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HomeMy WebLinkAbout0695 SOUTH MAIN STREET - Health (3) E 695 So. Main St., Centerville J17 A=1.86-065 i i I� I 1 No. 42101/3 ORA ESSELTE 10% O O O O i 4 j F/,%ay 26 2016 21:54 Jim The Inspector Man 5085349919 page 1 ■�■ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 695 South Main Street N = Property Address Richard &Jean Rompala Owner Owner's Name t information Is Centerville ✓ MA 02632 5-24-16 m required for every page. Cityfrown 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 outpforms . /_� `������ttt1OF u* on the computer, `�� �N use only the tab 1. Inspector: key to move your 3 s cursor-do not C5 James D.Sears ='• JAMES use the return = Name of Inspector v; key. *: :j Capewide Enterprises, LLC Company Name r�rsRT—Fa.' 153 Commercial Street ��''�,,�•5 INBPEG� ��� Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 6 (310 CMR 16.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5-24-16 �spectorrsSignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. 3 ""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. 151ns•3/13 - Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 1 of 17 I .. May 26 2016 21:54 Jim The Inspector Man 5085349919 page 2 Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 695 South Main Street Property Address Richard &Jean Rompala Owner Owner's Name information Is required for every Centerville MA 02632 5-24-16 page. cityrrown State Zip Code Date of Inspection B. Certification (cost.) Inspection Summary: Check A,B,C,D or E l always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal. Tank D Box and six cultec chambers. 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-V13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 May 26 2016 21:54 Jim The Inspector Man 5085349919 page 3 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 South Main Street Property Address . Richard &Jean Rompala Owner Owner's Name information is required for every Centerville MA 02632 5-24-16 page, City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Condition's 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-3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 i May 26 2016 21:54 Jim The Inspector Man 5085349919 page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 695 South Main Street Property Address Richard &Jean Rompala Owner Owner's Name information is required for every Centerville MA 02632 5-24-16 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 sail absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: " This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered_A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No . i ❑ ® 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 is less than 6" below invert or available volume is less than V day flow ,C F"57eyti e 15ins•3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I May 26 2016 21:54 Jim The Inspector Man 5085349919 page 5 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 South Main Street Property Address Richard & Jean Rompala Owner Owner's Name information is required for every Centerville MA 02632 5-24-16 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 11 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. 15ina•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 May 26 2016 21:54 Jim The Inspector Man 5085349919 page 6 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 695 South Main Street Property Address _Richard &Jean Rompala Owner Owner's Name information is required for every Centerville MA 02632 5-24-16 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 NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage.back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System.(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 15ins•3113 Title 5 Oftidal Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 May 26 2016 21:54 Jim The Inspector Man 5085349919 page 7 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 South Main Street Property Address Richard 8l Jean Rompala Owner Owner's Name information is Centerville MA 02632 5-24-16 required for every page. CitylTown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and six cultec chambers. ;x Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 2014-286,000Gal g ( y g (gp ))' 2015-296,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Y Date Commercial/Industrial Flow Conditions: 4. 