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0065 SCUDDER BAY CIRCLE - Health
65 S 7UDDER BAY OR., CENTERVILLE A= 188 099 //// QEccFo UPC 12543 $COV.- Now 14'csr. HASTINGS,ON TOWN OF BARNSTABLF LOCATION 4 " �ucy % � �i,�c� SEWAGE VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Ella CB C .frv�+r ( (size) NO. OF BEDROOMS ,3 OWNER 4!;Avlcc PERMIT DATE: .COMPLIANCE DATE: z Z + Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet. Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY r� � .,�„�.,.ir 1 B O� Oy • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville Ma. 02632 2/28/2012 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms w, on the computer, use only the tab 1. Inspector: key to move your cursor-do not Raymond Dumas use the return Name of Inspector key. Dumas Landscape Const. Inc. Company Name 564 Old Stage Rd. Company Address Centerville, Ma. 02632 Cityrrown State Zip Code 508-778-0249 S1437 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 s+te sewage disposal systems. I am a DEP approved system inspector pursuant`to Section 4340W Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Falls ❑ Needs Further Evaluation by the Local Approving Authority --t rn 2/28/201201- In--1 pe is Sig ature Date i The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11110 Title 5 Official Inspection forth:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 5 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owners Name information is required for every Centerville, Ma. 02632 2/28/2012 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ one or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville, Ma. 02632 2/28/2012 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11/10 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 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville, Ma. 02632 2/28/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: House has town water.. D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville Ma. 02632 2/28/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below.high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304, The system owner should contact the appropriate regional office of the Department. t5ins-11/10 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 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville, Ma. 02632 2/28/2012 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville, Ma. 02632 2/28/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2010/170000 gallons 2011/94000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: occupied now Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville, Ma. 02632 2/28/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Presently occupied Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 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 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville, Ma. 02632 2/28/2012 page. City/rown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System upgraded 2/2010 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 43 inches below top of foundation feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): cast iron to pvc Distance from private water supply well or suction line: approx 25 ft from town water across basement Comments (on condition of joints, venting, evidence of leakage, etc.): all good Septic Tank(locate on site plan): Depth below grade: 12 inches feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) tank 4 ft below grade with riser 12 inches below grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•11/10 We 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts ASS Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville, Ma. 02632 2/28/2012 page. Citylrown 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 none Scum thickness 2 inches Distance from top of scum to top of outlet tee or baffle 8 inches Distance from bottom of scum to bottom of outlet tee or baffle 12 inches How were dimensions determined? measure stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): not needed at this time 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is Centerville, Ma. 02632 2/28/2012 required for every page. Citylrown 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.): All good, pump not needed at this time, should pump Feb. 2013 for maint. tees good 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville, Ma. 02632 2/28/2012 page. City/Town 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 at level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Level and no evidence of carryover Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: As per plan on record at B.O.H. t5ins-11110 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 ,M 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville, Ma. 02632 2/28/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500 gallon ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativelalternative system Type/name of technology: Precast Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): All good 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville, Ma. 02632 2/28/2012 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.): All good 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-11110 Title 5 Official Inspection Foam:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville, Ma. 02632 2/28/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville Ma. 02632 2/28/2012 page. Cityrrown 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: 5 ft. + 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: 2/2010 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: Engineered Plan on record ❑ Checked with local excavators, installers-(attach documentation ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on Record Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 16 of 17 f ~Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Scudder Bay Circle Property Address J.D. Crawford Owner Owner's Name information is required for every Centerville, Ma. 02632 2/28/2012 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11f10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �sBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION /,,,,r C,-1 SEWAGE#.2D -B30 VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. �d�df,���pt)^�rsc�.dry+ y1 S z�y1G SEPTIC TANK CAPACITY LEACHING FACILITY:(type) nb Ce C C v�.