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Home My WebLink About0574 SOUTH MAIN STREET - Health t•' 574 South Main Street A= 186--046 Centerville I SMEAD No. H163OR UPC 10259 smead.com • Made in USA J4 gc 2 i c Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u- 574 South Main Street Property Address Mike&Catherine Reilly Owner Owner's Name / information is required for every Centerville V MA 02632 10/13/2020 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 forms A. Inspector Information on the computer, use only the tab James Ford key to move your Name of Inspector cursor-do not Ford Septic Services, LLC use the return Company Name key. P.O. Box 49 ue Company Address Osterville MA 02655 City/Town State Zip Code r 508-862-9400 S 12482 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 10/19/2020 Inspec 's Signature Date The s s m inspecto shall submit a copy of this inspection report to the Approving Authority (Board of Hea 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.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c Commonwealth of Massachusetts p Title 5 Official Inspection Form i1. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 574 South Main Street Property Address Mike& Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 page. Cityrrown 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: ® 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: 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 cam, Commonwealth of Massachusetts p Title 5 Official Inspection Form `I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c�u!% 574 South Main Street Property Address Mike&Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 page. Cityrrown 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 �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 574 South Main Street Property Address Mike& Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 page. Cityrrown 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 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. 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 El ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form vi% Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u- 574 South Main Street Property Address Mike &Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 page. Cityrrown 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 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cam !% 574 South Main Street Property Address Mike&Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 page. Cityrrown 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 ® ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 f c Commonwealth of Massachusetts Title 5 Official Inspection Form <� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............c� !% 574 South Main Street Property Address Mike & Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 2 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 ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: currently Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 i c , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t; 574 South Main Street Property Address Mike& Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 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: pumped 2 weeks ago for maintenance 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 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 574 South Main Street Property Address Mike &Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 page. City(Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: installed 11/19/1985 per as-built Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 f c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 574 South Main Street Property Address Mike &Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"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: 1000 Sludge depth: 2 Distance from top of sludge to bottom of outlet tee or baffle 24 Scum thickness 2 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? measure 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 Tee's were present. There was no sign of Ieakage.The inlet cover is to grade. There is a injector pump in the closet for the kitchen and it was working. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 574 South Main Street Property Address Mike&Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): N/a 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): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/a Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 574 South Main Street Property Address Mike & Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 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.): N/a *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Even 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 normal and the cover was at 17". t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 574 South Main Street Property Address Mike &Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 page. CitylTown 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.): n/a * 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: ❑ leaching pits number: ® leaching chambers number: 3 flow diffussorsper asbuilt ❑ 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 c Commonwealth of Massachusetts : Title 5 Official Inspection Form c� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e � 574 South Main Street Property Address Mike& Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 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.): There was no sign of failure. The bottom to grade was 3.4' A camera was used. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): n/a t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 c Commonwealth of Massachusetts e Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 574 South Main Street Property Address Mike&Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: N/a Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 r cam, Commonwealth of Massachusetts �n I Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �% 574 South Main Street U- Property Address Mike &Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 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: ® hand-sketch in the area below ❑ drawing attached separately A - O a O 0 O 3 i y A 8 `!3 13 3 So ay y 3-7 3y t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 574 South Main Street Property Address Mike &Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 page. Cityrrown 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: 5.4 +/ 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: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Topo and water contours maps ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: I hand augered down to groundwater which was 6.5' below on next door lot. The high groundwater adjustment for this site was MIW 29 July 2020 was 1.1'. Making the adjusted groundwater level 5.4' below. 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 Commonwealth of Massachusetts �- _ Title 5 Official Inspection Form IIIF�; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 574 South Main Street Property Address Mike &Catherine Reilly Owner Owner's Name information is required for every Centerville MA 02632 10/13/2020 page. Cityrrown 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 TOWN OF BARNSTABLE LOCATION._]7`/. &VA /&j; c� SEWAGE# VILLAGEL.�x3 ASSESSOR'S MAP&PARCEL / OV(, I INSTALLERS NAME&PHONE NO.-D r-k,S A y2 D- SEPTIC TANK CAPACITY /O ,6�y LEACHING FACILITY: L" (h'Pe) c lfec Cy /lD�IS (size) 1—1211 NO.OF BEDROOMS OWNER / i- PERMIT DATE: COMPLIANCE DATE: Q Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility _ �� Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY $l-45 16 11 FtcN Of 3-gip' j; ti—yip t3i -iy 3 L i F2I/ 12q `1 HD DRAN c��eis a I I C Y. 4, 7 - No. - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes pplication for 3i5pont gppgtem Construction 3permit Application for a Permit to Construct O Repair(grade( ) Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. S71 goaeA A i;v Owner's Name,Address,and Tel.No. 1 Assessor's Map/Parcel C �trvt Ili L°'� c• Mc G1c,4aleI Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. '-0vQc S A- '73(owea C08-140-7,59 Type of Building: Dwelling No.of Bedrooms '3 Lot Size 2sAs_ sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow#(m' .required) 3!,�(� gpd Design flow provided 3fli.q� gpd Plan Date Number of sheets Revision Date Title Size of.Septic Tank 10M j,�XZCARV I Type of S.A.S. CUlh'C G'H d&,Aels Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1A)S ,1, A)aw S, q.S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in g g g P Y 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 ealthh.., Signed (iC e to Application Approved by J ate Application Disapproved b Date for the following reasons Permit No. Date Issued ell THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance --°=- THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by at 1 has been ''• i�nee with thf�py�otisio �ie a�rdhe.for Disp•sal stem Co truction Permit No. dated G!N (o�i��/l/i��rp Designer Installer.. g #bedroom�ts�. It 1 i,., Approved design flow , �r gpd The issuance of�tlii�permit sh ,,l'l not bd construed as a guarantee that the system ;l`l iron%�a e6sa�,g/*o V"'IMY'Ai Date Inspector / (,I( s� No.62 .Jl s -Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Migpogar i§pztem Con5trUction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at / and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction mus e co pleted within three years of the date of this permit: Approved by Date ( ,) 119 '� �/ O Fee No. R THE COMMONWEALTH OF MASSACHUSETTS Entered in computer, a Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Apphratiou for 3Di!5pogar :�ppgtcm (CoiYgtructiou vermit Application for a Permit to Construct( ) Repairqlo Upgrade( ) Abandonr( ) ❑.Complete System ❑Individual Components Location Address 4Lo o. Sore w ` , ner�7Nam� �,de No. ° Assessor's Map/Parcel o /t Installer's Name,Address,and�,Ttel.No. PDe�stg��v p�,Add�r�� oS\c,s �J s05_` 00-7/S? ,. Type of Building: 3 2 5 03 5- Dwelling No.of Bedrooms Lot Size t sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) `r Other Fixtures a. 3 Design Flo w�(m�n,1, ed) I gpd Design flow provided gpd - C/ VV Cv Plan Date Number of sheets Revision Date t Title /1fN1 - _/�y.�l rn�t ��/Lr/ �� ,�15 Size of.Septic Tank " ' Type of S.A.S. Description of Soil r Natureo y f Repairs or Alterations(Answer when applicable) INSfi& S. A c t 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. Signe / /� 2� Date , Application Approved by / �///1 Date 1 Application Disapproved by: 5 k, Date p for the following reasons U Permit No. //C Date Issued -- Town of Barnstable Regulatory Services Thomas F.Geiler,Director a Public Health Division 9',,TFo; A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: AW9+Zl Designer: K916 Installer:. Address: . �>rS�G�s ��1� Address: On fCR j jgjj S nv.,� was issued a permit to install a (d te) (installer) septic system at :5 7� Sno+V\ fVV,ra based on a design drawn by (address) dated (designer) 1-certify that the septic system referenced above was installed substantially according`to :she design, which may include minor approved changes such as latera .relocation of the distribution box and/or septic tank. I certify:that the septic system referenced above was installed with mEa}oir_changes.'( ;e; greater ffi m'l0' lateral relocation of the SAS or any vertical'.relopition of any componc�at of the.septic;,system)but in accordance with State&Local,Regidations. Plan revisiorx or certified as-bult`by designert$ follow. �tH9�Mgs� taller's Signature) � ►"MASON rn g OT-K �P (D er s Signature) (Af$x er's Staihp Her PLEASE RETURN TO BARPTSTABLE,PUBLIC HEALTH DIVISION, C1E;RTMCA,TE OY COMPLIANCE WII L 'NCiT E,:= SSUEDj :, � `BOTH T$hS FORM =BUILT CARD ARE RECI M; n'ftv THEBAIt< S'I'ABI:E PUBLIC BEAcB'I'a6[DIVIgIM THANK YOU. _..r. Q:Hea1tidSepbc/Designer Certification Four, Y 4 FYHE Tp� Town of Barnstable aarl,stauie O w �a„, A®AR1tICaCity ,, � . Pelv Regulatory Services Department R 'AICN ACILE6, Public HealthDivision Y 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 19, 2008 Lori McDonald 574 South Main Street Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 574 South Main Street, Centerville MA was inspected on February 6, 2008, by Robert Paolini, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within One (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDEBOARD OF HEALTH r; Qas ,.4Kean o , , CH Agent of the Board of Health CERTIFIED MAIL# 7006 2150 0002 1038 6827 Q:\SEPTIC\Letters Septic Inspection Failures\574 South Main Street.doc r Commonwealth of Massachusetts W ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' f ° 574 South Main St. l4 0` cp Property Address Lori McDonald I �' Owner Owner's Name y; information is required for iCenterville Ma. 02632 2/06/20Q8 every page. City/Town State Zip Code Date DER-spection Ur l C.i7 Uz C.>t Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information - ' When filling out r`�� forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC Company Name rab P.O.Box 763 Company Address Centerville Ma. 02632 erom 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 ❑ Needs Further Evaluation by the Local Approving Authority 2/06/2008 Inspector's Sighat a Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 574 S.Main St.