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Home My WebLink About0027 YACHT CLUB ROAD - Health 27 Yacht Club Road Centerville _ A = 210 - 023 5 M E A D� Na Z•1S3LOR UPC 12ad sm..a.conn « Haft In UM r,4Q ' wtu��w�oouaw IF I Gh lu s ca„ No. =X ID- 0 ` L/ FEE `' O e Board of Health, MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑Complete System ❑Individual Components Location L C Owner's Name / ) UL Map/Parcel# Address .4 T u 49. Lot# Telephone# Installer's Name ` CM�;AAZIA94d Designer's Name ¢SPA) Address12 f,,� Address iG Telephone# ,� 4/� 9 Telephone# Type of Building Lot Size_6.v sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.re uired) 'yyd gpd Calculated design flow #410 Design flow provided yy2 gpd Plan: Date 0 ��Z Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS �//S�A/r /G44& 11i y CAZI J �B�;c TJ/yl,L Sr1STif lr The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agols,,not t ce the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signe Date Inspections r-7I C:) No. C) J Q FEE COMMONWEALTH OF MASSACHUSETTS Board ofHealth7B:g-C`lr`A- -�P- bl�, MA. ➢ ISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct(e7/Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at 7 V4 6111 dGg as described in the application for Disposal System Construction Permit No.9Q, 30 ,dated 0 1 y)` �^ Provided: Construction shall be completed within three years of the date of-th-is_permit. All local conditions must be met. `+ Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date oard of HealthC �� — I'�7f'Sr .rns-'ay 4 '��t�w-. '+r. :.w,�N"'J"`7»,y�'1�.✓+'i7`"'*•<'.yr ').�sll.+"7r `^.. ,jX"Ir.�9N*'`hr\+i' :,.Y'"yr' .e+'��i.h:YR*' !''d4+!'SA$' Y'�''I '� .,�i`i'*,. 4,.� nh"'F. No. �1 D- J 31'J - p, :K h FEE t . }� I�\duTl�n�p �I,I'+ {I�'�1+,.}�. \(\\l\ �TI I,I�I�/IgI�II\(\\l\ � I -,'®MM®1 V WLALT14 O `�1-✓ C 'l.l S��JL JL iJ' � .. f,2 Board of Healti MA. rl'SYSTERCONSTRUCTION PERMIT f Application forPermit to Construct,(,) ) /Upgf a O AbPP"dot, ❑Complete System ❑Individual Components Location 4(_ A A /4, CV I J\p Owner's Name ;,41V L/L Map/Parcel# �U / Address Q� T t r Lot# Telephone# j! Installer's Na Designer's Name i - 11f .4 / ( �Q°�i.�t,�l� , .�r 1 Address Address ,/ y*4 d /Telphone# Telephone# Type'of Building kes, /LAC//"/1:� Lot Size C/•�-.� sq.ft. Dwelling;`No.of Bedrooms Garbage grinder ( Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) '�7�y1) gpd Calculated design flow Design flow provided. gpd Plan: Date �/02.`/ Z0/L Number of sheets Revision Date Title - I Description of Soil(s) > Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OFREPAIRS OR ALTERATIONS 4.0 C,QO/U✓1 _G gl , 7r.1 X 7Z:/+STAB/ e11a/1r bee 4 the undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agr s nottttoo plll ce the system in.operation,until a Certificate of Compliance has been issued by the Board of Health. YSigned 5/_ Date loll`&0It- Inspections a No. FEE C a COMMONWEALTH OF MASSACHUSETTS t l Board of Health,- �� IJ�� MA. r`! CERTIWATE OF COMPLIANCE "Description of Work: ❑Individual Component(s) U Complete System s The undersigned hereby certify that the Sewage Disposal System; Constructed (j�Repaired ( ),Upgraded ( ),Abandoned ( ) by: rd,�?�JzAvAL P i at wellT Z! ( has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to j application No. / dated /� fApproved Design Flow V LJQ (gpd) Installer < ( d�/hD // L�&1sf/AfL }� r t Designer: A/,. �. �t1 j�,� �� Inspector: /��1�, ./1�P lz� Date: 111013. The issuance of this permit shall not be construed as a guarantee ththe system will function as designed. Z t%lV - M STkaa O—W Ay 4 y of s�-p►�-S i r. 1`r$6 ,Aazm��s -�v fit,S Be a�a ec S I Town of Barnstable �t►+E r Regulatory Services ;- WI Zti Thomas F. Geiler,Director BABNSPABLE. Public Health Division y MASS. Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 5 8-86 -4644 Fax: 508-790-6304 Date: l� 20�� Sewage Permit# Assessor's Map/Parcel �� Installer &Designer Certification Form Designer: l� I/'Y (JuI Installer: 'Xi 60qt7i Address: &AAA w LW Address: (!Qv L I t► l FoveOn `�COAL Colo " • was issued a permit to install a (dat ) (installer) septic system at based on a design drawn by (address) Wuq 12� dated Z (designer) :k I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocationof the--; 'f distribution box and/or septic tank. Stripout (if required) was inspected and the:"soils,,,;,;, were found satisfactory. :�?,� M'�,+,. 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 R- -'-tions. Plan revision or certified s-built by designer to follow. Stripout (if rP acted and the soils w re u satisfactory. 1 OF M� z DAVID 9�yt x,v o B. ler's ig to e) MASON �t 14.1 9 No.1066 0 ( si er' a re) � PLEASE RETURN TO BARNSTABLE PUBLL_ ��fE OF COMPLIANCE WILL NOT BE ISSUED UN i iL Du i n i niN t'ORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formMesignercertification form.doc Postal M10ERTIFIED . r ru (Domestic .