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Home My WebLink About0016 WEQUAQUET AVENUE - Health 16 Wequaquet Ave Centerville A= 251-121 1 EISMEADI No.2453LOR UPC 125U ameadcom • Us&in usa MMIN"Noaip La IFI �� ' f _ 1 iv Commonwealth of Massachusetts Title 5 Official, Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M e,•''V 16 Wequaquet Ave. Property Address Peyton Beals Owner Owners Name information is required for every Centerville MA 02632 6/29/14 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms - on the computer, D • use only the tab 1. Inspector: key to move your cursor-do not James Ford key the return Name of Inspector Y• p . Fir- VU11b Company Name II P.O. Box 49 Af Company Address ieAM Osterville MA 02655 City/Town State Zip Code 508-862-9400 S 12482 Telephone Number License Number B. Certification I certify that I have personally i,pspected 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 any a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails I. . ❑ Needs Further Evaluation by the Local Approving Authority 7/6/14 InspZtE Signature Date Theem inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspectid`h does not address how the system will perform in the future under the same or different conditions of use. I V q l5ins•3/13 I, Title 5 Offici I ns tion Form:Subsurface Sewage Disposal system•Page 1 of 17 V Commonwealth of Massachusetts Title 5 Official; mnspection Form _ a Subsurface Sewage Disposal 'System Form - Not for Voluntary Assessments ,M 16 Weguaguet Ave. Property Address ' Peyton Beals Owner Owners Name information is required for every Centerville MA 02632 6/29/14 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check�A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or Sin,3.10 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. I Comments: i . y, i 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' "r!?,or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain.! 4.� The septic tank is metal agIdiover 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 tahk`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): i I y5 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i`. Commonwealth of Massachusetts Title 5 Officia(s Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments F t; 16 Wequaquet Ave. Property Address Peyton Beals i Owner Owners Name I information is required for every Centerville MA 02632 6/29/14 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)yare;replaced ❑ Y ❑ N ❑ ND (Explain below): fl ` ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): i� F I i ❑ 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 pipes)are replaced ❑ Y ❑ N ❑ ND (Explain below): t ❑ 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 151303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: j , ElCesspool 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 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i t . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments l 16 Wequaquet Ave. ' Property Address Peyton Beals Owner Owners Name required for is every Centerville required for eve MA 02632 6/29/14 page. City/Town t 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 peptic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has 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 they 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: i, i � r D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static'hquid 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 1lYi day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 t% i ' Commonwealth of Massachusetts u Title 5 Officia't Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 16 Wequaquet Ave. Property Address Peyton Beals # Owner Owners Name t information is required for every Centerville i MA 02632 6/29/14 page. CitylTown State Zip Code Date of inspection- B. Certification (cont.) Yes No I El ® Requ:ired'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. is ❑ ® An ortion of a cesspool oI R poor 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 Oortion 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.] El ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. El ® 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. i' 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. i For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. l Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the s�.stem is within 200 feet of a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area'—'IWPA)or a mapped Zone II of a public water supply