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0024 RAINBOW DRIVE - Health
24 Rainbow Drive Centerville A= 188- 140 S/m � UPC 12534 .2.153E �wmiwtlr µ' C Commonwealth of Massachusetts leg- Iyo Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments rp (; M 24 Rainbow Dr ,n Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information is ill t Cenerve ✓ Ma 02632 1/21/19 required for every C"� 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 5Y 1 35,340 on the computer, Michael DiBuono use only the tab key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Lane rab Company Address Cotuit Ma 02635 Cityrrown State Zip Code �taa 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 1/21/19 I pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............. 24 Rainbow Dr u- Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information is required for every Centerville Ma 02632 1/21/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1000 Gallon septic tank as well as a Concrete distribution box and two 500 hundred chambers in stone. 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 C Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Rainbow Dr V Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information is required for every Centerville Ma 02632 1/21/19 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 24 Rainbow Dr Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information is required for every Centerville Ma 02632 1/21/19 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 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form T .I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Rainbow Dr V� Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information is required for every Centerville Ma 02632 1/21/19 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. ❑ ® 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 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 15insp.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 24 Rainbow Dr Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name inormation is Centerville requiredforevery Ma 02632 1/21/19 page. Citylrown 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Rainbow Dr Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information is required for every Centerville Ma 02632 1/21/19 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 198 GPD 9 ( Y 9 (9p ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 i Commonwealth of Massachusetts IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Rainbow Dr Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information is required for every Centerville Ma 02632 1/21/19 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-sanitarywaste discharged to the Title 5 system?9 Y El Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped at time of inspection. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Rainbow Dr Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information is required for every Centerville Ma 02632 1/21/19 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: New leaching installed 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): i Depth below grade: 2feet 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.): System is vented through the roof l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 f Commonwealth of Massachusetts i Title 5 Official Inspection Fo rm o rm Subsurface Sewa ge e Disposal System tem Form Not for Voluntary Assessments 24 Rainbow Dr Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information is required for every Centerville Ma 02632 1/21/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Rainbow Dr V� Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information is required for every Centerville Ma 02632 1/21/19 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 