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HomeMy WebLinkAbout0040 WILTON DRIVE - Health 40 Wilton Drive Cenetrville A= 209- 078 S M EAe No.2-153LOR UPC 12534 smead com • Made In USA No, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS fipritation for 11isposal 6pstrm Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System 06ndividual Components Location Address or Lot No. yQ i i6Q, Owner's Name,Address,and Tel.No. cj 4 -9% Assessor's Map/Parcel Conte-rulL Map �v � �jo� . 1� 3P_ Installer's Name Address,and Tel.No. ,i$ - y�8' oZ� A Designer's_Name,Address,and Tel.No.,JOS•-Yc� -ts (3yef. c,�V�` -fib M� S�i1C�.4° ri35t o'�bit.o'' '• ) B c3CCv`7 Type of Building: Dwelling No.of Bedrooms Lot Size �oo,'j�7 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3�9 gpd Plan Date N JAI L,13 '}O 19 Number of sheets 1 Revision Date Title ;+n Bie P .q9L YO 05" ra Size of Septic Tank 106oaaa Type of S.A.S..k, Description of Soil KV/+e 1 C' Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environments a an of to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe - Date1 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued �j_C W�� } i� 1(96 No NFee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for Misposal 6pstettt Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System N11ndividual Components Location Address or Lot No. yO(� } Owner's Name,Address,and Tel.No. J 4 e'er rv�`lr�' uh .Qiayrn t =awl►1 h�c �Pt o/• UCJ>( r�1Dr: Assessor's Map/Parcel. 69 , Installer's Name,Address,and Tel.No. 41.28- ";t6 Designer's Name,Address,and Tel.No. ' +atatfi.Qpr4irLc t-:31 art qs-Tr,,-A"4 Ll�. 14 �)���e .r e.Ylf�2/tr. 3�r st- !K c A41k 0,avuS Type of Building: Dwelling No.of Bedrooms Lot Size /D7�r� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 0 gpd Design flow provided gpd e•Plan Date Or inn a 13 3.6 19 Number of sheets i Revision Date TitleQ_ Size of Septic Tank 4X1e,1ktAq Type of S.A.S. ,', Description of Soil ,, u�:; j�,c+, r Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore descr- ibed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code an of to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed - Date Application Approved by Date /ft.'' Application Disapproved by Date for the following reasons Permit No. 0 Date Issued , --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CCERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by at �U{�),�i }�, � �p��,r.1, b, ,,p has been constructed in accordance o� with the provisions of Title 5 and the for Disposal System Construction Permit No. 01- )'�L3dated Installer ����{�; Designer ap , 1� G # � J bedrooms j Approved design flow � -, gpd The issuance of this permit shall not be construed as a guarantee that the system will functions designed. { Date i t �f Inspector ,✓ .[!t /1 I ---------------- ----------------------------------------------------------------------C--------------------------------------------- No. O d Fee rG� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem.Construction pertnit Permission is hereby granted to Construct!,( ) Repair(N Upgrade( )) 7 Abandon( ) ,, System located at 1/ � ® 1 t_P ! n �n l n, r i (/ o and as described in the above Application for Disposal System Construction Permit. The applicant-recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. / ^ Provided:Construction must be completed within three years of the date of this permit. Date (g�—(� 1 Approved by /Ins 1_L Town of Barnstable �+ � E' •� Regulatory Services �. Thomas F.,Geiler,Director * BAMSTABM s MAS& Public Health Division a6;q. En " Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: if Sewage Permit# !f!!�g/!q 7,7 2?Assessor's Map\Parcel Z 7t Designer: u w r` C t 'i Installer: �4Y' to p — U Q Address: 9 3 Q MC( V t' Address: 6, C� M 0 L-1A faL 4.t cf.r On -/ -/ / s /o��< '�g�rl��,l lovas issued a permit to install a (date)' (installer) septic system at qd w; �0,_ � n Ve based on a design drawn by r (address) Gt�►• 2,� 6- o-1 a PZ A.S dated / (desi r) V I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved.changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. ����ZN OF,ygSsq o DANIELA. yes o OJALA qq&lks Signature) " CIVIL N No.46502 G/STER�Ga�� S10NAL EN (Designer's Signature) J (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE. PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLUNCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE " RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc TOWN OF BARNSTABLE LOCATION 46 61 fr�dN�(�_ SEWAGE# -IPU�- VILLAGE -�l�l`z��^ri,/�� ASSESSOR'S MAP&PARCEL ' INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY eF)r I C�'�i� f.066 LEACHING FACILITY:(type) `"i 4Z&1 6J4--- (size) "Ic ice- ' f;;' 4 44, NO.OF BEDROOMS - OWNER PERMIT DATE: >- I COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY par,i C c/Js �i�oevsvn i x Q JV i�w O . • oRECEIF. 