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: l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 w May 26 2016 21:54 Jim The Inspector Man 5085349919 page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 695 South Main Street Property Address Richard & Jean Rompala Owner Owner's Name information is required for every Centerville MA 02632 5-24-16 page. City/'Town State Zip Code Date of Inspection ;x D. System Information (cost.) f Last date of occupancy/use: Date Other(describe below): +1 General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No 4 t If yes, volume pumped: 1 4 gallons � How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system F ❑ 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): 15ins-3113 Title 5 Official Inspecilon Form:SubsuAace Sewage Disposal System•Page 8 of 17 .a y May 26 2016 21:54 Jim The Inspector Man 5085349919 page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 South Main Street Property Address Richard &Jean Rompala Owner owners Name information is required for every Centerville MA 02632 5-24-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1998 Permit#98-92. Were sewage odors detected when arriving at the site? ❑ Yes ® No k Building Sewer(locate on site plan): Depth below grade: 26' feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40, Septic Tank(locate on site plan): Depth below grade: 16" feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 4 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10 Sludge depth: 15ins-3113 Title 5 Official Inspection forth:Subsurface Sewage Disposal System-Page 9 of 17 k May 26 2016 21:55 Jim The Inspector Man 5085349919 page 10 k Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 695 South Main Street Property Address Richard &Jean Rompala Owner Owners Name information is required for every Centerville MA 02632 5-24-16 page. Citylrown Slate Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" OilScum thickness it Distance from top of scum to top of outlet tee or baffle t3 Distance from bottom of scum to bottom of outlet tee or baffle 18" ; How were dimensions determined? Asbuilt- Plan-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and outlet cover at 16" below grade wlinlet cover under walk way at 4" In and outlet tee's. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: a ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: r, Scum thickness v 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 (Sins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 a May 26 2016 21:55 Jim The Inspector Man 5085349919 page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 695 South Main Street • Property Address Richard &Jean Rornpala .Owner Owner's Name information is required for every Centerville MA 02632 5-24-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: } Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date 1 Comments (condition of alarm and float switches, etc.): r Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No I t5in3-3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal Syslem-Page 11 of 17 May 26 2016 21:55 Jim The Inspector Man 5085349919 page 12 Commonwealth of Massachusetts R Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,a 695 South Main Street 4 Property Address ' Richard & Jean Rompala Owner Owner's Name information is required for every Centerville MA 02632 5-24-16 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 0 ; Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x 1 T-15" below grade. Box is clean and solid w/three lines out. No sign of over loading or solid carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required). If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 May 26 2016 21:55 Jim The Inspector Man 5085349919 page 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 695 South Main Street Property Address Richard &Jean Rompala p Owner Owners Name information is Centerville MA 02632 5-24-16 required fior every page. City/Town State Zip Code Date of Inspection D. System Information (cont,) Type: ❑ leaching pits number: ® leaching chambers number: 6 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Typetname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is six cultec contactor 100's w/4'stone. Ck D Box and camera out. No sign of over loading or solid carry over. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): j Number and configuration Depth—top of liquid to inlet invert 4 Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No l5ins•2113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 May 26 2016 21:55 Jim The Inspector Man 5085349919 page 14 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 South Main Street Property Address Richard &Jean Rompale Owner Owners Name information is required for every Centerville MA 02632 5-24-16 page. CitylTown State Zip Code Date of Inspection D. System Information (cost.) fi Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): a 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.): d i I t5ins•3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 :t May 26 2016 21:55 Jim The Inspector Man 5085349919 page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments N s 695 South Main Street Property Address h Richard &Jean Rompala Owner Owner's Name information is required for every Centerville MA 02632 5-24-16 t page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately c z 13, / e / a 3 t L' if t5ine•3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 or 17 May 26 2016 21:55 Jim The Inspector Man 5085349919 page 16 g Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 695 South Main Street Property Address Richard &Jean Rompala Owner Owner's Name Information is Centerville MA 02632 5-24-16 required for every Page City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water V ❑ Check cellar ❑ Shallow wells i 4 Estimated depth to high ground water: 8'-4" 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. 