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HomeMy WebLinkAbout0050 MIDWAY DRIVE - Health 50 Midway Drive . Hyannis f A=252 — 066 ; o TOWN OF BARNSTABLE LOCATION �® ������ 49a SEWAGE# VILLAGE 1����'�"`'r' ASSESSOR'S MAP&PARCEL ��� -INSTALLER'S NAME&PHONE NO. 0�- SEPTIC TANK CAPACITY �X'��'��c� /�� LEACHING FACILITY: (type) (size) NO.OF BEDROOMS OWNER �1�+sA�',p J' PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: D Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /XYFeet 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 ri 3 ` ri � � TOWN OF,BARNSTABLE L6CATIO'N So �+ dw�`7 �r• SEWAGE # _ V,%LAGE C��rI-t/V+ �� ASSESSOR'S MAP & LOTo;Sc� r&& INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY (�eS gpps LEACHING FACILITY: (type) Ccsl/>oy (size) NO.OF BEDROOMS -- — BUILDER OR OWNER 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 I9aching facility) J Feet Furnished by StnTJt. �itl�erU�l0/�—T_ CD i Cr, � -; f t J � �f)du No. I I�I Fee /00" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:—�/ - PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitatiou for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Andiidual Components Location Address or Lot No. S"_® -0074/40 Af" y 4!:�7OZ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel a 5.1 — a Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 4-.-" 7�S`®moo' -0 -- A 4,17, Type of Building: Dwelling No.of Bedrooms j Lot Size sq.ft. Garbage Grinder( ) Other Type of Building JT 40%P No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -7 J* gpd Design flow provided gpd Plan Date �` ����� Number of sheets _' Revision Date Title Size of Septic Tank�X����iy' �S'oG; Type of S.A.S. Description of Soil dc- 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 h. Si Date �d, Application Approved by Date Application Disapproved Date 4 for the following reasons PermitNo.20/6— 17-t Date Issued_Z{ 14 2�tb I k4. No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .w Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS '9pplication for Disposal Opstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade() Abandon( ) []Complete System ndividual Components Location Address or Lot No. 15 O W y 4!::76 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel .2 r,� — 0-,nr 44.-_--fX6�p Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 79S--o>o> '���, �s7J4✓'o/''" dc'.J'� .�����/�� i Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building A'.n No.of Persons Showers( ) Cafeteria( ) Other Fixtures t Design Flow(min.required) 10 gpd Design flow provided'; JS'/,g gpd Plan Date T ���—119< Number of sheets ' Revision Date Title If Size of Septic Tank�X��'J�'i✓ /SoG', Type of S.A.S. �o "" «����i)✓�7i ���� Description of Soil r'<1%r 6'- 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 h. Si Date / Date Application Approved by (,J Date L f//,Y/Z®/6 —�r Application Disapproved Date for the following reasons f Permit N0.�117--' -a:i,, Date lssued y 1 1 y ' 20 l b THE COMMONWEALTH OF MASSACHUSETTS t BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Upgraded �T l Abandoned b �t�'� � lr � C ( ) Y at has been constructed in accordance - with the provisions of Title 5 and the for Disposal System Construction Permit No.09/&' 1 Z1 dated '0 417.01(0 Installer J,:,ram ZGr�OerlJ� Designer 16 d 11 ,4✓�a., P. - 1 #bedrooms 3 Approved design flow( gpd The issuance of this permit shall not be construed as a guarantee that the system will�fu ctibn as designed. Date q 12 o'r� Inspector ��� --------------------------------------------------------------------------------------------------------------------------------------- No. 00 I b ^ I Z I Fee Md THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(� Upgrade(� Abandon( ) System located at JT o 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:Construction must be completed within three years of the date of this permi Date y Y 17011. Approved by Tj Town of Barnstable Regulatory Services Richard V.Scali,Interim Director WAS• g Public Health Division ibg9. �0 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862.4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: r ;o Sewage Permit# a1� '®' J Assessor's MaplParcel Z Designer. Installer: F Address: ` �1 � Address: On �y �� �.1] was issued a permit to install a (date) (installer) septic system at SID t'yt�it k based on a design drawn by addres �"t��� �• , � , ��j _ dated (designer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in c nl}ance with the terms e AA approval letters(if applicable) 0F414S �N 0�, D AVID <G t Pr1ASOP `'� ' [rt a er's a �� -f FarSc£T� " Destgner's Signature) (A Des _; Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH .7 < D THIS FORM AND AS- BUILT CAR ARE RECEIVED By THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:1Septic\Designer Certification Form Rev 8-14-13.doc 11iE 'own of Barnstable p it t SDCO Departinent of Regttlatory Services '• �►aMt r• Public Health Division 3>K ; Date 3 (� �s79 200 Main Street,Hyannis MA 02601 ly jfb tAI►'l� GPI ' Date Scheduled Timeee pd. � / Soil Suitability Assessment for Se - a Disposal Performed By: Y: .Witnessed B LOCATION& GENERAL INFORMATIONLocation Address �� J''4J 4, Owner's Name Address �� G Assessor's Map/Parcel: 2 4r Engineer's NEW CONSTRUCTION REPAIR TelephaneH`� �a >lr Land Use Slopes(%) �} Surface Stones . Distances from: Open Water Body�It possible Wet•Ar v (f • �'.:it` ft Drinking Water We11�,=, Dralhage Way ft Property Llne 15 ft Other ft SICCTCH:(street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity, to holes) ty-� Parent material(geologic) VV ( pth to Bedrock Depth to Groundwater. Standing Water in Hole: /v vWeeping from Pit Fnea � Estimated Seasonal High Groundwater Al �1 DETERMINATION FOR SEASONAL-HIGH WATER TABLE Method Used: r Depth Observed standing in obs.hole: In. Depth to loll mottles: Deilth to weeping from side of obs.hole: In, Groundwater Adjustment fr. Well/r Reading Date: Index Well level A ,factor ,r Ad.Groundw6ter level PERCOLATION TEST bates �tm Observation j f Hole# ( Tlme at 4" ! _ i Depth of Pero Time at G" Start Pro-soak Time Q Time End Pro-soak Rate Min./inch Site Suitabllity Assessment: Site Passed -Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observ'dtion Hole Data To Be Completed on Back----—� ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) weep;prior to beginning. Q:1S EPTIC\PER CFORM.DOC { Deptlrfrom DEEP.OBSERVATION,HOLE Hole#Soil Horizon Soil Texture Il Color LOG 9011 Other-� Surface(in.) ='; (USDA) (Munsell) Mottling (Structure,Stones;Boulders. n lstency,%Braver i Im DEEP OBSERVATION HOLE LOG Hole# Depth from 'Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Q- U DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other : Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistangy.%0 DEEP OBSERVATION HOLE LOG Hole# Depth from, Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Slopes;Boulders, Consistency, i Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 100 year flood boundary No-14 Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious qiiterlal exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring p vious material? Certification U 2. I certify that on. (date)I have passed the soil evaluator examination approved by the Department of Env ronm ntal.Protection and that the above analysis was performed by me consistent with . the required train! g expertise d per' nce described in 10 CMR 15.017. Signature Date F • Q:\9EPT1C\PBRCPORM.D0C I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c,M 5.0 Midway Drive Property Address Sean McGeoghan Owner Owner's Name information is required for --WA n h i S Ma. 02632 03/26/2009 j --__ every page. Cityff own State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the (.2� computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 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 mai6enanceof on-site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 9340 of Title 5(310 CMR 15.000). The system: I ® Passes ❑ Conditionally Passes ❑ Fails c ❑ Needs Further Evaluation by the Local Approving Authority ' -- '; 03/26/2009 `` Ins ctor's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. LA M t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 r 1 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I 50 Midway Drive Property Address Sean McGeoghan Owner Owner's Name information is required for Centerville Ma. 02632 03/26/2009 every page. CitylTown 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: ® 