'p p Doinestic Mail • NOFFICIA 0 Certified Mail Fee Er �- $ Extra Services&Fees(check box,add fee as appm �P ❑Return Receipt(haMcopy) $. _a�\5 ,r^ ❑Retum Receipt(electronlq) $ ...lY` po a p r_ p ❑Certified-Mail Restricted Delivery $ ge , ,G- O []Adult Signature Required $ Jo p []Adult Signature Restd -cted.Delivery$ � QvJ- Pgy PRYOR, WILLIAM H II &GIGL' `�j _ 40 WILTON DRIV :V p; ` CENTERVILLE, MA 0202 r� r r rrr — - Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail 1�*nsurance A unique identifier for your mailpiece. associate for assistance.To receive a duplicate Electronic verification of delivery or attempted return receipt for no additional fee,present this- delivery. USPS®-postmarked Certified Mail receipt to the A record of delivery(including the recipient's retail associate. u signature)that is retained b the Postal Service"' -Restricted delivery service,which provides for a specified period:j delivery to the addressee specified by name,or tY a�+ •�- to the addressee's authorized agent. -1 fiReminders. Adult signature service,which requires the 3a naypurchase Certified Mail s -E signee to be at least 21 years of age(notClass Mail®,first-Class PackagENe ® available at retail). o Priority Mail®service. "a Adult signature restricted delivery service,which Certified Mail;service is notavailabie for requires the signee to be at least 21 years of age•, international,tnail. qj and provides delivery to the addressee specified'I Insurance coverage Is notavailable for pu by name,or to the addressee's authorized agent with Certified Mail service:However,the purc; a (not available at retail). r_jof Certified Mail service does not change tl,�> a To ensure that your Certified Mail receipt is coverage automatically included1with accepted as legal proof of mailing,it should bear a-' certain Priority Mail items. USPS postmark.If you would like a postmark on 1 '- ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for F the following services: postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion- of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. t.Z electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. PS Form 3E00,April 2015(Reverse)PSN 7530-02-000.9047 COMPLETE • • . ON DELIVERY ■ Com fete items i„ nand 3. ° #{ € f ;It, tt 7 (t�i{ } ■ Prinfyourname p�addresson� {!'€I. !�... !�"` I. so that welcarixe rn the card to ■ Attach this card to the back of the mailpieee; I ° neceivea oY7Nrtnreti IVameJ"T'-C�Da#e elivery or on the front if space permits. .JC a ss different from item 1( Ye ivery address below: p No I tYOR, WILLIAM H II &GIGLIOTfI, FILOMENA A�`:" 40 WILTON DRIVE - CENTERVILLE, MA 02632 ; i�servlce`lype �' ❑Priority Mail Express® I II I IIIIII IIII III I II IIII'III I(III I II II II I}I II I III ❑0 Adult Adult Signature Restricted Delivery ❑Re.stered Mail Restricted 9590 9402 4798 8344 8567 69 WCertified Mall® Delivery ❑Certified Mail Restricted Delivery Return Receipt for ❑Collect on Delivery Merchandise `2_Arti_rle-NumhPr_?ransfar_frnm_ca. ;�a_t.i en n_r-u—+^n Delivery Restricted Delivery ❑Signature ConfirmationTm ll 7015 1730 0001 4987 7600 ail ❑Signature Confirmation ail Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt USPS TRACKING# First-Class Mail I Postage&Fees Paid USPS Permit No.G-10 9590 9402 4798 8344 8567 69 United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service g Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 i i I� Town of Barnstable Barnstable P` ti ° Inspectional Services ;eficaC'' BAF2Nb ABLE, MASS. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7800 May 17, 2019 F' PRYOR, WILLIAM H 11 &GIGLIOTTI, FILOMENA 40 WILTON DRIVE CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 40 Wilton Drive, Centerville, MA was inspected on 05/10/2019 by Frank Nunes III, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH /�Zfci Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\40 Wilton Drive Centerville.doc Town of Barnstable 9�BARNMEILF, Inspectional Services Department fD MA'S Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE 1 YEAR DEADLINE CRITERIA tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to 11-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts 0?0 13— 0'�7_6? - F Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Wilton Dr. Property Address '1`S Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 Yt page. City/Town State Zip Code pate of Inspection t ' yF{ Inspection results must be submitted on this form. Inspection forms may not be altered !many way. Please see completeness checklist at the end of the form. A. Inspector Information t312liC4-._ Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 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 1 have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 5/10/19 Inspector gnature 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 Commonwealth of Massachusetts ,9 Title 5 Official Inspection Form I' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 page. Cityrrown 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: 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 - ,9 Title 5 Official Inspection Form 1' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 page. Cityrrown 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 FIND (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 r Title 5 Official Inspection Form le Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wr? 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 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 1 f f w r r' r I . 