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Home My WebLink About0052 ZENO CROCKER ROAD - Health (2) 52 Zeno Crocker Road Centerville FIR tit A = 170 249 Yff UPC 12543 % No.53LOR HASTINGS MN F Gll h, xw� Apr 28 1510:32p p.1 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` 52 Zeno Crocker Road Property Address +.k Jill&Jeff Levesque :<7 Owner Owner's Name information is required for every Centerville MA 02632 4-27-15 �a 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 J on the computer, , \`O�� qN � OF use only the tab �.�`` ••••..•-=y;SS V/%� 1. Inspector: 1/ •�c key to move your J ORN y cursor-do not 3 '.LP use the return James D.Sears JA M ES :m_ ke Name of Inspector ^v Y• CapewideEnterprises,LLC s*' Company Name ��- T ice` O - � 1553 Commercial Street Company Address Mashpee MA 02649 Cityrrown State Zip Code ` 508-477-8877 S1623 Telephone Number License Number y. B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. l am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: N Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority a7�M4� 2�e 4-28-15 spector'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. rU. t5ins-3113 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Apr 28 1510:32p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Zeno Crocker Road Property Address Jill &Jeff Levesque Owner Owner's Name information is required for every Centerville MA 02632 4-27-15 page. Cityfrown State Zip Code Date of Inspection B. Certification (cunt.) 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 16.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal.Tank D Box and five chambers. 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): ts!ns.3n 3 TNB 5 Official In spection Form Subsurface Sewage Oispcsal System•Page 2 of 17 Apr 281510:33p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'r 52 Zeno Crocker Road Property Address Jill& Jeff Levesque Owner Owner's Name information is required for every Centerville MA 02632 4-27-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpstalarms are repaired. B) System Conditionally Passes(cunt): ❑ 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. I. 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 ISins•3/t3 Title 5 official Inspection Form:Subsurface Sexvage Disposal System•Page 3 d 7 T Apr 281510:33p p.4 Commonwealth of Massachusetts Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for voluntary Assessments 52 Zeno Crocker Road Property Address Jill &Jeff Levesque Owner Owners Name information is required for every Centerville MA 02632 4-27-15 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 eesspea#is less than 6"below invert or available volume is less than 'r4 day flow / t5ins-3113 Title 5 oflidal Inspedwn Farm:SubsuAaee Sewage Dismal System•Page 4 of 17 Apr 28 1510:33p p.5 Commonwealth of Massachusetts _ : Title 5 Official Inspection Form wag Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Zeno Crocker Road Property Address Jill &Jeff Levesque Owner Owners Name information is Centerville MA 02632 4-27-15 required for every page. Cky/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: Cl ® Any portion of the SAS,cesspool or privy is below high ground water elevation. F ® 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 fleet 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.] ❑ Z 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. tins-3It3 Tide 5 Official Inspeckn Farm:Subsurface Sewage Olsposaf System•Pape 5 of 17 Apr 28 1510:34p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Zeno Crocker Road Property Address Jill &Jeff Levesque Owner Owner's Name information is required for every Centerville MA 02632 4-27-15 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 NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information_ For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x*of bedrooms): 330 t5ns•3113 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Apr 28 1510:34p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Zeno Crocker Road Property Address Jill &Jeff Levesque Owner Owner's Name information is required for every Centerville MA 02632 4-27-15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and five chambers_ 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 2013-54,000Gais 2.014-64,00OGal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: na 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: ISM-3/13 Title 5 Official Inspection Form Subscyface Sewage Disposal System-Page 7 of 17 Apr 28 1510:34p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Zeno Crocker Road Property Address .fill & Jeff Levesque Owner Owner's Name information is required for every Centerville MA 02632 4-27-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 2010-2012 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): t5ins•3113 Tine 5 Oifidal hWcllon Form!SubsuAace Sewage Disposal System•Page 8 of 17 Apr 28 1510:35p p.9 Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Zeno Crocker Road Property Address Jill &Jeff Levesque Owner Owner's Name information is required for every Centerville MA 02632 4-27-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cons.) Approximate age of all components, date installed (if known) and source of information: 2002 Permit#2002-180. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 28" feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4"PVC SCH 40. Septic Tank(locate on site plan). Depth below grade: 17" 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: 1000 Gal. Precast H-10 Sludge depth: 3" t5ins•3113 Ti11e 5 OlFiaal 1rePagion Form:Subartaoe Sewage Disposal System•Page 9 of 17 Apr 28 1510:35p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 52 Zeno Crocker Road Property Address _Jill &Jeff Levesque owner Owner's Name information is required for every Centerville MA 02632 4-27-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cons) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert; evidence of leakage,etc.): Tank at working level.Tank and cover's at 17" below grade. Inlet tee, outlet baffle. No sign of leakage or over loading. Tank should be pumped. Grease Trap (locate on site plane 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. ,,cite t5ins•3113 ?file 5 Official Inspeetion Form:Subsurface Sa age Disposal System-Page 10 of 17 Apr 28 1510:35p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Zeno Crocker Road Property Address Jill &Jeff Levesque Owner Owners Name information is required for every Centerville MA 02632 4-27-15 page. Citylrown State Zip Code Date of Inspection D. System Information (cost.) 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 t5ins•3113 Title 5 Offidd Insp ection Fomr Subsurface Sewage Disposal System•Page 11 of 17 Apr 28 1510:36p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Zeno Crocker Road Property Address Jill &Jeff Levesque Owner Owner's Name irrformation is required for every Centerville MA 02632 4-27-15 page. City(Town State Zip Code Date of Inspection D. System Information (coat.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-24" below grade. Box is clean and solid Wone line out. No sign of over loading. 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3A3 Ttle 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 12 of 17 Apr 28 1510:36p p.13 Commonwealth of Massachusetts Title 5 Official Inspection .Form ' - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Zeno Crocker Road Property Address Jill& Jeff Levesque Owner Owner's Name information is required for every Centerville MA 02632 4-27-15 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Type: ❑ leaching pits number. ® leaching chambers number: 5 ❑ 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.): Leaching is five Infiltrators. Ck D Box, Camera out and prob at leaching. No sign of over loading. 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 t5ins•3113 Title 5 Official Inspection Fans:Substoace Sewage Disposal System•Page 13 or 17 Apr 28 1510:36p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Zeno Crocker Road Property Address Jill &Jeff Levesque Owner Owners Name Information is required for every Centerville MA 02632 4-27-15 . page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) 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.): ISins-3I13 Title 5 Official Inspection Form:Subsurface Sewage Dispose;System•Page 14 of 1T Apr 28 15 10:36p p.15 Commonwealth of Massachusetts Tine 5 Official Inspection Form - - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 52 Zeno Crocker Road Property Address - Jill&Jeff Levesque Owner Owner's Name _._ _.._.. _----- _--•- --_-., information is Centerville MA_ 02632 4-27-15 required for every _ page. citylrown State Zip Code Dale of rnspection 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 i i/ � 3G I a J—.3 — 3 ]] L- 3 40 _q: 3 i i was•3M 3 rift 5 Q[fWW bvpperron Fam UbsuRace Sews Ohq Deal System-Page 15 of 17 Apr 28 15 10:37p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Zeno Crocker Road Property Address Jill &Jeff Levesque Owner Owners Name information is required for every Centerville MA 02632 4-27-15 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells V0 Estimated depth t high ground water. 