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0025 SAIL-A-WAY - Health (2)
S Sail-A-Way Centerville P A = 230 098 f �QE�YCtfpco J y�, All UPC 12534 No.2�3 OR k°osrcoNS°� NA;TINGI,MN TOWN OF BARNSTABLE ai`JCATION -Z 5 Sa\ A tx (1 SEWAGE# 2015 • LJO) VILLAGE Or-r—Ar u'.rt 11+✓ ASSESSOR'S MAP&PARCEL �30 09 INSTALLER'S NAME&PHONE NO. J;'6 3 EXCaVa-� i O✓� SEPTIC TANK CAPACITY /OO® gca.I LEACHING FACILITY:(type) 500 go,) L C- Z�) (size) 13 x ZS x 7- NO.OF BEDROOMS 3 OWNER � 1-Ic�rno.tl PERMIT DATE: 1 f-/Z -I s 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 3� _ 28►L�� � �� W��i: AZ )$ ► R AS- 33�L�. O 2 B3" Z$ r 1 A4+ �� -------------- �-zs ��.hrcyr `+!MNIri► No. Z0`5 14® ' Fee . 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:�� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for disposal .6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. pis )CUI--A Jet,/ er's Naamee,Ayddress,and Tel. No. Assessor's Map/Parcel .� V — ' (� ��U /� rma 1 5Q q-z?2—,5 oo Ins Her's Name Addre ,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(min.req .red) D gpd Design flow provided gpd Plan Date I f r D rJ Number of sheets Revision Date Title Size of Septic Tank e-X 15 f 1 nQ, Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) WO O (Q C 2 5-DO (hQ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board H lth. Si 9" Date 11/10t j� Application Approved by Date Application Disapproved b Date for the following reasons Permit No. 7,p I �D I Date Issued l 4 No. 4/L�'�� �O ' Fee—. O ` uter: THE COMMONWEALTH OF MASSACHUSETTS Entered in corn P Yes 4 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Bisposat 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (9 5 a iL- A WA V Ora er's1N�amee,Address,and Tel.No. � Assessor's Map/Parcel 0 / �(� �7 --Installer's Name Addres ,and Tel.No. Designer's Name,Address,and Tel.No. [31 G �XC(j c 0_f oO 5Dk-/-177- 0653 tOo-%-2 cb 609 .36k/ - 6 R9 � ' 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(min.req fired) V gpd Design flow provided gpd Plan Date ) 1 0 l 0 5 Number of sheets Revision Date Title Size of Septic Tank 0O(�QGj Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Wo d' bO v; (2�� S o 0 QQ-1 r-ho(Yl bl-j..S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this BA.. H SIRR Date 11 I►©1 M`� Application Approved by Date - Application Disapproved Date for the following reasons Permit No. �� `j, (7 Date Issued / ---------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site 1Sewagge Disposal system Constructed( ) Repaired(/) Upgraded( ) Abandoned( )by t r XC n V(.0 t o n ) w L at o15 S o i l-A- w A V v j t(-f has been constructed in accordance r - ) with theprVi ons of Title 5 d-the for Disposal System Construction Permit No. dated WJ7 Installer k,(� 1 (f'&V Designer 15c f) '7[Q #bedrooms Approved desi:�Co_tiwo gpd iThe issuance of this pe it shall not be construed as a guarantee that the system wi. design"dDated Inspecto K J -------------------------- ------------------- ) _ `` . No. / �"(1l,10 Fee 1p�W THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION— BARNSTABLE,MASSACHUSETTS Misposal 6, pstpm Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at r �.J C{( L V\t \1!F�( 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. t Provided:Construction must be completed within three years of the date of this permit. Date /�2� 7 Approved by Town of Barnstable F, ,o,�, . o Regulatory Services Richard V. Scali,Interim Director BAMSTABM 9�A 6� 1�$ Public Health.Division �F1639. Thomas McKean,Director 200 Maier Street; Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 41D l5 Sewage Permit# 20(S— H Dissesso.r's Map\Parcel 230/98 Designer: David Coughanowr Installer: 155 George Ryder Rd South Address.; rr � -E Dbf(f\j iLUL_,e_ Chatham, MA 02633 12L On t 1�-�15 _ o_4 vas issued a permit to install a (date) (installer) septic system at 25 Sail-a-Way' based on:a design drawn by (address) David D. Coughanow ,, RS dated November 10, 2015 (designer) X 1.certify that.the septic.system .referenced above was installed substantially according to the design,:which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. :1 certify that the septic system referenced above was installed with major changes (i.e. greater than 10" lateral relocation of the SAS or any vertical,relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. certify that the system referenced above was constructe i ce with the terms of the I\A approval letters(if applicable) wQ� DAVID a n D. COUGHANOWR (Installer's SignatL e) No. 1093 � o I SVU on,� (1 9 /S T ERF S4NI rARtt'N (Designer's Signature) (Affix Design amp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Fonn.Rev 8-14-13.doc LO CATION SEWAGE PERMIT NO. �-) VILLAGE INSTA LLER'S NAME i ADDRESS r c i --IT PP— Li 7 m - • UI DER OR OWNER u — I- 0 A T E PERMIT ISSUED DATE COMPLIANCE ISSUED l 1 � L oT 8? SME T Town of Barnstable Barnstable • y .� Regulatory Services Department - , - V k P MASS 0 D "�'. 539• Public Health Division on m " 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL 47015 1200 0001 0358 6999 November 10, 2015 Peter S Herman 25 Sail-A-Way Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 25 Sail-A-Way, Centerville,MA was last inspected on October 8,2015 by Matthew F. Gilfoy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code 360-9.1) You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. a R OF THE OARD OF HEALTH ean, R.S., CHO Agent of the Board of Health QAL.etter Septic Inspection Failures or Future Eva1\25 Sail-A-Way Cent Nov2015 Parcel Detail Page 1 of 3 f � `V1 � �' r , � . r�i�/9� Logged In As: Parcel Detail Monday, November 9 2015 Parcel Looku p Parcel Info Developer Parcel ID g230-098 � � �f Pot,LOT 4C Location 25 SAIL-A-WAY � Pri Frontage 1256 Sec Sec Road FPHF LANE �� Frontage1µ84 I villageCENTERVILLE Fire District!C-O-MM w Town sewer exists at this address INO _a � Road Index 11403 ` �., Q- Asbuilt Septic Scan: InteracMavP ' f 230098_1 '-v . Owner Info Owner ILIADIS,ANNIKA& HERMAN PETER S � Co-Owner Streets r25 SAIL-A-WAY . . Street2 City 10ENTERVILLE �� state KAD zip(.02632 Country Land Info Acres 0 46 ) use,Single Fam MDL-01�� zoning RD-1 —�j Nghbd F0105 � Topography,;eyel - I Road FPaved . utilities I Public Water,Gas,Septic Location Construction Info Building 1 of 1 Year 1984 " - RooffGable/HipAI ExtClapboard � Built° Struct Wall Living1604 I Roof AiAsph//F GIs/Cmp ( AC 1Central J its Area Cover Type ' Z ; Colonial Int D wall Bed 13 Bedrooms Style � 1s Wall Rooms. 