1-6-98 Date F ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health- explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: 5 ' You must describe how you established the high ground water elevation: S T.H. on design plan 1-6-98 8'-4"G.W.. Bottom of leaching at 29"below grade. Bottom of leaching at 6'above T.H. Depth. Y p Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Farm:Subsurlace Sewage Disposal System-Page 16 of 17 May 26 2016 21:55 Jim The Inspector Man 5085349919 page 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 695 South Main Street Property Address Richard &Jean Rompala Owner Owner's Name Information Is required for every Centerville MA 02632 5-24-1.6 page. City(rown 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 t t5ins•3/13 Title 5 Official Inspection Fort:Subsurface Sewage Disposal System-Page 17 of 17 p TOWN OF BARNSTABLE "..''LOCATION / S S 0 U"�]y M A hV 5Z SEWAGE.# ` VILLAGE CP/✓t ex V 122 e - ASSESSOR'S MAP& LOT�G D� INSTALLER'S NAME&PHONE N0. J•P AA/Q C d A lS ex t SON ,: SEPTIC TANK CAPACITY /-s o D LEACHING FACILITY: (type) - C o N 1 A C to/f. (size) /06"s NO.OF BEDROOMS ..::' .BUILDER OR OWNERWAL .:..,,,..,_PERMIT DATE: i -9$ COMPLIANCE DATE: -a- Separation - Q • i Distance Between the: -MaximumAdjusted Groundwater Table and Bottom of Leaching Facility Feet :.,.PrivateWater.Supply Welland 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 Aq Pagsmm&,.:..: (�r11ov3 8uryoval 3o 1333.00£unp! laa3 tag our ova uv ue a o a8` tslxa spuvllom Aug,B).�lij. 3 r 'I P P P M 3 04:;,: tov;8utgmol;o laa3 OOZ u►tllln+Jo ails uo,'• "::• laa3 tov 811,T1131001u¢ a ddn .taly aliti ; lsna sllom.fuv� �lq d. P 1l M 1 S M laa3 lov3 Sunloew l Jo tnouog P algg L iatgnnpunoiO patsnfpd inn :ath uaaMlog aoumsl(l uopewdas � ,. �':B,LdQ�_"' �I'IdY�I00- �(J h -i3NMO210daulfIH:%:. ' ShI002IQSt3 30`OI�I`; 0 (ans) .�� O _ (od") :A.LI'IIO'd3 DNmov.. 0 n,f' A,LIDdddD )INVI OLIARS 'ON 3NOHd V 3NPdN S,2I3'1'1d:L9tZ /✓�S ioz avw s.�ossassy a 77111 Ya -A aJ a�dz #mvmas NOLLd�O"I' J 31flb1.SNXVq 30 KMOJ J p TOWN OF BARNSTABLE LOCATION (e / •f -5O1J-r11 ,M A 1,V 5-7 SEWAGE # VILLAGE CLO t X V 121 Gip- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. T./-p AA A C 0 /4 9 EEC 'k .5O/i1 SEPTIC TANK CAPACITY f-s'o LEACHING FACILITY: (type) tol— C o N 1 A c t6/f• (size) AW S NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet I Furnished by 1 0. r �_ r N Fee 5 0 .0 V ro� * Entered in computer: — THE COMMONWEALTH OF MASSACHUSETTS 111 Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACNUSETTS 01pplication for Th5pogof bpotem Con0truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( )XK]Complete System ❑Individual Components Location Address or Lot No. 695 South Main Street Owner's Name,Address and Tel.No.4 2 0—0 2 9 3 Centerville,Mass. 02632 695 South Main Street Assessor's Map/Parcel A Centerville,Mass. 02632 Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.7 7 5—9 7 0 0 J.P.Macomber & Son Inc. Ron Cadillac Box 66 Centerville,Mass. 02632 Box 258 West Yarmouth,Mass.02673 Type of Building: Dwelling XXNo.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder(NO Other Type of Building RES No.of Persons 0 Showers( ) Cafeteria( ) Other Fixtures Design Flow 440 gallons per day. Calculated daily flow 4 x 1 1 0 gallons. Plan Date 1 /1 5/9 8 Number of sheets Revision Date Title Size of Septic Tank 1 500 Type of S.A.S. 6 Cultec Contactnr Description of Soil Fill to medium sand 1 00 ,s Nature of Repairs or Alterations(Answer when applicable) c)M i tt:in n GesspegIr . 1n s t isl l VI E nar-kPr3 in 4 ' of stnAe DFSIGNIPIG EN 1�{TIFY IN WRI 1 G IN.tTA� � D D IN S1i RTC.'—' Date last inspected: 2/11 /9 8 T4-IE YSTEM WAS INST�-I-E Agreement: ACCorDANGE TO PLAN- The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by this B and f e Signed a Date 2/1 2/9 8 Application Approved by jL' Date Application Disapproved for the ollowing reasons Permit No. Date Issued • 50.00 1�0�- �° • �,�� Fee ` ;THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes f PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Mizpozar *potem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( )X&Complete System' ❑Individual Components Location Address or Lot No. 695 South Main S t r ee Owner's Name,Address and Tel.No. 4 20—0 29 3 ,(J 1 Centerville,Mass. 02632 695 South Main Street /U Assessor's Map/Parcel (y (/ Centerville,Mass. 02632 Installer's Name,Address,and Tel.No.'5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No.7 7 5—9 7 0 0 J.P.Macomber & Son Inc. Ron Cadillac Box 66 Centerville,Mass. 02632 Box 258 West Yarmouth,Mass.02673 Type of