10.5' 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: 4-23-02 Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T_H_ on Design Plan 4-23-02 no G.W. at 10.5'. Below grade. Bottom of chamber's at 6'above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page- t5i"s-3n 3 Tole 5 Official Inspection Forth:Subsurface Sewage Disposal system-Page 16 of 17 . Apr 28 1510:37p p.17 Y Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Zeno Crocker Road Property Address _Jill &Jeff Levesque Owner Ownees Name information is required for every Centerville MA 02632 4-27-15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, 6, 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 t5lns•3r13 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syslem•Page 17 of 17 ASSESSOR'S MAP -NO. / - 2.Z CEL / LO.1CAT10N -z Z SEW.,A/!GE PERMIT NO. ' Lot 2 Z ytNo ISO �Q �O�/j`.P c_ e%Vrcc y��.C.�' VILLAGE Ayr INS*TA LLER'S NAME i ADDRESS B U I L D E R OR OWNER 1-EBEG 4'Qg.L0 /_g COOP DATE PERMIT ISSUED r DATE COMPLIANCE ISSUED P/ -'* �� r , / 1600 74--,a 416 •�"' /a00 aGiT s 67 v - � 0 cefsS �rtsm,��-r TOWN OF BARNSTABLE LOCATION SQ SEWAGE # .200 :_Jb() VII.LAGE_42 �A?4 ASSESSOR' MAP & LOT `1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Aif)O LEACHINP FACILITY: (type) 40 (size) S x(o NO. OF BEDROOMS_,®�_ BUILDER OR OWNER �/ A PERMITDATE: uI� 2— COMP CE DATE: 3- a AX 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 0 T �`� ` Oak 4�\�� • l 3 t 04 e' r" �. No. 0 �-'� o Fee _52 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �/ ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppricatfon for 10igool *pztem Con5truction Verna Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a �Q�1J CYz C4te r Owner ' s Name,Address and Tel.No. Assessor's Map/Parcel 17 o--M ce,kQ '/1R U7�Q�Ct`C '✓� �f Z-P-�c C'vr-o G �f�-a Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. C2.7 e, v,11'_Q ky,# 5x goo f G� �� s-��2 ucz�� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. r*c ' r Description of Soil Nature of Repairs or Alterations(Answer when applicable)kP GiGt 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 issued)"is B and of He Signed Date -TD G Application Approved by Date 7P 2 Application Disapproved for the following reasons Permit No. A22 Date Issued D No. ()��rLIC ��-•...,..�,,.r'` � �.e+j�4 i�• ;,, ,,,,ta � Fee '+ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. ✓ PUHEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes .� 21ppfication for �Digpogal *pgtem Congtruction Permit Application for a Permit to Construct( ),Repair( )Upgrade( )Abandon( ) O Complete System El Individual Components i Location Address or Lot No. I.Owner's Name,Address and Tel.No. 1� Assessor's Map/Parcel �7��yh .��w r. ��:2 ,f/l o i t,co ret i. 2-eo ('v2.o G fZ 6 Y Installer's Name,Address,•a d'TeL.Nd i Designer's Name,Address and Tel.No. cell rod� y A goo 141144 Type of Building: j Dwelling No.of Bedrooms 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 X(yw Type of S.A.S. I'var,p or Description of Soil t i � �./ Nature of Repairs or Alterations(Answer when applicable) !1� ✓Ia&i ( �e�'Gacr� i� Ll . 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 issuedby-tjiis Board of H�lt . SignedCG« Date �O G Application Approved by 4 Date 3d Z Application Disapproved for the following reasons Permit No. lOv; iU Date Issued y74 o THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by at 2 PCn)rj2r rj rPdLv,AP has been construct d in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. W-2- A0 _5 dated G 0 Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will unction as d 'gned. Date �� /I) 2, Inspector Tl TG+ /w --------------------------------------- 37 No. 2 Uy — 18 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS 33igpogal bpgtem Congtruction Permit Permission is herebygranted to Construct( )Repair( )Upgrade( )Abandon( ) System located at 1-^0 C ra r �.�< I rc�(, (RI kllk lde. 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:Cons"ctiol must be completed within three years of the date of th ermit. Date: N3 f Approved by TOWN OF BARNSTABLE CI LOCATION �� lU�j��'� � _ SEWAGE # y .206 VU LAGE aA ,//U/ ASSESSOR' MAP & LOT�QJ��6 L INSTALLER'S NAME&PHONE NO. 2 O S ,20 SEPTIC TANK CAPACITY l�D LEACHING FACILITY: (type) S � A-16--d (size) 36,S X/o NO. OF BEDROOMS ?i BUILDER OR OWNER /I PERMITDATE: 72, COMPL CE DATE: Z G� 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 & � 3 r 3� of r" . .�........., R Be �..s�ci For the Re-pair W Failed Nntire. This 3FOrM Is Septic Systems Only F�Cr�i.t4T fU` TEST AND SOM E' `ALLAVON EJUMPT[O;� FORM z �N s d t.-�,,.,_, , heta�y ceritg trzat•a:a es.`reerest�ia:s tiigAad by ma dated. 02._�,conernirg the prOPOY located at 5 2- e No Gt?ca GEC of _._._. mflet8 ! of the ftlb��r:nyi oraeeia; _ • Tni:i Yailod .jfy steer, only. Tt x-aro t►o cou::nc*ciA-or b.tsines► u4ts s;saciattd*h:t :hed-•ke11irt • ';kg&oil is �;iiS>ije4 as CLASS i and the parcoix.M.11 rant 19 ?RSS t:,an or Oquei to f Inirnutrs par irch. The acolicaat may-»se 116"0tic.ai bta to conchAt this fact or May conduct preiiminm, tests at the slto without a healM want F:ts`t 1. e F1 etC 19 rt� I crsSSz Ii:floti�'and'v►6hange in use prgzud rt:ere era zc, requested ar neudei. • UG bimrr. of:hm proposed Ivuh,nb tar J) wi,y,be iocoted rq lots than#��®fEes &Cc'''ti s�' Maximam M4�-.I ad groundwater table diatiatiewn. Adjust thb jrouudwater tWl using tt,e Frimpto.method w'her.atjpiira5!ei Plw a complete►the followttift IK Top o:;Grauts9 S�rfacr E:e�a�.ior.i;at�'ta rriS inSt+t3natier) _�__„�..