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HomeMy WebLinkAbout0014 POWDERHORN WAY - Health 14 Powder Horn Way Centerville A= 190— O10 No. 42101/3 ORA p o 0 10% ® o o i I I i TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE �e.4- 1-" %�A- ASSESSOR'S MAP & LOT /�U INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY W-0 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 Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by���','4` An f,_W44 l �� ._ ., � , .� 3� �� j commonwealth of Massachusetts �!� -0/0 W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M >`r 14 Powderhorn Way Property Address Robert Sullivan Owner Owner's Name information is required for every Centerville MA 02632 4/5/2018 page. Citylrown 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 f A. General Information filling out forms 64ta17olL f on the computer, use only the tab 1. Inspector: key to move your cursor-do not Paul Martin use the return key. Name of Inspector Cape Cod Septic Services rab Company Name 350 Main St Company Address nrmn W.Yarmouth MA Ity own - 02673 State Zip Code 508-775-2825 S15016 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4/6/2018 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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The.original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•page 1 of 17 IO G� Commonwealth of Massachusetts F W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 14 Powderhorn Way Property Address Robert Sullivan Owner Owner's Name information is required for every Centerville MA 02632 4/5/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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 is in working condition. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 14 Powderhorn Way SVey Property Address Robert Sullivan Owner N information is Owner's ame required for every Centerville MA 02632 4/5/2018 page. Clty/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if Pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M •r 14 Powderhorn Way Property Address Robert Sullivan Owner Owner's Name information is required for every Centerville MA 02632 4/5/2018 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 coli form bacteria e 'a indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that.no other failure criteria are triggered. A copy of the analysis must be attached to this.form. 3. Other: . D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 14 Powderhorn Way Property Address Robert Sullivan Owner Owner's Name information is required for every Centerville MA 02632 4/5/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: 11 ® Any.portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined-that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title. 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 14 Powderhor"M n Way Property Address Robert Sullivan Owner owner's Name information is required for every Centerville MA 02632 4/5/2018 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [31.0 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number.of bedrooms(design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 110x3= 330gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments g° 14 Powderhorn Way 'Ar Property Address Robert Sullivan Owner Owner's Name information is required for every Centerville MA 02632 4/5/2018 page. City/Town. State Zip Code Date of Inspection D. System Information Description: Number of current residents: Unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) El Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 2016=192gpd Detail: 2017=200gpd Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts M W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments yt,y She`'V 14 Powderhorn Way Property Address Robert Sullivan Owner Owner's Name information is required for.every Centerville MA 02632 4/5/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No Records Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box,.soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts 0 Title 5 Official Inspection Form Subsurface Sewage Disposal System 9 p y tem Form Not for Volunta ry Assessments P 14 Powderhorn Way Property Address Robert Sullivan Owner Owner's Name information is required for every Centerville MA 02632 4/5/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of in 2011 Per BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3011 feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from +10' private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Line checked with sewer camera and was found to be clean, properly pitched with no sign of root intrusion. Septic Tank(locate on site plan): Depth below grade: 20" feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500Gal Sludge depth: 8-10" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts M Title 5 Official In Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 14 Powderhorn way Property Address Robert Sullivan Owner Owner's Name information is required for every Centerville _ MA 02632 4/5/2018 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 Scum thickness 3-511 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? Estimated Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500Gal tank in good structural condition. PVC tees in place. Tank at normal operating level. Covers 8" below grade. Recommend service of tank. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page 10 of 17 Com monwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,. 14 Powderhorn Way Property Address Robert Sullivan Owner Owner's Name information is required for every Centerville MA 02632 4/5/2018 page. Cityrrown State Zip Code Date of Inspection D. system Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete 0.metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons. Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No- .Date of last pumping: Date Comments (condition of alarm and float switches, etc.): " Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 11 of 17 i Commonwealth of Massachusetts w Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Powderhorn way s Property Address Robert Sullivan Owner information is owner's Name required for every Centerville MA 02632 4/5/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-10 D13-3 with 1 line in and 2 lines out in good condition. Box is clean and level with minimal solids carryover. No sign of overloading or hydraulic failure. Cover 16" below grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 14 Powderhorn Way Property Address Robert Sullivan Owner Owner's Name information is required for every Centerville MA 02632 4/5/2018 page. City/Town State Zip Code Date of Inspection D. System Information (Cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2-2'x3'x32' ❑ 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.): 2-2'x3'x32' Trenches with perforated pipe and stone. Lines found clean and dry during inspection. Stone in trenches was probed and found dry. No sign of overloading or hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �y 14 Powderhorn Way Property Address Robert Sullivan Owner Owner's Name information is required for every Centerville MA 02632 4/5/2018 page. Cdy/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic.failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc): l5ins•&13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M Vey'a. 14 Powderhorn way Property Address Robert Sullivan Owner Owner's Name information is required for every Centerville MA 02632 4/5/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 14 Powderhorn Way �M y0v Property Address Robert Sullivan Owner Owner's Name information is required for every Centerville MA 02632 4/5/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: +10' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2011 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 per plan on file at BOH. Engineers certification on file indicating system put in per plan. I Before filing this Inspection Report, please see Report Completeness.Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 14 Powderhorn Way Property Address Robert Sullivan Owner Owner's Name information is required for every Centerville MA 02632 4/5/2018 page. City/Town State Zip Code Date of Inspection E. Report.Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurrace Sewage Disposal System•page 17 of 17 Page 1 of 2 TOWN OF BARNSTAiau LOCATION r a SEWAGE# /_y Pe►�de horn r.l 2001 - /s1 VILLAGE Ien�er ASSESSOR'S MAP&PARCEL /90-/O INSTALLER'S NAME&PHONE NO. R it R SEPTIC TANK CAPACITY. /SOD 9a 1 LEACHING FACILTI'Y.(type)Tr,tee/.e e C-0 (size) NO.OF BEDROOMS_ 3 i OWNER_ C�n�/arPa PERMIT DATE: ( I J I COMPLIANCE DATE: A Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility out 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 Of any wetlands exist within, 300 feet of leaching facility) Feet FURNISHED BY All gl• z5'� ° • AZ• A3. 691 83• 24'G" A 4• g4'`F" 9Y- -q9'G" 3 a a F'ron4 http://www.townofbarnstable.us/Assessing/HMdisplay.asp?mappar=190010&seq=2 4/2/2018 . • n, e. - IC3 TECEIPT m (Domestic Mail Only, . Provided) Ln For delivery information visit Ln o ru � u7 AL USE m Postage $ O 0 Certified Fee �;Sfem- C3 0 op Retum Receipt.Fee (Endorsement Required) OM Restricted Delivery Fee tri (Endorsement Required) �O,1� Total Postage&Fees..A p Sent - C3 N Sreet,:Ap£No.;" Mr Paul Ciavarra or PoeoxNo. / 207 Washington Street _. :ciCy sieie,'zir� Marblehead,MA 01945 I Certified Mail Provides: -, .