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Home My WebLink About0274 STONEY CLIFF ROAD - Health L274 STONEY CLIFF RD, CENTERVILLE A= 170 045 llil 77 UPC 12543No. 531-OR- HASTINGS, TIN TOWN OF BARNSTABLE LOCATIONoZ7y SEWAGE# �f jZY VILLAGEJ:JArZj/i/LL ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO G� SEPTIC TANK CAPACITY LEACHING FACILITY:(type)_A�-) QAC. G41q"0& tsize)3S�x NO. OF BEDROOMS y OWNER PERMIT DATE:,ghP4 COMPLIANCE DATE: 3 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 Pu� 2-7 c yn�7 t No. v U2 THE COMMONWEALTH OF MASSACHUSETTS FEE dv� l BOARD OF HEALTH OF APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Applicationfoi a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - omplete System [-]Individual Components 21 i`�•br <_'Lk FF i2pQ 1742,0 �JV�t t j,� `70 t'lo�� n � ,,, n , wne' arne ` 1 p/Parcel# /�� Addre s 'CIF ^ jw L # J / hone# t_V1nrr'sNam71 Telephone ff Telephone# Type of Building: Lot Size 01 Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures ` Design Flow(min.re wireI� LIDgpd Calculated design flow` `v gpd Design flow provided gpd Plan: Date—) 2 Number of sheets Rev'sion Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluato Date of Evaluation DESCRIPTIQJN OF REPAIRS Op AJTERATIONS The underst ed agr4t�oijntall the above describ Individu wage Disposal System in accordance with the provisions of TITLE 5 and fu er agreeace the sys n ape until a ficate of Compliance has bee issued by the Board of Health. Signed r Date 1 �� Inspections _;2 FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 ----------------- -- - -----------------------� No. U( � U� j THE COMMONWEALYHOF MASSACHUSETTS FEE UU� BOARD O�•7F HEALTH Ic OF s APPLICATION IFOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Applicationfoi a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - omplete System ❑Individual Components Z_T -c70Wj <a F�F t2jND ^ tt��/E7wne' NamerC' �1 �l p/Parcel# ^ Address —T one �. � CS er" J"I�s er's Nam w N� )QJ I4 // d;ess ddress �]'� Telephone TeI�Z�/ / Type of Building, �'�\► Lot Size Sq.feet . Dwelling—No.of Bedrooms Garbage Grinder ( ) -- Other—Type of Building No.of persons Showers ( ), Cafeteria Other fixtures Design Flow(min.AY uire gpd Calculated design flow*b gpd Design flow providedpd Plan: Date ID7 �D/ Number of sheets Rev'sion Date — Title Description of Soil(s) 1(-, LIPQ Soil Evaluator Form No. Name of Soil Evaluato Date of Evaluation (. O DESCRIPTIO_N OF REPAIRS Q�R AkTERATIONS The„undersi ed agrees to install the above describe Individu. wage Disposal System in accordance with the provisions of TITLE 5 and fu er agrees no lace the sys nr1n ope until a ficate of Compliance has been issued by the Board of Health. Signed Date �� r ((]] Inspections FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 — NO� ZU I�W 2——y ———. + — - �y THE COMMONWEALTH OF MASSACHUSETTS IU� �._�_.�.�•� / BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) omplete System The undersigned hereby certify that the Sewage Disposal System; Construct d( ),Repaired( pgraded( ),Abandoned( ) by: CQt)w 14L_" �U-MU -+ �dL at 2741 V 1 Pk Ff= �v 9�--� �(QP�✓t��M , has been installed in accordance with epr�ovisions of 310J CI), R 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. Z U/( " l dated 2/7'I // 1 Approved Design Flow y U/L� (gpd) Installe / Designer: • tUAL—D Inspector Date The issuance of this certificate shall not be construed as a g!rantee that the system will function as designe J. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. Zu�� "y2 / THE COMMONWEALTH OF MASSACHUSETTS FEE /GO _ BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby rante to Construct ( ) Repair ( rade A a don ( ) an individual sewage disposal system at 5 CL as described in the application for Disposal 4ystem Construction ermit No. 7_U / `—'0) t./ dated /) / 6 Provided: Constructio shall be completed within three years of the date of this permit, loan conditions ust be met. Date 2 f �I✓o Board of Health i,, 1 FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS- BOSTON i Town of Barnstable "E A Regulatory Services Richard V. Scali,Interim Director * anaxsTnai.e. 9� NAM Public Health Division 1639. '°'Fc n►p�° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: �0a Sewage Permit%Z0/6—g 1I2 Assessor's Map�Parcel Designer..?Ay i'O 1 . /'''t 4�lL.. _ Installer: Address: t9��— 6Sq,��/�/I G Alf Address: On