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Home My WebLink About0072 HILLSIDE DRIVE UNIT #A - Health i 2 Hillside Drive Centerville A= 193 —052 iMiAD No.2.153LOR UPC 12534 I ` smead.com Made in USA ��cvcc� I s a— Commonwealth of Massachusetts 19� o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments rz 72 HILLSIDE DR l Property Address SEELEY ' Owner / information is Owners NTERVILLE V MA 02632 6-19-17 X required for �. every page. City/Town. State Zip Code Date of Inspection r"jj Inspection results must be submitted on this form. Inspection forms may not be altered in way. Please see completeness checklist at the end of the form. Important: A. General Information S/fir /at3q 9 When filling out forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name VQ P.O. BOX 145 Company Address CENTERVILLE MA 02632 Cityrrown State Zip Code 5084204534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-19-17 Inspe rs 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 72 HILLSIDE DR Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 6-19-17 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: AT TIME OF INSPECTION SYSTEM MET ALL PASSING REQUIREMENTS. THIS REPORT DOES NOT PREDICT THE FUTURE PERFORMANCE UNDER THE SAME OR INCREASED USAGE. THIS REPORT IS NOT TO BE USED AS A BEDROOM COUNT DETERMINATION DESIGN FLOW. 13) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 72 HILLSIDE DR Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 6-19-17 every 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 pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 72 HILLSIDE DR Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 6-19-17 every 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 t more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/Z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 72 HILLSIDE DR Property Address SEELEY Owner owner's Name information is required for CENTERVILLE MA 02632 6-19-17 every page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, ` provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 72 HILLSIDE DR Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 6-19-17 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 HILLSIDE DR Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 6-19-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: SYSTEM CONSISTS OF A 1500 GALLON POLY TANK D-BOX AND A 4 BEDROOM S.A.S CONSISTING OF 16" HI CAP BIODIFFUSERS. Number of current residents: UNKNOWN Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2016--------556 GPD 2015--------410GPD Sump pump? ❑ Yes ❑ No Last date of occupancy: CURRENTLY OCCUPIED Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Mt 72 HILLSIDE DR Property Address SEELEY Owner Owners Name information is required for CENTERVILLE MA 02632 6-19-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: CURRENTLY OCCUPIED Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 72 HILLSIDE DR Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 6-19-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 11-24-14 PER AS-BUILT Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 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.): Septic Tank locate on site plan): p ( P ) Depth below grade: 2 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: 1500GALLON Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 72 HILLSIDE DR r Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 6-19-17 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): IF TANK HAS NOT BEEN PUMPED IN THE LAST 3 YRS I RECOMMEND PUMPING AT TIME OF TRANSFER AND EVERY 2-3 YRS THERE AFTER FOR MAINTENANCE. 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 scum of to to of outlet tee or baffle P Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 72 HILLSIDE DR Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 6-19-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons I 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M r� 72 HILLSIDE DR Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 6-19-17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): BOX LEVEL NO SIGNS OF LEAKAGE OR CARRY OVER 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M '< 72 HILLSIDE DR Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 6-19-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Type: ❑ leaching pits number: ® leaching chambers number: BIODIFFUSERS ❑ 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.): THE VENT/OBSERVATION PORT WAS OPENED AND THE BIODIFFUSERS WERE FOUND TO BE EMPTY WITH DAMP SOILS IN THE BOTTOM, CLEAN SAND COULD BE SEEN AT THE BOTTOM OF THE CHAMBERS. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 72 HILLSIDE DR Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 6-19-17 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 72 HILLSIDE DR Property Address SEELEY Owner Owner's Name required fo is CENTERVILLE MA 02632 6-19-17 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 72 HILLSIDE DR Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 6-19-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: NONE ENCOUNTERED AT PERC TEST 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: 6-19-17 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: DESIGN PLAN Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 72 HILLSIDE DR Property Address SEELEY Owner Owner's Name information is required for CENTERVILLE MA 02632 6-19-17 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Assessing As-Built Cards Page 1 of 2 TOWN •�OF BARNSTABLE U LOCATION x1�5�t) r SEWAGE#aOfK-y3� VILLAGE _ASSESSOR'S MA.P&PARCEL _ INSTALLER'S NAME&PHONE NO. ,�ts A f, SEPTIC TANK CAPACITY , f N LEACHING FACILITY:(type) " (size) NO.OF BEDROOMS_q OWNER PERMIT DATE: 11�13—/y_COMPLIANCE DATE: Separation Distance Between the: +4eye a9^QNlI; 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 FURNISBED BY d.•�4,G 2 —30,c, 3-W,G 3 4ti L) -48 Y -H9 i G 5� -366 L 0 http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=193052&seq=2 6/20/2017 g g TOWN OF BARNSTABLE LOCATION 7 15/de Or SEWAGE#9CD/If- t-/3B VILLAGE C,� PF a r ASSESSOR'S MAP&PARCEL Jqn a INSTALLER'S NAME&PHONE NOD', s 4 1 SEPTIC TANK CAPACITY f- ev LEACHING FACILITY: (type) (size) NO. OF BEDROOMS OWNER 'Se ete 4 PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: l P46" e- °f-6' perr, 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 h 3 -ys,Co, 3 — 4 Y _y �) —4e, a., Do 1 n Main File No.017991 Pa Bttuiiding Sketch 17ft 17ft Bettina S 8 Lawrence W Brown - 72 FGllside Dr Centerville Couny Bamstable State MA lip Code 02632 Steams Lending,LLC-Wholesale Fail"ttgly Room Rec w Plot size: .27 acres Room ---rSfA9KE DE UORS REWEWEO 4f 3 � wet V—W JB ;NZ�BUI DING DEPT. DATA ai Bath12ft l � 0 Bau-' Firs n FIRE DEPARTMENT DATE 20ft' {70t aft v -BOTH,CIGNATURESARE REQUIRED FOR P RMllTING �' 11, Unf. Basement n' Larry & Tina's wing -' W [369 Sq ft] Patio Total 1,200 Sq. ft. [z60'sq-ft] Pc Bedroom X Oft 17ft cc Shed Amber's wing total Vic Kitchen eft 598 Sq. ft. X Bdrm a o1 W Common Rec room Wt y z car Carport � will.be shared by all. Living 1606 Sq ft] Its area, 166.5 sq. Bdrm K Room Bdrm x Ceiling mounted fire/smoke L /C0.1 alarms will be marked Q7 4.Oft 22ft as / off seesaw 900.......................HILLSIDE DRIVE.......................................................................-....................... 9}( Town of Barnstable °V�"E'"�� Regulatory Services } + Richard V. Scali, Interim Director 3 �rsr�.rsr.E; ' MASS. Public Health Division L65g;. �? pxfD. t Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Offit 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Dat : /i Sewage Permit# 1014 -43t Assessor's 1Map\Parcel 19 3 SZ Des' Der: Installer- Ad( ress: 61 Address: P G °Co`(�'( C eh l-en�11A t�'1►�- (� �z(o`3 Z On ti 2� �'"'�- vas issued a permit to install a. +L-e sept}'c sytem at': t ! r t , s`l-,F' . 1 based on a design drawn by (address) Aj, dri:Leti '7 1 r y L_v g 1 -1 (designer) 1 .cer it that the septic system referenced above was installed substantially according to the des' wl ich a Say ii)clut�e minor approved changes such as lateral relocation of the distribut an bcrx and/ar Septic tank. Strip out (if required) was inspected and the soils r-e foiirid satisfactory, .,certify Thai`,he septic system referenced above was installed with major changes (i.e, greater than 1 Q' lateral, relocation df th SP S or any vertical relocation of any corrlpone:nt 6f the,septic system) but in accordance with State & Local Regulations. Plan revision-or ceiti ed'as-built by designer to Follow. Strip out (if required) was mi spected and the soils �ere found satisfactory. eN'�p4lLkhq�i' I certify that the system referenced above was consuu 'i with the terms of the I\A approval letters (if applicable) �. %. ' r '1-� k r. yin I CIVIL � ( sta er's Signature) �j,g t PJnL � '�fi+v'rtv k.. (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABEP`I.TBI,IC HEALTH DIy1ION. CI{1TIFICATE 'OF C01Y-E'LL NCE-' WILL NOT BE ISSUED UNTIL BOTH T11-18 FORM'. AND AS �+ BUILT CARD ARE RECEIV-ED'jBY`'CIE BA INSTABLL PUBLIC I EALTI3 DIVISICtN; 7HkNK,YOU. Q:"*h�iOpesiper Certification Form Rev 8-14-13°doc T • No. 0 Fee l Uv i v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLatlon for -Misposal *pstem Construction permit Application for a Permit to Construct( ) Repair(iU pgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. 'T:Z ��i1r�t P �cr , Owner's Name,Address,and Tel.No. Assessor's Map/Parcel � �. VC Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. r, lc5 A "1�cox,5:a 1' �N i^3c' ��'��► i.�c��lc Tfpe of Building: Dwelling No.of Bedrooms Lot Size t;L ,,JQ S sq.ft. Garbage Grinder( ) Other Type of Building a(e-,tC�Pr.