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HomeMy WebLinkAbout0104 ROSEMARY LANE - Health 104 ROSEMARY LANE, CENTERV'ILLE A= UPC 12534 No.2 152 OR , NA$TINpN.YN a` r i Commonwealth of Massachusetts Ay5�-00 _ c73 Title 5 Official Inspection Form XSubsurface Sewage Disposal System Form -Not for Voluntary Assessments ., 104 Rosemary Lane Property Address US Bank National Association Owner O r wner's Name information is required for every Centerville MA 02632 2/19/2020'. 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 A. Inspector Information filling out forms p on the computer, '7 use only the tab James Ford key to move your Name of Inspector cursor-do not Ford Septic Services, LLC use the return key. Company Name P.O. Box 49 tab Company Address Osterville MA 02655 City/Town State Zip Code &A 508-862-9400 S 12482 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; thb 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 2/19/2020 Inspe t 's Signature Date The tem 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 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 104 Rosemary Lane V Property Address US Bank National Association Owner Owner's Name information is required for every Centerville MA 02632 2/19/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 { Commonwealth of Massachusetts (o Title 5 Official Inspection Form a ,l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments n 104 Rosemary Lane Property Address US Bank National Association Owner Owner's Name information is required for every Centerville MA 02632 2/19/2020 page. Cityr own 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 4L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Rosemary Lane Property Address US Bank National Association Owner Owner's Name information is required for every Centerville MA 02632 2/19/2020 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 1 Commonwealth of Massachusetts _ Title 5 Official Inspection Form X Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Rosemary Lane Property Address US Bank National Association Owner Owner's Name information is required for every Centerville MA 02632 2/19/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (Cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/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 g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doe-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 104 Rosemary Lane Property Address US Bank National Association Owner Owner's Name information is Centerville required for every MA 02632 2/19/2020 page. Cltyrrown 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 104 Rosemary Lane Property Address US Bank National Association Owner Owner's Name information is required for every Centerville MA 02632 2/19/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms 3 3 (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 0 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 information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: unknown Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts l� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 104 Rosemary Lane L;— Property Address US Bank National Association Owner Owner's Name information is Centerville required for every MA 02632 2/19/2020 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: unknown 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 p y Form Not for Voluntary Assessments 104 Rosemary Lane Property Address US Bank National Association Owner Owner's Name information is required for every Centerville MA 02632 2/19/2020 page. Cltyrrown 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: installed -5/12/1989 per as-built Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection 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 Vf 104 Rosema Lane Property Address US Bank National Association Owner Owner's Name information is required for every Centerville MA 02632 2/19/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 18" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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: 1000 H-10 Sludge depth: 5 Distance from top of sludge to bottom of outlet tee or baffle 20 Scum thickness 8 Distance from5 to of scum p to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? 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.): The tee's were present. There was no sign of leakage. A riser was installed on the outlet. recommend pumping'. 