HomeMy WebLinkAbout0077 THOREAU DRIVE - Health 77"Thoreau Drive
Centerville P
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No. Fee I�
HE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplication for Misposaf 6pstent Construction 3permit
Application for a Permit to Construct( ) Repair()l Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ' -j 'T1jo v 1)a Owner's dame,Address,and Tel.No.
Lt,�
Assessor's Map/Parcel 1911;t-,X-7 -r4ogaito6timG =-ys,/fLk--'�
Installer's Name,Address,and Tel.No. 5�-47?- 8 3 7 Designer's Name,Address,and Tel.No.S®S—X 7�-�b 371
jormmoT G At.V. C'J Z6 ONrNC- Zt SQL
Type of Building:
Dwelling No.of Bedrooms Lot Size /5�1)6 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided 343 tq gpd
Plan Date 4�k i f 17, -ool f Number of sheets Revision Date
Title _ 71 77 1_*4P_G*U IRL06 C Jf 466_
Size of Septic Tank Type of S.A.S.
Description of Soil `fr[0C L_L),+AC�t � _ ,� ;�et &,4/j
Nature of Repairs or Alterations(Answer when applicable) USA � �,-t f ll?C� l.eve:i C-z/ce 1 i rec-T lX
a
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and intenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmen C and not plac;the system in operation until a Certificate of
Compliance has been issued by this Board of Tet .
Signed G Date - y ®rt-�
Application Approved by KA de( Date
Application Disapproved by Date
for the following reasons
Permit No. I Date Issued `�� r
" 'No. V`0. y s"�? C�Yt � � { Fee
tTHE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION.- TOWN OF BARNSTABLE, MASSACHUSETTS Yes
9pplication for 3Disoosal Opstem (Construction permit
Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. -1-1 -THoPAa4U IM Owner's t1ame,Address,and Tel.No.
C�.r V t E U IC_ t Kl M 1>t�2t,X�p
Assessor's Map/Parcel �q( ��„'-'y
Installer's Name,Address,and Tel.No.5o0e-4"77-V81*7 Designer's Name,Address,and Tel.No.505-�?��-�3 71
ROgap-C rb Ot it 4I.v TE. Fs' �1�lC lee aL1G.
3103 PA- S. ( ."125 C t OF.
'Type of Building:
Dwelling No.of Bedrooms Lot Size I Oa sq.ft. Garbage Grinder( )
Other Type•of Building gzmzd}.,1r,1" ,4t, No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) .34340 gpd Design flow provided , .34,3,L gpd ,
Plan Date d Ll y l S.100 ( ��' Number of sheets Revision Date
Title-1-1 T*&'AG*6' 1i?_I0 -00J7"C'i0J1 4CC_
Size of Septic Tank ? `' Type of S.A.S.
Description of Soil V'j A-& LQ,+Aett '.FAI(
• k
Nature of Repairs or Alterations(Answer when applicable) r`(J Cs i�•�,?!ltXr l,�.lpe� ('P�LC1�L]�1 Saortc -` 1F1�
-ta, f,)t u a - 80X -ra (5) _6 <,YK4 (Ad T-b4 A-9= z cam'
Q-�� r✓�c Av O�!!o s AKA 44 eAzn— o0 s rD
Date last inspected: 1;
Agreement:
The undersigned agrees to ensure the construction and mdintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Eqy,. onmenta-1 Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Hea ltM.
.. " Signed r / i fi'! Date "7.- 'o�OaR-1
Application Approved by �~ / ( Date W✓ !
Application Disapproved by
for the following reasons
f r.
Permit No. �br1 ( Date Issued , '�' " �"
... THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( )
Abandoned( )by RD_e9C ' R Z�Q L. C� `C7�.r
at Z �(� bQ CQ07&V�e.;,,,� has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.�� ed ",
Installer krA6yXZ A go(_)P_ CL.> Designer �C... z�C��'ltJ� ZAJC.
#bedrooms Approved design flow ( gpd
The issuance of this permit shall not construed as a guarantee that the system will fanction as designed.
Date ` l y ' �` ! Inspector
1.
