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HomeMy WebLinkAbout0302 PRINCE HINCKLEY ROAD - Health 302 Prince Hinckley Road Centerville A= 171-169 I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr Owner nformation is Owner's Name - required for every Wethersfield CT 06109 7/26/2019 page. CitylTown �— 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,out When fillip out forms A. inspector Information /# on the computer, y use only the tab Paul C. Martin key to move your Name of Inspector cursor-do not Cape Cod Septic Services Inc. use the return pan -- y Com Name y 350 Main St. reG Company Address West Yarmouth ____ MA _ 02673 City/Town State 508-775-2825 Zip Code Telephone Number - S15016 License Number B. Certification I certify that:I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails of8/2/2019 Ins or's Signa ure Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. t5lnsp.doc•rev.7126/2018 Title 5 official Inspection Form:Subsurface sewage Disposal System•Page 1 of is Commonwealth of Massachusetts Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System in working condition. 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): l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts —, Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 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 ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. El ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments emu, 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 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 ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 cl Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 page. Cityfrown State Zip Code Date of Inspection D. System Information 1. 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): 110x2= 220gpd Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 2017=285gpd 9 ( Y 9 (gP )) 2018=359gpd Detail: Note irrigation system in use on property. Sump pump? ❑ Yes ® No Last date of occupancy: Jan. 2019 Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �1. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: 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: t5insp.doc-rev.7/26/2018 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 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2010 Per BOH Records Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): Line checked with sewer camera and found to be clean, properly pitched with no sign of root intrusion. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): 8" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No Dimensions: 1000Gal Sludge depth: 6-8" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 2-3 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.): 1000Gal Tank in good condition. PVC Tees in place and clean. Tank at normal operating level. Covers 8" below grade. 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 � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �L 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 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): Depth of liquid level above outlet invert 011 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 DB-3 with 1 Line in and 1 line out in good condition. Box is clean and level with minimal solids carryover. No sign of overloading or hydraulic failure. Cover 16" below grade. 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 302 Prince Hinkley Rd. Centerville, MA 02632 u Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 8-Arc chambers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 i Commonwealth of Massachusetts �r Title 5 Official Inspection Form 14 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 page. CitylTown 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.): 8-Arc chambers in a 10'x30.4'x10"trench. No standing effluent in chambers during inspection. No evident stain. No sign of overloading or hydraulic failure. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2016 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 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l 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 '= �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 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 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 is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 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: +5' From SASfeet 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: 2010 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 the BOH. No water 5' below sas. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinkley Rd. Centerville, MA 02632 Property Address John Cooper 18 Eastern Dr. Owner Owner's Name information is required for every Wethersfield CT 06109 7/26/2019 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification:Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 `�' _ —��--• v��v � Page 1 of 2 ' a TOWN OIL BARNSTABLE LOC:ti IUN le.," ,�:sire t�/ .... .._ Sf;1l:AG1?!?jl �. .. .J 73 � f V y`r ILLAGE ASSESSOR'S NIAP&RARCEL /7/. G-; 5. I1 STALLEICS NAME&PIIONR NO. • SEPTIC TANK CAPACITY LF.i1CIIr�G FACILITY:(ty c '�. �,� • P j/i..•, r �r (size) Y �(1' NO.OF BEDROOMS % — PERMITDAI'E:__�' /�A' COMPLIANCE DATE: Separation Distance Betw4een thc: ' Maximum Adjusted Groundwater Table to 11,00ttom of Leaching Facility _ Ir1�" feet a . Private Water Supply Well and Leachtlig Facility(if any wells exist -- ' on site or within 200 feet of leaching.facility) `r feet Edge of ll'etland and Leaching Faciliq.-(it'anyocflands exist � within 300 feet of leaching -• " f FURNISHED BY r tow r -may • Jyr w � o � ti'aYi •� � ter.°" I � �S° }" .. � �� x"�` , t a 7G� -, 'Q• s w 7 M I A [} 47 \•'. .wr .. �� w , _ ate. • .,. .. Cr • w • NMI 5 . II • • • • i m https://townofbarnstable.as/Departments/Assessing/P`toperty_Values/HMdisplay.asp?mapp..,Y_6/10/201.,9 r t. Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is required for Centerville MA 02632 May 27, 2010 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: I I only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name 189 Cammett Road Company Address Marstons Mllls MA 02648 Citylrown State Zip Code 508.428.1779 SI 12855 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of 4 Title 5(310 CMR 15.000). The system: 4 � ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 0)vv-�. May 27, 2010 Job# 10-135 InVector'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•09/08 Title 5 Official Inspection Form:Subsurf4ageal Syste P e 1 f 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is required for Centerville MA 02632 May 27, 2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described In 310 CMR'i 5.303 or in 310'CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ one or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is y required for Centerville MA 02632 May 27, 2010 every page. Cityfrown 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 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is Centerville MA 02632 May 27, 2010 required for every page. Cityrrown 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the_surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow l5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinckley Road Property Address _Betty Cooper Owner Owner's Name information is required for Centerville MA 02632 May 27, 2010 every 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. ❑ ® 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 CM 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 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 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is required for Centerville MA 02632 May 27, 2010 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on.the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 l5ins•09/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is required for Centerville MA 02632 May 27, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): N/A Irrigation System. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied 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? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: l5ins•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 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is y required for Centerville MA 02632 May 27, 2010 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Tank pumped two years ago. Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 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): l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts IMEEMEMN Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is Centerville MA 02632 May 27 2010 required for Y every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Compliance date: 9/28/79 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): ' Depth below grade: 1 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1'feet Material of construction: ®concrete El 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: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 4" 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is Centerville MA 02632 May 27, 2010 required for Y every page. Cityfrown 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 2" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found over outlet invert with solids and staining indicating tank had been full to top due to leaching system failure. 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 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments yY 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is required for Centerville MA 02632 May 27, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day 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 t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is Centerville MA 02632 May 27, 2010 required for Y every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Full to top. Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins-09/08 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 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is y required for Centerville MA 02632 May 27 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: One pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Liquid level was found over top of structure by probing soils over and surrounding leaching pit. Soils were found saturated with effluent over top of leaching pit. Leaching pit is in 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is Y required for Centerville MA 02632 May 27, 2010 every page. Cityrrown 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.): 15ins-09/08 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 y 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is Centerville MA 02632 May 27, 2010 required for ----- every page. City/Town 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 ❑_drawinq attached .separately. Prince Hinckley Road Water Service \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ ♦ \ \ \ \ \ \ \ 4 'v \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ ! / / / / I / / J \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \!\/\f\�\!\!\!♦ / ♦/♦ \ \ ♦ \ \ \ ♦ ♦ ♦ \ ♦ ♦ \ \ \ ♦ ♦ \ 11 \/\'\r\/\!\/\/\/\'\r\f\/\/\f\r\f\ \r\r\/\/\f\/\/\r\/\/\ \!\!\/\/\J♦J\/\/\/\ .% .% I,I%I,/,."I,1,11 5 62 45 4 .� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is Centerville MA 02632 May 27, 2010 required for Y every page. CityrTown 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: N/A feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑. Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 302 Prince Hinckley Road Property Address Betty Cooper Owner Owner's Name information is Centerville MA 02632 May 27, 2010 required for every page. Citylrown 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-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE 3 5 3 LOCATION SEWAGE#a0,1,a- J� VILLAGE ASSESSOR'S MAP&PARCEL /?