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 h 104 Rosemary Lane Property Address US Bank National Association Owner Owner's Name information is required for every Centerville MA 02632 2/19/2020 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): N/a 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): N/a 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 1l� Subsurface Sewage Disposal System F - N Voluntary Assessments � . Form Not for Volunta w 104 Rosemary Lane u— Property Address US Bank National Association Owner Owners Name information is required for every Centerville MA 02632 2/19/2020 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.): N/a *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 Even Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The D-box was normal. 3 outlet pipes to the flowdiffussers t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts I� Title 5 Official Inspection Form <la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .......... , 104 Rosemary Lane Property Address US Bank National Association Owner Owner's Name information is required for every Centerville MA 02632 2/19/2020 page. CltylTown 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.): n/a * 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: 3 flowdiffussors w 3' stone ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 13 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Ro semary Lane Property Address US Bank National Association Owner Owner's Name information is Centerville required for every MA 02632 2/19/2020 page. Cltyrrown 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.): There was no sign of failure from flowdiffussers A camera was used 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.): n/a t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 16 Commonwealth of Massachusetts �w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 104 Rosemary Lane Property Address US Bank National Association Owner Owner's Name information is required for every Centerville MA 02632 2/19/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: N/a 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 E Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Rosemary Lane Property Address US Bank National Association Owner Owner's Name information is required for every Centerville MA 02632 2/19/2020 page. Citylrown 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 /A f_ GA(A Q. 3 p I i Ro i s � o a as 19 I 3 al� as yga38 t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts �v ,.9 Title 5 Official Inspection Form yS Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 104_Rosemary Lane Property Address US Bank National Association Owner Owner's Name information is Centerville required for every MA 02632 2/19/2020 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: 15 +/- 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: Topo and water contours maps ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: using topo and water contours maps. also pond in back yard 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 r� . , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c e 104 Rosemary Lane Property Address US Bank National Association, Owner Owner's Name information is required for every Centerville MA 02632 2/19/2020 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 t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 104 ROSEMARY LANE CENTERVILLE, MA 02632 M147 P007 L13 Name of Owner HORMAN Date of Inspection: 9/25/00 RESID NTIA : FLOW CONDITIONS Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):n/a Total DESIGN flow: 330 gpd Number of current residents:3 Garbage grinder(yes or no): NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): nla gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL MO (STRIA Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow: n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings. if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: 1998 System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYP l]F uamlz X Septic tank/distribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous inspection records, if any) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other: n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: 1989 PERMIT 89-29 Sewage odors detected when arriving at the site:(yes or no): NO f f f I f f revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Paae 6 of 11 Ci��tt fo apfParc 1 700701 �� ,� ow�n�of arrlstab .