� (size) /G*X 3rd Scot NO.OF BEDROOMS .3 OWNER 4,.cj PERMIT DATE: X J-/d COMPLIANCE DATE: 2 Z 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 BYJ ��/c t'��w•wy+r _ � (t Li N d J79 r 491-yid' 193- yl. 0 J,&4 4 CJ 03 oy http://issgl2/intranet/propdata/prebuilt.aspx?mappar=l 88099&seq=2 2/23/2012 No. ©� ^� 3 � r , Fee /0 V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pplication for Misposal bpstem Construction permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) 10/complete System ❑Individual Components Location Address or Lot No. 6 �p�n Owner's Name,Address,and Tel.No. Assssesssorii4lap/Parcel Installer's Name Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms _Lot Size 2,4EQ s_ �' sq.ft. Garbage Grinder Other Type of Building A No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.re72Z ' ed) <3® gpd Design flow provided�.� gpd Plan Date ` Z A9 Number of sheets Revision Date Title Size of Septic Tank /,� Oj> Type of S.A.S. �ijQ► Description of Soil !� T Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealth igne Date Z. Application Approved by Date Application Disapproved by Date for the following reasons Permit No. _10,30 Date Issued 'a— f. --.—...'.. - ....�. .. ..__ _ .•._ _ -.f� .r.'�.: 1s="`'6'1ti-..7..r....,,.:qMw-^„ryYSra'W`✓.+"''r R ^' .-z,. n 'L. y..'e.•'t.++^"�,.n ..., nr-. No. Fee /QV THE COMMONWEALTH',O"F MASSACHUSETTS, '- Entered in computer: PUBLIC HEALTH.DIVISION -TOWN OF BARNSTABLE--MASSACHUSETTS Yes 2ppriration for Disposal *pstrm Construction j3ermit Application for a Permit to Construct( ) Repair/Upgrade( ) Abandon( ) 10/complete System ❑Individual Components Location Address or Lot No.�v c.�� Owner's Name,Address,and Tel.No. 9 v , 1,I� ,n/y Asse sor7s 44ap/Parcel �' l�`U% r_ Gll� G/4`A/I_04�/ Installer's,Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 11o147/©�`l Cv���` 771�.3?9 �o�tiC ° Z - s Type of Building: �-�- Dwelling No.of Bedrooms 3 Lot Size Z� Q J�J sq,ft. Garbage Grinder(/ � Other Type of Building (��$/' ��� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.requ}ked) ' gpd Design flow provided gpd Plan Date /Z 11,9 Number of sheets Revision Date 0 Title _ C/ e✓t y G/ G'-� Size of Septic Tank /,��Q Type of S.A.S.Z__ Description of Soil 'i Nature of Repairs or Alterations(Answer when applicable) Date lasi.inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealth R igne Date Z. ` Application,Approved by Date •t t Application Disapproved by Date for the following reasons + Permit No. / �3C> Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(k.< Upgraded( ) Abandoned at s Z C—I l has been constructed in accordance with the provisions of Title 5 and the f(Disposal System Construction Permit No. "O 4: .hated V Installer tq/`&A 4j C0Ws7- Designer f'owe #bedrooms .J Approved design flow( `},Tjf,� gpd The issuance of this permit shall not be construed as a guarantee that the system wi lhfunctio� as designed. Date 'c—h o Inspector �` ��r�l �- 9 No.,,J l0 030 -- - -Fee`/06 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Disposal *pstem Construttion 3permit Permission is hereby granted to Construct( ) Repair(1/) Upgrade( ) Abandon( ) System located at lr (,/ L' G 0 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mu t b 20" pleted within three years of the date of this permit. (— Date 7 7 Q Approved by -TOWN, BARNS TABLE �► I.0CATIO S IQd WAGE # VILLAGE i ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER r PERMITDATE: 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 it% Iqkj -75 �1 eel q 04 �g SHED GUY WIRE / GARAGE x SLAB I PAVED 1 —— — DRIVEWAY I PLAY 1 I x 1500 GAL ST YM 1 _---- ---- UNIT C.O. QQQ BRICK WALK S 5�--- 1 I / I Y E7GSTING 2_500 GA (n I DWELLING DECK I STO EERS IN COV. TOP FHDN' I 1 PORC ELEV. 49.S' r� II � I n1 0l \ o w '�I SHELL 0' n I PARKING I W W W W W D3 n I MMR I� / I I I 166.03' 1 SEPTIC AS-BUILT 1 0-002 PREPARED EXCLUSIVELY FOR THE HEALTH DEPT., NOT FOR ANY OTHER USE LOCATION 65 5CUDDER BAY CIRCLE, CENTERVILLE SCALE : 1" = 20' DATE : 2/27/10 PREPARED FOR: REFERENCE : MAP 188 PARCEL 99 BORTO LOTTI CONST./ CRA�� 1'TO O �ZN OF 4q q, cy �o DANIEL I off 508-362-4541 O A. fox 508-362-9880 OJALA downcape.com © ,0 No.40980 down cope engiaeefing,inc. �o �P F civil ey S ors — ��--- qN� land surveyors L` SU 939 Main Street ( Rte 6A) YARMOUTHPORT MA 02675 DATE REG. LAND SURVEYOR 1&1-7 �a Town of B a r nsta We TKE 7 Departmont of Regulatory Services � • 0/Q y DAMSTAHM 4 Public Health Division Date t 9- 200 Main Street,Hyanuis MA 02601 • �Pfo paA't P+ Date Scheduled b Time A JHee Pd �' OD Foil Suitability Asses,snient for Sewage Disposal Performed By: A- 4- / 1�7 z - Witnessed By: 1iDV —�� LOCA7[ION & GENE' AL INFORMATION _. L cation Address r „/� �j�� Owner's Name C-A��� ^ f��/ Address Assessor's Map/Parcel: ! �O / l� !`CO Bngiueer's Name �V"), C,,%,P e NEW CONSTRUCTION REPAIR Telephone It C Od 3f0 d Land use. / E I Slopes(%) 2 �- Surface Stones Distances from: Open Water Body AeAo= ft Possible Wet.Area ft drinking Water Well _TY_ft Drainage Way OeUft Property Line Ft 011ter tt SKETCH: (Street name,dimensions of lot,exact locations of lest holes St pert tests,locale wellands'it n pro)cinuty to holes) J � V � 213 �i- ler Zy L u� v i 9 Zo 5° Parent material(geologic) 0[i?"LCJ4�t4 Depth to Bedrock, Depth to Groundwater: Standing Water in Hole:_P.&2 /�_4_E___ Weepiltg 1'I011)Pit Pltt:e Estimated Seasonal High Groundwater DE TE NATION FOR SEASONAL HIGll-3[ WATER TABJ[.,.]E Method Used: L Depth Observed standing in obs.hole: %A .. Depth to weeping from side of obs.hole: In. Crouadwater Adjustment Index Well I# Reading Date: Index Well level Adj-faetoi,_ Adi,GrOL111dWatef UVO PERCOLATION '.EST — Date _ TIM1e���_ Observation A Hole#I Tinto tlt V Depth of Perc TI me at 6" �•a� Start Pre-soak Time @ _ Time:(9"47 End Pre-soak t/0•, fJ� Rate Min./Inch / �/ Site Suitability Assessment: 5ile l'asseil_!� Sit.G.Failed: Additional Testing Needed(YIN) /'Y Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***It percolation test is to be conducted. Wit➢Iill 100' of Wetland, you must first Uotify the. Barnstable Consevvation Division at least one (A) Week prior to beginouinog• QASEPTIC\PERC FORM.DOC DE E,ROBSE R V kTIOI�gy®g, � LOG Depth from Soil Ilorizon Holq # Surface(in.) Sail Texture Soil Color (USDA). (M Soil Other ansell) Mottling (Structure,Stones;Boulders, .ie,Yle s Con istenc %' r4vef & ]l REP OBSERVATION HOLE LOG Depth from Soil Horizon fIO]e# —Z - Surface(in.) Soil Texture Soil Color (USDA) 5ott Other (Mansell) Mottling (Structure,Stones,Boulders• Consis ency,%Gravel le,Y �a ')-EIEP®]BSI+RVATI®N HOLE LOG Depth from Soil Horizon I10je# Surface(in,) Soil Texture Soil Color (USDA) Soil } (Mansell) Mottling Other (Structure,Stories,Boulders. Co siste c G vel DE,E P OBSERVATION HOLE Depth from Soil Horizon IIOIe# Surface(in.) Soil Texture Soil Color Soft (USDA) (Manse ) Mottlin Other ll --- g (Structure,S(,ones;Boulders, Consi ten a I ]C'good Insurance](gage MHPa Above 500 year flood boundary No Yes Within 500 year boundary No_ Yes T Within 100 year flood boundary No^ Yes Pellth oT [Nat"rally�nl ]EDetvious Material Does at least four.fe©t of naturally occurring pervious material exist in all a areas observed throughout the area proposed for the soil absorption system? ��'2d It not, what is the depth of naturally occun'ing pervious material? Cetrtl—�catio�l ..