/ /G INSTALLER'S NAME&PHONE NO. / i��Jl ` C�gs�. ✓ y2�` �� SEPTIC TANK CAPACITY LEACHING FACILITY:(type,G nd L �,r,/ ��� (size) /O IX TO,i/ X ? NO.OF BEDROOMS r OWNER PERMIT DATE: •/O 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 ,e9 �� °' -3 N. � Fee O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Q� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes \ \ RppYI tat10U for Disposal 6psteUt Construction permit Application for a Permit to Construct( ) Repair( if Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Addressor Lot Noj- 0,Z 101 ,46e Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel C� In Her's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 11, alp Type of Building: �f ?�z Dwelling No.of Bedrooms !s Lot Size ✓✓ sq.ft. Garbage Grinder Other Type of Buildings �(� (i� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 2— ZO gpd Design flow provided 3�1. gpd Plan Date y l Number of sheets I Revision Date ► Title r7 Size of Septic Tank 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 bytthiedBoard of He h. Date �} Application Approved by Date d Application Disapproved by Date for the following reasons Permit No. Date Issued No. i'� .,:�^ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: A PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes T' application for Dis oBal stern Construction 3dermit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) Q Complete System ndividual Components ~ Location Address or Lot No. ,�.1i je Owner's Name,Address,and Tel.No. Qssor's Iv7ap/Parcel C� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. j �ar't�lo ,Z/i Type of Building: ..��JJ Dwelling No.of Bedrooms Z% Lot Size Z sq.ft. Garbage Grinder( � Other Type of Building ��jJ (;" No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3!g//, 3 gpd Plan Date `17 ��� Number of sheets d Revision Date Title T 5Z ,� 1y�� Size of Septic Tank 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 Hea th. &ig Date Application Approved by //� Date Application Disapproved by Date l for the following reasons ti.. Permit No. 1q19 Date Issued -- -, - _._- ._ - - - - __ _ _ -_ -: _ - -------- ----------------- ------ 'S THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of CComplianre THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by at V has been constr cted in accordance with the provisions of Title 5 and the for Disposal ystem Construction Permit No. � to Installer ,* 2 o Designer �'!�-/y f •,deco #bedrooms �... Approved design flo _ 2 7 gpd The issuance of this p rmit shall not be construed as a guarantee that the system wi 1 fu c io as desig ed. Date Inspector r, --- --------- -------7 --------- ------- --- -- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstent Construction i3ermit Permission is hereby granted to Constru t( ) Repair J Upgrade( ) Abandon( ) System located at / r-/- V and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Con tru ion s e completed within three ears of the date of this permit. Y Date Approved by I '- FROM :down cape engineering inc FAX NO. :15083629880 Sep. 02 2010 02:27PM P2 P-Ji IJ YIIS il-12"D.I P-- ff 7, 14 X C Z Thomas F. 'Geiler, Direetov TImmas Mo;K(? mi, Dbi-PCIPT 200 ME-bin Hyi:mni.-4,PAII.02601 Suwage, Fenmig-fl %A) k C I fW luislajJeTC, 5�yA.Adire!"s. � , 0-11 was,issucil pel Irit Lo in!-Aall a omtitley gffpti.(; stem at "'LU t 1�K C4 ba,;Bd on a.dosip dra-Wil 1. Cel-ti-FY lat t1le, septic systtm i-cftTemiced above was iustzijjctj according to th,, drs,'IT, w1adt may iarludn jUjuorappcoved Ch',)JIg_,essuuh as 1231,ral fCI0C-,--Iti0D. Of 1.110, .1*sffibiition box andlor 5(-.pt' I 1. ceytify fliat ffir, sopfic qystem referenced above was installud With =AjO.V Cat.e I. than 10, of t4c SAS or ,3j)T vertical rt;loeilion Of AT C-ODIPOIml cei-fi led LL",'-bUiIt by desif-,,nu to 11611 i)v,,. -j\A OF AfA DANIELA, OJALA, I .9t. CIVIL P10,46502 41 421 Co T 5 .......... P !Ij,tA,9F- TIETURN AD BA-RNBTAULL PUBLIC M,A'VJk')Q( DIVISION. -PF LT411L eo'.1111 llms ]FOR.T.K* AND -AS-j3L1.I9L',T ARE THANKIOU. i -own oUBarhstaWe xe tb r =]Da l�aa kxrt�nt of llegulato¢y Services �, T� la ll ruartere>3t e 4 '.Pu �fl� Health1Il g�IlSll®IUl *.1Cyate t200 Main Strdet,Hyan,,uts'MA 07601 ' e 9-C 0 Tinie. .. Fee Pd. bate Schedul d_ l Soil Suitability Assessmient for Sewage ispo al am � � � 1'crfonned ay': ,� �L AALA` `�'j �Witnessed By: {�. Jl � J L �, 1LO CATION & GENE rN F ORI�/.