HomeMy WebLinkAbout0138 SOUTH MAIN STREET - Health (2) 138 South Main Street
- - Centerville
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes.
ftpYication for bisposar 6pstent Construction Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.(`3 O SoUTIA Ms4i),i 4;q r T Owner's Name,Address,and Tel.No. t4eorm-i 426L,_b.
Ge-x1'ev✓o I(.c
Assessor's Map/Parcel 20 p 6-7 e
Installer's Name,Address,and Tel.No. f?o ReK ?e3 Designer's Name,Address,and Tel.No.
�d{Pe�c rye �tifi �✓i3' S [�� Trr.,;k(c s-r
Z37 ' 037 1 +� ,�,
Type of Building: fi
Dwelling No.of Bedrooms Lot Size ! Of 3 Zo - sq.ft. Garbage Grinder( )
Other Type of Building S (y No.of Persons Showers( ) Cafeteria( )
Other Fixtures Design Flow(min.required) L4 4;p gpd Design flow provided y(0 Z •3 gpd
Plan Date 7-2ct - Zoo-c; Number of sheets � Revision Date
Title 1 w A 5. ^4-&
Size of Septic Tank I (po !;t4 14-(U Type of S.A.S. �� S T ZIYct�.v�ss T/P�c e3
Description of Soil
® .Otto
Nature of Repairs or Alterations(Answer when applicable) Lion C - j) 7b -7- Box
7-0 ckj"V cg �_� 3 6 4�C
h Date last inspected: fioOct
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 Heal
Si d A Date 1316
Application Approved bi Dates 7
Application Disapproved by Date
for the following reasons
Permit No. G Date Issued 21113
r '1��..,�,_-...4�;,...,�_.•.-.-...*..r'�+n...-w....•.�....._.� ...ar`"+,,,,�" '' .. "`"'"^re-- �, f-,.:-^r, .. •,-....-....N„-e•,,m,-:.-r+...-.•..,--, . .. , •.. ..
;� j `J .��Syr,^ �--, ra � .�, �•, ,� p"a
No. �� '►— Fee -
1 ` Entered in computer:
THE COOMMONWELTH OF MASSACHUSETT Yes
PUBLIC HEALTH DIVISION TOWN,OF��BARN"STABLE, IIIIASSACHUSETTS '
1 m j.k,
2pplitation for 30isposai 6pstem Construction Vertu w
Application for a Permit to Construct( ) Repair Upgrade( )'Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.J j� SOQ Ti-1 Myr(,)., 4;; � � Owner's Name,Address,and Tel.No. N eom ;
Assessor's Map/Parcel -,p o p 8-7 -jR.m e-
Installer's Name,Address,and Tel.No. /P�O 134k ?t,3 Designer's Name,Address,and Tel.No.
J,�,11 � py r"
Type of Building: ' �
Dwelling No.of Bedrooms Lot Size 10, 3 7-0n
0 sq.ft. Garbage Grinder( )
Other Type of Building ,-1c i B fi aaYr,(y No.of Persons Showers( ) Cafeteria( )
J
OtheriFixtures -
Design Flow(min.required)k, H y 7 gpd Design flow provided q(o Z . 3 gpd
Plan Date `7-2 Ci - p y q Number of sheets Revision Date
Title ( 5r
Size of Septic Tank `00 (o Type of S.A.S.
Description of Soil
<00 UtAe1, �' L/r
Nature of Repairs
`ornAlterations(Answer when applicable) �� ,� (���� G� -/, % - f3r3X
c@ t �✓+O C�I+f 41 ism l C Aju 3 k> 4c,
f
Date last inspected: Oct
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
j
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
r '
a Compliance,,has been issued by this Board of Health.— ,,
Si d Date 3 W;.1 (
Application Approved b Date — 0-�
Application Disapproved by Date
for the following reasons
Permit No:_L Date Issued
._ 7 7, - --- - --- - •r. .- - - - - -- ----- --- -- - - - -- - ---THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certifitate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Y ) Upgraded( )
Abandoned( )by (�A C)04 +tea k)ll ig id/t�e S � •��
at 139 Sb.j'V. ,M4 S I(-c e._1 Cc,a,r{r ru(� 9 has been constructed
in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No Z7_, ' dated
Installer ./�-/)o �; (/h �-(�/ /f/,�CS CC Designer tee,,, Cos J r Vic.