�. Ele-vatioct Iowa __ • ad;ustrnent for hlgi, ON a1G:S0 CATS! HnAed .;pan tiie ats�tr a iafotmatioi.a npeir pennit'wil be t rued for ,,�,,,,,_bedrounis �max:s,am. NoK�aditicttat;cedn,�-Mj&TV etu$."rised in th+a futut-o without enSinenred septic system! y hcal A:alder.rle;ec�enp �1 12 ti� 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO PART A `�UL 1 �m►or CERTIFICATION , 99 w 52 Zeno Crocker Road 0D� - Property Address:Centerville,Ma Address of Owner: 44 (if different) Date of Inspection: 4 June 1999 Inspected by: James Holler I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Holler & Son Construction LLC Mailing Address: P. O. Box 702, Marstons Mills,Ma 02648 Telephone: (508) 420-0280 CERTIFICATION STATEMENT 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 inspection. The inspection was perfonned based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ®Passes ❑Conditionally Passes ❑Needs Further Evaluation by the Local Approving Authority ❑ Fails Inspectors Signature 5� Date: !9�9 The system inspector shall subnu a copy of this inspection report to the Approving Authority within thirty(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 Department of Enviromnental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: ®I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. 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. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not. ❑The septic tattle is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank-was installed within twenty(20)years prior to the date of the inspection-,or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank:as approved by the Board of Health. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (Continued) Property Address:52 Zeno Crocker Road,Centerville Owner: Date of Inspection:4 June 1999 B) SYSTEM CONDITIONALLY PASSES (continued) ❑ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). Describe observations: ❑ broken pipe(s)are replaced ❑ obstruction is removed ❑ distribution box is leveled or replaced ❑The system required pumping more than four 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 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet to a Surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and soil absorption system and the SAS is within a.Zone I of a public water supply well. ❑ The system has a septic tank and soil absorption system and the SAS is with 50 feet of a private water supply well. ❑ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:52 Zeno Crocker Road,Centerville Owner: Date of Inspection:4 June 1999 D) SYSTEM FAILS You must indicate either"Yes"or"No"as to each of the following: ❑I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.The basis for this detennination is identified below. The Board of Health should be contacted to 15.304. detennine what will be necessary to correct the failure. 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. ❑ ® 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. ❑ ® Any portion of a cesspool or privy is with 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 with 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for colifonn bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes"or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: ❑ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 H of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 52 Zeno Crocker Road,Centerville Owner: Date of Inspection:4 June 1999 Check if the following have been done: You must indicate either"Yes"or"No"as to each of the following: Yes No ® ❑ Pumping infonnation was provided by the owner,occupant,or Board of Health. ® ❑ None of the system components have.been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ® ❑ As built plans have been obtained and examined. Note if they are not available with N/A. ® ❑ The facility or dwelling was inspected for signs of sewage back-up. ® ❑ The system does not receive non-sanitary or industrial waste flow. ® ❑ The site was inspected for signs of breakout. ® ❑ All system components,excluding the Soil.Absorption System,have been located on the site. ® ❑ The septic tank:niaiilioles were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location or the Soil Absorption System on the site has been determined based on: ® ❑ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. ® ❑ Existing infonnation,Ex.Plan at BOI-i. ❑ ® Detennined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) ]15.302(3)(b)] SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property