�fi \ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) y H C) gpd Design flow provided_L4 15 gpd Plan Date ;L— 7 —%tl Number of sheets Revision Date g U41 Title Size of Septic Tank i To 0 Type of S.A.S. (C,11 14 i C« H•2 0 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S /WDate Application Approved by Date i Application Disapproved by Date for the following reasons Permit No. (� Date Issued No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:{� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MAiSACHUSETTS Yes Zipplicationifor MisposalOpstem Construction Permit Application for a Permit to Construct( ) Repair(Vf/Upgrade( ) Abandon( ) ❑Complete System Et5ndividual Components Location Address or Lot No. 72 W,2 $1 e T f Owner's Name,Address,and Tel.No. ,. !Assessor's Map/Parcel I Y -S� � \/c See1e-J Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1c. A Z-ccwroS,\x 1-i L'000C. Type of Building: Dwelling No.of Bedrooms Lot Size I A ,Vw_1 sq.ft. Garbage Grinder( ) Other Type of Building CS\c)rN E\U\ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Ll H gpd Design flow provided cU 2 S- gpd Plan Date 2- -7 -!4-1 Number of sheets Revision Date y r r L/ Title Size of Septic Tank_1 S� Type of S.A.S. JC.11 14 t Caw b�oe��FhUStmrS H 2(� Description of Soil Nature of Repairs or Alterations(Answer when applicable) l NSte.1i N rt-0 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in i 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. Date Application Approved by -I Date Application Disapproved by Date for the following reasons Permit No. I - 14 3 Date Issued r 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 c% A A 1--NC at 7 2-- 1-I # 11 g i TAP V Q C c-N Y has been constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit No.�a ]fp dated (1/f 3 y i Installer :Zb,3�1C_s A T_ AX Designer le e j-e-e- y,'.v t ✓�C $ #bedrooms // Approved design flow H 2 S— / gpd The issuancd of "is ermit shalhnot be construed a71911F_,�,Iyj that the system wi cf on as desJignneed. / Date �� Inspector -------------------------------------------------- ------------------------------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pBtrm Construction Permit Permission is hereby granted to Construct( ) Repair(�) Upgrade( ) Abandon( ) System located at -7 1- H ► I(S i t� r �j f C r.,y and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:ConstructionT'ust be completed within three years of the date of this permit. Date M � Approved by XFINITY Connect Page 2 of 4 i Pad '1 W1$PM M IMP a� T I X 1 J I 6� lone Town of Barnstable t, Regulatory Services '" °• Richard'V:ScalL Interim Director ( � i Public Health Division t`sa►, Thomas Mc.'Kentt,Director 200 Main street,ayianais,]l4A'OU01 09io: 501462-4644 'FaXz 508-790-630i lniuCo++'tr r Gcrtiflt atiion form for Alter- 84ivc$ a;te Properiy-Address: Uscssor's 11t1&nrcel: 19-3—O 5�- _ Lropsr Qwller4tiamc: lc aacoidance wit Massachusetts DEP altenia+tivt S)'stcm aPpr oval 3c xers,the iollov i4td Ce?lificeitUor intorii upon, L regwree by Une Oivtier of record. "fie Chmer of record trust plF=an 'Y' in We uppfl a b It bras next to each line certifyiaie the irforr"U 1ori. }f,oa 1\i�ai Ij I naive been provided a mpy of the We 5 VA'ta-1knlogy Approvdilevers, (15 page Sumdard Coodilions lever and the 5peci is 5.ecau10109y Jw kx) l r'' l havG bem provided wits the o vner's Njanual 1. 1 have$eeg provided with Cale Operation twd M riance Manual For Systaans iaista3lled tinder it Fj--nd-E Use tlpurtov�sl,I aggee w fuli it ay rewpomibilitiz s to p+c�'ide a DwA Notice as tequirsal by 310 OWL 15:287(1,0) and the A,pM-val L !fi For Sys 'ns nstslied Lander la R-ctrledial Ilse.Approval,i agree to-fulfil my reT' sibilitias 1-0 FraiJide tiVriti i nnt]fiCation of the Apprrvnl to any new 0wner,..as required by 310 CUR 15 287(S) FW 04 If the desiga does not provide R)r the use of Surbage grind ers,the resuiciior.is and eusrood and Rsxepted QW Q Wi)cthex or cotcovared by a"t—ranty f'aitdersta0d the rcgttim—nr to repair,r.placc,modily or talm my miter action as required by llie 1)eyeat>mt or thu LAA,if the Department arr the . J.,AA dctumines the Systonn to be failing to Frntcct pu•lic bmIth wid sgety:acid the envirorimt,m,as defined in 310 CMR 15.303 James JI Seeley ame o camply wish a l ierms and condition kh"ive. 11112/14 Pi t}' cr&Statute D°M Note.• Tbk rtiritl mm5t be vnhmittcd aionR Ivith the se lie svctem dison.gal is,orl.s nermit €AppHe`itio dar sil- LSA hV t4tuts ;xmikidini tray Construction! 'C8lairslunsyr'ades l<'atit. and Wifh aut affnreE<ate fstwnel and rvikh eorlv+`ntiitittAl Ar€ietl cratctaa or credited tieea�ia cr°ateria. Q:i3'��[its��ha��cewnctce:tM1h�rirgige http://web-mail.comcast.net/zimbra/h/printmessage?id=598662&tz=America/New York... 11/13/2014 Town of-Barnstable P# _ / Departi pient of Regulatory Services a Aj Public Health Division Hate ai.5 A,fP 200 Main Street,Hyannis MA 0260I pa, Date Scheduled d ' ' Ma. Time Fee Pd, Soi uitability Assessment for Sews zs j Performed.By: � � �`' � F�d�S y2 Witnessed 6 : Y LOCATION & GENERAL INFORMATION Location Address -2 2 �.g,'/l s,'e�t �,^L Owner's Narn- -— Ja.h M CG�t�it/e l L4 MA- Address _2? Assessor's Map/Parcel: /9 3 6S 2 Engineer's Name AX, C_& f't?'6 NEW CONSTRUCTION REPAIR x Telephone# Land Use Slopes(%) � � 2— Surface Stones r` Distances from: Open Water Body�ft Possible Wet Area —ft Drinking V 'e Wei17_�ft Drama a Wa N 6� ft Pro ert Line G r g Y ` P Y 1 ft .Other` T ft r rs SKETCH:(street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands n[roximity to holes) -;,a, 7 f &f w Parent material(geologic) �yf t�l9CtS Depth to Bedrock /0. Ai/Z— Depth to Groundwater. Standing Water in Hole: NQ G C0 Weeping from Pit Face Nam' Estimated Seasonal High Groundwater / _z_ DETERMINATION FOR.SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: __--In, Depth to soil mottles: - ,, DcYth-ta w.• ping fr n:side of oba:hole: —in, groundwater Adjustment fl. Index Well.