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HomeMy WebLinkAbout0132 HARBOR HILLS ROAD - Health .32 Harbor Hills Centerville A=227—096 S M EAD® No.2-153LOR UPC 12534 smead.com • Made In USA �" aa=� -- 09 cP j eL � Commonwealth of Massachusetts 3 Title 5 Official Inspection Form ICI Subsurface Sewage Disposal System Form -Not,for Voluntary Assessments 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name / information is required for every Centerville t/ MA 02632 10-19-20 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. A. Inspector Information j# jc f q gq Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address East Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);l have personally inspected the sewage disposal'system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10-19-20 '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 has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form C�'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments >.. 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-19-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: - ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑N ❑ ND (Explain below): t5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1.= 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-19-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): , ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced El ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y El ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, ' safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts if Title 5 Official Inspection}Form �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-19-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has,a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS,is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. []The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must.indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts { r� y Title 5 Official Inspection Form C�li Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y > z >� 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-19-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes , No ® Static liquid level in the distribution box above outlet invert'due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This t system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 6 Commonwealth of Massachusetts Title 5 Official Inspection .Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-19-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question'in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for aH inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑' ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water,been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A). ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all'system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Wasthe facility owner,(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts r� 3 Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments " f 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is Centerville MA 02632 10-19-20 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2020 Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form l.l :.ai. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments :. ? 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-19-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �''rIyI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r, 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-19-20, page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2009 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 30"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.): Good condition. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts ,'. Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-16-20 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 6. Septic Tank(locate on site plan): Depth below grade: 24"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) F . If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1560 gal Sludge depth: 61r Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 611 Distance from bottom of scum to bottom of outlet tee or baffle ' 15" How were dimensions determined? Tape. 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 is in good condition with baffles installed and no sign of leakage. . t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts UTitle 5 Official Inspection Form �i Subsurface Sewage Disposal System Form Not for Voluntary Assessments _. m"` 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-19-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is r required for every Centerville MA 02632 10-19-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): r , Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with baffles installed and no sign of back-up from field. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Q Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-19-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes', ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required):,. If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 20-Biodiffusers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts j P Title 5 Official Inspection Form w:� 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-19-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Biodiffuser field in good working order with no sign of back-up into d-box or surrounding stone. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 sue" Commonwealth of Massachusetts Title 5 Official Inspection Form ,_i'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-19-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 rk:\ Commonwealth of Massachusetts y Title 5 Official Inspection Form �-r IQ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,1- 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-19-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) r 14. Sketch Of Sewage Disposal System: , Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Fir f ? i Y ! t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts .a Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-19-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: , ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ 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: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 132 Harbor Hills Rd Property Address Laura Magee Owner Owner's Name information is required for every Centerville MA 02632 10-19-20 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 18 of 18 T4'�VN. F B 1STA B Lp 'u'iON. f �r r 3 �L SWCi ' . �.