___ i�,a^edi zoos ear oose W,o�sa • A mailing receipt • A unique Identifier for your mailpiece • A record of delivery kept by the Postal Service for two years hi0ortant Reminders: to Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. • Certified Mail Is not available for any class of international mail. • NO INSURANCE COVERAGE IS PROVIDED-°with Certified Mail. For valuables,please consider Insured or Registered Mail. • For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mallpieoe"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. tM For an.additional fee, delivery may be restricted to the addressee or addressee's authorized age�nt.Advise the clerk or mark the mailpiece with the endorsements"Restricted`De/ivery": . ' a If a postmark on the Certified Mail receipt is desired,please present the arfi- cis at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it.when making an Inquiry.- Internet access to-delivery information is not available on mail addressed to APOs and FPOs. SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign"mire item 4 if Restricted Delivery is desired. Y� �/ ❑Agent ■ Print your name and address onthe reverse / ddressee so that we can return the card to you. Bec ed by,(Rnnted Name) D to Delivery ■ Attach this card to the back of the m ' �c�H� or on the front if space permits. 1. Article Addressed to: Ile is"del address different from item es 91 YES,enter delivery address below: No 3 2 11 1 I Mr Paul Ciavarra \ -207 Washington Str `Marblehead, MA 019 3 1 019 s. Se ceType 190ertified Mail ❑Express Mail is ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number I'` ': i :: t { , , s (Transfer from service label) 7 0 0 6 0 8�1!J 0�(1 0'� 3 5 2'5 5 3��9 J PS Form 3811,February 2004 F Domestic Return Receipt 1025 2-M-1540 UNITED STATES I POSTAL SERV ,OaFz.: �:._:�-,,»c_ 7: ':�-,p•' ir's,�:&Ja& I�Fail�,,.,,�: - .:N+1.;:i �Y+.ih.. �• �•'1�,r. ,ilc7rsp+�e� ?ia'''�nrwr^% • Sender: Please print your name, address, and ZIP-4-1h1his box • "' I Town of Barnstable Public Health Division 200 Main Street I Hyannis, MA 02601 I r Town of Barnstable Barnstable of t� P, row Regulatory Services Department AN-AmedcaM + RARNS`rABLE, "Ass. Public Health Division ArF°MA�s 200 Main Street, Hyannis MA 02601 2007 v Office: 508-862-4644 Thomas F.GeilerLeach pit is only3f wndwagter,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3525 55309 May 31, 2011 Mr Paul Ciavarra 14 Powderhorn Way Centerville, MA ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic 14 Powderhorn Way, Centerville, MA was last inspected on 4/14/2011 by Troy Williams a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in Hydraulic failure . The system,upon completion of the replacement or repair, as approved by the Board of Health, will pass. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action ER OF• -HE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\1-1 SAMPLE 60 Day Deadline.doc O.OHE T°� Town of Barnstable Barnstable Regulatory. Services Department�`' As-Am" acitlr IIARNSTADLE• Q MASS. t3 t639. �0 Public Health Division ArF°"Mamma. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3525 5194 April 25„ 2011, Mr Paul Ciavarra 14 Powderhorn Way, Centerville, MA 01945 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system 14 Powderhorn Way, Centerville, MA, was last inspected on 4/14/2011, by Troy Williams, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Liquid depth in septic tank is less than 6"below invert or available volume is less than '/2 day flow. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q;\SEPTIC\Letters Septic Inspection Failures\1-I SAMPLE 60 Day Deadline.doc Y S Commonwealth of Massachusetts 's .� Title 5 Official Inspection FOl"n1 P- 10 'to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Powderhorn Way, Centerville Property Address Paul Ciavarra Owner Owner's Name information -- is required for every 207 Washington Street, Marblehead MA page. City/I own 01945 _ Aril 14, 2011 State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in an way. Please see completeness checklist at the end of the form. y Important:When filling out forms A. General Information on the computer, use only the tab key to move your 1. Inspector: G O cursor-do not TroyWilliams use the return -- -- key. Name of Inspector _ Troy Williams Septic Inspections rae Company Name -- -- _ 19 Hummel Drive -� Company Address South Dennis MA 02660 508 385-1300 State — - Zip -- ��__ S1682 Telephone Number -- ------ License Number — B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority � :m., Inspector's Signature — -----__ Aril 14, 2011 -- - Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system Is a shared system o has a design flow Of 10,000 gpd or greater, the inspector and the system owner shall submit the0' report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. """"This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•o9/o8 Title 5 Official Inspection Form:Subsurface Sewa e l g Disposal S tam Page f 17 a , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Powderhorn Way, Centerville Property Address Paul Ciavarra Owner Owner's Name information is n 207 Washi ton Street, Marblehead MA 01945 April 14, 2011 required for every _�. _ _ page. CityfTown 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: N/A I B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" secti on 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): N/A t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Powderhorn Way, Centerville Property Address Paul Ciavarra Owner Owner's Name information is 207 Washington Street, Marblehead MA 01945 April 14, 2011 required for every 9 p page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y. ❑ N ❑ ND (Explain below): N/A ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): N/A C) Further Evaluation is Required by the Board of Health: . ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment.. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is,not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of,a bordering vegetated wetland or a salt marsh t5ins•09l08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts N . Title 5 Official Inspection Form F s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Powderhorn Way, Centerville Property Address Paul Ciavarra Owner Owner's Name — information is 207 Washin ton Street-----Marblehead MA 01945 AAp—ril 14,'2011 required for every -— --.—. - ----- ----- -- ------- 4, page. CitylTown State Zip Code Date of Inspection B. Certification (cons) 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. I . ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent.and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: N/A D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No to each of the following for all inspections: Yes No ❑ . ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day.flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 i. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 14 Powderhorn Way, Centerville Property Address Paul Ciavarra Owner Owner's Name information is 207 Washington Street, Marblehead MA 01945 April 14, 2011 required for every 9. p page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. 0 ® 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. El ® 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- 10 000 d. 9P M ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To.be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes or"no"to each of the following, in addition to the questions in Section D.. Yes No ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area IWPA) or a mapped Zone 1.1 of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts o - - - - Title 5 Official inspection Form Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments rr 14 Powderhorn Wa Centerville ---- Property Address ---- - — Paul Ciavarra _ Owner Owner's Name information is required for every 207 Washington Street Marblehead MA 01945 Aril 14; 2014 _ page. City/Town State Zip Code Date.of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and.examined? (1f they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ❑ ® Were the.septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® El 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 2 — (design):, Number of bedrooms (actual):. 2, DESIGN flow based on 310 CMR .15.203(for example: 110 gpd x#of bedrooms): t5ins•09/oa Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 17 Commonwealth of Massachusetts U. Title 5 Official Inspection Form A o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Powderhorn_Wa_y, Centerville Property Address y _ Paul Ciavarra Owner Owner's Name information is 207 Washington Street Marblehead MA 01945 April 14, 2011 _ required for every _ r_ _ page. City/Town State Zip Code. Date of Inspection D. System Information Description: N/A Number of current residents: 0 I Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? Yes ❑ No. Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 10 = 32,000 gals. 9 ( years 9 (9P )) 09=37,000 gals. Detail. Sump pump? ❑ Yes ® No Last date of occupancy: vacant 2 weeks Date Commercial/Industrial Flow Conditions: Type of Establishment: _N/A Design flow(based on 310 CMR 15.203). N/A _ Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.). N/A 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: N/A t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 wM 14 Powderhorn Way, Centerville Property Address Paul Ciavarra Owner .. - Owner's Name information is tOn 207 Washin required for every g Street, Marblehead MA 01945 Aril 14, 2011 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/A -Date Other(describe below): N/A _ t . General Information Pumping Records: Source of information: -Last pumped in 99 per info from owner. Was system pumped as part of the inspection?,. ❑ Yes ® No If yes, volume pumped: N/A gallons How was quantity pumped determined? N/A ^--- Reason for pumping: N/A —.-- 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) �I Innovative/Alternative technology, Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Insp ection Form:Subsurface Sewage plaposal System•Pape 8 of 17 i Commonwealth of Massachusetts i Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ••` 14 P_owderhorn Wes, Centerville Property Address -- __ - --- - -- Paul Ciavarra _ Owner Owner's Name -- information is 207 Washington Street, Marblehead MA 01945 April 14 2011 required for every g p i page. City/Town _State Zip Code Date of Inspection q ' D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Ordinal to home built approx. 