f Commonwealth of Massachusetts �r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 24 Rainbow Dr Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information is required for every Centerville Ma 02632 1/21/19 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 Level and at normal level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form.Subsurface Sewage Disp osal System Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Rainbow Dr Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information is required for every Centerville Ma 02632 1/21/19 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: 2 500 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leachingfields 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 Commonwealth of Massachusetts �r Title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u / 24 Rainbow Dr Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information ati is re wired for every Centerville Ma 02632 1/21/19 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 f( gns o hydraulic failure, level of ondin dam soil, condition of vegetation, etc.): P 9, p two 500 Gallon leach chambers 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 ondin condition of vegetation, etc.): P 9, 9 , 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 24 Rainbow Dr Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information is required for every Centerville Ma 02632 1/21/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Rainbow Dr u- Property Address BAGLEY, WILLIAM F&ANNA M Owner Owner's Name information is required for every Centerville Ma 02632 1/21/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where ublic water supplyenters p the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 1/21/2O19 Assessing As-Built Cards LOCATIO � SEWAGE PERMIT N0. YILL�ACE I N S T A LLER'S NAME Ill, ADDRESS BUILDER OR 'OWNER c_,A S DATE PERMIT ISSUED ���a�/�� � DATE COMPLIANCE ISSUED G, �s /?BN.2 0 oafE �oT 3 http://web.townotbarn stable.us/Departments/Assessing/Property_Values/HMdisplay.asp?mappar-188140&seq=1 1/2 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form f.. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Rainbow Dr Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name information is required for every Centerville Ma 02632 1/21/19 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: 10+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 8/30/2006 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Rainbow Dr Property Address BAGLEY, WILLIAM F &ANNA M Owner Owner's Name inormation is Centerville requiredforevery Ma 02632 1/21/19 page. City/Town 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 i, i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Town of B rnstabie. tt+r Department of Regulatory Services j • ' Public Health Division t`. Hate *6 �e'r 200 Main Street,Hyannis MA 02601 3 ~QED titA't w 6 Fee Pd. Date Scheduled Time i --4e $oil Suitability Assessment for Sewage Disposal Performed By- 1�AV1 D U co 14 NW 0W rko z 7 Witnessed By Dft") 5 1 kUT®W— ! LOCATION &GENERAL INFORMATION _ l.ccation Address W o Q.� Owner's Name 86 Lzy P Addressr APO Rox4q.F' .Cv1'11e Assessor's Map/P4tcel: Engineer's Name 0, NEW CONSTRU . ION REPAIR Telephone# Land Use R'es'.detn+i slopes(oo) ` 07O Surface Stones ®� Distances from: Open Water Body t d o ft Possible Wee Area LOO 4 ft Drinking Water Well t00 4. ft ! a Drainage Way. b® ft Property Line A+ ft Other ft SKETCH:($beet name,dimensiods'of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) s I / N S 1 4 v Parent material(geologic) r® 4C t ` ooftvA Depth to Bedrock Depth to GrroundwaWr. Standing Water in Hole:' i __ Weeping from Pit Face Estimated Seasonal;ligh Groundwater D&ERMINATION FOR SEASONAL HIGH WATER TADLE G�y�''� Method Used: �fit— a i S �iQS —' t -1 Depth tl4erved standingan obs.hole: _.In. Depot to loll mottles; in, Depth toiweeping from side of obs.hole: ! in, ©roundwnter AdJurftment ' Index Well#MIW•a.il Reading Date 21016 index Well leer l AdJ.faetor t..:�.s Add,f1Yp0t1dvvateir Li:V 1. ;2 eeN C D L TION TEST ' DntpS�lSl06 Mine PERCO A •. : Observation i Time 6t 9" #Tt Hole# I - Depth of Pere 6 ,t n Time at 6" i o"39 Time(9"•G') Start Pre-soak Time.