• I certify that on &D 0 (date)I have passed the soil evaluator examination approved by the Department of Environmental.Protection'and that the above a,nalyois,was performed'by me consistent with the segitired training, expertise and experience described in 10 CMR 15.017. Signature Date / 210'e�?v 1` Q:1S E PTICU'E R CEO R M.D O C 9 Ae -- aa/ ag THE 7 1Departriacut of Regulatory Services �ttt"a��e 4 Public Health Division Date � re 9 �� 200 Main Street,Hyannis MA 02601 �PFO Date Scheduled a 2 (b Tine II ]Fee]Pell. `oil Suitability Assessment for SeMage isposaIl Performed By: Witnessed By: ale Location Address lit d� Owner's Name /�� h� �r��✓�..��/ Address /`� . Assessor's Map/Parcel: .� yt� 5 q / Lngiueer's Name Wf1 ✓` NEW CONSTRUCTION REPAIR Telephone It SYJ J ,� Land Use A4?r+_ 62x Slopes(%) J�0 Surface Stones @/�0 Distance's from: Open Water Body ft Possible Wet Area OV4 ft Drinking Water Well o* ft 01 Drainage Way R Property Line _t��_ft Other it SKETCH., (Stree name,dimensions of lot,exact locations f lest holes&pert tests,locate wetlands 4n proximufly to holes) Ljq_ �d v tNq �� - t \tiA � o TO V N � Parent material(geologic) 7/Tw&rSl f' Depth l4 Bedrock, 'U� Depth to Groundwater: Standing Water in Hole: '044n Weeping from Pit♦Ales Estimated Seasonal High Groundwater DE TERAUNATION FOR SEASONAL 11101 WAFER TABLE Method Used: s Depth Observed standing in obs.hole: Depth io soil motd s: ram Iu. Depth to weeping from side of obs.hole: In. Orouildwater Adjusltnent.e Index Well## Reading Date: Index Well lev 1l' vel _ _ry_t Ad�l,factor Aa).Oruundwuter Level y, PERCOLATION .ESrA Observation Z y Hole## Time at 9" _ �/ Ly1 yyj�ti►,, Deptli of Perc Time at 6" Start Pre-soak Time @ Time(9"-6') .�aM . ✓a 6 End Pre-soak ®� Rate Min./Intl] 2 '�T Sitc Sullability Assessment• Sile Passed _ Sih 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 wltilln 100' of wetland, you n➢USi Ift-St UOUEy UIC. Barnstable Conservation Nvision at Yeast oiie (I) week prior to begia➢iau➢➢g. Q:\SCPTlC\P1SRCFORM.DOC Depth from Soil liorizon ®,� # Surface(in.) Soil Texture Soil Color (USDA), SD1t' Other :(Munsell) Mottling. (Structure,stones;Boulders. 4_ Z/ Can istenc % ravel 3 3Z -�3Z C me's DEE,P OpsRRVATI®1V H®I,1G LOG Depth from Soil Horizon Hole # Surface(in.) Soil Texture Soil Color (USDA) 5oil Other (Munsell) Mottling (Structure,Stones, Boulders, 0- . 7 Consis enc %Qravel (�W -]EEP OBSERVATION TION HOL* E ]LOG Depth from Hole Horizon ®]�# Surface(in.) Soil Texture S°II Color (USDA) SoilOther (Munscll) Mottling (Structure,Stones,Boulders, Co siste c O ve DREPOBSERVATIONHOLE LOG Depth from Soil Horizon Hole# Sllfface(in.) Soil Texture Soil Color Soil(USDA) (Munsell) M4ttlln Other g (Structure,Slpnes; Boulders, Consistency.c a I FMadl r nsurance Rate lea Above 500 year Rood boundary No "_ Yes" Within 500 year boundary No Yes Within 100 year flood boundary No ygs . )Depth of Naturally Oecu¢rrini]Eeryious 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? ?/� If not, what is the depth of naturally occurring pervious marori07.�_ �_. Ce>ctB--cation I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmen al.Protection and that the above analygis was performed by me consistent with the regttired training, expertise and experience described in CIO CMR 15.017. Signature_ Date �z �G U Q:1SP-PTlC1PERCFORM.DOC t COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 66 SCUDDER BAY CIRCLE CENTERVILLE, MA SYSTEM ONE 02632 Name of Owner PHILLIP SCHILLER F Address of Owner: BOX 104 W.HYANNISPORT MA.02672 Date of Inspection: 10/25/00 ` Name of Inspector: JOHN GRACI 4/b 'Ict,, I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.006) Company Name: SEPTIC INSPECTIONS �jaiti_ 'l Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 <000, Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I ' I certify that I have personally inspected the sewage disposal system at this address and that the informatiomreported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience n'the proper,function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: 1116100 The System Inspector shall s mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If 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. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.M, inspection does not imply any warranty`or'guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM PASSES TITLE V INPECTiON:RECOMMEND PUMPING THE SYSTEM EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. f r, revised 9/2/98 Pane 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 65 SCUDDER BAY CIRCLE CENTERVILLE, MA SYSTEM ONE 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10/25/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion o the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances. If"not determined",explain why not. nLa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. n/a Sewage backup of breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)o due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced n(a The system required pumping more than four 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 SE: 3s ' WE . to, i� 5• j •rC revised 912/98 Paae 2 of 11 'tti. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 65 SCUDDER BAY CIRCLE CENTERVILLE, MA SYSTEM ONE 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10/26/00 ` C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM I: NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic,.tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nla (approximation not valid). 