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HomeMy WebLinkAbout0461 SOUTH MAIN STREET - Health 61 South Main Street Ceilterv:i lle A= 207-067-001 SMEAD No.2453LOR UPC 12534 smead.com • Made in USA FOusEo INTO PR UNE SDIrdiOmmWKmm OWSR souzcwcED wwwaa or- NO. 1 — �(� ' ~ Fee t.(�� Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHIFTTS Yes 2pplitation for Disposal *pstem Construction Permit i Application for a Permit to Construct( ) Rep, Upgrade( ) Abandon( ) ❑Complete System idual Components Location Ad ess or of No. SQ lJ f(h /✓/yta✓, f, . , Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 20 7 leG 7 Ks ��/� `, /44¢rs Installer's Name,Address,and Tel.No. 7 S.yWy,� Designer's Name,Address,and Tel.No.jVe.775/,^bT/ Type of Building: Dwelling No.of Bedrooms Lot Size e��, �01 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures f Design Flow(min.required) gpd Design flow provided `7S� gpd Plan Date Tj �/ q ,�Cya Number of sheets Revision Date � 30 0? 7 2 Title Y Size of Septic Tank /,�e� e)ri TA y%A Type of S.A.S. 3 fay '4 Description of Soil 4 b;nry &ic Nature of Repairs or Alterations(Answer when applicable) !' 1-.0:n• �✓� P�C� in Hd�do i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date ® �� Application Approved by Date 1 Application Disapproved by Date for the following reasons Permit No. ;L0 Date Issued r a No. '- .0 ! $V s i Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:-v- ' y^ "f PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACKV11SETTS es Rpplication.for Misposal *pstrm Construction permit Application for a Permit to Construct( ) �Repai grade( ) Abandon( ) ❑Complete System " A-rnlividuai Comp4 nts Location Address or Lot No.�/&I J6tJ h /Jq , ,j"ye, Owner's Name,Address,and Tel.No. , Assessor's MapTarcel 2a 7 06 7 Av 1 J/142 WA �M*s' Installer's Name,Address,and Tel.No, / �; Yarujk Designer's Name,Address,and Tel.No.-Pred7V i Type of Budding: Dwelling ' No.'of.Bedrooms � Lot Size a? , � sq.ft. Garbage Grinder( ) Other Type of Building /iS�'dc� ® o No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) d gpd Design flow provided T 7/10� //gpd Plan Date JV � d� Number of sheets I Revision Date " 11 Title 11 Size of Septic Tank �5�� �'Y,'ST�tncn Type of S.A.S. 3 a' fOu 74 �1..<<•.bps' (�p2� Description of Soil �tn ft !1' Gy�yr� re,V� ,Aze ,,,� Nature of Repairs or Alterations(Answer when applicable) re Aee Date last inspected: Agreement: � �. t 4 ;#'• ' The undersigned agrees t ensure the construction and maintenance of the afore describ' demon-s tete'sewag disposal system in accordance with the provisions of Title 5 of the Environiiiental Code and not to place the sstein-m operation until Certificate of Compliance has been issued by this Board of Health. ' Signed .►�` Date-»..---�1 i�u,cf 0 efy� r r Application Approved by �. t;+. r s ft } _ Date , �l / Application Disapproved by _ for the following reasons ' v Permit No. 2't`u ( '•1 d' Date Issued ( ---------- - ------ ----- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS eertifirate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repai�(:� Upgraded( ) Abandoned( )by 7� e !�l�ti / 1} Di < i(�t,—,-- at k M,4tN ✓lc� has been constructed in accordance p f with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 O��-2grdated 1' Installer A. xv. , Designers L,cy A Merl Mirk #bedrooms` >G'rc�,r—' Approved design flow yyQ �: 3 �,,gpd The issuance ofCthhis,permit shj(111 n t be construed as a guarantee that the system i `on as des gned. Date �' f { Inspector ___ ---• .------ -_^- .-a.. -1 • - ------------- .. Nd. q f' ,� FeeUt> THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS . ' misposat 6petemtonstCULtiott Vermit Permission is hereby granted to Construct( ) I aira(-""f"'f ----Upgrade,( ) Abandon System located at qG J a`.��- MQ►r, rG� and as described in the above Application for=Dis osalConstruction S stem Permit. The app licant cant recog nized his/her du to comply with pP P YPP Sn duty P Y_ l Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. - date r / :1 ( Approved by 2 Jo'��`"1 �� ,j Town of Barnstable Inspectional Services Public Health Division s tt�srtereevs, IL Thomas McKean,Director we" 200 Main Street,Hyannis,MA 02601 Office: 50"62-4644 Fax: 509-7904304 Installer& Designer Certification Form Date: Sewage Permit# .7031 • A?)7 Ass or's Map1P reel zU O GG 7 OU 1 M E f t: Installer: Ut>r1L Z,?C[ay�'f► �T' Designer: 1' ►A Gc�1.NNx S GaSr.