� 2 vl �-G��c> Irk f e �SFSSO1tS 9riAP�LOT. ,JN T/444 NAIMIfi lh t?NB APD. . Ol li��ii~1,i�t OR DgVN1�s`[� PiRRi't'iJ ' 'E: ::Cf1STCB IIA' E: low a Betvreag r Ow -PA*. „ PA ��l�r S*13t ww u�tdl�, iing�adUty �e�y�tls a gp di<'�fetd act x.oaciai* tiW w+ leucls exist �+iltiai��9Q�sec a�i�salf�g � 2 � �l- YOB A,3 _ a6� 6 5-Ft I•l J � i it No. --ALA Fee �l J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Migpogal �§pgtem Cougtructiou Permit Application for a Permit to Construct O Repair k Upgrade( ) Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. ( 32 t-kiq/L—i- t4,`,\5 tt.r,4 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Z 2-) Installer's Name,Address,and Tel.No.Ct1{w ' t h k/ek1 Designer's Name,Address and Tel.No. 7Y L c I.Vt f. e)1 Type of Building: _ Dwelling No.of Bedrooms Lot Size 1 Ot 2 D-7�— sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 30 gpd Design flow provided IOMLL355:--L gpd Plan Date S 09 Number of sheets l Revision Date Title l 3"2 14va-e6,r tit l f Size of Septic Tank (�b p Type of S.A.S.�j"i2n�s�(�S� 20 " ARG 3,6 Description of Soil -(3CO 17° 5�'-> Yo,° Nature of Repairs or Alterations(Answer when applicable) N ew 1+-14 I oa S vim- ran\ T—U 7-i3a X Date last inspected: -7i0 a Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar Health. gned Date "(o /Z 0 0 Application Approved by Date V Application Disapproved by: Date for the following reasons Permit No. � � Date Issued 1 �( No. c� L . "L-' l Fee THE COMMONWEALTH OF MASSACHUSE'RTS )t' Entered in computer: es UBLIC.HE LTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Rpplicatior" for Wgpo5at �&p!tem Congtruction Permit Application for a Permit to Construct O Repair K Upgrade( ) Abandon O Complete System ❑Individual Components Location Address or Lot No. 1 '3-2- ",np­t,.r l 1, \5 ICaa4 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel -4 2-) 4 Installer's Name,Address,and Tel.No.eA nG d_v6 0,�1/e,>f Designer's Name,Address and Tel.No. SL _ C�'1 II.AA ,-1' 2. q 1 Type of Building: Dwelling No.of Bedrooms Lot Size 1 Ot 3 d-7� sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) *3 3n gpd Design flow provided 355; -L gpd Plan Date ^S—09 Number of sheets Revision Date Title l 3 2 t l✓u{1 / l�i(1 Size of Septic Tank (jpA Type of S.A.S. (e59 -2 — A2c 3 t Description of Soil �Io�7, ��5.►�� Nature of Repairs or Alterations(Answer when applicable) N ew 4-10 / j OJ E jo 1, T C) 7-3a A a Date last inspected: ?,,.0 tt Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. gned C /""" Date /z.00(l Application Approved by Date F 9 Application Disapproved by: Date for the following reasons Permit No. Date Issued Q� —� ————— ———————- - ��.t1it�►�retrw+r+r�r�!!�r.wp-*r..!Fw�.r�rtl+�+�'Mr..pt�►�!.i.'.r,7��.►.i+r+1.+t►4A.F 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 l_.a..o C..): at 02 (AiJbuc i(&A Lt -e_ has been constructed in accordance �Q with the provisions of Title 5 and the,for Disposal System Construction Permit No. r;)X 9 c:9- 4 dated Installer ,aQ1,-),L1 - Designer J #bedrooms ! Approved des,m flo pp t gpd The issuance of this permit/Shallll�not be construed as a guarantee that the system�w`ll fund onr'as designee Date 1 1 I V 1 Inspector �/� �+ta+►+�•�.�e+w•.t�r�wiirw�•+i ++�an�w(�ri�sRr�.e+ No. C 00 � Fee v v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS �Digonl *y,tem Con.5truction Permit Permission is hereby granted to Construct ( ) Repair (k�2 Upgrade ( ) Abandon ( ) System located at 1 3'L 4t ,r Lm„C lH\\1, (�6(4 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: Construc767s ' 'tQbe completed within three years of the dat of�-it Date I Approvld by l oWn of llarnstame Regulatory Services Thomas F. Geifer, Director URN at#LL, _ Public health Division T botnas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862..4G44 Fax; 5W-,,T'0-6304 nstl�er Desianer Certification >H_orm Date: wlu� �,E f7 Z009 ' w._.� UCsigdler: 5 ��r� �ncac-in�� , Tn c . _ Installer, C" 'w%& C_Y er c(se N, Address: �18`;H _Cc�1 ,be_` _Nitwn ,_.... Address: Cc) o .._-_• .�? �t�'r)was issued a permit to install a(anstaller) septic system at _1 l�2 Nnbor (address} Roac( based o: a design drawn by �. rfle`C_Ciil 1d1G, d ate d �u��50;A � r . .zcc? I certify that the septic: systern referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of che, distribution box and/or septic tank. _ `v✓ I certify that the septic systc;rn referenced above was installed with ma'or changes (.C. greater than 10' lateral relocation of the SAS or any vertical relocation of any con porient of the septic systern) but iri accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. <r4 4 nr A1 Stil!!Cr'5 Fi. ^iVVI. d1(;07 _ (Designer's�Si c) ------ - (Affi - es pnerrs lamp Sere) TU ARNS'T PU C V ' CAN CE ' FI C OIF CWILL, O B N. - B RECEIVED T AB S VISIIO: HAMIQU- U: Health/SepticMesigner C:ertifwapon f'otirt TOIJ 4920 2LZ 809 8N I 2133N I 8N38f wo t T : 60 600Z-z T-nnu TOWN OF"�BeeA��RNSTABLE LOCATION 32 `��G,c,� ,}�Its 'rt d SEWAGE# 6 VILLAGE C'2il WV r l Cc ASSESSOR'S MAP&PARCEL o1oZ'7 41a INSTALLER'S NAME&PHONE NO. 4 SEPTIC TANK CAPACITY k S O o \,4 t 0 LEACHING FACILITY.(type) (2 j4, 6ab il,a 7aC(size) /S Y �U NO.OF BEDROOMS J OWNER o vy\ �2SAU PERMIT DATE: $ -Co - 20 O COMPLIANCE DATE: -2 0_Z 0 5 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility evu it 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) (t Feet FURNISHED BY C 4,oe-a,rQ c (.