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W ` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c,M 574 South Main St. Property Address Lori McDonald Owner Owner's Name information is iCenterville Ma. 02632 2/06/2008 required for 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: Flowdiffusors are in hydraulic failure.New leaching needs to be installed. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If''not determined," please explain. ❑ 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. ND Explain: ❑ 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 ❑ obstruction is removed 574 S.Main St.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 574 South Main St. Property Address Lori McDonald Owner Owner's Name information is iCenterville Ma. 02632 2/06/2008 required for every page. City/Town - State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled-or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,.safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the 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. 574 S.Main St.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts ti. W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 574 South Main St. Property Address Lori McDonald Owner Owner's Name information is required for iCenterville Ma. 02632 2/06/2008 every page. City/Town State Zip Code Date of Inspection t B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 an 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 ® El or 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 ❑ ® 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. 574 S.Main St.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments nM 574 South Main St. Property Address Lori McDonald Owner Owner's Name information is required for iCenterville Ma. 02632 2/06/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) t D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 ❑ El 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. 574 S.Main St.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cw 574 South Main St. Property Address Lori McDonald Owner Owner's Name information is required for iCenterville Ma. 02632 2/06/2008 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? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? . ® ElWere 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)] 574 S.Main St.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 574 South Main St. Property Address Lori McDonald Owner Owner's Name information is required for iCenterville Ma. 02632 2/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2006:46,000 g ( y g (gpd)): 2007:52,000 Sump pump? ❑ Yes ® No Last date of occup 2/06/2008ancy: 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: Last date of occupancy/use: Date Other(describe): 574 Smain St.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 574 South Main St. Property Address Lori McDonald Owner Owner's Name information is required for Centerville Ma. 02632 2/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: J.P.Macomber, Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Last pump 6/1/2007 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: system installed 1986 Were sewage odors detected when arriving at the site? ❑ Yes ® No 574 S.Main St.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 574 South Main St. Property Address Lori McDonald Owner Owner's Name information is required for iCenterville Ma. 02632 2/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 14" feet f Material of construction: ❑ cast iron 0 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 through 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: 2" Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness 0 8" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured 574 S.Main St.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 574 South Main St. Property Address Lori McDonald Owner Owner's Name information is required for iCenterville Ma. 02632 2/06/2008 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.): Pump septic tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be 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 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): 574 S.Main St.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 574 South Main St. Property Address Lori McDonald Owner Owner's Name information is required for iCenterville Ma. 02632 2/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level:, Alarm in working order: ❑ Yes ❑ No f J 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 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 rotted with stain line half way up outlet lateral.Evidence of solids carryover.Evidence of leakage out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 574 S.Main St.