#bedrooms (.( Approved des' n flo* gpd
The issuance of this pe if shall not be construed as a guarantee that the system ( 1 functro�n as designed,
Date Inspector ,
..--- •-----•-•------•_•-•-_•- --_•--.-•-.-.--•F.-.---•- .-. -- --
No. Fee _
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS ---
BisposaY *psteat Construction J)ermit
Permission is hereby granted to Construct( ) Repair()() Upgrade( ) Abandon( )
System located at 138 Sn y i (-1 Ai 4,lam S i(-c.c-T
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction mus be completed within three years of the date of thi`�rm'.
Date Approved by
TOWN OF BARNSTABLE
LOCATION Sp ]n�Vh SEWAGE# ZOa S Z 3
VILLAGE ASSESSOR'S MAP&PARCEL o7Q h - O,F 7
INSTALLER'S NAME&PHONE NO. 0?!fi.QcvL& CvJ
SEPTIC TANK CAPACITY 1 SU U
LEACHING FACILITY.(type)r� i la LE 1 3 c u bi M(size) Q) 3 )C yo
NO.OF BEDROOMS 7
OWNER n& n r, L�ay�cft
PERMIT DATE: '._ 1- ®9 COMPLIANCE DATE: -S Z o 69
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Al 6 It 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 �w N� S eS t—L e-
f
G .
Cb) rr
- q
A) 17.E
AZ %b.v 37-
31
�93 \Lo 33 a�,f
TOWN OF BARNSTABLE
LOCATION S% SEWAGE#
,VILLAGE ASSESSOR'S MAP&LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY A
LEACHING FACILITY: (type) 406k' >3C-<Z PI'r (size)
NO.OF BEDROOMS a---
BUILDER OR OWNER bje J>AE J
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the: �n D %�o•�if z S't
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility -so' Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) 44/ Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) V0 Feet
Furnished by Go,-,- 6—va%e
Y
j
17
;c r s4 e ta�
i
F Commonwealth of Massachusettsi�
a Title 5 Official Inspection Form ro
Mr -
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �v
' 138 South Main St.
Property Address
Stephen Giatrelis
Owner Owners Name
information is required for every Centerville MA 02649 11/17/2014
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. General Information
filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Paul Martin
use the return Name of Inspector
key.
Neighborhood Waste Water
4:1 Company Name
350 Main St
Company Address
W.Yarmouth MA 02673
City/Town State Zip Code
508-775-2820 S15016
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
11/19/2014
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
� I
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
r
Commonwealth of Massachusetts
Title 5 Official .Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owner's Name
information is Centerville MA 02649 11/17/2014
required for every tY
page. Ci /Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E!always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
System in good working condition
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired.The system, upon completion of the replacement or repair,as approved by
the Board of Health,will pass.
Check the box for"yes","no"or"not determined"(Y, N, ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
i
t5ins-3113 Title 5 Offidal Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owners Name
information is required for every Centerville MA 02649 11/17/2014
page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y I ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owner's Name
information is Centerville MA 02649 11/17/2014
required for every
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health(and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for 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.
3. Other:
D) stem S Failure Criteria Applicable to All Systems:
Y PP Y
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less
than 1/day flow
t5ins-3/13 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owners Name
information is required for every Centerville MA 02649 11/17/2014
page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis,performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails.The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered"yes"in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304.The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owner's Name
information is Centerville MA 02649 11/17/2014
required for every tY
page. Ci /Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes"or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
El ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
Was the facility owner(and occupants if different from owner) provided with
® ❑ information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 110x4=
440gpd
I
t5ins-3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owner's Name
information is Centerville MA 02649 11/17/2014
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
0
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
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 2012=25gpd
g ( y g (gp ))' 2013=36gpd
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Unknown
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owner's Name
information is required for every Centerville MA 02649 11/17/2014
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
No Records
Source of information:
r Was system pumped as part of the inspection? ❑ Yes ® No
If yes,volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection,of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owner's Name
information is required for every Centerville MA 02649 11/17/2014
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
5 Years per plan on file at BOH
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
28"
Depth below grade: feet
Material of construction:
❑cast iron ®40 PVC ❑other(explain):
+10'
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Line inspected with sewer camera and was found to be clean, properly pitched with no sign of root
intrusion.
Septic Tank(locate on site plan):
20"
Depth below grade: feet
Material of construction:
®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500 Gal H-10
8"
Sludge depth:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owner's Name
information is Centerville MA 02649 11/17/2014
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle 31"
1"
Scum thickness
Distance from top of scum to top of outlet tee or baffle 5
Distance from bottom of scum to bottom of outlet tee or baffle 17
How were dimensions determined? Sludge Judge/Tape
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
1500 Gal H-10 tank in good condition. PVC tees in place and clean. Tank at normal operating level.
Risors on inlet and outlet within 6"of grade.
Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owner's Name
information is Centerville MA 02649 11/17/2014
required for every tY page. Ci !Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage,etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis -
Owner Owner's Name
information is required for every Centerville MA 02649 11/17/2014
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
11
Depth of liquid level above outlet invert 0
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
H-10 DB-3 with 1 line in and 2 lines out in good condition. Box is clean and level with no sign of solids
carryover or hydraulic failure Speed levelers in place and clean.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owner's Name
information is required for every Centerville MA 02649 11/17/2014
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ Teaching galleries number:
® leaching trenches number, length:
2-34.5"x40'
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
2-34.5"x40 leach trenches with 8-ARC 36HC biodiffusors per trench. Units were dry during inspection
with soil being clean No signs of overloading or hydraulic failure.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owners Name
information is Centerville MA 02649 11/17/2014
required for every State Zip Code Date of Inspection
page. City/Town
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
t
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owner's Name
information is Centerville MA 02649 11/17/2014
required for every State Zip Code Date of Inspection
page. Cityrrown
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
t5ins-3113 Title 5 Official Inspection forth:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owner's Name
information is required for every Centerville MA 02649 11/17/2014
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated high depth to round water: +10'6"
P 9 9 feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
� 7/29/2009
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Test hole data per plan on file at BOH dated 7/29/2009. Test hole to 10'6"with no groundwater
encountered. Bottom of leaching at 46". Minimum of 6'8"groundwater separation.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main St.
Property Address
Stephen Giatrelis
Owner Owner's Name
information is required for every Centerville MA 02649 11/17/2014
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
Assessing As-Built Cards age'1`of 2
TOWN OF BARNSTABLE
LOCATION ,_,�$ 5otA4•6_ MaI j, SEWAGE# 200 9-Z-3>
VILLAGE n f P(Oil(A ASSESSOR'S MAP&rrPARCEL -4 U F 7
INSTALLER'S NAME&PHONE NO. O v�elv dt ivk� t(ZQ yfJ B
SEPTIC TANK CAPACITY 1 SU U 0-to
LEACH NG FACIL17T.(type) it, L4 t V— ll u b, (size)S() 3 Y( 9,1
NO.OF BEDROOMS
OWNER nh nwt r dot&A
PERMrr DATE: 7-3 i-a 9 COMPLIANCE DATE: S-5 z o Og
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Al 00 It 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 Of any wetlands exist within
300 feet of leaching facility) Feet
FURNISYED BY Gee a l�2 Ew4C�pl1�ej t_t,t
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http://www.town.bamstable.ma.us/Assessing/HMdispldy.asp?mappar=208087&seq=2 11/11/2014
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
UVSubsurface'Sewage Disposal System Form-Not for Voluntary Assessments
138 South Main Street
Property Address
Neomi Boyden
Owner Owner's Name
information is Centerville MA 02632 11-1-12
required for every
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Imng out t forms
x
>f:When
Riling A. General Information ,tnngrr t�
��t� qti
on the computer, .��`������K OF I_.4S�4�
V
use only the tab 1. Inspector ��` .. ` %
key to move your p o�� �G'
cursor-do not .LAMES James D. Sears 5�5 =Z. •t in
use the return Name of Inspector
key.
Capewide Enterprise,LLC '.�,� & ..s
Idl Company Name C.
153 Commercial Street ry�''��ary r;N11koo,
Company Address
rPm, Mashpee MA 02649
Cifyf1rown State Zip Code
508-477-8877 S 1623
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection.The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
11-1-12
spe tor'sSignature 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.,lf the system is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
""This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•1 V10 Title 6 Of a on Form[Subeurlace Sewage Disposal System-Page i of 17
r
IVOV U-1 lL un:4/p P.z
N Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal! Form- Not for Voluntary Assessments
138 South Main Street
Property Address
NeomIBoyden
Owner Owner's Name
information is Centerville MA 02632 11-1-12
required for every
page. City/Town State Zip Code, Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E l always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are
Indicated below.
Comments:
B) System Conditionally Passes:
❑ one or more system components as described in the"Conditional Pass'section need to be
replaced or repaired.The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for'yes', "no"or"not determined"(Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old" or the septic tank(whether metal or not) is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
tsm Title 5 O1RcW lnapec6on Form:Subsurface Sewage olspcsai System-Page 2 of 17
i
IVOV V-1 1z Vn:4yp N,J
S
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments,
lug,
139 South Main Street
Property Address
Neomi Boyden
Owner Owner's Name
information Is required for every Centerville MA 02632 11-1-12 page. Citylrown State Zip Code Date of Inspection
B. Certifica#ion (cost.)
B) System Conditionally Passes(cunt.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
C) Further Evaluation is Required by the Board of Health: ,
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15-303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
tsk s•11 r1 o Title 5 Ofiidal hrspedon Form:Subsurface Sewage Olspoaal Systan•Page 3 of 17
i
Nov U1 l L UbAdp P.4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main Street
Property Address
Neomi Boyden
Owner Owner's Name
informatrequired for
is Centerville MA 02632 11-1-12
required for every
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier,if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well''.