3) OTHER nla V., . s; revised 9/2/98 Paoe 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 65 SCUDDER BAY CIRCLE CENTERVILLE, MA SYSTEM ONE 02632 Name of Owner PHILLIP SCHILLER ' Date of Inspection: 10/25/00. D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. - X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. - X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. - X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, - X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n/a. - X Any portion of the Soil AbsorptionjSystem,cesspool or privy is below the high groundwater elevation. - X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - X Any portion of a cesspool or privy is within a Zone 1 of a public well. . - X Any portion of a cesspool or privy is within 50,feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facilityiwith 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: ouk, Yes No - X the system is within 400 feet of�a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply - X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412). Please consult the local regional office of the Department for further information. revised 9/2/98 Paqe 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 65 SCUDDER BAY CIRCLE CENTERVILLE, MA SYSTEM ONE 02632 Name of Owner: PHILLIP SCHILLER Date of Inspection: 10/25/00 , ,pi, Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No «I: X - Pumping information was provided by the owner,occupant,or Board of Health. X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. _ X As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X - The site was inspected for signs of breakout. X - All system components,excluding the Soil Absorption System,have been located on the site. X _ The septic tank manholes°were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material it of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, IL 1t X _ Determined in the field(if any of 5the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 1 5.302(3)(b)] X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. ,, nn 'I revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 66 SCUDDER BAY CIRCLE CENTERVILLE, MA SYSTEM ONE 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10/25/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):Wa- 3 Total DESIGN flow: 330 gpd Number of current residents:0 Garbage grinder(yes or no): NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COMMERCIALIINDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow: n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no): NO Water meter readings.if available: n/a Last date of occupancy:n/a -� OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous inspection records,if any) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a + APPROXIMATE AGE of all components,date installed(if known)and source of information: CESSPOOL-1976 WITH A NEW PIT IN 84 Sewage odors detected when arriving at the site:(yes or no): NO revised 9/2/98 Paae 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: 65 SCUDDER BAY CIRCLE CENTERVILLE, MA SYSTEM ONE 02632_ Name of Owner PHILLIP SCHILLER Date of Inspection: 10/25100 BUILDING SEWER:X (Locate on site plan) Depth below grade: 24" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 12" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: V X V BLOCK CESSPOOL" Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 3" Distance from bottom of scum to bottom of outlet tee or baffle: nla How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) Art THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE GREASE TRAP: _ (locate on site plan) Depth below grade: nla Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: nla Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) n/a !r i of t.t ^F: revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 SCUDDER-BAY CIRCLE CENTERVILLE, MA SYSTEM ONE 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10/25/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) E. Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:NIA Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: n/a Comments: (note if level and distribution is equal,evidence;of solids carryover,evidence of leakage into or out of box,etc.) n/a PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a urn E revised 9/2198 Paae 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 SCUDDER BAY CIRCLE CENTERVILLE, MA SYSTEM ONE 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10125100 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)1000 GALLON PIT leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT WAS EMPTY AT THE TIME OF THE INSPECTION.THE STAIN LINES INDICATE THE PIT HAS BEEN V TO PIPE. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. We Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO z} 1 Comments: t (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a. Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 912198 Paoe 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 SCUDDER BAY CIRCLE CENTERVILLE, MA SYSTEM ONE 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10/25/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) C A pecK 0 A '�� a CA 3)L OA PA 14 H Gg `lL DA uL Dg S3 O� '•4 revised 9/2/98 Paoe 10 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 SCUDDER BAY CIRCLE CENTERVILLE, MA SYSTEM ONE 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10/25/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet n/a Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions _ Checked with local Board of health Checked FEMA Maps _ Checked pumping records _ Checked local excavators,ihstallers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12 FEET revised 9/2/98 Paae 11 of 11 Town ®f Barnstable ti Regulatory Sei-vices Thomas F. Geiller, Director * BARNSTABLE, w X"S. �, Pu blk Health Division 1639. Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: °2 Id, Sewage Permit# C>?%— 036 Assessor's M ap\par°cei Designer: �OWVI Installer: U orl_�I YA Co,,4_bu�Vki Address: JY_- � K On ,g®F A"IWI e2W5/ - was issued a permit to install a (date) (installer) septic system at 6 c5 c�r C kJhV1 6t C 11'tom based on a design drawn by (address) �a✓► ?i/ 'AJCt /0 /��.f• dated 7 6?0 esi er) I 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. I 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. H OF Mgssgcti -G ` DANIELA. (Inst 'er's Signature) ; OJALA �, No.40980 P �. CgoFfiSS10 O� j((Desigg�ner's SURVigna e) (Affix Designer's Stamp Here) PLEASE RETURN TO )BARNSTABLE PUBLIC HEALTH IRVISION. CERTIFICATE OF COM-FL NCE ILL NOT BE ISSUL-iD ITNTIL BOTH THIS FORM AN9D AS-B><JMT CARD ARE RECEW EID BY THE BAItNSTABLE PUBLIC HEALTH IDWISION. THANK YOU Q:Health/Septic/Designer Certification Form 3-26-04.doc 4 a. A. 1 COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 66 SCUDDER BAY CIRCEL CENTERVILLE, MA SYSTEM TWO 02632 Name of Owner PHILLIP SCHILLER Address of Owner: BOX 104 W.HYANNISPORT MA.02672 Date of Inspection: 10/26/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date:1116/00 The System Inspector shall s mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If 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. NOTES AND COMMENTS "The inspection is based on criteria defi ed in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.M, inspection does not imply any warranty oir guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. r, s; revised 912198 Paoe 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 65 SCUDDER BAY CIRCEL CENTERVILLE, MA SYSTEM TWO 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10/25/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion o the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nla The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether"or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. n(a Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)o due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced n/a The system required pumping more than four 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 A F -jel revised 9/2/98 Paoe 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 65 SCUDDER BAY CIRCEL CENTERVILLE, MA SYSTEM TWO 02632 Name of Owner PHILLIP SCHI'L'LER Date of Inspection: 10/25/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: I Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM I.- NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 jeet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water•supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. '_t.:E The system has a septic.tank and soil absorption system and the SAS is within 50 feet of a private water supply well, c _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nLa (approximation not valid). 3) OTHER n/a r ' i� wl Ir. revised 9/2/98 " Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 65 SCUDDER BAY CIRCEL CENTERVILLE, MA SYSTEM TWO 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10/25/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No - X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool - X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. - X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, - X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nla. - X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - X Any portion of a cesspool or privy is within a Zone I of a public well. - X Any portion of a cesspool or privy is within 50 feet of a private water supply well, - X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.if the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following:. The following criteria apply to large systems in addition to the criteria above: 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 environmenf tiecause one or more of the following conditions exist: )Ito Yes No - X the system is within 400 feet ofta surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply - X the system is located in a nitrogen�sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. I is revised 9/2/98 Paoe 4 of 11 �rltii SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 65 SCUDDER BAY CIRCEL CENTERVILLE, MA SYSTEM TWO 02632 Name of Owner: PHILLIP SCHILLER Date of Inspection: 10/25/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X - Pumping information was provided by the owner,occupant,or Board of Health. X - None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A. X - The facility or dwelling was inspected for signs of sewage back-up. X - The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X - All system components,excluding the Soil Absorption System,have been located on the site. X - The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based'on: X - Existing information,For example,Plan at B4O,H, X - Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)] X - The facility owner(and occupants,'if different from owner)were provided with information on the proper maintenance of SubSurface Disposal System s. 4 r 1 revised 9!2/98 Paoe 5 of 11 A,-t 1�1( • . i` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 65 SCUDDER BAY CIRCEL CENTERVILLE, MA SYSTEM TWO 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10/25/00 FLOW CONDITIONS RESIDENTIAL ; Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):ells 3 Total DESIGN flow: 330 gpd Number of current residents:2 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):-NO Seasonal use(yes or no): NO Water meter readings,if available(last'tWo year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COMMERCIAUINDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: nla System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:nla ' TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous inspection records,if any) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other: n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: CESSPOOLS 1976 WITH A NEW PIT IN 84 Sewage odors detected when arriving at the site:(yes or no): NO revised 9/2/98 Paoe 6 of 11 L I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 SCUDDER BAY CIRCEL CENTERVILLE, MA SYSTEM TWO 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10/26/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 18" Material of construction: _ cast iron _ 40 Pvc X other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 12" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 6'X 6'BLOCK CESSPOOL" Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or-baffle: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) 'i MAIN CESSPOOL AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY ONE TO TWO YEARS DEPENDING ON USE TO PROLONG THE SYSTEM'S USEFULL LIFE.THE CESSPOOL WAS EMPTY AT THE TIME OF THE INSPECTION. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and,outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) n/a �!i ',r rfi revised 9/2/98 Paoe 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 SCUDDER BAY CIRCEL CENTERVILLE, MA SYSTEM TWO 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10/25/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: nla Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nla DISTRIBUTION BOX:_ (locate on site plan) A R Depth of liquid level above outlet invert: n/a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) n/a PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2/98 Paoe 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 66 SCUDDER BAY CIRCEL CENTERVILLE, MA SYSTEM TWO 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10/25/00 SOIL ABSORPTION SYSTEM(SAS).: X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)1000 GAL 6'X 6' leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT WAS EMPTY AT THE TIME OF THE INSPECTION. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. nla Dimensions of cesspool: nla Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO y, Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a ^ Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a .a revised 9/2/98 Paoe 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 SCUDDER BAY CIRCLE CENTERVILLE, MA SYSTEM ONE 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10/25100 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes Into house) A O A Aq LID + pecK OA I PEA 4 . c A 3� k . g Dq yl ,n. Al l revised 912198 Paae 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 SCUDDER BAY CIRCEL CENTERVILLE, MA SYSTEM TWO 02632 Name of Owner PHILLIP SCHILLER Date of Inspection: 10/25/00 NRCS Report name: nla Soil Type: n/a Typical depth to groundwater: n/a ,s pry^ USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet n/a Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions Checked with local Board of health _ Checked FEMA Maps Checked pumping records Checked local excavators,installers X Used USGS Data Describe how how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12 FEET revised 912/98 l'' Paae 11 of 11 t No..