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 574 South Main St. Property Address Lori McDonald Owner Owner's Name information is required for iCenterville Ma. 02632 2/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ® leaching chambers number: 3-flowdiffusors ❑ 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 damp soil.Flowdiffusors were full at time of inspection with wtaer level 2" below invert. 574 S.Main St.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 574 South Main St. Property Address Lori McDonald Owner Owner's Name information is required for iCenterville Ma. 02632 2/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 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.): 574 S.Main St.•12/07 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 f Map' Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size D 0 ❑ Zoom Out J J J J J fl 'J U In r ` q .r 0 -.2,&Fpet Set Scale 1" = 20 I- Aerial Photos a r`-,rinhf 9MF-')007 Tn... of KAA All rinhfe reconn http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=186046&mapp... 2/6/2008 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M -574 South Main St. Property Address Lori McDonald Owner Owner's Name information is required for iCenterville Ma. 02632 2/06/2008 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 leaching T 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 ti ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:Gaherty& Miller model 12/16/94 ground water elevations.USED:USGS observation well data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of ground water elevations. 574 S.Main St.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 l Town of Barnstable OF THE r, Regulatory Services saxwsrnsi� e Thomas F. Geiler,Director MA ��pIE1639. g Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health 1Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Barnstable Assessing Search Results Page 1 of 3 Home: Departments:Assessors Division: Property Asse s an ,e Results New Search 1 New Interactive Maps >> M r Owner: 0 ssessed ti Values: MCDONALD, LORI C 574 SOUTH MAIN STREET Appraised Value Assessed Value Map/Parcel/Parcel Extension Building Value: $ 124,900 $ 124,900 186 /046/ Extra Features: $0 $0 Outbuildings: $ 14,600 $ 14,600 Mailing Address Land Value: $386,500 $386,500 MCDONALD, LORI C Totals $526,000 $526,000 574 SO MAIN ST Residential Exemption Received=$105,082 CENTERVILLE, MA.02632 ! I 2008 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Community Preservation Act Tax $83.09 Fire District Rates Town Barnstable FD-All Classes $2.04 $6.58 . C.O.M.M. -All Classes $1.03 Commei C.O.M.M. FD Tax(Residential) $541.78 Cotuit FD-All Classes $1.03 $5.80 Hyannis-Residential $1.53 Persona Town Tax(Residential) $2,769.64 Hyannis-Commercial $2.35 $5.80 Hyannis-Personal $2.35 Other R; W Barnstable-Residential $1.86 Commur W Barnstable-Commercial $1.86 W Barnstable-Personal $1.86 Total: $3,394.51 Construction Details Buildin Property Sketch AS BUILT Property Sketch egend Building value $ 124,900 Interior Floors Carpet Style Cape Cod Interior Walls Plastered Model Residential Heat Fuel Gas Grade Average Heat Type Hot Water Stories 1 1/2 Stories AC Type None http://www.town.bamstable.ma.us/assessing/assess/displayparcelO8map.asp?mappar=1860... 2/15/2008 Barnstable Assessing Search Results Page 2 of 3 Exterior Walls Wood Shingle Bedrooms 3 Bedrooms Roof Structure Gable/Hip Bathrooms 2 Full Roof Cover Asph/F GIs/Cmp living area 1426 ' Replacement Cost $156090 Year Built 1920 l Depreciation 20 Total Rooms 5 Rooms Land CODE 1010 � Lot Size(Acres) 0.59 j Appraised Value $386,500 AsBuilt Card N/A Assessed Value $386,500 `d `' View Interactive Maps > Sales History: Owner: Sale Date Book/Page: Sale Price: MCDONALD, LORI C Apr 21 1998 12:OOAM 11371/059 $ 145,000 YEOMANS, FRANK A SR Apr 21 1998 12:OOAM 11371/057 $ 1 YEOMANS, FRANK A SR Apr 21 1998 12:OOAM 11371/055 $ 1 YEOMANS, ELIZABETH 'M792 $0 YEOMANS, ELIZABETH A 1437/ 109 $0 YEOMANS, PETER J'M792 $0 Extra wilding Features Code Description Units/SQ ft Appraised Value Assessed Value BRN1 Barn- 1 Story 132 $2,600 $2,600 FGR6 Gar w/Lft Avg 400 $ 12,000 $ 12,000 Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area UST Utility Area (Unfinished) (Finished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story (Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story (Unfinished) http://www.town.bamstable.ma.us/assessing/assess/displayparcel08map.asp?mappar=l 860... 