�'�K✓�Orfi i e' L LL 40•0 A 2 31,9 W L( s A g 94,0 �,� s9 �qK N`{,1 � 7aL WP U-7.f l V 0,2 1 co'f 1 7 . . Is Town of Barnstable P# I j Department of Regulatory Services searrarest e Public Health Division Date a� oD >� t639 200 Main Street,Hyannis MA 02601 Date Scheduled d Time 1 Fee Pd. IOU Soil SuitabilityAssessment for bt� Sewage isp sal Performed By: 11(6G i0,_t f cw en k,( , e LT CSC% f + Witnessed By: ✓ e J LOCATION& GENERAL INFORMATION Location Address 3 a 0044,Oar 14:1ls ® Owner's Name Address Assessor's Map/Parcel: 7 1 16 916 Engineer's Name C q P dye�l� (�v��r�p�j Y NEW CONSTRUCTION REPAIR y Telephone# L1 a q Qzi Land Use _ale 6-Ai'y c st[&&V41 Slopes6—ha w (9'0) Surface Stones Distances from: Open Water Body '" ft Possible Wet Area — ft Drinking Water Well ft Drainage Way ft Property Line /0 ft Other ---- ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&.pere tests,locate wetlands in proximity to holes) .see a,do&.�&. fton C ySC.64vee" L c. Parent material(geologic) QA#moy� 7 t 3Z b Depth to Bedrock Ss u Depth to Groundwater. Standing Water in Hole: 7 13 Z s Weeping from Pit Face 7 13 2' 55 Estimated Seasonal High Groundwater '7 13 2" S DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: PLetr_ &%.eNaa 04,,j Depth Observed standing in obs.hole: 7 t32 in, Depth to sell mottles: >13Z Depth to weeping from side of obs.hole: +3 —in, Oroundwater Adjustment ft. Index Well# --Reading-Date: Index Well Adj,factor— Adj.CroundwaterLevel , Observation PERCOLATION TEST D8t0_Z-_30'0 Tinie_ —'---- X fin Hole# Time at 9" Depth of Perc �,�S� Time at G" Start Pre-soak Time @ /U. o yAll Time(9"-V) w End Pre-soak l0 A) A/y Rate Min./Inch 4 Z Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) 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:\SPPTIC\PERCFORM.DOC _ - l DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. on i tenc ravel LJo-132- G P-Cs DEEP OBSERVATION HOLE LOG Hole# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stone_ Boulders. Consistency.%Gravel) yo-132 C_ MGS 2_SY`/ _ ^ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,9 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, I Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes L/__ Within 500 year boundary No Yes Within 100 year flood boundary No—Z 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? 'l2S If not,what is the depth of naturally occurring pervious material? Certification ` I certifythat on �e'Z 7"f date I have passed the soil evaluator examination approved b the —(date) P PP Y Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and p rience described in 310 CMR 15.017. Signature Date Q:\SEvnC�PERCFORM.DOC THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA � � �...r ..-.+x-'*GIs!'^,�,�pP'A+••,_T'^!•.�!�!'�.'fi'd"T"Tq: '+7nr�iv�T�+•..'�,ax.�,}"p ,'IFFrr{'^'.''r�'';,�`*r.v*'le,'x'}-ar �r:Tr�:sn t'ms:..'f.R?rt�yp�t..�.wvyy„�yr ,r� 9i.P+'7G'.»mn;!v'a ".n'�^"r?fi TOWN OF BARNSTABLE BAR-W % Ordinance or Regulation WARNING NOTICE Name of Offender/Manager " ` ` �. ,C1� _�, MV/MB Reg. Address of Offender t ;'- ii. L r'� Village/State/Zip t -i '! Business Name 4, 6) am/pm,) on- = 20 ,ram 4 Business Address ;�, �-... •c kf,, ,.� e � , signature of Enforcing Officer Village Zi '~ g p .... C" � t�� '�•.�'i� � �" i Locatil'on of Offense Enforcing Dept/Division Offense ��• ��, -tom �� � +.1. rat tC ;'�, �i. . � i J 1 �`.1 �,t t' �F; �� 4 ijt. Factst L�/1.•� 1 M 1...l�\. 1 4.r! ^1 ��..� �4 i . '^ .,. M .�,..'i i ''E ��* Y This will serve only' as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violation's will result in appropriate legal action by the Town. WHITE OFFENDER CANARY ORD./REG PROG PINK ENFORCING OFFICER GOLD-ENFORCING DEPT. Citi-z-en Web Request Page 1 of 2 -u• 4 t11E 0 .. _ Citizen Request Management - Internal Use �-�- Request ID: 25484 Created: 5/13/2009 1:49:51 PM � - . Status: Assigned To Staff Assigned To: Cabot, Jaime Health Office + Chapter 170 : Housing Anonymous: No Category: Overcrowding . Section 353-1 GarbagE and Rubbish E.C. Date: 5/28/2009 ; " ¢ Created By: Wadlington, Ellen Citations: BARW5563 „ Health Office Time Worked: 4.00 Response Time: 6.00 Requestor Details: Request Location: Hyannis, Ma 02601 � - Parcel Number: Map: 000 Block: 000 Lot: 000 . Request: The above residence has marked deterioration, i.e., large pile of discarded house items including mattresses, awing, couches, beds and baby items. Also now there is overcrowding. r •!Pot' ,1 r.,'MA'•• Request Work History: Entered on 5/14/2009 11:43:05 AM by O'Connell, Timothy On 5-14-09 went to said address and knocked on door. I did not get an answer at the door. I , also knocked on door at walk out basement. No answer. I left a card to call me. I also alerted RA from zoning who is putting together a night BIRST Team. This property is on the list. Will see if I -- get a phone call or wait to see what BIRST Team see' s. . Entered on 5/18/2009 7:49:35 AM - by O'Connell, Timothy http://issgl2/IntemalWRS/WRequestPrint.aspx?ID=25484 5/21/2009 . CitiEen Web Request Page 2 of 2 On 5-15-09 went to said property no one home. Entered on 5/21/2009 9:42:24 AM by Cabot, Jaime ,i I•.•t�N JAC inspected property on 5/20/09, Spoke to the occupants 14 year old son who was home with his mother who does not speak English. JAC informed them of the violations observed at the property. Issued a Citation and gave a week to make corrections.or be subject to a fine. Internal Note History: System entry on 5/13/2009 1:49:51 PM: �-- Assigned to O'Connell, Timothy System entry on 5/20/2009 4:01:01 PM: -- -- Assigned to Cabot, Jaime --' - Entered on 5/21/2009 9:42:24 AM by Cabot, Jaime Resident Erotides Borge. Cell 508 299-3846 dob 11/8/62 i ; - 444 ii� . ,. 44 . ii nk Y i•.n:epl^• http://issgl2/IntemalWRS/WRequestPrint.aspx?ID=25484 5/21/2009 DATE: 9/22/97 PROPERTY ADDRESS: 132 Harbor Hills Road 71P Lt Mass. On the above date, I Inspected the septic system at the above address. This system consists of the following: 2 '. 1 -Dis.tribution box. 3 . 1 -1000 gallon precast pit. Eased on my InP�actlon, I certify the following conditions: 1 . This is a title five septic system. ( 78 Code) 2 . The septic system is in proper working order at the -present time. 3 . Pumped septic tank. Maint. Heavy solids and scum layers. 