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HomeMy WebLinkAbout0085 WHITE OAK TRAIL - Health �5 White Oak Trail Centerville A= 191-054 4 J Omcford NO. 1521/3 ORA --------------------- �,�, 10% Certified Mail#7012 1010 0000 2850 8388 �S"E Tati Town of Barnstable Regulatory Services HARNSTABM HAS& Public Health Division TfD MA'S Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 1, 2014 Richard Cross PO Box 203 n Osterville, MA 02655 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, TATE SANITARY CODE II— MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION ��� AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 85 White Oak Trail Centerville, MA was inspected on March 31, 2014 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of'a complaint. The following violation(s) of the State Sanitary Code were observed: 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements -Cracked sliding glass door within living room. ✓ t�- -Baulked head in disrepair and in need of replacement.✓ '�"` -Rotten fascia board and hanging gutter on back of dwelling unit. , -Rotten window sills and outside trim boards on windows located within bedroom and Living rooms. -Rotten siding observed on side of garage.. The following violation(s) of the Town of Barnstable Code were observed: 170-4 — Certificate of Registration. Property is not registered with Town of Barnstable Health Department. You are order to correct violations within thirty (30) days of your receipt this notice. You are order to register this property with the Town of Barnstable Health Division within fourteen (14) days of your receipt of this notice. You may request a hearing before the Board of Health if written petition requesting same - is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of$.100.00. per violation. Each day's failure to comply with an order shall constitute a separate violation. ER OF HE BOARD OF HEALTH T omas A. McKean, R.S., CHO Director of Public Health Town of Barnstable QAOrder Ietters\Housing violations\Rental ordinance 85 white oak.doc g SE�DEIR:COMPLETE THis SECTION ',COMPLETE rHI&SECTIOMON DELIVERY,'., I ■ Complete items 1,2,and 3.Also complete A.•Signature item 4 if Restricted Delivery is desired. X � ❑Agent ■ Print your name and address on the reverse � ❑Addressee so that we can return the card to you. B. Received by(Printed ame) C. Date of Delivery ■ Attach this card to the back of the.mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1 Article Addressed to: — - SdS� If YES.enter delivery address below ❑ No I F-. 1 a . � � Richard Cros 0 6 qdV {i PO Box 203 d s.. sery rypeOsterville, MA 0265 1\' ertified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail 13 C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2.Article Number (Transfer from service label) ?�7,2 1�10 �0�0 s285� 8388 PS Form 3811.February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATE$POSTAL,SERVICE, First-Class-Mail Postage&Fees Paid USPS Permit No.G-10 Sender: Please print your name, address, and ZIP+4 in this box• I Town of Barnstable ' I d' Health Division 200 Main Street Foy I Hyannis, MA 02601 � I I ¢111llfif ii}eljiiidl!his. i.I!i�li,,.If-jit.iiiii�pltl'1j11li !�!!t Citizen Web Request Page 1 of 3 -Alv� } I iC� , �tlp� j Logged In As: Citizen Request Management � Monday, March 31 2014 TOWN\oconnelt Route to Users Search Requests Create Requests Reports Request Information Request ID: 48662 Created: 3/28/2014 3:43:36 PM Status: Assigned To Staff Assigned To: O'Connell,Timothy Health Office Anonymous: No Request Category: Chapter II : Housing Substandard edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 4/11/2014 Change Estimated Mar April 2014 May Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 30 31 1 2 3 4 5 6 7 8 9 10 it 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 Created By: Donnelly, Sarah Priority: Medium edit Health Office Citation Numbers: edit Requestor Information Requestor Request Parcel Number Map: 191 J Block: 054 Lot: Caller reports that the windows are falling out and the roof and basement are leaking. He has Parcel Lookup contacted owner but no repairs have been made. Email: Edit Requestor Information http://issgl2/intemalwrs/WRequest.aspx?ID=48662 3/31/2014 TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date 1 Time: In Out Owner Tenant