�c..:l.`. .� � -FEE.../.I .........._ Tfr COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH eays App iratilan for Disposal Works Tonstrurtiun rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......(d. - Sc:C, rS1e .....................................� CA e .......................................a........................................................ Location-Addr ss or Lot No. _�.�m.-�lc����,- rQ� eta ........... - - :.0�....--• ................ Y..... ` ........................................ (1,wn �� Address a -•-•••--� k. ---•_ --��.n -----•••.. .. .... _E . n c. P T .................. Installer Address Type of Building * Size Lot............................Sq. feet Dwelling—No. of Bedrooms......L1•••---••••-------•--•-•--_____--Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures ................................................... --------------------- W Design Flow........ __gallons per person per day. Total daily flow--------- _0 . --•-.--._..•..•....gallons. W Septic Tank—Liquid capacity............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 ( ) aPercolation Test Results Performed by ----------- Date �Y Test Pit No. 1...........:....minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••••••••-•••------------•---•-••••••••••••••-•••...•---••-•--••............•••.............................................................................. 0 Description of Soil.........................................................................................---------------------•------...------------------------------•--•----•--..•... x U •-•---------------•----------------------••---------•---------------------------------•-----•-------.....------------.-••-•--------•---•-----.....-----•----••------•--•------................---•-•••. � -•-••••-................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable.._.__.. }`E, _ ....... �?Q_..C�.f4. [-cyr�,.,..._.�a .........•.... ................ ."... .. `------5.. .._......V...0....t_Sel z.O•... '2�LS�_t. .Sc. ob .............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'LHUE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance sued b the b La,�d-•of-tn_ . Signed----- •............• \ Date Application Approved By.......... �a ` � L j i ..............•-•-.......... - -•-••-••..._.... Date Application Disapproved for the following reasons:...........--------------------------------------------------•-----------------------......................... ------••-•-•---••••-••••••-•--•-•••-......••••••••--••••••-•••-•--••••••••...-••--•---•••-••••••••-•-••••......•••----••-••-•••-••-•------•••---•-•••••••------•-----•••••--••••-......••-••--•...•-•-•- Date PermitNo......................................................... Issued........................................................ Date �L.--- - - ---------------- No......................... jp FEs.............................. HE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --•................ ...................OF..................................................................................... Applira Lion fur Disposal Works Tonstrurtion rranit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: (4 CAL oration 6es .. ...�- or Lot No.. VY\ +— Z V ✓Owner ` (cA,C- Address ------•-----. ...._ ----- k---------------------------- ' ystalle F' Address W,621'dincll Type Size Lot............................Sq. feet �-� Dwelling—No. of Bedrooms.... -L-f----------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) � Other fixtures -------------------------------------------------------•------•-•--•-•-------•-•-•----•-•---•---•-----•--.....-•--•-•--••-•-•--._....._.._...------•. W Design Flow............................................gallons per person per day. Total daily flow........ a.Q-..................gallons. WSeptic Tank—Li�id�cQcity.�. ...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...................--------------------- 04 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--__--_-------•-•---•_-. GX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P --•-•---••--------------------------------------•-••---••--•-------•-••----•----..........-----••••----•••••......•-•-................. ---------- •-- O Description of Soil....................................................................................---------------------------------•-----------------------•••... ............ x U w x ----••-•••------•----•--------...•----------•--•-•-••--•----------------•----•-••........................... -----------------•------•-•---------•-------------------•-----•-••-•• ............. ------•------------ . ...---- ---------- ----•--- Agreemetlty SZ c tiz T o W _ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITA IE 5 of the State Sanitary Code— The undersi ned further agrees not to place the system in operation until a Certificate of Complianceshasbee ueq9by the bCard of �..... . -------------------- ------....... � �. ..�.. ate Application Approved By.................................................................................................. ..................... .................. F. Date Application Disapproved for the`f ollowing reasons:-----•--------••----------------•----------------------•----------------------------------............••-•-••--- ......-•-•---:..----•--------•-------•-------------------•-------•-------•---------•-----------•-•-------...------•--------------------------------------------------------------------------------•-••-- i Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ``N' BOARD OF HEALTH ..........................................OF..................................................................................... rrfif irFatr of ToutpliFaurr THIS IS T TI ^t t e Individual Sewage Disposal System constructed ( ) or Repairedby ( ) -•-----------------•------- ............... Installef at..................................................................................................... } has been installed in accordance with the provisions of TIT 5 oFThe State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................................................... Inspector............... =-�..................................................... THE COMMONWEALTH OF MASSACHUSETTS C��_ ;`�/ BOARD OF HEALTH /f ......................................._OF................................