45 +Years ago. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: �88"+ feet Material of construction: ® cast iron ❑40 PVC ® other(explain): orangeburg Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Lines were found clear at the time of inspection. _.: S©ptic Tank (locate on site plan); Depth below grade-. ' feet---- — --� Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) N/A - If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No N/A Dimensions: Sludge depth: N/A r t 511s•os/oe Me 5 Official inspection Form:subsurface sewage bisposai system peps d bf i 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments 14 Powderhorn Way Centerville Property Address — Paul Ciavarra w owner Ownor%Name - ---------------- -- information is required for overy 207 Washington Street, Marblehead MA 01945 Aril 14, 2011 page. City/Town T State Zip Code Date of Inspection D. System Information (cont.)` Septic Tartk (cont.) Distance from top of sludge to bottom of outlet tee or baffle N/A Scum thickness N/A Di.Opt wo from tale of tick trn to tap of ot:ttlot lease or b€affl® NIA Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? N/A_ Commartts (or1 purrlplt��j r�s3ririirilE�rldF�tl�r�ea,IMlet eirid outlet tee or baffle condition, structural Integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A of@Abe 1 r0p (loubtc,mi sild uldn) Depth below grade: ' Material of construction: concrete metal fiberglass polyethylene other(explain): _ � �Dimensions: N/A _ Scum thickness N/A t. - ,.-- -. __ { N/A Distance from to of scu m to to 0 f but let p p I t tee or t§affle — _' NIA Di6tanco from bottom of ecum to bottom of outlet too or balflo - - - --- - - 4 Date of last pumping: N/A— ---- Date t51ns•00/08 Title 6 Oflicinl Incpectlon Form:Subsurfaca Sewage Disposal System•Pape 10 of 17 1. Commonwealth of Massachusetts __---_ Title 5 Official Inspection Form A -- - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c 14 Powderhorn Way,Centerville Property Address Paul Ciavarra Owner --------...__—_--------- _ Owner's Name --- — information is 207 Washin ton Street Marblehead MA 01945 Aril 14 2011 required for every _9 � p , page. Cityfrown 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.): N/A Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): _ Dimensions: N/A-- Capacity: N/A gallons N/A_ Design Flow: gallons per day Alarm present: ❑ Yes 0 No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No Date of last pumping.- N/A -Date Comments (condition of alarm and float switches, etc.): . N/A "Attach copy of current pumping.contract (required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System,-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 14 Powderhorn Way, Centerville Property Address Paul Ciavarra Owner Owner's Name information is 207 Washington Street Marblehead MA 01945 Aril 14 required for every 9 _ _ , 2011 page. City/Town State Zip Code Date of Inspection . D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A 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.): N/A I 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.): N/A Soil Absorption System.(SAS) (locate on site plan, excavation not required).- If SAS not located, explain why: N/A t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-f age 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments µM 14 Powderhorn Way Centerville Property Address Paul Ciavarra Owner Owner's Name information is required for every 207 Washington Street, Marblehead MA 01945 April 14, 2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 -5'X 5' ❑ 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.): Cesspool was found dry on inspection with walls found stained above inlet line. This is evidence of cesspool-bein�_full and in hydraulic failure when home was occupied. Cesspools(cesspool,must,be pumped as part of inspection) (locate on site plan): Number and configuration main cesspool Depth—top of liquid to inlet invert 4"---- Depth of solids layer 3" Depth of scum layer none Dimensions of cesspool 5' X 5' Materials of construction cesspool block Indication of groundwater inflow ❑ Yes ® No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System?Page 13 of 17 t VN ,..; I - Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form- Not.for Voluntary Assessments •'' 14 Powderhom Way' Centerville Property Address Paul Ciavarra Owner Owner's Name information is 207 Washington Street, Marblehead MA 01945 Aril 14 2011 required for every — 9 _ _� , page. City/Town State Zip Code Date of Inspection D. System. Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspool was found with 4' of water(in inspection due to vacancy with the walls found stained up to the inlet line. This is evidence of ces i ool being full and in hydraulic failure when home was occupied in the past. Privy(locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding; condition of vegetation, etc.): N/A t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System+Page.14 0(17 r q Commonwealth of Massachusetts W Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 14 Powderhorn_Way,_Centerville Property Address -- Paul Ciavarra Owner Owner's Name information is 207 Washin_ton Street, Marblehead MA 01945 April 14, 2011 required for every 9 p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water, supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 6 y 2 - y z � t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Powderhorn Way, Centerville Property Address Owner Paul Ciavarra Owner's Name information is required for every 207 Washinq ton Street, Marblehead _ MA 01945 April 14, 2011 _ —_ h page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells I Estimated depth to high ground water: 10.0' 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: pate ® 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: SDW 252 Zone D 46.9' 2.5' adjustment You must describe how you established the high ground water elevation: Hand augered 3' below cesspool with no water found at 9.0'. Groundwater adjustment in area at the time of inspection was 2.5'..Bottom of cesspool at 6.0'.was found not to.be located in the high groundwater elevation at the time of inspection__ Before filing this Inspection Report, pleo!§e see.Report Completeness Checklist on next pag4. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Powderhorn Way, Centerville _ Property Address Paul Ciavarra Owner Owner's Name information is 207 Washington Street, Marblehead MA 01945 April 14, 2011 required for every ___�_ p 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 t t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of'l7 _ TOWN OF BARNSTABLE LOCATION 114 Pou),dc r b orn l.Jau SEWAGE# 2 oo/ - /$/ VILLAGE Ccn,4cru;I1c. ASSESSOR'S MAP&PARCEL /90 -/O INSTALLER'S NAME&PHONE NO. S{3 6"c Lkx4io r% SI''77 -OGS3 SEPTIC TANK CAPACITY /SOo go.1 LEACHING FACILITY:(type)T e n c)%c S a z) (size) Z x 3 x 3 Z NO.OF BEDROOMS 3 OWNER_ a iJa rPa. PERMIT DATE: 6)13)// 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 AI - 53 14 to z5' " Az- �0'G " A3' �g 'g Aq- .Bq ' -q9'G `� 0 3 R B F-row-� No.C 6 l u Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Bispo8al 6pstem Construction permit Application for a Permit to Construct( ) Repair(VI/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I LITO CV41tr hoc t1 WO Rwner's Name,Address,and Tel.N"'7 AJ'3 C?_y12.Z3 Assessor's Map/Parcel czntery I j Ie Mrz.ei19 G` avar r Gf I I k`e I tall 's e,Address,and Tel.No. 1�"I"�. 0 !j� Designer's N e,Address,��,T�el.No. �ulva_ ton Type of Building: Lc Dwelling No.of Bedrooms \13 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �110 gpd Design flow provided 3Y gpd Plan Date G 1 l Oil Number of sheets Revision Date Title Size of Septic Tank 4 X Type of S.A.S. 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 Certificate of Compliance has been issued by this Board of Health. Signed AA, Date 4I1.3 11 Application Approved by Date "/q—G Application Disapproved by Date for the following reasons Permit No. ;?Oil— IV Date Issued "l3— r/ No.CN'_ is) - Fee t THE,,.gM ,pNWEALTH OF MASSACI�USETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -'TOWN OF BARNS TAd M, MASSACHUSETTS 2pplitatlon for JMispoBal 6pstem Construction J)ertI d ',-`% Application for a Permit to Construct( ) Repair(01/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Addressor Lot No. r y TO Ct7JCr{or n WO y Rwner's Name,Address,and Tel.N"I -1 3 ct -Ll 223 Assessor's Map/ParcelCen i er v l t�e G r Ova r l0 19 r G CIv C ni lI�`E' In tall 's me,Address,and Tel.No. -I''. 0 S3 Designer's Na e,Address a d Tel.No. " � G C►V t d n �aef�'\I L-L., T,/)(ktdaLP_ N/CA M QQJ Type of Building: Dwelling No.of Bedrooms 13 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures - Design Flow(min.required) _3 3 0 gpd Design flow provided 3 Y{ / gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank } Type of S.A.S. Description of Soil / •� . Nature of Repairs or Alterations(Answer vvh n-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 Certificate of Compliance has been issued by this Board of Health. Signed Date 611.3 I Application Approved by Date 6- Application Disapproved by Date for the following reasons Permit No. d`lJl' - let Date Issued �3- THE COMMONWEALTH OF MASSACHUSETTS a BARNSTABLE, MASSACHUSETTS " (Certificate of Compliance THIS IS TO CERTIIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Y ) Upgraded B ( ) Abandoned( )by �`(t'Ci\1 c,+i ej n at 1 �1 01� let hor n (.U6U4 has been constructed in accordance with the provisions of T� vt3\jniton le 5 and the for Disposal System Construction Permit No.o70t_ dated `l 3- Installer 's Designer (1 p,r #bedrooms\,. Approved design flow_ 3 