IL
No :101 a 1 Fee 1 I 1
v THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal *pstem Construction Permit '
Permission is hereby granted to Construct( ) Repair X
Upgrade( ) Abandon( )
System located at 11 )'72-"l
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date p Approved by r� wr "f!� ,. A
r
Town of Barnstable
.�`to Regulatory Services
Richard V. Scali, Interim Director
BA SrABM
9KAM Public Health Division
4r ' Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 8-11-21 Sewage Permit# ZDZ� 6IS Assessor's Map\Parcel 191/227
Designer: JC Engineering,Inc. Installer: Robert B. Our Co., Inc. (RBO)
Address: 2854 Cranberry Highway Address: 363 Whites Path
East Wareham, MA 02538 South Yarmouth,MA
On S Z RBO was issued a permit to install a
(date) (installer)
septic system at 77 Thoreau Drive based on deslgn_drawn by
(address)
JC Engineering,Inc. dated 7-17-21
(designer)
X 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.
Y
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 i iance with the terms
of the I\A approval letters(if applicable)
c
�OHN L JF
CHURCHIL(.,IIt, H
(Installer ` nature) CML
4�
41
o�.
(D ner''s Signature (Affix De p Here)
PI, RV RETURN TO ARNSTABLE PUBLIC HEALTH D SION. 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.
Q:\Septic\Designer Certification Form Rev 8-14-13.doc
Commonwealth of Massachusetts M " 7Z
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is Centerville ✓ MA 8/13l18
required for every
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:out forms. A. General Information S/filling out forms.
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Chad Hathaway
use the return Name of Inspector
key.
Y
H.P.S.-Debarros Septic pumping
VQ Company Name
P.O.Box 151
Company Address
Forestdale Ma 02644
Cityrrown State Zip Code
774-274-2581 12866
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
8/13/18
1 pector s Sign re Date
i"
The system inspector shall ubmit a c y of this inspection report to the Approving Authority (Board
of Health or DEP)within 3 completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page
1 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is required for every Centerville MA 8/13/18
page. Cityrrown 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:
® 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:
Septic in working order. NO failure criteria encountered during inspection
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is required for every Centerville MA 8/13/18
.
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M , 77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is required for every Centerville MA 8/13/18
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is required for every Centerville MA 8/13/18
page. City(rown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is required for every Centerville MA 8/13/18
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): minium 2 Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220+
l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
,•'�< 77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is required for every Centerville MA 8/13/18
page. Citylrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents:
1
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ® Yes ❑ No
Water meter readings, if available(last 2 years usage (gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: part timeseasonal
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
sV•,y 77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is required for every Centerville MA 8/13/18
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: none
Was system pumped as part of the inspection? ❑ Yes ❑ No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is required for every Centerville MA 8/13/18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
1975
Were sewage odors detected when arriving at the site? ❑ Yes ❑ No
Building Sewer(locate on site plan):
Depth below grade: 1.5
feet
Material of construction:
® cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line. 10+feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
no evidence of leakage or poor venting
Septic Tank(locate on site plan):
Depth below grade: 1
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 gal H10
Sludge depth:
4"
t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is required for every Centerville MA 8/13/18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle 28
Scum thickness less then 1"
Distance from top of scum to top of outlet tee or baffle 511
Distance from bottom of scum to bottom of outlet tee or baffle
18"
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
pump every 2-3 years as maint. to protect leaching. tank at working level no siggns of cracks or leaks.
concrete baffles in place
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle ,
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
77 Thoreau Drive
Property Address
Powell
Owner Owners Name
information is required for every Centerville MA 8113/18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
L
Commonwealth of Massachusetts
Title 5 Official inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is required for every Centerville MA 8/13/18
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
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.):
no D box
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M Svey`'� 77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is required for every Centerville MA 8/13/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1)6'x6'
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
6 foot pit. current level 4'10" below invert pipe staining 2'6" below invert pipe
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of Liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M ,e 77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is required for every Centerville MA 8/13/18
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is required for every Centerville MA 8/13/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
-------------------
W
U �
( — _?0I tol I
3 0
7
C3 Ito
t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is required for every Centerville MA 8/13/18
page. Citylrown 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: 20
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:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
town GIS mapping lot el. 52 groundwater in area 30.5
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
= W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M ,a 77 Thoreau Drive
Property Address
Powell
Owner Owner's Name
information is Centerville MA 8/13/18
required for every
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
LOCH 10 _SEW&C,E PERMIT u6._
p�
iMSTa R &N� ADDRESS
BUILDER t` &MF- A RESS _
DINTE PERMIT
DATE COMPLi W-ICE ISSUED C� �
Y
i
',
��
Jr
No. 1 S Fics.....1 v...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
--------- ---�------- ---------O F................ .....................