_._.................................................. No.............•-----.....- FEE........................ 'Disposal- ag iun rrntt Permission is hAry7ra nted. --------- to Construct ( ) oir ( a u ewa I) S osal SystEQ at No.......... Snt et as shown on the application for Disposal Works Construction Pe it �o.___.________________ Dated.......................................... ................•-------•--...-------•-••---•--•-•••------•••-•--------•---•....-----••-•...--••••--...._ Board of Health FORM 1255 A. M. SULKIN. INC., BOSTON id No.O.. . Fss....P.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........:77�4*v ........O F.....A/Qiz✓J. _Roll .................................... Appliration for Biipuual Works C ontitrurtiutn Famit Application is hereby made for a Permit to Construct ( ) or Repair (&-�'an Individual -Sewage Disposal System at: -�..►.`. .........fc -•-•-------------------•---------------------...-------- .................. Lo ation-Addre or Lot No. ...._ afe_-. . ......-•.............................•.... ..............................................-----..-.------------.-..------------------------.-- Owner Address ---•---•--•-•------------•-•-•--••---- -•......................... Installer Address Q Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms..... Expansion Attic ( ) Garbage Grinder ( )H ................................. aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures -----------------------•------......•-•-----.................-------------•---------------------------•--------------•--•---...----•-..........._..... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity..--........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.---.................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------•--•-------------------------------------------------------------------••-••--•••...._......................................O Description of Soil...................................................................................................................................................... x U ............................ w x --•••••--•----•----•-•--•-••----•-••••--------•••-•-••------------•-•••-•-----••••--------•---••---••-•••--•-------•---•--•---•••----•••--•••-•-•--•••••----•-••••--------------------•--•••-•-•...... U Nature of Repairs or Alterations—Answer when applicable..../0 V....--.Fr41........4��............................................ ------------------------•--------------•-----------------....................••-••--•••---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. / ' y---.. ...��/...' Application Appr cam.✓ ........................................................... .... Date Application Disapproved th ollowing reasons:..............•--.:..................-------•----------•--------------------•-••----------=-----........_...._.. .....................................•-------------•-----.....----•------••••-••----•....._. Date PermitNo......................................................... Issued........................................................ Date L rt No. FES...................`......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1'5.4err.�........OF.....tot.. � -.�1�/ra�. ........ ..................... Appliration for Di,iVuiittl 30urk,i Tomitrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (G+<an Individual Sewage Disposal System at: Of p- ---.-.--.--•-•........................•---•---............-----....--•-••-•••.................. Lo ation Addres or Lot No. a ............................................ .......... ..............•••••...........................•••-- Kner Address Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms._..._ Expansion Attic ( ) Garbage Grinder ( )-•--------•-..•--- aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures ------------------------------------------------•------------••-•-••-------•-•...•-------•••-••-------------------......----•-••-----•--.....-------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ W 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........................ Gti Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1:4 --••-----------------------------•-----•---•-••------••--••••-•......---•--...........................•-•---•••••---.................-----•---•-•- ...... --- 0 Description of Soil........................................................................................................................................................................ x U .............................................. •-------------••--..........-•-----•--•----......--••-------•-••...•------------------•••--••-•-------••-•---------------------•------•-•--------------... W UNature of Repairs or Alterations—Answer when applicable.____ Czkv------jw/--------Ag� !-----------------------•---•-.-.----------. . •-- ------•••--•••-•---••---------•------------•---•----•....•---- Agreement: The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of Health. - - ........... ----- ----- -=------- ---/�/h �' ..---- Application Approved"B ....... ...•---•--- . '" .... Date Application Disapproved f th ollowing reasons:---•----....---•-•---------••---...------•--------••...............•------------........._.....--•------•---•---• ...-----•-•---•---------•----•--.....••-••---.--•••-•--••-----•---•-•-•---•---•............................ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a ...................dWOw0"......0 F............ .-0K . Tatif irate of Toutphatta THI IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �/ f Installer at l ` { c----------•-•------- ............................. ......... has been installed in accordance with the provisions of TIT 5 of The State Sanitary Coca bed in the application for Disposal Works Construction Permit No.- All.......... dated_!!/: .........:....:.....:......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT THE SYSTER+1,r WI /F zNCTION SATISFACTORY. / r ..---------DATE../.... ......-•---...-•..........................••--•--•-•---. Inspecto ...... ..... I •-------•--•--------.....------...-----•-----.....-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p �F' No. ................ ..................... r"" . .... ( /9L+.OF.....----.. l ,rfi..; ,r :. .............. �t��u�Ml urk� �oat��.rttr##iori Fr21tt� FEEA.............. Permission is hereby granted...... _ ( ':..................�r ! ' �x.. ''.. u - 'G .. ........................................................... to Construct ( ) or Repair � an In ividual Sewage Disposal System at No.•--�a�---•---..t L'.a✓+Q! �•�x;-•---- r+ --•--------- '� '°i`-------------------- la'* oo - -... Street as shown on the ap 'cation r Disposal Works Construction Permit N :__:: _____- ,..r afed°'.........................