a(L116 was issued a permit to install a (-date) (installer) septic system at o?7 y �7 . W,*. based on a design drawn by ddress dated / (designer 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. Strip 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 that the system referenced above was constructed in co niiance with the terms oft e AA oval letters (if applicable) / OFil'gS 4 X 4- UAVIU stall s lgnature) g MASON `v � No.1066a � . GIST (De ' er's Signature) (Affix De ��;,�� hip Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc U � Town of Barnstable P# 1 gyp, Department of Regulatory Services . aeae3rAaM M. Public Health Division Date l .6`j�q. 200 Main Street,Hyannis MA 02601 'rep Mpy s / 6Ir l Date Scheduled Time M Fee Pd. Soil Suitability Wssessmentfor Sgwagq Disposal Performed By: � Witnessed By: I --y—� LOCATION&GENERA INFORMATION . Location Address C./1 Owner's Name I , -I( j� ///Address � Assessor's Map/Parcel: I IDI Engineer Name `I t�� .AS On NEW CONSTRUCTION REPAIR Telephone# '/ Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) �v V— Parent material(geologic) Depth to Bedrock Depth to Groundwater:Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time Observation Hole# Time at 9" Depth of Percv Time at 6" Start Pre-soak Time @ ` Time(9"-6") End Presoak Rate MinAnch / !� Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC y�� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel � 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) Flood Insurance Rate Map: / Above 500 year flood boundary No Yes Within 500 year boundary NoZVI' es Within 100 year flood boundary Noes Depth of Naturally Occurring Pervious Material Does at least four feet of natural Voccurring pervfo at exist in all areas observed throughout the area proposed for the soil abso on system? 9 l If not,what is the depth of aIlly occurring pe ious t Certification (�j I certify that on `" (date)I have passed the soil evaluator examination approved by the Department of Enviroilm n I Protection and that the above analysis was pe rme by me consistent with the r \-training,ex rti an elu escribed in 310 CMR 15.017. _ Signature " Date Q:\SEPTIC\PERCFORM.DOC r� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,FORM Address of property ._). 7 4 Owner's name C4 �U U ` l Date of Inspection �� PART A CHECKLIST Check if the following have been done: Pumping information_ was requested of the owner, occupant, and Board of Health. `None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. �As built plans have been obtained and examined. Note if they are not available with N/A. L--'�The facility or dwelling was inspected for signs of sewage back—up. - The site was inspected for signs of breakout. 11 system components, excluding the SAS, have been located .on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. v The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. /r J The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance -of SSDS. APR R 1995 HEALTH DEPT TOWN OF WNW 7LE � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM, INFORMATION FLOW CONDITIONS If residential number of bedrooms number of current residents garbage grinder, yes or no S laundry connected to system, yes or no �tJv seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: Ll"-1,a0 Last date of occupancy GENERAL INFORMATION Pumping ecords a d source of information: (JCS System pumped as part of inspect ' n, yes or no if yes, volume pumped S"oB . Reason fo pum ing: r 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) " __. O.the, r (exp ain); Aroximatea a of 11 components. Date installed, if known. Source of PP .�. 9 .. . information: , r f Sewage •odorsrde�tected when arriving at the site, yes or no SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC T"K: (locate onX ite plan) 'f depth below gra e: material of constru on: concrete metaY' FRP other(explain) dimensions: sludge depth distance from top of sludge' to ottom of outlet tee or baffle scum thickness distance from top of,scum to top of utlet tee or baffle distance from bottom of scum to botto of outleL tee or baffle Comments: `' ~ (recommendation�f10-rpumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) DISTRIBUTIION BOX: (locate on site. plan) depth of uid level above outlet invert Comments: ,(note if level aid distribution is equal, evidence of solids carryover, evidence of �kage into or out of box, recommendation