well If you have answered "yes";td,any question in Section E the system is considered a significant threat, or answered "yes" in Sectiop P 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 31.0.CMR 15.304. The system owner should contact the appropriate regional office of the Department. l t5ins-3/13 I Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i ' 7 Commonwealth of Massachusetts W Title 5 Officiall Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 16 Wequaquet Ave. Property Address Peyton Beals Owner Owners Name information is required for every Centerville MA 02632 6/29/14 page. City/Town State Zip Code Date of Inspection C. Checklist Y` 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? I• ❑ ® Has theisystem 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 th'e 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 tl7e,'septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? El ® Was the',facility owner(and occupants if different from owner) provided with ii information on the proper maintenance of subsurface sewage disposal systems? The slie and location of the Soil Absorption System (SAS) on the site has been deteFmined based on: i, ® ElExisting: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 approxf,Ml a'tion of distance is unacceptable) [310 CMR 15.302(5)] D. System Information , .l Residential Flow Conditians' , Number of bedrooms (design)': 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 i.CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 i, l5ins•3/13 �� a Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r Commonwealth of Massachusetts Title 5 Official'. Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •GSM 16 Wequaquet Ave. Property Address Peyton Beals Owner Owners Name information is required for every Centerville MA 02632 6/29/14 page. City/Town State Zip Code Date of Inspection D. System Information Description: t ;I `f Number of current residents;° ' 0 ;i Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? z ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: : unavailable Sump pump? ❑ Yes ® No ti Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? El Yes ❑ No Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? El Yes ❑ No Water meter readings, if available: t5ins•3113 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 ;M 16 Wequaquet Ave. Property Address Peyton Beals Owner Owners Name information is required for every Centerville MA 02632 6/29/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use:' Date Other(describe below): General Information Pumping Records: Source of information: unknown Was system pumped as part.of the inspection? El Yes ® No 1. If yes, volume pumped: v 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(descrbe): 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 F Commonwealth of Massachusetts Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Weguaguet Ave. Property Address Peyton Beals Owner Owners Name information is required for every Centerville MA 02632 6/29/14 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: installed on 12/29/2010 i Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on'''site plan): c Depth below grade: feet Material of construction: ❑ cast iron ® 40,PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site}'pla.n): Depth below grade: 15" feet Material of construction: i ® concrete ❑ m`etal ❑fiberglass ❑ polyethylene y El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No l., Dimensions: ;; 1500 gal. Sludge depth: 2 l5ins•3/13 ` Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 l l: ' I Commonwealth of Massachusetts Title 5 Official: Inspection Form Subsurface Sewage Disposa"l System Form - Not for Voluntary Assessments 16 We ua uet Ave. Property Address tl Peyton Beals Owner Owners Name information is required for every Centerville MA 02632 6/29/14 page. Cityrrown State 0 Code P Date of Inspection D. System Information (cost.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness 7" Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scam to bottom of outlet tee or baffle 14 How were dimensions deterihined? measure Comments (on pumping re6ommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The liquid level was even with.the outlet invert. There was no sign of leakage. `I Grease Trap (locate on sitefplan): Depth below grade: 4. 