` ApplirFation -fair Di!ipaoai Workii Tatuitrurtioaa Vrrmft
Application is hereby made f a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst at• .� ��
........................... --8--•- ----•-----------------------------A_.... ..--•-------_____...._..__------------..............-:_------------------.._..........------.
Locatio A ress or Lot.N
. --......•..... .... .................................... ........... ......... ......•.... .................................
�j� -wri r Address
Installer Address
Type of BuildingSize Lot-------------------------_Sq. feet
U DwellingNo. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ___________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
� Other es ------------------------------ ---- -
W Design Flow...........:................................gallons per person per day. Total daily flow.._._____...__...... b.....__-._gallons.
P4 Septic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter.......--------- Depth................
xDisposal Trench�o.___;_______________ Width.................... Total Length-------------------. Total leaching area-------------- -----Sq. ft.
Seepage Pit No...........�0 Diameter-------------------- Depth below inlet.................... Total leaching area.---..____-_____--sq. ft.
• Z Other Distribution box ( ) Dosing tank ( ) e
Percolation Test Results Performed by---------------------------------------------------------- Date
If
a
Test Pit No. 1----------------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------------------------
------------ -- 13 - -------------- -- ----
-----------.--------------...---------•--------------------.------------------------------
O Description of i.__ __ ..._
-
A.. .... AP_4�
VNature of Repairs or Alterations—Answer when applicable..----------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ............................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to e the system in
operation until a Certificate of Compliance has been issued by thelyd o ealth.
ed--- - .----_ - ----------•-- -------------------------------------- 2
Application Approved By--- ------ . -•--- .... . . � P •--•------- ..��........ .... 3_
Date
Application Disapproved for the following reasons:...............................:................................................................................
Date
PermitNo........................................................ Issued.......................................................
Date
No.......LBLS....... FRs.....r. ...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
'
--------.OF............. -'(a.�afJ---. ,'�. ..:..
Apphration `for Ubtipoiitt1 Works Cnonoarurtion 13rrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at '`r1
Ecati�-Address N
........................................................ i �_!. .�.G'i� Cif—C..'C-i'C-4
W �Y+h ( Owner ............. Address
Installer Address
UType of Building Size Lot............................Sq. feet
.-+ Dwelling No. of Bedrooms--------------------------------------.-----Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building ............................ No. of persons-.-___-----_--___-_-----____ Showers ( ) — Cafeteria ( )
QI Other fix es ---------------------------------
W Design Flow--------------------------------------------gallons per person per day. Total daily flow....._.._..._.._._. -el---.-.--_gallons.
WSeptic Tank—Liquid capacity_--_-.-__-_gallons Length................ Width................ Diameter---------------- Depth----------------
x Disposal Trench o. .................... Width.................... Total Length-------------------- Total leaching area--.-----_-.__---_-_sq. ft.
Seepage Pit ----------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. it.
Z Other Distribution box ( ) Dosing tank ( ) �(`
f '-" Percolation Test Results Performed by---------------------------------- ................................. Date----------------------------------------
0-1
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water...-----.-_---_--_---.
} (s, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water----_--_--_-_---__.-..
�i -----•--•--------•-•- -------•---- -----------------------------------------------------------------
Description of S iL__. -' _2 ::_ _ �� �
-a........... ------ �-- --I........ _ / I-------
0_- ------- ........ ..---- ` !!......---.......... ...... 11_a ---.-r-� �'''_:_t�/�,• r�Y_�p'.
-•--•----------------------- ------------------------------•---------------------
U Nature of Repairs or Alterations—Answer when applicable..----------------------------------------------------------------------------------------------
-----------------------------------•------------..-.---------------------------------------------------•--------------------•--•--•-----------------•-----•-----.------•-------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to ace the system in
operation until a Certificate of Compliance has been issued by th boarZoealth.
\
----
e/
Date
Application Approved By---- - f ,.( LG�t/L. `:" -- ?
Date
Application Disapproved for the following reasons:................................................................................................................