for repairs, etc. ) PUMP CHAMBER: (locate on site plan) pumps in working der, yes or n�- Comments: (note condition of pum hambe condition of pumps and appurtenances, recommendations f .r aintenance r repairs,etc. ) V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIONy'--FORM PART B SYSTEM INFORMATION Continued SOIL ABSORPTION SYSTEM (SAS) (locate on site plan, if possi le; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. _ v� leaching pits and number 1 / . OLLZ leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number -12-0) Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of veg tat * re o endat ' ons for maintenance r repair ,etc. ) _ e CESSPOOLS locate on site plan) : ( P ) number and configuration G . depth-top of liquid to inlet invert 44 depth of solids layer depth of scum layer -3- . dimensions of cesspool x materials of construction indication of groundwater inflow (cesspool must be pumped as ZA� part of inspection) / iyce aA4' Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetal-lon,--;-ecopmepdation for maint Rance or repairs,etc. ) d PRIVY: (locate on site p n) materials of constructio dimensions depth of solids Comments: (note co ion of soil , signs of hydraulic ' lure, level of ponding, cond ' on of vegetation, recommendations for mai enance or repairs,etc. ) . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' -c, 33 - � 3L DEPTH TO GROUNDWATER 7 depth to groundwater method of determin tion or appr ximation: f2 I _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C j FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined" , explain why not) Backup of sewage into facility? AJ Discharge or ponding of effluent to the surface. of the ground or surface waters? D Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <6" below invert or available volume< 1/2 da f low? Required pumping 4 times or more in the last year? number of times pumped 44 1 Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: . AJ below the high groundwater elevation? within 50 feet of a surface water? O v within 100 feet of a surface water supp'ry�o'r tributary to a surface water supply? l/U within a Zone I of a public well? ,�� within 50 feet of a bordering vegetated wetland or* salt marsh- (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? less than 100. feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water anti- for coliform bacteria, volatile organic compounds, ammonia nitro 9 P 9 and nitrate nitrogen. . i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION _ II Name of Inspector .J p mcatq) Company Name R (rFX3 $gyp GS Company Address --�5 �S Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maiitenance of on-site sewage disposal systems. Ch!e .FcX one: I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15. 303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature Date I/ 1�- 9S Original to system owner Copies to: Buyer (if applicable) I Approving authority s COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS M, fD DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED r d MAR 2 2001 TOWN OF BARNSTABLE »`, �• HEALTH DEPT. TITLE 5 '' :' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ' a" SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 274 STONEY CLIFF RD CENTERVILLE,MA 02632 1:11 ; Owner's Name: KATHY ROBERTGNS' Owner's Address: 274 STONEY CLIFF RD CENTERVILLE,MA 02632 5# Date of Inspection: 1/26/01 Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.'BOX 2119 TEATICKET,MA.02536 ; `t. Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and - 1U s S. Ff 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: . = r X Passes Conditionally Passes Needs Furthel Evaluation by the Local Approving Authority r, , Fails , f y h Inspector's Signature: Date: 1/26/01 The system inspector shall submit a copy of this inspection report to the Approv�,ng Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a c;sign now 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. Notes and Comments THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING SYSTEM EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ****This report only describes cond tins at the time of inspection and un.ar the conditions of use at that time.This inspection does not address how the'system will perform in the future und::the same or different conditions of use. sr y, Page 2 of 11 s .'l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i~ti PART A F ° +Y CERTIFICATION(continued) ` Property Address: 274 STONEY CLIFF RD CENTERVILLE,MA 02632 LI I ,ru Owner: KATHY ROBERTONS Date of Inspection: 1/26/01 k; Inspection Summary: Check A,BC,D or E/ALWAYS complete all of Section D A. System Passes: X 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 SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING SYSTEM EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. B. System Conditionally Passes: ?, fit: P _ 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. ,"? t;;'.�. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. 1,!P o i, n/a 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. ` y" *A metal septic tank will ass inspection if it is structural) sound not leaking and if a Certificate of Compliance indicating P P P . Y � g p g that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or'lreak 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 _ distribution box is leveled or replaced ND explain: n/a tK ' n/a 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 ;t _obstruction is removed ND explain: n/a ,5 A.r:y° t j Page 3 of 11 :,+ ;t;t OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS ;Lfi< SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A `!a CERTIFICATION(continued) s z Property Address: 274 STONEY''CLIFF RD CENTERVILLE,MA 02632 L11 g Owner: KATHY ROBERTONS t' Date of Inspection: 1/26/01 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. F 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: a(. _ Cesspool or privy is within 50 fM.6f a surface water ; j _ 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 an determines that the Y) �s system is functioning in a manner that protects the public health safety and environment: ; ;# Y g P P � Y � _ 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. r.,. >n 'y f(, 'r _ 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and T . volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammoma , t nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy x ` of the analysis must be attached to*his form. f � �j1 li Yi c a i ! 3. Other: t ,i,r, i `y 7 i s Page 4 of 1 I k :e OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' CERTIFICATION(continued) Property Address: 274 STONEY CLIFF RD CENTERVILLE,MA 02632 Li 1 Owner: KATHY ROBERTONS £Ir Date of Inspection: 1/26/01 a` 4Tj 344 n D. System Failure Criteria applicable to,'all systems: You must indicate"yes"or"no"to each of the following for alLinspections: Yes No X Backup of sewage into^facility or system component due to overloaded or clogged SAS or cesspool X Discharge'or ponding of�effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ "s .• X Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow ' X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped.111NF.2000. ^ 9 X Any portion of the SAS;cesspool or privy is below high ground water elevation. t X Any portion of cesspool'or priory is within 100 feet of a surface water supply or tributary to a surface water supply. ;,• X Any portion of a cesspool or privy is within a Zone 1 of a public well. ! X Any portion of a cesspool or privy is within 50 feet of a private water-supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free ' from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or b; f.k_.t less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _ (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 t.i' : CMR 15.303,therefore the system fails.The'system owner should contact the Board of Health to determine what will bz necessary to correct the failure. •5 E. Large Systems: To be considered a large system the system must serve a facility with a desig<t Cow of 10,000 gpd to 15,000 gpd. You must indicate either yes or no to each of the following: .' (The following criteria apply to large systems in addition to the criteria above) yes no ;.'. .i, X the system is within 460 feet of,a surface drinking water supply '' - X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area Interim Wellhead Protection Area—IWPA or a mapped Zone I1 of a ublic water supplywell p .d If you have answered"yes"to any,question"in Section E the system is considered a significant threat,or answered �' r "yes"in Section D above the large system;has failed.The owner or operator of any large system considered a significant threat "1 under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner !''�'1` ;. should contact the appropriate regional once of the Department. i t 41 tt.> _�;JtlfiLr.� d { Page 5 of 11 It 1 Z�'w st OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 274 STONEY CLIFF RD CENTERVILLE,MA 02632 L11 Owner: KATHY ROBERTONS Date of Inspection: 1/26/01 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: t Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health } X Were any of the system components pumped out in the previous two weeks? U,, ' X _ Has the system received normal flows in the previous two week period? .<y ; _ X Have large volumes of water been introduced to the system recently or as part of this inspection? �r l X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) i X _ Was the facility or dwelling inspected for signs of sewage back up? ,r X _ Was the site inspected for signs of break out X _ Were all system components,excluding the SAS,located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? 4, X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance _; of subsurface sewage disposal systems?,L The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ X Existing information. For example,a plan at the Board of Health. f X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is ?'Ar unacceptable)[310 CMR 15.302(3)(b)] J Syr, Y a Page 6 of 11 • a. 4 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ' ' r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C :SYSTEM INFORMATION ' Property Address: 274 STONEY CLIFF RD CENTERVILLE,MA 02632 LI1 `l Owner: KATHY ROBERTONS Date of Inspection: 1/26/01 t $ FLOW CONDITIONS RESIDENTIAL 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 Number of current residents:4 Does residence have a garbage grinder(yes or no):NO ��} Is laundry on a separate sewage system(Yes or no):NO [if yes separate inspection required] ' Laundry system inspected(yes or no), NO Seasonal use:(yes or no): YES ' _4 R Water meter readings, if available(last'2 years usage(gpd)): n/a ; . Sump pump(yes or no): NO .J Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a `. �qt,1r1 . Design flow(based on 310 CMR 15.203,):+,n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trapes or no : NO resent(yes ) Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title`S system(yes or no): NOit Water meter readings, if available: n/a " ;H Last date of occupancy/use: n/a An OTHER(describe): n/a EY ytkl; ,t GENERAL INFORMATION . Pumping Records t '!< ; Source of information:JUNE 2000 Was system pumped as part of the,inspection(yes or no): NO If yes,volume pumped: n/agallons;==;How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system `o _Single cesspool _Overflow cesspool c, _Privy t _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 % p system owner) _Tight tank Attach a copy of the DEPNapproval x.r Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: CESSPOOL ORIGINAL Were sewage odors detected when arriving at the site es or no):NO Page 7 of 11 �tc�fix• OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS H i$ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 274 STONEY CLIFF RD CENTERVILLE,MA 02632 LI I Owner: KATHY ROBERTONS Date of Inspection: 1/26/01 BUILDING SEWER(locate on site plan) > } Depth below grade: 12" Materials of construction:_cast iron —40 PVC Xother(explain): ORANGEBURG Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): . TOWN WATER SEPTIC TANK:'X(locate on site plan) Depth below grade: 6" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explau)n/a If tank is metal list age: n/a Is°age confirmed by a Certificate of Compliance(yes or no):NO(attach a copy of certificate) Dimensions:6' X 6' LEACH PIT" ' Sludge depth: 2" s,-'` Distance from top of sludge to bottom of outlet tee or baffle:32" rr i';j. 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: n/a ° How were dimensions determined: MEASURED Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet.invert,evidence of leakage,etc.): RECOMMEND PUMPING ''`kf MAIN CESSPOOL AND ALL COMPONENTS ARE STRUCTURALLY SOUND. EVERY ONE TO TWO YEARS DEPENDING ON USE TO PROLONG THE SYSTEM'S USEFULL LIFE. gk-r GREASE TRAP:_(locate on site plan) }' ' Depth below grade:n/a Material of construction:_concrete_metal fiberglass_polyethylene other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a ; !q Comments•(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.):n/a 4 1 s ' i +i Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C a}•' SYSTEM INFORMATION(continued) Property Address: 274 STONEY CLIFF RD CENTERVILLE,MA 02632 LI I Owner: KATHY ROBERTONS to 3 Date of Inspection: 1/26/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) (. - .1. Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a i Dimensions: n/a a' Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A i Alarm level:N/A Alarm in working,order(yes or no): NO `r Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): ' n/a R s � DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): ; ; n/a PUMP CHAMBER:_(locate on site plan) E + Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO A<.e Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a : n y E i a.lr i 15, ! �*,•qjj Page 9 of 11 ,tY ;• OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS1 i E SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 4 :4'l Property Address: 274 STONEY CLIFF RD CENTERVILLE,MA 02632 L11 Owner: KATHY ROBERTONS Date of Inspection: 1/26/01 '�'' �� SOIL ABSORPTION SYSTEM(SAS): .X (locate on site plan,excavation not required) If SAS not located explain why: n/a I ;# Type , 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a J, .� n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a q n/a innovative/alternative system , Type/name of technology: n/a I`AIG t 1 ;�•. r. 4 '3, . Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT ' g;L HAD 2 OF WATER IN IT AT THE TIME OF THE INSPECTION.THE PIT HAS NOT HAD MORE THAN 2 OF WATER IN IT.THE PIPE COMES INTO THE PIT PLOWER THAN NORMAL. CESSPOOLS: (cesspool must be''pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a '� Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): '! n/a PRIVY: (locate on site plan) ? tit Materials of construction: n/a Dimensions: n/a Depth of solids: n/a �� Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a t•' i� r; ,t Page 10 of 11 F_f OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION(continued) d Property Address: 274 STONEY CLIFF RD CENTERVILLE,MA 02632 L11 Owner: KATHY ROBERTONS Date of Inspection: 1/26/01 i SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. X I1J O AA e ` A-6 2 q L1 L) xjd i ti�^l4iC� Sri i. :i `.t ,9 ' Fd i in Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 4 k Property Address: 274 STONEY CLIFF RD CENTERVILLE,MA 02632 Ll1 j Owner: KATHY ROBERTONS, Date of Inspection: 1/26/01 ; SITE EXAM _Slope _Surface water _Check cellar _Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: ; NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) ' NO Checked with local Board of Health-explain: n/a ;: NO Checked with local excavators installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: ?. .i USGS MAPS AND CHARTS-12+FEET d`x I ( 1 V• y°a t q q t. LOCATION C _ SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME i ADDRESS B U I L D E R OR OON ER DATE PERMIT ISSUED ::GATE COMPLIANCE ISSUED �` % a.. � a �� o ;� J i � � , o � p'� �- ,, � r �, r '�� j, ' it i i .:, r No..�..5..�:..... Fxs.. ...15.00 ..... 9 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................... T.Qwn......OF............Barrmtable-.................................................. Appliration for 11ispooal Works Tanstrur#ion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: _17?LStoney_Cliff,Rcad .............•------------...........-------- --•-------...-•----------........-------•-------•••----------•--•----•---......-----........•.... Thomas Hersey_ .-- Location-Address . or Lot No. ___________________________________ 274 Stoney Cliff.Road, Centeryille, _MA___02632 Owner Address a A & B Cesspool Services Ins .____.____ 128 Bishops Terrace, _Hyannis, MA 02602 Installer Address Type of Building Size Lot...... ......... .......Sq. feet �-, Dwelling—No. of Bedrooms..........................3 .................. Atti ( ) Garbage Grinder ( ) a`4 Other—T e of Building ._..... No. of YP g --•-----••-----•----• 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 ( ) a Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ I ••-----••-.-•----------------•--•-•----•••••-•---•---•-----...--•-•---•--•------•--••--•---------•--..................................... 0 Description of Soil.....Sand x U .........................................