#— Reading Date: index,%V01evel._ Adi.factor Adj,OroundwaterLevel o PERCOLATION TEST bate 1 ,2� Time G� Observation Hole# I Time at 4" Depth of-Pere �6 �' Time at 6" `j' 77 Statt Pre-soak Time® 1/',) _ Time(9"-611) ,. t6^ End Pre-soak Rate Mini/Inch. C Z- Site Suitability Assessment: Site Passed__-_Q� Site Failed: Additional Testing Needed(YIN) Original: Public Health Division ` Observation Hole Data To Be-Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland you must first notifythe P Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEFTIWERCF0RM.DOC DEEP.OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture Sod Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure;Stones;Boulders.. rt Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color. Soil k . Other Surface(in.) •. (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) 44 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture, Soil Color Soil Other Surface(in.) (USDA) (Munsell) 'Mottling (Structure,Stones,Boulders. dConsistency, DEEP OBSERVATION HOLE LOG H016# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling, (Structure,.Stones',Boulders. 0 i Flood Insurance Rate Map: Above'500year flood'boundary No_ Yes .� Within`500 year boundary No—A Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area for the soil absorption system? proposed If not,what is the depth of naturally occurring pervious material? ..�. CetXtification I certify that on (date)I have passed the soil evaluator examination approved by:the Department of Environmental Protection and that the above analysts was performed by me consistent with . the required arcing,expertise and experience described in�10 CMR 15.017. Signature Date Q:\S•EPT[QPERCFORM.DOC TOWN OF BARNSTABLE LOCATION v9, mll .. Dt 1 SEWAGE# VILLAGE �-l{'` I I ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY WtV i S `G\-) �IbPrt2 LEACHING FACILITY.(type) IP I xish (size) NO.OF BEDROOMS `/// OWNER 1M <iee PERMIT DATE: COMPLIANCE DATE: r Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well 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 y within 300 feet of leaching facility) Feet FURNISHED BY Pik No. . _ — I Fee a THL�6MMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for �N5 o� Y *p.5tem� Coaztruction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. -7 5 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel (C1.3 Installer's Name,Address,and Tel.No. Designer's Name,Address 7//A o. Type of Building: (q.14 -' Dwelling No.of Bedrooms �`` Lot Size o 2� sq.ft. Garbage Grinder ( ) Other Type of Building �)005 e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Crl Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this rd o He Signed av� Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. �_Uj/-3 0 y Date Issued No. _ ( T Fee kvr^ '''I M Entered in computer: TH GMONYVEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYicat.ion for �Bigogal i§pgtem Conotructiou Verm tt Application form Permit to Construct( ) Repair(:;;Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. -7�L Wt,'s Oe Owner's Name,Address,and Tel.No. ce+�trfQ�l�f' 5� , Assessor's Map/parcel `C�s 0rJ 2 K Installer's Name,Address,and Tel.No. 'F Designer's Name,Address and a/No. —0oosl cp Type of Building: Gl -� -7 Dwelling No.of Bedrooms �LL Lot Size o o�7 sq. ft. Garbage Grinder ( ) Other Type of Building V)00 No.of Persons Showers( ) Cafeteria( ) b � Other Fixtures Design Flow(min.required) gpd Design flow provided /gpd Plan Date Number of sheets Revision Date Title. � i Size of Septic Tank Type of S A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) C PSJ c J'-fi1M �a. 1500 .Cl DN �1 of r c,% tt. s J its C c t, v Date last inspected: d 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. /f f Signed ; jQQ" "`- Date . Application Approved by / N F� Date Application Disapproved by:r i i Date for the following reasons Permit No. )vCUr Date Issued 7 / (/ T' - )�I� f THE COMMONWEALTH OF MASSACHUSETTS If ( BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (graded ( ) Abandoned( i by at r e(J has been constructed in accordance with the provisions of Title,55 and the for Disposal System Construction Permit No. dated—7Aild Installer ��,G Tl 3 G(m3a Designer #bedrooms Approved desig&5t gpd The issuance ,f thi permit shall }o bed onstrued as-a guarantee that the system willas designed, �' a Date Inspector ----------------------------------=—==------ z No. � �L � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS �Diopo.zal ,p5tem Construction Permit Permission is hereby granted to Co (- ) Repair ✓ Ups jde ( ) Abandon-, \ y System located at 7*. /jiff 5/Oe D;Iye (P&1r1V171 1& 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 conditio��Fo Provided: Constructi h must be completed within three years of the date of t / W/ Date !2- Approved by TOWN OF BARNSTABLE LOCAT J11ION �rl�l r S i aJ e 17 w SEWAGE# _';TILLAGE (:eA-Rry ASSESSOR'S MAP&PARCELSa-- INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY CQ,SSOQb r LEACHING FACILITY:(type) P17 Lx G^ (size) 07 S7-DA,,_ NO.OF BEDROOMS OWNER W A(ki,/ PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY q—'A Spci.T, FDi c1 Y101 A /3 AL (3. i Q a � 3Fs a� PT a �0 38 cC J k COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE.5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 