00 feet o a surface water supply o tributary to a surface Ovate supply. PP Y rY PP Y ❑ 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 ® El clogged 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 r� Title 5 Official Inspection Form I° Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 page. Cityrrown 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. ❑ ® An portion of a cesspool or privy is less than 100 feet but greater than 50 feet YP P P Y 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 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 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? ® El available 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 G Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 page. Cityfrown 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: Number of current residents: 2 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: Occupied Date 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts - ,p Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Wilton Dr. Property Address Pryor Owner Owners Name information is required for every Centerville MA 02632 5/10/19 page. Cityrrown 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: Pumped last September per owner 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 (0 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 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: 1994 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): 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 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) 6. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) H-10 tank appears to be structurally sound If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: 31' Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness trace-1/2" „ Distance from top of scum to top of outlet tee or baffle >2 Distance from bottom of scum to bottom of outlet tee or baffle >2° How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doe-rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Iig Title 5 Official Inspection Form jn Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 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 I b Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 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 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 flooded at this time t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 page. CityrFown 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: 1 ❑ leaching chambers number: ❑ 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 ,9 Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 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.): Leach pit is 2'6" below grade and is in a state of hydraulic failure at this time, effluent is to the very top of the pit 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 ' I Commonwealth of Massachusetts ro Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 page. Cityrrown 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 ,9 Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 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 CN1(O Y 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 a Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 page. Cityrrown 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: 14' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record N/A 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: Previous inspection reports on file ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping You must describe how you established the high ground water elevation: Site is at 40'msl and nearby surface water is at 26'msl 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 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Wilton Dr. Property Address Pryor Owner Owner's Name information is required for every Centerville MA 02632 5/10/19 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 e pRIVE WILTpN N 8929 h� (� MAP 209 N 0ti v! PCL. 67-2 � 11 Q �0 N i N � O_ v\S��N Z6 0 PR pECK N � i Z• 91'' o cp cT 2 0 � r Q N MAP 209 1i1 LOT 12 \ PCL. 44 10,577t S.F. (0.24t AC.) 5 'i�•33 3 \ MAP 208 PCL. 54 SITE PLAN LOCUS 40 WILTON DRIVE BARNSTABLE (CENTERVILLE), MA ���I"OF,yySsgc �o JOHN yam REF PLAN BOOK 146 PAGE 23 Z. DEMARE5T,JR '' CA o PLAN PREPARED FOR 90 �,No. 36859— q ESs\ oQ� WILLIAM & FILOMENA GIGLIOTTI �Z2�8 DATE RE ND SURV OR SCALE 1"=30' DATE 5/22/2018 DEMAREST LAND SURVEYING ASSESSORS MAP: 209 PARCEL 78 338 MAYFAIR ROAD SOUTH DENNIS, MA 508-364-9049 FILE=18074.DWG f - _ r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments N 40 Wilton Drive, Centerville M -209 P -78 ✓ _ °°+ Property Address — Greg Curtin _rA Owner Owner's Name + information is +..n required for every 809 Creswell Court, Knoxville TN 37919 April 2, 2015 page. City/town State Zip Code Date of Inspection + Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information n l on the computer, use only the tab 1. Inspector: key to move your cursor-do not Troy Williams use the return Name of Inspector key. Troy Williams Septic Inspections Company Name 19 Hummel