3 0 gpd The issuance of this perm't/shall rjOt be construed as a guarantee that the syste Qwill =iosi .ned. Date l/ �/ Inspecto P No. c?o r'l— Fe THE COMMONWEALTH OF,MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,MASSACHUSETTS )Disposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(V/) Upgrade( ) Abandon( ) System located at , ~-► ��(�)(! ,(h n )(� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with 1 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 ���� 3` Approved by fr. —;1(a _r.! CI B;Iz- t I;`w 4 It l's I F TIh6_mas ire (Ge ler, Direct or ems. Tij.bIne Hea1fih Di7vI zon 46.3 C, , Thom as McKeon, Director ,-700 Main St-eet,Hyannis,1�1�A 02601 O`rice: 508-862-4644 Fax: 508-790-6304 Installer & Desig r cCertificafnon Form Date- � �� Sew2ge 1perm t4l od l —��� Assessor's M2pTar cell V�On e ]Q�e�ngnere J vJ /rt�n >Cn� �Illlero ��/J X f/a-tI� q �/� e / 61 Address'. l3 � "��1 � Address: On was issued a permit to install a (date) n(ianst/aller) septic system.at � fo�n3G�A °` � based on a design drawn by (address) JCQ 11'(Pi %t 1 Q P dated (designer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. plan revision or certified as-built by designer to follow. N OF M,43,9, �o DANIfiLA. o OJALA (Installer's Signatuye)U M 0CIVIL C No.46502 (Designer's Sig_,atui:e) (Affix,_Dcsiguer's Stamp here) PLEASE RETLM1� TO BARIgST'ABLE PUBLIC HEALTH t1.dV9S1Or4. CERTIFICATE OF C.oreUL d0,E WILL PdOA BE mSS E �riTffi �OAH ��HIS �+O �1 A-t? AS-BUILT OAS A-PZ R EC)F]C D BY TBE BARNSTABLE PUBLIC=ALTH]DMSION. THA1IkTK YOU. Q:Health/Septic/Designer Certificatioa Form 3-26-04-doc _ Town of Barnstable P#— °f?FRIE Ib` ]Dep artmolt of Regulatory Services a r3J�f�'t�t• EL4 4 public 11caltth Division Date i6 ,erg 200 Nlain Street,Hyannis NIA 02601 9 P/00- M Date,Scheduled_ Tinie Fee Pd. Soil Suitability Assessment for Sewage Disposal Perfonned By:' Witnessed By.: ]LOCATION & GENE'RA L ]N[+'O1UWATdON Location Address / /0O _�J. 0�� Owner's Name G/a CQ -✓t.A` `Q Address Assessor's Map/Parcel: /90//0 \ Cngiucer's Name .�.O w v- V e NEW CONSTRUCTION REPAIR � Telephone 11 0.4 �7 Lnd Use � Slopes(%) ZC Surface StonesNO^ 1, / Distance's from: Open Water Body Ae#n —ft Possible WE[.Areu. 014— ft Drinking Water Well a"' ---ft Draibage Way ft Property Line 4-0 ft Other e— ft F SKETCH:: (street name,dimensions of lot,exact locations of lest holes&pert tests,locale wetlands'1n proxinuly to boles) 17 Y0 ��— Parent material(geologic)_ 8' Dcplh 1p Bodrack Depth to Groundwater: Standing W ater i_ n Hole:_. /� N0 Estimated Seasonal High Oioundwater P _ p t� �._._. Weeplhg l'faltl fait Ftlue _ /V//-d-- D]CTERNIINA ION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Deptla to s411 Itit)t1153;. T In, Depth to weeping:from side of obs.holc: It.l, dYoulldWuteY Ad�uslment,_ Fe. Index Well M Rcading Datc: Index Well leVnl Adj,factgY— A41,(JI'I)nndWafeP UVeI ca3 ]PE RCOLATIONTESrr flDnlaG _ A'Lulm Observation .. �� HoIc!I Time,tit h" 11 Depth of Perc 40 Tlmp at 6" Start Pre-soak Time @ ILA / Time(9"-6") "/ MA ' End Pre-soak Rate Min./lnch /�G7� M r r Site Suitability Assessment: Site Passed_ Silq,Failed: Additional Testing Needed(Y/1\1) ./yl Original: Public Flealth Division Observation Mole Data To Be Completed on Back----v-- ***l percolaatiou test is to be conducted wil.iiin 100' of wedaand, you nilust first u0ti y tile .Baarnsttable C0nseVv71tio11 J)ivISd01.1 at least one (1) weelc priOr tO begiuldug. QnSGPTIC\PERCF0RM.D0C DIE P �y �-,� �T/� r�'r �Depth from �ri2on�ll P i�1 JL A®�T,O—L 1 L0 Soil 1lorizon Soil Texture Mole # _ .p Surface(in.} Soil Color Soil (USDA). Other (Mansell). Mottling (structure,Stones,Boulders. Y2y/ Con istenc % ravel _ L 1 / - 2 c $ - ]i REP O-BEER VA'�IoN H®LE]LOG Depth from Soil Horizon Role# (USDA) Surface(in.) Soil Texture soil Color Soil } (Mansell) Mottling (StructurOe,ler Stones, Boulders. -L7-6 4 - . �5 � Consis enc y %'ravel 4--5 0 --- /� /1 REP (()RSERVATION HOLE LOG' Depth from Soil Horizon e# Silrface i Soil Texture � (n.) Soil Colo r. Soil (USDA) (Mansell) Mottlln Other g (Structure,Stones,Boulders. ' Consistency,rya Onvell .. ------------- Depth fi-om Soil.Horizon �'®�` Hole# Surface(in.) Soil Texture Soil Color(USDA) ., (Munsell) 5011 SoilOther Mottling (Structure,Stones;Boulders, Cons[ ten Flood Insurance Rate P,J,p Above 500 year flood boundary No Yes Within 500 year boundary No Within 100Year flood boundary No yes IDle t➢� o, t 1�Tt teutr�lB�l OCCIR �Ang Zerviou,s matertg➢ Does at least four feet of naturally occurring pervious material exist in all areas obsel'ved thl•oughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious marel,iW W � CelrtificafcioQ� I certify that on ` ' (date)I have passed the soil evaluator examination approved by the Department of Environmental.Protection and that the above analysis,was performed by me consistent with the required training, expertise and experience described in CIO CMR 15.017, g Signature Dat0 0 ?Y— Q:1SEPTICTRRCFORM.DOC J r ALL LL SYSTEM PROFILE MAR EYD WITHCMAGNETICTTAPEAOR BE NOTES 1 COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVD o 0 PROVIDE MIN 20" DIAM. WATERTIGHT (NOT TO SCALE) ACCESS COVERS TO WITHIN 6" OF FIN. GRADE OP FOUND. EL. 46.67' PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE 2. MUNICIPAL WATER IS EXISTING C " �J - 45.5' 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT. �, o 45.0' 2% SLOPE REQUIRED OVER YSTEM �p MINIMUM .75' OF COVER OVER PRECAST 4. DESIGN LOADING FOR ALL PROPOSED PRECAST o PRECAST H-10 MIN. 8" DIAM RISERS (1YP.) UNITS TO BE AASHO H-� «.