•. For delivery information visit our website at www.usps.corna Ln m Postage $ C3 CertifledFee _... Return Receipt Fee fto/ Postmerk I3 (Endorsement Required) 1 NI 1?f Here - t C3 Restricted Delivery Fee. r-I (Endorsement Required)EV I3 Total Postage&Fees s, C3 O Jon & Brian Roderick - -- 27 Yacht Club Road { Centerville, MA 02632 ► Certified Mail Provides: j o A mailing receipt _•,a(evaAaid)zooz aunr'ooe£-od Sd 'IN A unique identifier for your mailpiece N A record of delivery kept by the Postal Service for two years Important Reminders: in Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ■ Certified Mail is not available for any class of international mail. la NO INSURANCE COVERAGE IS PROVIDED with. Certified Mail. For valuables,please consider Insured or Registered Mail. to For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811�to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required... s For an additional fee, delivery may be-restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery".= ,, nl If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. if a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY I ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X U ❑Addressee so that we can return-the card to you. B. Rle d by(Printed Name) C. Date ot Delivery ■ Attach this card to the back of the mailpiece, 1 or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No i Jon & Brian Rnz rick j ,17 Yacht Club Road \..Centerville, MA 02632 s. Service Type ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Ekft Fee) ❑Yes 2. Article Number (transfer from serWce`fabeq i i i a.7. C 6, 6 81 Q q D pt2 D 3 5 2 4 6 7 2 7 PS Form 3811,February 2004 Domestic Return Receipt•.-': 102595.02-M-1540 UNITED STATES; Td ul :...q�'npMiJY�..$:h :..-. ,.Amf'I�Qi Arle•�a • Sender: Please print your name, address, and ZIP+4 in this box • Town of Barnstable Public Health Division 200 Main Streety Hyannis, MA 02601 TOWN ,./OF2BADRNSTABLE LOCATION*07 7 Y46 Cl U�/ /�D. SEWAGE# �Olaj`y vILLAG) ff tT�_V�/!e_ ASSESSOR'S MAP&PARCEL *0?/O, ' 73 INSTALLER'S NAME&PHONE NO 4oWi&4 C SEPTIC TANK CAPACITY � j QQ!/OhS LEACHING FACILITY:(type �( NO.OF BEDROOMS Y OWNER /2,00%402)0 PERMIT DATE:! !Y /L COMPLIANCE DATE: l6 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 �\� �� ,� `J� - �� . . -� . . . � � 1 _ J M �C� -�� ,�� N � I .�� IVn ��r� l ^ V Town of Barnstable P# J 7 S 4 �INE 'f gyp` Department of Regulatory Services l wuvsree�e Public Health Division Date q I �� KAM. 200 Main Street,Hyannis MA 02601 rFD MA'1 A Date Scheduled `' � Time G" u/ Fee Pd. Soil Suitability Asses meet for•S age Disposal :Performed B �� Witnessed B Y Y LOCATION & GENERAL INFORMATION Location Address 2-7GL Owner's Name 3011 � Address Z 7 ^i efiF e-u—)S Assessor's Map/parcel: 2 �V A� Engineer's Name NEW CONSTRUCTION REPAIR Y Telephone# J c)8 v o-7 i_Q Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft, Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft .y SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes), �I Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE _ Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time Observation — I Hole# 1 Time at'9" t'1 Depth of Perc ry� Time at 6" Start Pre-soak Time @ �1'`� Time(9"-6") End Pre-soak Rate Min./Inch N� Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Graven Flood Insurance Rate Man: Above 500 year flood boundary No_ es Within 500 year boundary No 1;s Within 100 year flood boundary No v Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? t If not,what is the depth of naturally occurring pe4ious ial? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Envirgfimental Protection and that the above analysis was performed by me consistent with the required training,expertise 4nd experience described in 310 CMR 15.017. 7 Signature Date 2 Gb f Q:\SEPTIC\PERCFORM.DOC Town of Barnstable Barnstable Alt Regulatory Services Department j BRA A MASS. ` public Health Division m 00 i639 �� ATit MAC° 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3524 6727 September 13, 2012 Jon and Brian Rodrick 27 Yacht Club Road Centerville, MA 02632 The septic system located at 27 Yacht Club Road, Centerville, MA was last inspected on 8/24/2012 by David D. Coughanowr, R S, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: 0 Septic system is in hydraulic Failure You are ordered to repair the septic system within sixty (60) days from the date you receive this notification by repairing.the leaking septic tank and by rectifying the problem of having the septic components beneath the driveway which are not H-20 loading. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE B ARD OF HEALTH Tho O Agent of the Board of Health Documentl Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=15002 Logged In As: Pa C Ce Detail l� I Tuesday, September 1.1 2012 Parcel Lookup Parcel Info Parcel ID 210-023 ( DevelopeY LOT 8 Location 27 YACHT CLUB ROAD I Pri Frontage 71 Sec Road INDIAN TRAIL I Sec 121 Frontage village CENTERVILLE I Fire District C-O-MM Town sewer exists at this address No I Road Index 1888 Interactive r Map'6 l I - Owner Info owner RODRICK, JON J & BRIAN F I Co-Owner Streets 27 YACHT CLUB RD I Street2 City CENTERVILLE ( State MA zip 02632 Country Land Info Acres 0.21 I use Single Fam MDL-01 I zoning RD-1 Nghbd 0108 Topography Level I Road Paved utilities Public Water,Gas,Septic I Location - Construction Info Building 1 of i Year 1962 I Roof Gable/Hip I Ext Vinyl Siding Built Struct Wall Living 1072 I Roof Asph/F GIs/Crop I AC None Area Cover TypeInt Be `4^ 11 Style Cape Cod I Wall Plastered I Rooms 4 Bedrooms I i' 14 F PTO 1 Int Bath FAT- Model Residential I Floor Typical I Rooms 1 Full I 11 ? sns 11 DMT GAR 21' Grade Average Heat I Type Hot Water Total I Rooms 7 Rooms I ens a . Stories 1 Story F A Heat I Fuel Oil I Foation Typical I 14 vi 26: Gross 3040 Area Permit History http://issg12/intranet/propdata/ParcelDetai1.aspx?ID=15002 9/11/2012 � d � � �1L�,�.� i�`e �. , 1 � T Commonwealth of Massachusetts - W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 August 24, 2012 required for every 9 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. mportant:When filling out forms A. General Information f + on the computer, use only the tab 1. Inspector: key to move your cursor-do not David D. Coughanowr, R.S. use the return Name of Inspector key. Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364-0894 1328 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 RAugust 24, 2012 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 the future under the same or different conditions of use. LOW 1-/� zu t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts ' W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 August 24, 2012 required for every 9 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: 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 Au ust 24, 2012 required for every 9 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cost.): ❑ 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 i❑ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 August 24 2012 required for every 9 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 'h day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 August 24 2012 required for every 9 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °°M a 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 August 24 2012 required for every 9 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 the were not ❑ ❑ P Y ( Y available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ❑ ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms (actual): 4 (assessor) DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a- no plan t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 Au ust 24, 2012 required for every g page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 58 gpd Detail: 2010, 2011 and first half of 2012 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/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 August 24, 2012 required for every 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 Yacht Club Road M Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 August 24 2012 required for every 9 , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Age unknown - no records on file. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5 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.): Sewer line appears to be functioning with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 ..�hR'M klMts at?+{rp°aic>� �aWkBi9#.'.i:r.+t rya. tr.,y. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , M 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 August 24, 2012 required for every 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 Au ust 24, 2012 required for every 9 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is 9 required for every Centerville MA 02632 August 24, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Evidence of hydraulic overload was observed at primary cesspool. One line out appears to cross property line. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 Au ust 24, 2012 required for every 9 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 2 ❑ 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.): Two lines lead out of primary cesspool and are assumed to feed overflow cesspools. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 3 -one primary, 2 overflow Depth —top of liquid to inlet invert at outlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction concrete block Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 August 24, 2012 required for every 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Primary cesspool was opened and two lines were observed to pass out-one appears to lead over property line. A heavy solids buildup was observed on outlet pipe and staining was observed into riser. Structural stability of the blocks is questionable. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of M"assachusetts Titlefwc� Isec t r_ s S"ub"surface Sewage:.Disposal System Form-Not for Voluntary Assessments ,�. 27 Yacht Club Road Property A jdress Jon and Brian Rodrick' Owner Owner's Name inforrrlatton:is required for every CenteNille MA" 02832 August 24, 2Q12 Pa9@; City/Town Sfafe Zlp Cede Dake,of Inspection D Sys:tem Information (cons) Sketch �.f Sewage Disposal System::.ProA e a view of thesewage`;disposaI system, including ties to. at least two permanent reference"landmarks ac benchmarks.-;Locate all wells within 100 feet. Locate where public.w' I r:supply enters the building. Check one of the boxes below: R hand-sketch in';the area,below drawing attach'ed'separateiy - cote. �-- I I-- N t 15ins-11(10 Title VOtfiaal Inspection Form:Subsurface Sewage:Disposal System•page 15'or17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 August 24 2012 required for every g 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: 15 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: Barnstable GIS You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is over 15 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form: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 27 Yacht Club Road Property Address Jon and Brian Rodrick Owner Owner's Name information is Centerville MA 02632 August 24, 2012 required for every _ 9 page. Cityrrown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Q •� N fo. .�`7 ' ,� Fee $ 50.00 l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for 30iopogal bpztem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( )XK)Complete System El Individual Components Location Address or Lot No. 27 Yacht C l u b'R O a d Owner's Name,Address and Tel.No.5 0 8—7 7 5—7 4 7 7 Centerville,Mass.02632 Brian Roderick Assessor'sMap/Parcel A 40 0�4 5 27 Yacht Club Road Centerville MA Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 CEnterville,Mass.02632 Box 66 Centerville,Mass.02632 Type of Building: Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil; Loamy Gana to medium fine sand- Nature of Repairs or Alterations(Answer when applicable) Omitting cesspools. Installing 1 -1-500 gallon on GP ti r- tank,I ni str;h„+-ion hex and 2-500 gallon 'leaching chamhPrG packed in 4 'Qi !:I"' stone . 25 'X13 'X2 ' Date last inspected: Agreement: - The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by this oajd o ea Signed Date 6 2 7/01 Application Approved by Date mac' Application Disapproved for the following reasons r � -n Permit No. Date Issued - -----' ------- ------------ ———— ———————— - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance IS CERTIFY„THIS TO that the On-site Sewage Disposal System Constructed( )Repaired( )UpgradedKXXX Abandoned( )by J.P.Macomber & Son Inc. at 27 Yacht Club Road Cent ryi 1 1 P,MaGG has been construct d in a 'cordance with the provisions of Title 5 and the for Disposal System Construction_Permit No. _ dated G ZY' Installer J_P_MacomhPr P. Snn Inc. Designer—J.P.Macomber & Son Inc The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector $ 5 0.0 0 No. ZCl7) c7a 6 "y*, f x; _....,.. . ,. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: f Yes -� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication.for Mig;pozal *pgtem Con0truction Permit Application for a Permit to Construct( , )Repair( )Upgrade( )Abandon( )XXI►Complete System ,Individual Components Location Address or Lot No. 27 Yacht Club Road Owner's Name,Address and Tel.No.5 0 8 7 5-7 4 7 7 Centerville,Mass.02632 Brian Roderick'% / Assessor'sMap/Parcel p 3 27 Yacht Club Road 9bnterviY.le MA Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No./5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & SoW Inc. B6x' 66 CEniterville,Mass.02632 Box 66 Centerville,Mass.02632 h , 1Type of Building: Dwelling XX No.of 4rooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow gallons per day. Calculated daily flow le gallons. Plan Date Number of sheets Revision Date, Title i Size of Septic Tank Type of S.A.S. Description of Soil: Loamy -sand to med i tam fin- sand- Nature of Repairs or Alterations(Answer when applicable) Omitting cesspools. Installing 1-1500 gallon septic tank, l-ni stiri but i on box and 2-500 