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HomeMy WebLinkAbout0139 WHITE OAK TRAIL - Health 139 White Oak Trail Centerville A= 192— 192 INISMEAD® No.63WR UPC 12543 smead.acm • Made Its USA s i c Commonwealth of Massachusetts 19a • �� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name/ information is required for every Centerville - Barnstable Ma 02632 7/5/2020 page. Cityfrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information H(N-S— on the computer, use only the tab Chad hathaway key to move your Name of Inspector cursor-do not Hathaway Septic Inspections use the return Company Name key. r� Company Address Forestdale Ma 02644 ielun CitylTown State Zip Code 774 274 2581 12866 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 7/5/2020 Inspectors�ture Date The system inspector shall su <it a cop f this inspection report to the Approving Authority(Board of Health or DEP) within 30 d s pleting this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 cam, Commonwealth of Massachusetts �n l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 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: This inspection is not a guaranteeand applies no warrantyof the described septic components in this report including but not limited to piping structual intergrity of components and life exspectancy of leaching and described components. This inspection is to describe conditions witnessed at time of inspection only. Regular tank maintenance and water conservation can prolong life of septic systems Information on care and do's and don't's can be found at town health dept or mass.gov 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 fn Title 5 Official Inspection Form _ 11. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 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 cam\ Commonwealth of Massachusetts �w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 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 cesspool is less than 6" below invert or available volume is less than 1/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. -❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis .and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. . For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water,supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts ,jp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 page. CityTrown 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 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: 2 L.C. 13'x25'x2' Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �d Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 page. CityrFown 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: system upgraded 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.5' feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): 25'+ Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): no signs of leaks or poor venting t5insp.doc•rev.7/26/2018 Title 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 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1000 gal H10 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No .Dimensions: 8'6"x4'6" Sludge depth: 4 Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness less then 1" Distance from top of scum to top of outlet tee or baffle 5„ Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? tape and 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.): tees in place. tank does not require pumping at time of inspection. recommend pumping tank in 1 year then every 2 years after as maintenance. tank shows no major decay or cracks. liquid level was at bottom of outlet. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 'I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 page. Cityfrown 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.): Camera inspected due to bad measurements on as built card. Dbox has no carry overs and is at working level with no staining over current level. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .• 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 page. Cityrrown 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: as built measurements are not correct. camera'd Dbox I Type: ❑ leaching pits number: ® leaching chambers number: 2) 500 gal CHambers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface •Sewage Disposal System Page 13 of 18 P Y 9 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 page. Cityrrown 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.): no signs of ponding or damp soils 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert layer Depth of solids la p Y 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 3 I C � i 0 0 3 o 0 0 a o f � a y a u O A3 tt914 - 13 I -- SS i B3 no4 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection 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 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 36 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: town GIS mapping You must describe how you established the high ground water elevation: Lot el. 68' lake waguaget el. 32. 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 • ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 139 White Oak Trail Property Address Vagts Owner Owner's Name information is required for every Centerville - Barnstable Ma 02632 7/5/2020 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 yTOWN OF BARNSTABLE ATION iSEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. ��w SEPTIC TANK CAPACITY .- LEACHING FACILITY: (type),-Z (size) NO.OF BEDROOMS OWNER ��_ PERMIT DATE: 1 e Q r COMPLIANCE DATE: O Separation Distance.Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching",Facility e•A feet Private Water Supply Well and Leaching Facility(if any wells exist e 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 a FURNISHED BY F7 y �, Li 14 Town of Barnstable P# _ Iq Department of Regulatory Services nn 1 Public Health Division Date i63p �� 200 Main Street,Hyannis MA 02601 0� Ali) -Date Scheduled- �G �/�-' Time . Fee Pd. Soil Suita iiity Assessment for Sewa a Disposal Performed By: Witnessed By: S A LO TI ���yyy ON& GENERAL INFORMATION Location Address �� W4' I e, ,,K T,` ) Owner's Name Nenryi `_ �vn e U al $ @ er'V 1 E' Address C on'I ervii(e, N A 0243 Z Assessor's Map/Parcel: (� Z Z Engineer's Name NEW CONSTRUCTION REPAIR ✓ Telephone# Land Use �C'SI �IPIA}1�►� 1. Slopes('Yo) � !O Surface Stones .Distances from: Open Water Body t D o * ft Possible Wet Area 1 40+ ft Drinking Water Well ft Drainage Way 90 t ft Property Line 10 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) P� ® i ® 0 E GROUNDWATER ADJUSTMENT EXISTING GROUNDWATER LEVEL k I BASED ON TOWN OF BARNSTABLE R L ' GIS DEPARTMENT RECORDS. � INDICATED GW 35.00 P ° INDEX WELL SDW-252 ZONE C READING DATE APRIL. 2007 0) READING 46.9 w ADJUSTMENT 2.0 ADJUSTED GW 37.00 l- _- -- — -- �- f AK ` WHITE Parent material(geologic) rC qU�` 1 s Depth to Bedrock 'No n"e Depth to Groundwater. Standing Water in Hole: �D 14 p Weeping from Pit Face Estimated Seasonal High Groundwater 4ee obo V e DETEATION FOR SEASONAL HIGH WATER TABLE Method Used: S 01100vt Depth Observed standing in obs.hole: _ __in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor— Adj.droundwater Level _ PERCOLATION TEST Date 51!0 6 Titne'I o A vA ' Observation Hole# t Time at 9" �Vt A Depth of Perc D h Time at 6" 9 Start Pre-soak Time @ 0 ZCt 'lime(9"-6") �Lq End Pre-soak apD o Rate Min./Inch r Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(YIN) 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 Conseliwation Division at least one(1) week prior to beginning. Q:\SEPTICIPERCFORM.DOC SI DATE OF TEST: MAY 9. 