�, i?rG n� Address: U y� Z Address: 40 i4l► C�(.m� LA.. i��t l' a Ct-► l HA 02>S3 7 �;? L)Q nln►S myA O'Z(SUO QU,*k tAwjm4ing, -''C was issued a permit to install a (date) (installer) septic system at yLJ 4,-pw based on a design drawn by H A (address) l�t/i✓C S t'l; dated_ -3 - 2 1 / (designer) V 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. Step out (if required) was inspected and the soils were found satisfactory. 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. Strip out(if required)was inspected and the soils were found satisfactory. ---—"'I certify thathe system referenced above was construct ' aance with the to rms of ....- ESN Of AqS the I1A_approval�lietters(if applicable) SHAWN 5 � o MacINNES CIVIL `n (I taller's Signature _/gyp` J/ No.41328 �SS�ONAL (D 's Signature) (Affix Des' tamp Here) esigner PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. 11roa%ftts\HEA1.TMEWER connecMUT1C1Designer Certification Form Rev&14-13.DOC J \ ' U.S.POSTAGE>>PITNEYBOWES �pTHEip`_ Town of Barnstable Public Health Division • ARM A`E' ' 200 Main Street %ED MP� Hyannis,MA 02601 ZIP 02601 $ 006.900 0000373143 JAN. 05. 2021. 7015i ,1730 0001 4987 8296 �i I RAPO, ANDREW &ALEXIS FIFE i � ' 461 SOUTH MAIN STREET NI xi 915 DE 3. RE TujRN TO SENUE c II C UNABLE TO FORWARD I ? 9 A7�R ;RlA 6i9: LlNf I FSt_; 02 601 dR07Gl ! .f7433?-00197 f?j -. g8> :• � Z�' I lI9� 1'!'l� '1�i ��1a39�a9ICIi� I° ai�Iii��Il4 aiall'11111a,11! I� j �IdO13AN3=10.• COMPLETESENDER: comPLETE THIS i • ON DELIVERY I ■ Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse X ❑Agent I ' so that we can return the card to you. ❑Addressee I ■ Attach this card to the back of the mailpiece, B• Received by(Printed Name) C. Date of Delivery I or on the front if space permits. 1. Article Addressed to: D. is delivery address different from item 1? ❑Yes - - - -'p ter delivery address below: ❑ No r a� I - RAPO,ANDREW&ALEXIS FIFE I 461 SOUTH MAIN STREET --CENTERVILLE, MA 02632 = 3_ � El Priority {I `T I ' ❑ Mail ailEress@Adult Signature RegisteredEl Mail- It Signature Restricted Delivery ❑ Mail Restric tedI�I0111111111111111[11111111-11111111111111 III uirtfed Mail® a n9590 9402 5849 0038 3914 57 Keertifed Mail Restricted Delivery 4eurn ) Receipt for � ❑Collect on Delivery Merchandise 2 Article Number(transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationTm I I 7 015 17 3 0 0001 4987 AP 9 6 �c �D� ry ❑Signature Confir ry lion tail Restricted Delivery Restricted Delivery i PS Form 3811,July 2015 PSN 7530-02-000-9053 -= - - Domestic Return Receipt 51 :: i i .__�...ii . . . . . . . . : . : . . . . : :1: : ::i:: : . I Town of Barnstable B Inspectional Services Department M ~ BA MASS. Public Health Division i63p. ♦Q' 1639 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 8296 January 4, 2021 RAPO, ANDREW & ALEXIS FIFE 461 SOUTH MAIN STREET CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 461 South Main Street, Centerville, MA 02632 was inspected on 12/07/2020 by Brett Hickey, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\461 South Main Street Centerville.doc �TW Town of Barnstable "I Inspectional Services Department awxtvsrwst�. 1639.S. ��$ Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 8296 January 4, 2021 RAPO, ANDREW &ALEXIS FIFE 461 SOUTH MAIN STREET CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 461 South Main Street, Centerville, MA 02632 was inspected on 12/07/2020 by Brett Hickey, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\461 South Main Street Centerville.doc Town of Barnstable aARNBPAHLE, ' 6 9 A,44 Inspectional Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) VL,eaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc ovr Commonwealth of Massachusetts Title 5 Official Inspection Form +_ 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 461 South Main Street Property Address Alexis Rapo Owner Owner's Name / information is Centerville V Ma 02632 12-7-2020 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. Inspector Information /SCSI filling out forms on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return key. Company Name 374 Route 130 45 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑■ Fails Brett H1Cke Diguany signed by Brett Hickey y Date:2020.12.0810:26:00-05•00' 12-7-2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Tille 5 Official Inspec8on Form:Subsurface Sewage Disposal System•Page 1 of 18 I` Commonwealth of Massachusetts - ------ - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a� 461 South Main Street �a Property Address Alexis Rapo Owner Owner's Name information is Centerville Ma 02632 12-7-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System was in hydraulic failure at time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments IK 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is Centerville Ma 02632 12-7-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is Centerville Ma 02632 12-7-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 10 0 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ a Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 i Commonwealth of Massachusetts �_- - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,�yl! 