@ t o 4,7 i End Pre-soak i Ivey; •{•h�'ib t�5�1��Jh � Rate Min./Inch �` eL P t =V% 11 ! i V !. Site Suitability Asse$smeut: Site Passed• . Site Failed:. Additional Testing Neetied.(Y/N) "1 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 +�r,Ip rA,�cervation Division at least one(1)week prior to beginning. DEEP OBSERVATION HOLE LUG"' Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel O _3 0 LiRMk SNWD 10 YR 2/( N0NE FRI 4 8LC -4o B LOAMY ! 'wb L0 4P— `116 �Jo PC L005E 40 t'20 C NENUM 5NW O -1'4 c vote DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling. (Structure,Stones,Boulders. Consistency.%Gra el q-..11 O SqvDq C,ortM t0 q R0—/Z, NOWE FRI NNLc .1oAtA` 5hwi 10gR4/4 t�OWC f-RIRBLL FRI 4 34.-1= 9/6 WW 6 zK- k 2.41 ►MEDIM �RWD W kK 5/4 NDWC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, o Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. on ist Flood Insurance Rate May: Above 500 year flood boundary No-.--.,. Yes._.,V- _ - - Within 500 year boundary No Yes,.. Within 100 year flood boundary No Z Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? t4 0 S If not,what is the depth of naturally occurring pervious material? Certiflcation 1 certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,a ertise and experience described in:U0 C1V1R 15.017. Signature �"'� C�"'�'�'' �✓ Date Q:VSEPTIMERCFORM.DOC TOWN OF BARNSTABLE "eo 3-9y i LOCATION ILI Z,,"w ke--> M— SEWAGE# VILLAGE /ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) X z NO. OF BEDROOMS OWNER Ill IL /�54 y� PERMIT DATE: �?vo w& COMPLIANCE DATE: Oj— I -CC, 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 3 o � � is 200�v100.00 No. �� --t Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V PUBLIC HEALTH DIVIS-110-iv ' TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYfcation for Mtgo!6a1 .6p.5tem Cots.5trurtfon 'Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑ Complete System t&Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 7 71 —3 0 2 5 24 Rainbow Dr Centerville William Bagley Assessor'sMap/parcel 188 140 PO Box 695, Centerville Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 2—2 9 2 2 Wm E Robinson Sr Septic Darren Meyer PO Box 981 E. Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size �S� sq.ft. Garbage Grinder (no) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow( .re uired) 3 gpd Design flow provided ` :30, 0 gpd Plan Date � p Number of sheets Revision Date Title Size of Septic Tank Irl, 660 p,n Type of S.A.S. 0 Description of Soil Nature of Repair's or Alterations(Answer when applicable) Install a new Title 5 leach system to plans ofUPW 4 rAelowE 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 Signed i t' " Date / Application Approved by 1�.] Date _ d —0 6 Application Disapproved by: Date for the following reasons Permit No. Q-d e6— 3 g`ll Date Issued —_?&4—06. _ No.. F 3 THE�COMMONWEALTH OF MASSACHUSETTS Entered in computer: t�-- PUBLIC HEALTH DIVIS•IJni=`TOWN OF BARNSTABLE, MASSACHUSETTS Yes M ,° rfcation for ig pEW stem Cho ¢ hors per Application for a Permit to Construct O Repair( 'Upgrade O Abandon( ❑ Complete System Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 7 71—3 0 2 5 24 Rainbow Dr, Centerville William Bagley Assessor'sMap/parcel 188 140 PO Boy 695, Centerville ' Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's-Name,Address and Tel.No. 3 6 2-2 9 2 2 Wm E Robinson Sr Septic. Darren..Meyer - "'' 20 Box 1099 , CentervillePO Box 981 , E. Sandwich Type of Building: ) _ Dwelling No.of Bedrooms 3 t Lot Size 5 1 To� sq.ft. Garbage Grinder PI) Other Type of Building No.of Persons,`," Showers( `) Cafeteria Other Fixtures x Design Flow(min.required) 3 gpd: Design flow provided 30, U y gpd Plan Date J?0k Number of sheets Revision Date Title r 'S /` Size of Septic Tank (i '�d Lq f(Jr� =Type of S.A.S. 2 <)fJ C. a� C — �lU k / Z Description of SoilLj Nature of Repairs or Alterations(Answer when a plicable) II1Sta11 J a neut-Title 5 leach system to plans of - Ie� r. p �0 w vP o y i, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in f 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 oard of Heal.• Signed 7,41 Date C> Application Approved by r1N, A r-b`. Date " 3a Application Disapproved by: Date 7. for the following reasons i Permit No. �d d�. 3 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Bagley Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage DisposalAystem Constructed ( ) Repaired ( X ) Upgraded ( ) / Abandoned( )by Wm E Robinson Sr Septic Service at 24 Rainbow Drive, Centerville has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated r Installer Designer -i #bedrooms 3 ApprdVedP-1sign7nbW L5,Z0 gpd The issuance of this permits all of be construed as a guarantee that the syste will funct'o d sign Date `/�7 n Inspector F No. a(X�6-381�l �« Q o o.o 0 t Bagley THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION:-B'ARNSTABLE, MASSACHUSETTS I=t.5pogat �p!gtem Con!6tructiou Permit Permission is hereby granted to Construct ( ) Repair ( X) Upgrade ( ) Abandon ( ) System located at 24 Rainbow Drive, Centerville 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: ConstructionCJ ust be completed within three years of the date of is pe it. Date Approved by - Town ofBanistable 0 Ref,111.1ton, Services 1,11imm's V. (4 ilcr, Director NI A, . "M/ 1639. Public 11c,11th DiN.ision Thmllw, MCII.-C-1111. Director '00 ;Main Strect, I IN mufis, iNIA 02oo I Office: 508-862-4644 I:iix: 50S-790-0301 Date: Designer: Darren Meyer Wm E Robinson Sr Septic Installer: Address: PO Box 981 Address: PO Box 1089 E. Sandwich Centerville On -.Wm E Robinson Sr SeR4F,,,,,,, a permit to install a (dale) (installer) septic s%:steill at 24 Rainbow Dr, Centerville I)ascd on a design draw In, ddress) dated 8-17-06 (cf—esigliel.) I certify that the sq)[1c SN!Stclll rd'eleliced al)0v C \\as installed accoldilw h) the design, "'IlICII IllaY HICILRIC 111mor approved clijillges sjjcjl as IjItcl-,11, I-Ciocatioll of,the distribution I)k-)x alld!or septic tank. I certify that the septic S%'ste'll Nficl-cliced above was installed w-ith major chall" Ics (I.e. greater than 10' latcl-111 I-Jocatlmi (11 the SAS or ail,,, N-cl-tic�11 1-cjocatloll of am CoIIII)oIlclit of the SCI)tic svmcill) but in accordance wi th state & I.ocld Rc-ul'itiolls. Plu'll FeVISIMI kff aS-I)Llllt hVLICSlj,IlCI. to 1-611m.%.. OF DAVID yG Di COUGHANOWR lgllatLlI.0 t4o. 1093 P AIITA �7 (Des giier's Sluilaturc) ITFIASI.,.' RETURN TO BARNSTABLF PUBLIC 11EMI'll DIVISION. CFIRTIFIC:Vl V OF (70IM1'LIANCV WILL NOT BF ISSUH) UNTIL IMT11 'I'llIS 1,,OIZ11 ND AS- IWILT CARD ARV Ifl. 1. I\ 1,J) 1,1V TIIF BA WNSTA M.1:1 1,1111Y, 111"Al"I'll DIN I\ V 01. . ("I 11calth "Cl)[IC Dcsignci (-.cmnL,itwii I ,;jj, —4— L'OCAT10 SEWAGE. PERMIT NO. //e- VILLAGE I N S T A LLER'S NAME i ADDRESS d U I L pD E R OR 'OWNER DATE PERMIT ISSUED ,2F/e�� DATE COMPLIANCE ISSUED ' �ts .74 � 3� �aT 3 No. �! . Fss:........................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ............G....�........ ..OF.......e�...,e:....�-:f....---------------------�- 1 Appliroftun for 11topoottl Works Tontrn.r#uon Pam Application is hereby made for a Per to Construct ( ) or Repair ( ) an Individual Sewage Disposal �d System at: e. ---Location-Addre 41 / or No. Owner Address W Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................ ..-.-------_-.._--Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons-_--.__=-.--7------------- Showers Cafeteria 04 d Other fixtures .------••----------------------•-•-•------------•----......---------------------------------------......-----•--......_.......---•-•--•-•-••---•--••-- W Design Flow............................................gallons per person per day. Total daily flow...................j_;r..0.........gallons. WSeptic Tank—Liquid capacity/64P. allons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area.__.`&.<_`sq. ft. Seepage Pit No--------------_---- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank '-' Percolation Test Results Performed by...... 1smA_-0.. ..... Date......��.�,.... ........�� Test Pit No. 1 141 minutes per inch Depth of Test Pit.................... Depth to ground water........................ f=, Test Pit No. 2 . ....minutes per inch Depth of Test Pit.................... Depth to ground water........................ W •-- ....-••• 5 - r 0 Description of Soil............... x 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 iITA LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has,been iss y the bo d of health. ned Application Approved '.. : ......... ................ Date Application Disapproved Torth fiollowing reasons:.............................................................................................................•_. ............................••-•---•-----•---•----....---•--------------.....---••---------•---.....-----•-•--•---•••-•••-•••-•-••-----•-----------................................................... - _ Date Permit No................. .. 1.: a FEB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH • ....................OF....... ........... ..................;.....#�........ Applirattion for Dispaiial Works Towitrurtion Vantit Application is hereby made for a Per to Construct or Repair an Individual Sewage Disposal System at: ............... ............. . ........ .......3 -2ft ................ Location-Addre r No. .4%. ................. ....... Owner Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...................3------------------Expansion Attic Garbage Grinder Other—T e of Building ............................ No. of persons.......... ' * Cafeteria yp ---7------------- Showers (k� P4 Other fixtures Design Flow.....................................I......gallons per person per day. Total daily flow-._._.__._________%70 W , _ . ___._._._gallons. 1:4 Septic Tank—Liquid capacity,/ffPCIons Length________________ Width.__.__.____._._. Diameter__--...__._.____ Depth................ Disposal Trench—No_.................... Width_...___.________._.. Total Length.___.____________.__ Total leaching area.....Z�_Csq. ft. Seepage Pit No_____________________ Diameter__._____.___________ Depth below inlet___.____....__._____ Total leaching area...............---sq. f t. Other Distribution box Dosing tank Percolation Test Results Performed by •.......j!�-- ... Date...... _/--- --- ---- 04 Test Pit No. I inutes per inch Depth of Test Pit.................... Depth to ground water- . ./ Test Pit No. 2.t ____minutes per inch Depth of Test Pit____________________ Depth to ground water....____.__.___.___._._. ------------------ ....... ............ --- -------------------"----------*-------------- ----------**........"------------ 0 Description of Soil_______________ ............................................................................................ W - U ......................................................................................................................................................................................................... W x -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------*------------- 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 undersigned furtL,,er agrees not to place the system in operation until a Certificate of Compliance has been iss y the b9gd of health. _1_*1 ' .................... 