address: 52 Zeno Crocker Road,Centerville Owner: Date of Inspection:4 June 1999 FLOW CONDITIONS RESIDENTIAL Design flow: 110 gpd/bedroom for SAS Number of bedrooms 3 Number of current residents:2 Garbage Grinder:No Laundry connected to system:Yes Seasonal use:No Water meter readings,if available (last 2 years usage in gpd):N/A Sump pump:No Last date of occupancy:Current COMMERCIAL /INDUSTRIAL Type of establishment Design flow: gpd Grease trap present: Industrial Waste holding tank present: Non-sanitary waste discharged to the Title 5 system Water meter readings,if available Last date of occupancy OTHER: (describe) GENERAL INFORMATION PUMPING RECORDS and source Owner System pumped as part of inspection No Volume pumped: Reason for pumping:. TYPE OF SYSTEM ® Septic tank-/distribution box/soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑Privy ❑ Shared system(y/n)(if yes,attach previous inspection records,if any) ❑ I/A Technology etc.Copy of up to date contract? Other APPROXIMATE AGE of all components,date installed(if known)and source of information:BOH, 1986 Sewer odors detected when arriving at the site:No SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address: 52 Zeno Crocker Road,Centerville Owner: Date of inspection:4 June, 1999 BUILDING SEWER (Locate on site plan) Depth below grade 26 inches Material of construction❑Cast Iron®40 PVC❑other Distance from private water supply well or suction linenone Diameter 4 inch Comments:(condition of joints,venting,evidence of leakage,etc. ) SEPTIC TANK (locate on site plan) Depth below grade 24 inches Material of construction®concrete❑metal ❑Fiberglass❑Polyethylene❑other If metal list age is age confirmed by certificate of compliance Dimensions: 1000 gal Sludge depth: 18 inches Distance from top of sludge to bottom of tee or baffle 22 inches Scum thickness l inch Distance from top of scum to top of outlet tee or baffle.75 inches Commients:Tail:should be pumped GREASE TRAP (locate on site plan) Depth below grade Material of construction❑ concrete❑metal❑Fiberglass❑Polyethylene❑other Dimensions Scum thickness Distance from top of scum to top of outlet tee or baffle Date of last pumping Continents: (reconmiendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leak,etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address:52 Zeno Crocker Road,Centerville Owner: Date of hispection:4 June 1999 TIGHT OR HOLDING TANK: ❑(Tank must be pumped prior to,or 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: GPD Alann level: Alarm working?❑ yes❑ no Date of previous pumping Continents: (condition of inlet tee,condition of alarm and float switches,etc. ) DISTRIBUTION BOX: (locate oil site plan) Depth of liquid level above outlet invert:even Comments(note if level,and distribution is equal,evidence of leaks or solids carryover,etc. ) PUMP CHAMBER: ❑ (locate on site plan) Pumps in working order: (yes or no) Alanns in working order:(yes or no) Conunents:(note condition of pump chamber,pumps,and appurtenances,etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(Continued) Property Address:52 Zeno Crocker Road,Centerville Owner: Date of Inspection:4 June 1999 SOIL ABSORPTION SYSTEM: (SAS) (locate on site plan,if possible,excavation not required,but may be approximated by non-uitrusive methods) if not determined to be present,explain: Type; leaching pits,number one,500 gal leaching chambers,number' leaching galleries,number leaching trenches,number&length leaching fields,number&dimensions overflow cesspool,number: Alternative system: Name of technology Comments:(note condition of soil,signs of hydraulic failure,ponding,vegetation,etc. ) CESSPOOLS: ❑ (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 Material of construction Indication of ground water inflow(must be pumped as part of inspection) Conunents:(note condition of soil,signs of hydraulic failure,ponding,and vegetation,etc.) PRIVY ❑ (locate on site plan) Materials of construction: Dimensions Depth of solids Conwients:(note condition of soil,signs of hydraulic failure,ponding,vegetation etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(Continued) Property Address: 52 Zeno Crocker Road,Centerville Owner: Date of hispection:4 June 1999 SKETCH OF SEWAGE DISPOSAL SYSTEM Include ties to at least two pennanent references,or benchmarks,locate wells within 100'and where public water supply enters house. flLC k L 3o s -5Z Zo-d �3 q® _0 53 0 _o 54 3Z-0 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) , Property Address: 52 Zeno Crocker Road,Centerville Owner: Date of hispection:4 June 19999 Depth to Groundwater 26 feet Please indicate all the methods used to determine High Groundwater Elevation: ❑ observed from design plans on record ❑ observation of site(abutting property,observation hole,basement sump) ❑ detenmine it from local conditions ❑ check with local Board of Health ® check FEMA maps ❑ check pumping records ® check local excavators,installers ® use USGS data Describe in your owm works how you established the High Groundwater Elevation. (Must be completed) 01r- 1 — No-. �1C7�-10 F>c8... � THE COMMONWEALTH OF MASSACHUSETTS BOARD -OF H ALTH PPa^ l1 I .