2008 0 I L -TEST 0 G APPROVED SOIL EVALUATOR: DAVID D. COUGHANOWR. #461 WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. PERC NUMBER: 12192 NO' TEST PIT I PARENT MATERRIA ENCOUNTE PROGLACA LED OUTWASH PERC AT 70 to - 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING ' 70.50 0-16 FILL 18-20 O LOAM 10 YR 2/2 NONE FRIABLE 20-22 E LOAMY SAND 10 YR 4/1 NONE FRIABLE i • 22-26 A LOAMY SAND 10 YR 3/4 NONE FRIABLE 67.17 26-40 B LOAMY SAND 10 YR .4/4 NONE FRIABLE 40-132 C MEDUIM SAND 10 YR 5/4 NONE LOOSE 59.50 NO GRONCOUNTERED TEST PIT 2 PAARENTU MATERIAL: PROGLAC AL OUTWASH PERC AT 80 to - 2 MIN/INCH IN C SOILS - ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING f 70.95 I 0-12 FILL 12-15 O LOAM 10 YR 3/2 NONE FRIABLE 15-17 E LOAMY SAND 10 YR 4/1 NONE FRIABLE 17-22 A LOAMY SAND 10 YR 3/4 NONE FRIABLE 67.78 22-36 B LOAMY SAND 10 YR 4/6- NONE FRIABLE 38-132 C MEDUIM SAND 10 YR 5/4 NONE LOOSE 59.95 - - -- - -- — ------ - Surtace- (tn:) `_[o�un� - (muusuq.4. __ ..,........6.�.. .._._._, �; Consistency.%Gravel) 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 Map: Above 500 year flood boundary No_ Yes . Within 500 year boundary No V/' Yes Within 100 year flood boundary No✓ 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? If not,what is the depth of naturally occurring pervious material? Certification I certify that on �� �R (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 wit the required raining,expertise and experience described in 310 CMR 15.017. y�jN OF MSSSq DAVID pbrr( C,Mw.�--- 2S Date Signature o D. -+ COUGHANOWR " 0 0 Z/CENSE� Q- Q:\SEpTIC�PERCFORM.DOC /� EVALUP�O L N. w.—JORDO wi Feed THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for Mi.5poaY �&pftem Con0truction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location, A d;ess or Low t No._ `@;, .— g` � � �� Owner's Name,Address,and Tel.No.��—�� Assessor's Map/Parcel a =� c A C er)-t�o I C 5D!R-3�' n4- Ttk-j Installer's Na d Ad ress,a Tel.I�,� G Desi ner's Name,Address and Tel.No. LO Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs gr Alterations(Answer when applicable) �rjTC 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 th. Date ✓` *� Application Approved Date _5 at Application Disapproved by: Date for the following reasons i - Permit No. Date Issued S (0/ `'a -_ -_ ___-- - — --- ----------- ------------..----- - -- - -_- ---- No.J ;)6 c� ." k. �� Feeq/✓� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zpplintion for Migonl 6p5tem Con5trUction Permit Application for a Permit to Construct( ) Repair) Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Locatio�gdreesss or Lost No. `t / ,&n t® �-o I U Owner's Name,Agdrpss,andd Teel.No.�IR"-7-1+" q Y, Assessor's Map/Parcel 1-1� , JL" ccX( ` ,C2f-)-tFU l W Installer's Name Address,and Tel.N '�o 775' 7�o Designer's Name,Address and Tel.No.n�9'� 1 `o� -1 '� l C- [-o �-C Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design,Flow(min.required) gpd Design flow provided gpd Plan Date, Number of sheets Revision Date r Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)�1�1S� Q., `nVt✓ �t�` -Fv aims ` d3,5 �w � �e -�l Ta11ao . 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 Ith. reed Date Application Approved Date �3 ) 8 Application Disapproved by: Date for the following reasons Permit No. c/�-X-'6" )Qc Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS vo-945 Certificate of Compliance THIS IS TO CERTIFY,that the On-site_Sewage Disposal System Constructed ( ) Repaired (u ) Upgraded ( ) Abandoned( �)by �oM -[_:� r c- at V39 c�(�C�� . l b O I �i has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer � Designer #bedrooms Approved design flow gpd The issuance of this permit shall no be c nns�trued as a guarantee that the system wil{(a upc=tion a�gne f O �� U, Date ! 1 Inspector ,C(�/!