---•••--•-•----••--•-----••-•---•---------------------------•----•-------••••-----••--•--•-••-...--------------.----------......-•--•-•••---•---•-•---------•----•----------------•......-----•-•_-----
Date
PermitNo..........................._............................. Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF;HEALTH
..%....n.........OF.......... C', -'s- 77--..............................
t+
err#ifira#r of Tilmithanrr
T l.S IS TQlCERTIQ That the Individual Sewage Disposal System constructed ( or Repaired ( )
by....... 4------C.:- ' - �-z'I '-
--------------------- ..-
`
a at Y .•-- •-•-
,� In aller
� ----------- ---- -- �� /` �.... ...... r< -�
L'
hasmeen installed in accordance with the provisions of . rticl XI of Tie State Sanitary Code as described jin the f
application for Disposal Works Construction Permit No----�.__-1. .............. dated'- (t._.-_�-�. ...........................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......................................... ---------------------------••-•...... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
? S~ BOARD /0 HEALTH
...........OF........ c.. .. w ...No......................... FEE.../d-••...........
Permission is hereby granted=------------ .._...�o�_..�. 1�-ti.�'....................
f.....
to Construct(/,
> o epair n ndividual Sewa Disposal lem
------- - ! - ---- � � ------------------------------------------------------
al.
� Streetas shown on the application for Disposal Works Construction ,er it No_ ' - Datedl�-__:-.� '3 J `
Board of Health
DATE---..........................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
1%
3 'l/71�
xj q, TM r v:�w -I^
I eu)<�.
3
V
I
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAI
II COPY
DEPARTMENT OF ENVIRONMENTAL PROTECTION
d RECEIVED
MAY 0 6 2003
TOWN OF BARNSTABLE
TITLE 5 HEALTH DEPT.
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
r, CERTIFICATION
Property Address: 77 THOREAU DRIVE CENTERVILLE,MA 02632
Owner's Name: DAVID AND ESTHER TOPIN
Owner's Address: 8 PRENTISS LANE BERLIN NJ 08009
Date of Inspection: 4/7/03
Name of Inspector: (please print) JOHN GRACI,INC.
Company Name: SEPTIC INSPECTIONS
-Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536
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 pe,formed 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:
X Passes
_ ConditioIle
sses
_ Needs Fvaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: 4/7/03
The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspecti n. 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 approN ing authority.
Notes and Comments
SYTSEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFUL LIFE.
****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.
Title 5 fncnartinn Fnrm F/i v,?n n 1
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 77 THOREAU DRIVE CENTERVILLE,MA 02632
Owner: DAVID AND ESTHER TOPIN
Date of Inspection: 4/7/03
Inspection Summary: Check A,B,C,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:
SYTSEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFUL LIFE.
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.
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.
*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: n/a
n/a 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
_ distribution box is leveled or replaced
ND explain: n/a
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
_obstruction is removed
ND explain: n/a
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 77 THOREAU DRIVE CENTERVILLE,MA 02632
Owner: DAVID AND ESTHER TOPIN
Date of Inspection: 4/7/03
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.
_ 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
volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy
of the analysis must be attached to this form.
3. Other:
n/a
Page.4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 77 THOREAU DRIVE CENTERVILLE,MA 02632
Owner: DAVID AND ESTHER TOPIN
Date of Inspection: 4/7/03
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections:
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
_ X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped nLa.
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with
no acceptable water quality analysis. [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
less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be
attached to this form.]
NO (Yes/No)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.
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
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)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.
d
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 77 THOREAU DRIVE CENTERVILLE,MA 02632
Owner: DAVID AND ESTHER TOPIN
Date of Inspection: 4/7/03
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection ?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
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?
X _ 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:
Yes no
X _ Existing information.For example,a plan at the Board of Health.
X _ 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(3)(b)]
5
Page.6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 77 THOREAU DRIVE CENTERVILLE,MA 02632
Owner: DAVID AND ESTHER TOPIN
Date of Inspection: 4/7/03
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 2 Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220
Number of current residents: 1
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): NO
Water meter readings,if available(last 2 years usage(gpd)): i �1
Sump pump(yes or no): NO Ol `�S 1 00 c)
Last date of occupancy: n/a t `Z ,c6b
COMMERCIALANDUSTRIAL
Type of establishment: n/a
Design flow(based on 310 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged to the Title 5 system(yes or no): NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: n/a
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
_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): n/a
Approximate age of all components,date installed(if known)and source of information:
1975 BY OWNER
Were sewage odors detected when arriving at the site(yes or no):NO
F
Page,7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 77 THOREAU DRIVE CENTERVILLE,MA 02632
Owner: DAVID AND ESTHER TOPIN
Date of Inspection: 4/7/03
BUILDING SEWER(locate on site plan)
Depth below grade: 20"
Materials of construction:_cast iron _40 PVC Xother(explain):20 PVC
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: 14"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)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: 1000 GALLONS"
Sludge depth:3"
Distance from top of sludge to bottom of outlet tee or baffle:31"
Scum thickness: 3"
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: 15"
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.):
SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.
RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.
GREASE TRAP: _(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(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
7
Page,8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 77 THOREAU DRIVE CENTERVILLE,MA 02632
Owner: DAVID AND ESTHER TOPIN
Date of Inspection: 4/7/03
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no):NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
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.):
NO D-BOX,SNAKED THROUGH.
PUMP CHAMBER: _ locate on site plan)
( P )
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a
R
IPage;9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 77 THOREAU DRIVE CENTERVILLE,MA 02632
Owner: DAVID AND ESTHER TOPIN
Date of Inspection: 4/7/03
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GAL 6' X 6' leaching pits, number:
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number: n/a
n/a innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY
TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.PIT HAD F OF LIQUID IN IT AT TIME OF
INSPECTION.PIT HAS T OF LEACHING LEFT IN IT.BOTTOM IS AT 7'8".
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)
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
9
Page 10 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 77 THOREAU DRIVE CENTERVILLE,MA 02632
Owner: DAVID AND ESTHER TOPIN
Date of Inspection: 4/7/03
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.
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AA ZLI
16A N
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C� �S
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Pa.ge.-11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 77 THOREAU DRIVE CENTERVILLE,MA 02632
Owner: DAVID AND ESTHER TOPIN
Date of Inspection: 4/7/03
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
YES 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)
NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
HAND AUGER-12+FT.
11
PLOT PLAN SHOWING LOCATION OF BUILDING
IN
CENTERVILLE B A R N S T A B L E MASS.
FOR
ALAN E . SMALL INC.
SCALE' I" = 60, PATE : JUNE 20, 1975
CHARLES N. SAVERY INC. REG. C.E.a L S. 712 MAIN ST. HYANNIS, MASS !
{
45 4C
100.00' -
82
I S, 000 S-
0
81 0 0 83
0 244+ 44'
0
1P N ,Dwell incL_
M I i
24+` A
co
36'+
100.00'
THOREAU DR.
I hereby certify that the building exists
on the ground as shown on this Alan znd
is in accordanc,,, with the zonin^_
OF
requirernm-rt's of the Towel of Barnstable,
ROBERTP.
G�
9UNIKIS H
Registertd Lana Surveyor No.8420
0
SURIt40
f
THIS LOT IS NOT LOCATED IN A FEDERALLY DESIGNATED FOOD PLAIN ZONE. Z 2 38
ti=w.
P
PLOT PLAN SHOWING LOCATION OF BUILDING .
p CENTERVILLE BA R N ST A B L E MASS.
FOR
ALAN E . SMALL INC.
SCALE: I" = 60' DATE: JUNE 20, 1975
CHARLES N. SAVERY INC. REG. C.E.8, L.S. 712 MAIN ST. HYANNIS, MASS
45 4�
100.00'
8 2
15, 000 S.F
0
81 0 —p 0 83
o + 9�. 44,��• 0
0 24- tf'
u' a Dw el I i nTq._ —
(n I i.
I A
24+
3('+
100.00, .
TH0REAU DR.
I herby cerilty that the building exists
-)n the ground as shown on this clan and
is in aocordanc,, with the zonin^
requirpmonts of the To-9 of 13amstable, iH or
ROBERT Gr
BUNIKIS H
Ike,-istertd Lana Surveyor No.8420
!-�'-C?/3T0k @
U RV
THIS LOT IS NOT LOCATED IN A FEDERALLY DESIGNATED F OD PLAIN ZONE. 2. 2 3 a
FINISH GRADE OVER D-BOX= 59.1 FINISH GRADE OVER CHAMBERS= 59.1 - 5$.$' I-,P NI F P A
T.O.F. EL.= 61 .4 f ,. 10TES
PROVIDE EXTENSION RISER SLOPE @ 2% MIN. OVER SYSTEM 3/4 TO 1-1/2 DOUBLE WASHED
REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE
WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE j 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
4" SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS BOX METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
FINISH GRADE OUTLET TO WITHIN 6"OF F.G. MIN SLOPE 1% TO F.G. (SEE GENERAL NOTE#21) 2"OF 1/8"TO 1/2" DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES.