Drive _ Company Address South Dennis MA 02660 Citylrown State Zip Code (508) 385- 1300 S1682 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority April 2, 2015 Inspector'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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in th uture under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive, Centerville M-209 P-78 Property Address Greg Curtin Owner Owner's Name information is required for every 809 Creswell Court Knoxville TN 37919 April 2, 2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•W3 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive, Centerville M -209 P-78 _ Property Address Greg Curtin Owner Owner's Name information is 809 Creswell Court Knoxville TN 37919 Aril 2, 2015 required for every � p page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Wilton Drive, Centerville M -209 P-78 Property Address Greg Curtin Owner Owner's Name information is 809 Creswell Court, Knoxville TN 37919 April 2 required for every p �il , 2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Wilton Drive, Centerville M -209 P-78 _ Property Address Greg Curtin Owner Owner's Name information is 809 Creswell Court, Knoxville TN 37919 Aril 2, 2015 _required for every p page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive, Centerville M -209 P-78 Property Address Greg Curtin Owner Owner's Name information is 809 Creswell Court, Knoxville TN 37919 April 2 2015 required for every p � , page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface Y sewage disposal systems? P The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 40 Wilton Drive, Centerville _ M-209 P-78 Property Address —— Greg Curtin Owner Owner's Name --- information is 809 Creswell Court Knoxville TN 37919 A 2 required for every April , 2015 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 14=38,000 gals. g ( y g (9p ))' 13=36,000 g_als. Detail: Sump pump? ❑ Yes ®�No Last date of occupancy: Nov. 2014 Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/A Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A _ __ t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive, Centerville M -209 P -78 Property Address Greg Curtin Owner Owner's Name information is 809 Creswell Court, Knoxville TN 37919 April 2, 2015 required for every p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/ADate Other(describe below): N/A General Information Pumping Records: Source of information: No pumping info was available. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 8 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 40 Wilton Drive, Centerville M -209 P-78 Property Address — Greg Curtin Owner Owner's Name information is Creswell Court, Knoxville TN 37919 April 2, 2015 required for every 809 C P _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Tank, d-box and leaching were installed on 12/12/94 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"+ — feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): ---- Distance from private water supply well or suction line: feet - Comments (on condition of joints, venting, evidence of leakage, etc.): Lines were clear at the time of inspection. Septic Tank(locate on site plan): _ Depth below grade: 1'feet - Material of construction: .® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'X9'X6' 1000 gallon -- ---- 4" Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .'' 40 Wilton Drive, Centerville M-209 P-78 Property Address Greg Curtin Owner Owner's Name information is required for every 809 Creswell Court, Knoxville TN 37919 April 2, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2' 8" Scum thickness thin layer Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? probe/measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts p Title 5 Official Inspection Form _ s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive, Centerville M -209 P-78 Property Address Greg Curtin Owner Owner's Name information is 809 Creswell Court, Knoxville TN 37919 April 2, 2015 required for every --- page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A _ Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Capacity: N/A p gallons Design Flow: N/A gallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments(condition of alarm and float switches, etc.): N/A *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Wilton Drive, Centerville M-209 P-78 Property Address Greg Curtin Owner Owner's Name information is 809 Creswell Court, Knoxville TN 37919 April 2 2015 required for every P , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level 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 was found level and in working order. 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.): N/A *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive, Centerville M -209 P-78 Property Address ---- Greg Curtin Owner Owner's Name --- inform ation is 809 Creswell Court, Knoxville TN 37919 April 2 required for every p �il , 2015 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 -4'X6' pit with 3' of stone_ ❑ leaching chambers number: ❑ leaching galleries number: ---- ❑ leaching trenches number, length: — ❑ leaching fields number, dimensions: ----- ❑ overflow cesspool number: -- ❑ innovative/alternative system Type/name of technology: —.- Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was dry on inspection with a visible stain line approx. 18" below the inlet invert. No evidence of hydraulic failure or problems in the past were found at the time of inspection. _ Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A — -_ Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive, Centerville _ M-209 P-78 Property Address Greg Curtin Owner Owner's Name information is 809 Creswell Court Knoxville TN 37919 Aril 2 2015 required for every � p , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A Privy (locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Wilton Drive, Centerville M -209 P-78 Property Address Greg Curtin Owner Owner's Name ------ information is 809 Creswell Court, Knoxville TN 37919 A _ requiredd for every April 2, 2015 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A g OG I � 7 `�`' i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts -- W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY 40 Wilton Drive, Centerville M -209 P-78 Property Address Greg Curtin Owner Owner's Name information is required for every 809 Creswell Court, Knoxville TN 37919 April 2, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 13.0'+ 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: MIW 29 Zone D 7.3' 2.7' adjustment You must describe how you established the high ground water elevation: Hand augered 5.5' below bottom of leaching with no water found at a depth of 12.0'. Groundwater adjustment at the time of inspection was 2.7'. Bottom of leaching at 6.5'was found not to be located in the high groundwater elevation at the time of inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 40 Wilton Drive, Centerville _ M -209 P-78 _ Property Address Greg Curtin _ Owner Owner's Name information is 809 Creswell Court, Knoxville TN 37919 April 2, 2015 required for every p —.__— page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 ��" fi f � //f/j /// ' 7. �� �� , ��� .� � �1��'`�, j�. ,�`r,.� �, � _ _ J� .� � :y ..�.._ �_ 7 f ��� C&��� 1_' „(_ i 1 , Commonwealth of Massachusetts W� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is required for Centerville MA 02601 2/13/09 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms the I computer, r, use 1. Inspector: only the tab key to move your Carmen E Shay cursor-do not Name of Inspector use the return key. Shay Environmental Services, Inc. Company Name rab 185 Ashumet Road Company Address Mashpee MA 02649 emw City/Town State Zip Code 508-539-7966 3080 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority f 2/13/09 _' Inspector's Signature Date The system inspector shall submit a copy of this inspection report to th" µ" vr �A ity (Board of Health or DEP) within 30 days of completing this inspection. If the sys ee s#� r ' system or has a design flow of 10,000 gpd or greater, the inspector and the system o 11 submit the E. report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. I L 18 f U� 40 Wilton Drive,Centerville•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is required for Centerville MA 02601 2/13/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/ always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: leach pit has 2.5' Liquid., 4' stain line noted. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 40 Wilton Drive,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is required for Centerville MA 02601 2/13/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 40 Wilton Drive,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is required for Centerville MA 02601 2/13/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 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. 40 Wilton Drive,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is required for Centerville MA 02601 2/13/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 40 Wilton Drive,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W(CIL Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \a 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is required for Centerville MA 02601 2/13/09 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ® ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ 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)] 40 Wilton Drive,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is required for Centerville MA 02601 2/13/09 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 330 GPD Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: None Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/person s/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 40 Wilton Drive,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is required for Centerville MA 02601 2/13/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Board of Health Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe).- Approximate age of all components, date installed (if known) and source of information: 1981-BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No 40 Wilton Drive,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is required for Centerville MA 02601 2/13/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2 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.): No evidence of leaks, plumbing properly vented Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1,000 gallon tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 5' x 8' x 5' Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness 1/2 Distance from top of scum to top of outlet tee or baffle 4 Distance from bottom of scum to bottom of outlet tee or baffle 14 How were dimensions determined? Measured 40 Wilton Drive,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is required for Centerville MA 02601 2/13/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): inlet tee and outlet baffle in good condition - no evidence of exfiltration or infiltation 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.): 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): 40 Wilton Drive,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is Centerville MA 02601 2/13/09 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert D-Box Present 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.): one outlet to pit-in fair condition-no cracks or leaks noted Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 40 Wilton Drive,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is required for Centerville MA 02601 2/13/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 6'diam x 6' D ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS fuctioning properly, 2.5' liquid in leach pit. 2' effective depth available per stain line. Cover is 3' below grade. 40 Wilton Drive,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is required for Centerville MA 02601 2/13/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): 40 Wilton Drive,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is required for Centerville MA 02601 2/13/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) , Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 7 U3 L �t�G F)- O 3 0 1 CO Mo C� Ton►� 40 Wilton Drive,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 40 Wilton Drive Property Address James Murphy Owner Owner's Name information is required for Centerville MA 02601 2/13/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: more than 13 feet 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: El Checked with local excavators installers- attach documentation ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Inspector has performed perc test on adjacent street. GWI @ 14+ BLS 40 Wilton Drive,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 No..... ' _:_ .y F.RB..... ... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dhrip ial Wor1w Tou.6trurtioii rumit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: /� 0..... f L�O dV--_..�.d"i v� Location•Address or Lot No. ---• •�C?!^tic ....-•----1=AN-�-------------------------------- ------------C'_�u 'T' �r-a,t:�-��&'`- Oe ncr Address a ° 1w�D-.- �.� � Y ---------------------------•----- Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms----- ----------------------_-------_...Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- - - W Design Flow.--..---.-.-�5--7�5----------------- --gallons per person per day. Total daily flow_....??3-.Q..--.--------_.._..---..gallons. tx Septic Tank 1 Liquid capacity. =gallons Length----- Width--. Diameter..--............ Depth................ x Disposal Trench— No. ___--------------- Width-------------------- Total Length.................... Total leaching area-_..................sq. ft. i------------- V�....... Depth below inlet.... ........... Total leaching area..................sq. ft. Seepage Pit No...... ..__. Diameter..._ . _ Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ a Test Pit No. I.-..----___---minutes per inch Depth of Test Pit-................... Depth to ground water.....................,... f1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 •-••---------•---------------•-•------------•-•-•--..........._..••---------.....-----------•------.....------------•-----......._.............---------..... 0 Description of Soil..............•--•-•------------•--...........-•-•-•-•----•-•--•-•--•--•-•-•---...-•--------••------••••--------•-------------•---------------•------------------------- x U W ............... ---------•--•---• ---------------------------------------------------------------- ----------------------------------- -------------------------------------------------------------- UNature of Repairs or Alterati ns—Answer wh n appI cable.�wU�zTl4l 1---f�Q(�_ ��7 f_L7 4'-�-__---.-.-. -----------------0:t­6d4-•--...... -3-----.57 ----------------------------........---•-•-----------•--------..........--------------• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is board of Vealth. J G Signed ........... ..... ..... . ....... ------- L:Y Q Ihce Application Approved By --------�• .n� � - .-..- - -t-� Date Application Disapproved for the following �earons- --------------------------------...-----------------------------------------------..-.-......_.............-.--...-....-......... ...................................................._....................