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or dogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
Ej ® Liquid depth in Is less than 6"below invert or available volume is less
than '/day flow .4"0111A,,d.'
t5ins•11M Title 5 Offidal Inspeotim Forw Subsuftm Sewage Disposal S/slam•Page 4 of 17
Nov U1 12 Ub:4dp p,o
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main Street
Property Address
Neomi Boyden
Owner Owners Name
information is required for every Centerville MA 02632 11-1-12
page. Cityrrown state Zip Code Bate of Inspection
B. Certification (cunt.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ 10 Any portion of the SAS,cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form-]
® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
® The system fails.I have determined that,one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 16,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(interim Wellhead Protection
Area-IWPA)or a mapped Zone II of a public water supply well
If you have answered"yes'to any question in Section E the system is considered a significant threat,
or answered"yes"in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304.The system owner should contact the appropriate
regional office of the Department
t5ins•11110 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 5 or 17
Nov U1 11 U(i:48p p.b
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
138 South Main Street
Property Address
Neomi Boyden _
Owner Owner's Name
information is required for every Centerville MA 02632 11-1-12
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ Were as built plans of the system obtained and examined?(if they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all.system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions,depth of liquid, depth of sludge and depth of scum?
0 ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN Flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440
►5ns•11110 Title 5 Official Inspection Form:Subeurface Sewage Disposal System•Page 6 of 17
NOV U I I L Ub:4,4p P./
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main Street
Property Address
Neomi Boyden
Owner Owner's Name
information s Centerville MA 02632 11-1-12
required for every
page. CityrTown State Zip Code Date of Inspection
D. System Information
Description:
The system is a 1500 Gal Pre Cast Tank D Box and 2 rows of 8 biodiffuser
Number of current residents:
0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)). 2011-16,000Gal2012 1/2-2,000Gal
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: NADate
CommerciaUlndustrial Flow Conditions:
Type of Establishment
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
tsms•11110 Title 5 Official Inspection Form.SWsurrace Seviage Dsposal System•Page 7 of 17
IVOV u 1 "I L ub:4&p P.o
Commonwealth of Massachusetts
Title 5 Official Inspection Form
J - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
138 South Main Street
Property Address
Neomi Boyden
Owner Owner's Name
information is required for every Centerville MA 02632 11-1-12
page. CitylTown State Zip Code Date cf Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: NA
Was system pumped as part of the inspection? ❑ Yes E No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution.box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
ISm•11110 TRIa 5 Otfidal lnspedion Form Suhanfarm Sewage Disposal System•Pape 8 of 17
NOV u i .i t uo:4yp
Commonwealth of Massachusetts
Title 5 Official inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
° 138 South Main Street
Property Address
Neomi Boyden
Owner Owner's Name
information a Centerville MA 02632 11-1-12
required for every
page. Citylrown State Zip Code Dale of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
2009 Permit # 2009-235
Were sewage odors detected when arriving at the site? ❑ Yes No
Building Sewer(locate on site plan):
Depth below grade: 31
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.):
Pipeing is 4" PVC SCH 40
Septic Tank (locate on site plan):
Depth below grade: 27"
feet
Material of construction:
®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) 'El Yes ❑ No
Dimensions: 1500 Gal Percast
Sludge depth: 1
ts:ss-ttna Title 5 Cnciat mspection Farm:Subsurface Sewage Disposal System-Page 9 of 17
