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Home My WebLink About0338 PRINCE HINCKLEY ROAD - Health (2) 338 Prince Hinckley Lane Centerville A = 171 - 172 f c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 338 Prince Hinckley Road r TI V� Property Address Brenden Ai uier Owner Owner's Name information is $ required for every Centerville Ma 02632 10-2-18 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information S'/ I33u -/ on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 Q Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113747 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. ❑E Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Brett Hickey 10-2-18 'Wta:3018.0.03ID:3t:@-0a'OO 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 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 338 Prince Hinckley Road �V Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town 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: The system was in working order at the time of inspection. 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 i c Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 338 Prince Hinckley Road Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 i - Commonwealth of Massachusetts Title 5 Official a i i I Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 338 Prince Hinckley Road u Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town 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 El El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ O 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 r� i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 338 Prince Hinckley Road �v Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No El El or liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ E] Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ El Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ F Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ El 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- El El 10,000 gpd. ❑ El 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. 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form - I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments oil 338 Prince Hinckley Road V Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town 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 ID ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? 0 ❑ Has the system received normal flows in the previous two week period? ❑ O Have large volumes of water been introduced to the system recently or as part of this inspection? El ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ El Was the facility or dwelling inspected for signs of sewage back up? ❑ ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? El ❑ 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: E) ❑ Existing information. For example, a plan at the Board of Health. ❑ a 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 338 Prince Hinckley Road Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 3 3 Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow b9sed on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 340/gpd Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes G3 No Does residence have a water treatment unit? ❑ Yes 0 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 0 No Seasonal use? ❑ Yes No See below Water meter readings, if available(last 2 years usage(gpd)): Detail: ***2016-122,000gallons 2017-198,000gallons*** Sump pump? ❑ Yes 0 No current Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �- rTitle 5 Official Inspection Form 15 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 338 Prince Hinckley Road u Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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: Owner- last pumped 5 years ago 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=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 338 Prince Hinckley Road Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: 0 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: 2013 Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 21611 Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑ other(explain): Town water 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 Form:Subsurface Sewage Disposal System-Page 9 of 18 c Commonwealth of Massachusetts ,i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 338 Prince Hinckley Road v Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): /� 1'611 Depth below grade: feet Material of construction: ■❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 000gallons 4" Sludge depth: 3211 Distance from top of sludge to bottom of outlet tee or baffle 211 Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 1411 Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is not in need of pumping at this time but should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form - �?1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 338 Prince Hinckley Road Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: i Capacity: gallons Design Flow: gallons per day l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments U 338 Prince Hinckley Road .Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town 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): o„ Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in working order at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F� 338 Prince Hinckley V� y Road Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every 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 FE] No* Alarms in working order: ❑ Yes R No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): NA *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: (2) 500 Gallon El leaching chambers number: ❑ leaching galleries number: ❑ _ leaching trenches number, length: ❑ 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 C\� Commonwealth of Massachusetts Title 5 Official Inspection Form fI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I; 338 Prince Hinckley Road Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town 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.): The leaching was in working order and was dry with no high staining at time of inspection. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA 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 —v 338 Prince Hinckley Road Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 338 Prince Hinckley Road V Property Address Brenden Aiguier Owner Owners Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town 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 Asbuilt Ground water 36" 52,E REAR I500 gallon chamber A 6 1 Al-15' >12 O A2-20'6" A3-44'6" A4-41'6" A5.51' >71 tB1.41'4" 82-47 83.635' .84-5r6" B5-63'5" l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 338 Prince Hinckley Road Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town 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: No GW @ 144" feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record 5-7-13 If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: A plan on file with the Board of Health was used. 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 �d p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 338 Prince Hinckley Road u Property Address Brenden Aiguier Owner Owner's Name information is Centerville Ma 02632 10-2-18 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: 0■ A. Inspector Information: Complete all fields in this section. M B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ■❑ C. Inspection Summary: rY: 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 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st Fl., 367,Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 1 5- Y Fill in please: APPLICANT'S YOUR-NAME/S:_ P,-/UIJeit/ AI(ryLE� . BUSINESS YOUR HOME ADDRESS: 3 fS F'j2 l A)CF A)c LL n k� ,. , r SaIS-Zz 1 3EG 6jF,t1Tt-I-\j(I-LE /" 02G 3'Z_ TELEPHONE # Home Telephone Number to a� NAME OF CORPORATION: NAME OF NEW BUSINESS 0` TYPE OF BUSINESSM4;,- 6`Y1 eCG>��1j IS THIS A HOME OCCUPA ION? YES NO -7 ADDRESS OF BUSINESS 3 �GC� �C,I=L�Y AP MAP/PARCEL NUMBER 11 1 J I 1 V I (Assessing) ENT V I lr :) AA A-- 01�3Z When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has b en inf r l ed,-ott e�r mit requirements that pertain to this type of business. NAUST'�,;®MPL`1f iNITN ALL Authorized Sigi ature** '-L!'..ZARDOUS MATERIM S RE;I!i.n7--911 COMMENTS: 3. CONSUMER AFFAIRS(LICENSINVdt HORITY) This individual has be rilinfor e licensing requirements that pertain to this type of business. XX ��uthorize Sign ture** COMMENTS: /Tf) .