4 . SIGNATURE: /O Name J P. Macomber Jr_ __ ___ i Company J P'Macoalber &_ Son•_Inc , Addreea —.Sax—bb-----=1---,-- __CentervilleAass__02632 ` Phone:-__508. THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. � o�m Tanks-C#upools-Leathflelds f • Pumped & Installed GAO N Town Sewer Connections9 P.O. Box 66' Centerville, MA 02632.0066 tio�9y�9e �99 to 775-3338 775-6412 `' � <F ` 19 ' e e. f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS _ DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 WILLIA't F.WELD TRLDY C Govemor Sc: ARGEOPAUL CELLUCCI DAVID B STF Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM commis. PART A CERTIFICATION Property Address:1 32 Harbor Hills Road Address of Owner: Date of Inspection:9/2 0/9 7 (If different) Name of Inspector:'Ingp=h p Macnmber Jr. I am a DEP appproved system inspector ursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: J.P.Macomber & �on Inc. Mailing Address: Box en eryl e,Mass. 632 Telephone Number: 508-775-333A CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accur: and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function an maintenance of on-site sewage disposal systems. The system: l� Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails '7 Inspector's Signature: / Date: The System Inspector all submit 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 subm the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system ow 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 15.30 Any failure criteria not evaluated are indicated below. COMMENTS: BJ SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, u): 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 tank 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 inspe lion, the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tal 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. (revised 04/25/97) Page 1 of 20 DEP on the World Wide Web: hnpww~rnagnet.state.ma usidep Printed on Recycled Paper i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 132 Harbor Hills Road West Hyanisport Ma Owner: Craigville Realty Date of Inspection: 9/1 0/9 7 Bj SYSTEM CONDITIONALLY PASSES (continued) jLb 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 levelled 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: VP 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 ,GD 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: A-V 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, /1,to 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 within 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 y� (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 132 Harbor Hills Road West Hyannisport Ma Owner: Craigville Realty Date of Inspection: 9/1 0/97 D) SYSTEM FAILS: You must indicate ei:• et "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 CNIR 15.303 The bas, for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to con, the failure. Yes No , Backup of sewage into facility or system component due to an 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 o cesspool. Static liquid level in the istributron box above outlet invert due to an overloaded or clogged SAS or cesspool AEACA Liquid depth in c{�SCGoGl is less than 6" below invert or available volume is less than 1/2 day floes Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipets) Number of times pumped ,a. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supplti Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. �ny portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with r acceptable water quality analysis. If the well has been analyzed to be acceptable, anach copy of well water analysis is coliform 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 IUA 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 11 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 prograrr requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Depanment for further information (rwls-d 04/25/97) Dag. 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 132 Harbor Hills Road West Hyannisport Ma Owner: Craigville Realty Date of Inspection: 9/1 0/9 7 Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes —K/ Pumping information 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. _ ��r>> All system components,�icluding the Soil Absorption System, have been located on the site. _ The septic tank manholes 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 of the Soil Absorption System on the site has been determined based on: _ The facility owner (and occupants, if cbHerent from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.3020)(b)) (z.vlsed 04/25/97) Dag. 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 132 Harbor Hills Road West Hyannisport Ma Owner: Craigville Realty Date of Inspection: 9/1 0/9 7 FLOW CONDITIONS RESIDENTIAL: Design flow: IN19 p.d./bedroom for S.A.S. Number of bedrooms:q Number of current residents:, Garbage grinder (yes or no):_4lp Laundry connected to system (yes or no): &1; Seasonal use (yes or no):—" _ water meter readings, if available (last two (2) year usage (gpd): �y� Sump Pump (yes or no): /9 �� �L/C9xiZ7 9 r Last date of occupancy.�/� COMMERCIAUINDUSTRIAL: Type of establishmencAl/4 Design flow: Vd Rallons/day Grease trap present: (yes or no)AL11 industrial Waste Holding Tank present: (yes or no)" Non-sanitary waste discharged to the Title 5 system: (yes or now.111 water meter readings, if availablek.# N Last date of occupancy; OTHER: (Describe) Last date of occupancy. GENERAL INFORMATION PUMPING CORDS and urce o in(�aatlo,9 ./A. �� /r�iLrf At ,Gb9l'T d 7/ ivs�O��,uli System umped as fan of inspection: (yes or no) If yes, volume pumped: GM gallons Reason for pumping ?d: TYPE OF YSTEM Septic tank/distribution box/soil absorption system ,GAD Single cesspool ,06 Overflow cesspool AQ Privy Shared system (yes or no) (if yes, anach previous inspection records, if any) .G' VA T hnology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)&0 (revised 0.4/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:1 32 Harbor Hills Road West Hyannisport Ma Owner: Craigville Realty Date of Inspection: 9/1 0/9 7 BUILDING SEWER: (Locate on site plan) Depth below grade: it Material of construction; Zast iron V40 PVC_other (explain) Distance from private water supply well or suction line &4 Diameter _ Comments: (condition of joints, venting, evidence of leakage, etc.) , ' SEPTIC TANK:ACdlJ9r�.v ., (locate on site plan) I Depth below grade: Material of construction: concrete _metal _Fiberglass Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions; Z'Z",I( '& Sludge depth: /'Z> Distance from top of sludge to bonom of outlet tee or baffle: Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: Distance from bonom of scum to bonom