(//L�y hh --- — a-1CJC"� — � Fee /(J(.J---------------------- ---- No. C7E-J" THE COMMONWEALTH OF MASSACHUSETTS w PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS �Biopo!gaf 6p5tem Construction Permit Permission is hereby granted to Cgns`truct ( ) Repair ) Upgrade ( ) Abandon ( ) System located at W, ., 04),(-- U t- and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special con of conditions. Provided: Construction mu t be co plleetted within three years of the date thi it. Date � 9_3 b Approved V rpm- - Town of Barnstable a.� Rem #€pry Seces Thomas F.der,Director * HaS�ts'��rr y 16.79� Pubic Health DWWan Thomas Herein,Director 200 NIaiu Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 509-790-6304 Installer&Designer Certification Form Date: C—z vow Sewage e'er # �-�- Assess©r's iapLE'arc�e3 `l� a/ ►�l a Designer: co_ e Ittstatiem'� Address: `�J�� LQ.��,�2_ �� Address:_Ga .,,,16kL) C-\ Cc PACCV I' 1 LL'i 6< On c5-- w -vg� t"� �C � gc��as issued a permit to install a (date) (installer) C- septic system at W09. �_Tzt.�V,CQA'I(t�,�se" -ft a design drawn by (address) Cr)- 1 P�": dated (designer) Icertify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 1 Q' lateral relocation of.the SAS or any vertical relocation of any component of the septic system)but in accordance-with-State&1,ocal lZeg�ilatiow_ Plait revision or certified as-built by designer to follow-. �N OF Mgssgc DAVID D. yGm o in (Installer's Signature) CONo.H1093 R N ��G�STE4�O (`o SqN/TAR\AN (Designer's Sigiature) (Af fix Desiggpees Stamp Mere) PLEASE RETURN TO B_ARNST_ABLE PUBLIC EMALT Il-1V7BIQN. CER` MCATE OF COMPLIANCE WELL NOT..BE ISSUED UN7M BOTH THIS FORM AND -AS-BUILT CARD. ARE RECEIVED BY T13E.BARNSTABL E PLYBLIC HEALTH DIV-MON. THANK TOr. r` Q:Health/SeptidDesimer Certification Fo=nn 3-3 `doc I� e _ THE COMMONWEALTH OF MASSACHUSETTS BOAR® A HEALTH— -.------.oF............ .. ... ...... ...................... �� � lirttt�n -fur Utipoiittl Workii C owitrurtion Prrulit 1 Application is hereby made for a Permit o Construct ( or Repair ( ) an Individual Sewage Disposal J�►, system, t• 6 - / o aton-Ad es o L Own Address - _ ----"- ----"------------------ Installer Address UType of Building Size Lot............................Sq. feet Dwelling!No. of Bedrooms.___-___13.. ___-______Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons_..._____________________._- Showers ( ) — Cafeteria ( ) Q' Other fixtures'_ --------------------------------------------- W Design Flow_______________________�._...���aons per person per day. Total daily flow..�.���__--_--_-_-._-.-__gallons. WSeptic Tank.—Liquid capacity/ ons Length---------------- Width................ Diameter__.__...__.____ Depth...-_____--- x Disposal Trench—N ._______..._r.__..___ Width .___._ bel— *nlet Total leaching area_.------------------sq. ft. Seepage Pit No..... .....__.. Diameter__�v_ _°.. Iqe below inlet...t.__....... .. Total leac ling "rea............. sq. ft. z Other Distribution box ( ) Dosing tank ( ) �` I2117��� W Percolation Test Results Performed by......... ----•-------•--•-•----••......•--...--••------•----• ---... Date---------------------------------------- Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water_._.___.._.__.___-_..._. (_, Test Pit No. 2................minutes per inch Depth of Test Pit................. Depth to and water-.__...._____-_.__-_-._. ----------------------------------• --...... -------•------------ -------------- Description of Soil -- • . ---- ---- - . --- • ----------------------- --------------------------------------------------------------------------- --- -------- - W ------------------------------------------------------------------- �•i,G_' ------- �;� 1 x Nature of Repairs or Alterations—Answer when applicable...