@ FND. EL.= 60.2 f F.G. OVER TANK EL. = 60.0 f r5 DIA. OUTLET(S) STONE OR GEOTEXTILE FILTER FABRIC-�
2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
„ I TOP OF SAS= 57.63' PLACE RISERS ON ALL DESIGN ENGINEER.
PROPOSED 4 9 MIN. CHAMBERS WITH i
- EXISTING 4" � 9"MIN. 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
INLET PIPES TO 6 OF SYSTEM UNLESS OTHERWISE NOTED.
� SC'vvCR NirE SCH. 40 PVC 36 - 56.8Q 3s" MAX. BREAKOUT EL= 57.30' i
SEWER PIPE FINISHED GRADE
6" 3" 3" DROP MAX L-36't 1. 1 i 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
-- - _ 2" DROP MIN 3 9 - MIN.SIOPE@7% PROVIDE WATERTIGHT o ELEVATION =57.30' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A
* f ' ��� 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF
4' PVC IN FROM JOINTS (TYP-)
SEPTIC TANK 4" PVC OUT TO 0 C� 0 O 0 0 0
14 ] .6 f o 0 0 0 O 0 • o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
CONTRACTOR TO PROVIDE ---- • LEACHING FACILITY oo� o o � 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
0 0 D O D O
SPECIFIED DROP BETWEEN 12„ o0 00
INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL �\ OUTLET TEE 57.17� MIN. Tj7 00' 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
SHALL VERIFY SIZE 48 VERIFY CONDITION OF \ 1 0 0 0 0 o 0 00 ook� 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
AND CONDITION OF EXISTING TEES GAS BAFFLE 6" CRUSHED STONE 00
0 0 o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY o0 00 NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
TANK NECESSARY COMPACTED BASE
AND DESIGN ENGINEER.
2.0' 6.0' (gyp) 2.0 4.a' 4.0'
OUTLET DISTRIBUTION BOX 3.0' j 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. SEE BENCHMARK ELEVATION AS
- - TO BE INSTALLED ON A LEVEL STABLE 34.0' (n'P)
' SHOWN ON PLAN.
BASE. FIRST TWO FEET OF OUTLET 55.80' GROUND WATER ELEV.= < 47•80' 11.0' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK CROSS SECTION VIEW 5 - LC-6 CHAMBER PROFILE 5' MIN- REQUIRED ii-% 0Li Ix Li'vu IL v v I 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
*CONTRACTOR 10 VERIFY EXISTING SEPTIC' -r A I''!� PROFILE TYPICAL C H B E O L (' r A R 8 r1l r 7 � TO THE DESIGN ENGINEER.
ELEVATION PRIOR TO ANY WORK & D I STR I E L n Lj I -TAIL L ��- v ®�T���� 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT.
NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE
-- -----�-- - 11 NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
•� • • ,� TEST PITDATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
.• • 1 . • ` , 'R I��` w i I` �` �' • APPROPRIATE AUTHORITY.
} ry A PERC NO. 21-184
' • '% Q // '' '` �`= - 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED
/ .� 1 ql/ b • ,� . • ` ,• • INSPECTOR: David W. Stanton(BOH) UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR
SWING-TIES r o , . '
_,. EVALUATOR: Michael Pimentel, EIT, CSE TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING.
DESCRIPTION HCA HC-2 r,•*•, 'y /. • - ' . • (i� C.S.E. APPROVAL DATE: Oct- 27, 1999 j
• • _ i` ' /• "?• ` • - ` ' 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
' f• �l« 4R • _« _ DATE: July 12, 2021
CORNER OF STONE (1) 66.0' 33.9' j
6 •fl' • ' •� 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
s., + -- V_ .: ...._._..,� « •-s . ..., . '- TEST PIT#: 1 �
CORNER OF STONE(2) 71.T 44.0' ,: • • • MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
ELEV TOP= 58.80' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
\\ CORNER OF STONE (3) 47.8' 45.T i .• �� • ' ' , �' • N t j `•'. FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
MAP 191 �, � � � � ••+ •� ELEV WATER= <47.80
' \ . •� ti �__., . '•�` • 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
LOT 127 �i � \\ CORNER OF STONE (4) 38.8 36.1 .� "" . � , •
. PERC RATE _ < 2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
\ \\ ��i-� ,°Dn ; �► % +• • , • ,• ; C DEPTH OF PERC= 12" -30" 16• PROPOSED PROJECT IS LOCATED WITHIN.