of outlet t9p or baffle _ How dimensions were determined:�9'�0 Comments: (recommendation for pumping, conditi n of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, ev Bence of I akage, etc.) J's > i GREASE TRAP:,djLt/lie, (locate on site plan) Depth below grader Material of construction Vdconcrete4Vgmetal4�dFiberglassVgPolyethylenfAAnther(explain) Dimensions: AJA Scum thickness:—.AA Distance from top of scum to top of outlet tee or baffler& Distance from bottom of scum to bottom of outlet tee or baffle:—AJZQ Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) �re�.5-P r19 l� 'Z)D (revised 04/25/97) Pegs 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 132 Harbor Hills Road West Hyannisport Ma Owner: Craigville Realty Date of Inspection: 9/1 0/9 7 TIGHT OR HOLDING TANK:L✓p{&' (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grader Material of construction:N�concrete,4metaWAFi berg lass�lPolyethylene{/other(explain) NR u11 Dimensions: A,14 Capacity:—gallons Design flo�.,: A,14 gallons/day Alarm level:_Alarm in working order Yes;A.,M No Date of previous pumping: A)A— Comments. (condition of inlet tee, condition of alarm and float switches, etc.) i i t" ;m DISTRIBUTION BOX:I (locate on site plan) Depth of liquid level above outlet invert: Comments: (not .f lev and istribution is eq I, evidence of solids carryover, evidence of leaks e i to or out of box, etc.) PUMP CHAMBER--,dL1f---lf_ (locate on site plan) Pumps in working order: (Yes or No),&.'8 Alarms in working order (Yes or No)_4j,6" Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revisal 04/25/97) P.9• 7 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:1 32 Harbor Hills Road West Hyannisport Ma Owner: Craigville Realty Date of Inspection: g/1 0/97 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non intrusive methods) If not determined to be present, explain: Type J leaching pits, number: leaching chambers, number: d leaching galleries, number:_ leaching trenches, number,length:�V — leaching fields, number, dimeo, ions: // overflow cesspool, number: V Alternative system: Name of Technology: Comments: (note conditio of soil, signs of ydraul c fail e, level of ponding, condition of v getati n, etc. 0 CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet inven: Depth of solids layer: Ally Depth of scum layer: /1J1Q Dimensions of cesspool: 44 Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: lnote condition of soil, signs ofhydraulic failure, level of ponding, condition of vegetation, etc.) � a i PRIVY: i(�i (locate on site plan) Materials of construction.: Dimensions: Depth of solids: Ui Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) AZ- t 1 (revlrred 04/25/91) page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:1 32 Harbor Hills Road West Hyannisport Ma Owner: Craigville Realty Date of Inspection: 9/1 0/97 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 3 (bsvised 04/75/97) '1 94117 9 of 10 V `r. d / 3 � LJ,nPRnr' 4.1 ,'ilc i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 132 Harbor Hills Road West Hyannisport Ma Owner: Craigville Realty Date of Inspection: 9/1 0/97 ��y Depth to Groundwater 9r4 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Obseryaoon of Site (Abuning property, observation ole, basement sump etc.) _ Determine t irom local conditions Check .cith local Board of health Check FEMA Maps heck pumping records // Check local excavators, installers ---fff"'--- Use USCS Data Describe in your o—n words how you Pmablished the High Groundwater Elevation. (Must be comol—A' J.P.Macomber & §9n : Installed a syste t a ,,,,888"Har'b6r .Hills Road West Hyahnispo.rt,Mass. r 4/22/88 Permit# 88-177 Nowater encountered at 12 ' t tr•vis•d 01/15/97) Fag• 10 of 10 n'TT—.�—R..'....gpp--...,.T.T.f:•.T+.'�..:w�nAT-..L AIT'.�►T. �a"v.'.�-r�-r�� - . TOWN OF Barnstable WARb OF IIEALTii SUBSIMPACF SFWAQF DISPOSAL SYSTFM INSI'FCTION FORM - PART D - CEWrl FIC1M0'r —TYPO OR PRINT CI.EARLY— Pll0 PERT Y INSPECTED STREET ADDRESS 132 Harbor Hills Road West Hyannisport,Mass . ASSESSORS MAP , DLOCK AND PARCEL Ii OWNER' s NAME Craigville' Real Estate Company PAflT D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr . COMPANY NAME Joseph P. Macomber & '%on , Inc . COMPANY ADDRESS Box 66 Centerville , Ma . 02632-0066 Street Town or Clty Stet. t;{ COMPANY TELEPHONE (508 1 775 -3338 FAX ( 508 ) 790 -1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa-1 system this nddres-s and that the information reported is true , accurate , and complete as of the time of .inspection , The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of of site sewage disposal systems . Check one : MXXXXXXXXXSyste6 PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healLh or the environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED; The inspection which I have con ilcted has found that the system fa ! i s tc Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . r .Inspector Signature i Date 9/22/97 One copy of this certification must be provided to the OWNER, the DUYER ( where applicable and the DOATID OF HEALI'11. If the Inspection FAILED , thle owner or operator shall upgrade the ayotem .: ir.hin one year or the dnte of the inspection , unless allowed or required otherwise as provided in 310 CHR 16 . 305 . partd . doc < w V 7 rV7 y b THE CON MONWEALTH OF MA.SSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERT MD TITLE S SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws_ Issued by The Department of Environmental Protection_ )unc 8. 1995 Acting Director of the ion of Witer Pollution Control TOWN OF BARNSTABLE 7L(03C�Ar.10N e� �.S ' SEWAGE #ASSESSOR'S MAP&LOTNAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 Le hing Facility(If any wetland xist within 300 feet f 1 hin Feet Furnished v y b - L- I I i -10 / d No.��..l.... ... FEs....1....................... THE COMMONWEALTH OF MASSACHUSETTS �l BOARD OF HEALTH ................. OF............................................----------.........--------................... Appliration for Biiipoiittl Works Tonstrnrtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 1 1�f� C pA K 02 R l US -------•. ......................•.......... .......................... <z3 (,,Location-Address or Lot 2f No Po/ .. :�t. ..........