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 .j Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 is Commonwealth of Massachusetts W Title 5 Officials, ,Inspection Form Subsurface Sewage Disposal System Form - Not for Vo luntary Assess ments Y s 16 Wequaquet Ave Property Address Peyton Beals Owner information is Owner s Name required for every Centerville '• MA 02632 6/29/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert; evidence of leakage, etc.): i. : l Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): l . Depth below grade: Material of construction: ❑ concrete ❑ metal',; ❑ fiberglass ❑ polyethylene ❑ other(explain): N/a Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No i. . Date of last pumping: Date Comments (condition of alarpM land float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 t 3 � r . Commonwealth of Massachusetts W Title 5 Official' Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Wecivaauet Ave. I Property Address Pe on Beals Owner Owner's Name information is i required for every Centerville MA 02632 page. Cay/I own State 6/29/14 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.odtlet invert even Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out,of box, etc.): The box was normal 1, s t i, Pump Chamber(locate on site plan): I Pumps in working order: El Yes ❑ No* i . Alarms in working order: t ❑ Yes ❑ No' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Y, t * 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 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 t: C Commonwealth of Massa6husetts Title 5 Official Inspection Form Subsurface Sewage Disposal'.System Form - Not for Voluntary Assessments 16 Wequaquet Ave. Property Address Peyton Beals Owner Owners Name information is required for every Centerville MA 02632 6/29/14 page. City/Town State Zip Code Date of Inspection D. System Information: Type: ❑ leaching pits! number: ® leaching chambers number: 20 -Are's 3616 ❑ 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.): The field was dry and clean':There was no sign of failure 0 Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inletis invert Depth of solids layer I' Depth of scum layer ' a Dimensions of cesspool Materials of construction Indication of groundwater inflow El Yes ❑ No 15ins•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 16 Weguaguet Ave. Property Address Peyton Beals Owner Owners Name information is required for every Centerville MA 02632 6/29/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions F� Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `M a 16 We ua uet Ave. Property Address Pe on Beals Owner Owners Name information is required for every Centerville MA 02632 page. City 6/29/14 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,",ters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I` a Q A ao t3 3 a a� yy 3 y� you IV 31 a8 ,S tlo y 1 15ins•3/13 Title 5 Official Inspection Form: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 a 16 Weguaguet Ave. Property Address Peyton Beals Owner Owners Name information is required for every Centerville MA 02632 6/29/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells TF Estimated depth to high ground water: 25'+/- 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 loyal. Board of Health - explain: Using topo and Water contours maps ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: see above I Before filing this Inspection Report, please see Report Completeness Checklist on next page. r 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 �,. 16 Weguaguet Ave. Property Address Peyton Beals Owner Owners Name information is Centerville required for every MA 02632 6/29/14 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 i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 C I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 16 Weguaguet Ave. Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Informati0 forms on the _ computer,use 1. Inspector: C/ I� rl only the tab key VV FR l� to move your Robert Paolini I I cursor- not Name of Inspector use the return urn S E P 1 u REC'D '� key. Ca ewide Enterprises,LLC. Company Name r� P.O.Box 763 By Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification 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 9m W."' ,W�/" 8/31/2010 Inspe or's Signatur Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and.copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. IogeDisposal t5ins•09/08 Title 5 Official Inspection F rm:Subsurta a Sewa System-Page 1 of 17 r Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 16 Weguaguet Ave. Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 16 Wequaquet Ave. Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ;M 16 Wequaquet Ave. Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to.this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 16 Wequaquet Ave. Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 16 Wequaquet Ave. Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) Z ❑ 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 16 Wequaquet Ave. Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town 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? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes-❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2008:78,000 g ( y g (gpd)): 2009:35,000 Detail: 2008:214 gpd 2009:96 gpd Sump pump? ❑ Yes ® No Last date of occupancy: 8/31/2010 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts L W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 16 Wequaquet Ave. Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: ' Date Other(describe below): General Information Pumping Records: Source of information: 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): l5ins•09/08 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 ° 16 Weguaguet Ave. M Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): - Depth below grade: 18"feet Material of construction: ❑ cast iron 40 PVC orangeberg ❑ ® other(explain): Distance from private water supply well or suction line: 10'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 16 Wequaquet Ave. Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 - every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 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.): 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Wequaquet Ave. Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight 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: flats Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Lt5m. 09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , 16 Wequaquet Ave. Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town State Zip Code Date of Inspection De 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G M 16 We ua uet Ave. Q Q Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: El 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.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Main and 1*overflow 6" Depth—top of liquid to inlet invert Depth of solids layer 8 Depth of scum layer 2° Dimensions of cesspool 6'x8' Materials of construction Concrete block Indication of groundwater inflow ❑ Yes ® No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4M 16 Weguaguet Ave. Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Main cesspool is collapsing.Approx. 10 blocks of sidewall have fallen into cesspool. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size 0 Zoom Out J J fl J J J J In 11 R. I[II t L 0 20 Feet Set Scale 1" = 20 I I Aerial Photos I MAP DISCLAIMER (`nnirinhf 7!1l1F_7f1�f1 Tn...n of P.—fohla KAA All rinhfc rcecni http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=251121&mapparback= 9/3/2010 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 16 Weguaguet Ave. Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: �. Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of CP 50' 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: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of, groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/06 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 ° 16 Weguaguet Ave. M Property Address Kathryn Beales Owner Owner's Name information is required for Centerville Ma. 02632 8/31/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable Regulatory Services Thomas F. Geller, Director A MAN, • Public Health Division 21 Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Offlice! 50.9-862-4644Fax: 508-'191 Date: J I.,V1 -10 Sewage Permit Assessor's Map Parcel 2 ' Installer & Desiuner Certification Forin Designer: _YC 6".I,:\ o e e�C n a Installer: Co c ..)e,t4; e. ............... Address: 2 Address; PO -7G3 ....................... 6":ksi uj�qy,nyl H Vvi A _% .1................ ......... Os Was issued a permit m install a .(dale) er) seplic systern at Co t,A',e. C\ o ...... hased on a d('s -)Il drawn 131 .............................. I. .. e e(0)C, -rn c dated pec {designer) I certify that the sptic systern reflerenced above was installed substantially accordinf,, to the design, which may incIUCIC minor approved changes such as later,.fl relocation oftlic, distribution box and/or septic tank. StripOLIt (if required) Nvas inspected and the soils %.QTQ COUnd satis fitQ tory. I certify that the Set)tic system referenced above was installed with major chanl-ms (i.c, f,,reater than 10' lateral relocation of the MS or any vertical relocation (A,111y C01'ripollont of tile SO . 