� Appliration for Diupu,ial Wurkii Tutu trtutiurt Permit Application is hereby made for a Permit to Construct• or Repair ( ) an Individual Sewage Disposal Sys....---_•. at. - ;.Z- ..(�[�i1i. g...� .... .. vc�V.._� c�............ L.............. / c ou- dres� .... ... > it f. r Lot No... .......... o.. ._......._ ..._.......... _. ` L O r .. = • • —— C 4�YM I�i1� ess ................ Installer Address // Type of Building Size Lot: /-(t2 Z___�er Sq. f � Dwelling—No. of Bedrooms........3............................Expansion Attic ( ) Gafbagein N Other—Type of Building ........................... N of persons...::....................... Showers (` ) — Cafeteria ) dOther fixtures .......... ............................•--- ---.......--•••---•--••---............ --••... W Design Flow..............14.10......- .� gallons p r n dy. Total y 0ow......�. ? ...........--. lons( W Septic Tank—Liquid capacity. gallons Length. 1... Width_(... Diameter:............... Depth4.4.0. dT :. x Disposal Trench—No..................... Width.................... Total Length...............---- Total leaching area.............. ..sq. ft. 3 Seepage Pit No..........).......... Diameter...... _..... Depth below inlet....._?........ Total leaching area&: .s..Esq. ft. Z Other Distribution box ( ) Dosing tank a Percolation Test Resin Performed by.......7. .A 15! � ......... Date.....t . .. .... a Test Pit No. L. .minutes per inch Depth of Test Pit. Depth to ground w ter.. i 44 Test Pit No. 2................minutes per inch epth of Test Pit. ...... Depth to ground water......... x fi .. .. 0 Description of Soil..... -22 ............................ .:_`.f....... J.. w _ VNature of Repairs or Alterations—Answer when applicable............................................................................................... ............ ............. ---------- ••••-------•- ........... ..........•- .... Agreement: The undersigned ree�o install the aforedescribed -Individt 1 Sewage Disposal System in accordance with the provisions of�ITL 5 of the State Sanitary Coe The un- sig d f ther agrees not to place the system in operation until a ertifi a Compli has be y oa o lth. j Signed.... ....... .. ...... . ..•-- .. . ............---....:.............. ...1.. .... ... .......... ... ate Application Approved ca A... ........................................ Date Application.Disapproved for the following reasons:............................................................................................................ .:.::.... -------------------- --•-•.........................:.......... ......: Date Permit No....... .�.�._..�.....:'._1�. .�............ Issued......................................................... Date No - IL��/p t OF- c�- '- •�" THE COMMONWEALTH OF MASSACHUSETTS r , BOARD OF HEALTH ti .1�J.��....�.............OF'........ 2.K....,��'.t._.--�.....t Appliratinn for Diipn, al Works Tonstrurtiun Vern fit Application is hereby made for a Permit to Construct`'( ) or Repair ( ) an Individual Sewage Disposal System at• _ .. N mud...C ._...t �- .Location Address �/* "� r Lot No. / ••••••.••.... LOwner• .... e ddiess...... ..........................._..... a -�- . -..- �'.------��'�.4�� .............. ....._.......... ... :_ :::. - ..... Installer Address Type of Building Size Lot. .......Sq. feet aDwelling—No. of Bedrooms.................................. .....Expansion Attic ( ) Garbage Grinder (��)' a Other—Type of Building ............................ No. of persons.................__ ......._._. • ------ Showers Cafeteria ( ) QOther fixtures .............................. IV i rJf/tA...........................•..........-----...........---........--•--......................... W Design Flow.............._N.n------- --:.....gallons perFper-son per y. Totalydailylflow......�� ...............gallonsjf WSeptic Tank—Liquid capacity ( �.�.gallons Length_�1.T �,/.--. Width •A1 Diameter................ Depth Y�: _ . x Disposal Trench—No..................... Width.................... Total Length....................Total leaching area....................sq. ft. 3 Seepage Pit No.......... -�--a-.r ........... Diameter.....- ...... Depth below inlet...... r....... Total leaching ar 1)J.:..(...sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by... _ "�! S C ► 1� ....... Date..... :/ �?a...�, Test Pit No. L.2-' _...minutes per inch Depth of Test Pit. ....__ Depth to ground water... :! 