7 ned..... at ApplicationApproved ............. ................. ............................................................... ... Date Application Disapproved f r the o lowing reasons:................................................................................................................. ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................. ................................................... (Intifirate of Toutpliaurr THIS IS TO CF,,RTIFJ,', That the,1qdividual,.,Sewage Disposal System constructed or Repaired r y� n .................................................................................... by 4� . . ------ Installer ,!V-T — at.............*................... ............................ ............... been installed in accordance with the provisions of.-T-------------------------he.'State.-Sarlit. sled�e in the has b Sanitary o s application for Disposal Works Construction Permit No_________________________________________ dated_...._.._.-.-__________:.._._._______..._____.__ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT THE SYSTEM WILVFUNCTION SATISFACTORY. DATE.Z 13A?-1kf............................................... Inspector-- ...... ......................................................... .... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............OF...- ............ . ................77 �. ............... ......... No......................... FEE........................ thii Woutlr Ve rutit Permissionis hereby granted.............................;................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No. 0.i............................................................ .................................................................... ------------------- Street' as shown on/thea licati for Disposal Works Construction �P. mit 0.--.-:................ Dated.......................................... ..... ......... ...................................................................................... Board of Health DATE.Z'�--------- .... ...................................................... FORM 1255 HoBBS & WARREN. INC., PUBLISHERS f N�r d o yN 2692 A- ' Q z G, OF MgsS Lp f C Cl -q)'JMORSE N0.10951 O 1 1, .op o IN, TEP����� C/ FFSS/ONAL��� 4D. i END EXISTING SPOT ELEVATION Ox0 CERTIFIED PLOT PLAN EXISTING CONTOUR _ 0 L�: FINISHED SPOT ELEVATION z :� FINISHED CONTOUR 0 - �' R��lif.RT J /o*' BRUCE, ` � APPROVED , BOARD OF HEALTH E�oRr IN STE� � . DATE AGENT SCALE+ / = ? DATE , (eL DREDGE ENGINEER " Co' 'Na) �►/ec,�UtAs ' CLIENT. ) CERTIFY THAT THE PROPOSED EGISTERE REGISTLRED JOB NO, 831-3 BUILDING SHOWN ON THIS PLAN CIVIL LAND BY 21 CONFORMS TO THE ZONING LAWS DR. ENGINEER URVEY R OF BARNSTABLE , MASS. 712 MAIN STREET CH. BY, 3, z5 HYANN I S, MASS. SHEET F Z 4A&T03 "R EG. OR LAND SURVEY. 0 —'E/'�C!'1//�/G P/T A,tE �y0.4c T/•rA.•/ i2'" 9EL.^�iv � /® PT. /M/�/. S4i4 OE, A ?4 �O/.�1,'N F TE'R CDNC•p;T'� CC t�C.ia. '_ . �A ( 4'PYL' P/Pt SNAG/- BF BROU6.YT• TO G.3AOF ;�•v —tea ! CDIYC�BTi[ MIN. AlrCN J'iEAVy C•'1 ST :RON. G i/F.� SH 1 •, /=" C7. CGYER.S oE.Q FT i %F/,V OR,'VE eV.o y 3 /RaAf R/Ps /0 C) • • • • • • a pLFTI+I • • • •, • • : WASITEC, 5TJ,1/E 470 -7 gx r ,o _ . .. . . . , . . . . .- v� . • i• • t • • • • • • • • o • PRECAST SE�4G£ jAFVAACA7 ZZ&VAiTIONS �/7 ��,�� C_i-.../ �•�-`-4u (: pA � I t e • a • • • • • ._ • •• P/7 C.4 FQ UI V. IX4VER7' At ®LVLOINQr ®I�7C. : �L 1 Sr TL�T. TiC�df�4/ItG'CSEC TA 414A7-)OJV� /JI�dETOiISF�OdI7!®��� '�0 4- /e.°�►=_-�!=- ,�.�C'TOQ/M 0I�_ �i12!"TD/. l�tlTj®lid g,Z�g �- , l�1P[rr tgA"IAAG - 7,5, AS& 4V/O~AL SY.STE/r! - ► . IrAS111-ATIO/M DESAW CglTEq!