--------------------------Y U P` / '� --------------------------------------------------------------------------------------------------------------------------------------------`------- fit,- --------- ------------------ -------- Agreement: / The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee sued by the board of health. igned_ . . -- --------------•-------- ----------------------•--------- ^Date Application Approved By---- - ------- -- - f,,t�✓L. / dace// Application Disapproved for the following reasons:......................... --•-------=•----------------------------------------------- ------•-•-------•...............................•---•-----"-"----------------------------•-------.-----------------------------------.--•-----------------------------;4-•--•---------------------•---- j Date PermitNo......................................................... Issued.-L/3/.................................................. Date ca LUCQTION 5EWW:aE PERMIT U0...... tj)J VILLAGE 1t .5- TQLLER5 U&MEN DDRESS , $UILDER 5 IJ L�I�IIE A ® E SS DN,TE PERW-IT ISSUED D ATE COMPLI &MCE ISSUED : — — — �Sec r< o /vj L 1000 5AC ,jr__ OF?HE y`Py y TOWN OF BARNSTABLE o BARNSTABLE, o° 9�p M6 g. Board. of Health A�0 MPY k. FROM THE OFFICE OF Z 1 -. 6z I �Z Fimic THE COMMONWEALTH OF MASSACHUSETTS BOARD 05 HEALTH OF...........&.. , .� l fz_ S--� ........ Appliration -for Uiiipoittl tarkii Tonotrurtion Prrutit Application is hereby made for a Permit o Construct ( or Repair ( ) an Individual Sewage Disposal System t ' I --------- 1<o anon-Ad es 3 0 0. �.. .trr- t_... - ----- - - W Own • Address = G= ---- ----- -----•---------------------•=-----------•-----------••--•------•-••. Installer Address Q Type of Building Size Lot............................Sq. feet U Dwellin No. of Bedrooms------ .Expansion Attic Garbage'Grinder P., Other—Type of Building ------------------ ------- No. of persons----------------------------- Showers ( ) Cafeteria Other fixtures, ---- ------------------------------- W Design Flow....................... ►. ons per-person per day. Total daily flow__ -..............._..gallons. WSeptic Tank—Liquid capacity _ ___ga Ions Le'ngth---------------- Width.----_ _.--- Diameter _.__ -------- Depth. ----_... . x Disposal Trench N __I_'-_,--_:_ Width..._. f... __ _ L_ ength................... Total leaching area------ --- ft. See a e Pit No Diameter___-.f/ F' p elow inlet__. _Total leachin rea.___.___.. sc ft. -.- - P g / - ff g 1. z- Other Distribution box ( ) Dosing tank ( ) + C* �, / ;/? r•. r ' '~ Percolation Test Results Performed by -- �] s ;- ate Test..Pit No 1?...............minutes'per'irich Depth of Test?Pit--___________-_-_-- Depth to ground water------------------------ Test Pit No 2.- ...............minutes per inch ,-D th of Test Pit-----:.............. Depth to and water.-..-.-_-_-.---_-__ --- p -------------------------------- -- •-•-•• •. .. -- -- ------ - Description of Soil------_ --------------...............!` x , - --- V ............. } ��. - -`----------•--------•--.:.__.`--------------•---------------•-------------•-•-------•------------.__..._ - - W --' -' --- -------------------- -------------------------- Nature of el�,epairs or Alterations—Answer when applicable------ _.__.:... . ._.__....._.......____._____.. . ='= - ------------- -=--- ---=`--- ------------•----------------------------------------------- Agreement: TW6 undersigned a;fees to install the aforedescribed., Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operatiomuntil a Certificate of Compliance has been.' sued by the board of health. igned_ ..4_.; _ Application-Approved By--- ------- Date ----•- ---- --- --- -= --- - , �• - t•�,.'_./r_.- ate ---- �: s Application Disapproved for the following reasons:--•----•----------- ------••----••----- --- -------------•----•----------------------------------------------- 1 __________________________________F--------------------------------------- ._____-________-•-----_--•-_--.