-.............................................................................................................................................................. W •••---•••---------------------------•---•-••----•-----------------•-••-----•------------•-•-----•-•--------------•--•---------•---•-----•-•---------------•-------------------•--••------ U Nature of Repairs or Alterations—Answer when applicable..installat ion of a 1.000 gall on, pre-cast, stone packed leach pit (overflow . -•----------I•---•-•---------••----•----••--•----------•--•-..-••-------•------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T IT Li; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has a issued by the board hea h. igne . ..._ �...... . ...................... 711 84 ........ Dat Application Approved By......... .... ...:•.......-•---......-•--...........---......------------...... 7/11�84 Date Application Disapproved f o the llowing reasons:-------•-•----•---••----••--•------•---------••••-------•----••-•------------•.................••-----••-------. ......................•----•---•--------..........----•-.._...------------...-•--•-------------•---------...---------._...-••••••----------••----••--•--•-----••-•----•----•--••--•--•-••-•--•-•--------- Date Permit No. 84 - .. IssuecF/11/ . Date 15-00 No......... . t ..... Fps.:`........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ....... ..fin.......OF........... a eta ,le. Appliration for Disposal Works Tnnstrnrtinn rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: 274 Stoney -Road ..---____• ................... ............................ ..........._..........-•-•-••.........•----...---------•-•--••••-•---•....-•--._...._......_-•---- Location-Address or Lot No. ..Thomas..Hersey -_-•_--_._•_ 274 Stoney Cliff :Rom.d,._Centerville....PIA..--•02632 ........... ...._.....----••- --... ............ Qwner Address W A & B Cesspool Service Inc . 128 Bis ho-os Terra,Ce, Eyannis MA 02602 Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...................... ...................Expansion Att ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a � Other 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....................................... W Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix ---------------------------------------••----•--------•-------------.....--••-•......---•-••---••-•......................................................... 0 Description of Soil.....Sand......................................................................................................................................................... U -----------•-••-••-••••-------••----•--•-•---•-•--•------------•--.....--••--••--•---•-•--••----••------•--•---••••-----••---•----•---•---•-•--•---•--•-•----•--•-•••---••...----•-•-----••------------- W x .......................... .......................................................................................................................... N ture of Repairs or Alterations—Answer hen applicable._.:nstallation of .. 1,000 ..allon, p�-Cast, s one paced leach pit (overflow. ................................... • ------... . •---•---•-••-••------•••-•--•-•--••-••......•-•------•••----------••-----------------------------•----------••-••-••------..........---......._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha �issued by the-board-o h ltha. ' igne •--••---•...� - - - ............................................. ................................ Application Approved By........ ..... 7/1 Application Disapproved f the ollowing reasons_...._____________________________________ -------•-------------------•--...................Date ...-•------- -------------•-•-----•---------•--•--•--•••---............------.Date ......•----- � .No......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS.,, BOARD OF HEALTH ...................Town.............OF..........7 r stable ............................................................••... Trrtifiratr of f omplianrr H I TO CERT FY That the Indi ' a Se z e osal System con tructTe�l ( 08�1 Repaired ( X) SB esspool eiVice, Inc., �1 �iS S . ps c�rrace, Hyannis, by--------------------- -----• ...-••---•--••-----------•--•---------- --------_---------•--------------------------.------------------------------------•--------•--- 274 Stoney Cliff Road, Centerville, MA" 32 - Thomas Hersey at...................................................................................................... has been installed in accordance with the provisions of T L� y�ef�The State Sanitary Cod gibed in the application for Disposal Works Construction Permit No.. ___:$___r1...._.