[Zkri c i •� /S 7�i TOWN OF BARNSTABLE Date• / I L/ TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: SEPr T'C//5 BUSINESS LOCATION: 3 3 y Plel,ycr H/,yc'--L-G x ED cenl(I-Ac. ✓I X 020e INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: SofS 2Z / 3G G CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: M-r tP-t /VI ec�+c-n,'L INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No J NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. i Observed / Maximum Observed / Maximum i Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants /0 Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) V Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous(please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Sign t Staff's Initials i TOWN OF BARNSTABLE LOCATION EWAGE#�®�� VILLAGE ASSESSOR'S MAP&PARCEL Z%`/ INSTALLER'S NAME&PHONE NO. (/mil Z 4470 e- SEPTIC TANK CAPACITY /a00 GX-Z o A LEACHING FACILITY:(type) size) NO.OF BEDROOMS OWNER PERMIT DATE: J COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Job 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 e 1 d lime Town of Barnstable � 4 P# 13 Department of Regulatory Services Public Health Division 200 Main Street,Hyannis MA 02601 Date Date Scheduled ✓ / l Time=— ',Fee Pd. Soil Suitability Assess ent for Sewa e Dis Performed By: �� xj 1 � osal ' Witnessed By: � ®/��Oti LOCATION&GENERAL INFO (�C.Fk Location Address 33�'6�'.yCEt RMATION / • ' C� ��/Owner's Name a ti L Assessor's Map/Parcel: r t% Address w / Engineer's Name®'d v�+b�/��✓Yiiq'�f NEW CONSTRUCTION REPAIR11 - Telephone# Land Use Slopes('Yo) Surface Stones Distances from:. Open Water Body ft Possible Wet Area �ft Drinking Water Well 'Drainage wayfr property Line Other ft SKETCH:,(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands n proximity to holes) ZF o 0 `+ "r0 y Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: . Weeping from Pit Face Estimated Seasonal High Groundwater Method Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE Depth Observed standing in obs.hole: Depth to weeping from side of obs.hole: in, Depth to soil mottles: 10. Index Well# Reading Date: - Index Well level_ in, Groundwater Adjust ft. .. AdL flactor Adj.aroundwaterLevel,= Observation PERCOLATION TEST Date . �, � Hole# I - l F Time at 91, Depth of Pere ?j -- lime at 6" Start Pre-soak Time @ 2 , ----�- Time(9"-6") End Pre-Soak, , Rate MinJinch Site Suitability Assessment: Site,Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted.within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:1SEPTICIPERCFORM.DOC 1 t t DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil , , Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. on i to c % ravel L--T DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi ten %Gravel) XF DEEP OBSERVATION•HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color, Soil I ' Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel DEEP OBSERVATION HOLE LOG , ' Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Z Within 500 year boundary .No Yes `. Within 100 year flood boundary No Yes Depth of Naturally Occurrim Pervious Material Does at least four feet of naturally occurring perv'ou aterial exist in all areas observed throughout the area proposed for the soil absorption system. If not,what is the depth of naturally occurring per ous material? Certification ' I certify that on �� (date)I have passed the soil evaluator examination approved by the Department of Environ enta Protection and that the above analysis was performed by me consistent with d�training,exper the requireexp ie ce described in 310 CMR 15.01�7+. Date Signature Q:\SEP'1'ICUP$RCFORM.DOC 3 No. Fee �' J� .ram U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes UBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[pprication for 33igozal i§p6tem Conotruction permit Application for a Permit to Construct( ) Repair( ,) Upgrade( ) Abandon( ) ❑ Complete System Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel .3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No. of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building 4_!!_f No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank/,J�/n 7" 00 ,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>e9d of Health. Signed 4,40, 40 ate Application Approved by ate Application Disapproved b Date for the following reasons Permit No. Date Issued No. _ �" Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: q PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZI rication for Xf� 9temc ConfStructior� �� ool� / p Permit Application for a Permit to Construct pp O Repair( ) /IJpgrade( ) Abandon(�)., 0 Complete System U Individual Components c. 'k �« Location Address or Lot No.AwOwner's Name,Address,and Tel.No. 1F .O.dN�.�"L moo..