Building: Dwelling XXNo.of Bedrooms 4 Lot Size sq.ft. Garbage Grinddr( NQ Other Type of Building RES No.of Persons 0 Showers( r" Cafeteria( ) Other Fixtures f Design Flow 440 gallons per day. Calculated daily flow 4 x1 1 0� gallons. Plan Date 1 /1 5/9 8 Number of sheets Revision Date Title Size of Septic Tank 1500 Type of S.A.S. 6 Cultec Contactod Description of Soil Fill to medium sand 100,s Nature of Repairs or Alterations(Answer when applicable) Omitting cesspools- Installing 1 -1 500 gallon tank 1 -Di skri h rt i on hox and 6 Cu 1 bec ootartorc 100 , S packed in 4 ' of stone_ f Date last inspected: 2/1 1 /9 8 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system t in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuefi by this B and OfA&I kr. /� Signed &Date 2/1 2/9 8: Application Approved by Date Application Disapproved for the ollowing reasons Permit No. Date Issued ----- ---- ------------------------�-"-- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS I Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded(XX) Abandoned( )by J.P.Macomber & Son Inc. at 695 South Main Street Centerville,Mass. has%een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer J.P.Macomber & Son Inc. Designer Ron Cadillac i The issuance of this permit shall not be construed as a guarantee that the syste will function as designed. Date -� t� q Inspector ,n L-7 No. � -- ---------- —--------------Fee $ 50 .00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'iOpozal 6p5tem Cow5truction Permit - Permission is hereby granted to Construct( )Repair( )Upgrade(I, )Abandon( ) Systemlocatedat 695 South Main Street Centerville,Mass. and as described in the above Application for Disposal System Construction Permit. The applicant recogniz°s his/he duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructionjmusta co 4rithin three years of the date oft 4errnit. - Date: Approved by �/ 0 a r Dn RONALD J. CADILLAC, PLS,RS Professional Land Surveyor & Registered Sanitarian P D. Box 258, West Yarmouth, MA 02673 (508) 77/5-9700 Date: To: The Board of Health I inspected the septic system installed at and found it to be: . In substantial compliance with TitL.le 5 Not in compliance with Title 5 Comments: L- Op kjj� o p Cl AS-BUILT -SKETCH --�- ril- E O14 0 i IN OFeyjgss RONALD 9°tip I T^ AM 2, 2 CADf. AC 9 #1 60 s ' sT f G� Ronald ,xs Town of Barnstable B►RNsTAM, = Board of Health 9 MASS. .�A P.O. Box 534, Hyannis MA 02601 Office: 308-790-6265 Susan O.Rask,R.S. FAX: 508-790-6304 Ralph A Murphy,M.D. Sumner Kaufman,M.S.P.H. February 13, 1998 Ronald Cadillac, R.S. P. O. Box 258 West Yarmouth, MA 02673 Dear Mr. Cadillac: You are grant multiple variances on behalf of your client, Joy Hambly, to construct a replacement onsite sewage disposal system at 695 South Main Street, Centerville, Massachusetts. The variances granted are as follows: 310 CMR 15.248: To install a soil absorption system without any provision for a reserve area. 310 CMR 15.211(1): To install a soil absorption system four(4) feet from the property line, in lieu of the required ten feet separation distance. 310 CMR 15.211 (1): To install a septic tank six(6) feet away from the foundation wall in lieu of the required ten feet separation distance. 310 CMR 15.211 ( . To install a soil absorption system fifteen (15) feet away from a coastal bank in lieu of the fifty(50) feet separation distance required. Board of Health Part VIII, Section 10.00: To install a soil absorption system eighty- eight(88) feet away from a wetland in lieu of the required 100 feet separation distance. Board of Health Part VIII, Section 10.00: To install a soil absorption system fifteen (15)feet away from a coastal bank in lieu of the 100 feet separation distance required. The variances are granted with the following conditions: (1) The existing cesspools must be disconnected, removed or filled with clean sand. cadillac (2) The designing registered sanitarian shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in strict accordance with the submitted plans dated January 15, 1998. These variances are granted because the existing cesspools are located closer to the .wetlands and are, in all probability, sitting in the groundwater table. Thus, the proposed septic system would alleviate a source of pollution to the Centerville River. Sincerely yours, /Susan G. Rask, R.S. Chairman Board of Health Town of Barnstable SGR/bcs cadillac I TOWN Or DAnNSTABLC DAIF. I OrrlcE OF FEE I .Al„rin. ! DOAHU : HCALTH RFCFtvFn nY _ '". r 16j9• 991 MAIN S111EET l "1 IIYAIIIII9 MA93.02601 _ VARIANCE REQUEST PORN s.n `LP d ALL V11itJJ1f1ChS MUST nr ..",UIIM1TTi'il FIFTEEN L�5) DAX��` t TO-P T0. 