1111C S\stein) but in accordance with State & Local Regt.dati0fts, Plan revision Ot' ccrtdlwd as-built In dCSigflQ1' to 1'0110W. Stripout (it'req I nspected and the sorts %VCBe FOUIld S,16sl."It L 0 t'y. -%V*OP J13 .................. Iris ler's Sit',11;'ift] AL .......... 'ipatUl' esil e s rip HLre) PLEASL,-, RETURN 0 BARN,'rABLE PUBLIC HEAL-1-H. LHVISION, CERjjUj;Aj.L", 0 F CO N WELL NOT 13E ISSUED UNTIL BOTH Tins FQRM AND AS- :BUIC LT ARD ARE RECTIVED BY THE BARN R STABLF PUBLIC EALTI'll DIVISION. 111ANK YOU. :;w,!o......io< i r TR ',4 j p�at <z 1 7 R m C IJ T]J 7 7 IJ T n Id 7 n No. ® � �i Fee VY TH,E COMMONWEALTH OF MASSACHUSETTS Entered in computer:PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYiratiou for Vsposal *psteut Coustrurtiou permit Application for a Permit to Construct( ) Repair("� Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location w A dress or t No. 1t0 We f)Vag,,� .�t Owner's Name,Address,and Tel.No. c &4 �c Oa A.a--,t 31 -o ( 5- Assessor's Map/Parcel S/ — I Z �Q n I_e,u �(.l Installer's Name,Ad��d77re s,and Tel.No. f-v-g y Z� �( uZ�' Designer'sI�1 e,Address,and Tel.No. v if 0-3 7 C O.jo>i1�.L!✓4 C rt� .� �✓�fJ�/l Al Type of Building: Dwelling No.of Bedrooms Lot Size 1,0 \ L{ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 gpd Design flow provided 3 S S , -Z gpd Plan Date j.Z 3 i i^ Number of sheets Revision Date Title Size of Septic Tank 15' 0 Type of S.A.S. 1) (i re 3(ca i le 5}urQ.Le S S Description of Soil riud C" s-e A-n&I Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He Sign v Date Application Approved b Date Application Disapproved by Date for the following reasons Permit No. Date Issued p— j,. •_w ..__.•,. vim..., . _ _ ..w • - ^may..,•( IZI ..-...-- -.. �+-• � • Y I••• No. Fee TKE.COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, gASSACHUSETTS Yes 4plitatlon for Disposal 6pstent Construction 3dermit F t f Application for a Permit to Construct( ) Repair(-.)/ Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address o,i� t No. I(, W.o r 05 u � .�, Owner's Name,Address and Tel No. 0 P A � rQ�w 3 I S Assessor's Map/Parcel S / - 11 t "(C, 0 C"k-f Luc Installer's Name,Ad1re s,and Tel.No. Sv $ y7,p I u�. Designer's�ame,Address,and Tel.No. 1-�' 3 0 3 7 P 0�?!n ,dr f'�l (� r,,,(-e y / j c r\r,y1(�C 1 1•1•. 9S-o-1 2 FLF "vLAJI, i"ed /'��/rvl' t $�( ,dv7 f Type of Building: Dwelling No.of Bedrooms 3 Lot Size 10 \ Lk 3 sq.ft. Garbage Grinder( ) Other Type of Building (2 o S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided ? ) S Z gpd Plan Date - t U Number of sheets ` Revision Date Title g Size of Septic Tank I � t)U Type of S.A.S. vw n- rc -:i r` Description of Soil 6' ,J y !'ieP2c S-c 40 �/ } Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of HI. Signe ) Date ` C Application Approved b Date C / �7 ,;. Application Disapproved by Date h. for the following reasons ` Permit No. ae/6 Date Issued 4- 0 5 J Q ------------•--------- -------------------------------------------------------------------- --------------- -------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of (tompliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by 0k X. � P 1 (2 Y\ srt I at 11,9 U-)- 91 LKCA ,%.C-C4 /}wk - has been constructed in aac/co d with the provisions of Title 5 and the for Disposal System Construction Permit No.1 '/_jf ated � j ID ,�Installer CnPk_t, Ob •C VV.L-F.A. S-c S Designer rk, v,.2R h. #bedrooms J Approved design flow 2 5 gpd The issuance of this permit sh 1 not be nstrued as a guarantee that the system ill functi a i \P g Y c�'esigned. Date / p C/ Inspector -----No.------------------- - ----------------- ---------------------------------- ------- --------Fee---------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon(, ) System located at i \o -y',to (. q, L Lt V � n vt,e A v[ lb v V 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 , /a//L57 �Z� Approved`by__ TOWN OF BARNSTABLE LOCATION I(Q UJ"9,,xJ Az�_q SEWAGE# Zolo- qcS VILLAGE r ul(,IQ ASSESSOR'S MAP&PARCEL Z-1 - i a ! INSTALLER'S NAME&PHONE NO. Ja4kLuteV `r e^,Dr`1 c"5 </19 4/01_;ta' SEPTIC TANK CAPACITY 1 hod 1+t u LEACHING FACILITY:(type) (AO) Orr- 16 t ke (size) I�{<q x 2 o NO.OF BEDROOMS ,3 OWNER PERMIT DATE: Id\-1.;_ -Lal® COMPLIANCE DATE: 1 of Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility e/VU l 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 FURNISHEDBY �,gP WrL n6p,73ef L(, 43 0y,5 53 Vo,S N r Town of Barnstable P# 3 0 _7 Department of Regulatory Services ► � r Public Health Division j�oMtK�16 a� 200 Main Street,Hyannis MA 02601 .Date Date Scheduled a Time Fee Pd. 1� Soil Suitability Assessment ePiSposalfor Sewag Performed By:�,�„ei` Y�MENtEt_ E- :T eS'e- 0 " Witnessed By: r. LOCATION& GENERAL INFORMATION Location Address W�G�vc��g� Owner's Name Address S� Assessor's Map/Parcel: 9-S1 �/a f Engineer's Name ( tom per:(�C F SG OnS ww- NEW CONSTRUCTION � ✓ I � REPAIR Telephone# ,5a-8•-27 3•-d 3 7 .