-_-__.-_______-______-----__-__________-__-•_---_____--____-_ r Date Permit No.---.*,.----------••••• Issued..................................................r Date yk` THE COMMONWEALTH OF MASSACHUSETTS .�. ./ 2 i �! � BOARD<�'� OF HEALTH , ... .......i.,.OF........ .. ............. Ord fira#r of,M mphauri ' . w + �A IS T ERTIFY, That ty Individual age Disposal System constructed K) or Repaired ( ) b �Installe; at _: - -----------•-------------•---------------•------------------ has een nstalled in accordance with the provisions of A e of The State Sanitary Code as described in the application for Disposal Works Construction Permit No_____________ __a �/ --- dated------�___).----�_�-_� ------- THE ISSUANCE-OF THIS CERTIFICATE SHALL NOT.-BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F¢I:NCTION SATISFACTORY. DATE----------- ----------------------------------------------------------------- Inspector-------------- --•---•---•--------------•-------•-•-••••••----•--••--•-----••--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH "' ~' -s1r-3 IS O N t, ;. FEE_ VIC— i� o nl ,i T p#rur#ion rrrmiV m PermissionAl)�, ereby granted,-...N ------ ----------- �� ------------------•-•-- to Constr t r Repair (, an nd dual ewag posal S em at N ' ........__._. as shown on the application for Disposal Works Construction Per, o.... "-' ated--- __ 7 - , rs DATE_f-�, ,t� ----- " ----- FORM IZ HOB.BS. & WARREN. INC.. PUBLISHERS , r: J. CONTOURS � o EXISTING - - - - - - - 50 0 ~ BENCH MARK o r \ MINIMAL GRADING PROPOSED �,� o PAINT SPOT ON � � Locus BITUMENOUS WALKWAY X 0 ELEVATION = 70.89 71''/ \ GARBAGE GRINDER o N �0 3 BARNSTABLE GIS DATUM t � \ IS NOT ALLOWED W �o oT J + m �50a�' WITH THIS DESIGN. H<J � � �� y � h O OW< mJ(D i CENTERVILLE. MA y� �; LOCUS MAP w a< NOT TO SCALE :;:;:;:r;:r, � 69 m z ;,;::,:,:,,,:. z 24 Ft. x 125.f t x f t o U :>;:s:>:>:>;>:; / ;:.:;:.,. w < LEGEND w �, :;:;:>:>:.>:>:. ui << y LEACHING �CLERY / it w O a a o > o� 1 1 1 TP `a EXISTING ~o _ju°� �J z 3 �° N q p O / `a 1008 GALLON )-9 <cn<-. <W W CO I oo SEPTIC TANK W W W x U I � O 31)((D I d b 12-0� LJ 20-0 Is-oi I / ` EXISTING LEACH o <� L� 4)X a OZ N = 68 I O ; PIT/CESSPOOL a C) C7 z [w < W Q W W 1 I 2�� e0) 0 m mF ��1 v o I �� TEST PIT D-BOX O W= Wo z N l__1 W 1 I TP-1 �� I b12-D LOT 43 / \ W a u w :;:,:;;: m �� \ DRAIN 19 AREA = 21678 --F �- m <o : J w "'`''''"' / / ` DECIDUOUS CONIFEROUS �Idj }:;;;:;: I z �m v ;;:}:;: / r s9 TREE qOp TREE Lu W W O< X q 67 / "N`� / / ` WWb 12-M �12-P O Wz Q m (0 N I / / L �,� � (p u),� / XI� O M 68 -NUMBER REFERS TO DIAMETER IN O (I W L� � __ I / E" O / / INCHES. LETTER DENOTES TYPE. W (nw p `O I INE OF, INC, / 67 O-OAK M-MAPLE P-PINE C-CEDAR �� u Eo / GA5 t. / 3 8 �'� / w z �� E� a-LZ x ow FUDM �� on / 5 / 0� z W? j \ E P, �� / � s�`��jNOFM4,9. F3'jµOFj�Ssy W �c� WPC / / �� 1,00' / �o� DAVID yG�c� °�� DAVID c��N j a z z �, IpRI`1 / o D. o D. Lu o w= COUGHANOWR N c, w cn o 3 + „ u I P P\ + / / / No. 1093 COUGHANOWR W L m Z LCl N \ \� / / // / �R �� cS' /�/ O`O W tD v \ / G/STEM O CENSE Q _ U w / \ — / / /�/ / S-IN AR EVA Ld O \ Mu i WII W W Z 0\ / TE SEWAGE DISPOSAL SYSTEM PLAN J z J (� 0 z \ \ �03?9 / �� �`y -TO SERVE EXISTING DWELLING LL 3 <Q z � j P 0pl� EST. HENRY AND JUNE VAGTS O Z 0 (o m U ` �./� E� CLIENT acn I,, : / f P � 139 WHITE OAK TRAIL co X / I= / OF �� 1995 ��' CENTERVILLE. MA n 0 + LLJ LLI ` v9`` / k /�p ��®N��i� PROPERTY ADDRESS Ln m / FLAN ASSESSORS MAP 19 2 PARCEL 19 2 43 TRIANGLE CIRCLE / SANDWICH MA 02563 LAND COURT PLAN 32373 F 0 p �( SCALE: 1 In = 20 FL 508 364-O894 DATE: MAY 12. 2008 W X w w \\ i` r 20 0 Z0 40 JOB #E T E-2 9 2 0 PAGE 1 OF 2 VERSION: Pj THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED. I 10 Za SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING PLACEMENT OF ADDITIONS, SHEDS, FENCES OR SWIMMING POOLS. OWNER • SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. f. DATE TEST: MAY 9. 