72 Hillside Drive Centerville, MA 02632 LA Zo Owner's Name: Walter Walker Owner's Address: Date of Inspection: September 14, 2007 WAR 11� �sZ Name of Inspector: (Please Print)James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 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 the inspection. The inspection was performed based on my c training and experience in the proper function and maintenance Qf on site sewage disposal systems, I am a=DEP => approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _,, ✓ Passes Conditionally Passes Nee urther Evaluation by the Local Approving A=tithority �> Fail (y) �rl Inspector's Signature: Date: September 2 2007 -v The system inspector shall sub t a copy of th i.sl 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. Notes and Conunents ****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. Title 5 Inspection Form 6/15/2000 page 1 - J Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 72 Hillside Drive Centerville MA Owner: Walter Walker Date of Inspection: September 14, 2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not detennined(Y,N,ND)in the for the following statements. If"not detennined",please explain. The septic tank,is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is.replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will . pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 72 Hillside Drive Centerville IM Owner: Walter Walker Date of Inspection: September 14 2007 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,.safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 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 colifon-n bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of anunonia 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: 3 ' Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 72 Hillside Drive Centerville, MA Owner: Walter Walker Date of Inspection: September 14, 2007 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the.ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructedpipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or.privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ ✓ Any portion of.a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have detennined 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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gPd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 contactthe appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: .72 Hillside Drive Centerville, MA Owner: Walter Walker. Date of Inspection: September 14, 2007 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant, or Board of Health ✓ Were any of the system components pumped out in the previous two weeks ? _ ✓ Has the system received normal flows in the previous two week period? _ ✓ Have large volumes of water been introduced to the system recently or as part of this inspection.? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,excluding he SAS, located on site? ✓ Were the septic tank manholes uncovere I,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 Abso ption System (SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a pl n at the Board of Health. ✓ Determined in the field(if any of the fai ure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 72 Hillside Drive Centerville, MA Owner: Walter Walker Date of Inspection: September 14, 2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example:110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] . Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings; if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of infonnation: Unavailable Was system pumped as part of the inspection(yes or no): 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) Tight Tank Attach a copy of the DEP approval Other(describe): - Approximate age of all components,date installed(if known)and source of information: A new pit was installed in 1992-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 72.Hillside Drive Centerville, MA Owner: Walter Walker Date of Inspection: September 14, 2007 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Commments (on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) (Cesspool acting as a septic tank) Depth below grade: 20" Material of construction: concrete _metal fiberglass _polyethylene ✓ other(explain) Concrete cesspool block If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 6'W x 8'T x 9'bottom to grade Sludge.depth: -- Distance from top of sludge to bottom of outlet tee or baffle: -- Scum thickness: Distance from top of scum to top of outlet tee or baffle: -- Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Measuring stick Continents(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): The cesspool was dry. An outlet tee was present. The cover was 20."below grade. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 72 Hillside Drive Centerville, MA Owner: Walter Walker Date of Inspection: September 14, 2007 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments (condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Continents (note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): 8 ,. Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 72 Hillside Drive Centerville, MA Owner: Walter Walker Date of Inspection: September 14, 2007 SOIL ABSORPTION SYSTEM.(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I -(1000 aQ leaching chambers, number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Commments (note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.); The leach pit was dry and clean. The scum line was approximately Pup from the bottom. The cover was 12"below rag de There did not appear to be any signs offailure. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 72 Hillside Drive Centerville, MA Owner: Walter Walker Date of Inspection: September 14, 2007 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. L--,3 A, r3 Q a 3 aL �- 2- G0 3 10 a Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 72 Hillside Drive Centerville, MA Owner: Walter Walker Date of Inspection: September 14, 2007 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 45 +/- feet Please indicate(check)all methods used to,determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers_-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: UsinY,Barnstable topographic and water contours maps, the maps were showing approximately 45'+/-Around water at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 : • Town of Barnstable �' pp 7HE tp� Regulatory Services snar+srns Thomas F. Geiler,Director 's639. �� Public Health .Division rEDMAyA Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. TOWN OF BARNSTABLE 9, r LOCATION 7,�L 1,04Z f/®� ®�ILI£ SEWAGE # VILLAGE C4;k T L)/" ASSESSOR'S MAP & LOT -GAT INSTALLER'S NAME & PHONE NO. X.,>.& SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ZaSl&L .01 (size) 6,�e)d NO. OF BEDROOMS % PRIVATE WELL OR LIC WATE:R�__ UILDE R OWNER elGC CC��S�� DATE PERMIT ISSUED: ��- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No d 1 N 4 i v ,: •�1� I��IO r THE COMMONWEALTH OF MAS CHUSETTS BOAR® OF HEA TH TOWN OF BARNSTA LE , pphratiun for Dispnm1 Workii nnutrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: .. • - -��. .. 'lS�`Q mac'- - . ............................... � 1'LLi.. -1��1' ............................... Loc ti n-A dre ..-or Lot No. O er Addr s Installer Address... Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms......... _.._ ............Expansion Attic Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfix res -----•-•-------•--••------------•---------------------••-----•-•-----••--•------•--------••. • ......_............_......---- W Design Flow............. . ..........gallons per person per day. Total daily flow....................... ..a...............gallons. WSeptic Tank—Liquid capacity/l�._....gallons Length................ Width................ Diameter._..-f..... Depth....�i........ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq, ft. Seepage Pit No....... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fst Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ a .--------•••---•----------------------•-•-------•-•----•--•-------•--------- ---•-•.....----------- . Description of Soil...Q._-Z�:9..4, �. � x - -- ................ U .....•-•-••-••---...-•-••.......................•.....------••---••-•-•-••-•-•--•---.......-••-------•---...--------•••••-•...-•-----••-••-•-------•...--•----•-•-•-•----... W x Nature of Repairs or Alterations—Answer when a llcable._. '�D•t�____.. /7— U P PP P. oo Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant has een 's e0AVthe bo d oj health. Signed ...... Dare ApplicationApproved By .... .. . . --------------- ----- - ------------------- --- -- ----- ... ....................................... Date Application Disapproved for the following reasons: . .... ............... ---- ...........................--- ............ ------------------------------------------ ......----------------------------------------------------- J— e PermitNo. -------- ................... Issued ---...------....... .-. .. j 9 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLEIt, . Applirutinn for Disposal Works Tonstrnrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ..........�� f LDSZO .... ��_�-/..LJ ............... ...... , � .:. --....................... ------------- Location-Addres or Lot No. Owner � ' �.15%. 7� _ C.c7�c� � / ......... Address a ..------• • -- -••---......••.. ---- ......... Installer Address Type of Building Size Lot............................Sq. feet 1•-1 Dwelling_No. of Bedrooms___.._ ..._/__......�_e............Expansion Attic ( ) Garbage Grinder ( ) `k Other—Type of Building .............. No. of persons............................ Showers Pk g -------------- ------------------P•--------•----- ---- ( ) — Cafeteria ( ) Other fixtures .------••--••-------------- -----------------.........-•-••-••..... •-------•-.........----•---...•--- W Design Flow.............• ...........gallons per person per day. Total daily flow._._.........._ ...............gallons. WSeptic Tank—Liquid capacityZ' gallons Length................ Width................ Diameter----I....... Depth....l.'..... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....... - --__. Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 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........................ ....................