•-••.................... Owner Address ..........xnl:i��,:,:,::k....:=... /........ ..............................:................................................................... Installer Address Type of Building Size Lot..1dE.1�©_......Sq. feet Dwelling—No. of Bedrooms..... ...................................Expansion Attic (AU) Garbage Grinder P) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other tures ...•-••-•--•-•--•-•--•-••-......- - ...............gallons per person per day. Total daily flow....... _0 Design Flow g P P P Y Y .....................................gallons. � Septic Tank—Liquid capacitv.��gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No....... g g q.�' ..._..._ Width.................... Total Length Total leaching area.,;,_.._._.._._..___s ft. Seepage Pit No....__.-_I........... Diameter......J®._..._.. Depth below inlet....._6_._........ Total leaching area._a e....sq. ft. Z Other Distribution box qis) Dosing tank ( ) `"' Percolation Test Results Performed by...................... �o� C`l`s ............. Date....'/�_ L................ Test Pit No. 1.4WC z.minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------------------------------ ----.---------............. .... •••------------ -----------...---•----•-------- •••.....................-- 0 Description of Soil............................••-•---------...........-•--•-•----.......-•---••----•--•---------------------------------••----.....-•-•----••••......--•-................ x U ------------------------------------------------------------------...................................................................................................................................... x - U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -------•--•-------•--•------•--------•-••------•-•-•-----•-•---••••••--•••-•••••--•••--.....-•-•••---•-------...•-••--•-•-•------•-•-•-----••--•-•-•••-----•-•••----•-•---•-••--------•-•--•••••••••--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b the of health. r -ned. .. 6� � r --•... .......••...'....... ......��t�...._---•-------••••-•.••... --•- -------••....... ApplicationApproved By............. ••----. ...... ......................................................... �b -......._.._. Date Application Disapproved f or f ollo zng reasons:..................................... ...............•-•--••--•••----•-----•----•-••--••••--- ••--------....•......••-••----••-...............--•I-----•----•--------...-•--•---••-.....-••--•-•-•--------... ........................... Date PermitNo......................................................... Issued•....................................................... Date --- - -- -- - - - - -�...a.........�..- - t No................. .. + i Fxs.....(.............:..:.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4 .... ;. -:OF............................................ .. Appiiration for Dhipoli ai Workii Tomitrnrtion "prod# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: A o� Location.Address or Lot No. Owner Address a ! .l�1 l4S l "-AZ,44`L...................................... ........---.................._ ----•----........_......---......---•--.. Installer Address d Type of Building Size Lot.410,10- ......Sq. feet U Dwelling—No. of Bedrooms___..3-----------------------------------Expansion Attic (NO) Garbage Grinder Qt,)Q) aOther —Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d fixtures ----------------------------------•-----•----................_...-•--------------------....-----------------.......-•----.........------............... w Design Flow....... ...........................gallons per person per day. Total daily flow..........31P......................gallons. WSeptic Tank—Liquid capacity.11000gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No....... ....._.. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........I----------- Diameter.._... ...... Depth below inlet....... Total leaching area...02.7.d....sq. ft. z Other Distribution box (Y Dosing tank ( ) aPercolation Test Results Performed by--------------------------- l�S........................ Date...4�..'71 ................ Test Pit No. 1. < .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........................ 04 .............................................•------------•---.....•-------...........-------•-••--•......................................................... 0 Description of Soil........................................................................................................................................................................ U ---------------•-------------------••-••------------......_...........-•-•--------....---------------------------------------------------------------.......---------------•••......--•-•-----••---••--- w U ''Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------------------------------------------------------------------•----------------........----••--------•----------------------•-•---------•--------------------•.........---......_•--•••---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersi ed further agrees not to place the system in operation until a Certificate of Compliance has been issued b the d of Health. fined- r ._. t •--- ." 6"' .. _ -- -- . _ .-. Application Approved By......t...................... .. ............7 ............. Date Application Disapproved for t. e f ollo ng reasons---------------------------------------------•-----•----------•----------------------•--- ....._......... ........................................................... .............................................•................••................................•....•...--•..........--Date PermitNo......................................................... Issued-....................................................... Date . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... d Tntif iratr of f�u�t�haurr T IS SC TIFY, That e IndI idual Sewage Disposal System constructed ( or Repairedby............. -�` -- .... ..-•--••-•---•------ --------•---------..........--------••--------..............................------........