gallon leaching chambers nackg'c7 in a ' of 1111 Storm- - 25 X1 3 'X2 ' - Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuedlby this Bo of eal Signed ,�+/' Date 6,�2 7/01 Application Approved by J� _ Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS .. Certificate of Compliance THIS IS"TO CERTIFY, that the On-site Sewage Disposal System Constructed Repaired( )Upgradedl(XX)X Abandoned( )by J.P.Macomber & Son Inc. S , , at 27 Yacht C1ubbRoad Centerville,Mass. has been construct d in a cor ance with the provisions of Title 5 and the for Disposal System Construction Permit No.7AD _ a 7 dated 4 p . Installer J.P.Maeolliber & Son Inc, Designer J.P.Macomber & Son Inc! 3 The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ---7--------- ——————————- // ----------- 50.00 No. !�!U l /1, Z Fee THE COMMONWEALTH OF MASSACHUSETTS t PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwfqpool *pztem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(Xl)Abandon( ) Systemlocatedat 27 Yacht Club Road-Centerville.Mass and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this •e .t. Date: �,/ 7 / O Approved by 0.. a 1/6/99 NOTICE: This Form Is To Be Used For.the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) Joseph P.Macomber Jr. hereby certify that the application for disposal works construction permit signed by me dated 6/2 7/01 concerning the property located at 27 Yacht 'Club Road Centerville.,Mass-meets all of the following criteria: ( The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to S minutes per inch. i� There are no wetlands within 100 feet of the proposed septic system ` There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed There are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable) s If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the maximurn adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) ` . B) G.W. Elevation +✓ +the MAX. High G.W. Adjustment. D=RENCE BETWEEN A and B SIGNED : DATE: 6/27/01 (Sketc pr sed plan of system on back]. q:health folder art -�.- _" .��,�;. � ., �' �. �.� �• �� I �i ;� e (® Y � .. V ASSESSORS MAP : TEST HOLE LOGS NOTES: PARCEL: -7,3 FLOOD 20h1E: SOIL L EVALUATOR:�!1�'1/t 1) The installation shall comply with Title V and Town of� -yhwoard of WITNESS : �. � .;'22 �2 ��-7 I-Iealth Regulations. REFERENCE: -~gy p 70� _P�� PATE: 2,� {� 2) The installer shall verify the location of utilities, sewer inverts and septic � � ....................____.__.._._._.._._._....... .....-._�.._.............. ........... _..... . . .. PERCOLATI N RATE; � l t components prior to installation and setting base elevations. �1 ) ! g cl 8 per foot. t ._......._._........_.-._..._....__.........._.............._. ......... ...._..._. .. . 3 All septic piping to be 4 inch S i 40 PVC at 1/ " e Tile firs G' " 0"''V� . �J2� two feet out of the d-box to the leaching shall be level. Q � _....., .___._....._....-....._...... __.. ........_._..._.-_.._'�U16 65 Ze$ � 711- I TH 2 4) This plan is not to be utilized for property line determination nor any other _....._-..._.... l � W h ............__..-.---__........ ..._.. .. . ........__�_ � purpose other than the proposed system installation. S) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. y 7 The property is bounded b property corners and property lines. ) p p Y Y p P Y p p Y L.00AT I ON MAP I 8) The property owner shall review design considerations to approve of total design.flow and number of bedrooms to be considered for design. Receipt �'J � { �� • of payment for the plan and installation based on the plan shall be deemed r V0 approval of the design flow by the owner. k 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service SEPT I C SYSTEM DES I G N ( line. The line is to be sleeved as aforementioned and maintained in place. 11) If a garbage grinder exists it is to be removed and is the responsibility of the FLOW ESTIMATE owner to ensure such. 12)The installer is to take caution in excavation around the gas line if such y� ' exists. ,9E0:?OQMS AT GAL/DAY/BEDROOM - GALIDAY 13)The installer shall.verify.thelocation,quantity and elevation of the sewer lines exiting the dwelling"rior to the installation. { ,, SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting ! _ 7 D 07 GAL/DAY x 2 DAYS - Title V requirements. GAL ' a USE y GALLON SEPTI C TANK L� 241�4 r.71t4 NTJ_ V��\OW� -\kk OF L l SORPT SO l A I ON SYSTEM DAVID SON rcno , NO.1066 th ........... .. . ............ ..... ....... .. S TIC SYSTEM : SECTION \m (A GAL sill U l' 0 0 4p,0 SEPTIC TANK �- Y'. 0 y� D �� Avj SITE AND SEVIAGE PLAN LOC#ATIONA OJJ6' PREPARED FOR : C0ZP11&4A1. CWMLXPMj M M �-_ ------ V T a SCALE: 77 DAV I D Q . MASOI b DATE: DBC ENV I RONMEN'TAL DES I GIBS z FAST SANDWICH . MA Z DATE HEALTH AGENT 508 } 833-• 2 177