4, : Model Residential Int 4 Pete Bath 2 Full-1 Half Floor Car Rooms _ FCf$' PrIS�1" Grade Z ra a Plus Heat Hot Water Total Rooms 9 ( Type � Rooms_ o stories f 2 Stories �� Heat Gas Found- Poured Cone c. �� ��" o� s Fuel ation Gross 3564 Area 3® Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=16389 11/9/2015 I ti 0 � Town of Barnstable + HARN3IABLE, �p �9 ,m� Regulatory Services Department TED MA'S� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. o Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation l ❑Any portion of the cesspool within a Zone 1 to a public well ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) �eaching pit or cesspool with high liquid level, <12"below inlet(per Town Code 360-9.1) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name -J-1 information is requiredCenterville for every Ma 02632 10-8-15 ',,, page. City/Town State Zip Code Date of Inspection M5: I 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 15/ on the computer, use only the tab key to move your 1. Inspector: cursor-do not Matthew F. Gilfoy use the return Name of Inspector key. B&B Excavation —I Company Name 14 Teaberry Lane Company Address LA Sandwich Ma. 02644 City/Town State Zip Code (508)477-0653 S113640 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 i ❑ Needs Further Ev luation by the Local Approving Authority 10-8-15 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board j of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or j has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the I 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. i i ****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 ithe same or different conditions of use. i t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 � �e r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i M 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) i Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ( ❑ I have not found any information which indicates that any of the failure criteria described I in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: i I 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): e t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 page. CitylTown 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): i ❑ 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 L15ms•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 M 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 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) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ® El clogged 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 nor cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Y 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ M 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 ;M 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 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 ava ilable ilable note as N/A® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 ` Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts 4 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 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 Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d see below 9 ( Y 9 (gP ))� Detail: 2013-66,000gallons 2014-67,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: current 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: 4 t5ins•3/13 ` Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner- pumped past month 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 M 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: repair completed 1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 2 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 2" 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 gallon h-20 011 Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 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 0" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 0" 11 Distance from bottom of scum to bottom of outlet tee or baffle 0 How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order with liquid level equal with outlet invert. Tank is not in need of pumping at this time as tank was pumped this past month. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan).- Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 �. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 1 I Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): At time of inspection D-box is in working order but is h-10 and a small portion is under driveway. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order. ElYes ❑ 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: i 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 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 1 ❑ 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.): At time of inspection leaching was in hydraulic failure. System was backed up into pipe between d- box and leaching area. SAS with need to be replaced. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)-. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 ' page. City/Town State Zip Code Date of Inspection D. System Information (Pont.) 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 *�4 �x7 Way h wk t f I I. � I fi f T Si a 'l qqdt f ¢' S � l h _ 9f�".tiMc y,u � i 4 t5ins-3/13 Title 5 Official Inspection Form: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 ,N 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is required for every Centerville Ma 02632 10-8-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 7.5 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: Permit dated 12-30-1996 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: Permit on file with BOH 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 _ w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 25 Sail-A-Way Property Address Peter Herman Owner Owner's Name information is Centerville Ma 02632 10-8-15 required for every page. City/Town 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 VE Town of Barnstable P# Department of Regulatory Services rwwarnar$ Public Health Division Date D l 9 MAM 200 Main Street,Hyannis MA 02601 Date Scheduled Time T°T Fee Pd.— ©Q + " 2/39 Soil Suitability Assessment for Se ge is osal Performed By: I RV) D 60 UGN4VVW 1, Witnessed By: � Je` J (n,1, R-- LOCATION&.GENERAL INFORMATION Location Address 2-5 (;q� 1/, � IW � _ `'y,y Owner's Name pe+p f p�n cemlcn—V'IIl ✓L Address �-5 a Assessor's Map/Parcel: ' n / (, D Engineer's Name I XVA l..61 J dl. aJ 3 � NEW CONSTRUCTION / REPAIR /Telephone# Ser6 364� 0,)Mr Land Use /(,(pV]T t Slopes Surface Stones Distances from: Open Water Body L 0 0 ft Possible Wet Area/��0+ ft Drinking Water Well & ft /V Drainage Way ft Property Une ` -f ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands(n proximity to holes) I r_j F� �j �N Parent material(geologic)r6W 6 10 l CL" rMa S h Depth to Bedrock Depth to Groundwater. Standing Water in Hole: U.©k I Weeping from Pit FAce h Estimated Seasonal High Oroundwater '3 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: yno tl te5 Depth Observed standing in obs.hole: In. Depth to soil mottles: 40" oil Depth to weeping from side of obs.hole: In, Groundwater Adjustment - ft. Index Well-# Reading Date: Index Well lcvol Adf.fttor, q. AdJ,GroundwaterLevel,.,,e, PERCOLATION TEST DA u G/t' Thna c(p'�A Observation Hole# Tinto at 9" Z I- 10 r! Depth of Perc �2� t� Time at 6" 27' Start Pre-soak Time® 'lime(9"4") "2- End Pre-soak 15 ©� Rate MinJlnch . i' Site Suitability Assessment: Site Passed ` e 5 Site Failed: Additional Testing Needed(Y/N) 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 Conseirvation Division at least one(1) week prior to beginning. Q:\SEPTIWERCFORM.DOC rs DEEP-OBSERVATION HOLE LOG Hole# l Depth from Soil Horizon Soil Texture Soil Color Soil- Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones,'Boulders. orisistency.