�.� TIO'1�----- ----- Location Address a Owner's Name (J Ad less Assessor's Map/Pa Cn rcel; giueer's Nanic tJCale b. NEW CONSTRUCTION REPAIR Telephone It ✓leJ U 6 land Use• A4 Siopes(%) 0— 7 Surfade Stones Distance's From: 0pcn 'YVater Body �— ft Possible Wti-Area ��� ft Drinking Water Well ft Drainage Way �— ft Property Line 2 ff Other I't 6 SY-E'*TCHt (StTrrL nBmC,dimensions of lot,exact locations of test Boles Sr pert tests,locate wetlands.in proi(intity to 11,01es) (ICAD f}- 8.1 ' -70.14 Vj Tj Jr -73 5*0 10 Parent material(geologic)_6A,�•�0.� C94 W , Depth 10 Betb'uelt, Depth to Groundwater: Standing Water in Hole; ' W)eeplhg Il0111 11it Pil�e Estimated Seasonal High Groundwater r / ( �/.ir DE TERMINATION FOR SEASONAL 1110 -1 WA7('ER u'AB L.lE Method Used: - /A � ` Depili Observed standing in obs.Bole: Clta, Depth w05Q11 mwtivi: Depth to weeping from side of obs.hole: __ _ l!L dPtlullcJwulaY Ad�u9ltTtent awe@ _Pt. Index Well lF Reading Date: Index r�1Well rlepVnrylr� �y Adult,,Atetov Aq).fjrUluldWatCF UVul 11 lUA�Il.O Lt1�1�L JIN.J+A s ICA SrA Date Il'lil o 1 7� Observation Hole## ' J - Thm m 9" G \f Depth of Pere � Q l Time at 6" Start Pre-soak Time @ • _ Time(9"-0") End Pre-soak ✓ID 2��JVJ vo0 Vr^v Iz Rate Min./Inch �►^' �v L Silc Suitability Assessment: kite Passed_ V/ Sile'Failed: Additional Testing Needed(YAN) Original: Public Iicanh Division Observation Hole Data`1'o Be Completed on Back----------- **q`IP Percolation test.is to be conduclteci tivitlnin 100' of welliand, you anuxsit firslt Uotafy ltlne Barnstable Conservation I)ivisiorl at least one (1) week prior to Ibegiull1nuog. QAS CFMC\PERCroRN7.DGC Depth from Soil Horizon oil Color Hole # Surface(in.) , Sail Texture :`S (USDA), Soil- Olher (Munsell ) MoltHrig (Structure,Stones;Boulders. E9+I` w' c Con istene ravel `� 30 5 Lb -Z. . N DREP � - OBSERVATION HOLE LOG Depth from Soil diorizon Hole # Surface(in.) Soil Texture Sail Color w' USDA)• Soil Other ^�� (MiinsZll), Mdfflint ' ^(Structure, es, B°older,. V Stories 1 Corsi ene % avel � LOG lE]EP OBSERVATIONOBSERVATIONHOLHOLEDepth from, Soil Horizon S �# (USDA) Surface Soil Texture Soil ail Color. Soil (Munsell) MottlingOther (Structure,Stones,Boulders. Consistency 4o gravel_ ------------ 4 ' * R ATIO Depth from H®LE 1L OG.Soil Horizon ]�][O]E'# Surface(in.) Soil Texture 5oih'Color _ (USDA) soli ;Other (Munsell) ; Mottling (Structure,S e•;B 1Dn S polders, Consistency — i F,10_gd Insurance Rote Map— Above 500 year flood bounder No W v y --_ Yes Within 500 year boundary No - Within 100 year flood boundary No yes ](�e�iiklfD ®� I'�ta�P�>r�➢ly orul��Ovi__ o-�-ous Matgdgi Does at least four fe©t of naturally occurring pervious matorlal exist in all areas observed throughout the ace i prop'osed for`jhe soil A� orp't]on system? Tf not, what is the depth of naturally occurring pervious matt�rin'I?- N� f ` Ce�tl catl0n z , A certify that On V "5 (date)I have passed the soil evaluator examination approved by tl,e ;Department of Environmental.Protection'and that the ab,ou.e„a.nalysj%,was perforli�ted+,by me consistent with fPae aegltired lrr a ni ertise and experience descri'ied in �10 CMI2 15.017. ' .' is Signature_ r %L`/ ___... mate ! /• U/0 �6 Q:%SRB't'ICU'EIZCFORM.DOC LOCATION o1*xA* j,, SEWAGE PERMIT NO. lot 2 4 Qrt}'IC 2 VILLAGE 0 Centerville, MA. INSTA LLER'S NAME i A00RES'S Alfred Fuller 995 Cotuit Rd. Marstons Mills, MA. BUILDER OR OWNER Alan E. Small, Inc. Box 536 Centerville, MA. DATE PERMIT ISSUED 9-10-79 DATE COMPLIANCE ISSUED C�_ �2 �- 77. �29`� , ,i �� \ � s� �� � � , �2� ,� . _J THE COMMONWEALTH OF MASSACHUSETTS BOARD O° I-IEALTH - -1"" �".... OF......:..,........:..... .. *..............-------• -•------•----..................... Applira#ion for Bispooaal lVarkii Tonotratrtion 1hruti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an (Individual Sewage Disposal System a .6. .b... ...... ........... t pZ-•...'