•.............. .. ....... • . ........ Board of Health DATE.__.l _ _ ...lJ---- ------------•----- FORM 1255 A. M. SULKIN, INC., BOSTON lli�0CAT, ION � SEWAGE. PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS R UILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED t t VO CAT ION, SEWAGE PERMIT° NO- YILLAGE INST—cxALLER'S NAME i ADDRESS ' . p �� t e u I L D E R OR -OWNER ..� D A T E PERMIT ISSUED S g yd °? DATE COMPLIANCE ISSUED 9a2-�, ; T gr,Qooep- Gwy SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) CONiPARABLE MEANS FOR FUTURE LOCATION. PROP. VENT 1. DATUM IS APPROX. NGVD Ro'te 28 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 2. MUNICIPAL WATER IS EXISTING TOP FOUND. EL. 49.5' FILTER FABRIC OVER STONE \ 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. Locus 48.7' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 48.3 MIN 4. DESIGN LOADING FOR SEPTIC TANK AND D'BOX . 8" DIAM Road Mtn s PRECAST H-10 BLOCKS OR UNITS TO BE AASHO H-10; SAS UNITS TO BE H-20. 8 et RISERS (TYP.) J ti " PRECAST RISERS 2'0 4 0SCH40 PVC R� �'� �• PIPES LEVEL 1ST 2' MORTAR ALL H-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. COMPONENTS 8' �n ' -*45.9 �ENDS (TYP.) 10" 1500 GAL H-10 14" SIDES EL 4.78' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 'o�o�o'o'° „°°°°°° WITH 310 CMR 15.000 (TITLE 5.) *45.9' 44.6' TEE SEPTIC TANK TEE ° ° ° ° oaaa 0 000� °go oaoa_o °o 44.35 ° ° o000 -mDDO ° ° ° ° ° o > ° ° ° ° 'o 0 0 0 0 0 6" MIN. SUMP >°o°o°o°o 0 0 0 0 0 o 0 0 0.� °p°°°° o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ° ° ° ° ° ° ° ° ° ° 0000a�000a.� °° ° ° oaaa0000000 °°°°°°°° GAS BAFFLE °400 °o°o° 12" MIN. INT. DIM. ;°o°o°$°o 0 0 o o 0 0 0;:� o00000 0 0 0 0 0 0 0 0 0 0 0 ;o o N '°°°oo°°° aooao�o�o oo°o°o ����00�0(]00 ,o°o°o°o° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND �� °°°°°°°° °°°°°° 4' LIQ. LEVEL (ACME OR EQUAL) ; 44.1 43.93 ;°o°o°o°o 00000° I °o °g NOT TO BE USED FOR LOT LINE STAKING OR ANY �`- LH-20 EL. 41.78 OTHER PURPOSE. �% a`D J°O O; O O O'O•O O'O O O O O•`O O•O O O O O O"t o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o°o „° ° ° ° ° ° ° °°°°°°°n° 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC.o 0000 °_ n.o oo 3/4"-1-1/2" DOUBLE WASHED STONE (2) UNITS REQUIRED � aP 6" CRUSHED STONE TONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30' X 9 83' 9. COMPONENTS NOT 'TO BE BACKFILLED OR �� oln Rood COMPACTION. S 1 [2]) CONCEALED WITHOUT INSPECTION BY BOARD OF O M Beoch 00 HEALTH AND PERMISSION OBTAINED FROM BOARD St on9 ( 2 % SLOPE) ( 1 % SLOPE) ( 1 % SLOPE) `r U) OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FOUNDATION 31' CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP SEPTIC TANK 25' D' BOX 17' LEACHING 37.5' BOTTOM TH-1 & 2 VERIFYING THE LOCATION OF ALL UNDERGROUND & FOUNDATION 65' MAX FACILITY NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF NOT TO SCALE NOTE: NO G-W FOUND TO ELEV. 36.0' WORK. *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL TH 2 CAVED AT 12' DEPTH) 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 188 PARCEL 99 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS SHALL BE REMOVED 5' BENEATH AND AROUND THE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE PROPOSED LEACHING FACILITY. IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR 140TE: 7AERE ARE 4 CESSPOOLS ON PROPERTY, 3 OF WHICH 12. EXISTING LEACHING FACILITY SHALL BE PUMPED I BY HEALTH INSPECTOR WERE FOUND BY FIELD CREW AND REMOVED OR PUMPED AND FILLED WITH CLEAN L E G E N D PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED SAND. BY THE BOARD OF HEALTH REVISED DURING A PUBLIC 99 - EXISTING CONTOUR HEARING HELD ON AUG. 4, 2009 X 99.1 EXIST. SPOT ELEV. 3) FAILED SYSTEMS ONLY : SOIL ABSORPTION SYSTEM SEPTIC DESIGN 99 PROPOSED CONTOUR INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) �9g 4] PROPOSED SPOT EL. AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS BE LOCATED MORE THAN SIX FEET BELOW GRADE. Z� 6' GARBAGE DISPOSER IS NOT ALLOWED TH1 TEST HOLE VARIANCE REQUESTED UNDER MFC 15.405: x--48 36- 1b: SAS TO BE GREATER THAN 3' BELOW FINISH GRADE --x\8.49 /,x 47.40 SHED DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD 4 .60 2> SLOPE OF GROUND �P, ,47.75 USE A 330 GPD DESIGN FLOW x 4P.76 x\48.50 UTILITY POLE GUY �_� �� wIRE x 48.70 x 4 8 47.83 7 83 SEPTIC TANK: 330 GPD (2) = 660 07 _ x 48.88 47..7 45.46 Q46 37 USE 1500 GAL. H-10 SEPTIC TANK FIRE HYDRANT / �j 65 _ CP f y x 1y5 -ELEC. �� , _ v 48.90 J !. F 48.08 NOTE; NUT ALL S'AZOS MAY APPEAR IN DRAWING x 6.31 HAND B X � ' GARkjL x � x UG RES i I SLAB ,�_� 98 48.37 LEACHING: 48.18 I I -x 31 PAVED SIDES: 2 (30 + 9.83) 2 (.74) = 118 GPD TEST HOLE LOGS I 4-&--,3� 9 ' PROP. X ,- PLAY 1 DRIVEW \e 148.54 48.53" x 48.75 8.53 GYM 403.11 BOTTOM 30 x 9.83 (.74) = 218 GPD e� 48.21 TOTAL: 454 S.F. 336 GPD I -«461- F48.1$ / 2 �UN T ��' 0 0 0 x 48.75 48.49 ARNE H. OJALA, PE, SE x .t - - BRICK 48.90 ENGINEER: 18 .01 �E WALK s WR DAVID W. STANTON, RS 1 4% \ �'- f 48.82 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) WITNESS: 46.62 I / WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' EL=45.9' DATE. JANUARY 26, 2010 r 5 ACS ` 00 BETWEEN UNITS 45 < 2 MIN/INCH EXISTING Lux 48.47 PERC. RATE _ / I DWELLING DECK I W TOP X 4 21 CLASS I SOILS P# 12826 046.�91 j�j I PORCH ELEV. D49.5'N. 50.36 I 26'`�I Q o f 41 O 4 18" ELEV. ELEV. m I \ 00 J 49.83 11 48.50 32' 1g, HOLLY- 148.42 MA 4 4 m m 1 \�469Q, �! a 4o APPROVED DATE BOARD OF HEALTH » 48,0 " 48,0 � SHELL INV.OUT PRO48.66' I PARKING 47. 1 WEL=4`�.95' C.O.P. 2A A m1 W w w w LS LS Z 46 8 TH 1 1 4 METER 48.45 x 4 .3 48.25 I 81 48.05 10YR 2/1 10YR 2/1 6„ 6" 1 . G G G -� x 4 . x 4 . 6 2 ' 48 TITLE 5 SITE PLAN '6 S OF B B /� a' . 1 C 48 G _�48.35 TWIN OA � x 4 4T 2 n I �Q 63 c LS LS r _ _ CESSPOOL OAKS V5 SCUDDER BAY CIRCLE 10YR 5/6 10YR 5/6 146 �� r', " m 47 LOT 24 x�`7.r � n rvY �N� FND j /r -�47.71 NAIL IN BENCHMARK8 OAK 28 45.6 30 45.5 25,955 SFf x 4r� - - - x� �, Y'�,Y CENTERVILLE 648.13 ELEV. = 49.5'46.49 \C � L"P ` ` PREPARED FOR PERC C C x 49.11 PROP. VENT WITH CHARCOAL FILTER BORTOLOTTI CONSTRUCTION/ x4785 AND BUGSCREEN (FINAL PLACEMENT BY �66 CONTRACTOR WITH HOMEOWNER CRAWFORD MCS MCS 446.417 03, 48 CONSULTATION) / JANUARY 27, 2010 / x 4 47-/ 1 OYR 7/4 1 OYR 7/4 / x 46.17 (HOF4fjs °s off 508-362-4541 / DANIBL �� 7�„ I fax 508-362-9880 tips '� U�[--,!! 1 `'� downcope.com Q,IALAt A. n\' 126" 37.5' 144" 46.39 ;0 `, � � ra c�9svi 'a down cope eng/neefIft 36.0 �. � civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' ems , n� �;a ��� e land surveyors 939 Main Street ( Rte 6A) 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 0-002 10-002.DWG(SBO)