------ - --- nstaller, _... has been installed in accordant with e provisions of TITIF 5 of The State Sanitary C de/a; . c ed in the application for Disposal Works Construction Permit No....... "A-""".'I�.. _....... dated_.. .C-2 ------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A A/GUARANTEE THAT THE SYSTEM WIL FU TION SATISFACTORY. / (- DATE....... ............................................... --•-.. Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4/0 ...........................................O F..................................................................................... No. . ...... FEE._ * ... ............. Map a r Qla otr ion rrmi# Permission is eb 'granted_..:.-" '. ' Fll' System to Construct�, •epair ( ) a • -ndi dual Se y atNo - �'............ . . . ............ '-•-- ................................................. ........ Street as shown on the a licati for Disposal Works Construction Permit No..................... �.......... ............................................ ..... ......... �j 19' Health ......... DATE.........--- ... .. FORM 1255 A. M. SULKIN, INC.. BOSTON LO"CATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME i ADDRESS � rch �d - L ® U I L D E R ON OWNER DATE PERMIT ISSUED ®DATE COMPLIANCE ISSUED 1 �2 a 2` v` 03 TT3M @ sTK. Lot / M u I1 s WV-" " (� ul TM lu �. L foT 7 / 4s* G I WNLL OF ON su f � / �T 2. • \ a � � h\y � v ti 1 t ti' JN 6 Z 0 3 3 v drf •�a L,:=T P✓ s. a LEGEND EXIBTINB SPOT ELEVATION OsO ����lN °F"''ss CERTIFIED PLOT PLAN EXISTING CONTOUR ---_ O AL E^ L.G/-r {',�?!�' U,mot Jt. f r 171#19MED• SPOT ELEVATION a 0 MOR CAA l G�\/r LLB FIIR9IDi1E0 CONTOUR ARSE �jNo.10951�Q IpI A VED+ BOARD OF HEALTH 0 o�Fs NA, L AAAA SIB o •L • S/ONA E a . d ATE AGENT SCALE, DATE 29 DATE+ `7"17Z7 t-f3 /PJE�6 E'MGIMEE�T1AfGi Cal CLIENT I CERTIFY THAT THE PROPOSED EGISTEAR RESISTED JOB CIO. 8� BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZOMINQ LAVES -11 'RV DR.BY+..AM OF BARNSTABLE, ASS. 712 M A'-I "I STREET.. CH. By J Q� J t-7 03 HYANN I S,, MASS. ' 2 SHUT-I OF �.. OATS LAND SURVEYOR .9r/K ORNOT F /F TYER T�/E _ ?T/C T ,'=Ei4Ch+livG G/T A.tE IyOR,- T//A:`/ /2"BELOJJ` /O /•T M/N. 1RAf OEM 24�D/al METER CONC'RET.E COVE, '.. - I S/,►AL,L .BE BRdG/GNT .TO 4RADE..��.'/ EXTeg GONCRGTE . � 4PYC P/PL �yE,4Vy CAST IRON COY�R Sf:�:4LL 04F USEJ ! P/TCN -� 1' : —•i=L=9 8.5 - co fiE�"'- a CC) ✓ER r� 57 4N---------------------- Ssa,vJ � -- VOV/D LEY. f a 1 2lLAYER i GAS V IRON /�/PE 000 G�tL. _ -0 PE?i�T S�PT/C TANK , f . . . . .a . • O/ST, ' . s f • • • • •:♦ . o� e WA5HEO STCNE • • D�PTX • ♦ ► • o WA S q-C.P 57,911E . ! � tea` I • •' • I .. • f 1 - o a ,. ._. . 4'71 'G-��L� ; ' •` • . • • . • . ► p PREC.A.ST,SEEPAC,E. lJ1/i/�itT CLZVA7.'oeYs T ?6.5 dor^/7 OR EQL!/Y. YN�ER7- AT l!lIILDING °�o.S FT : : f 1it%LET ,SEP'TfC TANK ^9y.o FT x` ' I� .t? 7/AM.` v- C.'�5E"ETADUL/tTpn dON, OtJTGET S. PT/C TA/VI� f39.8•FT ,' IAILETDi3T AIMON Box `g9.o FT .SEGT�ON l F G i'ovND,14IC4Tfir TAdtE 0tJTZLF7-D/STR>®1!T/ON 49QX1 .8IC7r INLET "-AC/N/NG•. PIT. C- e'o FT s 1NNAGE Dl.SPDeSAl.'SY.STEM LEi4CHCNG .0/T . 7A$4/L�4TlLi/V D4CSIG/V CR/TERI•� DJME/9/S/ON A 8 = FT� 0/MAC-N3%40N. yvuAsaER of�►EVRoo>ys �_ v/MEwsiow: 'C�:='FT. �. urr. ,. aa��E.vis�os�L uv/r � So/L LOG T17T.4L F3'T/M�i'TEO FLOW� GA¢./DAY .SO/L TEST Af/ SOIL 7ZrST 2 SO/L T.EST NUMBER dic 4EACMllV9S R/T'S ) fE[t•Y. � 3 . 1�-ELEi! 3 i .OATE.OF 30/L TEST S1GE L�ACHI/VG PER R/T f f58 so. lw7. ��1 ,54& iL RESULTS h/IT/VESSEG 3Y F'a BOTTpM LFar1C'N/NG PER P/T � $Q. �T. _ f't'�rtCOLAT/011� IIAT�_ >b7/N�I%VC,Id TOTAL LEACH/NG AREA yr- .AENC04A►7-ION,RATE/f�2 a• 1+ ING/Y :RESER&IV ZHAC IA16 ARE SQ. FT. ��_1N OF M �.for MAD 3 (P-&W&J) 1u1 r: K ' .c.�t E_"TE�T.. tom. 1 1 3- cp ZN 0 Af F T tiNu� Lt�T /L Z� y A ° go v MFORSE P No.10951 NIA FG/S4E¢ Q �€o ��Fssr®N��F3��'` °.. �D w EL DREDGE EN�rI N,EERING CO,>NG. SUS" L 1'7.3 �t ..3 7/2.MI!!N•ST. ,..HYR.clNi3 MASS.. ® NO G/j0VN0 yN,4TCR .11rIVC'OIJNTEREO CL/EDIT:•�-i��R- DATE S iL 8.3 F Q GR07J0 hr.4 TE.P AT ELM/ CIO.D fSLAB ELEV. = 28.75' PROVIDE CONC. RISER WITH INISH GRADE OVER D-BOX= 26.6'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE OVER BIODIFFUSERS= 26•8' - 26.4' GENERAL NOTES - SLOPE @ 2% MIN. COVER OVER INLET&OUTLET FINISH GRADE OVER TANK EL.= INSPECTION PORT WITH UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION REMOVABLE WATER-TIGHT COVER OVER 1. TO WITHIN 6"OF F.G. 29•5,+ RISER TO WITHIN 6"OF FINISHED GRADE ��ACCESS BOX TO WITHIN METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL /-5" DIA. OUTLET(S) 3 OF F.G. (ONE PER ROW) CODE AND ANY APPLICABLE LOCAL RULES. 20"MIN.ACCESS 36"MAX. } } � 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE COVER(3 TYP.)- YP.) 12"MIN. I I DESIGN ENGINEER. !-EXIST. SEWER PIP_ 9" MIN. 18" MIN. 36" MAX. 36"MAX. TOP OF SAS 23.80' 3.B.O. 4' SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL / = ' (23.791) SYSTEM UNLESS OTHERWISE NOTED. - 2" DROP MIN. 4 MIN.SLOPE @1% 6 3' ° R P MAX 3"j PROVIDE WATERTIGHT TO PREVENT BR 3 D O EAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN JOINTS (TYP.) ELEVATION =23.79' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A PROP. PVC 10" 4" PVC IN FROM 1EA=A .33' Q 16„ 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF / SEWER PIPE 70� SEPTIC TANK 4" PVC OUT TO 0.59' (TYP.) t10.75" (TYP) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. `-*25 801 11 , LEACHING FACILITY . SLOPE ALL SOLID 25.35' (25.05 ) + � 5 PIPE AT 1.0% MINIMUM. 12" IF (25.30') 48" OUTLET TEE 24.0' MIN. 23.83' (23.93') 23.31' 22.72' �22.71') 2.875'(34.5")---I (STONELESS SYSTEM) 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. (24.12') 6"CRUSHED STONE (23.30') 5•0' (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 22"ZABEL FILTER MODEL (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS #A1801-4x22(GAS OVER MECHANICALLY 5' MIN. 14.375' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH BAFFLE ON BOTTOM) COMPACTED BASE 20.0'(TYP FOR ALL 5 ROWS) AND DESIGN ENGINEER. 6" CRUSHED STONE 5 OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 28.00' ESTABLISHED OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE GROUNDWATER ELEV.= < 16.3' ON A NAIL SET IN UTILITY POLE AS SHOWN ON PLAN. COMPACTED BASE �`, �,` BASE. FIRST TWO FEET OF OUTLET PIPES TO BE LAID LEVEL. 