ASSESSOR'S MAP 191 LOT 227
60 \ C,�t , - \ a fl• ,� ` • .fr 'r TEXTURAL CLASS:
' \ -62 - ti = // • J e OWNER OF RECORD: ERIC & KIMBERLY DIRUSSO
cv Viz/ `;�° jj • • • •,• r • • • • : • •f 4
\ \\ • • • • •
\ \ \ a it ( ll . ; • ` 0" 58.80' ADDRESS: 77 THOREAU DRIVE
("� Loamy Sand
\ -- ZONE I I °' /1/ ; § • LOCUS F� r Al2" 10Yr 3/1 57 80 CENTERVILLE, MA 02632
TREE r ') - \ , I� • • ' • '
\\ // • ' P�.; Fine Loamy FEMA FLOOD ZONE X
x 59.6 / // • • •
Sand 56.30' COMMUNITY PANEL# 25001 C0561 J
�\ � N.� � Y arm // • • ' • . ` ' ► � B 10Yr 5/6
O r'� \ �. s!� • .f • a s__ . • 17. DEED REFERENCE: BOOK 31589, PAGE 253
o a • 36" 55.80'
^�U� ` - _ , MAP 191 • • • '. : \ `�• • ' 18. PLAN REFERENCES: 1.) PLAN BOOK 272, PAGE 58 2.) PLAN BOOK 352, PAGE 98
�u LOT 228 �_ ' • • • I-'; • ,rra et Y • ' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
^ \\ > > in ' rry ' • • •••. • •. 5 • �• Fine Loamy Sand
S • • • ' ' • C-1 ! 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
\ Nis7° �Op. / • . .`�''. f : . 2.5Y 6/6
\\ 57, �C `'.+ J/// ' •.•' ,r•: �. : ' •� • i FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
��� h \ \ \ �L / •4 . • • ii FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
\ To ' ! .•.• '�.`•"'� ' • . '• • ■ •. 21. A 4" PERFORATED SCH- 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A
,' / FIRE PIT � - .>y • y�� . ��• ` 90 51.30 F THE M F THE A AN EXTEND T WITHIN 3"OF FINISH GRADE. A
C_2 Silt Loam DEPTH O E BOTTOM O E SAS D O S
/ ' /GP5 GA \\ 108" 2.5Y 614 49 80' REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS.
A 1 1 / x58.9 / \\ Coarse Sand 22. OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL
/ dc, \ LOCUS PLAN 2.5Y 6/6 REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT.
LOT 126 / � HC-1 \ C-3 0
18" (3 x58.9 ; x59.5 / DECK � \ (10-5/o gravel;
}\ \ SCALE: 1"= 1000' some cobbles)
CIS, \ 132" 47.80'
eoll, / I i ' ' ` ue\ ` _ No Mottling, Standing or Weeping Observed
4) / / 04s -
�\ `\ w -- ` - I ;? I f I I u t-i I H
/ 4„ 5 Q -= ,/ ;; cis \ ______ °,�/w --- °/H/ �����' r�A TA + LEGEND
/ - o H/w ' PERC NO. 21-184
/ x 5`� I` o /w \��s/w �\ 7/ NUMBER OF BEDROOMS (EXISTING) 2 INSPECTOR: David W. Stanton (BOH) 50x0' EXISTING SPOT GRADE
/ 58.8 30 �\
x59.1 0 ?• 1 ��s y / NUMBER OF BEDROOMS(DESIGN) 3 (MIN. PER TITLE 5) EVALUATOR: Michael Pimentel, EIT, CSE - - -- 50 -- - - EXISTING CONTOUR
1 x 59.1 1 -- -- 3
h � �\ 7 DESIGN FLOW 110 GAUDAY/BEDROOM I C.S.E. APPROVAL DATE: Oct. 27, 1999
#77 , / r'�s � r•� PROPOSED CONTOUR
/ x59.2 / EXISTING // \ 'qs \ TOTAL DESIGN FLOW 330 GAUDAY DATE: July 12, 20�1 50 PROPOSED SPOT GRADE
/ l LP 2-BEDROOM , ` DESIGN FLOW x 200 % = 660 GAUDAY TEST PIT#'
•� / ) /� �-,�' DWELLING � ro'` �� � ----- EXISTING GAS LINE
USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 59.00 Vr+� -�-