� a �� Bt�s ess Narne � t S\ ,kFife/�Pe� N 2000655 �'' z izeofSepHc ` T pel Ize Sl�S 14x32 LF yfa` x1000nams \ a n a 147007013 r 8f HORMAN,ROBERT rQ 104 ROSEMARY LANE I TOWN OF BARNSTABLE Cl� 4 LOCATION ROS'LG/491411 e C19442 SEWAGE # VILLAGE S'eeZ7cr ASSESSOR'S MAP & LOT 07-0 —01-3 INSTALLER'S NAME&PHONE NO. 1n 1 h C 4I 42 SEPTIC TANK CAPACITY Ida 0 ' LEACHING FACILITY: (type) GG (size) 3,2 x 7 li NO. OF BEDROOMS 3 BUILDER OR OWNER PERMIT DATE: Z1 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 �" r a. Cps L_ No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes / PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for Zigpooar bpotem Conotruction Vermit Application for a Permit to Construct( )Repair( )Upgrade(V Abandon( ) O Complete System KIndividual Components Location Address or Lot No.k D Lk 1&_11kVW ,�qq V Owner's)Name,,Address and Tel.No. Assessor's Map/Parcel 47 h-7 Installer's Name,Address.No. Designer's Name,Address and Tel.No. o ird� Type of Building: Dwelling No.of Bedrooms :3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow mil ►s gallons. Plan Date 10—_30-0V Number of sheets Revision Date Title Size of Septic Tank 'E t S v K (A to (; Type of S.A.S. Description of Soil L o)m►6, S A,, 1 KA1-D p Nature of Repairs or Alterations(Answer when applicable) bv--I. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has d of Hea Signed Date Z//40 Application Approved by Date �//'� D Application Disapproved for the following reasons �` ' ,Permit No. 7.670V Date Issued 4 � 42 r No. —� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for -Mie;ftoY 6pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(V/�Abandon( ) ❑Complete System KIndividual Components Location Address or Lot No.k D t-{ ✓� d� Owner's nName,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address, d Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �� gallons per day. Calculated daily flow 6 , �], gallons. Plan Date 10 30-OD Number of sheets f Revision Date Title c f k Size of Septic Tank S F ti Type ofS.A.S. oZ t5v_c Description of Soil L a IA IMF/•S A,c kD ( Kk,Q SALD Nature of Repairs or Alterations(Answer when applicable) ��� 0 ms= Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has d of Heal Signed Date 4 _ C Application Approved by i Date y Application Disapproved for the following reasons Permit No.767/i/ 'G S Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY e site Sewage Di s 1 System Constructed( )Repaired( )Upgraded(!/f Abandoned( ) � W. - at 2 Z ; _ has been constructed in accordance with the provisions of Tide 5 and thefor Disposal System Construction Permit NoZq� �S� dated' //—/_ Zrl7�Installer n /V? ` Designer The issuance of t ;s permit shall not be construed as a guarantee that the system will fun1ct/i6n as designed Date �� �/Zc7y Inspector_/ �.� _ r � --------------------------------------- No. -�� Fee -5-0 I'�- N- - Go 7-v 13 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS xligool *pgtem Construction Permit Permission is hereby granted to Construct.(, )Repair grade( )Abandon( ) System located at 2 -,-- & 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: Construction/must be completed within three years of the date of this permit. Q Date: /��/ � Approved by /--�� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(p pfication for Migoof *pttem Con5tructiou Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer 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 Certifi- cate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued ti No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes { ZIpprication for Migozal *p5tem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Ueer's Name,Address and Tel.No. f ` Type of Building: P Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) j Other Fixtures i i Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil i Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: z.. The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued -_--------,`—. .,-------------_--------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CE�R�T Y, that t e O -site Se age��ts a ystem Constructed( )Repaired(Upgraded( ) Aband )b / f-z'� at ® n Vha be�nconstructed in accordance with the provisions of Titl 5 an f aLS stem Construction Permit No. dated E Installer��� Designer The issuance of ' ermit hall not be construed as a guarantee that the syste ill fun t'on aasesigned(.-- Date Inspector I � � � r No. Fee i i. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5 pogal *pgtem Con5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at Y V P 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. f Provided: Construction must be completed within three years of the date of this permit. i Date: Approved by i i i t TOWN OF BARNSTABLE LOCATION /I�/—Lt j1SL/j'I�I'l� C:/d?C/L SEWAGE # �/ VILLAGE ASSESSOR'S MAP & LOT 147607—o(3 INSTALLER'S NAME&PHONE NO. C 14 SEPTIC TANK CAPACITY o LEACHING FACILITY: (type) = C (size) 3:2 k : NO. OF BEDROOMS. 