-,a,� Assessor's Map/Parcel ooef Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling` No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Otherf Type of Building �,/"I No.of Persons Showers( ) Cafeteria( ) `- Other Fixtures _r Design Flow(min.required) 3O i {{ . gp Design flow provided gpd Plan Date Number of sheets Revision Date � Title Size of Septic Tank a (;;,',Type of S.A.S. ":Description tion of Soil �, 1� i,� 4 <. %'k, w Nature of Repairsor Alterations(Answer when applicable) j Date last inspected: Agreement: The undersigned agrees t nsure 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'B of Health. 'i Signed 4/J/p C)b I e ate r y Application Approved by 7 7 l , ' ate a' ti Application Disapproved by,/ { Date 'r for the following reasons L/ t` a k 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 ( ) Abandoned( )by at ��/I✓CE' �trjw C- ��/ ea�� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer(:P W • Z Designe ✓/,o #bedrooms 3 Approved design _ w _ gpd The issuance of this perm* sha not b �const ued as a guarantee that the system will cti designed. c r_ Date Inspector [/' T_---_ .-- ------Y T - - __-- --____[__-_-J _ No. ` f �j"�'� / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Diopogal *patent Cow5truction Permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) System located at 3 --1 49 Q��Zjr�G�" �/ir�C.�Z F% and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Cons faction viust be completed within three years of the date of this perm' . Date _ Approved by `�-� May 21 13 12:40p Colleen Mason 508-833-2177 p.1 Town of Barnstable "WE'n`yz Regulatory Services. Thomas F. Geiler,Director �Ae 1 Public Health Division Arf 9.<" Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508 862- 644 Fax: 508-790-6304 Date: 6Zol Sewage Permit#--70,,"3--/cF/ Assessor's Map/Parcel Installer&Designer Certification Form Designer: 1 � �, M Installer: -;flak Address: �1V1LQ[ Address: -HYA M K �? L I t) On ` o / � was issued a permit to install a (d e) JJ,,((i�install�e'rt) - septic system at /f el wxV Rl ED based on a design drawn by (address) -DN1P �j' . � Mated fj L` (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. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than l 0' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local u-- '+ions. Plan revision or certified as-built by designer to follow. Stripout(if r,-- cted and the soils were found satisfactory. �N OFIt414� DAVID 4\� (Installer's Signature) MASON n;,l No.1065 IsT , esign ignature) \�1� PLEASE RETURN TO BAR-NL STABLE PUB.L.- ��, �r,f E OF COMPLIANCE WILL NOT BE ISSUED UN'i ii gu i ti jLmN YORM AVD AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU. q:lotfice fonnsWesigrercertifnation fortn.doc ar LOCATION SEWAGE PERM NO. s y3g o ZJ "VILLAGE INST LER'S NAME&r/A�DDRESS \� /e"��-'�.Cam{ {�G•'�''� BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED Ii — BS- ai, 0 - f ti{ No....9S,J/d2'" FElic S ............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® W HEALTH ._.. OF.......... .... .............. Appliratiun for Dispasal Workii Tongtrnr#ion ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syspo at: _.... t ._ ^ ! ._. Z ...• -- ... . _.. ...-•-• ---- ....._ .. cation-A ss or Lot ..... ..................................... ......... . ...... ............. O er I Address a ••----•-••-- .. -- ----- ------------- i�..:................................. .................v.rO.. .i-s!K ..................................................... Installer Address /- Q Type of Building Size Lot--- Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fi tures _._. W Design Flow............. . ..Z ...........gallons per person per day. Total daily flow............. _ _.d.......gallons. WSeptic Tank—Liquid capacit allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—: _.... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._-_C _ iameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1...........:....minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ----•---•--•---•----------••------••--•---•-------•---------------------------------•---••------............................................................. 0 Description of Soil........................................................................................................................................................................ x U •-•..........--•----••----••••-•-•-•-•--•--•••---••-•••--••------•------•----------------------•---••---•••------------••--•----------•------•---....._................•--•----••-----•----••••------•- x U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------------------------------------------------------•--......---.....---..................---------------•------•--•----•--•--------•-•-------•-....._...-----------................ A ment: ` he undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the rov*siot of i f the State Sanitary Code—The undersigned fgother agrees not to place—the system in ra ifi of Compliance has been is the ealth. Signed.. ............. .................... ................... Date / p'cation Approved By.. ,� ,,.9.`.�.�-- .... .......... .. . J.Z��_ ------------- Date Application Disapproved for the following reasons:-•---------------------•----•------•------------------••----------------------------------------------••--••---- ---•-•--....--••----------•-••••-•---•-••..............•••-•.•-•-••-•-•-•••••••--•--•---•...---.----••••.---•---••----•-•••••----••-------•--•-•------•-------•---------••-----••-•-•-••-•••-----•------ / Date Permit No... �`....{ ® Z- .._..... Issued....................................................... Date ^ c r c. 4 No.. " , Q'L. Fps..` .. ........ fi THE COMMONWEALTH OF MASSACHUSETTS ti BOARD OF HEALET!-I � f. :t:..............OF........::.............................. .. k.% ..� C - ......... ........... - .... ..... Appliration for r#inn rrnti� ri Application'is,hereby made for a Permit to Construct (_ ) or Repair ( ) an Individual Sewage Disposal.: - System at ,ehocation Address F�/� � or Lot/No/ .. ....!°e-- ..... .. . ..............CF6`....+.s'yJ .. . Owner / Address --- �.C-r *-ta- •- ----F - r`-- »r--------- •-- --- - Installer Address Type of Building Size Lot __ r: .. ' q-- a a Dwelling—No. of Bedrooms......... ..................................Expansion Attic ( ) Garbage Grinder a Other—Type`of Building ........... No. of persons................................ Showers ( ) —;Cafeteria ( ) G Other fixtures ,! �, .; 11 . W.< Design Flow..._.... gallons per person per day. Total daily flow __.___-_ gallons R: Septic Tank—Liquld capacrty`t° ° adl{hns Lengt Total Length Wldth Diameter .._.___ Depth W Disposal Trench—'Vo .. ....._. Total leaching area ... sq.'ft. Seepage Pit No................. Diameter__ _______________ Depth below inlet.................... Total leaching area.................. q. ft. 'aZ Other Distribution box ( ) Dosing tank,,( ) a Percolation Test Results Performed by....................... .................................................. Date............................. Test Pit No. 1..........:....minutes per inch Depth of Test Pita. ...:_.______. Depth to ground-water-- -':_:_.____.___--- Test Pit No. 2...............minutes per inch Depth of Test Pit:_ p g De th to round water........................ a .Q Description of Soil.........................t .:..._. ...................................... °. •• --•- ---• ......................................... x ��..0 ....... ......_. ----_.... ._......3 ..._......... --.._....._._.. _ .................... t •• . UNature of Repairs or Alterations-Answer when applicable A ---------- -------•-•-•----•---•--••••••. -••--••-•--•••--••......-•••-•-•-•-•---•...... ._...--- •- ------------------- A ment he undersigned agrees to install the aforedesc`ribed Individual Sewage Disposal System in accordance with C th ovisiot of i � i f the State Sanitary Code The undersignedrther agrees not to place the system in rat' fifi of Compliance has been suOby the board) f health... Signed - :... --------- Date ation A roved B •- ` �- .............. hP Y :mac'". 'L:+'f�'Js e.tic-�+a-= ��e ..a�"� ( Date Application Disapproved for the following reasons:..._ ......: ..............................•-•---..... •.•.... ......•----•-----•-•-•••......- Date ;... Permit No.. " ,,----d t" ---- Issued........................... Date 'a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF......... ............ Trr#ifiratr of Tautplid"Urr THIS IS TO CERTIFY, That the Individual Sewage" Disposal System constructed (X) or 'Repaired ( )' bY------------- •------ Z j-1 F{ _~i.......0.04?................. Installer at J ={ ----- ---•---- has been installed in accordance with the provisions.of TITLE j`of The State Sanitary Code. a described in the f application for Disposal Works Construction Permit No.4,�.____. Z"_._.. dated_ _ .__�'{� > _ ................... THE ISSUANCE OF THIS CERTIFICATE SHALL:NOT OE CONSTR E"D AS OUAR TEE THAT,THE SYSTEh1 WILL'FUNCTION SATISFACTORY. DATE.................. .r_.�..�. ..Q. ............................ ;Inspector. THE COMMONV1 EALTH OF MASSACHUSETTS p� BOARD OF HEALTH ' ....... :fM.. ..........OF.....: .f3'K#...!.. �..................................... 'a.•».�... ;!^ , its2tdrItta,tt rMit ,Permission is hereby granted------.