VILLAGE Ili INSTA LLER'S NAME i ADDRESS J. CRAIG MEDEIROS ` Tricking - an 341 Cornnrailon SkZO :/I 0 W /HH rinis, Mass. 775-0828 � �Q ►QL# / GJ ID 1�V FsT,I 5�7 DATE PERMIT ISSUED ti �:DAT E COMPLIANCE ISSUED (7-v P?,& Nksl\ 7w ,, ASSESSORS MAP : TEST HOLE:. LOCHS NOTES: PARCEL 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH FLOOD ZONE : ��N �-�•�_p SOIL EVALUATGI� :D•m�P�, R•5.�G,j E THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF W I TRESS : 0A-�/11) STn7J j_V l� BOARD OF HEALTH REGULATIONS. REFERENCE: P,[!- 3765- DATE: L, 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, PERCOLATION RA E :l SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO N = n , gc tre ,�� C.�5 z S o l t� c.'r�t ; INSTALLATION.CA t-1, vn G/77Cej -SLOW .5oR tta �9 1 � TH- I E�_:4-5,150 TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION --- v ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE `jlFhl P\ A (( �3� DETERMINATION. 47 Cl 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS pl �� � �� IOy�S/ AlSPECIFIED OTHERWISE) LOCAT I ON MAP Dpl v,c� -f �3 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A R GARBAGE DISPOSAL. No pl-a-4 V l (z1RP?CC- � ���i► = Sallo �,�3�� r wIlti l�'or � � Welt w/t,� /5U 96 � G) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) I ! MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON 2 1/ A BASE OF b"OF CRUSHED STONE. r pm Flo CMR-15,211 -ro J� vw S a 5 y , 7, EX157?N 666, o P/T 7v RE Pvn110 �S v�eult)ct.vti, FWIA-tc) Za' �— ---- i / 055aRvzD Gw @13S Cruel. 37,G __ f (L_,)6 prig Po�Ev� _ - �a5. �w �c. ►,��.� V�UL A I w-2.7 S E P T I C; S Y S T E IVI DESIGN I� 'lo � -�c, sur r VAS�-N� -t-a &tA o-v' � Y� pp-tv � �-�' ��� � � �,; �/�{,9,3�..p�Q�p r.,�-c�_w�G�4N NEE�^^�.__5,�b• Ewsrru4 l/ i\l FLOW E:�T 1 MATE l�� �S 1� - T� � �_hn oc L711 W E I !�" _. IZ� � M IE.Rtx-r► ��tz8 P�rN�Le4cH � + (,�U�� Z440 S�w� n.� �� �fl�loS �a Ems• yV� ,� !!ct �7 ► o/ '` b - d ' BEDROOMS AT I10 GAL/DAY/BEDROOM GAL/DAY so A-ate PrD� �.�( 1 SEPTIC 'TANK 5�2F Mvvhl--tO � --��.' ---- f , � � ,r � v 6I,� 4 1 c.�yEr� OF- �. --• (, GAL/DAY x 2 DAYS - GAL � o Q ,. / rs' r goo I USE tLj GALLON SEPT I C TANK — A1StA1 '�y �\ �.,� rf SOIL ARSORPT i ON SYSTEM so t< _L�Z, -- Drt..� 121w x 12 L apfj i�tr L4> w� SIDE AREA: NfA T ` A,,J BOTTOM AREA ,�U x 2 k D, 7y = qqll CrAo r IA SEPTIC; SYSTEM SECTION r tf " 13P '( cov" 10 W/th ,� q f r�xdr i t ! 4 ,s Insh,h 2 ►t,�l 3 Ohs BRi� .�' 48,.14 "- J gsl,ed ovr- ®( 3�4q I P (�svble 'IShe4 GAL D-BOX 47: 97 mot•4 Qo oa. O ' ve Y6 / ` ( SEP I C TANK 'td � �7 /S + 56Ly zW Avi � = 7-01- of kJGIL ST-F—p .D (ASLS'uM F_p DESIGNING ENGINEER MUST SUPERVISE INSTALLATION AND CERTIFY IN WRITING Tt/ T 17 67ai EG: THE SYSTEM WAS INSTALLED IN STRICT ACCORDANCE TO PLAN. SITE AND SEWAGE PLAN F RA o s9� F LOCATION . A->J ;_. � ARR g� ,U, C- /vlIg v �P1JcnNT MUST OBTAIN A SEWER CONNECTION PERMIT FROM THE -�l—�1 ao o ENGINEERING nMSION e PREPARED FOR : la A/ G7STE� sAld17AR\PN wl� iCa2_C +vac> Y�r(21 b�, r14el Sf"� DARREN M. MEYER, R.S. SCALE : I DATE: 2 D LqN'2 17' 419_1 ""OA) 9 f � /, cffAR�JG�4w Pis 43 VINE STREET V DUXEURY, MA 02332 Z �Ivc�usr 17, /7 6 '7 DATE HEALTH AGENT (701) 535-0293