Nov U1 Iz ub:SUp p,Iu
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main Street
Property Address
Neomi Boyden
Owner Ownees Name
information is required for every Centerville MA 02632 11-1-12
page. Ciryrrown State Zip Code Date of Inspection
D. System Information (cont.)
.Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
29"
oilScum thickness
Distance from top of scum to top of outlet tee or baffle
8"
Distance from bottom of scum to bottom of outlet tee or baffle 18"
How were dimensions determined? Asbuilt- Plan-TapeSludge Judge
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank at 27 w/covers at 1% Tank at working level w/in and outlet tees, No sign of leakage or
overloading
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: Hate
l5ins•11l10 Tole 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17
lvov u l -i z ue:oup P.I I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
138 South Main Street
Property Address
Neomi Boyden
Owner Owners Name
information is
required for every Centerville MA 02632 11-1-12
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert,evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: galiDns per day
Alarm present: ❑ Yes ❑ No
Alarm level: -- Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
'Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
15ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposa;Systertc•Page 11 of 17
Nov 01 12 06:50p p.12
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main Street
Property Address
Neomi Boyden
Owner Owners Name
information is
required for every Centerville MA 02632 11-1-12
page. City/Town State 7 Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D Box is 16"x16'-34"below w:/cover at 16", Box is clean and solid w/two lines out, No sign of
over loading or solid carry over
Pump Chamber(locate on site plan):
Pumps in working order. ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments(note condition.of pump chamber,condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•11r10 Title 5 ofidal IrtspecAon Form:Subsurface Sewage Disposal System•Page 12 of 1 T
IVUV U I I L U0.0 I IJ - P. 10
Commonwealth of Mass chu e a s tCs
Title 5 Official Inspection Form
- -- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
v
138 South Main Street
Property Address
Neomi Boyden
Owner Owner's Name
information is Centerville MA 02632 11-1-12
required foravery
page. Cityrrown state Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number.
16
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number,dimensions:
❑ overflow cesspool number:
❑ innovative/altemative system
Typetname of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leaching is two rows of 8 Biodiffuser "ARC 36 HC" stone less, Chambers are 40"below
grade, Chambers are clean and dry, No sign of over loading, solid carry over or holding water
Cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins-11110 Tifle 5 official Inspecllon Farm;Subsurface Sewage Disposal System-Page 13 of 17
Nov U1 1'L Ub:b1 p P. t4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main Street
Property Address
Neomi Boyden
Owner Owner's Name
information is required for every Centerville MA 02632 11-1-12
page. Citylrown State Zip Code Date of Inspedion
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids -
Comments (note condition of soil, signsof hydraulic failure, level of ponding, condition of vegetation,
etc.):
gins•11/10 Titla 5 Official inspection Form:Subsurface Sewage oisposal system-page 14 of 17
ivov u I i Z Uo:a 1 p P.I a
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,
138 South Main Street
Property Address
Neomi Boyden
Owner Owner's Name
information
required for every Centerville MA 02632 11-1-12
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
{
Y1
0 1
a
�R aN-r
� `l ' lT7J
8--/=3 9
104''2_� r�s R,2: 3/
A • % �/
tsuu-11110 Tines offidal Inspection Form:Subsurfaoe Sewage Disposal System-Page 15 of 17
ivov U I I t Ut:):a/_P P.,v
r
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
138 South Main Street
Property Address
Neomi Boyden
Owner Owners Name
information is required for every Centerville MA 02632 11-1-12
page. City/Town State Zip Code Date of Inspedion
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
® .Check cellar
❑ Shallow wells NO
Estimated depth to hig 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: 6-13-09pate
❑ 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:
T.H on Design plan 6-13-09 126' No G.W., Bottom of chambers at 56", 70"above T.H. Depth
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
15'ns•111`10 Title 5 Official Inspedion Form:Subsurface Sewage Disposal System-Page 16 of',7
Ivov u-i I z utD:otp p.l t
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
138 South Main Street
Property Address
Neomi Boyden
Owner Owner's Name
information is required for every Centerville MA 02632 11-1-12
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary:A, B,C, D, or E checked'
® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
ISlns•i 1/10 Tlae s OTMdal Inspeaton Form:SuCsurtaoe Sewage Dispoaal System-Page 17 of 17
of�
Town of Barnstable P#
Department of Regulatory Services
' 'tea Public Health Division ( d
Date 6 U
200 Main Street,Hyannis MA 02601
Date Scheduled I U / Time C V$'t► Fee Pd. C ov
Soil Suitability Assessment for Sewage�D-sposal
Performed By: �`"C4A f 1�pil kt,( f 2T, C.56 Witnessed B : A 3 i j_ /C
LOCATION& GENERAL INFORMATION,
Location Address Owner's Name A)4o✓ i' J
�38 So�T� Ma�� s�, �� a�
C.2 en t ✓�< (t a Address P O 13&- 3 Zro
Assessor's Map/Parcel: Z o'6(D? ,/ Engineer's Name G �+ 5G L 19ce7 1n5� tci C
NEW CONSTRUCTION REPAIR " pe0 I d sob-. . 31
77
Land Use 5if1$I a FOB^`( /re-Add 70 Slo
Y Pes(R'o
) 0 Surface Stones
Distances from: Open Water Body - ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line I 0 ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
1d.