-- � !"4r... ._..._. .._. ... ... to Construct �/f Oor Repair ( ) an Individual wag isposal'S tem q �. at N;••-.c'�-•-- ,.; _ ELM l �t .a._.. ........................ a Street �+ as shown on the application for Disposal Works Construction Permit No&�__/_�GZ_ D" d.J 1_ _.. Board of Health DATE...... -- •. ....�-�-------------------- --------- P. FORM 1255 A. M. SULKIN• INC BOSTON < , tx y� a a DA / ,Q S%t4G-L_E IrAM1Ly - 3 60DIZoom qo GA 1 -BAGG Ge. ►.�D C 1�. DAIL'y FLoW a 410 x 3 = 33o G. P• O. SEPTt�- T/W K - 330 1, 1507, = 4q5 G.P•D. i USG 1000 . G-,AL,,.`T"AtJ{C., 0 Lo T z9(� D is P0SAL P tT• V 5E l C)C C GAL. 21 1 _ - ISo S.F x 2 . S 375- G,P. ID -'� �Tz97 goTT"nM ASS A - So 6.F � ISo1Z s.r• � J. F. �C I.o - .So G. P. l7. � vl I r ' `T m TA L V GS I G ►`1 = 4,ZS G-. P. D. z �� I 0 T'oT-AL DAILY FZoW = 33o GP,O, TANY I D g O PEKC,oLAT-1 c Q RATS ; I(�jti 2 MIti. 4f- LESS 0 37't Nnu. A 12 .,� �it �£:• .>� � � RICHARD 1 bo.Sb r BAXTER N'0. SULLIVAN No.24048 No. 29733 Lod' Z9 S su To Hn1 SA COM i A7)- ' ZU114 , FG• 57.6 .i 'i T��fs�o :•.,. /.f/i/• SS.G /coo S�uvY / Gq L /yii Box /.v✓. G,4L• , SS LA P,7- o TAn//C n 3�/ 7o f,/�I '' Slid.Q S$.O G'E.2T/F/EO PG OT pL.4i✓ w3SHC-D '. �A)p ,SGGL� /'_moo' ��TE ///i ih s— r}4 G NO SCALE �La7- Z9 7- ' No WA�• Y Tf/,4T"THE r-0 UAJ D14 jo At/ S VeW.V ,yE•�Eov G'OMpGY.S W/Tf/Tiy�':Sio�•,c.,iitiE B.dXr�,e �',VY•E; iNc. ,4Al2-9 SEp',Q/-1G` .eE4U/,eEkl�NrS G.� Th'� ,2,EGisr�,ecIJ.G4rvo.SlieriEyo,Ps Tox%V of ,g�,etJ STy 8(�; <lv� /S NaT ��,e�,/LG� a,• i i L ocQr,Fa W/T.'/%S/ r.YE A LA.V Tel T/1Lt Pl,.e,f/ /s i4/o7- I3.4SE0 G N,4,t//iY.ST.e S l f/�t/,�E,eEON.S.�v�oUG D�/p� QE USEv ASSESSORS h1AP : 4 1 TEST HOLE LOGS IVUTI+;S: PA110EL: 1"7 , FLOOD ZOIJE: SOIL EVALUATOti : ) comply �l�- � ' I 'I'lie installation shall coot it with Title V and 'I own of 13ual d of __ . .. WITNESS : W tot2t l I lealth Relmlations. fiEf=EfiEIJCE: DATE.- 17 ,7121 2) The insballer shall Vel'if the location of uliliIics sewer inverts and Septic PEftCOLA l'I 0111 1 t Al E components prior to installation and setting base elevations. _._ 7 3) All gravity septic piping to be 4 inch Scli ,IU PVC at 1/8" her foot. 'the lirst mb Ay, � C __q I 1 two feet out ol'the d-box to the leaching shall be level. - .-__.-.-__ I{1- I 114-2 4) This plan is not to be utilized for property line determination lion any outer purpose outer than the proposed system installation. lD Ql l S) All septic components must nteet'l'itle V specifications. _ 6) Parking shall not be constructed over I II U septic components. tU / T The property is bounded b property corners and property lines. ) P I Y Y 1 1 Y 1 l Y LOCAT I Old NIAI' 3Z �2 8) 'Flie property owner shall review design considerations to approve of total design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based oil the plan sliall be deemed I� �tD�1014 approval ol•the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and tilled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along wilh contaminated soil and replaced with clean.sand per Tille V specs. Prz rK�cE f-IrM cl,/J�--y fZoq� .10)System components to be lU feet front water Iiue. Sewer lilies crossing the 0� ... water line shall be sleeved with 4 inch SCl 14U PVC with ends grouted if t 3 a > Hirable. The proposed SAS ' �' .-�7 .— — � _ ._._. �11 I I is being installed below the water service S L I'-1 I C S Y S`1 E M DES I G N ( litre. 'l'he line is to be sleeved as aforementioned and maintained ill place. �, Ir -! t 11) 1f a garbage grinder exists it is to be removedmid is the responsibility of the owner to ensure such. I I FLOW EST I MATE ' 12)The installer is to take caution in excavation around (lie gas line if such exists. Gx,s7 1"fG- �2 hE(mool1S AT GAL/UAY/hED11001'd -'��r`�, GAL/DAY 13)'Hie installer slialtverily the location, quantity and clevatiun of the sewer r-- ,� FOUAJ /in o ti lines exiting the dwelling prior to the installation. o r" SEPTIC TANK 14)This plan is representative only that a system caii lit oil a property nieetiug s N N Title V requirettienls. oa {> _ _ �+ GAL/DAY x 2 DAYS - GAL nio - Z USE [ODOGALLON SEPTIC TANK ( 1 I a OF tijq DAVID 0 C`, 8.r no' B. _ --- -- - --- - ti- -,7P - MASON S I DE AREA: BOTTOM AREA: ( ' ,�, ,"7� -� 2)�r� .y R , T .-SEPTIC SYSTEWSLC-1- 10I1 --- f C1� I �r'+4� r�✓i/�I [�"J .)�1 � it f�1+ ��'J - - - M %'� HF 10 I ,F p ` 1 LVM GAL Ux l 0 SEPTIC TANK _. 53 1 / (?�OMV DF IM, r 2 S I �I-E Alt SEWAGL PLAN LC A I 1 old 5L ►► G . lD' 'fir y� V I ILPARED roll i F L t� a SCALE : ) . 0 w , --~�" DAV I D B , MA3014' uA1E :!5 t DBC E14V I RWIN E AYAL DES I GIJS L ST SANDWICH . MA DATE IIL"ALIT{ AGEtJh ( 5013 ) 533- 2 177