%Oravel) IL-L �-- t2 - 20 P Loam C,4qd If 8P— 3/2 2-0 - 4-2- F5 vt/ L.ogmy' SA' q 10 `fir;g 6le tZ-l20 C-- I-MvK 6 Y. 10 �R 5/4 rtt'q bye DEEP OBSERVATION HOLE LOG Hole# 2 Depth from Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. mm Consistency,% .v710 I L•L - to-t10 A L©oM 4 5 10 fZ 3/7- �Joo �rJgb lv Co,Ph (�4h ©q(- G1� Ft,14161P . 13 (20 L04M C,/14 to 1? -5l4 IF DEEP OBSERVATION L. N HOLE LOG . Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. r , DEEP OBSERVATION HOLE LOG Hole•# Depth from Soil Horizon Soil Texture Soil Color Sail Other Surface(in.) (USDA) (Munsell) Mottling; (Structure,Stones,Boulders. Consistency, t _ � 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? `fie 5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on W°'' 4 S(date)I have passed the soil evaluator examination approved by the y;�T Department of Environmental Protection and that the above analysis was performed by me consistent:vutittaF MgSs the required training,expertise and experience described in�10 CMR 15.017. DAVID q�4, C r b Signature �> Date �J&J -„ •N ..,�?UGHANOIIUR SEa o4q- VALUP� Q:\SEPTIOPERCFORM.DOC s'4 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP PARCE4 ®� LOB° '.. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 25 Sail A Way RECE--IVI=D Centerville MA 02632 Owner's Name: Chelsea Thompson MAR 10 2004 Owner's Address: Same Date ol'lnnspection: February 17,2004 TOVV'HEALTH DEPT. Name uI Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing;Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Teleph3ae Number: 508-428-1779 CERTIFICATION STATEMENT I certit-ibat I have personally inspected the sewage disposal system at this address and that the information reported below i 3 true,accurate and complete as of the time of the inspection. The inspection was performed based on Itttlltlq��� training and experience in the proper function and maintenance of on site sewage disposal systems. I am OF approved system inspector pursuant to Section 15.340.of Title 5(310 CMR 15.000). The system: ��� .•'••••••'' S :• G _X_ Passes TRICK ; 0 Conditionally Passes M. Needs Further Evaluation by the Local Approving Authority 010 �A Fails y • 1k* Inspector's Signature: -� ,�, d. -tf,l'ef Date: 2/17/04_ The systf in 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;neater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.Tho original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authorb y Notes and Comments: Original leaching pit under paved driveway is likely in groundwater and had to be permanently capped off. Also cannot positively determine loading capacity of pit,assumed to be H-20. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.Thiis inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Impection Form 6/15/2000 page 1 Page 2 a r l 1 12IFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 25 Sail A Way,Centerville Owner: Chelsea Thompson Date of Inspection: February 17,2004 Inspecl i.,)n Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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. Commeats: 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. `r.ie 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 existin€; :ank 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. ND exx lain: Cibservation of sewage backup or break out or high static water level in the distribution box due to broken or obstruc X-d 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 obstruction is removed distribution box is leveled or replaced ND exf Iain: 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 obstruction is removed ND exr k tin: Page 3 if 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Propert:v Address: 25 Sail A Way,Centerville Owner; Chelsea Thompson Date of Inspection: February 17,2004 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 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the syste m is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _— The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance *"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 :)f 11 CJFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 25 Sail A Way,Centerville Owner: Chelsea Thompson Date of [nspection: February 17,2004 D. System Failure Criteria applicable to all systems: You mirit indicate"yes"or"no'to each of the following for all inspections: Yes No X_ Backup of sewage into facility or system component due to 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 h: Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow _Y_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped h__ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _h._ Any portion of a cesspool or privy is within a Zone l of a public well. h_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _R:_ 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. IThis system passes if the well water analysis, performed at a DEP certified laboratory,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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] `No_.(Yes/No)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. La rge Systems: To be co nsidered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You mus indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. A Page 5 :)f 11 CiFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 25 Sail A Way,Centerville Owner: Chelsea Thompson Date of [nspection: February 17,2004 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 _X_ _ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X_ _ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ __ Was the site inspected for signs of break out? _X_ __ Were all system components,excluding the SAS, located on site? _X_ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the conditiou of the baffles or tees,material of construction,dimensions, depth of liquid,depth of sludge and depth of scum? _X_ ___ 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: Yes no _X_ __ Existing information. For example,a plan at the Board of Health. _X_ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance;is unacceptable)[310 CMR 15.302(3)(b)] Page 6 n f 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 25 Sail A Way,Centerville Owner: Chelsea Thompson Date of Jnspection: February 17,2004 FLOW CONDITIONS RESIDENTIAL Numbe-of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIG N flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):330 Numbe.-of current residents:0 Does re idence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no):No [if yes separate inspection required] Laundr✓system inspected(yes or no): Seasonal use: (yes or no):No Water rn-ter readings,if available(last 2 years usage(gpd)): 2002—143,000 gal.2003—50,000 gal.