3 BUILDER OR OWNER - i PERMTT DATE: Zt 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 within300 feet of leaching facility) Feet Furnished by i (141 �. 13 1 v g1 y Y A 2 �y ipa �f✓6 ° 6 �a blt� NO OO COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 104 ROSEMARY LANE CENTERVILLE, MA 02632 M147 P007 L13 Name of Owner HORMAN Address of Owner: 104 ROSEMARY LANE CENTERVILLE,MA 02632 Date of Inspection:. 9/25/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT a 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 inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority X Fails Inspector's Signature: Date:9/26/00 The System Inspector shall s mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If t e 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 Department of Environmental Protection.The original-should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS , "The inspection is based on criteria'd6fined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.N inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM FAILS TITLE V INSPECTION.THE LEACH FIELD IS PAST THE EFFECTIVE DEPTH OF LEACHING,AT THE TIME OF THE INSPECTION THE SOIL WAS SATURATED. revised 9/2/98 Paoe 1 of 11 ` i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 104 ROSEMARY LANE CENTERVILLE, MA 02632 M147 P007 L13 Name of Owner HORMAN Date of Inspection: 9/25/00 INSPECTION SUMMARY: Check A, B, C, Or D: A. SYSTEM PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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 o the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances. If"not determined",explain why not. n/a The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nLa Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)o due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced obstruction,is removed _distribution box is levelled or replaced nLa The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspectionJf(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed t: 1' revised 9/2/98 Paoe 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 104 ROSEMARY LANE CENTERVILLE, MA 02632 M147 P007 L13 Name of Owner HORMAN Date of Inspection: 9/25/00 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM It NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone 1 of a public water supply well. _ The system has a septic�ank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance n1a (approximation not valid). 3) OTHER nla ,tl i s revised 9/2/98 Paqe 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 104 ROSEMARY LANE CENTERVILLE, MA 02632 M147 P007 L13 Name of Owner HORMAN Date of Inspection: 9125/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: X I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X _ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n/a. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large.systems in addition to the criteria above: lit The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412). Please consult the local regional office of the Department for further information. revised 9/2/98 Paoe 4 of 11 lit SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 104 ROSEMARY LANE CENTERVILLE, MA 02632 M147 P007 L13 Name of Owner HORMAN Date of Inspection: 9/25/00 RESIDE_ NTIAL: FLOW CONDITIONS Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):n/a Total DESIGN flow: 330 gpd Number of current residents:3 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COMMERCIAUU ISMIeL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow: n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: 1998 System pumped as part of inspection:(yes or no): NO If yes,volume pumped n/a gallons Reason for pumping: n/a TYPE OF SYSTEM" X Septic tank/distribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous inspection records,if any) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other: n/a APPROXIMATE AGE of all components,date,installed(if known)and source of information: #1989 PERMIT 89-29 f Sewage odors detected when arriving at the site: (yes or no): NO r t t revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Paae 6 of 11 .y. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST, Property Address: 104 ROSEMARY LANE CENTERVILLE, MA 02632 M147 P007 L13 Name of Owner: HORMAN Date of Inspection: 9/25/00 Check if the following have been done:You must indicate either"Yes'or"No"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health. X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X _ As built plans have been obtained and examined. Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information, For example, Plan at B4O,H, t X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)J d , X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Paoe 5 of 11 PART C SYSTEM INFORMATION(continued) Property Address: 104 ROSEMARY LANE CENTERVILLE, MA 02632 M147 P007 L13 Name of Owner HORMAN Date of Inspection: 9/25100 BUILDING SEWER:X (Locate on site plan) Depth below grade: 18" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 12" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 8'6"H 5'7"W 4'10"" Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle: 22" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 2" Distance from bottom of scum to bottom of outlet tee or baffle: n/a "How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.THE SYSTEM FAILS,THE LEACH FIELD IS PAST THE EFFECTIVE DEPTH OF LEACHING.PROPER MAINTENANCE FOR SEPTIC SYSTEM IS TO PUMP EVERY TWO YEARS. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet'and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc. n/a to revised 9/2/98 Paoe 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 ROSEMARY LANE CENTERVILLE, MA 02632 M147 P007 L13 Name of Owner HORMAN Date of Inspection: 9/25100 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nla Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order: NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) r; Depth of liquid level above outlet invert: OVER PIPE Comments: (note if level and distribution is equal,evidence,.of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a .1 revised 9/2/98 Paoe 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 ROSEMARY LANE CENTERVILLE, MA 02632 M147 P007 L13 Name of Owner HORMAN Date of Inspection: 9126/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required, location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(n/a)n/a leaching chambers,number: (3)FLOW DIFFUSERS leaching galleries,number: (n/a)n/a leaching trenches,number,length: (0)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool, number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE SYSTEM FAILS TITLE V INSPECTION.THE LEACH FIELD IS SATURATED,THE FIELD HAS NO EFFECTIVE LEACHING LEFT. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a / Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 ROSEMARY LANE CENTERVILLE, MA 02632 M147 P007 L13 Name of Owner HORMAN Date of Inspection: 9/26/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) Y' III DA AA fC � Ala 'a �. PP as 3i revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 ROSEMARY LANE CENTERVILLE, MA 02632 M147 P007 L13 Name of Owner HORMAN Date of Inspection: 9/25/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 10 Feet+ Please indicate all the methods used to determine High Groundwater Elevation:. Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps - Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) UGSS MAPS AND CHARTS-10+FEET E. revised 9/2/98 Paae 11 of 11 V Form 11 -SOIL EVALUATOR FORM �C7 Page 1 Commonwealth of Massachusetts �O Barnstable, Massachusetts Soil Suitability Assessment for On-Site Sewage Pisnosal Performed By: Jason Youneouist(Outback Engineering, Inc.) Witnessed By: Donna Mioranda Barnstable Board of Health) Location, Address,or Lot# Owner's Name,Address,and Telephone# #104 Rose ary Lane r Rab4r} yo<<•.an 10y iLosc,..o�u Lew.e New Construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes Year Published 1993 Publication Scale 1:25.000 Soil Map Unit CcB Drainage Class 1 Soil Limitations none Surficial Geologic Report Available: No © Yes ❑ Year Published Publication Scale Geologic Material(Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes Within 500 year flood boundary No © Yes ❑ Within 100 year flood boundary No 0 Yes ❑ Wetland Area: National Wetland Inventory Map(map unit) N/A Wetlands Conservancy Program Map(map unit) N/A Current Water Resource Conditions(USGS): Month_ September 2000 Range: Above Normal ❑ Normal ® Below Normal ❑ Other References Reviewed: none r Form 11 -SOEL EVALUATOR FORM Page 2 On-Site Review Deep Hole Number 1 Date 10/25/00 Tune: 10:51 Weather Sunny 75° Location(identify on site plan) in front of house lsee site plan) Land Use lawn Slope(%) 1 Surface Stones none Vegetation_ Brass Landform�_ Outwash Plain Position on Landscape(sketch on back) on flat area in front of house next to driveway(see site plan Distances from: Open Water Body 200+ feet Drainage way 40t feet .Possible Wet Area 100+ feet Property Line 25+ feet Drinking Water Well 100+ feet Other N/A feet DEEP OBSERVATION HOLE LOG Soil Other Depth from Surface Soil Texture Soil Color Soil (Structure, Stones, (Inches) Horizon (U.S.D.A.) (Mansell) Mottling Boulders, Consistency, 0"— 14" Fill Gravel 14"—26" A Sandy 10YR 3/2 None loam 26'—40" B Sandy 10YR 5/6 None loam 40"— 120" C Medium to 2.5Y 6/4 Mottles coarse sand @ 90" and gravel Parent Material.