1'Illi SCIII:UU1riU 1101110) Ur' III;A1,111 MEETING. �T " '7 NAME OF APPLICANT J b y Iq V-YNZ LV TEL. NO. 420 - 0293 ADDRESS OF APPLICANT 233 W114v)nO Al/E f)A ® z 6, NAME OF OWNER OF PROPERTY RkC.kA ra �Jr✓Ayv Re)r i PA I-A SUBDIVISION NAME lul DATE APPROVED A' ASSESSORS MAP AND PARCEL NUMBER LOCATION OF REQUEST (b G 5 60T1t s r -ruaut .C.E SIZE OF LOT 1 -4 4-C 407' Q.FT WETLANDS WITHIN 2O0 FT.YES NO VARIANCH FROM REGULATION(bint Regulation) 3kO CVKr2 IS. 2-11 `1 to, CPA(7- bvejjLnj c" 6,11'k sew , REASON FOR VARIANCE(May attach if more space Is needed) i ►- -,e S too c4 t�A�c�c:, IZ6 Q 1 i r'eiA �t9 v- 5.4 f PLAN - POUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPPROVAL BRIAN R. GRADYt R.S. , CHAIRMAN SUSAN U. RASR, R.S. JoSBP11 C. SNOWt M.D. BOARD OF REALTR TONN OF BARNSTABLE i RONALD I CADILLAC, PLS, RS Professional Land Surveyor Registered Sanitarian P.O. Box 258, West Yarmouth, MA 02673 (508) 775-9700 January 16, 1998 Ms. Susan Rask, Chairperson Barnstable Board of Health 367 Main St. Hyannis, MA 02601 Dear Ms. Rask: Enclosed please find 4 copies of a site plan for a proposed septic system at 695 South Main Street, Centerville.. The system proposed is 5' above high ground water. Due to the proximity of wetlands and the coastal bank the proposed system is in the driveway area. Please call if you need any further information for the meeting. Thank you. Sincerely, Ronald J. Cadillac RONALD J. CADILLAC, PLS, RS Professional Land Surveyor Registered Sanitarian P.O. Box 258, West Yarmouth, MA 02673 (508) 775-9700 NOTICE OF BOARD OF HEALTH HEARING To: Abutters Project Location: 695 South Main St., Centerville, MA Applicant: Joy Hambly 233 Wianno Ave. Osterville, MA 02655 Project Description: Applicant seeks permission to upgrade existing septic system. Variances requested are: 1.Vary distance of leaching to: Top coastal bank by 35' (15' provided) property line (Way) by 6' (4' provided) Vary distance of septic tank to foundation by 4' (6' provided) Above 310CMR 15.211 (1). 2. No reserve area to be provided. 310CMR 15.248. 3.Vary distance of leach to wetland by 12' (88 provided) Vary distance of leach to top coastal bank by 85' (15' provided) Vary (if applicable) onsite sewage regulation to meet 1995 State Code. Above 3 items are local regulations. Applicants Agent: Ronald J. Cadillac Hearing Scheduled: Tuesday February 10, 1998 at 7 p.m., or as soon thereafter as practicable at the second floor Conference Room, New Town Hall, 367 Main Street, Hyannis, MA RONALD J. CADILLAC, PLS,Rs Land Surveyor& Sanitarian P.O. Box 258 West Yarmouth, MA 02673 ai SENDER: , ■Complete items 1 and/or 2 for additional services. (��,.•b�Y T3K 1 also wish to receive the M ■Complete items 3,4a,and 4b. following services(for an ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ai ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address permit. ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2, ❑ Restricted.tom Delivery.. to. ■The Return Receipt will show to whom the article was delivered and the date .. C delivered. Consult po;tmaster for fe61-` ' a v 3.Article Addressed to: 4a.Article Number d I OE5 ¢ ET,�— 4b.Service Type ❑ Registered ❑ Certified or rn ❑ Express Mail ❑ Insured S c11 1 1 CA— , �� ❑ Return Receipt for Merchandise ❑ COD '0 7.Date of Delivery 5.R Ive Mit Name _ 8.Addressee's Address(Only if requested W ✓ and fee is paid) i g 6.Signatu r see r ent) _1 LPS Form 381'1,,DecembWr 1994, 102595-97-8-0179 Domestic.Returh,Receipt UNITED STATES POSTAL SERVICE First Class Mail �1••1 1�1J p ,k, _. •.Restage—&'Fees_Raid l?ermiUNd G40 Q • Print your na q address„and ZIP C his-box=*'� = G RONALD J. CADILLAC, P.L.S. Registered Professional Land Surveyor 18 BREWSTER ROAD WEST YARMOUTH, MA 02673 Z _ tf.i1t!!_:tf lilt!fill!111,11,11,11I1 11111�ti'tlt�i'1'tl1'��11tf'�ttlll��-t'It�lltl�t� m SENDER: I also wish to receive the ;o ■Complete items 1 and/or 2 for additional services. ��,,�� u+ ■Complete items 3,4a,and 4b. kw\ following services(for an rn ■Print your name and address on the reverse of this form so that can return this extra fee): card to you. �► ■Atttaac permit.this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address d ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery y r ■The Return Receipt will show to whom the article was delivered and the date ., C delivered. Consult postmaster for fee. n o 3.Article Addressed to: 4a. rticle NumberN -0� 673 d a lD 4b.Service Type l`C'L ❑ Registered ❑ Certified uNi I MA ❑ Express Mail ❑ Insured c V e t " ❑ Return Receipt for Merchandise p_COD z 7.Date D ery c a 0 I 5.Received By:(Print Name) 8.Ad re see's Address(Only if requested x C W and fee is paid) W� 6.Signat re:(Addressee or Agent T X PS Form 3 1.1,`December 1994 i i , i i 102595-97-8-0179 Domestic Return Receipt r ®' First-Class Mail UNITED STATES POSTAL SERVICE �p. Niq O- �""�• -Pestrge-&Fees-Paid Permit No.G=10— • Print your name,`�!ddress, and ZIP Code in this box• RONALD J. CADILLAC, P.L.S. Registered Professional Land Surveyor 13 BREWSTER ROAD WEST YARMOUTH, MA 02673 m SENDER: 1„-,,.�� I also wish to receive the � ■Complete items 1 and/or2 for additional services. �yfYV W ■Complete items 3,4a,and 4b. C�+r` following services(for an W ■Print your,name and address on the reverse of this form so that we dah retu this extra fee): card to you. ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address permit. ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2.❑ Restricted Delivery W p ■The Return Receipt will show to whom the article was delivered and the date « C delivered. Consult postmaster for fee. a o d v 3.Article Addressed to: 4a.Article Number �► d ¢ Le-5 �� �1 SCti� 4b.Service Type � «'� 0 �� -")16 ❑ Registered ❑ Certified -N ?�" IC'� ❑ Express Mail ❑ Insured S W ❑ Return Receipt for Merchandise ❑ COD T Date o Delivery Z '12 Z / o n 5.Received By:(Print Name) 8.Ad ressee's Address(Only if requested c u~i and fee is paid)' r 6.,Signa r : Addre e a X Y v\ a� —` Ps 1= ' , December s a to2sse-s�-B-one Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid 'I USPS Permit No.G-10 • Print your name, address, and ZIP Code in this box• RONALD J. CADILLAC, P.L.S. Registered Professional Land Surveyor 18 BREWSTER ROAD' WEST YARMOUTH, MA 02670 q l SENDER: t and/or 2 for additional services. `� I also w' to receive the rn ■Complete items 3,4a,and 4b. � a !J followin Se s Iff r<ao� ■Print your name and address on the reverse of this form so that a can return this extra fee ��� JA� card to you. � ■Attach this forth to the front of the mailpiece,or on the back if space does not 1. ❑,Add?esset3� ddreSS ' permit. L y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery to r ■The Return Receipt will show,to whom the article was delivered and the date c delivered. Consult postmaster for fee. j. 0 3.Article Addressed to: 4a. 4a.Article Num r E � <7 �►1 C_ yp E Z.Service e u ❑ Registered ❑ Certified c 'to n ` A ' ❑ Express Mail ❑ Insured c G �� ,t' A ❑ Return Receipt for Merchandise ❑ COD a , 7.Dana of Delvery a z O� / C-�)a� o a n 5.Rec ed By:(Prin !arn�e) 8.Addressee's Address(Only if requested W and fee is paid) W cc IE F 6.Si A ee I ! PS Form 3811, December.19 102595-97-13-0179 Domestic Return Receipt NEW ( First-Class Mail UNITED STATES POSTAL SERVICE �S1 E R ��--�. t spa ems&- ees�al� o PM 9 _� -,. .'Fermi o:0 40 • Print your nam , air s, d ZIP CW�a.i��this o • RONALD J. CADILLAC, P.L.S. Registered Professional Land Surveyor 18 BREWSTER ROAD WEST YARMOUTH, MA 02673 T ai SENDER: I also wish to receive the o ■Complete items 1 and/or 2 for additional services. �� � �► ■Complete items 3,4a,and 4b. ���l`y(JJ� following services(for an d ■Print our name and address on the reverse of this form so that we`Fan return this card i you. extra fee): ■Attach tis form to the front of the mailpieoe,or on the back if space does not 1. ❑ Addressee's Address permit. d ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery i ■The Return Receipt will show to whom the article was delivered and the date c delivered. Consult postmaster for fee. m 3.Article Addressed to: 4a.Article Number Q►Y (l �e�,Uly� a E E 4b.Service Type m 0 - (d C�VN �1 ❑ Registered ❑ Certified d of N t ❑ Express Mail —} C7 Insured 5 ❑ RetumReceipt for;Me,$haad"kO,,COD c 7.Date of Delivery 5;({ A N : n Z p 5.Received By:(Print Name) L' 8.Addressees%ddress`(Only if requested W and fee is paid 4,9 t 6.Signature:(Addr4essee or gent c PS Folni 38 , December 1994 " ' "".` " 102595-97-a-0179 Domestic Return Receipt UNITED STATES POSTAL SERVICE r�t, First-Class•Mail _ Postage.&Fees aid- USPS .. Permit No.G-10 • Print your name•,,address and ZIP Code-in-thas.box_!k- RONALD J. CADJIU-pc. +�.5 Registered Professional LA& S�sveyor 18 BREWSTER ROAJ) WEST YARMOUTH, MA a73 RONALD J. CADILLAC, PLS,RS Professional Land Surveyor&Registered Sanitarian P.O. Box 258, West Yarmouth, MA 02673 (508) 775-9700 ABUTTER LIST AND NOTIFICATION DOCUMENT Date: 1 1 a jq8 To: Board of Health Re: Proposed Septic System at: �J 0 uj{ r-11 NI�-- AM 1�6, Lot G S-f-64--2- Owner/Applicant: �jo iAY1 `g L,y i ABUTTERS: Map j$( Lot Map& Lot / yp-ch tlp,�-y 110l/ q1nm5, Lns�n�iuet/ 1Z E10-rcenor- SE, 135 St. VY) MA Map Lot Maplg Lot_3a— N1 son Le- S I 1e- -:10pftf. ) 11�0�t: �ja D2�) CQ . .(11 11:Gn in k M 4 Avc AloaxAA 0-a I MA O'�L Map Lot Map Lot .i ,e NQTES NOT TO co LEGEND, t. LOCUS IS A,M. 186, PARCELS 64-2 & 65. SCALE" 2. ELEVATIONS SHOWN ARE NGVD29 BASED UPON BENCHMARK M280S=27.4-16% ,( TH 1 TEST HOLE LOCATION, NUMBER 3, LOCUS IS IN FLOOD ZONES B, AID & A13 ON FIRM DATED JULY 2,, T992. c j --- W^--- WATER LINE MARKINGS 4. ALL PIPES TO BE 4" SCH 40, AND'. PNTCHED AT 1/4" PER FOOT. (UNLESS NOTED): 5. MUNICIPAL WATER IS AVAILABLE. LOTS: WITHIN 100 ARE ON TOWN WATER, � © -----G--"' GAS LINE MARKINGS (IF SHOWN) G. COMPONENTS TO BE AASHTO H-10, UNLESS NOTED. Q ra ----tE UNDERGROUND ELECTRIC WIRE FLAGS 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". ( & PROP X' 8. IF TWO OR MORE: LINES, WATER TEST D--BOX FOR EQUAL FLOW c. x 9.5 x 11.D EXIST, . ELEVATIONS MARKS POINT) p D-BOX EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET, 7 C1 �'" ~- EXISTING CONTOUR 9. DEPTH OF COMPONENTS NOT TO EXCEED: 3', OR VENTING MUST BE PROVIDED.. .