Address v Address Compliance Remarks or Regulation# Yes O Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits � f 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; _ Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION t_ Date �' Time: In Out Owner t V ICU--�, Tenant ",f ()17 Address l.V C Address n Compliance Remarks or Regulation# Yes Recommendations 2. Kitchen Facilities 3. Bathroom Facilities ,i 4. Water Supply 5. Hot Water Facilities f _ 6. Heating Facilities 7. Lighting and Electrical Facilities J � 8. Ventilation a f 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use / 12. Exits 12 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width (�' �--��- C - --- r 19. Number of Tenants Observed PART 11 �( 37. Placarding of Condemned Dwelling; _ Removal of Occupants; Demolition i } - �✓___ Number of Vehicles Allowed max Number of Bedrooms (max) Number of Persons Allowed (max) 1 Person(s) Interviewed Inspector �i----� If Public Building such as Store or Hotel/Motel specify here 07/05/2011 00: 18 5082730367 90287 P. 002/002 Town of Barnstable Regulatory Services Thomas E.Ceiler,Director - s , • Public Health Divbion ' s Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-740-6304 Date: 7 5— Sewage Permit# '�°tt Assessor's:VMap/Pareel Installer&Designer Certification Form Designer: SC E0'\W)ee-cc()� ,TOC. Installer: Clftee"c�" ��Eerpecs�S Address: 2 34 Address: Ergsl w�rtlnowt+ t1.A_ 4253 ( dvYk so8-273•0377 On CO ^t�` Z(-< CAkLt,i c e 0jk5e' ) ; was issued a permit to install a (date) nstaller) septic system at 8!3 win e. 64k TW( based on a des and drawn by (address) C En5ineece'ng , 20c_ dated Z'oAe— (designer) v I certify that the septic system referenced above was installed submint ally according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with masjor changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocati(n of any component of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) n;;x�ted and the soils were found satisfactory. JOHN L. ay, CHuRCtIl..L �A s ler's Signa WL esigner s Signature (Affix De gn )I Here) P ASE RETURN TO ARNSTABLE PUBLIC HEAL DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED.BY THE BARN�LE PUBLI C HE A DIVISION. THANK YOU. q:loffice tomtsldesigFtc=rtification form.doc ' Town of Barnstable Department of Re gulatory Services samerksm F Public Health Division Date fo 1639. 9 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Disposalr Performed By: �tc�rtQe( P(me.(1W. CIT CSC Witnessed By: D&`Qid D S41CraS. 9,S , Location Address LOCATION&GENERAL INFORMATION g ',1�� O� T , i L Owner's Name CQ/Vi`rP.ti^V 1 1 Address q,y. 'Assessor's Map/P el: qq' l /a q_ /. 6 ~� L O 6" Engineer's Name C:rf Awi orf[ kz 10611P.f::1115 NEW CONSTRUCTION REPAIR Telephone# So 7 5)b-213.6 377 Land Use_St�c;�f= �cmi Ili aW21�iyt� Slopes 9� ("2 Sur ' p (�) face Stones a Distances from: Open Water Body ft Possible;Wet Area 'ft Drinking Water Well — ft Drainage Way ft "_Property`Une 7/0 ft Other . ft s SKETCH:(Street name,dimensions of lot,exact locations f test holes&perc tests,locate wetlands in proximity to holes) s ja(,W PIail ; . 1 Parent material(geologic) ObkL,-SDI Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater 7 i 2(a o b,T DETERARNATION' FOR SEASONAL HIGH WATER TABLE Method Used: K)tCC-�- t�bSt'_ro'al(ofl Depth Observed standing in obs.hole: 7 (21C In, Depth to soil mottled: Depth to weeping from side of obs,hole: —' _ in, Groundwater Adjustment fit. Index Well# Reading Date: Index Well level Adj,&ctor ,�",� Adj.C3lpundwater level 'PERCOLATION TEST Ditto 6- ,o /e Ae�J Observation — Hole# Time at 4 -. " �6 �`'/1 A'1 , Depth of Pere 3 Q y i Time at 6" /6 �i A Start Pro-soak Time @ A.2 '2 AN Time(9"-61f) End Pre-soak i0''YZ AH Rate MinJlnch Z Site Suitability Assessment: Site Passed �7 Site Failed: Additional Testing Needed(YM) 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:\SEPTICIPERCFORM.DOC DEEP Horizon VAT'ION HOLE LOG, Hole# gBoulders. Depth from) Soil Horizon Soii Texture OtSdil ColorSurface in. Soii.(USDA) (Munsell) Mottling (Structure,oLS DYr 3oriz� �.2 n _i�s 2. �Y6� 6 DEEP OBSERVATION HOLE LOG Hole# 2.Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. on i en % ra el 36./2b c-2 11-FS DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) Other {Munsell) Mottling (Structure,Stones,Boulders. it DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No= Yes Within 100 year flood boundary No_ Yes Death 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` _5't..5 Knot,what is the depth of naturally occurring pervious matorial? Certification I certify that on ID,27-fq (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 an4 experie ce described in 310 CMR 15.017. Signature 2JY Date G 1 Q-. EVnL-\PERCFORM.DOC No. l) � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: LZ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair()� Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.6,�'j4lh ff G 44 -rIZ ,L Comte Owner's Name,Address,and Tel.No. Assessor's Map/Parcel /q v (Ij &v>y �jt. j) � �t 0 el ot6 ,,L Installer's Name,Address,and Tel.No. Ito Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 2-53 l ± sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 7 Y 3 3 gpd Plan Date &—f i —Z o l l Number of sheets / _ Revision Date Title 8 5- &A-11 k 0/3& A Size of Septic Tank /,S pp Type of S.A.S. 5&Ljt t e,-J j � Description of Soil Nature of Repairs or Alterations(Answer when applicable) J J_?0 G©y, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date (j 4 - Z®l l Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 2011- Date Issued VJ f a u 1 I --—_--_——----------------------.—------------ ----------_ --- —— _ No. v Fee L!// ' THE GOMNWEALTH OF MASSACHUSETTS Entered in computer: t PUBLIC HEALTH.DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplitatioft for �M3sposal *pstrm Construction 3permit Application for a Permit to Construct( ) Repair bpgrade( I) Abandon( ) ❑Complete System ZKOIdividual Components Location Address or Lot No.$,5"wtir't' o aG rRv4L C ✓lt Owner's Name,Address,and Tel.No. 1 Assessor's Map/Parcel Installer's Name,Address,and Tel.No. %2o -2 63 Designer's Name,Address,and Tel.No. Y 2- - q'� Type of Building: Dwelling No.of Bedrooms Lot Size 25 3 1 a t sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 7 7 .3 3 gpd Plan Date ��! Z o /I Number of sheets j Revision Date Title E1 5- (.41+ k 04 A r4 AZ Size of Septic Tank /S D® Type of S.A.S. ,j 1ZO'tQ Description of Soil 36 Nature of Repairs or Alterations(Answer when applicable) l) (>J 0' 1 $. j; To t3 o K a. Date last inspected: ?� Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date 6 / 2.011 Application Approved by u Date-- Application Disapproved by Date for the following reasons Permit No. 2 1 Date Issued 10 a THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO C!TIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(A) Upgraded( ) Abandoned y )b`y- ► 4 & / d s< s �. L C at XS ;) -kt y A� T-a^C (1-- dtt has been constructed in accordance with the prov ions of Title 5 and the or Disposal System Construction Permit No.a U I dated Installer Designer taAB 4 e i #bedrooms % 'Approved design flow Zo �,� gpd The issuance of this permit shall of be c ns rued as a guarantee that the syst m� will fun io designed. Date ��� Inspec or No. I 0 d Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstent Construction Permit Permission is hereby granted to Construct( ) Repair(X) Upgrade( ) Abandon( ) System located at g S W^, t e- a✓4-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:Cont c/tio ust be completed within three years of the date of this permit. Date (p �(� I / Approved by S a i TOWN OF BARNSTABLE LOCATION &5- t4,, kt (Jae � ' SEWAGE# 2®11 - Z frs VILLAGE (en AAtt Lt ASSESSOR'S MAP&PARCEL I(; ( Sq INSTALLER'S NAME&PHONE NO. f do F- r s.-e S 14'77 77 SEPTIC TANK CAPACITY 1560 XA(,-I LEACHING FACILITY.(type) A it t C g tk 4,,-c. Ref 4 (size) _ //, Z � ,31 r 1- NO.OF BEDROOMS I� OWNER PERMIT DATE: (9 COMPLIANCE DATE: b-Z 3 *2© 1l Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Al-ozo 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) �1 Feet FURNISHED BY 6/-1D.?.u1i ®JIStS l•(,� v A lZ ,C/o i ° q y 77. Q c Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2 85 White Oak Trail t• Property Address C Rich Cross p Owner Owner's Name information is required for every Centerville ✓ MA 02632 10-4-19' page. City/Town State Zip Code Date of Inspection r " 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. 0F Important:When •• �., filling out forms A. Inspector Information 6j.