=264 gpd. Sump pump(yes or no): No Last da:c of occupancy: Summer 2003 COMNI ERCIALANDUSTRIAL Type of establishment: Design f..ow(based on 310 CMR 15.203): gpd Basis of iesign flow(seats/persons/sgft,etc.): Grease tj ap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water rn�:ter readings,if available: Last da:.e of occupancy/use: OTHE It(describe): GENERAL INFORMATION Pumping Records: Records show last pumping 3/25/96 Source of information: Barnstable WPC Was sy,,t-.m pumped as part of the inspection(yes or no): No If yes, vc lume pumped:_gallons--How was quantity pumped determined? Reason f)r pumping: TYPE OF SYSTEM _X_Se piic tank,distribution box,soil absorption system _Single cesspool _Ovar flow cesspool Pri vy Sharod system(yes or no)(if yes,attach previous inspection records,if any) Inno,tative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtaine 9 rrom system owner) —Ti&hi:tank _Attach a copy of the DEP approval —Othe•(describe): Approx in Late age of all components,date installed(if known)and source of information: 'tank and pit 1984+/-,leaching trench compliance date: 1/29/97 Were srwage odors detected when arriving at the site(yes or no): No Page 7 o f I 1 t-iFFICIAL INSPECTION FORM—NOT,FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 Sail A Way,Centerville Owner: Chelsea Thompson Date of.Inspection: February 17,2004 BUILDING SEWER: X (locate on site plan) Depth below grade: 4" Material:,of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: 30' Comments(on condition of joints,venting,evidence of leakage,etc.): No access to sewer,finished basement. SEPThC TANK: X (locate on site plan) Depth below grade: 2" Material of construction:_X—concrete_metal_fiberglass__polyethylene _othei(explain) If tank s metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificile) Dimens ions:8' long x 5.2'wide—1000 gal. Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How Aere dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as relatod to outlet invert,evidence of leakage,etc.): Liquid level in tank 5-6"below outlet pipe due to evaporation and no use for past 5-6 mos. GREAiIRE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimens ions: Scum tlii.;kness: 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: Commen is(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as relatod to outlet invert,evidence of leakage,etc.): Page 8 :)f 11 +,'1FFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 Sail A Way,Centerville Owner:Chelsea Thompson Date of Inspection: February 17,2004 TIGHT or HOLDING TANK: No (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/day Alarm p•esent(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (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.): No solids or high stains.One outlet pipe to trench. PUMP CHAMBER: No (locate on site plan) Pumps iir working order(yes or no): Alarms i n working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 :)f 11 CJFFICIAL INSPECTION FORM—NOT,FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 Sail A Way,Centerville Owner: Chelsea Thompson Date of:inspection: February 17,2004 SOIL/3SORPTION SYSTEM(SAS): X (locate on site plan,excavation'not required) If SAS not located explain why: Type leap hing pits,number: lea,.hing chambers,number: lea,.hing galleries,number: _X leaching trenches,number,length: One 60'trench leaching fields,number,dimensions: ovc rflow 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.): No excessive vegetation or damp soils. CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Numbe.-and configuration: Depth--lop of liquid to inlet invert: Depth of solids layer: Depth cof scum layer: Dimensions of cesspool: Material, of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (locate on site plan) Materials of construction: Dimens is ns: Depth of Solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Page W of 11 43FFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Propert3 Address: 25 Sail A Way,Centerville Owner: Chelsea Thompson Date of Inspection: February 17,2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchrr arks.Locate all wells within 100 feet.Locate where public water supply enters the building. Sail A Way I I I I I I I I I I 3i zu I n Page 11 (if l I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 Sail A Way,Centerville Owner: Chelsea Thompson Date of Inspection: February 17,2004 SITE EXAM Slope None Surface m ater None Check cellar Dry Shallow v✓ells None Estimated depth to ground water: More than 7 feet Please inc.icate(check)all methods used to determine the high ground water elevation; Obtained from system design plans on record-If checked,date of design plan reviewed: Obs,:rved site(abutting property/observation hole within 150 feet of SAS) _X_C he cked with local Board of Health-explain: Checked file for water info. C wo.,ked with local excavators,installers-(attach documentation) A ccossed USGS database-explain: You must describe how you established the high ground water elevation: kecords on file from time of repair in 1997 show 7.5 feet to water.Bottom of leaching trench 3-3.5 feet below grade. „ i T OF BARNSTABLE LOCATIO \L SEWAGE # VILLAG ASSESSOR'S MAP & LOT D 0 INSTALLER'S NAME&PHONE NO. \ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) — (size) "1 K0 NO.OF BEDROOMS BUILDER OWNE 1?ERMITDATE: COMPLLANCE DATE: .Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 1 bh�� _ T OF BARNSTABLE iQ - SEWAGE # l0� ASSESSOR'S MAP & LOTr INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY F1 LEACHING FACILITY: (type) (size) 4 XO NO.OF BEDROOMS BUILDER OWNE\ PERMITDATE: 21 9.6 .4 COMPLIANCE DATE: �— Separation Distance Between the: Maximum Adjusted Groundwater Table and 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, .� �Z 5 F 0, -, �J l No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS boo 01ppYicatiou for Moog Y *potem Cow5tructiou Vertu Application for a Permit to Construct( )Repair( ' Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or L No. t (� er's Name Address and T o. Assess s M IPaarce tk Installer's N ress,and Tel.No. Designer's Name,Address and Tel.No. R,),^AA) 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 Nat re of Repairs or Alterations(Answer when applicable) L 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 issue b t 1koard Signed Dated Q� Application Approved by Date 2 Application Disapproved for the following reasons Lr Permit No. Date Issued No. ., # Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 01pplication for Ot5 g Y *proem Congtruction Permit T Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lo No. �' er's Name Address and Tel o. AssessBPs Mdp7P'arce " � Installer's Napla—A- ress,and Tel.No. c_ 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 kt t,7 -n�., t Design Flow 1 c!altons per day. Calculated daily flow gallons. Plan Date 14UWbeiof sheets Revision Date � Title « Size of Septic Tank Type of S.A.S. Description of Soil i Nat re 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 1 cate of Compliance has been issue I oard Signed Date Application Approved by Date '2 �d Application-Disapproved for the following reasons On 4 Permit No. Date Issued 4 ���� ————————————————7—— Lit THE COQ7t1WEALTH OF MASSACHUSETTS -- NSTABLE, MASSACHUSETTS �lCertificate of Compliance � THIS IS TO C Y, that th - age Disposal System onstructed( )Repaired (graded( ) Abandoned( at 'has been constructed in accordance with the provisions of Title 5 and the for Disposal System Constructioh Permit i n dated Installer e v��/I The issuance of this permit shall not be construed as a,��a t t he system will function as designed. Date 1 _ ' % - �{'q �'.