�.._ TOP OF COASTAL BANK BUILD UP COVERS TO WITHIN, 1' OF GRADE, MORTOR CHIMNEYS IN PLACE, r6 �C, ONE COVER OF TANK 'TO BE WITHIN 6" OF GRADE. Gels , ---PG---- PROPOSED GAS LINE 10. STONE TG BE DOUBLE WASHED 3/'4 TO 1 11/2" WITH 2" MIN, 1/8 TO 1/2" PEASTONiE ON TOP, 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL_ LOG ARE FOUND, ( ) CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC,.lua LOCATION MAP � UTILITY POLE IF SHOWN) -- - ^� TREE (IF SHOWN, NOT ,ALL. SHOWN) 12. IF AN OVERDIG IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING BENCH MARK-PK NAIL IN BACK / t' r IS TO BE CLEAN GRANDUtLAR SAND MEETING SPECIFICATIONS OF 310CMR 15.255(3), OF WALK = 10.07 NGVD29 I pfi n EXISTING SEPTIC COVER 13. PUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE: ANY CLOGGED SOIL, BLOCK, AND STONE IN �_ f ❑ EXISTING DRAINAGE CATCH'BASIN LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. TEST HOLE 1 14. ALL CONSTRUCTION TO, MEET TITLE 5 AND LOCAL. REGULATIONS, 1 6.9 \5.6 0 DEPTHi (inches) ELEV.(feet) 6 P Q 1018 �`^►, f TEST HOLE DATE: January 6, 1998 Fill ° PLUMBER TO MOVE AND PERFORMED BY: Ron Cadiltw:, Soil Evaluator <y �1 WITNESSED BY: Jerry Dunning,, Irispector / , � / �6.4 ��� RAISE SEWER PIPE TO PERC RAISE: C2'-0:0"/inch (Cl layer) "`�,� { 7. `�. EXIIT CRAWL. SPACE X SOIL SURVEY(19:93): Carver coarse- sand5,9 � WHERE SHOWN. GEOLOGIC MAP(1986): Barnstable plain deposits69 �' Invert 9,12 C to er 2,5 6/3 r !"N�' \ C?��. 'e Invert 8.75 60. mediums sand 7 45.'L Proposed +� 4r use Gas Boffrs H-20 CONTACTOR 1QC1'S � �. Invert. 8.50- ` Proposed (provide 12" of cornpoctedl cover) ``K\5.2 GC' N F 8.9 4 x observed water, / \ ,5 h� NO GRADE CHANGES `"� provide q 5.3 5.fi PAPPAS ARE PROPOSED 1500 Gol. Top peastone S-varies screened 101" -- -- 2.4 vent f x 8 5\ LAND COURT PLAN Invert 9.90 , --' 6 / , 0.7 � � 5 2 x 4. NO. 1 Q4�33D I Proposed -nvert 8.6T Invert 8.40� , 0•9 r Use 6" Stome under Proposed - r�'opased I 5 Bottom Level f f 5.� 1 1 I 2' , 5.2 J �-6' �-4 1�- L f q tl 5' Adjustment 0 I DESIGN DATA ovided0'locus 4 x 11.0 9. ' � (,� I thin 300' of River x I o OBSERVED WATER=2,4 / \ x ci 4.9 V BEDROOMS: 4 / 11PV r 40 / x 6 4 pL GARBAGE GRINDER, No 4� m EL.E\{. REQUIRED CAPACITY: 440 GPa LEACH AREA / _ 1 2-- T __ _ -- T -- - _ 3 J.- - - -1 2' BOTTOM TANK: 1500 GAL. / °w 1 - !� - °' 5" _ - ---�-----�-- - -- LEACHING AREA: 638 SF USE 6• CUL TEE, CONITACTOR 100'S x�r4 fl F g - -- - -- - - - - - - 8 [(22' X 29')7 RE AND ROWS EXIIST, 9 cra 4_ ' c:. _- __ -1-__ _ __ - - IN 3 ROWSOF STONE ' BETWEEN ROWS 0.6 �6.0 e / %P_ [NONE]LEACHINGSIDE AREA. 0 SF AREA, AS SHOWN. (PROM FOR, A 22 X 29 X 6 DEEP (LEACH 2� to.1 STONE �.7 � =:4.5_ soac.Q ,� / / . DE VENT. DRIVE: / r pqr -71 SECTION A-A DESIGN CAPACITY. 472 GPD /� � TH SCALE: �"=�5' 3 �7 9�.� _ �v /� 4,7/ x 4 �C� �(638 SF) X .74 GPD SF] - 0 8g' / 4.2 X; 3.5 -5 MAXI'MUM FE�AS1�E Q0MPLIIANCE APPROVALS RE0UE$TED: 1�1 �`; 7 �� 7 '� 3 /` ff ground 3. 1. VARY LEACHING TO ROAD LINE: BY 6' (4" PROVIDED): 10.7 x / 4.1 VARY SEPTIC TANK TO FOUNDATION BY 4' (6' PROVIDED)„ / A XIC ' / f 1`' VARY LEACHING TO, COASTAL BANK: BY 35'± (15"dt PROVIDED) 1 9 { �� q f 0-irregulars 10. 3 `4 5.0 � 3,10 CMR 15.2.11 (1), �� 0.3 4.8 (ry 2, NO RESERVE' AREA SHOWN, 310CMR 15:.248. iota ` x 110.4 9 " 7 <v 5 3 2 3, VARY DISTANCE OF LEACHING TO A WETLAND BY 12'f (a8 t IS PROVIDED).. v��Q���`G� VARY DISTANCE OF' LEACHING TO, COASTAL BANK BY 85 ± (15'± PROVIDED). *� 5 3 BENCH MARK--NW CORNER OF 7.3 r�� x 4"' VARY (IF APPLICABLE) ONSITE SEWAGE: REGULATION TO MEET 19.95 STATE CODE. STONE STEP=11.37 NGVD29 .7 kkL `� ' � .8 - x _.2 LOCAL REGULATIONS. Q. �C` �.0 -- 7.9 \ 5.7 � BENCH MARK---TOP OF WOOD, �,k. tGQ°py 4.,9 STAKE = 6,60 NGVD29 3. �G`�ip�6;� _- x 4.3 PROPOSED LEACHING IS IN EXISTING DRIVEWAY: VENTING G�� \ � 5 Q 4.� IS PROVIDED. PROPERTY LINE NOTE: PROPERTY LINE (DIMENSIONS 4.3 PG x SHOWN ARE APPROXIMATE. THIS IS A SITE: PLAN SURVEY .� _.o AND NOT A PROPERTY LINE SURVEY BY THIS, OFFkCE. PROPERTY LINE DIMENSIONS SHOWN ARE COMPILED FROM &0 ,SITE PLAN LAND COURT SURVEYS, OR SCALED. 4.3 2.� I /� 4.3 FOR =4 DAVID R . & JOY K . HAMBL'Y' THIS PLAN IS A VALID COPY ONLY IF IT BEARS AN ORIGIN_AL RED STAMP AND SIGNATURE. 4.9 �� x � N/'F ���. 2. 95 SOUTH MAIN STREET, CENTERVILLE, M1A. ],�^1 OFk4S (�N�AOFAggs�9 � RA V'ECH 161 x .5 Otvm"u 9c RONALD ° �' JAN U AR Y 15, 1995 SCALE: 1 "= 310' o� AMES � ME ADILLA I.L ° LAND COURT PLAN 577 ';, NO. 317318 EXISTING DOCK NOT SHOWN ROJALI� J. CADILLAC, PI,.S, IRS � SU HITA�+`P 3.6 � � 2MARK PROFESSIONAL I_ANQ SUIRVEYOf C: REGISTERED SANITARIAN cr P� �yP P.O. BOX 258 \NNG� ���-�'' WE ST YARMOU TH, MA 02873 3 2 (508) 775-'9700 HEALTH AGENT APPROVAL DATE N1. 