(geologic) Glacial Outwash Depth to Bedrock 120"+ Depth to Groundwater Standing Water in the Hole: 108" Weeping from Pit Face: l08" Estimated Seasonal High Ground Water: 9011 Y Form 11 -SOIL EVALUATOR FORM Page 3 Location,Address,or Lot# #104 Rosemary Lane Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole inches Depth to soil mottles 90 inches ❑ Groundwater adjustment feet Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level 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? y� If not, what is the depth of naturally occurring pervious material? Certification I certify that on November 1997 I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise, and experience described in 310 CMR 15.017. Signature Date �i (� r Form 12-PERCOLATION TEST Location,Address,or Lot# #104 Rosemary Lane Commonwealth of Massachusetts Barnstable, Massachusetts *Percolation Test Date: 10/25/00 Time: 10:51 I Hole#Perc. 48"—66" Soak 10:51 oak 11:06 12 11:06 9" 11:10 6" 11:14 Time(9"-6") 4 min. Rate(MinutesJInch) <2 M.P.I. * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed 0 Site Failed ❑ Performed By: Jason Youngauist(Outback Engineering,Inc.) Witnessed By: Donna Miorandi(Barnstable Board of Health) Comments: A f THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH' -a.v�.N....... oF...... rz,..l.s:r- -B c P- 4043 Appliratinn for Dhiposal Workii Tonstrnrtiun thrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: Lac tion Address or Lot No. �. .....-.. .:r-....t-�.aR1--4AA!............................. ..........�S M...L�...R: .0,0 Sf .r M o ........._..._..._. caner / Add Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............3...........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons----_....................... Showers ( ) — Cafeteria ( ) d Other fixtures . W Design Flow..............................155_ __gallons per person per day. Total daily flow..................... .................gal)ons. WZ ee tic Tank—�i�uid capacity/Po O.gallons Length.g_�_._ z`Width. !—/0_."Diameter................ Depth_.S_.'��.`' x D1s� '�i—No......... :........ WidthJP.-:-.0_--.... Total Length...7;?�-=_U~Total leaching area...... PD Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (x) Dosing tank ( ) 0-4 Percolation Test Results Performed by.....R,----'�Q-Ll 6m..-ks....................... Date... ------------ Test Pit No. 1.......q-...minutes per inch Depth of Test Pit..... Depth to ground water.... �J . fZ4 Test Pit No. 2.......&=.minutes per inch Depth of Test Pit.....�a. .. Depth to ground water----- ....� a ....................... O n .. .. ......---ry Description of Soil-- - �°'..` S.,(a...0;,..3SL.. .t0� .%aN.._t�!l�l.......................................................... x W •. ._...--o-.boa----------------s�65a;�✓:.� nI 8_ --�1`t� -me.. `01"-...... .................. 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 TITL LE 5 of the State Sanitary Code— The undersigned furth , grees not to lace t system in operation until a Certificate of Compliance has been is ed by the board of heal Signed................... ...... = ................ ....... . Application Approved B Da PP PP Y 40, .. . ... -- -••...................... Date Application Disapproved for the following reasons----------------••-•--•-•••-•-•------••--•------••--••••----•••••••-•-•---•-••-------•--.............--------- --------------------•-----•------•-----------------•••---•---•------••---•-••----•••-•--�-••-j--•--•-•••.... -•-•---•••••••......_-••--- Permit No.------. qa/........................ Issued.-•-----• ..� .DateDat/ S 1 .......................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 777 V ............OF....... s�i a�) `T',i 6.1: ..... F- 4 e)e- 3 Appliration for Disposal Works Tonstrnrtion rnmit Application is hereby made for a Permit to Construct ( ;) or Repair ( ) an Individual Sewage Disposal System at: Aj ................_.......�..�c..- t, .+ - ......----•-----•-......---•----- --......---•-------•-•------•---..-....i. ! .. ...--•--••----------.._.................. Location Address or Lot No 3 .... r ' + > A. i � 14 Sd&C�4 r vl � !� `J r�r'9 r 1!A /�1. ............................ ....... .......................... --•-fir----................ wner Address a ... dr Y.:. '' ------------------------------------ -f�1 cs' Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............. ..........................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Buildin YP g ------•-----------------•--- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -----------------------•------------------•--••------. -••-•-------------•--•-•------------•----•------------------------•--•-------....--••-------- a :=f`�'' W Design Flow...............................'....`...._.gallons per person per day. Total daily flow.............................................gallons. g . Diameter-------•--•--.-- Depth--- a f� Septic dank—Liquid capacity_'�F�.J�gallons Length...'°�'_.'r.: Width_�`�- ! � --'. e �outi�� ��v��C� �.. a x Da,Sposa Z erteh ec No. .................... Width._?C_:. ...... Total Length___-.-- ___-.r, Total leaching-area.----- soft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (jE) Dosing tank ( ) '-' Percolation Test Results Performed by.....1 ... !%_.t e`s, :A k c,......................... Date.... Test Pit No. 1........a----minutes per inch Depth of Test Pit------ Depth to ground water......35_..8___T1 �-�1 Lz, Test Pit No. 2...........--...minutes per inch Depth of Test Pit......1.%_. _...... Depth to ground water...... axW --•-------•----•�-------,-------..•-----..•-..------ -------------•-- -----•--P----------..--.---'------- /-i----------r--u-•v•s-- Description of Soil.... o 3 -aa ... .............� ..... ............................. ----------•---........................................ --•-•---•-••........................ l------------ ..._ ....................... .... . -t------ V 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:e grees not to lace t system in operation until a Certificate of Compliance has been iss ed by the board of heal Signed.............. --- . - .................. --- - - p ` y Application Approved BY..... p- ` .� -•---••---------------- Date Application Disapproved for the following reasons---------------------•--------•--•••--------------------•-••---•-----•-----------•-------•-----•---••------•-.._ •-------••--•--------•----------------------•-----------••-----------......------•-•.._...------....--------•--------------------•-------••----•------•--......---------•••......--------------...--•--- Date Permit No--------- ._.�. �, ..................... Issued.............. *�/�/ 1...... ...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH J... 1'j. OF �i'SI,.+ ,I�l CS 7 ........... .... �..p ......................................................... krrtifirFatr of ToutpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by................................................................................................................................................................................................... Installer at.........................................----------------------•...----•-....._---•-•--•--------------•-••---•--...••--..._..---• has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code,as described in the application for Disposal Works Construction Permit No............e--- . .. ... dated.....Z. .../—7.-/ 1............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL --FUNCTION SATISFACTORY. DATE............. .......... Inspector................. . .................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ' 1 .............'%!. J AJ..............OF.......Yf,.� / A/5 � �1�L.4: .......................... y No._ FEE.... ' Disposal Works T nstr, ton rrntit Permission is hereby granted........... ----•---• --- •-. . -----• --•----------------•-----------.........----........................ to Construct�� or Repair ( ) an Individual Sew ge Di os System ":y�,, at No.... p..� ...1..�".G'? _,( 4 /.�/1l__.------. . _...... .. ..•--• ...../�!-,�.� Street .A as shown on the application for Dispos Works Construction Permix_.I ¢„_., .......f— Dated.......�.��-.../ ....... ------------- /�� Board -- Health . DATE......... --------- -�-?.�--•------......................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS '"� \ WETLAi4m T DELIIJEATF-p B 4 DAV/D hZcvS S^izms.ConlS.A4cijr 198¢ W�Tl..fwv�I D��tn1EP.�D 8y Att►-�N� W1�.SON �. : hlay. 1986 - ��► FL_ooD ZolJe:S B�L' - / ISoL�°`T� I AP�EO�c Z8 C Y o f P%L L. f" 8 v PFeK ZO0.7E W ETLRtiID S � � � ED6 E C�!oo PT• / :.