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PROPOSED 1500 GALLON CONCRETE SEPTIC TANK 20 - BIODIFFUSERS PROFILE BIODIFFUSER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT LENGTH 10' 6" WIDTH 5' $" DEPTH 5' 8" (Dimensions per ase Precast Corp., Pocasset CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES 'CONTRACTOR TO VERIFY ELEVATION SEPTIC TANK PROFILE ,MA) 20 - 1 611 HIGH ARC 36HC (#3616 B D BIODIFFUSERS TO THE DESIGN ENGINEER. NOT TO SCALE H-2 0 DISTRIBUTION BOX DETAIL `NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. _ _ 1 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING 11 'O "��+• - • TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM • `'�� ' • • •14 • • • PERC NO. 12661 APPROPRIATE AUTHORITY. MAP 227 • � � � � • • �• _ • ' . • �• • INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H 10 LOADING UNLESS PARCEL025 1 \ ' • , • • EVALUATOR: Michael Pimentel, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE •• I • THEY SHALL WITHSTAND H-20 LOADING. . � ' • •• ; C.S.E. APPROVAL DATE: Oct. 1999 0 • r �"` 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT DUST AND FINES. MAP 227 ��» * • #• • DATE: July 30, 2009 • • �+, '�+ ' TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE PARCEL 061-001 ,I • v •• • • MAT I ELEV TOP= 27.30' ER AL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. `�--'' (4 • REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, ELEV WATER= < 16.30' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). p ``' • •. _ 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PERC RATE - < 2 min./inch W MAP 227 "` • SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. a /)/60" • DEPTH OF PERC= 40"-58" 16. PROPOSED PROJECT IS LOCATED WITHIN: PARCEL 96 08, - EXISTING 1000 GALLON SEPTIC TANK TO BE PUMPED, + •* ti 7 30 BOTTOM RUPTURED AND FILLED WITH CLEAN SAND + TEXTURAL CLASS: 1 ASSESSOR'S MAP 227 PARCEL 96 AREA=10,307 S.F.± boo• °o - " . • , OWNER OF RECORD: KRIMERKS BORDIM DA SILVA m T o Z ' • + ADDRESS: 132 HARBOR HILLS ROAD OFF<i,� AS-BUILT 1500 GALLON SEPTIC TANK r 0" 27.3'g Fill CENTERVILLE, MA 02632 a 12" 26.3' J j - + •IN i A Loamy Sand 44 10Yr 3/1 �,/w \w aw N '• ,�+ • 14" 26.1' FEMA FLOOD ZONE C Loamy Sand COMMUNITY PANEL# 250001 0008D MAP 227 #132 HC B 10Yr 5/6 EXISTING 3-BEDROOM -B �w I +r • • • 17. DEED REFERENCE: DEED BOOK 18153 PAGE 202 \w ., e + * `+ 40" s PARCEL026 00 w I ` •• . ; Perc '%= 24 0 DWELLING 18. PLAN REFERENCE: PLAN BOOK 180, PAGE 117 o� o. 9s \w / "� `t w • + , • 58" 22.5' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. TOF 36.25' \ / !• ' + •• • 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY = w� .. ' � • �. i ' ) 1g >�t �i 0 + Medium-Coarse Sand FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY �� s • •• s o , C 2.5Y 6/6 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. CHANGE IN c';'' \w /�(0rr J�'� `..: .• • . (4 1t,il' FOUND HT. g) TOF = 31.25' �9s , �� LOCUS PLAN DECK SCALE: 1"= 1000' ,;; f ,O1 No Mottling, Standing or Weeping Observed LEGEND O _. 3 (1 0o 0 00 -_ .0' \ �� O DESIGN DATA A ' TEST PIT DATA 50xO EXISTING SPOT GRADE lbPERC NO. 12661 50 - - EXISTING CONTOUR (2 ® /�� EXISTING LEACHING PIT TO INSPECTOR: David W.Stanton, R.S. PUMPED AND FILLED WITH NUMBER OF BEDROOMS (DESIGN) 3 EVALUATOR: Michael Pimentel, E.I.T. -� 50 _ PROPOSED CONTOUR CLEAN SAND DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E.APPROVAL DATE: Oct. 1999 E/T/C EXISTING UNDERGROUND UTILITIES TOTAL DESIGN FLOW 330 GAUDAY � DATE: July 30, 2009 DESIGN FLOW X 200 % = 660 GAUDAY GAS EXISTING GAS LINE MAP 273 � LP �_.- TEST PIT#: 2 USE PROPOSED 1500 GALLON SEPTIC TANK W W-- EXISTING WATER LINE AS-BUILT `� ELEV TOP= 27.30' PARCEL 027 "D-BOX" TP 1 / i ELEV WATER= < 16.30' TEST PIT LOCATION / INSTALL 20 - 16" HIGH ARC 36HC (#3616BD) BIODIFFUSERS' PERC RATE _ � 1 / O ti 27.3' \ / 3 P 2 1 O� DEPTH OF PERC= E-0 EXISTING 1,000 GALLON SEPTIC TANK ( / SYSTEM CAPACITY CO TEXTURAL CLASS: 1 AS-BUILT 4" SOLID SCHEDULE 4 AS-BUILT 20-ARC 36HC \ 27 _� J 0 PVC PIPE BIODIFFUSERS IN - 8) �/ O (TOTAL L.F. OF BIODIFFUSERS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD ❑ AS-BUILT DISTRIBUTION BOX LEACHING FIELD 7), V v� (100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING/DAY zlz0 CONFIGURATION `o `"� 20 6)� � Fill 27 3' � AS-BUILT ARC 36HC (#3616BD) BIODIFFUSER M O 5) " Q� �� � TOTALS: A 12 Loamy Sand 26.3' \ GRAVEL 10Yr 3/1 AS-BUILT 1500 GALLON SEPTIC TANK S ° 4) ,k? DRIVE /�� 141, 26.1' 3230h o Loam Sand o o TOTAL NUMBER OF BIODIFFUSERS: 20 y (96•87') ACTUAL ELEVATION "AS-BUILT" 03• N O yC; / TOTAL NUMBER OF COUPLINGS: 0 B 10Yr 5/6 AS-BUILT INSPECTION /� 2 TOTAL LEACHING AREA: 480.0 SQ.FT. PORTS (TYP.OF 5) TOTAL LEACHING CAPACITY: 355.2 GAL./DAY 40" 24.0' \ rn / REV. DATE BY APP D. DESCRIPTION MAP 227 Fr "AS-BUILT" SEPTIC SYSTEM PARCEL 095 NOTE: AS-BUILT SWING-TIES EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE PREPARED FOR: � DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER C Medium.Coarse Sand Benchmark DESCRIPTION HC-A HC-B ' "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO 25Y 6/6 CAPEWIDE ENTERPRISES Nail Set in U.P. 209/9A ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST Elev. =28.00' TANK COVER INLET(1) 40.0' 40.8' MODIFIED OCTOBER 30, 2008). TRANSMITTAL NUMBER=W000052. LOCATED AT NOTE: Approx. M.S.L. 132 HARBOR HILLS ROAD 209/9A TANK COVER OUTLET(2) 37.8' 45.0' 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE / DISTRIBUTION BOX(3) 26.0' 59.0' CENTERVILLE, MA 02632 TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. INSPECTION PORT(4) 44.6' 72.0' 132" 1 16.3' SCALE: 1 INCH = 10 FT. DATE: AUGUST 17, 200 0 5 10 20 40 FEET 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE / INSPECTION PORT(5) 43.1' 69.8' 1 No Mottling, Standing or Weeping Observed ,OFU LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE INSPECTION PORT(6) 41.6' 67.4' JOHN L �,�� PREPARED BY: CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. RESERVED FOR BOARD OF HEALTH USE „ o CHURR MILL JC ENGINEERING, INC. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS INSPECTION PORT(7) 40.2' 64.6' AS-B U I LT' CML 2854 CRANBERRY HIGHWAY No 41807 ARE NOT CONSISTENT WITH TEST PIT DATA. INSPECTION PORT(8) 39.1' 62.5' EAST WAREHAM, MA 02538 3.) PROPERTY IS LOCATED WITHIN THE ESTUARINE SITE PLAN CLEAN OUT(9) 31.3' 25.3' 508.273.0377 PLAN _ _ WATERSHEDS. SCALE: 1"= 10' Drawn By: JLC Designed By:JLC Checked By:JLC JOB No.1662