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: The septic system is in proper working order at the present time. B System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"-section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the K 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 50 Midway Drive Property Address Sean McGeoghan Owner Owner's Name information is required for Centerville Ma. 02632 03/26/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Midway Drive 'M Property Address Sean McGeoghan Owner Owner's Name information is required for Centerville Ma. 02632 03/26/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and.environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Midway Drive M Property Address Sean McGeoghan Owner Owner's Name information is required for Centerville Ma. 02632 03/26/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 50 Midway Drive M Property Address Sean McGeoghan Owner Owner's Name information is required for Centerville Ma. 02632 03/26/2009 every page. CitylTown 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): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 Title 5 Official Inspection Form: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 ;M 50 Midway Drive Property Address Sean McGeoghan Owner Owner's Name information is required for Centerville Ma. 02632 03/26/2009 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists.of a 1500 gallon septic tank,distribution box and 24 Quick 4 infiltrators. Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required) ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2007:32,000 g ( y g (gpd))' 2008:15,000 Detail: 2007: 88 gpd. 2008: 42 gpd Sump pump? ❑ Yes ® No Last date of occupancy: 03/26/2009 Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.):. Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 50 Midway Drive Property Address Sean McGeoghan Owner Owner's Name information is required for Centerville Ma. 02632 03/26/2009 every page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. I ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Midway Drive M Property Address Sean McGeoghan Owner Owner's Name information is required for Centerville Ma. 02632 03/26/2009 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System installed in 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20'+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 18"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: 1500 gallon Sludge depth: 4" t5ins•09/08 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 50 Midway Drive M Property Address Sean McGeoghan Owner Owner's Name information is required for Centerville Ma. 02632 03/26/2009 every page. CitylTown 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 28" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 50 Midway Drive Property Address Sean McGeoghan Owner Owner's Name information is required for Centerville Ma. 02632 03/26/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons _ Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Midway Drive M Property Address Sean McGeoghan Owner Owner's Name information is required for Centerville Ma. 02632 03/26/2009 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 No. 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.): Bos is Ievel.Box has four outlet laterals with equal distribution.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 50 Midway Drive Property Address Sean McGeoghan Owner Owner's Name information is required for Centerville Ma. 02632 03/26/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 24 Quick 4's ❑ 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.): Sandy dry soil.No signs of hydraulic failure.No water observed in observation port. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M0 50 Midway Drive Property Address Sean McGeoghan Owner Owner's Name information is required for Centerville Ma. 02632 03/26/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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•09108 Title 5 Official.Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map SizeENE Zoom Out,, In o � V Gr v / 0717 ft I NO -Ol 1 4 / / 1 '1 1 1 1 l F 7 Y ✓ 89 __ 1 f + .... ........ __. ... _...... Set Scale 1" = 20 Aerial Photos MAP DISCLAIMER f nnvrinht 9f111�,_9l1/1R T--of Rorneknhle KAD All rinhlc reeenf� f http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=252066&map... 3/27/2009 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cw 50 Midway Drive M Property Address Sean McGeoghan Owner Owner's Name information is`required for Centerville Ma. 02632 03/26/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 58.9' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 2006 If checked, date of design plan reviewed: Date Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 50 Midway Drive Property Address Sean McGeoghan Owner Owner's Name information is required for Centerville Ma. 02632 03/26/2009 every page. City/Town 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE G G ` u TIGi. O � " D SEWAGE # V_;LLAGE r 6"e%1' 'SESSOR'S MAP & LOTa;J 4-0 C�rJrq INSTALLER'S NAME&PHONE NO. s7 a�.��. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) i c:lc. `/ s (size) NO. OF BEDROOMS BUILDER OR OWNER C .4 Hao" PERMITDATE: 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 r No. vim% Y/135 Fee 1 0 O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for -Mi.5po5al *p5tem ConMruction Permit Application for a Permit to Construct(.. )Repair V Upgrade( )Abandon( ) Complete System O Individual Components Location Addresj or Lot No. k4 jOtj_)R Y Q2, Owner's Name,Address and Tel.No. Dnu 1© C AArno*Q �Ml r k A Assessor's Map el LOT Zo APON - 2S Z- 0(P G Installer's Name,Address,and Tel.No. PAIS-rbj27,,-Q Ek(:A-U A-TIC 14esigner's Name,Address and Tel.No. UK-)b �.c, rrr� t'2, 5 RO1z�:5S O R U t-4 A Z w- c 2 sss��t=t'�t..D _aO :Fa-f,,"T'0r4 5.OF,- 477- S3I'S Type of Building: Dwelling No.of Bedrooms Lot Size 7�9Qp sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 130 gallons per day. Calculated daily flow 3 J z) gallons. Plan Date 3-23 --0(& Number of sheets 'Z_ Revision Date Title Size of Septic Tank (5 0 n Type of S.A.S. 0 (MU Description of Soil: A C) t.i ►1 51, `1 a 3 0 Sl._ C, 3 G `t._ .120 A, S.A00 Nature of Repairs or Alterations(Answer when applicable) .RZP AC cti LD -C.R'S;P2X5L tom_ CW Date last inspected: L 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 oft Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is e Bard Health. Sig Date 3' 7 C?Z Application Approved by Date Application Disapproved for the following reasons Permit No. c-} Date Issued :_1— --------------------- ——————— ——————— No. � , x z Fee i THE COMMONWEALTH OF MASSACHUSETTS ( Entered in computer: j' i Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Migpo all *pgtem Construction Permit Application for a Permit to Construct( )Repair 06 Upgrade( )Abandon( ) Complete System ❑Individual Components i Location Addres or Lot No % 1-4 low/�Y D1Z . Owner's Name,Address and Tel.No. DAu 10 C Pi4a o 0 MJ� Assessor's Ma cel Le>T 20 /LPN - 25 7- - O(P /o Installer's Name,Address,and Tel.No. PAS-76WQ' EkCAV A-1'1 1-)designer's Name,Address and Tel.No. 0-06 Wtb� Nv W ` P,C> c304 IZ� i f=oa STO q MA 1Z W- r-(LC`SSf-tom(.0 Q O -:FaV_,F,5TOt) "Ve - 30-D S0F,- 4-77- 5313 Iv� � • Type of Building: f , Dwelling No.of Bedrooms _3 Lot Size 7, Sa-o sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons k Showers( ) Cafeteria( ) Other Fixtures w Design Flow 3 3 O gallons per day. Calculaate``daily flow '3 J o gallons. Plan Date 3-Z3 - O(d Number of sheets Revision Date Title i* 1 W Size of Septic Tank 1500. Type of S,A.S. I�G i LTV4, S Description of Soil A Oil ' Il S L q `� 3(o I1 SL_ �.. 3 G.tj - �20�� /C. 'SAtNb Nature of Repairs or Alterations(Answer when applicable) W)LACB a LQ eF,S P60L. W ►tA v?0Qjry0ro0 -"trrL`G V Date last inspected: 4 . Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provision of Title 5 ofor Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is ue t oard o Health. Sig ed Date ' Application Approved by Date Application Disapproved for the following reasons Permit No. C`0 Date Issued 3/ ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded(k Abandoned( )by PaIS-1CP--s 1ZXC.t-VA-ry ON at 50 P ID w19 j Do_ C_rAv'MR•yILICZ has been constructed,in a cordance with the provisions of Title 5 and the for Disposal System Construction Permit NoaCO(9 /3S dated 3 311 Installer PAS' �cc A1P6- 1J Designer �V6-ItJ c�.