__...... dated___.-_____�._..ft_�......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................7/!I/ ............................................ Inspector..... .--- ------•-•-----•---••-•-••-•-•...............--••------••----••---•••--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 84-• <-9 ...................Town.......................OF.........rarnstable $ 15.00 No...................... FEE........................ Disposal Works 0-pnnstr ion rrmi# A & B Cesspool Service, Inc Permission is ll hereby granted....................................................................I c........-•-----------••---.......-•---••---...............---•----- to Cons} At I or air (X n i,,edi idual S w,g4Mpis� �ysteT 7 y' i f Road II �erviige �63 , homas Hersey atNo.................. Street _ / /8 as shown on the application for Disposal Works Construction Permit N. _. _........... Dated.......................................... ................... •---- ---••-----------•••-••---•------•--•....••---•------••-•--.........----••. Board of Health DATE............7/l l�c--�.b FORM 1255 A. M. SULKIN, INC., BOSTON r• � . TOWN OF(�B ABL LOCATION SEWAGE #_ VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by IA Veil 6 �° I bl3 . _ Ir i a� ASSESSORS MAP : I7�j TEST HOLE LOGS PARCEL : � � . 1) 'I he i nstallaliou shall Corrlpl %villr 'I'ille V and 'fmyn of`17 u1,ud of FLOOD ZONE: k/ A—m-v-A-e�_e_ SOIL EVALUATOR : Di A\1/qDg, Ilealtlr Re ulalions. � REFERENCE:: W I TNESS : cal �'y 2) The installer'sluilI verily lire 1006on of utilities, Sewer Invers rin td septic b . . cairn onenls Inior to installation and setting base elevalioos. PERCOLAT 1014 IlikTE: G. 3 All gravityseptic piping to be 4 inch Sch 10 I VC at 1/8 per loot. 'fie first �t..��• �� L� - �� '"' ��1�' I � ) two legit out of(Ire d bo x to the ieaclnirr shall) � ' 1 TJ °� �� 4) This plan is not to be utilized for prohedy line deterurination nor any other �Vr t� 1� 3 H_2 purpose ollrer llran lire proposed system inslallatiorr. (, kX06 /� /O y t, / r� ,/o�� I 5) /\II septic components must meet Title rile V specilicaLious. aU n /� _ n 6) Parking shall not be constructed over 1110 septic components. �o 6 . t 1� �y9 ��{� 7) 'I he property is bounded by property corners and property lines. /p/ � L1QiG'�-✓ Yy�?� 8) The property owner shall review design considerations to approve of total LocAT I oN MAP�q'(,5) / % ` z desig a 11ow and number of bedrooms to be considered liar design. Receipt of payment Im the plan and installation based on the plan shall be deemed approval of the design flow by the owner. C C WrL14 D 1 9) The existing leaching or cesspools shall be pumped and tilled with material 1 7 per Title V abandonment procedures. Those within the proposed SAS shall I _q be removed along with contaminated soil and replaced wilh clean sand per v v W ��1"L /�lv �p� Title V specs. �`1"1 �J 10)System components to be 10 ('eel from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCI 140 PVC with ends grouted if applicable. emg urs a ec a7\ SEPT I C SYSTEM DES I GN 11) If a garbage grinder exists it is to be removed and is the responsibility of llie owner to ensure such. :: 12 I Ire installer is to take caution in excavation around the gas line il•such 715,70' ,1 FLOW .STIMATE )� 6' exists. Rf,DROoMS AT GAL/JAY/BEDROOM - GAL/DAY l3)'I'ine installer shall verify the location, quanli(y and elevation of tlne sewer� 1'_L lines exiting the dwelling prior to the installation. k SEPT IC. TA14K 14)This plan is representative only that a system can fit on a property meeting ./ � Title V requirements. yD r SAL/DAY x 2 DAYS - GAL 10 USE f fVt GALLON SEPT I C TANK 0 SO I L A SO ZPT I ON SYSTEM ..r o , SIDE AREA: 2 �3�S-�-t<Z► ?� 7SZ�C 7 - 1�� r UAvIu y MASON ' � :.BOTTOM .AREA: �j �' 1 .n ,�� .:.3L� , \ p" No.toss At JA �^ �� ^\� ,, I� \/ � •�/./ � 1S,'Cis T, �`\ ' SE.!'T I C SYSTEM SECTION ofo�W( Tlot,-lM • .ti. � may, . _� ,off' S �, / WKI`'"^ g,83 Jto" 1►I'V 1- '►� 62 -cn+1' G I f3+1 �LJf rw b qr u n die► z." o�� •' � �,. ,.� , ' �JrDo GAL 8 b l► 1 �� " n SEPTIC TANK S I TE ' AND SEWAGE IDLAN L 0 C A T I ON : �-� �I o 1� �l-tf RD\A 1 t PREPARED FOR : CT�I fit✓ C,bl�4 �10"� M O O SCALE: O. W a DAV I D• B . MA S 0N R5 DATE: It? Z � DBC ENVIRONMEN AL DESIGNS a EAST SANDWICH . MA DATE HEALTH AGENT ( 508 ) 833- 2177