--------------•--......--•------------...-•-----••---------•---••--•-••----•---.........------------------------------------------•----- O Description of Soil--r ==` �� '11 •�SG�%Sd/( -`__' ...........�� s1�If�J•_8�_T'U �5 .... S Li�11�------ x (� ------------------------------------------------- --------------------------- .----------------•--------------------------- ••--••------------------------------•---------•------------•-----•------------------------------•-------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable._��h_.____,'IA4 ......................... , _-- ion .............. �ll_a ................. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance-has een 's/�/ueedd bb-)tthee board o health. Signed / n L1 .``/ .....a = -------------A �n'�y c Ll�p Application Approved BY ................. �� !- TT'i( / -/`r�/ -Ie; � -»ae Vy..,. t `�" L Date Application Disapproved for the following reasons: -- - ------------ -� ........................................... ..... ---- -------------- ------------------------------- ...................................- ------------------ ------- - ------- -- �- �------- Date s Permit No- ------------- �...- Issued /� --..C,7 �Date -�----'--j f ` d THE COMMONWEALTH OF MASSACHUSETTS BOARD-OF HEALTH TOWN OF BARNSTABLE Certtfirate of (foutyltalttre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ----_---------------- r 7 /L(3 1------(l-wtv ----- -------------------------------------------------- Installer has been installed in accordance with the provisions of TITLE 5 -f he State nvironmental Code as described in the application for Disposal Works Construction Permit No. ------ --- ------ .. ..._..-- dated ------------------------------.-.--------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTRU9D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE -�- ./ - -�------------------------------------ Inspector ---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.....1 y FEE. 0... Disposal Works Tonstrurtion jkrufit Permission is hereby granted............... G --------Z�S/-----....................................................... to Construct ( ) or Repair (-,SG,) an Individual Sewage Disposal Syst at No............................... .............//l�Sil ..... -----------em � ...... as shown on the application for Disposal Works Construction Permit Street No- _A_r�07jDated__ ��11 / `J Board oe Health DATE.. -- = /... -------•-••-. FORM 3860E HOBBS Q WARREN.INC..PUBLISHERS ' Y .. - • t �•Q/`(/I IT l.lf j^"' / V/P4, �J yl �41 •�V V'� C.�� / �u.tffC - ./k•,�..n�•_�� • ��/1,1� ' _ ` ,C':e r•' '. a ` R Y� • f ?` CONVENTIONAL SAS... " --99 --EXISTING CONTOUR o N FOR ILLUSTRATION ONLY-DO NOT:INSTALL ja, x 100.98, EXISTING SPOT GRADE 3-500 GALLON CHAMBERS W/4' STONE W EXISTING WATER SERVICE 12.8' x 33.5 S.A.S. FOOTPRINT GAS EXISTING GAS SERVICE r �� BENCHMARK BOTTOM SIDEWALL TOTAL AREA AREA AREA U UNDERGROUND WIRES TOP/CONCRETE BOUND 429 SF 185 SF 614 SF -6.H.W---OVERHEAD WIRES EL.=99.22 TOTAL CAPACITY = 0.74 GPD/SF(614 SF) = 454 GPD TEST PIT s 0 9 N BENCHMARK We ua uet 9, fence k x 96.5}0 100.22'x 9 .s4 9L5o LEGEND °his° �\\ CONNECT PIPES TO \ LOWER KNOCKOUT x 99,12 -1 Tp 2� 62 2 3 EXISTING LEACH PIT �, _ o _ 3 8 92,65 92.53 91,98 a 1�3,P0 3 1i TO BE REMOVED 90,80 s P SEE NOTE 11 yl 1 _ 97, \ LOCUS MAP 97.4 NOT TO SCALE 24 16" H-20 BIODIFFUSERS IL E- -- x 93,20 CONNECTED BY LOWER 100.14 x -� 6 8 97,27 97.6 93,80 GENERAL NOTES: KNOCKOUT ACCESSORY VENT �0'I I I 98 8 APARTMENT 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL ~ T.O.F=98. 1 f BOARD OF HEALTH AND THE DESIGN ENGINEER. I 1 I r7 98.10 97.571.AL 14 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 4-I-ICI EXISTING SEPTIC TANK OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 1NV.(OUT)=93.63 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: 100.82 1 -1-J G S o� PATIO j` -310 CMR 15.405(1)(b): INSPECTION PORTS 7, 3 S C•97,90 1) A 5' variance, S.A.S. to slab on grade, for a 5' setback. -- U) 2) A 3' variance to the 3' maximum cover requirement, for up 3F11 96.68 t to 6' of maximum cover. S.A.S. shall be H-20 and vented. 40 MIL POLY LINERS TOP OF LINER, EL.=93.5 p Y97.74 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR BOTTOM OF LINER, EL.=91.0 0 0 I0° J TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE N DESIGN ENGINEER. TINGo97,80 HDUSE(#72) CA4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING Z PORx 97 5 (? FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 101.45 / T.O.F.,=98,4t' m ENGINEER BEFORE CONSTRUCTION CONTINUES. (slab on grade) 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 7,97 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF �13g THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 102,25 x 98.08 x 97,96 o HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. x 97, 5 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 98.44 X :.',.-PAVED ';.,:.;` 97,51 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. f 97,91 9 04 OR�IrV+EWAY 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS �p AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 103.34 00,84 0CK RET. AL� T ( DIRECTED BY THE APPROVING AUTHORITIES. I 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY LOT 99 28 �: ,' I THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING Y101.46 A I CONSTRUCTION. _MBL 193-52 I 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 5�12,215 fSF x .1.