�7 Land Use / 1 Slopes(%) 1-3"/o Surface Stones N Distances from: Open Water Body ->150 ft possible Wet Area >6� . —__ft Drinking Water Well >ISC ft Drainage Way 10 ft Property tine >to -—�_ft Other SKETCH:(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands in Proximityto holes 5E6 gng4ft 51TE � ) Parent material(geologic) Our ,gsj Depth to Bedrock J 1119.- 6G5 Depth to Groundwater. Standing Water in Hole: l36S Weeping from Pit Face Iyy' tQCoS Estimated Seasonal High Groundwater >Iyy" &,S Method Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE t7�¢tcts o a� gnp„J Depth Observed standing in obs.hole: >.t'W Qfo5 tyy 64S ,ram__,.,,___in, Depth to soil mottles: In Depth to weeping from side of obs.hole: >1` t AGS in. Groundwater Adjustment f. Index Well# Reading Date: Index Well level, AdJ,factor Adj.Groundwaterlevel PERCOLATION TESL' �gtp +th �o �yt11e ri) Observation Hole# 1 Time at 9" Depth of Perc Hb-G 1" Time at 6" Start Pre-soak Time @ 10:21 Time(9"-6") End Pre-soak �;yL Rate MinJlnch ZMPI Site Suitability Assessment: Site Passed 1/ 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:\S EPTIC%PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell Mottling (Structure,Stones,Boulders. o i tenry�96 Graven O-1Z FILL -It, A i O"l 54N0 Io`lte 311 0 ib-34 LOAMI 54No FINE LOWM SaNO 1-61 IZO C_1 M50-0049 , 59No 2.5 1``r, twat .M4raiyc'S.to7e . IL6-14i'A G'3 /w4lum. Sgnrll Z.'Sy "It, wa56 DEEP OBSERVATION HOLE LOG Hole# z. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. . nsi ten % ravel �t4.. q cd4my Sgn,o lb y� 3I t 36-94b GI F,ng [°a Al Tit I?A -2 M -(c+gtse SAND Z.5 4 r, n- Ic ° Gd 17A -194 C-3 Way 5orro 2.611 SSE, DEEP OBSERVATION HOLE LOG Hdk* ' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co i to Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con i ten I ' A .i Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes __' Within 500 year boundary No X Yes Within 100 year flood boundary No.X Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas`observed throughout the area proposed for the soil absorption system? YES - If not,what is the depth of naturally occurring pervious material? Certification I certify that on ,y"Z�-g`� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and ience described in 310 CNM 15.017. Signature Date Q:1$EPTI0PERCFORM.DOC YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4years). A business certificate ONLY REGISTERS YOUR NAME in town (which.you must do by M.G.L.-it does not give you permission to operate.) Y611 must first obtain the necessary.signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367_Main St.-, Hyannis, MA.02601 (Town Hall) and get the Business Ceitificate that is required by law. DATE:0 —� �`�� Fill in please: l t� t `�""°Ifs �' ��`4 f APPLICANT'S YOUR N4ME/S: vt1 cv*r 1L��dEi9E�q ,vlN' . I' BUSINESS YOU HON4E ADDRESS: J �y a tP MOW ?3 �. ,a7'7 ([ - /V6{�• n� 1ELEPHONE # HomeTele- hone Number - ? 7 — o EIN;`or; Email Address: o o NAME:OF'CORPQRATION: NAME OF NEW'BUSINESS acx TYPE OF BUSINESS Lj IS.THIS A HOME:OCCUPATI.OW. YES NO ADDRESS OF BUSINESS- MAP/PARCEL NUMBER�57 (Assessing) When starting'a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is'intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. = (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate yd-ur business in this town. MUST 1. BUILDING COMMISQIONR'S�OFFIC RULES AOMPLY WITH HOME OCCUPATION This individual piaf r e .of a pe mit quireme is that pertain to thls type of business. REGULATIONS. FAILURE TO COMPLY MAY RESULT IN FINES. Aut o ized n ture-* MMENTS: 0 ' 2. BOARD OF HEA H 1 This individual has been ' fo ed f the permit requirements that pertain to this type of business. Aut on d ignature** MUST COMPLY WITH ALL COMMENTS: Ldr .ate HAZARDOUS MATERIALS.REGULATIONS .3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM l NAME OF BUSINESS: LeiU,001-j 4,7, rirJ c BUSINESS LOCATION: t4 y r INVENTORY r MAILING ADDRESS: TOTAL AMOUNT: cap TELEPHONE NUMBER: 55 6 7 /oQ5 CONTACT PERSON: . EMERGENCY CONTACT TELEPHONE NUMBER: ?Z 5i SSS'3 MSDS ON SITE7_j _ TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) v&AALI Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers n/�"1� � Miscellaneous Combustible Car wash detergents LeatherLeather dyes Car waxes and polishes (,( � Fertilizers Asphalt& roofing tar Vl\��,,� PCB's Paints, varnishes, stains, dyes jvt�j Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials 4"SCHEDULE 40 PVC MIN. SLOPE 1 % PROPOSED PVC VENT TOP OF FOUNDATION = 71 .1'± INISH GRADE OVER D-BOX= 69.2 ± FINISHED GRADE OVER BIODIFFUSERS= 68.2Q - 69.30 GENERAL NOTES PROVIDE EXTENSION RISER SLOPE @ 2%MIN. WITH COVER OVER INLET& FINISH GRADE OVER TANK EL.= REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISHED GRADE OUTLET TO WITHIN 6"OF F.G. 70.0'± RISER TO WITHIN 6"OF FINISHED GRADE ACCESS BOX PER WITHIN METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FOUNDATION = VARIES 5" DIA. OUTLET(S) 3"OF F.G. (ONE PER ROW) CODE AND ANY APPLICABLE LOCAL RULES. 20"MIN.ACCESS 9"MIN - �- } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE COVER(3 TYP.)- YP.) 36"MAX. I DESIGN ENGINEER. PROP.4"SCH. 40 9"MIN. SEE NOTE 21 PVC SEWER PIPE PROP.4"SCH.40 36"MAX. 60"MAX. TOP OF SAS/B.O. = 6t�,30' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PVC SEWER PIPE I SYSTEM UNLESS OTHERWISE NOTED. 11.11 :�s __EI„ 2" DROP MIN. _ MIN.SLOPE @ 1% 6 3 " 3" 9" _ ' PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 3 DROP MAX MIN.SLOPES 1% L - 11 ± JOINTS (TYP.) ELEVATION =64.30' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 10" 4"PVC IN FROM 1.33' Q 16„ 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF " t 66.25' SEPTIC TANK • 4"PVC OUT TO 0.90' (TYP.) 10.75"(TYP) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. EXIST. PIP' LEACHING FACILITY + 1 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 66.50 12" g" ---I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 48" OUTLET TEE 66.07' MIN. 65.90' 63.87' 62.97' (laid flat) 2.875'(34.5") (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 5.0' 6"CRUSHED STONE (TYP_) 5'MIN. FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS OVER MECHANICALLY 14.375' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 23.3'TO FOUNDATION COMPACTED BASE REQ D 20.0' AND DESIGN ENGINEER. 6" CRUSHED STONE 5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 70.00' ESTABLISHED OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 56.20' BIODIFFUSERS (END VIEW) ON A NAIL SET IN TREE AS SHOWN ON PLAN. COMPACTED BASE BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. 20 - BIODIFFUSERS (PROFILE) PROPOSED 1500�GALLON CONCRETE SEPTIC TANK 1 ) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT LENGTH 10 6 WIDTH 5'$- DEPTH (Dimensions per Wiggin CROSS SECTION VIEW (BY ADVANCED DRAINAGE SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY THIS ELEVATION & SEPTIC TANK PROFILE Precast Corp., Pocasset,MA) 20 - ARC 36HC #3616BD BIODIFFUSERS H-20 TO THE DESIGN ENGINEER. �r-^^_ NGINEER IF DIFFERENT NOT TO SCALE DISTRIBUTION BOX DETAIL NOT TO SCALE ! 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. �T Tr NO O SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM * • • PERC NO. 13157 APPROPRIATE AUTHORITY. } � INSPECTOR: David W. Stanton, R.S. 12, ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE MAP 251 Benchmark * EVALUATOR: Michael Pimentel, E.I.T. THEY SHALL WITHSTAND H-20 LOADING. • C.S.E.APPROVAL DATE: Oct. 1999 LOT 119 Nail Set in Tree ' ` j 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. Elev. =70.00' DATE: December 9, 2010 PROPOSED 4" PVC VENT PIPE; EXACT Approx. M.S.L. * "" * • ; TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE LOCATION PER OWNER • i x 68.7' �►�,�� ' -� • • I MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. 5 \ 1"y . ELEV TOP = 68.20 ! REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, S7 ° (�f$land * • I FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). O S 52'4p"E MAP 251 � • w*�� ELEV WATER= <56.20 1 < ��7- 78.Og� ` LOT 118 • PERC RATE _ <2 min./inch 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PROPOSED TOTAL 20 ARC 36HC (#3616BD) \ o@1' ' .« I SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. Cl) BIODIFFUSERS (H 20) IN A FIELD 20.0, o • • DEPTH OF PERC= 48"-64" ce) CONFIGURATION (6) , , • . • . 16. PROPOSED PROJECT IS LOCATED WITHIN: z CB/DH �n �'• ' . w + TEXTURAL CLASS: 1 ASSESSOR'S MAP 251 PARCEL 121 ULOCUS « t ' • + �• w OWNER OF RECORD: CATHARINE R. BEALS J TP 1 / ` • ' ADDRESS: 16 WEQUAQUET AVENUE PROPOSED INSPECTION PORT WITH x 68.2' 68.2' 0" ACCESS BOX TO GRADE (TYP OF 5) - • Fill 68.20' � � ; CENTERVILLE MA 02632 / Litt! , Al2" Loamy Sand 67.20' (4) / ZONE 2 CID PROPOSED DISTRIBUTION BOX •10` 0 w FEMA FLOOD ZONE C 16" • . • B Loamy Sand COMMUNITY PANEL# 250001 0005 C TP 2 LP / # • 10Yr 5/6 68.2 Qr �► • • ' I 36" 65.20. 