/R - JCALg : ys = f=O". OoMENs/ON -AffT. o/lrayvsiow r. , wRa.�c.Eois�os.�L vu/r N�y� S®/t LOG `.TOTAi- EYTI/MZATED FLOov 330G'.4L/PAv S®/L 7'&STAPI SoiL7rsroz -SOIL 7'4165 " NJMBEp GLF C.-ACAIlNC P/TS .SIDE LrACN/f✓G 0FR PIY 1 F?s /rT. ATE of so/t TEsr 3oT-row 4,G4 CHIva o--it O/T 7� S0. FT �� z RESULTS WlrVZSSED dY IAC.04� r Z Cz(� /c PEit CCLAT/Olv. �lgT� d-�ss. /yJ� //NCN T'D r.4 c «erg//vG i4 R EA sp F r A4 T t:3 A:eVCOL4T/ON RATE j*2 �. F o _ r N � - ROBERT �.� �"C '�4S � � -�-. j !��!1� �. J ?,f '•� "°� ,j•- :'� Bf2 U:;_ _ �� �'� .Y.� ,•--��j.per/', - .T--'Y /� -- ELDRED J4LEF2T / , I ORSE `" + �s Na.loss!�o _ ,w L 0.3EDGE cti'G/NF ,7ii`iG CO, .'Y /.YC.Np SUS �O FG�STE a 7/Z MA/ sr HY.-a�'.v.S. Eab� IYO15,10VIVO .Y.4TZ•1! Ei'VCOUNTE.,e.O AL CLIENT: �►►�� C3 G,CO L/NO HrAT�—R .4T EL�i! /v•.:-/�vGA-S DF!:� : %'l7 �. NU. pA I�+f�.Ll�.�S �I1.�I.at:11tJ'1' ,�—.- " (Non-refundable •u i;itl:;:,s TELEPHONE.-N6.11 fialm tvl:I.0 TEIEPHON NO. • sCul,c,l.Ii.l:u Jt�1.Y,16 . IQ�� Q. :.. —" ��CantJJ3 . signature• • • • • • • • • • • • •.• • ♦ • • ♦ •'• • • O • • • • • • • ♦ • • • • • • ,.LOG ;U11-ll1V1 S LUN° NArLI:: ���A DATE • 1� • �� '1']htL� ----- ;xl'AN5lUt, AREA : Y1: ✓ NO__ ..J®MI'�t � • I:NGINL•'L••K ,oWN WA'lE1t ✓ I'I:.CVA'1.'I: WL:,,I..� .JQF}1�1 .��CaDl�' _� 110AKI, (4' 11EA1,rB ;K.ETC,I: ( :;1.r.� �'1 ,•nn�' , �'l c:• ,��.lnit:f)tf.ions of lot, exact location cif l c.,A l,�r�:u]..al. i�,,► tu�;ts , locate: wetlands -in proximity to tut� L. Ili, I (::, ) NOTES: �sspo Ifv 1,ATI: : ` AA I�,4 It$4 ELEVATION: '1'I•::.;',' i lip l,l: t J i l : _ 1. or _ Ica" L..0,0Vm $ 1 _ _.. --- i op 7 1 9 i 11 lU ]. 3 13 1� teJ 14 - Ja 15 16 SU 1'['l+Ul,i: 1'tilc :.JUli-::URFACE SEWAGE:' - LEACHING FIELD LE'AC111116 PIT:: LEACHING THENC111,5 F U N u:1 TAil l.-E TOR Sufi-SURFACE SEWAGE♦ REASONS: ___...... NOTE : t•:t,GT14IrF:itTNG PLANS MUST SHOW. NUMBER ASSIGNED ON PGRC Ti AI'l'I,.I �.a+'1'lU1J fit r� trJAC.• ��tn>T.rTF]� 7N ENTIRETY BY R. ANI) FtETURNh:D •yo Ilr)A10) (d. ,11I; 1 1.111 — - N I L TEST L O G D A T A: OF—TEST:OTEST: AUGUST 15. 2006 SO SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. DESIGN CALCULATIONS WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. NO GROUNDWATER ENCOU'NO-YE-RED DESIGN FLOW: 3 BEDROOMS X 110 ..Ct?D = 330 GPD TEST PIT I p RENT MATERIAL: PROGLACIAL OUTWASH SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS f„ PERC AT 6B in : 2 MIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUNC),7,-STRUCTURAL ELEVATION = 38.50 +- CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) DISTRIBUTION BOX: USE 3 OUTLET D-BOX. DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOIL ABSORBTION SYSTEM: A 24 Ft- x 12.5 Ft- x 2 Ft. LEACHING GALLERY CAN LEACH (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING Abot = ( 24 x 12.5 ) = 300 sf 38.50 A s d w = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 a 0-3 O LOAMY SAND 10 YR 2/1 NONE FRIABLE At of = 446 sf Vt. 0.74 x 446 = 330.04 GPD 3-7 A LOAMY SAND 10 YR 3/6 NONE FRIABLE USE A 24 f"t. x 12.5 Ft x 2 f t GALLERY. Vt = 330.04 GPD > 330 GPD REOUIRED 7-40 B LOAMY SAND 10 YR 4/6 NONE LOOSE 35.1E 40-120 1 C MEDIUM SAND 1 10 YR 5/4 1 NONE LOOSE 26.50 LEACHING GALLERY SCCAL.E NO GROTUNDDWATE L ENCOUNTER LD OUTWASH USE SHOREY PRECAST 500 GALLON LEACHING DRYWELL lH-10 LOADING) TEST PIT 2 ELEVATION = 38.50 +- 2 MIN/INCH IN C SOILS CONSTRUCTION DETAIL 500 GALLON DRYWELL DIMENSIONS AND DETAIL DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DRYWELL UNIT STON USE H-10 l9NIT RISER TO WITHIN(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING INSTALL D INSPECTION N SIX 24.0 f L INCHES OF FINAL GRADE 38.50 m AND INDICATE LOCATION 0-9 FILL m4 ON AS-BUILT PLAN 4 4 9-11 O SANDY LOAM 10 YR 2/2 NONE FRIABLE �Q m- �Q N N 00 33 11-13 E LOAMY SAND 10 YR 4/1 NONE FRIABLE m o00000 0 0 00 In 00 