-....................-...................._.......................-......-........................................................ ---------------- .._.............. Dace Permit No. '.--� ;k y-------------------------- Issued ----------------1 `I ................. Dace ..----------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p' TOWN OF BARNSTABLE Certifir?XtQ l!..�� of IJ.IImplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired b Insrnlle at ....... ..-.......................................................... 0---------(.,v ------------_-.-_-......------------------.-.----------------------.------------------------ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------ -- dated .-------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT 1315 CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--. -... f` / Lid/ .� ' -''h' . I - fInspector--- - -------F.. .... ------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No 5.2� Permission is hereby granted -' --`---�------C t - . to Construct ( ) or Repair (J_J--j'n Individual Sewage Disposal System atNo.....................................................`J.0 6 /2.L 7 =`t= Q''� "-' --------------------------------•------------------•--•---............-- Street as shown on the application for Disposal Works Construction Permit No. .� .--- Dated......� ...- - ..-.. :.- ----•-------------------••----•-- _ ---Hea-•----lth-----------------------------------------_--- C� � Board of DATE. '. ..- ---•{ /---------------------------------------- FORM 36508 HOBBS 6 WARREN.INC...PUBLISHERS Fr�s....--5..r ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Uivj-puuttl Work.6 Tunitrnrtiun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: n .iLro�v U � ....................... --•---------•---------------------•-...........---- -•-••-----------------•---•-----------------••----•-••--•----•----••----••--..........•---.....--- Location-Address or Litt No. Owner Address Installer f' Address UType of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms-----S----------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeterias( ) _ dOther fixtures -------------------------------------------------------------•---•--------------------- -----•------•-•----------------------------------•••--------. W Design Flow......._.__..S . _ _. gallons per person er day. Total daily flow._---�3.©-__•------------------ lons. g -- ------------------g P P P Y• Y � WSeptic Tank Liquid capacityl(W_galIons Length---.��..__--_-- Width.--57-------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No...... ....... Diameter._-- --------- Depth below inlet----- ._.......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results, Performed by.......................................................................... Date........................................ Test Pit No. 1_________ ____minutes per inch Depth of Test Pit.................... Depth to ground water........................ GTo Test Pit No. 2...........\.._minutes per inch Depth of Test Pit.................... Depth to ground water-----___-_-_-___-----__. Rr' ----------------------------•-------------------------------------------------_-•--- --- 0 Description of Soil-----------------------%....-------•--•---•---•-------------•--•......•-----------... V ---------------------------------------------------------------------------------•-------------------------------------------------....----- W U Nature of Repairs or Alterations—Answer whjn applicable.-;;;Zu,.,G`I:tll_(.-L_-. ............ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to, place the system in operation until a Certificate of Compliance has been issued—by—the board of Vealth. Signed ----..... ...... ..... ......."....".�-...` --------- ---- .���'. : �! Dare e �... ......------- ----------- ------------- ------------------------------ -- ---Application Approved By ...._-----. - - s......... ..............................................Application Disapproved forthe followi a ..l. / . ......................................... ... . . ......................................... ................................ .. .. .... ............................... -------............................... 7 Permit No. ---- 7 vim-y-------------------------- Issued --------------..... -.(.a .-- .C�_ Dare 1'a...- Dace TOWN OF BARNSTABLE LOCATION 140 SEWAGE# q4_VILLAGE ASSESSOR'S MAP&PARCEL ZOO INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) A (size) r-to QCA NO.OF BEDROOMS OWNER VADQQ PERMIT DATE: "rx-0A L� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Jr�' Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching-facility) Al 16, Feet Edge of Wetland and Leaching Facility(If any wetlands exist. within 300 feet of leachin facility) Feet e FURNISHED BY S AAY TOWN OF BARNSTABLE W, LTDly SEWAGE # I`— 1 VILLAGE �.�t/VTCc���6"p ASSESSOR'S MAP & LOtP,*f INSTALLER'S NAME & PHONE NO. cA � .{Q6C .SEPTIC TANK CAPACITY 00 O (1 Lyu LEACHING FACILITY:(type) (size) S6E,6 ,61 NO. OF BEDROOMS _PRIVATE' WELL OR Pi�BL�E T / BUILDER OR OWNER— t-c)NAA ,.4-$ — n( DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: At<lV-v-,.- � VARIANCE GRANTED: Yes No ram, ; �a t \ 4 � } LOT .1,I O. :�� ADDRESS :- OWNERS NAME : - SEWAGE PERMIT NO. : NEW: REPAIR: DATE. ISSUED: DATE INSTALLED: IASTALLERS NAME; INSTALLATION OF: WATER TABLE : FINAL INSPECTTO.N. BY : DiIAIr'ING OF INSTALLATION ON REVERSE SID?: : . C VON W1LT� �(�f VLF' i L LAG k ASSESSORS MAP No. `-Z0 ___�_------Cc—N�?v,LL PARCEL IN 8,U I L D E R OR OWNER 4 { U E I� E � � I I I - D •,,1. __.Y.e�d l�.i"v� Q.► _ t �� �,, AsBuilt Page 1 of 1 TOWN OF BARNSTABLE J �1 LOCATION �7 W , t-TofV pr 1-c_- SEWAGE # VILLAGE �'�VL-'~�vv fl,� ASSESSOR'S MAP & LOT,;'G —,07 INSTALLER'S NAME & PHONE NO.f SEPTIC TANK CAPACITY 1 C�0 0 <<o✓U LEACHING FACILITY:(type)_Me ocis — (Size)� % NO. OF BEDROOMS PRIVATE: WELL OR BUILDER OR OWNER- -r V\ A A S ��', 1,cam( DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: /,/�I/J2. - VARIANCE GRANTED: Yes No il__� cy .I` "1 r -,. . f http://issgl2/intranet/propdata/prebuilt.aspx?mappar=209078&seq=1 5/2/2018 ALL STEM LL SYSTEM PROFILE MAR ED WTHC MAGNETIC TTAPEAOR BE NOTES PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS NAVD 88 o�sh Q FIRST FLOOR EL. 43.1' ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING Route 28 \ 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. Rd MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 42.0' d Sylvia d pos NOTE: 2" MIN. WALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST Fuller R �I 40 PRECAST H-10 THICKNESS REQUIRED BLOCKS OR UNITS TO BE AASHO H-1Q ocus O� RISERS (TYP.) PRECAST RISERS 2'o 4"OSCH40 PVC MORTAR ALL H-10 • 6" MIN. SUMP PIPES LEVEL 1ST 2' 4' COMPONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. 12" MIN. INT. DIM. (TYP.) L• 38.2 4' ENDS ul. . SIDES 39.03' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 10" **EXISTING 14" Po°0.6�6�- TEE SEPTIC TANK TEE ° ° ° ° 0��� O ���0 DOQ�—O —l�00� >0000g000 WITH 310 CMR 15.000 (TITLE 5.) ,-40.0 ° ° ° ° ° ° WATERTEHT D'BOX o °o°o°o �O��DDD�DOO OO DOO�������� ° ° ° ° ° ° ° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND �o° ° ° ° ° ° ° ° ° ° 000a000aaa� 0000a000000 ° ° ° ° GAS BAFFLE ° ,°_° FOR LEVELNESS �i >00000000` aoaa000�000 aoa000�o�oa 'a0000000 0. ° ° ° ° ° 000a000 � 000 00000o � o � oa ° ° ° ° NOT TO BE USED FOR LOT LINE STAKING OR ANY ' 36.2 OTHER PURPOSE. 38.49 38.32 °° 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4' PVC. 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. H-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. ^ •y ALL AROUND PRECAST STRUCTURES (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X •12.83 CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION. (15.221 [2]) N HEALTH AND PERMISSION OBTAINED FROM BOARD Ln OF HEALTH. orseshoe Ln 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING ( ) AND VERIFYING IGSAFE THE LOCATION OF ALL233 UND UNDERGROUND & LOCUS MAP (1 .6 % SLOPE) ( 1 % SLOPE) NO OGROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. SCALE 1"=2000'f FOUNDATION— EXIST. SEPTIC TANK 89' D' BOX 12' LEACHING 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 209 PARCEL 78 FACILITY BE REMOVED BENEATH AND 5' AROUND THE **INSTALLER SHALL CONFIRM MINIMUM SEPTIC PROPOSED LEACHING FACILITY. *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS FOR RE-USE. REPLACE WITH 1500 GALLON 12. EXISTING LEACHING FACILITY SHALL BE PUMPED`, PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM AND REMOVED OR PUMPED AND FILLED WITH CLEAN SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF SAND. LEGEND NOT SUITABLE 99— EXISTING CONTOUR � \ �50� X 99•t EXIST. SPOT ELEV. �� Q� —[991— PROPOSED CONTOUR SYSTEM DESIGN. Q 19$4] PROPOSED SPOT EL. BENCHMARK: GARBAGE DISPOSER IS NOT ALLOWED TH1 BULKHEAD COR. So TEST HOLE 1- -47 =42.5' NAVD88 \ �9 DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD 50 USE A 330 GPD DESIGN FLOW 2". SLOPE OF GROUND �46 / UTILITY POLE � � �,/ \ SEPTIC TANK: 330 GPD (2) = 660 , � C 2� FIRE HYDRANT �� **RE-USE EXISTING 1000 GAL. SEPTIC TANK NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING LEACHING: ' 7 > ( \ _ SIDES: 2 25 + 12.83) 2 (.74) 112 GPD BOTTOM 25 x 12.83 (.74) = 237 GPD TEST HOLE LOGS c0 TH1TOTAL: 472 S.F. 349 GPD ENGINEER: CRAIG J. FERRARI, SE #13871 �� �� \ s 16.0 2 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) \< \ WITH 4' STONE ALL AROUND WITNESS: DAVID W. STANTON RS EXISTING \� ' DATE: 6/11/2019 DECK t o DWELLING PERC. RATE _ < 2 MIN/INCH FFLR = 43.1 I 19-43 /G F��'i so APPROVED DATE BOARD OF HEALTH MA CLASS solLs P# LOT 12 ��, � ELEV. ELEV. 1 10,577 S.F.t01) 5 r LS LS �� / Li 10YR 4/2 10YR 4/2 � ° 3 . 01 TITLE 5 SITE PLAN 14 1811 PAVED � OF ��s1 DRIVE _ #40 WILTON DRIVE CENTERVILLE, MA 41 PREPARED FOR C C BORTOLOTTI CONSTRUCTION/ PERC WILLIAM PRYOR II MIS M S �, {0�M,n�' �° N OF/yyS��4 DATE: JUNE 13, 2019 l�o DANIELA � ,, DA"11EL 1OYR 7/4 1OYR 7/4 �� o!ALA �,` Flo A. CIVIL `� ' " 0J"'-�` off 508-362-4541 No 46502 ti N0.40'}80 fax 508-362-9880 �o �P downcape.com 1"ess\°you ds�pNAL ENyrs�R down cope engineering, inc. �w r Oj 132" 31 ' 132„ 31 ' civil engineers 1�. Scale: 1 20' ` land surveyors NO GROUNDWATER ENCOUNTERED 939 Main Street ( Rte 6A) D CE # , 9— , 75 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 19-175 I