Sce. a(oct,-u Q(cb, Ja(e_� 1- 29 0
Parent material(geologic) emu°"�n Depth to Bedrock 7 l 2(9 bs S
Depth to Groundwater: Standing Water in Hole: i 2(o' bg s Weeping from Pit Face (26 F's 5
Estimated Seasonal High Groundwater 10 g 5
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: 011ec,l- 0b:u0c(1<4 .
712l0 y t24
Depth Observed standing in obs.hole: in. Depth to soil mottles: In.
Depth to weeping from side of obs.hole: v 2 In, Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj,Netor Adj.Groundwater Level-
PERCOLATION TEST Date '-/ =09 Time/0 4-11
Observation .
Hole# Time at 9"
Depth of Perc e/D S8 Time at 6"
Start Pre-soak Time @ /0-% f2� _ 'rime(9"-6")
End Pre-soak JG':2 2 fl fl
Rate MinJinch G 2
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Al
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:4SEPTl0PERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole# t
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) , Mottling (Structure,:Stones;Boulders.
n iste ravel
Iv« s/6 -
yu iZb G I?ICS 2.5 i b%
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.% ravel
�0l:
d-/ZG G h CS 2, .r Y 6/b r /oust
DEEP OBSERVATION HOLE LOG ' Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Cnite el
DEEP OBSERVATION HOLE LOG Hole# -
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistency.
Flood Insurance Rate Man:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No '� 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? ` e.S _
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on J c''Z 7,9 9 (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 traiWexperda;and;�eerience described in 310 CMR 15.017.
Signature Date 7-Z
Q:\.SBPTICIPERCFORM.DOC
TOP OF FOUNDATION = 52.2'± INISH GRADE OVER D-BOX= 51 .0± " o/o GENERAL NOTE S
PROVIDE CONC. RISER WITH 4 SCHEDULE 40 PVC MIN. SLOPE 1 FINISHED GRADE OVER DIFFUSERS = 51 ,1' - 50.7�
COVER OVER INLET& OUTLET FINISH GRADE OVER TANK EL.= REMOVABLE WATER-TIGHT COVER OVER SLOPE @ 2% MIN. 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
FINISHED GRADE TO WITHIN 6"OF F.G. 50.9,+ INSPECTION PORT WITH ACCESS BOX TO
METHODS SHALL ACCORDANCE
@ FOUNDATION - 51 .0'± RISER TO WITHIN 6"5" DIA. OUTLET(S)OF FINISHED GRADE WITHIN 3"OF F.G. (ONE PER TRENCH) CODEAND ANYAPPLICABLELOCAL RULES TITLE 5 OF THE STATE ENVIRONMENTAL
_ _O
20"MIN.ACCESS 36"MAX. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
COVER(3 TYP.) 9" MIN. f DESIGN ENGINEER.
EXIST. SEWER PIPz: I 9"MIN. I "
MAX. 9"MIN.
3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
PROP. PVC 36
@ 3" DROP MAX. 3„ 9 PROVIDE WATERTIGHT
SEWER PIPE 36" MAX. TOP OF SAS/ B.O. = 48,08' SYSTEM UNLESS OTHERWISE NOTED.
MIN.SLOPE 1% 6" 3" 2" DROP MIN. ,..- 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
--- __
JOINTS (TYP.) ELEVATION =48.08' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE AS. UNLESS A
PROP. PVC 10" == 4 PVC IN FROM 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
4 .25 SEPTIC TANK 4 PVC OUT TO 1.33 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
SEWER PIPE 14" - 8 ' " n10.1"TYP
*49.0,,± O LEACHING FACILITY (TYP.) 6 TYP o
48.50� " ' 0.90 5. SLOPE ALL SOLID PIPE AT 1.0 /o MINIMUM.
12" 6" 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
48" OUTLET TEE 48.00 MIN. 47.$3
47.65' 46.75' (LAID FLAT) 2.875'(34.5") 5.75' -I 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
22"ZABEL FILTER MODEL 6"CRUSHED STONE 5.0' (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
13.0'TO FND #A1801-4x22(GAS OVER MECHANICALLY (TYP.) 11.50' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
BAFFLE ON BOTTOM) COMPACTED BASE 5'MIN. AND DESIGN ENGINEER.
6"CRUSHED STONE 5 OUTLET DISTRIBUTION BOX 40.0'(TYP FOR BOTH TRENCHES) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 52.00' ESTABLISHED
OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE ON A NAIL SET IN A FENCE POST AS SHOWN ON PLAN.