� ` r nspector ------------ --k--^2----------------------- No. !V- y R 6 64�r 1 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION = BARNSTABLES MASSACHUSETTS Migoogal *pgtem (fougtruction Permit Permission is hereby granted_L9 ct( )Repair( pgrade( )Aban ( ) System located at fl_- 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 tlfis-permit_ Date: i n � Approved by . r NOTICE:This Form is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL a WORKS CONSTRUCTION PERMIT ()LVITHOUT DESIGNED PLANS) �' 0 n� I , hereby certify that the application for disposal works construction permit signed by me dated , concerning the property located at' meets all of the following criteria: _ • There are no wetlands within 3b15 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED . DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. j xert �„o,�, �� �� �� �� L � a �v �x�� �� � «E Commonwealth of Massachusetts Executive Office of Environmental Affairs IDePartment of RECEIVED Environmental Protection FAN 10 1997 William F.weld HEALTE C'7PT. Trudy Coxe TOWN OF EARNSTALLE S.uduy.EOEA David S. Sttuhs Cpmm;n;o�n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM MAN a 30 PART A PARS 0yr w CERTIFICATION %,`D�PSoN Property Address: C E v Address of Owner: Date of Inspection: l g-- A3 —pG (If different) .Name of Inspector: 7-4m—c5 -2) SEiAiPS Company Name, Address and Telephone Number. A & B Canco 3S0 Main Street West Yarmouth, MA 02673 008) 77S-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, socurate 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 Inspectors Signature: Date: The System Inspector*hall submit a copy of this inspection report to the Approving Authority within thirty(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 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. INSPECTION SUMMARY: . Check A,B. C,or D: AJ SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure ria as defined in 310 CUR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. a system,upon completion of the replacement or repair, passes inspection. Indicate yea,no,or not determined(Y,N,or ND). Descri is of determination in all instances. If"not determined",explain why not) The septic tank is metal,cracked ructurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Healt (revised 11/03/95) 1 One Win trot • Boston,Massachusetts 02108 • FAX(617)5545A049 • Telephone(617)292-5500 A t PrinI.A on R.W I,4 Parw, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner. Date of Inspection: Bl SYSTEM CONDITIONALLY PASSES (continued) — Sewage backup or breakout or high static water level observed in the distribution box is due broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if th approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced — The system required pumping more than four times a year due to broken or o rutted pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALT Conditions exist which require further evaluation by the Board of H lth 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 D 1NES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC H AND SAFETY AND THE ENVIRONMENT'-. — Cesspool or privy is within 50 feet of a surface ater — Cesspool or privy is within 50 feet of a borde ' g vegetated wetland or a salt marsh. Z) SYSTEM WILL FAIL UNLESS THE BOARD O HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUN ONING}IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — The system has a septic tank and il absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. — The system has a septic tank d soil absorption system and is within a Zone I of a public water supply well. _. The system has a septic and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic and soil absorption system and is less than 100 feet but 50 feet or more from a private water suPPb well,unless a we water analysis for ooliform bacteria and volatile organic compounds indicates that the well is free from pollution from t facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) OTHER (revised /03/95) 2 i r o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner. Date of Inspection: DI SYS FAILS: I have determined that the system violates one'or more of the following failure criteria as defined 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. Backup of sewage into facility or system component due to an 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 wvif is less than 6"below invert or available volume is less than 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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 60 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 eoliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: 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: 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 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into Rill compliance with the groundwater treatment program requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for fluther information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address` Owner., Date of Inspection: Check if the fo llowing have been done: information was requested of the owner,occupant, and Board of Health. V 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. jAs built plans have been obtained and examined. Note if they are not available with N/A. YThe facility or dwelling was inspected for signs of sewage back-up. V The system does not receive non-sanitary or industrial waste flow /The site was inspected for signs of breakout. ZA11m components, / �� f 1'(c ludu►g the Soil Absorption System, have been located on the site. v The septic tank manholes were uncovered,opened, and the interior of the septic tank wag inspected for condition of baffles or :,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. size and location of the Soil Absorption System on the site— rp ygte to has been determined based on existing information or aT"! roximated by non-intrusive methods. he facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION Property Address: Owner. Date of Inspection: FLOW CONDITIONS RESIDENTIAL Design flow: gallons Number of bedrooms: Number of current residents: Garbage grinder(yes or : P00 Laundry connected to system(yea or no):� Seasonal use(yes or jQ: N d Water meter readings, if available: Al Last date of occupancy: CO M M ERC IAL/I NDUSTRIAL: Type of establishment: Design flow:_gallons/day Grease trap present:(yes or no)_ Industrial Waste Holding Tank present: (yea or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N� System pumped as part of inspection: (yes or no)_ Vo If yes,volume pumped: p1lons Reason for pumping: TYPE Off'SYSTEM Septic tank/distribution box/hoil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yea,attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information:_l%r,3 73— W Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. Date of Inspection SEPTIC TANK V (locate on site plan) r� Depth below grade: d" Material of construction:_k/Concrete_metal_FRP_other(e:plain) Dimensions: /D 00 g ECA 57" #-e2o ToP Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 3.3 Scum thickness: O•• �� Distance from top of scum to top of outlet tee or baffle: g ti Distance from bottom of scum to bottom of outlet tee or baffle: CommentA: (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.) 