\ _ --- O/H/W -- EXISTING OVERHEAD UTILITIES
x60.4 � � S ELEV WATER= <4800
-
10" � EXISTING LEACHING �
x58.5 PIT TO BE PUMPED, \` ^ _ MAP 191 PERC RATE = -W-W EXISTING WATER LINE
x 58.�8 / -7 o
(2Y ' - ( (0 FILLED w/CLEAN LOT 227 DEPTH OF PERC =
SAND& ABANDONED w 15,000 S.F. / INSTALL (5) LC-6 CHAMBERS w/ STONE
g g� �Tp 2 / HC-2 �'W TEXTURAL CLASS: I ■ TEST PIT LOCATION
CO
1) i % PROP - , TOF=61.4'± t �w o� .0 SIDEWALL CAPACITY i -. _ EXISTING 1,000 GALLON SEPTIC TANK
59x0' D-BOX ! ` �y,\ ^ � (LENGTH + WIDTH) (2 SIDES) (1' HIGH) (0.74 GPD/S.F.) = GAUDAY
PROPOSED INSPECTION PORT x58.9 1 4a �\ \`Y �ry \ (34.0' + 11.0') (2 ) ( 1' ) ( 0.74 GPD/S.F.) = 66.6 GAUDAY A 0., Loamy Sand 59.00' PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE
x60.2 -- - -
PROPOSED (5) LC-6 LEACHING , u< STUMP `� \ x6p.1 j J 60 //f \\ BOTTOM CAPACITY 12., 10Yr 3/1 58 00'
CHAMBERS WITH STONE TYP / w. \ = Fine Loamy PROPOSED DISTRIBUTION BOX
%r I ( ) / (LENGTH x WIDTH) (0.74 GPD/S.F.) GAUDAY B Sand O PROPOSED LC-6 LEACHING CHAMBER
w�. ' (34.0'x 11.0') (0.74 GPD/S.F.) = 276.8 GAUDAY 10Yr 5/6
Benchmark 't''�,t, \ \ i � � �
Nail Set in 7"Tree r,,yr \ i TOTALS: REV. DATE BY APP'D. DESCRIPTION
Elev. =60.00' x59.6 \ / im �OJ TOTAL NUMBER OF CHAMBERS 5 PROPOSED SEPTIC SYSTEM UPGRADE
Approx. MSL \ ---_60_ _ _ __ --'� Q�S TOTAL LEACHING AREA 464.1 SQ.FT. C-1 Fine Loamy Sand
v TOTAL LEACHING CAPACITY 343.4 GAL./DAY 2-5Y 6/6 PREPARED FOR:
S670s71 EXISTING 1,000 �� wQ-Q�m ROBERT B. OUR CO., INC.
" 7500 "F GALLON SEPTIC 59 / �
NOTES:
� TANK TO BE USED � i � r `\ �O�p 90 Silt Loam 51.50
MAP 191 IN THIS DESIGN i �0 108„ 2.5Y 6/4 50.00' LOCATED AT
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF i
EACH SEPTIC SYSTEM COMPONENT. LOT 226 1 s. - __--_- - -59-- - - - \ Coarse Sand 77 THOREAU DRIVE
C-3 2.5Y 6/6 CENTERVILLE, MA 02632
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE ,� , (10-5% gravel;
PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT some cobbles) SCALE: 1 INCH = 10 FT. DATE: JULY 17, 2021
DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF / 132" 48.00'
HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. I o s io zo ao FEET ;
No Mottling, Standing or Weeping Observed gat"
--V� JOHN L. �� PREPARED BY:
3.) ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS �' RESERVED FOR BOARD OF HEALTH USE �- CHURL LL JR. ti JC ENGINEERING, INC.
ONLY. / C L
NO. 41807 2854 CRANBERRY HIGHWAY
4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY %' S EAST WAREHAM MA 02538
FOR THE INSTALLER. INSTALLER SHALL VERIFY SWING TIE MEASUREMENTS '
IN THE FIELD PRIOR TO INSTALLING THE SYSTEM. CONTRACTOR SHALL SITE PLAN �� / 508.273.0377
NOTIFY ENGINEER IF MEASUREMENTS APPEAR TO BE INCORRECT.
SCALE: 1 = 10' j ' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No 5796