COMPACTED BASE C C C BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 40.50' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
PROPOSED 1500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
LENGTH 10' 6" WIDTH 5' 8" DEPTH 5' 8" (Dimensions per Wiggin CROSS SECTION VIEW BIODIFFUSER (PROFILE) G BIODIFFUSER (END VIEW)' 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
SEPTIC TANK PROFILE Precast Corp.,Pocasset,MA) 16 - ARC 36HC #3616BD BIODIFFUSERS TO THE DESIGN ENGINEER.
*CONTRACTOR TO VERIFY ELEVATION DISTRIBUTION BOX DETAIL 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT.
NOT TO SCALE NOT TO SCALE NOT TO SCALE
1. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
•�� " ' • ^`�' ,� " 11 1 TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
• • •• • •�`�`; • •* • • PERC NO. 12623 APPROPRIATE AUTHORITY.
«`\ '�r « • • ?b j INSPECTOR: David W.Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
• to LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
•r • s JJ
• ) • EVALUATOR: Michael Pimentel, E.I.T. THEY SHALL WITHSTAND H-20 LOADING.
. eech t C.S.E.APPROVAL DATE: Oct. 1999
° DATE: July 13, 2009
13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
f► ` •• • • TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
a ff�t ' o•• «+ -41 • • ' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
• « I ELEV TOP= 51.00,
• l • REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
ELEV WATER
•• •• • /jt <40.50' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
MAP 208 • =
' • • ! 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
n APPROXIMATE LOCATION OI �et•ry . • • • ! PERC RATE _ <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
0 G
• =EXISTING CESSPOOL & LEACHIN
a PIT TO BE PUMPED AND FILLED L OT - • � ' • • • " a
'
DEPTH OF PERC 40"-58"
� ��. ; 16. PROPOSED PROJECT IS LOCATED WITHIN:
rn WITH CLEAN, COARSE SAND �` • •� � I
Y 4
p N87°23'50"E ""i) # TEXTURAL CLASS: 1 ASSESSOR'S MAP 208 PARCEL 087
• • • • > •
0° S87°23'50"W -
Z 75.00' `I o r,- ' • '� ` OWNER OF RECORD: NEOMI J BOYDEN
a 21
oo w • 4 T • = ADDRESS: 138 SOUTH MAIN STREET
o o ` « !• II • • �' i 0" Fill 51.00' CENTERVILLE, MA 02632
• •-X-X- - „ • �� 4" 50.67'
LP ��-�- 50x3 rri U
c€ PROPOSED 1,500 GALLON SEPTIC TANK
50 LANDS
'TONE WALK "� Benchmark B CAPE ARc=a ` • •
DECK Loamy Sand FEMA FLOOD ZONE C
GAS -� PAT(O I� ' +►�i�
O O O _ 3k Nail Set in Fence Post • . ►` 10Yr 5/6 COMMUNITY PANEL# 250001 0008 D
J�1 C/�S� 0, 10. Elev. =52.00' 40" _ 47.67' 17. DEED REFERENCE: DEED BOOK 2805, PAGE 156
O o BH �3. �� Approx. M.S.L. Perc 'x
,`�C/ .� \ �5 _ K„q , 'o • =:t 18. PLAN REFERENCE: 1.) PLAN BOOK 90, PAGE 77 2.) PLAN BOOK 96, PAGE 151
�- ��Q' °(� h� INV.=49.2't • • � I 58" 46.17'
p ��` ��' #138 11 10.0' PROPOSED DISTRIBUTION BOX 1 • • I {f �'p 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
S� EXISTING , TP 1
4Q -C 4-BEDROOM I % • • ` 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
L_ _ PROP. TOTAL 16 ARC 36HC BIODIFFUSERS FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
DWELLIN(. ' 51 0 - Medium Sand
(8 BIODIFFUSERS EACH TRENCH) �. � + � • . � + C
TOF = 52.2'± I o ' • j i 2'5Y 6/6 , FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
g• ti I (loose) I
TP 2 4 • �` ,,,. = 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405, THE FOLLOWING LOCAL UPGRADE
��<} N. PROPOSED INSPECTION PORT WITH APPROVAL IS REQUESTED FROM 310 CMR 15.211:
> 51.0' ACCESS BOX TO GRADE (TYP OF 2) (1.) AN 8.3'WAIVER(20.0'- 11.7') FOR THE SETBACK FROM THE PROPOSED LEACHING
� PROGEOME LINER-"' LOCUS LIO i£ a s�� '� FACILITY TO THE EXISTING FOUNDATION.
MBRANE I
MAP 208 _52� PLAN
I
LOT 87 3 . ,z SCALE: 1" = 1000'
Q320 S.F. ± ISTONE DRIVE \ � � 75't m MAP 208 126" 40.50'
1
\ I 11.5 LOT 88 No Mottling, Standing or Weeping Observed
7�� � -52` �/ ' :-4
51x` 1x6 DESIGN DATA TEST PIT DATA LEGEND
1cps.