17. DEED REFERENCE: L.C.C.#125087 rn O , t' • • Fine Loa y and co 3 �i' h ' C-1 ! 18. PLAN REFERENCE: L.C. F AN#30367A • • EXISTING LEACHING PIT TO BE •• =" o �^? • . o ' . ! • Perc "- 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. N (2) o \, PUMPED, FILLED WITH CLEAN . �f • . • x- �, / COARSE SAND &ABANDONED • / , ort1 1 64" 62.87' ! 20_ PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY - (1) �, ` 11� 11 • " C_2 Med. Coarse Sand FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY nj EXISTING CESSPOOL TO BE • « w • 2.5Y 6/6 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. o PUMPED, FILLED WITH CLEAN )� p ••' • • �/ (Tight Matrix; 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405, THE FOLLOWING LOCAL UPGRADE /° \ COARSE SAND &ABANDONED 5-10 Gravel) APPROVAL IS REQUESTED FROM 310 CMR 15.221 (7): -► / (1.) A 2.0'WAIVER(3.0. 5.0') FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM. HC-2 PROPOSED 1,500 GALLON SEPTIC TANK LOCUS PLAN 120 Medium Sand 58.20 °v0 gH / HCA / C-3 2.5Y 6/6 �ry4' � SCALE: 1"= 1000' „ (Loose) MAP 251 �� 0��/NOFR HC-3 / 144 56.20' LOT 120 8� eC No Mottling, Standing or Weeping Observed SF Cis --- #16 FNT� DECK DESIGN DATA TEST PIT DATA EXISTING �'� / PERC NO. 13157 LEGEND '- �X / 50x0 EXISTING SPOT GRADE 3-BEDROOM INSPECTOR: David W. Stanton, R.S. _ DWELLING \�� - 50 - - EXISTING CONTOUR 9� TOF - 71.1'± �� 3 EVALUATOR: Michael Pimentel, E.I.T. 6 - NUMBER OF BEDROOMS (DESIGN) � C.S.E.APPROVAL DATE: Oct. 1999 PROPOSED CONTOUR / \�\ W DESIGN FLOW 110 GAUDAY/BEDROOM DATE: December 9, 2010 / O ko o TOTAL DESIGN FLOW 330 GAUDAY TEST PIT#: 2 ❑/H/W EXISTING UNDERGROUND UTILITIES / ^ o Cr 2 o MAP 251 DESIGN FLOW X 200 % 660 GAUDAY = ELEV TOP= 68.20' GAS EXISTING GAS LINE 4 3 USE PROPOSED 1,500 GALLON SEPTIC TANK ELEV WATER= < 56.20' / \�\ LOT 142 W W - EXISTING WATER LINE O PERC RATE = = INSTALL 20 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20) TEST PIT LOCATION DEPTH OF PERC \ TEXTURAL CLASS: 1 MAP 251 � o � � PROPOSED 1,500 GALLON SEPTIC TANK S6no °\ SYSTEM CAPACITY - 69__ 7 �47Sp LOT 121 � PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE S�0• F / 10,143 S.F.± (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD 0" 68.20' (100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING/DAY Fill Q PROPOSED DISTRIBUTION BOX 3 Al2�� 10Yr 3l1 Loamy Sand TOTALS: 67.20' PROPOSED ARC 36HC(#3616BD)BIODIFFUSER(H-20) i O \� � TOTAL NUMBER OF BIODIFFUSERS: 20 B 16„ 66 87 Loamy Sand ' DRIVE TOTAL NUMBER OF COUPLINGS: 0 10Yr 5/6 S75°S24 " \ TOTAL LEACHING AREA: 480.0 36" 65.20' F Fine Loamy Sand - TOTAL LEACHING CAPACITY: 355.2 C-1 \� 91.24, O 48" 2.5Y 7/1 64.20' REV' DATE BY APP'D. I DESCRIPTION w PROPOSED SEPTIC SYSTEM UPGRADE / FOGS Pq VF �` NOTE: Med.2 5Y 6/6 Sand PREPARED FOR: MFNT w !CB/DH EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE C-2 DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER (Tight Matrix; CAPEWIDE ENTERPRISES �FQvA ` "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED 5-10%Gravel) (4p wQUFTgVF `` DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST MODIFIED LOCATED AT FEBRUARY 18, 2010). TRANSMITTAL NUMBER=W000052. NOTES: tECAYOVT) NVE �'� SWING-TIES " 58 20, 16 WEQUAQUET AVENUE --._ DESCRIPTION HCA HC-2 HC-3 120 Medium Sand CENTERVILLE, MA 02632 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF C-3 2.5Y 6/6 EACH SEPTIC SYSTEM COMPONENT. SEPTIC INLET COVER(1) - 17.4' 16.2' 144" (Loose) 56.20' SCALE: 1 INCH = 10 FT. DATE: DECEMBER 13, 2010 0 5 10 20 40 FEET No Mottling 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE SEPTIC OUTLET COVER(2) - 14.2' 21.1' , Standing or Weeping Observed i _ �TH OFrvi �, PREPARED BY: PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT BIODIFFUSER CORNER(3) 33.7' 18.3' - RESERVED FOR BOARD OF HEALTH USE JOHNc m JC ENGINEERING, INC. DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF CHURC !«JR. BIODIFFUSER CORNER(4) 27.7' 31.1' - C IL 2854 CRANBERRY HIGHWAY HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. NO 4180 BIODIFFUSER CORNER(5) 42.1' 40.9' - �, > 5� ER EAST WAREHAM, MA 02538 3.) PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2 AND THE SITE PLAN BIODIFFUSER CORNER(6) 46.3' 32.2' - 508.273.0377 ESTUARINE ZONE WATERSHED. SCALE: 1"= 10' Drawn By: BSM Designed By:MCP Checked By:JLC JOB No.1917