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is Centerville Ma 02632 12-7-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ O Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/z day flow ❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 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. ❑ Q Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ [El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ El Any,portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. E] ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5lnsp.doc•rev.7/26/2018 We 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts - = -- Title 5 Official Inspection Form — i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is Centerville Ma 02632 12-7-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat,or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No El ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? 0 ❑ Has the system received normal flows in the previous two week period? ❑ Q Have large volumes of water been introduced to the system recently or as part of this inspection? O ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ El Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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? ❑ El 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: El ❑ Existing information. For example,a plan at the Board of Health. ❑ ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts --- --F Title 5 Official Inspection Form ~ — Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is Centerville Ma 02632 12-7-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. 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): 549/GPD Description: Number of current residents: 5 Does residence have a garbage grinder? Yes ❑ No Does residence have a water treatment unit? ❑ Yes No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes 0 No Seasonal use? ❑ Yes•[E No Water meter readings, if available(last 2 years usage(gpd)): See below Detail: 2019- 82,000gallons 2018- 91,000gallons Sump pump? ■❑ Yes ❑ No Last date of occupancy: currentDate t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form fi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'f 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is required for every Centerville Ma 02632 12-7-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day Y(9Pd Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner- last pumped 2018 Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form -- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is required for every Centerville Ma 02632 12-7-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overnow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed (if known)and source of information: 1990 per plans Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 1'6„ Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑other(explain): Town water Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t51nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts r- _- Title 5 Official Inspection Form -- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is Centerville required for every Ma 02632 12-7-2020 page. City/Town Satet Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 611 Depth below grade: feet Material of construction: ❑■ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500gallon H-20 10" Sludge depth: 26It Distance from top of sludge to bottom of outlet tee or baffle .311 Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 14if Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is Centerville Ma 02632 12-7-2020 required for every page. City[Town State Zip Code Date of Inspection D: System Information (cont.) 7. Grease Trap(locate on site plan): NA 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): NA Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t51nsp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ...- 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is required for every Centerville Ma 02632 12-7-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): I 'Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Or' Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in poor condition at the time of inspection. t5insp.doc-rev.7/26/21118 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts - - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is required for every Centerville Ma 02632 12-7-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located,explain why: Type: El leaching pits number: (2) 6'x6' pit ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Masgachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� 461 South Main Street / Property Address Alexis Rapo Owner Owner's Name information is Centerville Ma 02632 12-7-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS)(cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in hydraulic failure at the time of inspection. Both leach pits were full over inlet inverts when viewed. 12. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): NA Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer VDimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, p etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 16 r 4 Commonwealth of Massachusetts :. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is Centerville Ma 02632 12-7-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t51nsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form pia Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is Centerville Ma 02632 12-7-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑Q hand-sketch in the area below ❑ drawing attached separately 6, i t i T: j� 1 Ilk B t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts =- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is required for every Centerville Ma 02632 12-7-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑■ Check Slope ❑■ Surface water ❑■ Check cellar ❑■ Shallow wells Estimated depth to high ground water: No GW observed at perk feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) El Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: A permit on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 461 South Main Street Property Address Alexis Rapo Owner Owner's Name information is Centerville Ma 02632 12-7-2020 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑■ A. Inspector Information: Complete all fields in this section. ❑� B. Certification: Signed& Dated and 1, 2, 3, or 4 checked ❑■ C. Inspection Summary: 1, 2, 3,or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ❑■ D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 461 S.Main St. Property Address Nicholas &Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key p to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name fQ P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails i ❑ Needs Further Evaluation by the Local Approving Authority Zn / 2/19/2010 a Inspe or's Signature Date jl The system inspector shall submit a copy of this inspection report to the Approving Authoty( rd of Health or DEP)within 30 days of completing this inspection. If the system Is shared"systerr. or has a design flow of 10,000 gpd or greater, the inspector and the system ownei shall suit thsp report to the appropriate regional office of the DEP. The original should be sent to the sMem 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Dis sal S tt•Page 1 of 17 P Y 9 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 461 S.Main St. Property Address Nicholas &Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: The septic system is in proper working order at the present time. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c,M 461 S.Main St. Property Address Nicholas&Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every page. City/Town 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM Sy0', 461 S.Main St. Property Address Nicholas &Julianne Lawler . Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or 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 Y2 day flow t5ins•09/08 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 461 S.Main St. Property Address Nicholas &Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every page. City/Town State Zip Code Date of Inspection & 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 461 S.Main St. Property Address Nicholas &Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every 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): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 461 S.Main St. Property Address Nicholas &Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1500 gallon tank,D-Box and two leaching pits. Number of current residents: 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? El Yes ® No Water meter readings, if available last 2 ears usage d 2008:117,000 g ( y g (gpd)): 2009:105,000 Detail: 2008:320 gpd. 2009:287 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: 2/19/2010 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 461 S.Main St. Property Address Nicholas &Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Capewide Enterprises,LLC. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured Reason for pumping: Maintenance 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 461 S.Main St. Property Address Nicholas &Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every 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: 1993 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented throught the house vents. Septic Tank (locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon Sludge depth: 0 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 461 S.Main St. M Property Address Nicholas &Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle NA Scum thickness 0 Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Tank pumped at inspection. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 461 S.Main St. Property Address Nicholas&Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every 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 r Holding Tank tank must be pumped at time of inspection) locate on site plan): 9 to 9 ( P P P ) ( P ) 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 461 S.Main St. Property Address Nicholas&Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every 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 No 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.): Box is under asphalt in driveway.Observed with camera.No evidence of solids 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: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 461 S.Main St. Property Address Nicholas&Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.Pit#1 water to invert was 5'.Stain line 3' below invert.Pit #2 Water to invert was 3'.No stain line observed higher 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 461 S.Main St. Property Address Nicholas&Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): L15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map rage i oz z Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ■ 'Zoom Out '� 'In !fin",: • ��-s�f;"�.% s l K. F �I I 3 3q y� 0 2`0 Feet �°e' Set Scale 1" = 20 I I Aerial Photos I MAP DISCLAIMER f n—rinhf')nOr-')A1n T—in of Rornefohlc KAA All rinhfe raennk. �y Commonwealth of Massachusetts ti Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 461 S.Main St. Property Address Nicholas &Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LP 4.2' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high.ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °w 461 S.Main St. Property Address Nicholas&Julianne Lawler Owner Owner's Name information is required for Centerville Ma. 02632 2/19/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 � —� F_.... M o ........................... I� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H 00 '*� ' ��✓-e? ................OF............` X-e . Appliration for R-4pas al Morks T nstrartwi n Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (b )� Individual Sewage Disposal System at: VV7 ) ....W ../ I ..................... .2 Location-Address or Lot No. O r Address Installer Address Type of Building / Size Lot.................... .....Sq. feet U `T Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) P4Other fixtures ..-•----....---•-------------------•----------------------••-•--••-•-•------••----................••••- W Design Flow............................................gallons per person per day. Total daily flow____--� /_. - WSeptic Tank—Liquid capacit/A ..gallons Length_' A Width.J.'..'.&.'._, Diameter---------------- Depth..... ��.Q x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area-----_........____..sq. ft. Seepage Pit No....`�...... Diameter.................... Depth below inlet.....;'_,____..... Total leaching area.%�y sr..sq. ft. 6 a z Other Distribution box ( ) Dosing tank n ~' Percolation Test Results Performed by._...... 5./_`..... lt,.�l..l�_ .................... Date...._Cf Test Pit No. -_-_minutes per inch Depth of Test Pit.................... Depth to ground water--_---._ PLI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----._-_______--...___. a •-••-•-•••-•---•--•----•••-•----------•---•------••••••-•----•------••...•-•-•-----•-•...-------•--......................................................... 0 Description of Soil............................................................................. . --..... -.................... c4 -------•••••--•-••••-••---•---•-•--••-•-•••-----•---•---•-•-......•----•-••.....- UW •-••-•-----•...............................••---•-•---------------------•-•-•....------•--•-••-•-•••-••••-••---•-•••-•--•-----•----••-••-•--•-•••----•-••-•-•-••••••-•••••----------•••......--------•-- Nature of Repairs or Alterations—Answer when applicable-------------------------------------------.___-__--------•-_-.--__--___•-____-___---_---_---__. •------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iT:LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ssued by thc.board of health. Signed........ ....... --• . ---• --.... a Application Approved By____ _ __ _________ _ __ ______ __A_... _ ate Application Disapproved for the following reasons---------------------•-----------------...--------------------•-----•---------------•---••......•----....._._.._ ......................................-- ---------------•-•--•-----••-----•---•--------•-•-•-••-•. ------------.----- -.-Date f XPermit No.. -�- Issued------+� --- j� ---------.. Date IF t TOWN OF. BARNSTABLE LOCATION1 fiO%,, l�?4 7~ SEWAGE # deb VILLAGE Cep` .ZrIll `l� ASSESSOR'S MAP & LOT j>- .(j�,7 b6( INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 6';7& (size) 00 cz CO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER R OWNER J/lj a DATE PERMIT ISSUED: Z DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No L/ o q 3 { 1 i E No... �. .,9 Fizz ......./.......�........... ° THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH 'Applirta#ioat for Diupuual Works C> omitratrtioat 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .............................. ....... ........................Z� .....?................r..2Z............ Location-Address r Lot No. C N Address .................-------•-•'-----------•------------ Installer Address Q Type of Building �� Size Lot-------_--------------------Sq. feet U Dwelling No. of Bedrooms.............................. .....Ex Expansion Attic�••< g— ••-----•• p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------•----------------•----'--------....•-----------------------------. ----•----'••••••-'---------'••......--•--••-----•------••---. Design Flow............................................gallons per person per day. Total daily flow_.----�1 V...........................gallons. W Septic Tank—Liquid* -�capacity v.gallons Length.R...�-t__..__ Width.tC_'.__A..... Diameter................ Depth__._.k.%.._�j x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.._.......____......sq. ft. Seepage tit No..__ ,' .�______ Diameter.................... Depth below inlet.................... Total leaching area., �� ....sq. ft. Z Ott r Distribution box ( ) Dosing tank Test Pit No. 1. ............minutes er i ch Depth of Test Pit ....__....... Depth to ground��r--.-_- !.__. Percolation Test Results Performed b ........_��t.w.........ft. ...____�.r-.................... Date...... _ ..._._a..__.._.f........ �� P P P �' /-�'r. � c f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-----___--___.-__--_--. P' -------- ----------------------------------------- ----------------------- -........................... --•--------•--'-"----••---'-•-= ODescription of Soil..........'------'--•-••-------•--...._...-•••••-•--•..............'-'-•'--•-'--------------------•-----------------------------------'••......---..........•-•---•---- x U ---'--------'-'--•-------------•--------......-•"------------------------•-'•-'••-------•--...---------•-'-'-----------•-•-•--------------------•------•------------------...--•----•--•---•---------'- W ----'--------------- ----------------------------------------------------------------------------------------------------------------------..................................... ................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................--•------------"-••'•-•-••.....------••••-•-•'----'-'---••------------------•-------•---•---------•-...•--------•-----••-•-•-•-------.....---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITis 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b'e-en issued by t e board of health. ( Signed--•-'-- 1, ? e = t.:"'Via?_.......................... Application Approved By -'•--yl•Its'.........a - .= / ;/a-- Application Disapproved for the following reasons:....................................................-•-----'----............................................. ... I •-------------------------------------------------- Permit No.'---..�... _. ....................... Issued _( � nau....__ THE COMMONWEALTH OF MASSACHUSETTS �)�/��BOOARD�O) F yH�EAyTH ...........�L/.v�ll.!!.oF.......</4��� /...`,'�".. ZM646.......... Tntifiratr of TompliFaatrr I THIS IS TO G�RTIFY, hat the ndividu.l • gee ippo Syste Iconst ted ) or Re aired ( ) Installer ------- ---•--a- has been installed in accordance with the provisions of T t 5 of The State Sanitary Code-As AEE bed in the application for Disposal Works Construction Permit No._�Q_=�./`9.............. dated_...__ . _._ � ©--•------•---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANHAT THE SYSTEM WILL FUNCTION SATISFACTORY.. DATE..................... ... . .........:.b........................... Inspector....---...--. ............................................................ THE COMMONWEALTH OF MASSACHUSETTS /BOA r.l� AO,F� A/HEALTH "" ............I V...V..V/.U......OF� .l..d111.. NO. -Cf /� FEE/ iu u l urk �uatu rain ion rrntt , y� c Permissio is hereby granted-' _... �:....... `l�: •,.w,_,- :�. .K-G "----Alµ to Construct );qr Repair ) an Individually ISeAw/ag Di oral Sy -stem at No.-- -.._. •• t�L-- /--��-I------So-M. lA � � ,,,Street �-j as shown on the application for Disposal Works Construction Permit N .Q� _ __._.. Dated._ •••....••_• .......................................... ............................................................. Board of Health DATE...........................................+- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS • , r s.. 1 oS'12 of FoL-1Q"D o I _/ -�- — U w io o EL. 34:Ca I a/ � 8 0 M M H f=\1 M oC EL.�V- 15,37 r'1.5 L...-_ 71 �• _ � \ �LJ \ z3. zoo z�.�s ° � �. � � � , I o cr /00 (vr J a 71 u 13TALL \ \ ) UMfT ,' /I'x G' Acri \ w U ---�` . � 6 � 1 .a ., IOF 1.., IS I � MAtit40L C= CO IIE,�2 S TO t-JIT141AJ - , /2 of Iti!lSN� 3 �:e/9l7 a h ILIJ , L w i'FSTt � . r r• u Cr-1-7/n. //4per O W cn Q Layerin im fcoyumper SCHED. 40 F'Vc. 0l2 Crn m_ tit 1 '' ` S lP : Too PE T B iY L FOR Z . __ CL I / i —TANK �Evf Q 3 l t 14. f., Q- LY % '`a % ' QGTAIt 11 J L1Al_L LtRu/D N i �� l - D/ST BOX sump (- I V\ r t O F -'J i / ➢ o. i „ u,cz5 S7to nJ .,J Rul /,500" CAC. "SEPTIC AJQAea . / 2 D Ls r I d v U) \ Io &E �>=Mo✓� I 26 E 2 4 z w w f • i cc { rB r .-AAA,,, s� -? 0 1 C E�?Tl FY THAT THE BUILD/itlG a 1ry1%/.:'.�;,I 1ST • �• D 0�1_TH E G2 )U/vL� � 14 SHOWN ON_-_..THIS PLA�1 DC7E5 �-�W�' COA-IF_0121- To._ THE SU/C.DIIVG 5E7 ; u ! z j . ` •. 11 `, t ' _ ' ,' B�C-�. -)2G CCUII2E('?ErV7- 6 O)= T14E W11J OF 0E5 s i a /0 r f= i PATE O� T[ ST , �- ��� � 4 .Bl=DRc©M HO�5to -T I' S I BY !..-i NO IDI S PO S.,G r\ - W r - " _ r;: ,- �`� 0W RATE 440 qPV, r 1 a ! ma ^ �V K T 0 � 1.CO ION . r G �_ � l •, -� C. P�1r-'�P � Q�-Mo�lE >✓x-IsT1r.tG F_55�oat.�,p���,•.1C-� � l� OD , I - >' ` 'Cb� 1St !_a.IT 1r�1 cT D _moo LS s P2t --2L- c i h P ?0 C7 fit L.k ., to N ` p�f�c . T�s—F APFLI A-F 0 J 7 LE GHit�iG AI\1~/a, . 0 D t 1 # ' ' oC Ozl- l S 1© !r,1 A 1 L 18 8 S x 2.S �71 . 2 S (gyp , F><t sT1l l�t S Lj UE>,.l -�o i Sal � , f v� �s c� 1t f" w 15.0 O E 15.0 z Gdrur '�O Si: �SP�u i� b� '�L-'J/• M N � � 1L1 SliGTt 1zS 1d }�-Z� G i i {4 .0 12 • .- � l i � rI C j N �- ,. N J s I 6A1�lD =a cc Z w Z - ✓ SAND O a w 0 1 - W ITi i -i J -Al" M � 1 H O N s FIN - - Eel � O zw , / r- s t S k ld_ 1�1 f E5 O tU a. >- W LLJ W U) U)Z Z 4 aQ ti N N Z ,. 13 LP,.a, S f rT.0 n / ` / /�•� P j , crYD V t - Rv f�'1" 30 �I ..�.�.. 13o/a,r�,D o�- H EA h l M A ✓ DESIGN: �S (_,_• FF A DRAWN: WN: f .� � L _ p 0 0 E la ICJ N U CHECK: LE FI # 8 ' N • i DW G AA hones Hndr Loll C- I R ach lien METAL RISER COVER TO BE RISER COVER TO BE WITHIN VENT PIPE SCHEDULE 40 TFF AT GRADE FINISHED GRADE 6" OF FINISHED GRADE PVC FFE = 21.33' WITH CHARCOAL FILTER //"'20.66- 6" MIN. 24" TALL p WATER TESTED FOR LEVEL 9" MIN. COVER TYP. " 2' LEVEL 16.00'-18.00' +/- Ceo Sr Oe,MA D2632 IPE PVC PIPE 4 SCHEDULE 40 r PVC PIPE n.<< S= 0.02 r FT FT " ° S= 0.12 FT/FT 2" PEASTONE 20.0 +/- LF LIQUID LEVEL 38.0' +/- LF s S= 0.01 FT/FT 10" 14' 11.0 +/- LF 12.60' ' PIPE INVERT r' r LESS 2' LEVEL 0 0 0 O O 0 O I'd-t ( 1 C3 O C3 C3 C3 C3 C3 yi OUT 4' 16.43' 11.86 11.69' - 17.13' + - GAS O O O O C3 O/ EXISTING BAFFLE INLET T 0 O O O I hh BUILDING 16.68' PLACED BOX ON 6 11.60 9.60 OF MECHANICALLY p ' -� COMPACTED STONE I 4 3 1- 500 GAL RECAST CONC. i 4 ! 3/4" TO 1 1/2" EXISTING 1500 GALLON DISTRIBUTION DOUBLE WASHED STONE LOCUS MAP SEPTIC TANK H-20 BOX LEACH CHAMBERS (H-20) 4 MIN. NOT TO SCALE H-20 4'-10„ X $,6„ X 3'-0 AREA = 614.0 S.F. SEPTIC SYSTEM GROUNDWATER ELEVATION 4.60' (SEE NOTE 16 PROFILE ) NOT TO SCALE DATE: 6/9/21 HEALTH DEPARTMENT. DON DESMARAIS NOTES: TEST HOLE 1 - GSE = 15.00 SOIL EVALUATOR: DARREN MEYER - \ �4 Sx DEPTH OTHER 1 . VERTICAL DATUM: DRIVEWAY NAIL = 19.99' (ASSUMED) �\ - -. IQ. FROM 2. SEPTIC 5Y5TEM SHALL BE INSTALLED ACCORDING TO 3 10 CMR N SOIL TEXTURE SOIL COLOR n SURFACE SOIL SOIL (STRUCTURE, 15.00 (TITLE V) AND THE TOWN OF BARN5TABLE BOARD OF HEALTH �'' 26,5 ±S UPS-AND INCHES HORIZON (USDA) (MUNSELL) MOTTLING STONES, ETC.) REGULATIONS. .45± ACRES 0-67 FILL 4. THE D ST BHAUTiL BE 4" SCHEDULE 40 PVC ON BOX SHALL BE WATER TESTED TO IN5URE CP .� (I �- R(RECORD) LEVELNESS AND EQUAL FLOW. 'C� 67-71 A SANDY LOAM 10YR 3/2 5. THE INSTALLER 15 TO VERIFY THE LOCATION OF UTILITIES AND SEWER LINE ELEVATIONS PRIOR TO INSTALLATION. 71-107 B LOAMY SAND 10YR 5/8 G. 501L ABOVE C LAYER(SHOWN ON 501L LOGS) SHALL BE REMOVED AND REPLACED WITH CLEAN SAND ACCORDING TO MASS. 107-150 C MED. COARSE 10YR 5/6 LOCAL 5PECIFICATION5IN THE S.A.S. AREA. a SANG 7. EXCAVATION FOR AREA WHERE FILL IS REQUIRED SHALL EXTEND 5' 2Z � ca J �"�''"�,-�:. I I ILATERALLY BEYOND S.A.S. GROUNDWATER ENCOUNTERED AT 144" ELEVATION 3.00' 8. 5Y5TEM IS NOT DESIGNED FOR GARBAGE GRINDER. o ADJUSTED GROUNDWATER CALC: WELL: MIW-29 ZONE: A ADJ. FACTOR: 1.6 9. ALL PRE CA5T UNITS ARE TO BE PLACED ON G" MIN. CRUSHED i° ADJUSTED GROUNDWATER ELEV. 4.60' 5TONE MECHANICALLY A B COMPACTED. `�' � .:SIEVE ANALYSIS CONDUCTED AT 108" <2 MIN/IN CLASS I 10. MIN. PIPE SLOPE 1/8 IN/FT, 114 IN/FT PREFERRED. �� § ; c - D- x 67.2 70.0 R. 1 1 . MANHOLE COVERS OFF OF DRIVEWAY ARE TO BE WITHIN 9" OF TO�' EL. 2 . 30.03 J D - SAS ER 74.9 80.8 FINISHED GRADE. = r7 DESIGN CALCULATIONS: 12, 5EPTIC TANK TEES SHALL CONFORM TO MA55 * LOCAL r,--AE SEPTIC NK COVERS AT GRADE REGULATIONS. H fE'd(N4:�AR#i .AG NAIL S�� NUMBER OF BEDROOMS: 4 13. ALL STONE 15 TO BE DOUBLE WASHED ACCORDING TO MASS. lg.sJ (ASSUkfi' D) ,` GARBAGE DISPOSAL UNIT- . NONE LOCAL REGULATIONS. �I 14. GROUND COVER OVER SYSTEM COMPONENT5 SHALL NOT -21� p � ` 3 TOTAL ESTIMATED FLOW: (110 GAL/BEDROOM/DAY X 4 BEDROOMS) = 44 P EXCEED 3' UNLESS COMPONENTS ARE H-20. �' �� REQUIRED SEPTIC TANK CAPACITY = 200% = 880 GALLONS 15. CONTRACTOR TO NOTIFY DE51GN ENGINEER AT TIME OF � C� EXISTING 1500 GALL . 0 ?RECAST SEPTIC TAN ACTUAL TANK SIZE. 1500 'GALLONS (USE EXISTING) EXCAVATION TO VERIFY SOIL ABSORPTION MATERIAL IS -' (N-20) SATISFACTORY. O R=lass �� LEACHING AREA REQUIRED: 0SMH SOIL CLASS 1 0 PERC RATE - <2 MIN/IN. ? , LTAR - 0.74 GPD FT. 1 . 440 GPD / 0.74 GPD/S.F. = 594.59 SF USE: 595 SF LOCUS INFORMATION 1 � =19.73I CURRENT OWNER: s.As - 3 -.�0o LEACHING. CAPACITY: MACINNES o GALLON LEACH I 3-500 GALLON LEACHING CHAMBERS (H-20) WITH 4' OF STONE ON SIDES TITLE REFERENCE: BOOK: 33682 - PAGE:166 CHAMBERS (H-20) ASSESSORS MAP PAR �VATH-4 FEET oFr S oNE SIDES = [(33.5' + 12.8') X 2'] X 2 = 185.2 SF / CEL: 207 / 067/ 001 ARouNa LOT SIZE: 3.1 ACRES.6,, ``�� \ BOTTOM = [(33.5' X 12.8')] = 428.8 SF TOTAL AREA = 614.0 SF FLOOD ZONE: ZONE X _,,_•-.. - D-BOX t - o � ,ExlsnNc LE CHINc TOTAL CAPACITY: 207.0 -002 � CHAMBER"ABANDON -- �; � IN PLACE _ 614.0 SF X 0.74 GPD/SF 454 P NIFCD \ Date DESCRIPTION Drawn Checked STEVEN r t� ' °: EXISTING L/�EACHING AIKEN �„ \ � CHAMBER REMOVE do REVISIONS f �' DISPOSE SEPTIC YAS- BUILT VARIANCE REQUEST: C SYSTEM TE M OVER 40 DEEP EM c FOR MACINNES �' 1. LOCAL VARIANCE REQUESTED FOR SAS OVER 3' DEEP. AT `� L U TEST HOLE , 9.C'q, 461 SOUTH MAIN STREET Elal� r .____ sc� Poi IN UP - _ CENTERVILLE � � a� D SCALE: 1" = 20' ATE: AUGUST 18, 2021 SITE t r:"­ T SHOWN y PLAN a "`�lVi � u; MACINNES CONSULTING (1919 S.H.L,0.,� 41328 1 = 20' P.O. BOX 1182 NAL EAST SANDWICH, MA 02537 ' (508) 274-2091 NOTE: THE PROPERTY LINES ARE APPROXIMATE AND ARE COMPILED FROM FIELD SURVEY PERFORMED BY HOOD SURVEYING, RICK HOOD PL5, DATED JANUARY ENGINEER DRAWN BY. SGM 2 1 , 2021 AND 15 NOT INTENDED TO BE A SURVEYED PLOT PLAN. IT SHOULD BE U5ED FOR NO PURPOSE OTHER THAN 5EPTIC SYSTEM INSTALLATION 21 _ 9 9 9 CHECKED BY: SGM SHEET 1 OF 1