7i�,vk- "S OvTj� 'ZVA-A— ,CSilft OvfR avT.4L7T ®iP£ GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP_other(ezplain) Dimensions: Scum thickness: Distance Erom top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or Comments: (recommendation for pumping,wadi ' of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) (revised 11/03/95) 6 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner. Date of Inspection: TIGHT OR HOLDING TANK_ (locate on site plan) Depth below grade: Material of constriction: _concrete_metal_FRP_other(e:plain) Dimensions: Capacity: ¢allons Design flow: uallons/day Alarm level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX._V . (locate on site plan) Depth of liquid level above outlet invert:_V t/e O✓T.1-f .Z of L Ta J �O�( (�O/✓f/Z Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box,etc.) ('a d f,- O ti 6 0 /S eok-f.v — 10 L G✓,04 4- O A e o X /S x0eA'•Fti O X �/ -7o B L rP£.00A O f Z R d x i'S / x/G /G'' 6$£4ew /PAD£ PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner. Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible;excavation not required,but may be approximated by non intrusive methods) If not determined to be present,explain: Type. leaching pits, number: ` leaching chambers, number:_ leaching galleries,number: leaching trenches, number,length: leaching fields, number,dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) P/T 15 A&T C t✓R —o't c C a v f/2 / £A o cv G D£ P/7— / Fa L L --/-s C u v tit ,yo £g rl"iv4 .Z 02 /f/yA- Al ££t7 s ,B E CESSPOOLS:_ A (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(cesspool must be pumped as part of inspection) Comments:(note condition of soil,signs of hydraulic failure, level ponding, condition of vegetation,etc.) PRIVY:_ (locate on site plan) Materials of construction: Depth of solids: Dimensions: Comments: (note condition of signs of hydraulic failure, level of n po ding,condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner. Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100, 3G� 0 rre NT DEPTH TO GROUNDWATER Depth to groundwater: 1- G feet method of determination or approximation: £f �iG £ eL a o/v r�L t �T �A�/✓ v 9R 7 0 = fALTif< iA,- (revised 11/03/95) 9 f •q:. Completed by - — HIGH GROUNDWATER LEVEL COMPUTATION '/S G ty/� "' /t •—��1=--j��!/�/�/�(S f Lot No. Site Location:_ Owner: J. yh�i��c� ~�'`� Address: Address: Contractor: Notes: S-rEP 1 Measure depth to water table 6/W /&3 to nearest 1/10 ft. • •• • • • • • • • • • • .. " " " " --- date STEP 2 Usirig Water-Level Range Zone and Index Well M_ locate site and determine: A) Appropriate index well . . • • • • • • • • • • B) Water-level range zone . . . . . . . . . . . . ]� STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth .to 6/ 9-3 22.23 water level for index well ' • • • • • mo yr STEP 4 Using Table of Water-level Adjustments for index well (STEP 2AJ—, current depth to water level for index well (STEP 3) � and water-level zone (STEP 2B) determine ' water-level adjustment • • • • • • • • •• • • • • • • • • • • • • • • ' • " " " . . . . . ' STEP > Estiriate depth to high water by subtracting the water- _ level adjustment (STEP 4) �o iron, measured depth to water L level at site (STEP 1) • • • • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • i 6 y ,QV C,A T ION SEWAGE PERMIT NO. V f,L L E QQ.101- INSTVLMS NAME i ADDRESS j 2S2� a:�� B U I L D E R OR OWNER o DATE PERMIT ISSUED �%� "�� v � DAT E COMPLIANCE ISSUED cl THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF. ........................................ Appliratiun for Uiupu.ittl Work.5 Tunutrnrtiun ramit Application is hereby made for a Permit to Construct (N or Repair ( ) an Individual Sewage Disposal System at . ----- id a_ ocation•Address t>�& Owner ddress a ............ (/ ............................ ........•--•----.........-----............................. ....... ------- ._...-------- ..^ (((/// Installer Address dType of Building Size Lot.... Pj_IPP......Sq. feet U Dwelling—No. of Bedrooms............. . ._...Expansion Attic ( ) Garbage Grinder ( )1--1 .1. .............. PLO Other—Type of BuildingNo. of persons...........U---•---•---• Showers ( ) — Cafeteria ( ) dOther fixtures ..................••--•----••-•-•-•....•-••-..........••---._.......-----•...................._..........-•-•••-•••---•....-•-.....-•---....._.---••- w Design Flow..............5_5..................gallons per person per day. Total daily flow.......•. a�LO....................gallons. WSeptic Tank—Liquid capacityl- .gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil........................................................................................................................................................................ w UNature of Repairs or Alterations—Answer when applicable............................................................................................... ••...................•----••••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT IL- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue the board f healthPX/F Application Approved By--••- ........••.................•-•--••....................... _ / ._.....-•-•--•--- ---._. .... Date Application Disapproved for e f of ing reasons:--•...-••...........................•---•---------......--•----------------•-•--------......----............... ............••-----•---••---•-•-•----••-••-•-•-••--•-•---•-•..._._.-••-•-.......-•--•-----•--•-•--•-••-•--•-•-•--•--•-----•--•••....----•-•--- ......................................................... Date PermitNo...................... .................................. Issued....................................................... Date �y�__._ ------- -- --- - - 1! 20 I•T. M//Y lOTE = /F /TN -IT :.!A -E/4 COY lNG P/T A,'tE /''SORE •/ i2•"3EL0.ry ., 9`, JO PT MJ� 5.4�4DE CCY:v Sf. • GO/VCUlaTt 4�oYC P/Pt E.4V[ B^B40UGHT: 7-0 G 3AOE /6 Z$- MIN. P/TCN Y C ST .,PON C OY - -- r- C E1C.f � /1V E.Q FT. _P11 ?•LYc.? - v -3 s • v � _ r MJAI. TC�11 l L` mil_ • •... o � . , .� f �i9�-•�•a " �.�a1vx ir DJST SEJ�T CC _ -� �• • ♦ • •EFFECT/YL • • 3la�.- � %2 /5I ,-r •.c: • 3 S D STJ • • 5 c—=- a ,r v • 0 3 x�l I f • • p a • • •. • • a • • RECAS T `AIV&47 & EV.477O S P1 T CAI-A Cl7-,l 440 rim L/�'�"y s ►• • • • • • • • • a • P/7 C.4 V A E �L 9 �! R !/4IY�RT AT lG/ILDIJ�/� /®D•. !' � -• t sT: D/�4JK. f • �7C �TL�T S.e`P Ts4AfK ` (; SEE T.4dUL.ATJON� - l�Kd�7�DVSTJ;/BUTJ0I4I Ar SL'GT/d1yOF G�OIINO !W47,FI!' T�Lg - .9/,/ 9VTZETD/�TRI�tIT>®M G46a -VL e7 rnrr, r /A*45r.tgAW/AAG P,eT IAES/BAP`CA17'XRIA vJ/ysE/vs/oAt A �• --�'T. - N/lJ�IBER OF�DRbOMS DJMt7VSJON C ` . FT Nj� ✓. .' ,.�RcAc.�-o�spo .�L uaJr n/on� Sot- LOG TCTAL ESl1,vj TED FLOrV 3.3 0 G.,t.f�y 50J L TEST A/ SO/L 7FS7-,*g SDIL TE37' f XUN►,&ER GF LCACXING /0/73 E[vj! 9 7 S/OF LrACH/N6 PER PJT 1 fLEK Z - - S G44 TE OF SO/L TEST . sit ter. �` 3 0 T'TOnt Ljrm4cN/N6 OE R PIT � ; 3 � �t�- `� �U !\ / Z rr � ��p RFS[/t TS H//T/YESSED dr cl�e �J�r T07?tG LEACH/NG ��E.�1 �` ,s fT. • I ?b.P �� !"E4C0[ATIOJy. .eATjc / �ss MJ livtK �0 3 _ G Fi�tCOL.�T/ON R..•TE 2 2 .'?/N C'M ?ESFRVELEACNIJ Yd ARPA L `' S4. FT. V-7, "Ee sad0.zir13 ✓ V` ,f F''.--^' OT ALK cLDRED J MORSE No.10951O c �P � � e - �LOREDGF �:-ivG/NEc.