►� BVPPCR ZONE o qq _ ` - 14 �- �'� CaTc+k• �"NC i EASEM�►aT / � titi 1 �� o l\ I{ lroT 13 F,a a oa goo' \ � 1 � BvrFeft Loam Qj \ t OF NAAWf z 'A LTp �APt��TA�L.t E. V) ` #15223 40 � .h1 D tnl► c 4 M,ASe) . �Al <c`'� o Assoc. �ti,c. RAYaN4A-f Sc �L..E= I=moo' ►7c ,S, � ��3s3 , 37.0 SOW 34 06 ,N r .� P p 1sT gw. 7P17 " 1 LSa n l� 34,49 33•10 33•$ L o dN' 0 33•� LoA W RCo�•-A" l O N ��A-Te,- �,. n � M 1 fJ•l.iN•CI-� s 7 s e TEST' PER�orRmv- 3o•g ' 30" 3�•;' °"' 3o' 3 B �Eg •) 2; t9a S 6 y iZ. air6a,�ks eDROOM•5 )C IIOCgPD t CLEaN :M�b��M I�O C R�RE3�C-�E C R 1 N pEF� VSE �oao�illL. �JEPb7G�f��� "fPlUH C-P.{�,Act'��! PRoVt��U - SSE Two n SAND APT, �1-4VV Or� nsorz5 3D•0 �,,A,e-2 . Toes �oTTOIv� I O.K 2 Z K I , o 26 8—wdL6 r4 IPO 8 . SIDE- ��o +azjz _ � �•96X. 2,s PD 2s•9 P 2 �p� ` 3 7 4 Pp ��SPc�S,41 , S �STc - j1�1 t7 E 5 i G�Jl1 G d i t�J 24.4 In8" .OR DAtJCC WITH PROOS/'oM S OT' o. P -744E MPISS• ENVIRpNMLGNTR L TP' I GaDE . ALA. peS ST c©Nc-P-El - �� N �'�S -rc) RE: W�.�r Ta,��e �-d�v��d N -lo I_D.D.Dt►JG�, -I-o toe It Ai W 23 D ZONE C �.DJ• t3,2 P.4 i L- Cu r.; LoT 13 92osew., n��l Lti� . CC-Fa-T-E�R 0 BENCH MARK: TOP OF FND. ELE.= 34.0 (SAS) SHALL BE 32' LONG — MANHOLE COVERS TO EXTEND TO 14.0' WIDE WITHIN 6" OF FINISH GRADE 6" DEEP 10' MIN. 2% GAS BAFFLE REQ'D NEW DIST. BOX REQ'D NEVV (SAS) 1%31 .50 2" PEASTONE TOPPING 31 .3 W EXISTING 1% ELEV=31 .14 31 .05 D.B. <.. - CAP ENDS 1,000 GAL 30.89 30.72 �:yam: >: ,:::�::�:. �: :::,:��.:'d:.� 30.64 .L:.:,.�_:.: : L .i . �t.:s�: :: LOCUS O ^y �e�• ,ie d'.es .N.¢. .e',d::e.'•d:: e'a::eed;•„Y::"'s: ��l:wej:a Y 10' 6" C USHED TONE ELEV=30.14 e 16' 8' 3/4" to 1 -1/2" DOUBLE WASHED STONE ALL AROUND LOCUS MAP GENERAL NOTES: 20' MIN. -�--`� 32.00' — ELEVATIONS SHOWN BASED ON U.S.G.S. DATUM. USE LEACH TRENCH SOIL TEST LOG 32' LONG 5.04' SYSTEM PIPE SHALL BE EITHER C.I. OR A'��D 14 WIDE PERC RATE= < 2 MIN/INCH WITH 6" D�k:P STONE ALL AROUND — SCHEDULE 40 P.V.C. THE BOARD OF HEALTH SHALL BE NOTIFIED PROPOSED SEPTIC SYSTEM PRIOR TO BACKFILLING OF SEPTIC SYSTEM. DEPTH ELEV.= 32.80 NO SCALE ELEV = 25.10 (ADJUSTED) — SEPTIC SYSTEM STRUCTURAL COMPONENTS 0 FILL 1 .30' SHALL BE CAPABLE OF WITHS7ANDING A 14" N p H-10 LOADING, UNLESS SPECIFIED OTHERWISE 26 A SANDY LOAM 10YR 3/2 ELEV = 23.80 (OBSERVED) — SEPTIC SYSTEM UNDER DRIVEWAYS SHALL 30.63 NOTE: 32 COMPLY WITH A H-20 LOADING. B SANDY LOAM 10YR 5/6 PRIOR TO INSTALLING THE NEW (SAS) THE �� RICE qr 40" 29.46 OC — THE DESIGN AND COMPONENTS OF THE SEPTIC CONTRACTOR SHALL PUMPOUT LEACH PIT f Gqs /NE LIJ SYSTEM SHALL BE IN COMPLIANCE WITH THE C MED SAND 2.5 Y6/4 AND REMOVE LEACH PIT FROM SAS AREA 76 s OUr of STATE OF MASSACHUSETTS SANITARY CODE 108 23.80 I • 71 SOH TITLE V, AND SHALL BE IN COMPLIANCE WITH I Q THE LOCAL BOARD OF HEALTH RULES AND 120" , 22.80 I --� REGULATIONS. SOIL TEST CONDUCTED ON OCTOBER 25, 2000 UO � THE CONTRACTOR SHALL BE RESPONSIBLE FOR �DO• 23, drive Way �-- LOCATION OF ALL UNDERGROUND UTILITIES AND BY OUTBACK ENGINEERING WITNESSED BY,: DONNA, AGENT SHALL NOTIFY DIG — SAFE PRIOR TO YARMOUTH HEALTH DEPARTMENT I i --� a CONSTRUCTION. NO WATER OBSERVED ? 108 I I" 71 G — NO GARBAGE GRINDER 00 o G 1 � �, 14 asf �, �, ,� 1' W DESIGN CRITERIA: I \\ \\ \\ 1 DESIGN FLOW 32, Q O 3 BEDROOMS AT 110 G.P.B. / DAY 330 G.P.D. n A> LL o 10, �c� REQUIRED SEPTIC TANK: EXIST 1 ,000 GAL 6' I SEPTIC TANK PROVIDED NONE �� `r'IP DESIGN PERC RATE <2 MIN INCHR 2 '��7 14'x32' leach field SIZE OF REQ'D (SAS) AREA = 330/0.74 = 446 S.F. I I I 0 1� LEACH FIELD BOTTOM AREA ONLY I I LEGEND: I o i i � � BOTTOM O (14 )(32.0 ) = 448 S.F. I I �� f SIZE OF LEACHING FACILITY PROVIDED: EXISTING CONTOUR --- 24 ---- I �+ I I Vol PLAN � MG. 448 S.F.. EXISTING SPOT ELEV 30X80 I I 156' IMI ' r� I ' <c' _ = 331 .52 GPD WATER GATE W.M. I r I 1 W —W Yz WATER SERVICE 20 TEST HOLE I III EFFECTIVE DEPTH: 6" EFFECTIVE LENGTH: 3 2'GAS SERVICE G G EFFECTIVE WIDTH: 14' BENCH MARK �=,;BM � � � I � � 1-- I — � C� o 00 NOTE: OUTBACK ENGINEERING ADJUSTED `GROUND WATER WAS BASED 321 WEST GROVE STREET I I MIDDLEBOROUGH, MASS I UPON EXIST. ELEV OF SKUNKNET RIVER ELEV = 23.50 (508) 946-9231 I AND THE ELEV OF THE EDGE OF WETLAND PROJECT: SEPTIC SYSTEM REPAIR I� 1\ OR TOE OF SLOPE ADJACENT TO EDGE OF WETLAND ELEV=25.10 FOR 1 I \ NOTE: DWELLING HAS A FINISHED WALKOUT BASEMENT WITH A SLAB scALE: AS SHOWN 104 ROSEMARY .CIRCLE DMW" BY. JP ELEV = 26.4' WITH NO SIGNS OF WATER INFILTRATION. ALSO, THE DAM 10/30/00 MAP 147 / LOT 7-13 REVISED BY. ELEVEVATION JUST OUTSIDE THE WALKOUT DOORIS ELEV=25.73 OWNER: ROBERT HORMAN WITH NO SIGNS OF GROUND WATER PONDING. 104 ROSEMARY CIRCLE MARSTONS MILLS, MASS ME: ROSE