4��pRG "( � PAGE 1 OF 1 NQIE5 NOT TO co rQ LEGEND I. LOCUS IS A.M. 186, PARCELS 64-2 & 65. ) 7 2. ELEVATIONS SHOWN ARE NGVD29 BASED UPON BENCHMARK M280S-27.416'. o TH 1 TEST HOLE LOCATION, NUMBER 3. LOCUS IS IN FLOOD ZONES B, AID & A13 ON FIRM DATED JULY 2, 1992. C j Vr) ® -`-~W- WATER LINE MARKINGS 4. ALL PIPES TO BE 4" SCH 40, AND PITCHED AT 1/4" PER FOOT. (UNLESS NOTED) 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100' ARE ON TOWN WATER. G----- GAS LINE MARKINGS (IF SHOWN) 6. COMPONENTS TO BE AASHTO H-10, UNLESS NOTED. U 0 --- --UE-^ UNDERGROUND ELECTRIC WIRE FLAGS 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". n x 9.5 „11.0 EXIST. & PROP, ELEVATIONS ('X' MARKS POINT) 8• IF TWO OR MORE LINES, WATER TEST D--BOX FOR EQUAL FLOW CQ D-BOX EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET. p2 - 6-- EXISTING CONTOUR 9. DEPTH OF COMPONENTS NOT TO EXCEED 3', OR VENTING MUST BE PROVIDED. \� TOP OF COASTAL BANK BUILD UP COVERS TO WITHIN 1' OF GRADE, MORTOR CHIMNEYS IN PLACE. 66 G ONE COVER OF TANK TO BE WITHIN 6" OF GRADE. r �� --�-PG --^ PROPOSED GAS LINE 10, STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEASTONE ON TOP. / q UTILITY POLE (IF SHOWN 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, LLOCATION MAP 0- ) CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC. -- G� TREE (IF SHOWN, NOT ALL SHOWN) 12, IF AN OVERDID IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING BENCH MARK--PK NAIL IN BACK �� 13. PUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE A IS TO BE GLEAN GRANDULAR SAND MEETING SPECIFICATIONS OF' 310CMR 15.255(3). OF WALK - 10.07 NGVD29 � p O EXISTING SEPTIC COVER ANY CLOGGED 501L, BLOCK, AND STONE IN <� E7 EXISTING DRAINAGE CATCHBASIN LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT: TEST HALE 1 14° ALL CONSTRUCTION TO MEET TITLE: 5 AND LOCAL REGULATIONS. 6.9 5.6 "a DEPTH (inches) ELE'✓.(feet) 6 1 10.8 TEST HOLE DATE: January 6, 1998 Fill o PERFORMED BY: Ron Cadillac, Soil Evaluator PLUMBER TO MOVE AND <y WITNESSED BY: Jerry Dunning, inspector 18. 9 3 �6.4 RAISE SEWER PIPE TO • �\�l PERC RATE; G2'-00"'/inch (Cl layer) { 7 - �p l EXIT CRAWL SPACE SOIL SURVEY(1993): Carver coarse sand " ) ,�5 WHERE SHOWN. GEOLOGIC MAP(1986): Barnstable plain deposits v cJ'� Invert 9.12 60^` I C layer 2.5y 6/3 '`- �QV Invert 8.75 medium,sand 7.7 Q `"..� �' ,� Proposed 4r Use Gas eof's H-20 CONTACTOR 100'S `�.5 7 �,� �-^ Invert $•50 x � reposed (provide 12" of compacted cover) r 4 _ x `�•� �5 2- Q N/F 8 9 provide observed water ��5.3 x 5.6 Pappas NO GRADE CHANGES S=varies Top peastone screened 101" ,4 ARE PROPOSED 15j0Q Gal. went _r__� _ , 10$" 1.8 � 5� LAND COURT PLAN Invert 9.00 g 5.2 x 4.Zn NO. 10433D Proposed !,,--,nvert 8.67 Invert 8.40 7.9 _ 89 _ 019 0°7 , Use 6" Stone under Proposed Proposed 5 Bottom Leval 5. 2 5.2 ' <t 0.5' Adjustment 11.0 9. { 1 I- Provided--locus / 10 = I 1 Q� DESIGN DATA within 300' of River 0 x 7• © OBSERVED 1NATER=2.4 9 Q 4.9 U BEDROOMS: 4 • x 11 36'+ 1 ' .4 z GARBAGE GRINDER No ( g 0.4 O REQUIRED CAPACITY: 440 GPD LEACH AREA (� O 4.. x 2_.3 ELEV. ELEV. SEPTIC TANK: 1500 GAL. - � 5 12- - - - -- -- -- - - 12 4.6 BOTTOM LEACHING AREA: 638 SF USE 6 CULTEC CONTACTOR 10Q'S 9-::, l �Q~ 8 - - - - - - - - - -1` - - - - (22" X 29' IN 3 ROWS WITH 6' BETWEEN ROWS J o = _ f 4.5 - - - - - - - -- '""` [ )� AND 4' OF STONE ALL. AROUND EXIST. \;r7 0.6 arpw! - 6.0 / - - - - - - - - SIDE LEACHING AREA: 0 SF /� FOR A 22' X 29' X 6 DEEP LEACH 010.1 STONE 9.7 sDoce __ ,.j`�' / / Q [NONE] C� r� SECTION /a-A DESRGN CAPACITY: 472 GPD AREA, AS SHOWN. PROVIDE VENT. DRIVE 1�'� �QrCh _ p< „ [(63$ SF) X .74 GPD/SF1 y4. TH 13 Q) // j� 4.7� x 4. �0 SCALE: =1 5, G 0 I �� - Q ��'t 4.2 M 3.5 _5 MAXIM QM FEASIBLE COMPLIAN F APPROVALS RE 4. 3 �.� � �� � � ,QUESTED: 7 G / �c�- .7----�.. � .3 / f g r 4U n C3 O 3.°� V� / 1. VARY LEACHING TO ROAD LINE BY 6' (4' PROVIDED). 4.1 VARY SEPTIC TANK TO FOUNDATION BY 4' (6' PROVIDED), llC� Q �r7 / Q-irr I VARY LEACHING TO COASTAL BANK BY 35'± (15'± PROVIDED) 1p 9 � � A 0-irregular ar 10. _ S'T - 5.0 Q 310 CMR 15,211 (1). 0 3 ` 0.3 ( 4.8 �� 2. NO RESERVE AREA SHOWN. 310CMR 15.248. _ x 10.4 97 � 3. VARY DISTANCE OF' LEACHING TO A WETLAND BY 12't (88't IS PROVIDED)._ x 4.5 VARY DISTANCE OF LEACHING T4 COASTAL BANK BY 85'� (15'± PROVIDED). BENCH MARK--NW CORNER OF 7.3 5 34 VARY IF APPLICABLE) ONSITE SEWAGE REGULATION TO MEET 1995 STATE CODE. STONE STEP-11.37 NGVD29 •7 S ' - 7.9 5.7 '8 BENCH MARK---TOP OF WOOD x .2 LOCAL REGULATIONS, 4.9 STAKE = 6.60 NGVD29 3. 5 � x 4.3 PROPOSED LEACHING IS IN EXISTING DRIVEWAY. VENTING IS PROVIDED. 1 PROPERTY LINE NOTE: PROPERTY LINE DIMENSIONS 4.3 x �.o SHOWN ARE APPROXIMATE. THIS IS A SITE PLAN SURVEY � AND NOT A PROPERTY LINE SURVEY BY THIS OFFICE, )2 PROPERTY LINE DIMENSIONS SHOWN ARE COMPILED FROM �.�.� PLAN ABUTTING LAND COURT SURVEYS, OR SCALED. 4.3 2. 4.3 FOR 4 THIS PLAN IS A VALID COPY ONLY IF IT BEARS DAVIQ R . JOY K . HAMBLY`alp, AN ORIGINAL RED STAMP AND SIGNATURE. 4.9 \x x 6 N/F _71 2, 69,E SOUTH MAIN STREET, CENTERVILLE, MA j,ka A; P°" o Lo��� RAVECH �'Sc x 5 JANU--ARY 15, 199 SCALE: 1 "= 30' � R0NAL0 -JAA1 S JA�1FS CAD" AC o CADII,AC ;17 �- A a o LAND COURT PLAN ✓s�� NO. 31731E EXISTING DOCK RONAL D, J. CADILLAC, PLS, RS s'1N1TA1k\li"� NOT SHOWN �.2 PROFESSIONAL MARK LAND SURVEYOR & REGISTERED SANITARIAN , ) f G P.Q. BOX 258 g �c �G� ��•��r �" WEST YARMQUT.H, MA 0 2G73 3.2 .4PP�0 (508) 775-9700 HEALTH AGENT APPROVAL DATE PAGE 1 OF 1