2/15/2008 Barnstable Assessing Search Results Page 3 of 3 FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) I http://www.town.bamstable.ma.us/assessing/assess/displayparcelO8map.asp?mappar=1860... 2/15/2008 , 4 '1 a" T" An Nit 77, Iv, op Ak ,M ~ ur H ' t' "A'0• ..:� ,1W__. �.•. a .'�57 _. _ � a • r~' i - +q , t rL L , 11 • s .� 7; "2- AL aisi�. r.i'I�' yI.` .��/ y -i�• �':�rC - - „ _ X. � �. T � � � ., r � ✓^ l ri. � .�✓ r! J r IL IN dw AL -/ _ - _4 i C k- v i � �fit_. "pert s, �._ Ji��p/� ♦ _�- � c- tY,• IN eeop, � � • � vq kl` �• '� � - !tom� .��f►� � ` � E, -� 3 �� y ' 4. 096 r - �' "�o S • ow �. ILL 67. S � � (1�rl �n TOWN OF BARNSTABLE LOCATION j 71. ScoA r ylCti;q 5-1+- SEWAGE# VILLAGE Ce!�S)Jfu ASSESSOR'S MAP&PARCEL /b�G OyG INSTALLERS NAME&PHONE NO. i'S A r -SOB'�gO'yg3�I SEPTIC TANK CAPACITY /QQ7 )y$f7�•/� LEACHING FACILITY.(type) Co/fec ry 11,00;!CLS (size) r NO.OF BEDROOMS OWNER C PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility.(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 4 M5 ProN+ ot Ila�ase 3-ar' 1.4 �31 ay J q C"I 14® 0 RA !s LO CATION SEWAGE PERMIT] NO. jI'I p Vf"\ vILLACE INS LLER'S NAME i ADDRESS B U I L D E R OR OWNER DATE: PERMIT ISSUED DATE COMPLIANCE ISSUED D l�f lS �bv�-K M�l m 13T T No....&SI-Ld THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH ...........llaievw.........OF..... ..........------------Appliration for Roposal Works Taustrurtivit thrutit Application is hereby made for a Permit to Construct or Repair (4-)""an Individual Sewage Disposal System at: ......4AA7 ............I................................................................................ Loca r or Lot No. ------------------- ............... . ......... .... .................................................................................................. n Address ... ........... ..................... .................................................................................................. Installer Address Type of Building, Size Lot............................Sq. feet U DwellinglOeNo. of Bedrooms....1.Z.................................Expansion Attic Garbage Grinder ( Other—Type of Building .............................No. of persons...._._...._................ Showers Cafeteria ( Other fixtures .................................................................... ----------------------------------------------------------------*----------------- Design Flow............................................gallons per person per day. Total daily flow................................*...........gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter------------_- Depth.............._. Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area.....................sq. f t. Seepage Pit No..................... Diameter.._................. Depth below inlet.............._..... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.__.__............._ Depth to ground water.._................____. Test Pit No. 2................minutes per inch Depth of Test Pit.__............._._. Depth to ground water.___._.............._.._ 0 Description of Soil............ x ------------------ --------------*-------------*......."----------*-------------------------------- ------------*-----------------------------*---------------------***,-*-------------------------*-------- ...... .... . . ......... ... ... ..................... ............. ...... ........ ............ ........ .... .... Nat u re o f Repairs or Alteration s Answer when n applicable i cable....../-----------------f::- UX_ . .............................................. A..ItS .......................................................I....................................................... * ............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'L I T U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued th oard f health. Application A Signe .... . ... ---0/4 Dat Application Approved By----------- - -- ------ - at. A pll tjo i, pplication Disapproved for the following reasons:................................................................................................................ .................. ..... ...................................................................................................................................................................................................... Date Permit rmj ermit No..J,.5--- ----0 .................... Issued....................................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA E No......................... Fps.......`'.. ..... .� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Disposal Works Tonstrurtion prrmit Application is hereby made for a Permit to Construct ( ) or Repair (;-)'an Individual Sewage Disposal System at .... „.�.'...„ � ....._! t ✓`;;,,.......................................... ` ................................•....... ..........------......................... �•+n Location Address or Lot No. ' / r *'x . r Owner ` Address Installer Address Type of Building Size Lot__------------•------..---Sq. feet Dwelling o. of Bedrooms.....�r'�"..................................Expansion Attic ( ) Garbage Grinder ( ) a` Other—T e of Buildin 4 yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures .--------•-•-•------•--......-•-•--•------•----•----•.---•-••---------------•---•----- ...:.. W Design Flow............................................gallons per person per day. Total.daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ODescription of Soil .:,;. -.-•------------------•-------•----------------------------------------•-----------------------•-----------•-•------------- x U •=•----------•---••--- ..................................................-------------------------------------------------------------------------------•------------------..... -------------- W xJ ; ; ------------------------•-------.... U Nature of Repairs or Alterations—Answer when applicable.---___�:,.w w SSA. ..... ''`? !' ---------------------------------------------- s ' drf, ? ..............................................................................................................F..r ___. .�. ..... .............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI-S 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of-Compliance has been issued by the board of health Signed t r •r to-F ..................� �' �" .... ................ D .„. Application Approved By •. •--•- ` -V.-ate Application Disapproved for the following reasons:_..----•-------•--------------------•----------------------•------------•----------------------------........... •-•.................•---------------•--.......--------------•-----------•--------•--------------•-----------------------•----------------------•------------------------------------------------------- Date PermitNo......................................................... Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r t r f.............O F........ ............................................ (Irrtifirate of Tnntplia ttrr TUIS IS TO CERTIFY, That the Individual Sewage_Disposal System constructed ( ) or-Repaired by .............. ( � t ..-' . , .._._°.......:......:C" 8' e l 4r' s.w f d� P' •� .Cs------------------------r Installers As at............................t!`tra i s �` '" `f/ i ce�.......... ! f 1 !' �F?• „� ------ --- --•--------------- has been installed in accordance with the provisions of TITIP, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...&,r. 4._*2....4...... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FU)NCTION SATISFACTORY. ,� DATE.................6.f. lllq:�........-•-------........................... Inspector...................Ln....------------------...--•---------•------•---•---•-- THE COMMONWEALTH OF MASSACHUSETTS BOARD 4 HEALTF,EI, { ,r .............. � .....OF...... c !' '� L�•! . .................... No... .................... IFEE...:............................. Dispogo nr dun nrtUan �erutit . ! �. Permission is hereby granted..V. ,..... ...... d __ __�•��.f, `...-!��r""�....�. �. .............................. .... to Construct ( ) on Repa r f r a idual Sewage Sit;In J... Street / as shown on the application for Disposal Works Construction Permit N45.1,02. __ - _,,�, ,,j,,,. �_s, --• ---------------------- DATE....... �J Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ' GRAPHIC SCALE Locus t 30 0 15 30 60 S, CODDING7YJN "iP1 - t, i inch = 30 ft.: IIAY�� i 50 g°3 s 6 °— —° °°F�'N�E °�°—°'� ppND ° ° 0 LOT 2 c LOT 1 � o ASSESSORS j ASSESSORS MAP 186 PARCEL 079 —4 — SHED a' MAP 186 PARCEL 046 %� `''' AREA=25,035fS.F. BENCHMARK CENTERVILLE HARBOR 0 TOP OF FOUNDATION \0 5 EL 11.6 o j �° DATUM GIS-' 7 p r °\0 GOAT ° 8 THE EXIST. SEPTIC SYSTEM �=�• `�-�PEN WAS DRAWN FROM THE yy,4 2� TOWN OF BARNSTABLE DECK SEPTIC INSTALLERS CARD LOCUS MAP \°� iiiiiii iiiiiiii 11 O ��oe ,,,,,,,,,, PLAN REF. 205-61 & 94-59 ° 10 ';;;;; �O_ EXIST. 