�•�tf�� ;`02� 9�y on the computer, JAMES use only the tab James D.Sears key to move your Name of Inspector v: cursor-do not use the return Ca ewide Enterprises �+ o Q key. Company Name �F •... 153 Commercial Street 5 1 N 5P�``����� r� Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10-7-19 I ector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 White Oak Trail Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal. Tank D Box and 24 chamber's. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 White Oak Trail Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 85 White Oak Trail Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® 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 t51nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts l Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments la 85 White Oak Trail �V Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in awaspeni is less than 6" below invert or available volume is less than '/2 day flow A-'19('111AIr ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form j� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 White Oak Trail Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form <o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 White Oak Trail Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440. Description: 1500 Gal. Tank D Box and 24 chamber's. Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2017-83,000Gals g ( y g (gp ))' 2018-92,000 Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 White Oak Trail Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 White Oak Trail •`J Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2011 Permit # 2011 - 188. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 20" 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.): Pipeing is 4" PVC SCH 40. t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 White Oak Trail Property Address Rich Cross Owner Owner's Name information is Centerville MA 02632 10-4-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 10" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10 Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 28" 1" Scum thickness Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Plan-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and covers at 10" below grade.Two inlet Tee's w/outlet tee. No sign of leakage or overloading. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 White Oak Trail V Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form n Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 White Oak Trail emu= Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): D Box is 16"x 21"-33" Below grade w/cover at 6". Box is clean and solid w/4 line's out. No sign of over loading or solid carry over. t5lnsp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form M o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 White Oak Trail Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 24 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 White Oak Trail Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 85 White Oak Trail L. Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed &Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included W Na �w t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 White Oak Trail Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Na 12.5' Estimated depth tcplgh ground water: 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: 6-9-2011 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: T.H.on Design plan 6-9-2011 12.5'. Bottom of chamber's at around 5' below grade. Bottom of chamber's at around T above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Fps Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 u 85 White Oak Trail Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Li REAR � 3�� Ll t5insp.doc•rev.7/26/2018 Title 5 Official Inspecdon Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 White Oak Trail Property Address Rich Cross Owner Owner's Name information is required for every Centerville MA 02632 10-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 24 Biodiffufer's. Ck D Box camera out line's and prob area. No sign of over loading or solid carry over. No sign of holding water. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 TOP OF FOUNDATION = 68.2'± INISH GRADE OVER D-BOX- 66.3'± 4 SCHEDULE 40 PVC MIN. SLOPE 1 /o FINISHED GRADE OVER BIODIFFUSERS= 65,5' - 66.2' GENERAL NOTES �� o �- PROVIDE EXTENSION RISER WITH SLOPE @ 2% MIN. CONCRETE COVER TO WITHIN 6"OF FINISH GRADE OVER TANK EL.= REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH ACCESS BOX 1- UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISHED GRADE FINISH GRADE OVER INLET&OUTLET RISER TO WITHIN 6"OF FINISHED GRADE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FOUNDATION = 67.0'± 67•0 ± TO WITHIN 3 OF F.G. (ONE PER ROW) 5" DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. 20"MIN.ACCESS "MAX } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE 36 COVER(3 TYP.) 9" MIN. 1 I DESIGN ENGINEER. PROP. PVC 9�MIN. 9�MIN. PROP. 1.2'WIDE H-20 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE PROP. PVC 36 MAX. 36 MAX. TOP OF SAS/B.O. = 63.20 COUPLING(TYP OF 4) SYSTEM UNLESS OTHERWISE NOTED. *1% SEWER PIPEEXIST.SEWER PIPE MIN.SL 3" 3" DROP MAX. 3" 9" PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN MIN.SLOPE@ 1% L = 16_ JOINTS (TYP.)" 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 63.6'* 14" 63.25' SEPTIC TANK 4" PVC OUT TO (NP.) f THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. LEACHING FACILITY 0'90� 10.75"(TYP)6 . 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 48" OUTLET TEE 63.00' MIN. I 62.83' 62.77' 61 .87' (laid flat) 2.875'(34.5")�I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 5.0' (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK GAS BAFFLE 6" CRUSHED STONE (TYP.) 5'MIN. 11.5' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS OVER MECHANICALLY REQ'D NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 14.8'TO FND COMPACTED BASE 31.2' AND DESIGN ENGINEER. 6"CRUSHED STONE 5 OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 68.97'ESTABLISHED OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV= < 55.50' BIODIFFUSERS (END VIEW) ON A NAIL SET IN A 12"OAK TREE AS SHOWN ON PLAN. COMPACTED BASE (3 M BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PROPOSED 1, PIPES TO BE LAID LEVEL. BIODIFFUSERS PROFILE 500 GALLON CONCRETE SEPTIC TANK (H-10) (BY ADVANCED DRAINAGE SYSTEMS, INC.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT LENGTH 10'-6'� WIDTH 5'-87 DEPTH 5'-8° (Dimensions per Wiggin CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES Precast Corp., Pocasset, MA) TO THE DESIGN ENGINEER. ELEVATION OF BOTH PIPES;CONTRACTOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL ARC 36HC (#3616BD) BIODIFFUSERS (H-20) TO VERIFY THESE ELEVATIONS&REPORT 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. TO 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 • R • � `„ • TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM • ` • s O APPROPRIATE AUTHORITY. PERC NO �• • ; . • • � � ` �, v � ... • • .� . 13299 e Q l/ „ ; •s INSPECTOR: Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS f f • . 1 + LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE • EVALUATOR: Michael Pimentel, E.I.T. ( �, e ` -s A`� THEY SHALL WITHSTAND H-20 LOADING. C.S.E. APPROVAL DATE: Oct. 1999 PROP. INSPECTION PORT w/ -`, .. �� ` • ' '„ '� June 9, 2011 DATE: 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. ACCESS BOX TO GRADE (TYP OF 4) • f. ` �. - i ,, TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE - • . . • �� ; MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. PROP. TOTAL 24 ARC 36HC , *` • ' _ • ELEV TOP = 66.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, TRF (#3616BD) H-20 BIODIFFUSERS •` • • L0C U`+ ELEV WATER= < 55.50' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). F<�NF IN A FIELD CONFIGURATION r • a �' ��77 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN Benchmark „ ••+ • * • IN ��`� PERC RATE _ <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. f N77- , Nail in 12"Oak • ; * • • • • ' a o I DEPTH OF PERC = 30"-48" 16. PROPOSED PROJECT IS LOCATED WITHIN: MAP 192 i °24p"►W \ Elev. =68.97' w 69„09, �� • w-h ; ; TEXTURAL CLASS: 1 ASSESSOR'S MAP 191 PARCEL 54 r� PARCEL 50 Approx. M.S.L. ' • • ,�► , • • O �, MAP 191 . . ,� '• ,� �` OWNER OF RECORD: RICHARD A. CROSS, JR. co 66 TP 1 N �6)_. PARCEL 56 ' . `•"• «`' • •rN • • 0" 66.00' ADDRESS: 85 WHITE OAK TRAIL / 66.0` N /f ; • ; " ; • ', Fill CENTERVILLE MA 02632 J PROPOSED 12 WIDE H-20 / Z �� : • • • + • r� s g Loamy Sand COUPLING (TYP OF 4) 66.0' 'f 66 ROP. D-BOX N77'02'4p,•w 0 �l� �'`` '4 ! •• '`'= ` 12" 10Yr 5/6 65.00' FEMA FLOOD ZONE C 136.45. / // • r COMMUNITY PANEL# 250001 0015 C g Loamy Sand Ur a PROP. 1,500 GAL. SEPTIC TANK f • • ;, �'- ,+ C-1 17. DEED REFERENCE: LAND COURT CERTIFICATE 133839 Pi �� a ^ b 6� u P#�o��i�s f • • * •• • i` � + • 18. PLAN REFERENCES: 1.) LAND COURT PLAN 32373-E �. N � A f- p/H/w « • ' �. • « • . + r+. 