. '..f_•`_r-........... -` / ,s► C. !� ...... ... ...� ....- . - -• -• • ..f ............. --- ------------- ---------- Location Address Y of Lotto. I � _.. .._.. v................................... COw er `Address .................��... ....... ...... •........................... ......._... r ( /' t Installer Address 6 d Type of Building Size Lot..� _�.. -Sq. feet U Dwelling—No. of Bedrooms.--------••------•--•--•••.... .Expansion Attic�(/� Garbage Grinder ( I ` aOther—Type of Building ............................ No. of persons..................... Showers ( ) — Cafeteria ( ) P-4 Other fixtures .---•••-••--•-- -•-.....--•••.............. W Design Flow._ `.. �4�• �-------- --------gallons per person per day. Total daily flow........._�`a��_...._.._......gallons. WSeptic Tank Liquid capacity�l ..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..........` .. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........�ST `. iameter.................... Depth below 'nlet. .-- ..... Total leaching area....R.O./....sq. ft. Z Other Distribution box (dT Dosinri, ( '-' Percolation Test Results Performed by liQ ' Date.... 7�..--..--.--• �- �- Test Pit No. 1................minutes per inch De t�Test Pit........._._........ Depth to ground water........................ a P P P Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil.......IQ.' %......� -------^----..?--••-••-•--- ....... .. .� -..... U ....................•------•-•--------••-••---••----•----------•---•--•-••------....----.......-••-•-------------••-•----------•-----•-••------•-------------•.....-----...--------••--................ W -----------•------•-----••--•----•--•---•-----------------•---.....•--•---•----------•------•----•----------------------•--------•---•---•--•--------•----•-----................•--•- ---------••--- UNature of Repairs or Alterations—Answer when applicable...............................................•............................................._.. --------------•---- -------............................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to plat the system in operation until a Certificate of Compliance has been iiss, ieeed by the board of//ealth. 7 Sig ...:.... ..... W�D...../y Application Approved By._....._. . a_ ` n r ate D ate Application Disapproved for the following reasons----------------------------------------------------------------•----------------•----------••-•----------••-•••. ..........................••-----•--._.....----•--•---•------•-••--..........••---------•--•-•-•••-•--•---------•----------------------•-•---•-----.................................................... Date PermitNo......................................................... Issued---- F-- ..._...._F_7,9._.s..................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD © H EA , H ..........OF..... ............. .. Appliration for Disposal Works Cfonstratrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at:N .. P ... .,,.... - - n"" - .. .... Loeaon Address - - a LotNo. ... ......... ,'r- ::�::�. r •................. ...................... .......................... Ow er ✓, Address x: ,� .. ..:. :.:.:. ............................ --•---••-•-----.....--- ......-- ---.... t ...-----------....--•---.....------........._. nstaller I � Address Type of Building Size Lot_1,1,,5.,_ A.".Sq. feet Dwelling—No. of Bedrooms____ t--5. Attic (,,j,,,6 Garbage Grinder '4 e� Other—T yp of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Oth.C31er fixtures 00" -------•••--•-----•-------------- • ----••-•---.-•----------••-----------•---.._ _ - - �"" 'gallons per person per day. Total daily flow..____.._.. .............gallons. Design Flow..... _ g� W ---------•-••- g P P P Y• Y -- ----- WSeptic Tank-t Liquid capacity .gallons Length................ Width................ Diameter---_............ Depth................ x Disposal Trench—No.......... Width____________________ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.