44 Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water....................... O p ........................ ............-... .. .................. ... Description of Soil �....f�� .... /.. �� .:..._C ....Y.... �__ �f--. ►,�.........a�. V ---•-------- ....... .. ...,.. W ( t VNature of Repairs or Alterations—Answer when applicable............................................................................................... ..............................I....... ............. -•----•-----...-------•-•-•--•-----------••-•-----------------------......----------...--•--------•--••-•--•--........................ Agreement The under signed' g ees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLZ 5 of the State Sanitary Cod "The undersiggd further agrees not to place the system in operation until a Certificate oflComplianee has been isssu�d�by�th&board o,'health. v" Signed. !!✓/�� :// ./Q-�"- �,411 ' i , r w" v... ... .. Date Application Approved By:.._.._.._.: __..:}. ::....� G . ............................... �. .l z` .Q..S... Date Application Disapproved for the following reasons:.............. --------------------------------------------.----------------.--------•----•----.-------•---- Permit No.......�.�..`,� - 1 �. T1............ Issued---------------------•--•-•-......--•--....Dau...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF...............................:.... '-.................... Trrtif ratr of Toutphiturr THIS IS TO CERTIFY, That the Lndividual-Sewage Disposal System constructed (L -)or Repairedby ( ) . . Installer/ at............... .............................. ........................ = � .--•-- .. .....1 f ti ............. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit ....... dated.......... ...I Q,. .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARINTEE THAT THE SYSTEM WILL/FUNdTION SATISFACTORY. � DATE..................................../ C_ _v...------•............... ........... Inspector._.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -. to r) 6�? ...`��:..... ................. Disposal VarkoTanstrudion f rrtnit Permission is hereby granted.------ ` ......../.. `...:__....� is c,�vfl•L/............................ to Construct ( �)ors Repair-(L an Individual Sewage Disposal System / at No.......................X_J f ./'--�_ ��4 �i"a /W1/P<P � :��_ _....... ... ..---•....--.................•------•••--.--••• •---•--------••-••--•............. street as shown on the application for Disposal Works Construction Permit NoF'_-ln'ID Dated.._..,!-L_/�1_�. �?� ..._...... r - 2 Its ....................................... . . ...... Board of Health Y A kn o t t z M 4 0 � z Q H 5'-2 " 6'-4" 6'-4" a u # # # z 18'-0" i 17'-1 Qj" o ( E EXIST. FLOOR I ( EXIST. EXT. FRAMING co # # # WALL FRAMING I UNFINISHED BATT INS. # # BASEMENT j EXIST. REC. ROOM GRADELo VARIES # 'Ro =—% d' NEW CEILING �_ - - f- - - 9- -N -03 # _ o N � o EXIST. FNDN Z #� ►�# i # F`� 13'-10" # NEW 2x4 STUD rr ll E V 15'-7" :, FRAMING w/ o j BATT INS. I O i # N # n g NEW 1" RIGID BOARD INS. '? NEW P.T. 2x4 SILL n PLATE RAM SET TO CONC. SLAB N M I N r EXIST. BASEMENT p�p� ' SLAB ON GRADE ►�"1 PROPOSED BASEMENT PLAN TYPICAL WALL SECTION SCALE:4, = 1'-0" SCALE:2„ l�� U 21 a, t { s 1� CJ4 M SECTION SEWAGE ..:,: CAT04 '8�t Ira I v _ 1\3 2 -SEPTIC TANK- _..D"BOX- -LEACH. CLEV, 47.(DO. TOP OF FON 5�L V(MSL)y "l OF I18TO W'• WASHED STONE �> SZ,.g N IN• OUT•. - - - LOoOG t IN• OUT• IN• i ' f TANK ELEV. ELEV... ELEV. ELEV. ELEV. ELEV. 1. O Gt e, CFO` -WASHEDST.ONE - ydT.bl� o F -�- TEST HOLE LOG 1�rfz TEST BY 1 WITNESS t TEST DATE L� S f 3 BEDROOM HOUSE DESIGN T.H. r 1 T.H. +� 2 >,[ ELEV-153.I ELEV. NO ; II G 2 DISPOSER DISPOSER 5. . LOp 8 PERC RATE MIN/IN. CY r u /2i G b _ FLQW RATE 33o(cAL✓nAY) ( '' r 5 D SEPTIC TANK 3�.�0 (!S= .c.� t o REQ'DSEPTIC TANK SIZE od0 + / - , ,• Off' 2 I Lq6lEACH FACILITY _. _ x. ... ... . ......' SAME .. S- O - ,g . - SIDE WALL��-/� (Zr��).�.��• G/D. �I �f _ _. 7�....._. - -- --- - � �:------- --- F BOTTOM G/D. ,�,I- f-- } � M ,5 TOTAL IO/� / 2 _ /#� fig � � ' USE: LEACHING ?!T WATER ENCOUNTERED �r�. /✓/.d/ � � .... X Cam' �� 53 _ NOTES: (UNLESS OTHERWISE NOTED) R C -.O N I N G r 5 1.DATUM(MSL) TAKEN FROM QUADRANGLE:MAP 1 P-lo t,I-T - Z U AVAILABLE 3.PIPE PITCH:LYAPER FOOT / :eV l�H "Y at C'I 0 E, /®' A.'DESIGN LOADING FOR ALL -CAST-UNITS:AASHO- !y -44 �, x S.MIN..GROUNO COVER OVER ALL SEWAGE FACILITIES:(1)FT. O' y Rt A - lO ' ARNE N. G 6,PIPE JOINTS SHALL BE MADE WATERTIGHT g O.1RLA ri 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. I` SITE MAN STATE ENVIRONMENTAL CODE TITLE S 8. T�-�.� pc.�.� Fot 7e��xa .�uytX o.�� .o �+-��.•a 30' 2 QF h LOCUS: LOT- 02.2 ZF�IO C2dGkFl2 RQA� �,:�-�o-r VIE u�D �aZ.. '�Zc7crL�`C t_.uG ��-ls.�u._►c� ,r. f�! - - -- __ ARNE may✓ CEA1TFP'V/LLE' MASS REG. ENGINEER, _ H -- - _ REF. .