30" 63.50' 2.) PLAN BOOK 223, PAGE 103 ra Perc Z /w �`�( a • •'•.' y •� . ',• '� 48 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 62.00 EXIST. CESSPOOL TO BE \ C/p p/N/w D/H \ f! •� „ •+ `• •, •' +w,f •' + f � PUMPED AND FILLED w/CLEAN, 6S `� \ Jri ••r .• r` ' * ' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY COARSE SAND &ABANDONED / 4 rf .�"y . • • ® , +.+ • . � j FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY LP J #85 GAS GAS \ �' ��` - •` ` ` �+•~-`�-' ' • j •• C_2 Medium to Fine Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. �O -1 EXISTING' / 2.5Y 6/6 O / 4-BEDROOM EXIST. LEACHING PIT TO BE / a p r DWELLING TOF 68.2± LOCUS PLAN- PUMPED AND FILLED w/CLEAN, p = COARSE SAND &ABANDONED 6S \ 6, MAP 191 ��� SCALE: 1"= 1000' 126" 55.50' PARCEL 54 o co No Mottling, Standing or Weeping Observed a 25,312 S.F. ± ; / \ pprox o w_ �40 , DESIGN DATA TEST PIT DATA LEGEND / ♦ on/y�to�\ co PERC NO. 13299 be very , _ 50x0 EXISTING SPOT GRADE 2 ) \ GARAGE \ J EVALUATOR:UA OR: Michael E.I.T..S. AZ )Q11�p NUMBER OF BEDROOMS (DESIGN) 4 - 50 - - EXISTING CONTOUR Oct. 1999 50 PROPOSED SPOT GRADE C.S.E. APPROVAL DATE: rn / 0 DESIGN FLOW 110 GAUDAY/BEDROOM June 9, 2011 a DATE: -� 50 PROPOSED CONTOUR / �C/ TOTAL DESIGN FLOW 440 GAUDAY E/T O TEST PIT#: 1 N79° _ ❑/H/W EXISTING OVERHEAD UTILITIES 4950"w l' rn RIVE �� ` DESIGN FLOW X 200 % - 880 GAUDAY ELEV TOP = 66.00' 69,30• _ a I TREELINE (TYP) ELEV WATER <55.50 USE PROPOSED 1,500 GALLON SEPTIC TANK W W- EXISTING WATER LINE = / PERC RATE = GAS EXISTING GAS LINE SWING-TIES SCALE: 1"=20' N79o49'50-W l INSTALL 24 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20) DEPTH OF PERC = TEST PIT LOCATION 123.48' DESCRIPTION HC-1 HC-2 SYSTEM CAPACITY TEXTURAL CLASS: 1 PROPOSED 1,500 GALLON SEPTIC TANK SEPTIC COVER IN (1) 29.4' 28.3' MAP 191 #,°�� w (TOTAL L.F. OF BIO'S&COUPLINGS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD SEPTIC COVER OUT(2) 29.5' 35.3' PARCEL 52 /, (124.8')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 443.3 GAL. LEACHING/DAY 0f. 66.00' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE Fill /4F 4" 65.67' 13 PROPOSED DISTRIBUTION BOX BIODIFFUSER CORNER(3) 41.6' 48.6' TOTALS: B Loamy Sand BIODIFFUSER CORNER(4) 43.1' 56.8' W TOTAL NUMBER OF BIODIFFUSERS: 24 10Yr 5/6 Q PROPOSED ARC 36HC(#3616BD)BIODIFFUSER(H-20) O TOTAL NUMBER OF COUPLINGS: 4 12" 65.00 BIODIFFUSER CORNER(5) 73.6' 80.6' 6� W TOTAL LEACHING AREA: 599.0 o PROPOSED ARC 36HC 1.2'WIDE H-20 COUPLING (H-20) BIODIFFUSER CORNER(6) 72.8' 75.0' ' C-1 TOTAL LEACHING CAPACITY: 443.3 Loamy Sand 10Yr 5/6 t REV. DATE BY I APP'D. I DESCRIPTION (5 NOTE: 30" 63.50' PROPOSED SEPTIC SYSTEM UPGRADE in 1.21 EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE 4) P< L�t PREPARED FOR: <- DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER " Al "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED oj� t N L. q ` CAPEWIDE ENTERPRISES (6 DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST MODIFIED CH CHiL 3) JANUARY 11, 2011). TRANSMITTAL NUMBER=W000052. C-2 Medium to Fine Sand Civi 2.5Y 6/6 No, 4 LOCATED AT He-1 �'"�� 85 WHITE OAK TRAIL (2 7, O CENTERVILLE, MA 02632 NOTES: (1 14.8, B.H SCALE: 1 INCH = 20 FT. DATE: JUNE 15, 2011 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE 126 55.50 0 10 20 40 80 FEET OF EACH SEPTIC SYSTEM COMPONENT. No Mottling, Standing or Weeping Observed PREPARED BY: 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS&GROUNDWATER IN RESERVED FOR BOARD OF HEALTH USE JC ENGINEERING, INC. HC-2 #85 THE LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE EXISTING CONSISTENCY WITH TEST PIT DATA AND GROUNDWATER ELEVATION 2854 CRANBERRY HIGHWAY 4-BEDROOM SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF EAST WAREHAM, MA 02538 DWELLING SITE PLAN HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. TOF =68.2'± 508.273.0377 SCALE: 1"=20' 3.) PROPERTY IS LOCATED WITHIN THE ESTUARINE ZONE WATERSHED. Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.2013