►N� WORK-S The issuance of this permit shal o e cons ed as a guarantee that the system w 1'Nrnc joli as designed. Date i Inspector No. /•��--•-----------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS mi5po5at 6p$tem Con$truction permit Permission is hereby granted to Construct( )Repair(N)Upgrade( )Abandon( ) System located at 5 O M Q w A" OR- C.F�N► 2 y t l.0 MO, 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 conditi Provided: Constru lion ust be completed within three years of the to of this p Date:__ J;5 � Approved by TOWN OF 13AKNSTABLJ✓ LOCATION �7 ' D SEWAGE # VILLAGE ���'�liYi'1- '� L�� ASSESSOR'S MAP 8c LOT�j•�-� �b`f� I INSTALLER'S NAME&PHONE NO. P.*->7 &1�r yX j3�® SEPTIC TANK CAPACITY ` , LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER C PERMITDATE:: 3l L e 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 Fumished by 3 313 ttigi�lY E, sepdc symew b Form is To Be U For t Ir of yaWd y MCCL TT®N T'ZST AND WIL RVALUATION ION FORM bwft"My Ow by aae ® 'tWW ftWA 9YOUM is Gem WW 10 a $!dwst9iAX eWy, are ae GMWMU&W bwimm um warlmd with do d"It y{. G IU WU is CIOMAW ai CLASS i MW dw psmalaban rats if:so Ojm or 2&S mow pw bob. IU OPUO&tt my to ho l dm to cWN&two fact a racy tag bad and p9mM=IM at the ate wvdbm a bw Me spW pvmt. • Tbre a no 'wmvw in flew muter chwee a un e ® anno . s Mw baftm of lie propond laashin#facility wntl�le toc&W no Lm Om five ft aloe Ole =X%nWn 4#4VAP4 POWA"Ur Able 619vat9on. WJUP dW VWAVhPWW tam kOM 60 le) A) Top of Gaol Wks EUvatDor,terms GIS infAmawn) 5) G.W. ,� t far hwh G 'W. e MOTWR Awd tin doe abwm iftfanmbm, a rVair pmat will ba iw"d for. bsdmcm rt=irtt M. Na MWfdMI bG&WM are autP OnWd M the ftre pbm F Town of Barnstable Regulatory Services Thomas F. Geller,Director NAM Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,AAA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Des➢aner Certification Form Date: A LELL— Sewage Permit# Assessor's Map\Parce➢ 25 Z ,U Designer: Installer: �� � Address: 12 W (f S-A G-SACk Address: oveig On �cca,.rc>, � ,s issued a permit to install a (date) (installer) septic system at_ M`A u_)4y p T, CU\ -C_r� t�� based on a design drawn by (address) / dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes. (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. flan revision or certified as-built by designer to follow. c2 )) �Pvl H 01 PETER T. yN o WENTEE "+ Installer's Signature) CIVIL in -o No.35109 QI �VWJ (Designer's Signature) (Affix Designer's Stamp Here) PLEASE HETUM TO BAMSTABLE PUBLIC HEALTH DIVI&QN. CERTIFICATE of COMPLFA WILL NOT BE ISSUED UNTIL BOTH THIS fg M AND ,As-BUJT L MCEIVEID BY THE BA UBLIC HEALTH DIVISIQ& THA1Vj YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc Y r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 2� TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION RECEIVED Property Address: 50 Midway Drive . Centerville,MA 02632 OCT p 1 20 01 Owner's Name: Judith Cahoon Owner's Address: Same TOWN OF BARNSTABLE HEALTH DEPT, Date of Inspection: September 17, 2001 Name of Inspector:(Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Map:252 Osterville,MA 02655-0049 Parcel:.066 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 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 N urther Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: September 20, 2001 The system inspector shall submi 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 r ****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 1.1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50 Midway Drive Centerville, MA Owner: Judith Cahoon Date of Inspection: September 17, 2001 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 i 15.303;or'in 310:CMR 15.304 exist.'Any failure criteria not evaluated are indicated below. I 3 Comments: d,, 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 determined(Y,N,ND)in the 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. 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: 50 Midway Drive Centerville, AM Owner: Judith Cahoon _ Date of Inspection: September 17, 2001 ^ 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 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. 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: 50 Midway Drive Centerville, MA Owner: Judith Cahoon Date of Inspection: September 17, 2001 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 '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓} Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public 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 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 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 contact the appropriate regional office of the Department. 4 f u Page 5 of 11 - OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 50 Midway Drive Centerville, MA Owner: Judith Cahoon Date of Inspection: September 17, 2001 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? n/a 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: Yes No ✓ 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(3)(b)]. y 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 50 Midway Drive Centerville, AM Owner: Judith Cahoon , Date of Inspection: September 17, 2001 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Yes 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: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,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 information: System pumped after inspection for maintenance 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/Altemative 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: Approximately 35 years old-per owner 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: 50 Midway Drive Centerville, AM Owner: Judith Cahoon Date of Inspection: September 17, 2001 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: . Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Cesspool acting as a septic tank Depth below grade: 10" Material of construction: _concrete metal fiberglass _polyethylene ✓ other(explain) 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: 5'W x 5'T x 8'bottom to grade Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: -- - Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 5" Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The liquid level was up to the outlet tee The cover was 10"below. The system was pumped after the inspection. 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 4 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 'SYSTEM INFORMATION (continued) Property Address: 50 Midway Drive Centerville, AM Owner: Judith Cahoon Date of Inspection:` September 17, 2001 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.): DLSTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: .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: 50 Midway Drive Centerville, AM Owner: Judith Cahoon Date of Inspection: September 17, 2001 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: ' Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: ; leaching fields,number,dimensions: ✓ overflow cesspool,number: I Innovativelalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The overflow cesspool was S'Wx S'Tx 8'6"bottom to grade. The overflow cesspool had 2'6"ofwater on the bottom. There were no signs of failure The cover was 16"below grade 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: 50 Midway Drive Centerville, MA Owner: Judith Cahoon Date of Inspection: September 17, 2001 Map:252 Parcel 066 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. • .b 10 Page I 1 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Midway Drive Centerville, MA Owner: Judith Cahoon Date of Inspection: September 17, 2001 SM EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 45'+1- 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: The bottom of the overflow cesspool to grade was approximately 86". Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 45'+/-to ground water at this site. This report has been prepared and the system 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 system, the inspection and/or this report. 11 U o CQ - S � 3 S A C n c � I LEGEND sg PROPOSED CONTOUR }� o- j, F991 PROPOSED SPOT GRADE e _._ 4� EXISTING CONTOUR j J/ Lakeview Ave�> n� o < & x;3 EXISTING SPOT GRADE Aj TEST PIT �\ Hod Pa+he Ro Lokeslde Or / !p W - EXISTING WATER SERVICE LOCUS y T016E PUM�.SPCouAPWEn �� s 4 FIU..ED.W(Th BAND jl --OI1VV— EXISTING OVERHEAD WIRE (WEE.A1.50, NOTE 1 1) ( �/�,,� F1 N81°53'1 ORW t 6 EXISTING GAS SERVICE lli� 9; 5.Ofl' TP-1 7 j t EXISTING TREE 1 t c c r - Wequaquet Lake eO� ,,``l'" `-- LOCUS MAP N.T.S. "� 27"' 0 ( ; :�__ ;--- ,�, j GENERAL NOTES: �E�CNVI�1�� 1- ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL s 1 0 PROP. --t. R BOARD OF HEALTH AND THE DESIGN ENGINEER. � ` { 5 G TP_2 f CORPIER OF BULKHEAD 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS EL=100,00 (A55UMED) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE �,, LOCAL RULES AND REGULATIONS. w ty;z N 3, THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR p TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE �� O O O� - DESIGN ENGINEER. Vim.. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING " �:. 9", FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN NO. 50 N ENGINEER BEFORE CONSTRUCTION CONTINUES. I STY. WD. M 5, ALL ELEVATIONS BASED ON ASSUMED DATUM. T.O.F. = I00.1 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER. 9 ^� c�U. PP'cH' - $. THERE ARE NO ABUTTING WELLS LOCATED WITHIN 150' OF THE S.A.S. y > 9. ALL AREAS DISTURBED.-DURING CONSTRUCTION SHALL BE RESTORED LOT 2n0 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. AN 25G_06G 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING [ TwlsdF 7,500#5F CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 75.Od �� IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). N81 53'I O"W 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. Eb�E 41 9> OF 4fq PLAN REVISIONS N� sy- 3/27/06 — REVISE SEPTIC PROFILE AND SECTION ELEVATIONS MIDWAY DRIVE PETER T. PROPOSED SEPTIC SYSTEM UPGRADE. t McENTEE v CIVIL . 50 MIDWAY DRIVE, CENTERVILLE, ` MA ' No. 35109 R£CIS Prepared for: David Cahoon, 50 Midway Drive, Centerville, MA £SS a l \ Engineering by: Surveying by: SCALE DRAWN J06. N0. ' A ERgiR6 MgWorb HOOD SURVEY GROUP 1"=20' P.T.M. 129-06 12 West Crossfield Road P.O. Box 1724 t �l1 r Forestdate, MA 02644 1 Moshpee, MA 02649 DATE CHECKED SHEET NO. t v GY (508) 47Z— -13 r (508}- 539-7799 3/23/06 P.T.M. 1 of 2 f NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL- NOT BE .<:"EL.96.33 ELEV. TOP " FOR A DISTANCE OF 15' AROUND THE . FOUNDATION FINISH GRADE: 99.3t PERIMETER OF THE S.A.S.. (Existing) F.G. EL99.2t F.G. EL.99.4t F.G. EL.99.3t =100.1t ' MAINTAIN 2% MIN SLOPE OVER LEACHING AREA 36" MAXIMUM COVER INSPECTION RISER PIPE L = 14' I L = 6. L =6 � 4" SCH 40 PVC , 4' SCH 40 PVC 4" SCH 40 PVC @ S= 2% (MIN.) 10" 14" @ S= 1% (MIN.) 6 ® S= 1% (MIN.) 8" TO > A. 48" LIQUID INVERTU;SR _ LEVEL INV.EL=96.75 o e; GAS PROPOSED INV.ELEV.=96.00 BAFFLE 4 ROWS OF 6 UNITS AT 4'/UNIT + 2'(END CAPS)= 26.00' . - INV. EL.=96.42 INV. EL.=96.25 INV.EL=97.00 �` � SOIL ABSORPTION SYSTEM (PROFILE) PROPOSED 1500 GALLON SEPT11C TANK "T'A TIE IN TO SEWER NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ESTABLISH VEGETATIVE COVER OUTSIDE HOUSE PIPE INVERTS PRIOR TO CONSTRUCTION. INV SIDE O 2) SEPTIC TANK AND D-BOX SHALL BE SET LEVEL BACKFILL WITH CLEAN SAND AND TRUE TO GRADE ON A MECHANICALLY COMPACTED (NATIVE OR PERC SAND) SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN =` ` 310 CMR 15.221(2). 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BREAKOUT ELEV.=96.33 a 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE f AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. BOTTOM ELEV.=95.33 FTC Ilill�lt f EXISTING SUITABLE OVE BOTTOM OF 0.5' 2.6' 0.5 MATERIAL 3-5" ola. INLETS s-s" Dla. OUTLETS SEPTIC SYSTEM PROFILE T.P. N.EXCAVVATION OR G.W. EFFECTIVE WIDTH=12.7' 5-OUTLETS 3" USE 4 ROWS OF 6-QUICK4 STANDARD INFILTRATOR,CHAMBERS N.T.S. HIGH G.W. EL: 89.3 WITH 6" SEPARATION BETWEEN EACH ROW & NO STONE 5-INLETS FT `. `-1 181/2" SOIL ABSORPTION SYSTEM (SECTION ra 30. { Ni9 2" FILL UNUSED To View Section DESIGN CRITERIA �����`� KNOCK—OUTS o PETER T. �✓ WITH MORTAR NUMBER OF BEDROOMS: 3 BEDROOMS � MCENTEE � D—BOX �� r _�'';-_--2s' SOIL LOG SOIL TEXTURAL CLASS: CLASS I o CIVIL DESIGN PERCOLATION RATE: <5 MIN/IN No.. 35109 -�- x a DAILY FLOW: 330 G.P.D. h'EQs�i © c�Q 16" '_`. =•T�`--�J ___I�;g_� DATE: MaRCH 23, 2006 dESIGN FLOW: 330 GP.D. (MIN REO'D) SS lL T '!'_J J h SOIL EVALUATOR: PETER T_ MCENTEE P-E. GARBAGE GRINDER: NO o __-� 1- WITNESS: NO WITNESS-CLASS 1 SOILS PROPOSED SEPTIC TANK: 1500 GAL. CAPACITY �1 -L �J �J l 0 SIDE vlEw LEACHING AREA REQUIRED: (330) = 445.9 S.F. 0 0 0 �� �/ TP-1 Depth Elev. TP-2 Depth .74 Elev. + M 99.3 q` 0" 99.3 A 0" USE 4 ROWS OF 6—QUICK4 STANDARD CHAMBER UNITS WITH NO e SANDY LOAM SANDY LOAM r 52" INSPECTION PO :� {. 10YR 3/3 1OYR 3/3 STONE FOR AN S.A.S. HAVING THE DIMENSIONS• 12 7 x 26 0 TOP VIEW 99•0 Br 4 98.8 e 6 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.72 SF/LF OF INFILTRATOR) ,;34" SANDY LOAM SANDY LOAM 8 INVERT 6 UNITS + 2 END CAPS PER ROW = 26.0 FT " E D CAP 10YR 5/8 1OYR 5/8 P7N Q4STOE 4 ROWS x 26.0' x 4.72 SF/LF = 490.88 SF fiii" END VIEW No. 50 96.3 C 36" 95.8 C 42" MULTiPORT END CAP I STY. 1A%D. �, E DESIGN FLOW PROVIDED: 0.74(490.88 S.F.) = 363.25 G.P.D. r PLAN REVISIONS / SIDE VIEW NOMINAL CHAMBER SPECIFICATIONS T.O.F. — 100•1 1' MED. SAND MED. SAND 3/27/06 - REVISE SEPTIC PROFILE AND SECTION ELEVATIONS SIZE(w■L x H)............................34-.48` ,<12- 10YR 4/6 _. 10YR 4/6 EFFECTIVE LEACHING AREA. >20 GRAVEL, >20 GRAVEL, PROPOSED SEPTIC SYSTEM UPGRADE T. COBBLES&- COBBLES& BED.....................................................PER Dove BOULDERS BOULDERS 50 MIDWAY DRIVE, CENTERVILLE, MA TRENCH.. ........... ... .................PER CODE 34" INERT ELEVATIOA.................................._..........8 I _ Prepared for: David Cahoon, 50 Midway Drive, Centerville, MA , FRONT VIEW STORAGE CAPACIIT PER uMT..................44.4 GAL _ 89,3 { 120" 89.3 1.20" ' Enginte,,ering by: Surveying by: SCALE DRAWN JOB. NO. QUICK 4 STANDARD INFILTRATOR CHAMBER S.A.S. LAYOUT NO GROUNDWATER OBSERVED EngineedngWorb HOOD SURVEY GROUP N.T.S. P.T.M. 129-06 , INFILTRATOR CHAMBERS i PERC RATE <2 MEN/IN. ("C" HORIZON} 12 West Crossfield Rood P.O. Box 1724 ,1 Forestdcle, MA 02644 Moshpee, MA 02649 DATE CHECKED SHEET NO. (508) 477-5313 (508) 539-7799 3�23�06 P.T.M. 2 Of -2_. f N.T.S. ASSESSORS MAP : Z• �i _- 2��— __ _ TEST HOLE LOGS PARCEL: �'T 1) The installation shall c;oa),Ay Mth 'title V ajid Town of 5*board oI �✓ p �� � SO I L EVALUATOR : % ( 5� I Iealth Regulations. FLOOD ZONE: �, WITNESS: a I 2) The installer shall verily the location of utilities, sewer inverts and septic REFERENCE �_ components prior to installation and setting base elevations. ./ S� oco Z3- O� '312., DATE:, rG7 p 1 b PERCOLATION RATE: .e- 2 t ( 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first two feet out of the d-box to the iraching shall be level. 4) This plan is not to be utilized for property line determination nor any other -- � TH- 1 TH-2 purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. i' ID ObI L �� ( ,3 2 6) Parking shall not be constructed over 1-110 septic components. 7) The property is bounded by property corners and property lines. A �� D` r GJ 8) The property owner shall review design considerations to approve of total LOCATION MAP D design flow and number of bedrooms to be considered for design. Receipt DIUW of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall 2► �O ZI be removed along with contaminated soil and replaced with clean sand per Title V specs. O (o�,` I�� (02�` 10)System components to be 10 feet from water line. Sewer !hies crossing the water line shall be sleeved with 4 inch SCI140 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as aforementioned and maintained in place. SEPT I C SYSTEM DES I G N 11) 1f a garbage grinder exists(it is to be removed and is the responsibility of the owner to ensure such. FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line if such exists. 3—BEDROOMS AT 110 GAL/DAY/BEDROOM GAL/DAY 13)Tae installer shalt verify the location, quantity and elevation of the sewer lines exiting the dwelling prior to the installation. SEPTIC TANK 14)]'his plan is representative only that a system can fit on a property meeting Title V requirements. 'GAL/DAY x 2 DAYS GAL USE { GALLON SEPTIC TANKCN�(/j U1 '01 L' ABSORPfi`I 0N SYSTEM lr pass ; i q _ DAVID a *A �i�v -�— 7J X 1 I ' t � O I DE AREA: 2 Z► B. BOTTOM AREA: Z cv ti 2 = �'�j MASON � , v No. o sTE� SEPTIC SYSTEM SECTIONA 04e NO _ ,) 44 ____---�--- - ;�- to , � to I`1 ,� , -►c ' ra 0 -17 GAL i O - o I SEPTIC TANK 0J (b ff SITE AND SEWAGE PLAN ( LOCAT I ON : _ I U PREPARED FOR P ti MH v VIA SCALE: it DAV I D B . MASON k� DATE: �` IZ oI ul DBC ENV IRONMEN AL DESIGNS EAST SANDWICH . MA W DATE HEALTH AGENT ( 508 ) 833- 2 1 77 Z