•.----. ameter____________ __... Depth below�et__._.______ ..._ Total leaching area....R f___sq. ft. Z Other Distribution box (A0'f� Dosing. Percolation Test Results Performed by.._ ...r..ft' ''r '..•---._.... Date____ _"_l _TF .. Test Pit No. 1________________minutes per in Dept of Test **�191 Percolation Depth to ground water......................... r:[� Test Pit No. 2................minutes per inch Depth of Test Pit________...________. Depth to ground water.....:.................. O _.... ......................... Description of Soil__._____":. .. _ ........ �f U ---•---•-• ...................------- ...................... •-•------------------------------------------ •---------- ------ .----------- •-------- ----- ____-------- •._.... --••---•...... ----•- W U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ._ .--...-•---•----•--•-•--•----••---••----••------•------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersignedArther agrees not to plac the system in operation until a Certificate of Compliance has been�isgiS by the board o kiealth Sig .;: .:. .....•-- • -_-•- ...................... ••---- ----- ._. F ate Application Approved By..... ---� . _ . _-1 --• 1 C2 �✓✓l :.. �' Date Application Disapproved for the following reasons---------------•--.•-------------•-••-•------------•---•-------••-------------._.----•---•---------------....•--- ...........:.......................................................... Date PermitNo.........................................._........_..... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ....OF............... .'..": ....................................... �rrttf rtt a of Tomplia tta THIS IS C I Y, hat�tbe Individual Sewage Disposal System constructed or Repaired ( ) by {! .........._ _ •-•---... _ _-- ............................. 1 Installer at ---- .jot.ro . . ..... .................................. has been installed in accordance with the provisions'of T F 5 of The tate Sanitary ode a described in the application for Disposal Works Construction Permit No._'' I_____________ dated_-. 1_Q__"'.•!.�1_' �f; THE ISSUANCE OF THIS CERTIFICATE SHALL NOT EE.CONSTRUE AS UA NTEE THAT THE SYSTEM WILL FUNCTI N SATISFACTORY. �q a� 7 DATE......... ............ Inspector ----• ... . _•_..... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH No._.......:v�~ - FEE. . ...... Disposal o To rrutit Permission i y ranted...... __ _. _..... ..................... to Const ct/'� or pair ( Indi idual inge is S r } at No.__ t, `" �.�'. . ..................... K . -•-••- Street as shown on the application for Disposal Works Construction Pe No ........_e -•--.,' DatedAPy'.! M..... �..�,,fi-- '�• Board of Health DATE..---- �° ^." 7 A. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS f4 lµ r„c.t��.r F t�.,� = 1 I o � 3 t 33 n �•P•v. n ` r � 1� � " C Tp r.i K. 4-9 Ca 6.P 12 �Pot:Z'L UIT - usE IC>C>C> G4t.... 1C j�r�C�Gy'Y -1,'MGWALl_ I�.CJ SF 2.5 7Ci G.P.D. �S Ln To-T-,aL- 425 c�TQ� Laf of FG l�4u = 33� b.PD. MT T � �E.f. C:DL&TIc,Q 104,-rE t"IQ IMIu. 02 I.l--SS. F � Q tJea�� TA..�A. „ 44 Top F'wo L,dc>,,, `}$ �-� r7;;a. tu �nA�1 "APB loan IUV. ; v- ,a ,41 + 4'pv� tw. VKT- -Box %A Seprlc twv. 2 l I C l Ta�/K Gn.�. 9c, Z. 9a'd .• PIT W I rw (41CA V� WAut6D STow,E-- qp CCCZ.Tt1=1GD }PLC)'-r PL 4a1-j LbCATIo" '-�-rrc-4V,f� ; 1t 12. o Sc A,1✓� C A(S t= t`' �+t� l�, i'C— /'� 'I I Gt�tLZtE_�{ T►4A-r TI-AC-. ZVk)>'4710I4 5LACY'"Q Pt- ,►..1 G� t-1�.1?t_t�►,l Cc�ti�r�L�<S W ITI-A T►-i` 51t�� LII-iE: ( q `•- -To w Q 8 Z3 G ��- lzCGISIfrizLD LAII-ID SUev Yo�� Tt- 1-5 t L- UT L'�-;CC� �t J A�.1 U?TEZv%t_L -- o � . .