�• 2'0 4"0SCH40 PVC 3' MAX Locus a d PIPES LE✓EL 1ST 2' 2" PEASTONE ORRE /TEXTILE 0.75' MIN 5. PIPE JOINTS TO BE MADE WATERTIGHT. co �eoe FILTER FABRIC OVE STONE Greot r h 42.5 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE '�� orn *44.1 10.. 1500 GAL H-10qT1EE WITH 310 CMR 15.000 (TITLE 5.) ow el «' 43.0' TEE SEPTIC TANK42 75' o°o°o°o°°°°°°°°°°°°°°°o°°°°°°°°°°°o°O° °�°0°O°O °�°�°�°�°0°�° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND v 42.0' ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° 00 ° ° ° ° ° ° ° o ° ° ° NOT TO BE USED FOR LOT LINE STAKING OR ANY °°°°O°o°oO°o ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° oo ° ° ° ° ° ° ° ° a �� Rd. GAS BAFFLE °°°0°0°°°°°° °°°°°°°°°°°°°°°°°°°°°°°°°°°°°o°o°°°°°° °°°°°°°° °o°o°°°°°°°°°° 39.85' _o"'0o„Oo_ 2' 000000000000000°0000000000000000000000 00o00°0 0°0°°0°°0°°0°0°000' '�• OTHER PURPOSE. 01 Po5 +: 4' LIQ. LEVEL (ACME OR EQUAL) ' 42.21' 42.04� 4"'PVC SET AT .005'/' SLOPE d ON 6" DOUBLE WASHED 3/4" - 1 1/2" STONE 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. Jp0°O°O°O°00O°O°000000000°O°O°ODO°O°0°O°O°OLL - o°o°o°000°o°o°o°o°o°o°o°ocoo°o°o,°o°0000°o°o°o MIN 6" SUMP 2$ ,o 0 0_0_�_�_o_o 0 0 0 0 0 0_0.0 ° 9. COMPONENTS NOT TO BE BACKFILLED OR to 12 MIN INT. DIM. o� 2 0 32' LONG BY 3' W. BY 2' DEEP 4.65' 99+ CONCEALED WITHOUT INSPECTION BY BOARD OF 6" CRUSHED STONE OR MECHANICAL HEALTH AND PERMISSION OBTAINED FROM BOARD COMPACTION. (15.221 [2]) OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR ( 7 % SLOPE) (7 7% SLOPE) ( 1 % SLOPE) BOTTOM TH 1 & 2 EL. 35.2' CALLING DIGSAFE (1-888-344-7233) AND GROUNDWATER EXPECTED AT EL. 30'f VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP FOUNDATION 16' SEPTIC TANK 7' D' BOX 6' LEACHING PER TOWN MAP OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF FACILITY WORK. NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 190 PARCEL 10 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS SHALL BE REMOVED 5' BENEATH AND AROUND THE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM PROPOSED LEACHING FACILITY. AP DISTRICT 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. LEGEN D 99- EXISTING CONTOUR 115.00' X 99•1 EXIST. SPOT ELEV. -- x 4 „ 9 x 46.08 SYSTEM DESIGN: 99 PROPOSED CONTOUR 198.41 PROPOSED SPOT EL. �s �6 GARBAGE DISPOSER IS NOT ALLOWED TH 1 �Q TEST HOLE DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD 2� SLOPE OF GROUND 43.70 ((�^� x 44.32 i i USE A 330 GPD DESIGN FLOW ( (-X')4 75 xlq 06 I �� C_Q, UTILITY POLE 43.66 �,� ( -� ( x (��4� 2a SEPTIC TANK: 330 CPD -(2) = 660 X x ({(x144 0 x T 1 ` J USE 1 1500 GAL. H-10 SEPTIC TANK FIRE HYDRANT 43.54 - 1 45.31 x 6.31 ( ) I cc ss oL I L NOTE NOT ALL 51MDOla MAY APPEARiy DRAWING -ACHING: I -� CESSP OL -x 4 .63 . 43.44 •- = �I�� T� 45.20 SIDES: 2[2 (32 + 3) 2 (.74)] = 207 GPD TEST HOLE LOGS " 45.43.53 ( 95 247 -� 1i BENCHMARK BOTTOM 2[32' x 3 (.74)] = 142 GPD ` x 43.58 000 45.6 COR CONC. BULKHEAD 43.61 EL. 46.7' TOTAL: 472 S.F. 349 GPD ,o = ENGINEER: ARNE H. OJALA, PE, SE X x 44.48 5.93 x 6.44 USE (2) 32 LONG x 3 WIDE x 2 DEEP WITNESS: DON DESMARAIS, RS 4 6 GAS �, �= LEACH TRENCHES OF PERF. SCH. 40 PVC PIPE AND STONE DUNE 8, 2011 6.70 DATE: X 43 44.10 METER 45.77 � PERC. RATE _ < 2 MIN/INCH x 45.72 46.02 13294 ISUN I CLASS I SOILS P# °' ROOM EXISTING SLAB DWELLING x 46.02 ELEV. ELEV. GARAGE TOP FNDN MA SLAB EL. = 46.67' APPROVED DATE BOARD OF HEALTH 0» 45.2' 0» 45.2' A - A 07 e TITLE 5 SITE PLAN - LS LS 46 0 OF 6" 10YR 4/1 6" 10YR 4/1 B B I �Q oti�P 14 POWDERHORN WAY LS LS 145.44 145.53 3 �s CENTERVILLE 10YR 5/6 10YR 5/6 a4.4z 36" 42.2' 36" 42•2' 1 PAVED 1 LOT 40 0 DRIVE 1 5a PREPARED FOR C 1 C 1 1 16,822 SFt 3:Q PERC FS FS X 1 B&B EXCAVATION/ 60" 10YR 7/4 40 2' 60„ 10YR 7/4 40 2' L I x� 115.00' 95 C I A V A R R A x 44.69 44.56 �44.59 _ - - _ - - - - - --x 46.97 JUNE 10, 2011 f -:7- _ - - T x JUNE 16, 2011 (FIELD ADJUSTMENTS) - 44.484�8 EDGE PAVEMEN k Y C2 C2 x4 33- w,yp Mcs MCS pOWDERHORN WAY ,SHoFMgs off 508-362-4541 -� FA sycy ��oFMgsS fax 508-362-9880 DANIEaLA. G�, �� I downcape.com © '* o OJALA - DANIEL yN; . 10YR 7 5 10YR 7 5 clvll 02 �� ya A. , / / OJALA own cope enginee�ing, Inc 120 35.2 1209935.2 �o � No. 09,9 y e�,� TE� ,� .,� of civil engineers Scale: 1"= 20' �xi � s land surveyors NO GROUNDWATER ENCOUNTERED �o���� � - �� o`sYra, 939 Main Street ( Rte 6A) 0 10 20 3o ao 5o FEET DATE DANIEL A. OJALA, iP. ., P.L.S. YARMOUTHPORT MA 02675 -