�i.i•'G C0,1:1/C. �.. £ p• 90 FGI P �Q 7J 2 MI9/N ST. �- �D Sly � o�FSS/ONA�Ea�\a wO G.tOuw67".V,,4TC�T fNCOU/VTE.��O v LL/EN "f "'"= _ G1CO C//VO Lt s�TE,Q AT �L� . �_ T: '_��/? , � ` 16/�� i` l DFr-"� . l •.JOd ,1/O� '3 / SHEET : of z e k '•, "1.\, i, . _ .. v i .Y is, i Gomp eted by.,. - . HIGH ,GROUND-WATER LEVEL COMPUTATION 4 1. If Site Locati on:: _ate. _A, 1�1-.� ��1�'z/`►�/�S � Lot No. Owner: ,J• �'j'I�Y!?Azr9- Address: I Contractor: --- Address: C. ?Dotes: STEP l Measure depth to water_ table • • 6�Zi ��3 y to nearest MO ft. • - -__ L---_ date . STEP 2 Using Water-Level Range Zone and 'Index Well Map locate site and• determine: A) Appropriate index well . . . . . . 23p q B) Water-level range zone . . . . . . . . . . . . r 1 STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to Z2,Z3 water level for index well 61.93 mo yr STEP 4 Using Table of Water-level Adjustments for index well �TEP 2A�, current depth to water level for index well (STEP ,3) , and water-level /' U zone. (STEP 28) determine [ I , water-level adjustment STEP 5 Estinate depth to high water by subtracting the water- _ level adjustment (STEP 4) r- from measured depth to water level at site (STEP 1) n President: Member of: ROBERT BRUCE ELDREDGE,R.L.S. CAPE COD SOCIETY OF PROFESSIONAL ° ENGINEERS AND LAND SURVEYORS 5OHNw Etas,R.L.S. ELDREDGE ENGINEERING MASS.ASSOC.OF LAND SURVEYORS Associates: AND CIVIL ENGINEERS ALBERT A.MORSE,P.E.•R.L.S. COMPANY, INC. AMERICAN CONGRESS ON PHILIP WEINBERG,P.E.,R.L.S. SURVEYING AND MAPPING AMERICAN SOCIETY FOR ESE£ZEQ O\E9 i1EEZE� TESTING AND MATERIALS land 712 MAIN STREET cSUTVEYOLl En9inEvta HYANNIS,MASS.02601 TEL.(617)775-2244 November 185 1983 Board of Health Town Office Building 367 Main Street Hyannis, Massachusetts 02601 Attention: John Jacobi RE: Lot 46 Sail-A-Way, Centerville - Arthur Maddalena #83129 Soil Test No. P-2147 Dear Mr. Jacobi: We have checked the existing elevations on November .17, .1983 . of the sewerage system as built and have found the system to be substantially in compliance with the design plans . The results are as follows: .5 Design Elevation As Built Elevation Top of Foundation 102.5 102.1 Invert at Foundation 100. 1 99.4 Invert at Septic Tank Inlet 99.9 99.2 Invert at Septic Tank .Outlet 99.7 99.1 Invert at -Distribution Box Inlet 99.5 98.9 Invert at Distribution Outlet 99. 3 98.7 Invert at Leaching Pit 99. 1 98.2 Bottom of Leaching Pit 95.1 95.0 Since the actual effective depth of the pit is 3.2 feet instead of the design of four feet, the pit capacity is reduced to 414 gallons per .day (Design 490) but is still well above the minimum of 330 gallons per day. Sincerely, . ELDREDGE ENGINEERING COMPANY, INC. cc: Maddalena Ro ert B. Eldredge, President RBE/etb Fxs...��................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF...... . ApplirFation f or Uiipoii ai Works Tonitrur#ion Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: L ` ocati n Address t N ... . - Owner ddress Installer Address ® ' Type of Building Size Lot.___... .._I................Sq. feet U Dwelling—No. of Bedrooms.................._.................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building .......__.0 f_.... No. of persons...........�.D-............ Showers ( ) — Cafeteria ( ) Other fixtures ----------------------------- ------------------ W Design Flow................5..5................gallons per person per day. Total daily flow........�,�_ 30...................gallons. W Septic Tank—Liquid capacitylb-OD.gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet....._.._.__.______. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ •--------------------------•- ----------------•-•-----------------------..........•--••-•---••--------•--••-•----•••--•-•------•--.....••......_....---...... 0 Description of Soil------------------------------------------ -•----------•---------------------------------------------------.....-•----------------------------••---•-•--..........-•-•- x W .............. --•.................•--•••-----•-•••••-•••-••--------•---•-•-•-----•-•--•••••-•--••------•-••-••••••--•---•••••••----•-•--•-•-•-•-••••••••....•--••....-•••••............-•-----•---_.... UNature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------•--------------------------------•-------•------------•--••-------.................---........---•------------.....------------------•-•-----....-•-------•--••-•-•---••------•--..... Agreement: i The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issueApbthe board of Iiealth. ..../ ....... .... ----- D f 7 ApplicationApproved BY........... ..........................•----•---••---•-----..........-------------- ........7..... .................... j Date Application Disapproved for e f of ing reasons:............................................................................................................... x ...........•..............................•---•----....._........._........----•--•--•----.............---•---------------•---•--••--••-•-...•-•.....--•••---•--•-- --•-•--..... •---......... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH .........OF...... -..-'? �................... .................................. �4 Trrfif iratr of Tontpliatta THIS IS TO C 'TI Y, T the Individual Sewage Disposal System constructed (}() or Repaired ( ) by / !t C-�'.�!. J.... -•--••-•------- s-- - atd ... ............................. ---•- ---....---�. has been installed in accordance with the pro'' ions of TIr'�F 5 o The State Sanitary ,Code d �cr..' ed in the application for Disposal Works Construction Permit No../�_.....�..�� `.............. dated__.��__ � �� PP I f-••...... .................. THE ISSU ;j 'j OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI G FTION SATISFACTORY. DATE...��.�/... .............•--......--••---------•---••-----•-•---. Inspector-•--- ----• -•---•----•------•--------------------•---•-----.........---.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE TH 0r � ,f - OF. . s... ode. ......................... No......................... FFVt ............. �on� �i�n �rrntit Permission is hereby granted _1... .. '•`....'Q` ................................................................ to Constr t � or e air ( ) a In ' i 1 c. a e Di °sal S tem at No....... ... Street as shown on the -ppli ion for Disposal Works Construction Permit No. �......... ated.ft='.' ��-----•----.. ........... ---------------------------•--•------••-•--•------•--••-- // / �+ rd of Health FORM 1255 A. M. SULKIN, INC., BOSTON l / 1,4CA'1'lUtJ L_C=T fie•-_..- ---5A-i i- A-I - -►J.0. p- �l-IL/7 -� DATE G0 4. 1 6 3 V I LLAG I G�{�1 ..., V 1. LI..,I.:r APPLICANT N'Al>DALGI`.l A FEE ADDRESS Plwe TELEPHONE NO. •1�5 .0'24,4! an-refundable r ENGINEER TELEPHONE NO. DA,rr' SCHEDULED G� �� �3 ''•�-•�••�1..�, �/�'�T ( plicant' s signature SOIL LOG AM SUB-DIVISION NAME ►,t A ,DATE (���.���3 TIME OCR EXPANSION AREA: YES ✓NO e�H i•.