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HomeMy WebLinkAbout0031 MIDWAY DRIVE - Health 31 Midway Drive Hyannis F/R A = 252 072 " 0 it r { TOWN OF BARNSTABLE LOCATION � G'�2 .SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (Size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER RIIT� T)E?� nR OWNuR DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED 19 4 61, N A �Ix �a z -M � o SEWAGE INSPECTIONS LOCATION 31 Midwau [hive DATE 7124103 1.11dArit�; '_ VL' LAGE-- _ (1 a.e.i. �1^�i LGLJGV -0 7 Z "INSPECTOR ozeph 7 Mac mge2 12. SEPTIC TANK CAPACITY None_ 9-6 'X8' &.cock ce,3,3Roo.e and LEACHING FACILITY: (type) 1-LP- 1000 (size) 2500 gaiionz NO.OF BEDROOMS 3 'BUILDER OR OWNER /2o&e2t dwue2 OWNER MAILING ADDRESS . Same . W \� S w � \ �� by � � X � i ` � . i i j'�' ` �� � � i � � � -y� o a _. �. , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal SyMern R'srin NO#' for Volvntary Ass usr„vents Al cj('/ Property Address - / --T--- -/ Owner ON n me �. !�._. O �/ � er's Na —— -- information is required for every _ Page- CdylTown r State Zip Code :Date:of s pectan 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. t ngoutf When A. General Information Bing out moms �I# L J n on the computer, use only the tab 1. Inspector key to move your cursor-m not use ret the turn key Name of Ins--Tl� pector / t' ;°m ny Name — 00 Company Address Ay/TownS-09 Zip Code Telephon mber/ j 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 16.344)of Title 5(310 R 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority fll�7 Inspector' Signature Dale 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 DER The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only etescribes 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. t5ns•2113 Title 5 official Inspecficn Form subaeace sewage oisposal Sysoem•Page 1 of 17 V� �� r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Dis"l System Form -Not for Voluntary Assessments Property Address Ow nerON information is ner'S Name required for every CQyI �(/� f L/� moo` ✓ /I� page. G1tyllown State Zip Code Date of inspection B. Certification (corn.) Inspection Summary: Check A,B,C,D or E!always com plete all of Section D A) System sses: 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. Check the box for"yes""'"no'or"not determined"(Y,.N, ND) for the following statements. If"not determined,"please ex0ain. s- 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 fail ure 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 wig pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating t6t the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): k A t8ns-W13 Title 5 Official Inspection Form Subswace Se"e Disposal System•Fags 2 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Fora Sub surface Sewage Disposal System Form -Not for Voluntary Assessments 31 At c/vei 'D/I VL<-, Property Address '—— — Owner information is Owner's Name Gy required for every Cep—16✓y< ! Q� 3� / 9ft A�, page. City/Town State Zip Code Date of In pefstion Bo Certification (corn.) — ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(coat.): ❑ 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 CNIR 15.303(1)(b)that the system is not functioning in a mannerwhich will protect publiic 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 t5ns•3N 3 T09 5 0ffidal Irspecficn F orm SubSWace SeVM8 Disposer Systam,Page 3of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L/ dtl� �jr VC, �/, Property Add �/ ON ner 14(1 So information is Owner's Name required for every �,4,je y v6 -e 0)6 3� page. Ctyf row n State Z�Code Date of Ins n Be certification (cont.) — 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well. Method used to determine distance: *�This system passes if the well water analysis, performed at a DEP certified laboratory, for fiscal 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 day flow tans•W3 Tide50flicial I spectimFortrt SuhWace Se vAgeDisposal System*Page 4of17 ' I Commonwealth of Massachusetts 19 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Fo -Not for Voluntary Assessments Property Address S Ow ner f/ _ information is ON ner's Name �+ � G required for every infor (/ to �/di //�� ©d- 6 Z) page. City)sown State Zip Code Date of do — Be Certification (corn.) — 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 .150 feet from a private water supply well with no acceptable water quality anadysiis. [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.] ❑ e system is a cesspool serving a facility with a design flow of2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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 appropriake regional office of the Department. tsm-3113 - Tiits5 Official lns tlonForm;SubsufaceSe pec vrdpe Disposal System•Page 5 of 17 I Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal Sysstteev/gym, Form e Not for Voluntary Assessments Property Address 3/ /" ' (� �/�V1 Ow ner ` L So'1 information is Ow nets Name required for every ( /Qh Page. �lty/Town State Zip Cie Orate of In lion _ C. Checklist — Check if the following have been done. You must indicate"yes'or"no"as to each of the folloimng: Yes No ❑ umping information was provided by the owner, occupant, or Board of Health ❑ ere any of the system components pumped out in the previous two weeks? ❑ as the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or a:> part of this inspection? Were as built plans of the system obtained and examined?(If they were riot 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)pro%dded 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 n determined based on: Existing information. For example, a plan at the Board of Health. ElDetermine:d in the field (f any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CM R 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): — DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): — t5m•3M 3 Tide 5 Official lnspectianFortr[Subsurface Sewage Disposal System•Fgge6of17 ' Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Addre /G/ Ci �/l ss -- ON ner Cw ner' information is s Name 1 / 141W required for every �� eV,yr G •e Q4� Id- page. CityyRown State Zip Code Date of Ins ectlon D. System Information Description: (/) 6-r,- 1/0 17 �Ic L.,4f0­1 •0 �1 oZ Soo aa'W l J Vs�vk_ O Number of current residents: -- Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?(Include laundry system inspection El Yes No information in this report.) Laundry system inspected? ❑ Yes No Seasonal use? Cl Yes No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM R 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: — t5ns•3M3 Tile 50fficialInspectionFonrtsub rfacesewageoisposalSystem-I�age7of17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage ®isposal System Form -Not for Voluntary Assessments Property Address /9" Ov ner Ow pees Name information is required for every page. Cayfrown State Zip Code Date of howWn D. System Information (coat.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: ' Source of information: Was system pumped as part of the inspection? ❑ Yes C IVo If yes, volume pumped: gallons How was quantity pumped determined? — Reason for pumping: — Type 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/Altemative 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 VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(descri be): 15ins•3M3 WeSOffidallrepectioe Form SubsurtaceSe%wgeD1spasal system-Page8of17 Commonwealth of Massachusetts lug 3 Title 5 Official Inspection Form Subsurface Sewage Disposal System jForm -Not for Voluntary Assessments / Property Address Am ner W Ss information is Ow ns's Miry e required for every C-e 94'' --1 >° A4 64G 9 page. UR own State ip Code Date of pec' n D. System Information (corn.) Approximate age of all components, date installed(if known)and source of informatt"i'n' 020 — Qe/M I 0 3 f ice �So 1}, Were swage odors detected when arriving at the site? ❑ Yes ® PJ� Building Sewer(locate on site plan): Depth below grade: — _ feet Material of constructi;4ZOPVC El cast iron ❑ 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): Depth below g feet Materi f 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 Cl No Dimensions: X/ (O Sludge depth: 15ns-3h3 Tille5 Official Impaction Fcm:Subsurface Sewage Disposal Systain Flags 9of17 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form a Not for Voluntary Assessments 3/ /te/,— t✓a /l /qL_l �So✓I Property Address — ow ner Cw ner's Name information is is / /� /- required for every Ce�' ✓v! ! � /� / ��6?� IF l 6 page' aF/ own State Zip Code Date of In tion D. System Information (coot.) — 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 a �e vlC e" 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.): l / r^ 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 t5rs•3f13 Title50ffidd trspectionForm Subsrtace SevageDisposel Sysern•Page 10 of 17 Commonwealth of!Massachusetts L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address l — vl d SO Owner owner's Name information is / required for every Me. Cityylrown State Zip Code hate of l pection D. System Information (cunt.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow. gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in worldng order: ❑ Yes ❑ No Date of last pumping: Date — Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5Official UrepeotionForm Subst0ace Sewage Disposal System•Page 11 d 17 y• I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -blot far Voluntary Assessments 37 - 01-IL2f, Property Address / � /sO�� Owner ow ner me's Na G! information is f, / required for every e,4 -' y-! page. Cilylrown State Zip Code Date of Ifispectron De System Information (cont.) Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert eve - 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.): ,A4 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: t5ms•3M3 Title501`ficial lnspactionForm Subsurface Sewage Disposal System-Page 12 of 17 4 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary AAsnmil VIC.,ssessments v ✓ ��(��� "/ Property Address u OAF ner �s O QN naps information is Naitte required for every 6e,4wv, ` �01 C�oZ �g ✓� page. C ky/Town State Zip Code Date of k4pectioff D. System I ormation (cunt.) 02 0 V "- Type: '2' So — / �A&A4 Vk �c�� C �r ❑ leaching pits number: leaching chambers number. — ❑ leaching galleries number. --- ❑ leaching trenches number, length: — Elleaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovativetaltemati%e system Typetname of technology: -- Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): ✓u &7G c'/ctiw✓t c /< 1/14o"Lr 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 t5ns•3M3 riite50F8aal ImspectionForm Suhsurfam Savage Disposal System-Pge 13of 17 I. Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address - � Owner � 0 inform tfon is Cw ner's Name required for every page. %Ay/Town State Zip Code Date of Ins tion D. System Information (cons.} — 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.): I tons•W3 Title 50ffidal Inspection F am Subsurface Sewage Disposal%sham-Page 14 of 17 TOWN OF BARNSTABLE 0 LOCATION SEWAGE # 'a�® �. � 6b VILLAGE , ASSESSOR'S MAP & LOT�12 UU- INSTALLER'S NAME&PHONE NO..ad' �dLer„��d'�t ok. !��Y-1/77 017 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) � 4 �� 5 (size)-9)(514:03)(7 NO.OF BEDROOMS i BUILDER OR OWNMR � PERMITDATE: I'� COMPLIANCE DATE: 11'7k) Separation Distance Between the: � I 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) i Feet Edge of Wetland-and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) dQ Feet Furnished by , V4 774, i I q 2z i �g I 0 Q Z 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address ) --- Ow ne vl G S v 4 information is Ow ner's Name /required for every _ I//2ve-�VV2 Ile— page- 3�Cy/Town State Zip Code Date of Ins tan D. System Information (cunt.) M Disposal System: Provide a view of the sewage disposal system, including ties to ent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate supply enters the building. Check one of the boxes below:the area below ed separately v � t5m-3H3 Title 501'ficiai Irrepectian Form Subsurface Savage Disposal Syslam•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address ON ner 5 c9✓� information is ON nets Name I q ' required for every ✓,e w�-C./�/� /'V�/�T 9 page. uty/Town State 70 Code Date of pectan D. System Information (cost.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 0 Estimated depth to high ground water. 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 I al Board of Health-explain: 71 s 4- 1�1 ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must des '� how you esG Belisha their high groundwater elevation: — �� !//I ✓ TJ,� oc .S - S' r S Qo�� G► �O �, �fir"-�.oL� L/ Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ns'W13 T1tle50Ffid9Inspection F=SubW.-m Sewage Disposal SysWm-Pale 16 d 17 r Commonwealth of Massachusetts 9MMMUMM W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address QN ner ON hfoexion requiredforevey nt>r's Marne m is page- Wfrown (/ State Zip Code Date of bspeMn E. Report Completeness Checklist 0 poInspection Summary: A, B, C, D, or E checked Er"I'nspection Summary D(System Failure Criteria Applicable to All Systems)completed t� Sy IMormation—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate Ile t5m.3M3 - TOOSOffi U 1MPW atFom[SUftWae SOWMeDiIP-d SYWM*RIP 17 of 17 4`7 3 4 D AT E7/24/03 ----- PROPERTY ADDRESS: 31 Midw y Daive 1� pNN�S-- -----------' --------- 02632 FAILED INSPECTION On the above date, I inspected the septic system at the above address, Tnis system cons'lsls of the following: 1 . 1-6 'X8' /3.2ock Ce.6.6/2boe 2. 1- 1000 gaiio.n paecazt 2each.ing /2.it. 3. 7heze ate .in zee.ieh. SAP Z S`L- Basec on my inspection, I certify the following conditions: �°1Z PARCEL ; _ 4, 7h.iz .i-6 not a t.itie live zel2t.ic 'zyztem. LOT 5. 7h.iz 1.6 a .3ewaye zyetem ' that had a 1000 gaUon /12ecazt ieaeh.ing 1211- added ah -an oveal-eow. 6. Both the cea.6/2ooi and the ieach.ing /l.it ate in hydaauLic la.iiulLe. 7. Anew ze/2t.ie .6yztem needz to ge .ihztaiied. g. [da,6te. watea .i,3 even with inve,,zt 12i/2e to the Wieachi' t SIGNATUR Name : - J__ P . _Macomber_Jr . _-_- Corhpany :, gatph _per_ M�ggm�pr d_ Son, Inc . " cords s :_-@Qx _66------------ _ -(Z.US_P rY LLLP,_ �ja _ _QZ.6 3 2-0066 Pr)one : __508- 775_ 3338 -------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY IOSEPH P. MACOMBER & SON, INC. Tanks -Cesspools Pumped & Installed Town Sewer Connections P.0 Box 66 Centerville, MA 02632.0066 775.3338 775-6412 COMMONWEALTH OF MASSACHUSETTS r 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: 31 Nidway DIt-ive en e2y.e e, a�s�. Owner's Name: /2o e2 wyea Owner's Address: 2 03 Date of Inspection: 1124103 Name of Inspector: (please print)ao,seph P. Nacom9ea a2. Company Name:j. P. Macomge2 9 Son Inc. Mailing AddressBox 66 CPniP/z".l io', lyln.sA, n2632 Telephone Number:5 0 8-7 7 5-3 3 3 8 CERTIFICATION STATEMENT I certify that 1 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 eeds Further Evaluation by the Local Approving Authority 1 Fails / Inspector's Signature: Date: The system inspector shall mit 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. Notes and Comments ****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 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 31 Midway D z i v e Cen e lLviiie, a.6-6. Owner: Ro&ez;t Dwye2 Date of Inspection: 7124103 Inspection Summary: Check A,B,C,D or E/ALWAYS-complete all of Section D A. System Passes;k 1�s 1 have not found any informs ' which indicates that any of the failure criteria described in 310 CMR 15.303 or 3]0 C'WI 5.304 exist. Any failure criteria not evaluated are indicated below. Comments: The .6ewa e .syziem .iz .in hydzauiic /a.iiuAe. R new 71tie Five 1 1 ,6eiza..cc 3uozem neea.a to ge in,3taiZed. B. System Conditionally Passes: . _ld One or more system components as described in the"Conditional Pass"section need to be replaced.or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements'. If"not determined"please explain. � Le-ne 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: 4bd!1�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: 41b 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: 3 7 1' idwa y D z ive Cente,zv.i.P.Pe, Owner: /2o9e2.t Dwye2 Date of Inspection: 7/2 4/0 3 C. Further Evaluation is Required by the Board of Health: -A�)_ 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: 106 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 I 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 b4t 50 t or more from a private water supply well". Method used to determine distance v� "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 pollutiott 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. 3 Other: 7h.i- i.6 a zewa e ,3tem The zy,6tem con.6.i.6.t.6 o 1-6 'X8 ' 9.ock ce,6,6Rooi and 1- 1000 qatgon R2eca4i- .PParhing /2.i.t a,3 an ove2l.Pwo Both aza in hUd2au.P.e r 47.i.P1J1?0 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 31 Midway Dlt.ive Owner: Roge2t Dwye2 Date of Inspection: 7124103 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No ackup 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 squid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number /of times pumped t/arty portion of the SAS,cesspool or privy is below high ground water elevation. y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface ater supply. lAny portion of a cesspool or privy is within a Zone 1 of a public well. ✓_ Arty 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.] �C (Yes/No)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• 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 y e system is within 200 feet of a tributary.to a surface drinking water supply _ _ the system is located in a nitrogen sensitive area(I,nterim 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. 4 Page 5 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 31 Midway !hive en eavt e, 0wner:R0 e2.z< Twyez ' Date of Inspection: 03 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 tJ/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 pan 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? Jz_ Was the site inspected for signs of break out? — Were all system componenis,44luding the SAS, located on site? A1ddP 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 ? z _ 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: 6`-- no existing information. For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Pan C is at issue approximation of distance is unacceptable)(310 CMR 15,302(3)(b)) 5 Page 6 of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 31 Midway Da.ive en eay.e e, a,3.3. Owner: RoRea.t Dwuea Date of inspection: 7/14/0 3 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 .203 (for example: 110 gpd x#of bedrooms): 7t ID Number of current residents: Does residence have a garbage grinder(yes or no): Ye"i Is laundry on a separate sewage system yes or no):7b (if yes separate inspection required) Laundry system inspected(yes Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)):200I=8 9, 250 ya.2.2one=24 4. 52 qPD Sump pump(yes or no):.VO 2UU2= gai-eon.6=223. 98 Gl)D Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design now(based on 310 CMR 15.203): TP gpd Basis of design flow(seats/persons/sgft,etc.): All Grcase trap present(yes or no):AA Industrial waste holding tank present(yes or no):AA Non-sanitary waste discharged to the Title S system(yes or no): ) Water meter readings, if available: Last date of occupancy/use•. AH OTHER(describe): Allf GENERAL INFORMATIO Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes, volume pumped:_gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM .0 Septic tank,distribution box,soil absorption system Single cesspool Overflow v"spvei ,LJQ L V Privy �Shared system(yes or no)(if yes, attach previous inspection records, if any) XJ, Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank JA Attach a copy of the DEP approval ,cJV Other(describe): ,{}� Approximate age of all �Pmpo ents, daptnstalle if known)and source of informa to : Were sewage odors detected when arriving at the site(yes or no):Af a 6 Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 Nidway DlLive en e2v.e e, Owner: /2ogeat Dwyea Date of Inspection: 7124103 BUILDING SEWER(locate on site plan) 4" Oanagegzag pipe &' fit t ingz ;e2om the houze .to the ce.3.3nooP. Depth below grade: >> 4 ' E?ite PVC nine & litting� �2om Materials of construction: +_/cast iron �40 PVC r, other(explain):the ce 6.6po o-2 to the ieaeh-ing nit Distance from private water supply well or suction line: iD'eA- Comments(on condition of joints, venting,evidence of leakage,etc.): ?o.liniA aaaDona ilghf - Nn oi,idance 0,4 CaQ,krj9,6, 746 6 6' 4 L4 vented thzough the Zoo/ ventz. SEPTIC TANKd/ Lt(locate on site plan) Depth below grade:V Material of construction: ,4concrete,&_metaI,& fiberglass /�i polyethylene ,{/}1 other(explain) If tank is metal list age:,eZ Is age confirmed by a Certificate of Compliance(yes or no)4,,h (attach a copy of certificate) Dimensions: ,(did Sludge depth: X14 Distance from top of sludge to bottom of outlet tee or baffle: XO Scum thickness: _ A114 Distance from top of scum to top of outlet tee or baffle: lfl/ Distance from bottom of scum to bottom of outlet tee or baffle: /p How were dimensions determined: -4 Ily Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Svn# i r ,drink a.A nest nno.tonf _" tOilM J t`1ze fna LLRRLL6lQQl e1L68 �ha ,y.tfom iA ,ipq/7 at/or/--;rL,,7 Pa go cl�AanAo ia—, a6eraf. GREASE TRAP41&t(locate on site plan) Depth below grade:. Material of construction A&concretez/hmeta 1,��9 fiberglass j polyethylene4other (explain): 4)A¢ Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle:_ "Po Distance from bottom of scum to bottom of outlet tee or baffle: 4 _ 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.): G2eaae taap iz not p2e.sen.t 7 r Page 8 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 N-idway D1t ive en t e2vi e. a,3,3. Owner: 12oleaL Dwue2 Date of Inspection: 7/24/0 3 TIGHT or HOLDING TAN1G141&(tartk must be pumped at time of inspection)(locate on site plan) Depth below grade:X Material of construction:,�concrete�metal�_fiberglass�polyethylene, '4_other(explain): Dimensions: Capacity: NA allons Design Flow: AM allons/day Alarm present(yes or no): Alarm level: �f)/ Alarin in working order(yes or no): 114 Date of last pumping: VA Comments(condition of alarm and float switches,etc.): 7.i_ahl oa ho.Pd-na tank.6 a/te not Raezent DISTRIBUTION BOXjk g (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: �)$ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D.i.._st'Zigttt-.on Sox -iz not Raezen . PUMP CHAMBER: J/ (locate on site plan) Pumps in working order(yes or no): /W, Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): _PumI2 chamgga i,3 not R2ezent. 8 " Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31. 17.idway 172.ive en t e a v c Owner/2oPle2t wyea Date of Inspection: 7124103 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan,excavation not required) 1-6 'X8' &.9ock cezz/?oo.P and 1- 1000 ga.9ion paeca-6t .Peach.ing 12.it as an ove2tPow. If SAS not located explain why: Located: See Rage 10 Type eaching pits,number: L0 leaching chambers,number: Q ,&,o leaching galleries,number: D leaching trenches,number, length: 0 4),el leaching fields,number,dimensions: Z7 AJO overflow cesspool,number: 0 4" innovative/alternative system Type/name of technology: yOY' Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): fnrimy Arinr) In n2 d.ium Dine .eand. 7he cezzpoo2 and /:.it ate in hyd2auiic aze daUNa.6te move and even with the inveat 12zpe,. 1 R new .t it 2e tive ze/:t is .3yztem needz to ge .inztaiied. CESSPOOLlpz(cesspool must be pumped as part of inspect ion)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: 1.21Wi Depth of scum layer: , Dimensions of cesspool: X Materials of construction: Indication of groundwater inflow(yes or no):�0,* Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): a.ma, Qa aaa— PRIVY(locate on site plan) Materials of construction: Dimensions: /14 Depth of solids:A Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Paivu .i.b not R2ezent. 9 Page 10 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAG& DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:3 1 t7-idw¢ D2 ive en e,cv.i.9-Qe t'a,3.3. , Owocr:/20 9e2t wye2 Date of lDspectioo: 7124103 SKETCH OF SEWACE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system Including tics to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public.eater supply enters the building. SX � L'04 090 I 7\47 ' i I 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 Midway Dzive Cea#e2viiie. Ma.s.s. Owner:/2o9e2t Dw. ea Date of Inspection: 7124103 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 6 0 feet Please indicate(check)all methods used to determine the high ground water elevation: /. O Obtained from system design plans on record-if checked,date of design plan reviewed: Nd Observed site(abutting property/observation hole within 150 feet of SAS) ALLL Checked with local Board of Health-explain: NA Checked with local excavators, installers-(attach documentation) 7 Accessed USGS database-explainfztt/2://.t own. 9g zn.6ta9.Pe. ma. u.6. You must describe how you established the high ground water elevation: aed: Cahnv.ty R 11122pa Plnr/vD 12116194 Cnn)inr/ wrifon Pf_e))OfAnni nPn))v .6vn evei. }ed: USg.C -QOton>>rifinn ijo00 r/nfriJuno 199,2 hed: US -4 QJ-t-2.a- 4. Leaching ) Pit i Groundwater Feet Below Bottom of Pit High Groundwater Adjustment 1.8 f . J t per Fnmpter Method Therefore, the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is l��d feet. 11 J t>•nrnr+.-n.T+--��z+n-r.•r.nnr�.rt rwr.r*..rrnr++�nr+.�.�.r.n nen�u n�•w�+rn ' !3a�2�t�1�.Q a .^.-.t-•--•.-.--.....-. . TOWN OF BOARD OF HEALTH 1 SUBSURFACE SEHAGF DISPOSAL ,SYSTEM INSPECTION FORM - PART D •- CERTIFICATION .^•rn T••.••. f—T..IR��rr.ln.1.1'...1r.nR+rs9q'+.n'T.'-1•t r1tRRq�'r++IAwf��'1A7 tw�l -TYPE OR PRINT CI.EARLI'- PROPERTY INSPECTED STREET ADDRESS 31 M-idwaq Dz2ive Cgnte2v.G.Q•Qe, Ma.6-6. ' ASSESSORS MAP, BLOCK AND PARCEL # 252-072 OWNER' s NAME /2o&eat Dwyea PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber .Jr. COMPANY NAME J P Macomber & Son Inca'.'• COMPANY ADDRESSBox 66 Centerville Mass. 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 -1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete 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 on- site sewage disposal systems . Check one : System 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 . _1L=_ System FAILED* The inspection w}licll I h.Rve con tcted has found that the .system fails to 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 . Inspector Signature Date 01 [nd copy of this certification must be provided to the OWNER, the BUYER Where applicable ) and the BOARD OF HEAL'I'll. If the inspection FAILED, the owner or"'operator shall upgrade aVate within one year of the date of the inspection, unless allowedorthe requiredm otherwise as provided in 3,10 chIR 16 . 306 , partd . doc TOWN OF BARNSTABLE LOCATION to l' SEWAGE # � 0 f Gt6/1��/ 2-�Z ®OqZ— V11 LAGE dESSOR S MAP & LOT INSTALLER'S NAME&PHONE NO. y -4 c=0 �' G0 . - ZT-0i 7 SEPTIC TANK CAPACITY Zt Z� LEACHING FACILITY: (type) 5b0 r (size)Z.19)(5 1)" 113X7� NO. OF BEDROOMS BUILDER OR OWNER � PERMITDATE: 45J&3____COMPLIANCE DATE: 11'7/0 3 Separation Distance Between the: r -1 Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist `� Q 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 ��+-21 -� ���� - o�-_"_ JW vl�,.�� f� � 4� ►� �. � .q P f _' ��s 1 I A� � � i� � s -`� �-' � ��' �, No. ZCb 3 ' ' ' ' Fee `5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,MASSACHUSETTS ZIpprication for Mizpozal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No.2 , f 31 b c'3 A LY 1 U @ Owner's Name,Address and Tel.No. J4 u h.e a w 17 cJ.,y t-fZ Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.Row '' C� C�a-UKAI-1 6 /� IUN 14AKAs�S4+i,� Al f 01 o wh-ee Ie vt 7 M gr�r9--e ^n q /,c,d /4 ILo S fw Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) `P�,f-� i(e !`o d CA ( Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d by Bo of Health. Signed Date e5�/ Application Approved by S Date S G.3 .Application Disapproved for the following reasons Permit No. ��3 ' �� Date Issued t 5 o 3 No.? ° "` Fee 5 c) THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS -r Zipplication for Mtzpaal *pztem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. 1"YN 1 10 L,A'y (411 Y Owner's Name,Address and Tel.No. 7d�- �1y Assessor's Map/Parcel C) {� 1 D c.j - Installer's Name,Address,and Tel.N�o. `� t Designer's Name,Address and Tel.No. Row`_r mac. 1C C�.�, e ft ry (mil In hn i r S +a ' Ao- Type of Building: Dwelling No.of Bedrooms Lot Size :sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil t Nature of epairs or Alterations(Answer when applicable) ''—I4/ t( )V e , #,r(R o.o G rq S P �i Nam. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is d by s Bo of Health. Signed 7� . r x ~ Date / /d -2 Application Approved by S Date `d 1S C 3 Application Disapproved for the following reasons f Permit No. - S� Date Issued g r"5 f to-? 1 r --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS '� Certificate of Compliance THIS IS TO CFATIFY,that the On-site Sewa a Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by o'`� �r� 1C C �4 t� I. at 31 1 n w L,44 / -c- c has been constructed in accordance with the provisio Hof Title 5 and the for Disposal System Construction Permit No.2-003'`J 50 dated �-/ter-C 3 . Installer v. g ( Cx— Designer The issuance of this ermit s all not be construed as a guarantee that the system wil 'fct�6 / esi ne .� Date °7 0 Inspector- ----------------------------------------- Zco3- �o No. .,," Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lizpozat &pztem construction Permit Permission is hereby ranted to Construct( )Repair( )Upgrade( )Abandon m 4 4 ( ) Syste located at l / I� �(,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:Constru-tion ust be completed within three years of the date of this permit. Date: / t O 3 Approved by 6-7 - R�cEwfp JUL 6995 , T DATE: 6L1_6J95 e PROPERTY ADDRESS:__�� �y__ i 5 Centerville ------------------------ Mass . 02632 ------------------------- On the above date, I Inspected the..septic system at 1 the above address. This system consists of thq `following 1 . 2-6xY block cesspools ! Based on my Inspection,'`I � ertlfy the f6fid-v ',c� condltidns: 1 . ` This is not a titl,e,'five s^eptie-�: syA'fem- _� I 2: The sewage .system is >°in poer working order at the. present time.. SIGNATURE: N a m e: .T-p-Macomber jr------- 1 Company:_J.P 'acombe-r` -_>Inc Address: Box1 66 F #' Centervil�°e P;Mass Q`Z}632 Phone: 508-775-333'8 �9 THIS CERTIFICATION DOES NOT CONSTITUTE_ A ::31J-.R'ANTY OR WARRANTY c • i i LO�. P. N1aC0MBER & SON, INC. an.ks-Cesspo"oIs-LeachfIoIds Purnpod & Installed Town Sewor Connoctlons 66 Centerville, MA 02632.0066 li 775.3338 775-6412 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property °'5I Mtr2-,�p.Y , C Owner ' s name James Coyne _ Date Of Inspection PART A CHECKLIST Check if the following have been done: I Pumping information was requested of the Health. owner, occupant, and Board of 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 available with N/A. they are not The facility .or dwelling was inspected for signs of sewage back-up. ✓ P. The site was inspected for signs of breakout. ✓ All system components, excluding the SAS, have been located on the site . ✓ The septic tank manholes were uncovered, opened, and the interior pf 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 SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, different provided with information onthepropermaintenancemOfwSSDS,were ' 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential number of bedrooms 4_ number of current, residents eS garbage grinder, yes or no JCS laundry connected to system, yes or no seasonal use, yes or no If nonresidential , calculated flow: Water meter readings, if available: V--V-U f cc00 (T N 6 q E7j .S P,NIAI wi_�, Last date of occupancy GENERAL INFORMATION Pumping records and source of information: vu - - r��v 8��►..� uu P� System pumped as part of inspection, yes or no if yes, volume pumped 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) Other (explain) Approximate age of all components. Date installed, if known. Source of informa ion:_ GA 5 �} ec W G �� Sewage odors detected when arriving at the site, yes or no 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B ` � I SYSTEM INFORMATION continued SEPTIC TANK: N (locate on site plan) depth below grade: material of construction: concrete metal FRP other(explain) dimensions: 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. 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, recommendations for repairs, etc. ) � II DISTRIBUTION BOX: (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) . PUMP CHAMBER: �d U (locate on site plan) pumps in working order, yes or no Comments : (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) i 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION' FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : V (locate on site plan, if possible; excavation not re qu ' but may be approximated by non-intrusive methods) 2 ` If not determined to be present, explain: ---- Type leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number 'X rlc LC)CL Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or -r-epaixs,e c. ) i� L0CDjGS C�C'-0 O t,10 8 l 6 rl7S t)r- � CESSPOOLS (locate on site plan) : number and configuration depth-top of liquid to inlet invert 4* iF-k( T— Li G depth of solids layer _ c: %All•) .: N92 --AE- depth of scum layer `` °t444 dimensions of cesspool m 16 E iDe PLACTS— materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil , signs of hydrau is failure, level of ponding, condition of vegetation., recommendation for maintenance or repairs, etc. ) PRIVY: (locate on site plan) ,�` C) materials of construction \ dimensions depth of solids Comments: 1 (note condition .of soil , signs of hydraulic failure, level of . ponding, y condition of vegetation, recommendations for maintenance or repairs,etc. ) "­ 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' VATL ��S r_ DEPTH TO GROUNDWATER 1 t' depth to groundwater method of determ' nation or approximation: Z- ez e'.%6 v\jc- I u'u C CL ` TOWN OF A BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS `J� I'Ltk7�lA�`( �1✓t,4-T e.N/(C_LG ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME _ James Coyne CPART D - CERTIFICATION NAME OF INSPECTOR ETZZ2 cJuL�:varU �� , . S•iLL--..Jiw F—Nc�A)C--G�i tom, � kl(_ COMPANY NAME e0yUS0L-TAVV'_r Tp J P MA-<_0,• ,Q,=,-►L COMPANY. ADDRESS Box 66 Centerville,Mass . 02632 Street Town or City State ZIP COMPANY TELEPHONE ( 775 ) 3338- 508 FAX ( 790 ) 15 - 78 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time arf inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experien ,N 4 the proper function and maintenance of on site sewage disposal systegij OF . Check one : E�q�, pcTIR tc; Sf1Li IVAN , System PASSED ej No. ? 733 The inspection whit {roc cted has nq.t found any information which indicates that ;`vsy ;e fails to adequately protect public health or the environmen efined 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 conducted has found that the system fails to 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. e aL0 `1 Inspector Signature Date ` One copy of this certification must be provided to the OWNER, the BUYER I ( where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.doc SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART D CERTIFICATION Inspector : Peter Sullivan PE Location : 31 Midway , Centerville Date : June 16,1995 Certification Statement I certify that I have personally inspected the sewage disposal system at this address 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 on-site sewage disposal systems. I have not found any information which indicates that the system fails to adequately protect public health 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. Please note the summary of recommendations as presented in this form. Lastly please note 310CMR:15.302 Criteria for Inspection(1) "The inspection is not designed to provide information to demonstrate that the system will adequately serve the use to be placed upon it by the new owner. " Very truly your d �e�ter Sullivan PE Distribution: Original to system owner Buyer sL . ...,r Board of Heath ��` '3i 1t/0�v/9Y LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A LL.ER'S NAME S ADDRESS j CP-%yCL SCAes f so 0 , m c,, 2L BUILDER OR OWNER (Z C - k DATE PERMIT ISSUED to� �L - DAT E COMPLIANCE ISSUED d Ejal D r7a No... Finc... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. ........ ...............OF........................................ ........................................ villiration for Uispoiial Wilds (foustrurtion rrrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewag is osal� System at: ....................................... 'Location- ress er Et No. ............... ................................................................ ------------------------------------------ a Addes L...... .7.. ..... .....a .. . Installer Address as Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms....................:..............:........Expansion Attic Garbage Grinder ( Other—Type of Building ............................ No.' of persons............................. Showers Cafeteria ( Other fixtures --------------------------------------------------------------------_-- -----------------------------­*-------------------- -------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.........._.._..._.. Total Length.................... Total leaching area....................sq. ft.- Seepage Pit No--------------------- Diameter............_._..... Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) I . Percolation Test Results'--.. Per-formed by.......................................................................... Date........................................ Test Pit No. 1................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......................................................................................................................................................................... W U ........................................................................................................................................................................................................ ................................................ ..................................................................................................................................................; U Nature of Repairs or Alterations—Answer when applicable..../a C-�4 .......0.41 X...... .....4,ew.. .. .... .......................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTILE 5 of the State Sanitary Code—The undersigned further agrees not to place thels-ystern in operation until.a Certificate of Compliance has been�is.ued by the board of health. 001 S1 ned.... .... ..10.r:f .. ................... Date Application Approved, By...... ... ........ -- ---------------------------------- ------ -------- Date te Application Disapproved for the following reasons:................................................................................................................. ........................................................................................................................................................................................... Date ........................................ IssuedL....................................................... Date a (aJ No.... .._..... _.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .. .........................OF.........................----.............--------------•----••---......................_.. Applirattian for Disposal Works Tonstrurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (k�an Individual Sewage Disposal System at: ..j.e , !�(e ---•-...Cf?.X./-Y.�......------•------------------------•-•--.. �3} ------<r 4f,cr.�f!%L!»4 -ovation-Address Sr I of No. ----...-•---.... . .............................. ....... ..........--- Owner Address W � ..... ..�`'c�a�.�E! ..../.11:�4.'r.. .....24e �?1 "�tf .1 A'�t".Rt .�?.l, ,�. f►J; a (.4 Installer Address Type of Building Size Lot...........................Sq. feet V Dw -Expansion Attic ( ) Garbage Grinder 10tzr�-Typelling—No. of Bedrooms...........................................of Building ............................ No. of persons............................ Showers ( ) Cafeteria a ( ) Otherfixtures%.....-------••--••-•-••---------•--••------------••---•-•-•----------•------•-•---•--•--•-••---•-----•.......-----•---•-•-••........................ d �� W De ign Flow..................................R!:........gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity__...........gallons Length................ Width................ Diameter................ Depth................ 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. l................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........................................................................................................................................................................ U •---------------------------------------------------•-------•----------------.-.----------------------------------------------------------------- -------------- •-------------- W . •--•----------•--------------•-----------._....----••-•----------•-----••-•-••-••••----.._..------...•----•---------•-••------••--......••----••-••••----------•---•-••---•--•----------------. UNature,of Repairs or Alterations—Answer when applicable._._ AM-0.......4�094�!._.._..om . /. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ITT a, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by the board of health. Si ned..%� �...C)_�. 4 ..... ........."' Date Application.Approved By.......... ------------------------------ --• - - --------•--..•----- ate - Application Disapproved for the following reasons------------------------------------•---•---------- ............................................................. ......................................•.....--------------.......•--•----•---------------------------•-------••••...---------•-•-----•••--•-------------•-•--•••-••--•-••--•--•--------•---•-•-•••-•--- l Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH .OF MASSACHUSETTS BOARD OF HEALTH 11?-V.,r.s............OF........ ..................................... Trrtifiratr of f ompliunrr THI S TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (G� ----------------------------------------•....-....... . 0 Installer at.....3......!!.r!q- Vi c •-----C� 7. .1s�1.L, rd2► S�i.-................................................................................ - has been installed in accordance with the provisions of TITLE 59f The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... .......... ............ dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISF CT RY/. / DATE.................................................--�� I-•------ Inspector----------------------••�r-- ----------•------..-----------•--•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD . OF HEALTH ...................0 F.. s . .......................................... No..................`�..... FEE.-` .................. Disposal Morkg 01uns#rudion rrutit Permission is hereby granted.......... .. 0,u."'-------------------------•-----.....------•-------..................................... to Construct ( ) or Repair ) an Indio dual Sev�age D' osal System at No....•-----.�/'. r 1! P,---------------------•--------—--- •---------------treet-----•-------------------•---------------•-----------------------•-----•-•-------- S as shown on the application for Disposal Works Construction Permit No...................... I)ated.......................................... - = ---------------------------------------------- /� Z Board of Health DATE.... -- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS -- -- - -- - - - _ _ _ _ __ _ _ I � SITE PLAT Design Calculations SITE l � SCALE: 1 "=20' Number of Bedrooms: 3 EXISTING '�� rc BENCH MARK CORNER OF BRICK veGarbage Grinder: YES (TO BE REMOVED, GRINDER NOT ALLOWED WITH THIS DESIGN) STOOP ELEV.=100.00' (ASSUMED) Leaching Capacity Required: 330 Gal./Day ©r Leaching Area Required: 330 Gal./(0.74 Gal./Sq.Ft.)=446 Sq.Ft. Proposed -Leaching Structure: 1-251 X 13'W X 2'D Leaching Trench r Leaching Area Provided: 477 Sq.Ft. Proposed Leaching Capacity: 353 gpd > 330 gpd. req'd. o 0 0 m m c> I LOCUS j 99.02' NO SCALE GEC RA E I` N0 T E S (/ 1. ADDRESS: 31 MIDWAY DRIVE } 2. ASSESSORS NUMBER: 252-072 98. DI Y ` 3. DEVELOPER'S LOT: LOT 17 f\p t V E 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN 'A ON THE GROUND INSTRUMENT SURVEY. z °S9 5. TOWN WATER IS PROVIDED TO SITE & SURROUNDING PROPERTIES. 6. REFERENCE PLAN: PLAN BK 147 PAGE 73 & PLAN BK 270 PG 78 7. NO WETLANDS ARE LOCATED WITHIN 100 FEET OF SAS. 8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS. v J 98.94' I 2 w� LOT 17 7 o c'_21-3' AREA = 8,720 SQ.FT. � V �'J� m o s a 99 ' - CONSTRUCTION NaTL`J o J ' B . M o 1. Contractor is responsible for Di safe notification Q v i _� � a s p Dig safe protection of all underground utilities and pipes. 99.aT SOIL EVALUATION 2. The septic tank and distribution box shall be set level on 16" of 3/4"-1 1/2" stone. DATE: SEPTEMBER 13, 2003 3. Backfill ihould be clean sand or gravel with no 9894' NO. 3t 899 o PERFORMED BY: GLEN E. HARRINGTON, R.S. stones over 3" in size- Chair, Irnk y subject inspection g I . s em is to iti during installation 4 ��l ,j 4 This s STING D by Glen IE. Harrington, R.S. v 0" 98.50' 5. The contractor shall install this system in accordance DWELL/NC oamy sand with Tltl Vgof the Massachusetts Environments! Code I and the; Regulations of the Town of BARNSTABLE. I% 9e.78 fu11 eeua, 3" 1OYR4/2 98.25' 6. Provide pn Acme Precast 1,500 gal. H-10, septic tank, 1 H-10 5—hole 0-2ox and 2 H-10 500 gal. chambers or equal. oBw 7. No vehicle or heavy machinery shall drive over the o loamy sand septic system unless noted as H-20 septic components. DECK IOYR5/8 crawls 20" gg.83' 8. Install gas baffle or equal on septic tank outlet tee end. Pape 9. AN existing inverts and site conditions shall be verified by contractor. 3 99.48 0 10. Existing cesspools to be pumped and backfilled. 11. Existing garbage grinder to be removed by licensed plumber prior QQ to issuance of Certificate of Compliance. oCl o � ° f—m sand 1-20"4}qM.ACCESS MANHOLE 5 0 25Y7/4 0GARAGE 15% f. gravel I Sep is se boo, 98.40' 120" 88.50' 34" NO GROUNDWATER ENCOUNTERED `l _ C3 -.-— H 1 2 10 50 0 gal. chambers �. -- END—SECTION STEEL REINFORCED PRECAST CONCRETE H—1 0 500 GALLON CHAMBER 1728 BISHOPS T PLAN VIEW zse-ire ERRgCe N07 TO SCALE 2 51leaching X trench X 2,Orusing D USE ACME PRECAST OR EQUAL leaching trench using 2 H-10 500 gal. chambers with 4' of stone on sides & ends. REVISED: 9/14/2003, SOIL EVALUATION OFMq`s`r9 PROPOSED SEPTIC SYSTEM UPGRADE PREPARED FOR LEGEND RI -+ ROBERT F. DWYER ET UX EXISTING CESSPOOLS TO BE H Q coAT 0 ; PUMPED & BACKEILLED 31 MIDWAY DRIVE 0 o PROPOSED 1,500 CAL. 'N� /TAR\� BARNSTABLE (CENTERVILLE), MA 10• min. from *NOTE: ALL PIPES ARE 10 BE 4" DIA. SCHEDULE 40 P.V.C. H-10 SEPTIC TANK house to septic tank *NOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE. Septic tank covers must be finished grade overs stem=2% slope awa Existing House within 6" of finished grade 9 Y P Y X 104,46 DENOTES EXISTING PREPARED BY: 5 HOLE SPOT GRADE FF ELEV.=101.28' EXISTI ACE DIST. BOX Existing Grade Elev.=98.5'± 12" min.m 0.02' 36" ax. 9 LEDA ROSE LANE -- -95 ---- EXISTING CONTOUR L E. HARRIN `" TON' S. full 5 = Leve Min. 2'-1J8"-1 J2" Cellar 10, 1500 GAL. 4 l for 2' S=.o1 washed stone Top Peastone Elev.=96.19' _ _.__. 1-1_, Approx. IOcatlOn A ,A���O„ �A 02 64� N SEPTIC TANK n W - M (v MILLS,Bsmt, n. Elev.=92.94' w H-10 a a ao 15' Invert lev.= 69' existing water line O1 GAS BAFFLE a 'v rn ® eo r3 o 14"MIN. Bo{tom of Leach TEL: 508-428-3862 OR EQUAL i n n 2S• Trench Elev.= 93.69' LEACH TRENCH 39f FAX: 508-428-3862 6" OF 3/4"-11/2" STONE - c �Ad�sted GW per GIS Mops w SYSTEM PROFILE 6" OF 3/4"-11/2"STONE SCALE: 1 "=20' DRAWN BY: GEH SEP. 10, 2003 Not to scale DATUM: ASSUMED FILE: DWYERCVILLE SHEET 1 OF 1 ' i