`s S87o23'50"W BIT WALK
S87°23'50"W 51x
75.00' PERC NO. 12623
colvc.APRON - -- INSPECTOR: David W. Stanton, R.S.
52/ - 50x0 EXISTING SPOT GRADE
EDGE OF PAVEMENT NUMBER OF BEDROOMS (DESIGN) q EVALUATOR: Michael Pimentel, E.I.T. _ _ 50 _. - EXISTING CONTOUR
1 C.S.E. APPROVAL DATE. Oct. 1999
DESIGN FLOW 110 GAUDAY/BEDROOM
138 SOUTH MAIN STREET \ TOTAL DESIGN FLOW 440 GAL/DAY DATE: July 13, 2009 5o PROPOSED CONTOUR
(40'WIDE LAYOUT) s DESIGN FLOW X 200 % = 880 GAUDAY TEST PIT#: 2 ❑/H/W - EXISTING OVERHEAD UTILITIES
ELEV TOP= 51.00'
USE PROPOSED 1,500 GALLON SEPTIC TANK W W---- EXISTING WATER LINE
❑/H/W-❑/H/W-❑/H/W-❑/H/W- ELEV WATER- <40.50'
❑/H/W--❑/H/W-.-°/H/V---°/H/W--[I/H/W--(LH/V �/H/W--0/H/W (1 (2 -
PERC RATE = TEST PIT LOCATION
DECK PATIO" O
INSTALL 16 - ARC 36HC (#3616BD) BICIDIFFUSERS DEPTH OF PERC= O O O PROPOSED 1,500 GALLON SEPTIC TANK
BH
TEXTURAL CLASS: 1
HG1 (4 (3 SYSTEM CAPACITY PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE
#138 -
EXISTING ❑ PROPOSED DISTRIBUTION BOX
4-BEDROOM (TOTAL L.F. OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD 0" 51.00'
DWELLING (80.0')(7.8 SF/LF)(0.74 GAUSQ.FT.)= 462.3 GAL. LEACHING/DAY Fill
4" 50.67' � PROPOSED ARC 36HC (#3616BD) BIODIFFUSER
TOF - 52.2'+_ HC-
TOTALS: B Loamy Sand
10Yr 516
TOTAL NUMBER OF BIODIFFUSERS: 16 40" 47.67'
TOTAL NUMBER OF COUPLINGS: 0 REV. DATE BY APP'D. DESCRIPTION
TOTAL LEACHING AREA: 624.7 SQ.FT. - -
TOTAL LEACHING CAPACITY: 462.3 GAL./DAY PROPOSED SEPTIC SYSTEM UPGRADE
(5 (6
Medium Sand PREPARED FOR:
C 2.5Y6/6 CAPEWIDE ENTERPRISES
NOTE: (loose)
SWING-TIES SCALE: 1"=20' EFFECTIVE DEPARTMENT FH ING AREA OF 7.80 SF/LF OBTAINED FROM THE LOCATED AT
ENVIRONMENTAL PROTECTION APPROVAL LETTER
NOTE: DESCRIPTION HC-1 HC-2 "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO 138 SOUTH MAIN STREET
ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST CENTERVILLE MA 02632
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP SEPTIC COVER IN (1) 15.7' 35.6' MODIFIED OCTOBER 30, 2008). TRANSMITTAL NUMBER=W000052.
EDGE OF EACH SEPTIC SYSTEM COMPONENT. SEPTIC COVER OUT(2) 22.2' 38.9' 126"1 1 40.50' SCALE: 1 INCH = 20 FT. DATE: JULY 29, 2009
0 10 20 40 80 FEET
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE BIODIFFUSER CORNER(3) 24.5' 29.2' No Mottling, Standing or Weeping Observed
LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE BIODIFFUSER CORNER(4) 14.2' 21.2' tHOF4l PREPARED BY:
CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. RESERVED FOR BOARD OF HEALTH USE o?�'�` ` • JC ENGINEERING, INC.
REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS BIODIFFUSER CORNER(5) 49.4' 25.4' �� CHO R HILL �' 2854 CRANBERRY HIGHWAY
ARE NOT CONSISTENT WITH TEST PIT DATA. BIODIFFUSER CORNER(6) 53.3' 32.4' C'�4 EAST WAREHAM, MA 02538
SITE PLAN
3.) PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS. 508.273.0377
I SCALE: 1"=20'
Drawn By: MCP Designed By:MCP Checked By JLC __i JOB No.1642