(' t'.i': CJ=,it� � T i-, i71 .i-%,i�M I ►-�l- 1.._C�'�(" l_1 N i �:� -_. r ��tv ����.. ALL TEM S SHALL SYSTEM PROFILE MARKED WITHCMAGNETICTTAPE OR BE NOTES PROVIDE WATERTIGHT MIN. 20" DIAM. (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVD ACCESS COVERS TO WITHIN 6" OF FIN. GRADE PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADEr IX TOP FOUND. EL. XX.X' 2. MUNICIPAL WATER 1S\ EXISTING o 3. MINIMUM PIPE PITCH TO BE '1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED /ERSYSTEM n 4. DESIGN LOADING FOR ALL PROPOSED PRECAST o PRECAST H-10 UNITS TO BE AASHO H-10 0 RISERS (TYP.) 56.5E*, 4"OSCH40 PVC 2" DOUBLE WASHED PEAS E PIPES LEVEL 1ST 2' OR GEOTEXTILE FABRIC 54.3' S. PIPE JOINTS TO BE MADE WATERTIGHT. �C het 0 WITH 10" EXISTING 14" A.8' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE TEE TANK** TEE *� o00 o0CDCD0 310 CMR 15.000 (TITLE V.) Locus--- SEPTIC 55.1 f o 6" MIN. SUMP GAS BAFFLE: �-W0000lo- 12" MIN INT. DIM. o o ,53.97' 53.8' S: 51 8 7. THIS PLAN IS FOR PROPOSED WORK ONLY ANDo00 000o NOT TO BE USED FOR LOT UNE STAKING OR ANY y 4' UQ. LEVEL (ACME OR EQUAL) .': OTHER PURPOSE. H-20 3050 INFILTRATORS I 6" CRUSHED STONE OR MECHANICAL 3/4" TO 1 1/2" DOUBLE WASHED STONE 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 93 COMPACTION. (15.221 [21) 9. COMPONENTS NOT TO BE BACKFILLED OR OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30.4' X 10.25' CONCEALED WITHOUT INSPECTION BY BOARD OF °z ( 1 % 5.4' HEALTH AND PERMISSION OBTAINED FROM BOARD ( _% SLOPE) SLOPE) Roy e OF HEALTH. FOUNDATION EXIST. SEPTIC TANK 17' D' BOX 2' LEACHING 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP FACILITY CALLING DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE ' *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT BOTTOM TH-1 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF NO GROUNDWATER FOUND 46.4 WORK. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS, 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE ASSESSORS MAP 171 PARCEL 169 PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE (OR H-20 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SEPTIC TANK IF IT WILL BE SUBJECT TO VEHICLE LOADING). SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED LEGEN D 99- EXISTING CONTOUR x 2-6 33 x,56.23 X 99 EXIST. SPOT ELEV. O �56.27 SYSTEM DESIGN: 99 PROPOSED CONTOUR Oo \ [9a.a. �► A 4� �2 \ ] PROPOSED SPOT EL. GARBAGE DISPOSER IS NOT ALLOWED �0 . p p � \ �xAR�`''�..m TH1 \ DESIGN FLOW: 2 BEDROOMS ® 110 GP = 220 GPD TEST HOLE x 56. - USE A 220 GPD DESIGN FLOW*** 22 SLOPE OF GROUND �A uTlurr POLE A LOT 294 \ y SEPTIC TANK: 220 GPD (2) = 440 9�F 15,233± S.F. \ a \ RE-USE EXISTING SEPTIC TANK** Tf FIRE HYDRANT x 5 .43 �� \ NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAWING �� �O F •.\ Q \ � � LEACHING: x 14 �55.7o O SIDES:2(30.4 +10.25) 1.85 (.74) = 111.3 GPD rD \ TEST HOLE LOGS 7.63 x TWIN 12" MAPLE 58.24 BOTTOM 30.4 x 10.25 (.74) = 230 GPD 8. \ \ EL A. OJALA, PE, SE \ TOTAL: 461 S.F. 341.3 GPD DANIEL \ x ■�7 1 57.48 \\\ USE (4) H-20 3050 INFILTRATORS, (p RS 57.91 DAVID W. STANTON, , WITNESS: �q� 57 81 I \\ ! WITH 1 STONE AT ENDS AND 3' AT SIDES 1 DATE: 7/26/10 o� ____ i 57.35 \ PERC. RATE _ < 2 MIN/INCH ��Q!/� \ 55.24 ***2 BR DEED 'RESTRICTION REQUIRED x 5 .50 � CLASS I SOILS p# 12999 �� 5 .46 CONC. x 5 PATIO ELEV. ELEV. 94 EXIST. DWELL. x 58. 5 x 57.18 {� ;58.60 opt 56.4' p,, 4 56.5' TOP FNDN = 58.6' 8.43 7 9 14" OAK y APPROVED DATE BOARD OF HEALTH MA X 8.18 57 f, ORGANIC ORGANIC - UNDERGRovND �r 5� 2 3„ I x 58.35 i x 7 \ 5� 56.89 x 56.80 TITLE 5 SITE PLAN A A 5a C. x 56. BENCH MARK - CORNER OF LS LS 57.77 0 4„ 10YR 3/2 5„ 14 10YR 3/2 rs57.64 TH 2�,, � x 56.75 CONC. PATIO ELEV. = 58.4 � " OAK \ 4 ���' 302 PRINCE HINCKLEY ROAD B B �� TH 1 CENTERVILLE LS LS �7 2 51 , „ 53.9 10YR 7/6 ' » 53.8 10YR 7/6 ' 23 PREPARED FOR 6 '' 30 30 x x 56.43 5 x 6.44 BORTOLOTTI CONSTRUCTION/ 56.9 10" OAK COOPER C C PERC x 3.27 JULY 29, 2010 ���ZH OF Mass o ����rH of MA fax 508-362-9880 MS MS ssq off 508-362-4541 �y x 56.26 �' ti o DANIEL G DANIELA. ��, , OJALA A o A. downcape.com 2.5Y 7/4 2.5Y 7/4 o CIVIL OJALA . Po 46sa2 � No.40980 d /n own cope eopheering, c. 120 46.4 120 46.5 �F c STER \� tq �sS civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1 20' x 56.26 ,-�_,"��� �� ssr AL E�� Hsu-� y land surveyors 939 Main Street ( Rte 6A) 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P. P.L.S. YARMOUTHPORT MA 02675 0- ' 57 10-157.DWG