1000 GAL TANK TO REdfAIN ;GARAGE, / ..EXISTING��,�� STONE DEED REF. 11371-A ,,;;;;;.........;;;;;;;; ZONING: �,RD_1 ,,,,,,,,HOUSE..,.... --WALL p,Ll' °/° 77. SETBACKS: 30'-10'-10' \�--- ,,,,,,,, 1z FLOOD ZONE: "A10" (BFE 11' PANEL NUMBER. 250001 0016 D a�, \ oEN°,° N i�� DATED. 07-02-92 11 \ f o,° i GP`0-�0 0 � fr i" 10 of �, 1 o o 0 0 __ l� SITE PLAN OF LAND 10 ° � �, � / � LOCATED AT' AssEssoRs 0. D BOX 9 ; 30 °�' 011 574 SOUTH MAIN STREET MAP 186 PARCEL 045 2j e /BANDON / i' CENTER VILLE MA. EXISTING S.A.S. / PER TITLE V j . PROPOSF.D9 60, " �' cP LEACHING\ SYSTEM , �4 �jci IGy PREPARED FOR. LORI C. MCDONALD e �;j �.7 APRIL 24, 2008 REV REV Or ,u�, a REV AUGUST 18, 2008 STEP EN YANKEE LAND SURVEYORS o�Y �E_ 7 & CONSULTANTS P.0. BOX 265 e` UNIT 1, 40 INDUSTRY ROAD APROX EDGE �� MA 02648 OF MARSH LOCATED.- ® MARSTONS MILLS, 03-09-2008 TEL• 508-428-0055 FAX 508-420-5553 1 SHEET 1 OF 2 JOB 54340 JF / #' I • i 90' MIN. TO S.A.S. T.O.F. EL. 11.6' 4" SCHEDULE 40 P. VC MIN. PITCH 118 PER FT. FIN. GRADE = 11.8' FIN. GRADE = 9.5' TO 10.5' 6 ' / / / FlN. GRADE = 10.4' MAX. COVER OVER = 36" 6 MAXi CLEAN —INSPECTION PORT TO CONCRETE COVERS RISER WITH FLOW LINE CON�/ZETE COVER SAND BE PLACED ON END UNIT 110" LJ INVERT 710 REMAIN HILL 14" NVERT INVERT BGAFFZE EL.=AS 1 32 INVERTS 6" SUMP LEVEL INVERT EL.= 7.17' EL.= 9.57' EL.—_8.34— EL.=_8.-4— INVERT SPLASH PAD TO CONSIST OF DISTRIBUTION —7 89' UNDERLAYMENT OF FILTER FABRIC 1000 __GALLONS EL.-____ EXTENDING 16" IN FROM START OF ROW EXISTING SEPTIC TANK Box 3 ROWS OF 3-CULTEC C-4 UNITS X 81UNIT=32' PROFILE OF SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM + SYSTEM (PROFILE) NOT TO SCALE OBSERVED WATER TABLE (03-12-2008 / TIDAL) ELEV.=_-2.17', BOTTOM OF TEST HOLE ELEV.__0.50 OBSERVATION HOLE 1 ELEV.= 10—.5— PERCOLATION _ RATE _<_2 MINI INCH AT 26"__ INCHES OBSERVATION HOLE 2 ELEV.=_10.5_ DEPTH HORI TEXTURE COLOR DEPTH HORI TEXTURE COLOR CULTEC NO 410 ESTABLISH VEGETIVE COVER FILTER FABRIC BACKFILL WITH CLEAN SAND 0'-13" A LOAMY SAND lOYR 2-4 TEST PIT DATA 0'-13" A LOAMY SAND IOYR 2-4 (NATIVE OR PERC SAND) (P# 12140) i 12"-26" B LOAMY SAND IOYR 6-8 ' 12"-26" B LOAMY SAND IOYR 6-8 EL. 8.34 EL. 8.34n.n,n.nt EXISTING IIIWIII 36"-120' C MEDIUM SAND 10YR 7-4 136"-120' C MEDIUM SAND IOYR 7-4 MA TER I { MA TERM USE 3 ROBS OF S-CULTEC C-4 FIELD DRAIN UNITS r_�7H� 6'SEPARATION BETWEEN EACH ROW&NO S7t9NE 106" GROUND WATER EL. 2.17 106" GROUND WATER -- —EL. 2.17 SOIL ABSORPTION EL. 0.50 EL. 0.50 GENERAL NOTES SYSTEM (SECTIA rN Mqs F >> sq 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO DER DAVID �y 0311212008 . SOIL TEST DONE BY ,v TITLE 5 AND THE TOWN OF BARNST49LE---- RULES AND DATE OF SOIL TESTDAVID B. MASON CSE ;', B. cn G �i� MASOPJ REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. WITNESSED BY: DONALD DESMARIS �' i 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO DESIGN CRITERIA: s`v 9 No.1066 o y WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" NUMBER OF BEDROOMS . . . . . . . (3 EXISTINGf Fc3 EP`6 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF ►e s A A A 4 SOIL TEXTURAL CLASS . . . . . . . . WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN ®�D�.�:F 0,s3 �t DESIGN PERCOLATION RATE 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE v ,��` 'icy w DAILY FLOW . . . . . . . . . . . . . 3 s 110 G.P.D. R USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS e ��` CRFc DESIGN FLOW . . . . . . . . . . . . 330 G.P.D. MIN RE'QD) 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL ® QSTEPHEN �� ® GARBAGE DISPOSAL . NOT ALLOWED BE MORTARED IN PLACE. + a � J. ® EXISTING SEPTIC TANK. 1000 GALLON 7V REMAIN 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH Do7 LEACHING AREA REQUIRED. 330 = 445.94 S.F. 74 DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. ® = y° ® USE 3 ROWS OF 3 CULTEC C-4 UNITS WITH NO STONE 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR ® �a FOR AN S.A S. HA VING THE DIMENSIONS- 13.0' X 24.0' IS TO CALL "DIG— SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS ®° BOT7nM AREA- (GENERAL USE APPROVAL FOR 6.7 SF/LF OF C-4 UNIT) PRIOR TO COMMENCING WORK ON SITE. THE EXCAVATOR CONTRACTOR SHALL CONTACT fiT 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL.AS YANKEE SURVEY 24 HOURS PRIOR TO SYSTEM 3 RUOWS X,2'X 6.7 SF�= 482.4 SF SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. INSTALLATION INSPECTION. DESIGN FLOW PROVIDED.• 0.74(482.4 S.F.) = 356.96 G.P.D. 8) PARCEL IS IN FLOOD ZONE___',90'=(lF—E. EL 11) 9) LOT IS SHOWN ON ASSESSORS MAP _186 AS PARCEL 046 SHEET 2 OF 2 JOB NUMBER__54340 _JF ___