08. SOIL TEST LOG APPROV DFSOILEVALUATOR: DAVID DOCOUGHANOWR. #461 DESIGN -CALCULATIONS WITNESSED BY: DONALD DESMARAIS, HEALTH DEPT. PERC NUMBER: 12192 DESIGN FLOW: 3 BEDROOMS X HO GPD = 330 GPD TEST PIT 1 NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS PARENT MATERIAL: PROGLACIAL OUTWASH USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL PERC AT 70 in - 2 MIN/INCH IN C SOILS CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) ELEVATION DISTRIBUTION BOX: USE 3 OUTLET D-BOX. DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOIL ABSORBTION SYSTEM: A 24 Ft_ x 12.5 Ft. x 2 f t LEACHING GALLERY CAN LEACH '�0.50 (INCHES) HORIZON TEXTURE (MUNSELLI MOTTLING 0-18 FILL A6ot. = ( 24 x 12.5 1 = 300 sf A s d w = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 sf 18-20 O LOAM 10 YR 2/2 NONE FRIABLE Atot = 446 sf Vt 0.74 x 446 = 330.04 GPD 20-22 E LOAMY SAND 10 YR 4/1 NONE FRIABLE USE A 24 Ft x 12.5 ft x 2 Ft_ GALLERY. Vt = 330.04 GPD > 330 GPD REQUIRED 22-26 A LOAMY SAND 10 YR 3/4 NONE FRIABLE 67.17 26-40 B LOAMY SAND 10 YR 4/4 NONE FRIABLE 59.50 40-132 C MEDUIM SAND 10 YR 5/4 NONE LOOSE LEA CHI NG GALLERY 1000 GALLON SEPTIC TAW DIMENSIONS AND DETAIL NO T TO NO GROUNDWATER ENCOUNTERED USE SHOREY PRECAST 500 GALLON NOT TO USE EXISTING H-10 UMT SCALE TEST PIT PARENT MATERIAL: PROGLACIAL OUTWASH LEACHING DRYWELL (H-10 LOADING) SCALE PERC AT 80 to - 2 MIN/INCH IN C SOILS SEPTIC B PUMPED D CONSTRUCTION DETAIL AT TIME OF INSTALLATION AND IS TO ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER BE EXAMINED FOR STRUCTURAL DRYWELL UNIT STON7 INTEGRITY. INSTALL NEW PVC OUTLET 70.95 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING TEE EQUIPPED WITH A GAS BAFFLE. 0-12 FILL 24.0 f t cc] I in 12-15 D LOAM 10 YR 3/2 NONE FRIABLE m` .4i TAPER 15-17 E LOAMY SAND 10 YR 4/1 NONE FRIABLE (4- m Lo c 17-22 A LOAMY SAND 10 YR 3/4 NONE FRIABLE N `Q ` N o 0 6 .�8 22-38 B LOAMY SAND 10 YR 4/6 NONE FRIABLE �4 c 36-132 C MEDUIM SAND 10 YR 5/4 NONE LOOSE Q_ 59.95 3.5 f t 8.5 f t 6.5 F t .5 f t Un 24.0 FL � L� GROUNDWATER ADJUSTMENT e {£-61n EXISTING GROUNDWATER LEVEL 500 GALLON DRYWELL BASED TOWN OF RSTABLE GIS DEPARTMENT RECORDS. DIMENSIONS AND DETAIL S. COVER OUTLET COVER INDICATED G W 35.00 USE H-10 IJVIT INSTALL ONE INSPECTION 3 IN DROP INDEX WELL SDW-252 RISER TO WITHIN THREE —► /l FLOW LINE 1 ZONE C INCHES OF FINAL GRADE FROM READING DATE APRIL. 2007 AND INDICATE LOCATION BUILDING le,n 14 READING 46.9 ON AS-BUILT PLAN 1n D- BOX 48 in r ADJUSTMENT 2.0 LIQUID GAS f ADJUSTED GW 37.00 LEVEL BAFFLE V . .� I o p 33 ) O TES+ DOp p0�1�1 In oo�000 oo°o°o° N INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 000000�aooao CROSS SECTION VIEW 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED oo �j0 FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. 1021n 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES CROSS SECTION VIEW BEFORE EXCAVATING FOR SYSTEM. 2 in PEASTONE 2 to PEASTONE SEWAGE DISPOSAL SYSTEM PLAN 5) EXISTING LEACH PIT TO BE PUMPED. AND FILLED OR REMOVED. 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. KF -TO SERVE EXISTING DWELLING 28 3/4 u TO TIVE 4 ui TO 26 7) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES In 1n HENRY AND Jl_1NE VAGTS AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. 8) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT 46 in 58 in 46 in 139 WHITE OAK TRAIL CENTERVILLE. MA ' 150 in PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. ECO-TECH ENVIRONMENTAL 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL INSTALLER MAY SUBSTITUTE AN APPROVED GEOTEXTILE STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH FABRIC IN PLACE OF THE 2 in. PEASTONE LAYER SPECIFIED. 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. ETE-29201 MAY 12. 2006 1212