► C LL..LS ENGINEER TOWN WATER ✓PR:[VATE WELL BOARD OF HEALTH 01 -ZC=1. EXCAVATOR SKETCH: (Street name, etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) .35,5K. c® --DOTES: (Z 49.94 5 Qb' M 0� a � GtJ� g5TP'e r / Ir16 WI-- ©W P f t►Mom.S t./1 90 vt fto�,-T'f r!,R�rS kA o $, L+J S GE C'c.IC—Prp. P© Y� A=4'7.b4 1'ERCOLAT 7:ON RATE: TEST HOLE NO:G ELEVATION: TEST HOLE NO, � — I:1.1:VA'►'I:UN 1 m 1 L o/fit "T S 1 - 3 3 4 6 6 7 7 ---- 9 �aP.vvs w 9 10 �' 10 11 11 � � ,�,, ;,• 12 12 13 13 14 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD i/LEA I PIPS LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASON : �.4 r NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICA`1'ION ORIGINAL: COMPLETED IN .,NTIEETY BY R . E. ANC RETURNED TO BOARD OF HFAL'I.'li I 1 '�l 5.3 Jam: 3.Ico V a,q• ao t a. Q TAr rL io, tok- Vi 4.5 45 EGGU. L: .�• to S �1{ � r� CI Vr ? r no OF Af;4 .> L v 7` --;z 4, �.)MORSE. cn Nu. 10951 O i SIONAV-�� LEGEND EXISTING SPOT ELEVATION ono '��`'` CERTIFIED PLOT PLAN EXISTING CONTOUR -- 0 ——— q �": 'v,�` FINISHED SPOT ELEVATION HOBERT yes C� ,�✓7 =;�r; ',.i; _r FINISHED CONTOUR 0 BRUC at� ELORE N1 I N a APPROVED , BOARD OF .HEALTH• '/ST��ypB DATE AGENT �NO_sv_R�d� SCALES 1 '�_3 DATES LDREDGE ENGINEECRING CO. _ CLIENT. 1 CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB N0. g3 12 BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER URVEYOR DR.BY1 ` A,A— OF BARNSTABL MAS 712 MAIN STREET ; CH. By H Y A N IV I S, MASS. Z SHEET OF, TE REG. LAND SURVEYOR 1 NOTES �pK�UpOU�� E PUMP AND FILL EXISTING LEACH PIT. SOIL REMOVAL AREA - REMOVE EXISTING so9Fyr J9 a �0 LEACHING FIELD AND ANY CONTAMINATED OR UNSUITABLE SOILS DOWN TO THE C STRATUM AND REPLACE WITH CLEAN y PNlNN�YS ro MEDIUM SAND PER TITLE 5NOT (310 CMR 15.255(3)). / I gOUTF SCALE oko/ FAtM�UTH q0/ 4 3 � � AD / 42 CENTERVILLE, MA PROPOSED SOIL "20ft L� O C U S M A P ABSORPTION / k' SYSTEM / / 0.q A / h MAPLE-SEE DETAIL E L E V A 11 §O❑V S ELEVATIONS SPECIFIED ARE INVERT ON BACK / *15 in O ELEVATIONS (BOTTOM OF PIPE) / OAK/ ' 1 EXPRESSED IN DECIMAL FEET SOIL 1 SEWER LINE OUT EXISTING REMOVAL / ° SEPTIC TANK IN 42.05 AREA I ® 1 SEPTIC TANK OUT 41.80 ® v D-BOX IN 41.27 / D-BOX OUT 41.10 2 m 44 LEACHING SYSTEM IN 41.00 15 in `� BOTTOM OF LEACHING 3 9.00 OAK D� - I { 115 in o i OAK I ssr)SOOM a 42 �(I o 1 is , G D N Q �T QQ V QLL VE G WATER LINE I, .• 1 I - - - /� / 45 vA: �iirc OVERHEAD WIRE Q MINIMAL UTILITY POLE / pJ/' GRADING THIS �S A. I OTC PROPOSED COLOR HYDRANT 40L/I PLAN Q��\�G `�y ; . USE COLOR PLAN ONLY ' FOR INSTALLATION 15 in Q�\/ L�O-r 4 C FULL DETAIL IS BEST I OAK / AREA = 20100 sf+— VIEWED IN / � ( PLAN BOOK 182 PAGE 71 FULL COLOR ASSR MAP 230 Pa .98 I I L"EG MDR SV-f�® I I S9-dE® 1 SEPTIC COMPONENTS. GARB EXISTING G OT 1000 GAL �� SEPTIC TANK 43 \ . OWED G OEXISTING LEACH PITI \ \ \ CESSPOOL 9j 6 - - DISTRIBUTION BOX © TEST PIT 44. r186.27 ft 5 l EDGE OF PAVEMENT PUNNE U S LANE ELEVATION OF�DAVID SS9CyG SN 0f MAssq�ti TOp OF 89 D. ,f+ o DAVID PLAN D. COUGHANOWR n COUGHANOWR N No. 1093 No. 461 �F �a SCALE: I in = 20 ft o� SEWAGE DISPOSAL PAS° 0 20 40 SYSTEM PLAN 9 EST. -TO SERVE EXISTING DWELLING 0 10 20 ANNIKA ILIADIS PRINT ON 8-112 x 14 in '_'' & PETER HERMAN PA PER FOR PROPER SCALE '�•� 1995J OWNER(S) OF RECORD 25 SAIL—A—WAY CENTERVILLE, MA THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM 155 G6o Rgder Rd S PROPERTY ADDRESS DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING Chatham, MA 02633 PLACEMENT OF ADDITIONS. SHEDS, FENCES OR SWIMMING POOLS. OWNER DovidcouOHotmoipLcom DATE: NOVEMBER 107 2015' SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. SOH 364—OS94 PG.1/2 JOBS ETE-4002 SOL TEST L�OO PE C# 14883MBER 6. 2015 D -, „�,ti,, (�� I,'h �, �hI I,I,'�,�, ^„0�,��,�,�,�a SOIL EVALUATOR: DAVID D. COUGHANOWR, ASE *461 IL55 U(([�Jll!►1`�\IJ� V L� VLL ,ILIJfrIIIJI l!F�JV WITNESSED BY: DAVID STANTON, HEALTH DEPT. DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD TEST PIT 1 NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS PERC AT 68 in - 3 MIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER INCHES HORIZON TEXTURE (MUNSELL) MOTTLES SOUND STRUCTURAL CONDITION. IF NOT, INSTALL 43.00 0-12 FILL NEW 1500 GALLON SEPTIC TANK. 12-20 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. 39.50 20-42 Bw LOAMY SAND 10 YR 614 NONE FRIABLE SOIL ABSORBTION SYSTEM: 42-120 C LOAMY SAND 10 YR 5/4 NONE FRIABLE THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE 33:00 SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES TEST PIT 2 NO GROUNDWATER ENCOUNTERED PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. ELEVATION DEPTH SOIL ,USDA SOIL SOIL COLOR SOIL OTHER - THE 24 ft x 12.5 ft x 2 ft LEACHING GALLERY - INCHES HORIZON TEXTURE (MUNSELL) MOTTLES DEPICTED BELOW CAN LEACH: - 43.05 0-10 FILL BOTTOM AREA = (24 x 12.5) = 300 sq. ft. 10-18 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE SIDEWALL AREA = (24+24+12.5+12.5)x2 =146 sq. ft. 39 88 18-38 Bw LOAMY SAND 10 YR 6/4 NONE FRIABLE TOTAL AREA = 446 sq. ft. 33.05 1 38-120 C LOAMY SAND 10 YR 5/4 NONE FRIABLE FLOW CAPACITY = 0.74 x 446 = 330.04 gal/day INSTALL A 24 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED BELOW. FLOW CAPACITY = 330.04 gal/day WHICH EXCEEDS �� O N SEh T I T NI THE 330 gal/dog REQUIRED FOR A THREE BEDROOM DESIGN. TANK TO BE PUMPED DRY AT TIME OF INSTALLATION AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL ;SOIL S R P T I O I`I NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE. REPLACE WITH A NEWI in 1500 GALLON TANK ® ® I TAPER IF CRACKED, ROTTED DRYWELL 24.0 ft OR OTHERWISE UNIT -"- © COMPROMISED. c C C°w c m - o c) ° NOT ,� ® °°w Ln v CV TO LO SCALE `) l0J:: M 8 ft-6 in A �� STONE 3.5 ft .11 8.5 ft 8.5 ft 3.5 ft INLET OUTLECOVER 5 COVER COVER 00 GALLON DRYWELL DIMENSIONS & DETAIL INSTALL ONE INSPECTION . 3 IN DROP RISER TO WITHIN THREE -► Al FLOW LINE USE INCHES OF FINAL GRADE FROM = H-10 & INDICATE LOCATION BUILDING 10 in 14 TO ON AS-BUILT .1 D-BOX UNIT 48 in LIQUID GAS ozor op0' In3 LEVEL BAFFLE og000°obt"oo�a: b !n STONE BASE IF NEW GJ� SEPARATION BETWEEN INLET & OUTLET 102 io TEES NO LESS THAN LIOU/D DEPTH --- - - CROSS SECTION VIEW CROSS SECTION VIEW INSTALL AN APPROVED GEOTEXTILE-\ FABRIC OVER STONE �!lSTR � ' � T'ON io ®• ® 24in m 28 3/4 in TO 3/4 in TO in 1-1/2 in GRAVEL EFFECT® DEPTH IVE® 1-1/2 in GRAVEL I I O• : O• IO 46 in 58 in 46 in 12 In 150 in C MIN -- - - LO FROM e � (V TANK u LO TO O 6 K SAS -INSTALLER TO OBTAIN DISPOSAL.WORKS PERMIT BEFORE b in STONE BASE N STARTING WORK. 21 in 2� \ CROSS SECTION VIEW -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). T -INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. O A -ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES & APPLIANCES, AND PERIODIC o r u u y PUMPING OF THE SEPTIC TANK.. (C QO G -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. L7 DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. a p G`3 OOF El TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE SCH. 40 PVC EL = 44.89 +- 6 in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN 43.00 D-CEO { 3'USE H-20 MAX EMSTH3 41.75 EXISTING 1000 GALL 000 000�000Poo 22n //�� ��pp o 000p0�d%c PRECAST ;000 0 0°0 �L����� �/r\iIIV� 41.80 oop0000goaoo° DRYWELL6 in :oo°000;°oo°000 41.10 42.05 REFER TO DETAIL BOX STONE SOoL A°- BSORPT�ON + 41.27 BASE 41.00 PERC RATE EXISTING b In STONE BASE IF NEW CEEDS 11 ft 5-12 ft ������ DETAIL TBOX q 2XMIN/in. 39.00 NO GROUNDWATER MOTTLING OBSERVED _ 34.80 SEWAGE.DISPOSAL SYSTEM PLAN1125 SAIL-A-WAY CENTERVILLE, MA NOVEMBER 1072015 ETE-4002 PG 2/2 I