� OJr LA BTU k ya 3 P.4��F• Q..7 WOW# c�►pe en hOerin34 TF - PREPARED FOR: CIVIL ENGINEERS LAND SURVEYORS ------ BOARD OF HEALTH REG.1 AND SURV YOR IG 9"Aft CONTOURS (EXISTING)......••"•'• APPROVED DATE `S ' � - �*�MA ` YIr�. -SCALEC- (PROPOSED)-0-0-0-07 I DATE - TOP OF FOUNDANON EL y .p GROUND SURFACE EZ 5 z STANDARD NOTES " GROUND SURFACE EL 1) THIS .PLAN IS FOR THE INSTALLATION OF A SEPTIC SYSTEAf OUTLET PIPE LEVEL ' FIRST TWO FEET Oj6 /v p. VENT REQUIRED G 2) ALL INSTALLATION PROCEDURES AND MATERLILS SHALL-CONFORM 710 310 CAR 15.000, THE STATE ENVIRONZENTAL COD4 LI UID LEVEL 1 TOP EL TITLE 5, AND THE TOWN OF _ R y -- SUBSURFACE DISPOSAL REGULATIONS. 10" " D-BOX MIN 9"_LA 2 S ONE E wASHEn 3) NO DETER1ILVATION HAS BEEN MADE AS 7iD COMPLIANCE OF AVAILABLE PROPERTY INFORMATION WITH RECORDED DEEDS LWT'ERT EL 14 ' r _ - -- ` t 4 �` _ OR ZONING RE'GULa9TIO.,VS - / EFFECTIVE 4) TOWN WATER SERVICES THIS PROPERTY. is t --- - C,o,� GAS BAFFLE AT OU7ZE?' I11rVERT EL Q•smAW . 01 SIDEWALL 5) THERE ARE NO KNOWN PRIVATE WELLS ON THIS PROPERTY OR WITHIN 6LOF THE PROP EL OSED SOIL ABSORPTION SYSTEM f!j:= ZVVERT ' 6) ALL COVERS OF SYSTEAf COMMNEN?S SHALL BE BROUGHT 7l0 WITHIN 1'� INT'ERT EL OF FINISHED GRADE, WITH ONE COVER OF THE "o D - Box to Cb ,!6 `'E eu �C G VC c 4^-r'ot tDc- I SEPTIC TANK BROUGHT WITHIN 6" OF GRADE 3/4'- 1 1/2' DOUBLE INVERT EL t 5 � t ) Mpicel) �T EL I�p Vn,►tS v �I�r 5, gr WASHED STONE 7' ALL SYSTEM COMPONENTS SHALL REMAIN ACCESSIBLE FOR INSPECTION. I NO STRUCTURES SHALL BE LOCATED DIRECTLY 4000 Gal Septic Tank 4v t ST��C a� .Z - UPON OR ABOVE THE COMPONTNT ACCESS LOCATIONS; WHICH WOULD INTERFERE WITH THE PERFORMANCE ACCESS, INSPECTION ! {- p ( i B077UM EL '3 _ (6X 1 5 r/Al G) O _ S��5 PUMPING OR REPAID _ EL t , 8) NO DRIVEWAY, PA.RILWG OR TURNING AREA, OR OTHER IMPERVIOUS AREAf SHALL BE LOCATED ABOVE A SOIL ABSORPTION BO M OF TEST HOLE SYSTEM, EXCEPT WHEN W2ffING HAS BEEN PROVIDED 9) TANK,' GREASE TRAPS, DOSING CHAMBERS AND DISTRIBUTION B02W SHALL BE PLACED ON A 6" SYVAW BASE i ENSURE STABILITY AND PREVENT S1�777"G. 10) OUM7 DISTRIBUTION LINES" SHALL REMAIN LEVEL FOR A MINI fW OF 27M FIRST TWO FEET OF THEIR LENGTH -11) ALL SYSTEM COMPOAT2VTS SHALL BE CAPABLE OF WITHSTANDhVG H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVEWAYS OR PARKING OR TURNING AREAS, IN WHICH CASE H-20 COMPONENTS SHALL BE USED. 12) ALL BUILDING SEWER LINES SHALL HAVE AN INNER DL4ALET" OF 4" AM? SHALL BE CAST-IRON OR SCHEDULE 40 PVC. 53°45 'r) » 13) THE DEPTH OF THE TOP OF ALL SYSTF.11! COMfPON�N7S SHALL NOT EXCEiM 36"'UNLESS VMVTING HAS BEEN PROVIDED. r!'�1 STi^! rc D E 14) IN THE AREAS OF MCA VATION, EX 77NG GRADES SHALL BE REESTALENRED UNLESS NOTED AS PROPOSED CO (s, t�� IQ Q //�� N71�URS. 6 05 15) IF SOILS ARE ENCOUNTERED DURING THE EXCAVATION OF THE SOIL ABSORPTION SYSTEM, THAT DIFFER NOTABLY FROM THE DEEP OBSERVATION HOLE LOG, CONTACT THE ENGINEER BEFORE PROCEEDING. 16) CONTRACTOR TO VERIFY LOCATION OF ALL UNDERGROUND , Exist. Lea ch PI t 01�' FIVE cv LTE { 5 l 1l-f�� D. IG N DATJ � W1T s ' 0 E � SAD 3, ST ,� - " d' Number of Bedrooms. 3 06 Garbage Grinder: �TQ _ . - DEEP OBSERVA � Design Flow- 3 3d TION _` . (110 Gal/BR z Number BR) HOLE LOG 8 Septic Tangy - Design Flow Hole #f (Minimum x 200X) G �P t--� - Test Z6 • ' ,�a- --- XIS t Leaching Area. n� son son o ln) sorison Textwv �l o 'M►nl .� SitiewalL• Munson) D-BOX- Sideways x `5 F't �' b 0FiU Test _ _ _ ... L � (( A N `L �T wh..., stiw8n.ls Z r r_ .T._ __,.__ 1 O• r '_ 3 - 4 1. ? 1s sz 4 , LOCa t1OIZ � . - B roaarr s�tvD 7 sr�s I ........:Bottom. - « � a _ S2 - 114 41• . . � � � o _. ,. _ -_ J `{ Cf COARSE/SAN fOY 7i, z ) +� 2 >1� - iss y 1.`� C2 MEDI` AND a5r7/4 ^ a Long. Term Acceptance Rate (LTAR): 0. 74 ./ax a�caotot O �fNK FP Leaching Area Design Capacity. '34,� Deep obs Hots Date: 4/xa/bz 5 y FL ' / \ (Sideway Area + Bottom Area) z LTAR �.� witnessed Bar T 0101 cm Cass.((-**,IC Td P) i (-5Z,9, ExIS Ling �� Bata: < s urx/tx a so« o� � C��D .�, �`�' /Shower 1 r OV 0 C.r a 1, Geologic ter �ao�.aa,orar rws .� Q`' Depth to Standing later. NA Septic c Tank Depth to Weeping later NA 'C Q ^' Depth to Mottling(Color): NA Y� -�'� Est seasonal High GW: NA USGS Observation Well: NA Z Date of Last Measurement� / Bulkhead Comments: Nei Gas Z' )� Z or SL FFO.D a 3t3 \ �I s 1 P P U14AL Existsuit° Tree (Sl�`�� , ' Line PXOJ1'CT LOCATION 5� Zeno Crocker ker Road 17 o Centerville MA 0 O ASSESSORS MAP LOT Z � LOCUS el APPIXANT,- An�ehca Barry t \& , ' rin�e 52 Zeno Crocker Road O �'� Hinckley Cen terVzlle M N 62 °.�6 '4 6 " W . ' � T�.� Rd Ll NE �+ P.REPI4RED BY 00) A & M Land Services O O 15 Sunset Drive South Yarmouth, AIA 02664 { O (508) 394-2723 - Z _ ; SCALD:- 1 10 DATE' � � N 6216 46 TIT _ _ - ' ' _ ' � ' " LOCUS MAP � :R:E:Y. 134. 86 - - 100. 05 - - - - - _ - _ _ - 52 Zeno Crocker Road DHrG. NO. SHEET r OF / - - Centerville, MA3019