< 9'0� IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 104,07 •83 �'�:'.:'' REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 105,55 100.00 100,22 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE -- S 14'43 50 W �. INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. CB 101, 4 ;.•.::.:.. \ 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 106.45 107.35\� \� OF Mgss NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. U 101,97 Z 100,50 98.96 � q�y PROPOSED SEPTIC SYSTEM UPGRADE PLAN 107,81 PETER T. GJ M CIVIL 72 HILLSIDE DRIVE, CENTERVILLE, MA PLAN REVISION - /5/14 HILLSIDE TRIVE No. 35109 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 ADD 3 UNITS FOR 425 SF (NOMINAL) p� ofG/SZE`� �� Engineering by: SCALE DRAWN JOB. NO. OWNR OF RECORD A Engineering Works, Inc. 1"=20' P.T.M. 104-14 n SEELEY, JAMES J g g 72 HILLSIDE DRIVE UTILI Y POLE 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. CENTERVILLE, MA 02632 -l ` (508) 477-5313 2/7/14 P.T.M. 1 Of 2 y NOTE: TO PREVENT BREAKOUT A 40 MIL POLY 59.6' LINER SHALL BE PLACE 5' OUTSIDE THE 49.1' S.A.S. AS SHOWN ON SHEET 1 [::18. TOP i OF LINER, EL.=93.5 - - - - 30.4' - BOTTOM OF LINER, EL.=91.0 PROP. 1 SEPTIC TANK ,• PROPOSED D-BOX r- S.A.S. INSTALL RISERS & COVERS OVER INLET & PROPOSED S.A.S. CHARCOAL I I _ _ _ 300 T.O.F. • �COVER SET TO 6INSTALL RISER & WATERTIGHT° OUTLET AND SET TO 6" OF FINISH GRADE OF GRADE INSTALL INSPECTION 'iPORT OVER END UNIT VENT 1• � F.G. EL.=99.3(MAX.) m I PROP.1 EXISTING F.G. EL.=97.3t F.G. EL.=97.2f 1 , W I S.A.S.I ACCESSORY f MAINTAIN 2% GRADE (MIN.) OVER S.A.S. I I W S A APARTMENT x.• ou. xr ow I, _1 I I �•! T,0.F=98. 1 f L = 24'. L = 6' 2 INSPECTION PORTS P ® S=1% (MIN.) @ S=1% (MIN.) (MINIMUM) 4"SCH40 PVC 4"SCH40 PVC PATIO 3 .z L �o,• I - - �a° 6' 11.3" TO INVERT 8.5' ADD GAS BAFFLE INV.=93.17 PROPOSED INV.=93.00 3 ROWS OF 8 UNITS AT 6.25'/UNIT INV.=93.63t D-BOX INV.=92.94 EFFECTIVE LENGTH = 50.0' EXISTING EXISTING 1500 GALLON SEPTIC TANK HOUSE#72) PLASTIC TANK EXISTING(VERIFY) SOIL ABSORPTION SYSTEM (PROFILE) T.O.F.=98.4f1 CAR EXISTING i ESTABLISH VEGETATIVE COVER PORT ' NOTES: BACKFILL WITH CLEAN NATIVE OR 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE PERC SAND TO TOP OF CHAMBERS INVERTS, PRIOR TO INSTALLATION. r,•, :.;:; • ••;•;•.;.••;•• S.A.S. LAYOUT 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT EL.=TOP EL. •a.•,;'••, "•' TOP ELEV.=93.33 ___ GRADE ON A MECHANICALLY COMPACTED SIX 75 INV. ELEV.=92.94 INCH CRUSHED STONE BASE, AS SPECIFIED IN - --� 310 CMR 15.221(2). BOTTOM ELEV.=92.00 III III IIIII�II 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' MIN. ABOVE HIGH GROUNDWATER 2.83 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 4'(MIN.) NATURALLY OCCURING EFFECTIVE WIDTH=8.5' AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. PERVIOUS MATERIALS EXISTING SUITABLE BOTTOM OF TP, EL=86.0 _ MATERIAL 76 3 ROWS OF 8 - 16" (H-20) ADS BIODIFFUSER UNITS PROFILE SEPTIC SYSTEM PROFILE WITH NO SEPARATION BETWEEN EACH ROW & NO STONE j TYPICAL SECTION T N.T.S. N.T.% 16" 0� '� SOIL LOG 11 1 CONNECT PIPES TO LOWER KNOCKOUT I�-18.8'---I DATE: JANUARY 28, 2014 (REF#14,275) i-34"� DESIGN CRITERIA --T-_T_-__ SOIL EVALUATOR: PETER McENTEE PE(SE#1542) SECTION END CAP I ' _ I T -_ WITNESS: DONNA MIORANDI R.S. HEALTH AGENT NUMBER OF BEDROOMS: 3 (HOUSE) + 1 APARTMENT = 4 TOTAL I I I I - I -1- ELEV. TP- 1 t DEPTH ELEv. TP-2 DEPTH 16" HIGH CAPACITY (H- BIODIFFUSER UNIT SOIL TEXTURAL CLASS: CLASS I I-I-I-1 97.2 A 97.0 A 011 MODEL 16" HICAP UNITS MUST BE STAMPED H-20 DESIGN PERCOLATION RATE: <2 MIN/IN I I I I LOAMY SAND LOAMY SAND L,,I �I-I-i 96 5 10YR 4/2 96.3 10YR 4/2 LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT DAILY FLOW: 440 GPD I I I I B 8B 8 EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DESIGN FLOW: 440 GPD �'� LOAMY SAND LOAMY SAND DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. GARBAGE GRINDER: NO I I I I 10YR 5/64, 10YR 5/6 SIDE WALL HEIGHT 11.2" 94.7 30" 94.5 30" OVERALL HEIGHT 16" LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF I-I-I-I C C OVERALL WIDTH 34" 4640 TRUEMAN BLVD I I PERC HILLIARD OHIO 43026 • .74 GPD/SF II , LI-IJ 44"/56" 13.6 CF EXISTING SEPTIC TANK: 1500 GALLON CAPACITY PLASTIC TANK 99PUB � 8 5, CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. PROPOSED D-BOX: 1 INLET,,r4 OUTLET (MINIMUM), H-10 RATED MED.2.5Y SAND i ED. AN MED. 6/ , MED. SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 3 ROWS OF 8 - 16 H-20 ADS BIODIFFUSER S.A.S. CONFIGURATION / NO STONE IN THE CONFIGURATION SHOWN 72 HILLSIDE DRIVE, CENTERVILLE, MA - SIDEWALL AREA: NOT APPLICABLE Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF BIODIFFUSER) 86.2 JOB. N0. " . 86.0 132" SCALE DRAWN 132 Engineering by: 24 UNITS x 6,25 LF x 4.73 SF/LF = 709.5 SF P.T.M. 104-14 PERC RATE <2 MIN/IN. "C" HORIZON Engineering Works, Inc. N.T.S. DESIGN FLOW PROVIDED: 0.74 GPD/SF x 709.5 SF = 525.0 GPD NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET N0. ACTUAL BOTTOM AREA = 8.5' x 50' = 425.0 SF (508) 477-5313 2/7/14 P.T.M. 2 Of 2