13-16 A LOAMY SAND 10 YR 4/6 NONE FRIABLE m �aoca C:o o000 �00� 3.5 f t 8.5 f t 8.5 f t .5 FL ���OpOp DO 1� 16-45 B LOAMY SAND 10 YR 5/6 NONE LOOSE 2a.0 ft G�0 34.75 102 1n 45-124 C MEDIUM SAND 10 YR 5/4 NONE LOOSE 2B.1F CROSS SECTION VIEW 2 in PEASTONE 2 in PEASTONE NOTES 28 =i�nGRA EFFEC24 in 3/4 in TO 26 In DEPTHTIVE 1-1/2 in GRAVEL in 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 46 in 58 in 46 in OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES 150 in BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE GROUNDWATER ADJUSTMENT 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0- BEFORE PITCHING DOWN 6) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION .OF-'.LOW FLOW FIXTURES EXISTING GROUNDWATER LEVEL AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEP.TIC-TANK-- BASED ON TOWN OF BARNSTABLE GIS DEPARTMENT RECORDS. SEWAGE DISPOSAL SYSTEM PLAN \ 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. tDO.-NOT -TO SERVE EXISTING DWELLING > PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. - ,,. i. '. INDICATED GW 6.00 10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFOR;E;�STA1RTrING WORK. INDEX WELL M1W-29 WILLIAM AND ANNA BAGLEY ZONE D 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TC �iT UEO. GRADE) ON A LEVEL READING DATE DULY. 2006 24 RAINBOW DRIVE CENTERVILLE. MA STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED==AND,'�ON ,TO WHICH READING 6.4 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED tT:O,r,MINIMIZE UNEVEN SETTLING ADJUSTMENT 1.2 ECO-TECH ENVIRONMENTAL 12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF _SYSTEM REPAIR `AND CHECKED ADJUSTED GW 9.2 FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FIT_T.ED WITH GAS BAFFLE. 43 TRIANGLE CIRCLE SANDWICH MA 02563 ' ETE-240E31 AUGUST 30. 2006 2/2.. a Jw Mt 36 .—CONTOURS o o n //" ��� EXISTING - - - - - - - 50 N �° con o WN 38/� ♦ 36 MINIMAL GRADING PROPOSED W o(- x \.♦ _.. LOCUS J �m w ��m N 38 O m m ow LOT 3 /I P _ BENCH MARK eJ�PS C"�REA — 15.152 Sf +- ♦ CENTERVILLE. MA N =~ ♦ PK NAIL IN DRIVE e wZo Y `♦ ELEVATION = 39.23 LOCUS MAP P E` 0 Woz n 1 I�EWP ♦ BARNSTABLE GIS DATUM NOT TO SCALE z m N ow°o I Ep pR ��� m PPS LEGEND J z � 3 I ` � EXISTING Luz- <W = W W {� -+� 1 �8 1000 GALLON W U - 0 4 r- \ `8 SEPTIC TANK O It IY < J o �i Z D-BOX ❑ X (L m mE W w 1 \ ♦` TEST PIT W CD I lu o W R1 � m U)i I 4 \ ♦ EXISTING PIT O u' O m 1 m zl Z GA TER WA TER \ ♦ 38 TREE /f U uj f- LL � \ -NUMBER REFERS TO S. bi LLB LL O O m Lo \ LETTER DENOTESIAMETER IN TYPE. 18-P 4 rn O-OAK M-MAPLE P-PINE �,< w W (� tf1 m• C 1 ene I (nn} m o� 3 1 �C W 1XI ZO F v �,� m �� Z, ♦ REMOVE ANY UNSUITABLE SOILS W ? Z J N I (� O ` ENCOUNTERED IN THE EXCAVATION C) x °J w zo Ili ♦ FOR THE LEACHING GALLERY FOR 5 cn p< 1 !v —I //_ �� LATERAL FEET AND REPLACE WITH W z W W m m Z '—' TP-2�Q \ CLEAN MEDIUM SAND PER TITLE 5 W� ~ m_ � 0 � 20Ff �cn3Zu I� t 24FLx12.5ftx2FL a� z J 4 ~ o 0 ♦ LEACHING GALLERY Jx N o + 0 e W w m o m X 40 1 w \♦ WW w TP-1 < _ -- -- _� I ------------- z J CD 0 L�__._---- ---- 163.65 f L 38 ®e TE SEWAGE DISPOSAL SYSTEM PLAN J Z J I 40 �� �iy -TO SERVE EXISTING DWELLING LL O o o CDm Q U EST. WILLIAM AND ANNA BAGLEY Z � X U F- } OWNERS OF RECORD "' �I W �� 1995 24 RAINBOW DRIVE -Elo + Cw PLAN 1����NOFMASs'gC' lid �� CENTERVILLE. MA m off' DAVID yG ON PROPERTY PROPERTY ADDRESS O N �� D. Na ASSESSORS MAP 18 B PARCEL 14 0 c� SCALE. 1 In = 20 f L N 43 TRIANGLE CIRCLE f O " z z ~ C No.H1093 R SANDWICH MA 02563 PLAN BOOK 291 PAGE 32 1 N X 20 0 20 40 .�� �0 588 364-8894 DATE: AUGUST 30. 2006 w w w D ID 20 �!s A e� r11� JOB #E T E-2 4 0 8 PAGE I OF 2 VERSION.• /� THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED ��n77 SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM 2 J©i 20 0 DEPICTED� PLACEMENT OF ADDITIIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR.