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Home My WebLink About0118 CONCORD LANE - Health 118 Concord'i;ane Marstons Mills A= 122 - 119 a y -� - £ LOCATION SEWAGE PER T no. `VILLAGEMilo Ai i2Z 119` i __ INSTA LLER'S NAME 8 A D R E S hu 6 U Cl DI R OR OWNER GATE PERMIT ISSUED /3 DATE COMPLIANCE ISSUED /i��z- -�r 1 lBT1 S +o i 3� 3, , 31 Commonwealth of Massachusetts i Title 5 Official Inspection Form -o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is Marstons Mills MA 02648 August 7, 2013 required for every g page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, (1 use only the tab 1. Inspector: 1`\) key to move your cursor-do not David D. Coughanowr, IRS use the return Name of Inspector key. Eco-Tech Environmental �__A Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Q5August 7, 2013 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. U �IVD113 t5ins•3/13 Title 5 Official Inspection For ub ace Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is required for every Marstons Mills MA 02648 August 7, 2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Inspector's Note==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection.if it isstructurally sound, not leaking and-if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is Marstons Mills MA 02648 August 7 2013 required for every 9 , page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C Further Evaluation is Required b the Board of Health: 1 q Y ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is required for every Marstons Mills MA 02648 August 7, 2013 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or ® clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is Marstons Mills MA 02648 August 7, 2013 required for every 9 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. l5ins•3/13 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 �M 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is required for every Marstons Mills MA 02648 August 7, 2013 page. CityTTown 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 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is Marstons Mills MA 02648 August 7, 2013 required for every 9 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 124 gpd 9 ( Y 9 (gpd)): Detail: 2011, 2012, +first half of 2013 Sump pump? ❑ Yes ® No Last date of occupancy: current 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-3/13 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 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is required for every Marstons Mills MA 02648 August 7, 2013 page. City/Town 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: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 I I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is Marstons Mills MA 02648 August 7, 2013 required for every 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 3+ years. Certificate of Compliance for currents stem issued 11/23/2009 (Permit#2009-387) 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 PV❑ ® C Elother(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: 1feet 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: 8.5 x 5 x 6-1000 gallon Sludge depth: 4 in t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is required for every Marstons Mills MA 02648 August 7, 2013 page. City/Town 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 30 in Scum thickness 2 in Distance from top of scum to top of outlet tee or baffle 9 in Distance from bottom of scum to bottom of outlet tee or baffle 13 in How were dimensions determined? Design plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is not required at this time. Maintenance pumping is recommended within 2 years and every 2-4 years thereafter. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of co nstruction: ❑ 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•3/13 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 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is Marstons Mills MA 02648 August 7 2013 required for every 9 , 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is Marstons Mills MA 02648 August 7, 2013 required for 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 at 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-Box appears structurally sound and functioning as intended. No evidence of leakage in or out was observed. Few solids in sump. 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: l5ins•3/13 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 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is Marstons Mills MA 02648 August 7, 2013 required for every 9 page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ 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.): Soils above leaching gallery appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. An observation hole was dug into leaching gallery stone and no effluent contact staining was observed in the stone or overlying soils. No standing effluent was observed to a depth of 6 inched below the top of the stone layer. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey p Y p Y Owner Owner's Name information is Marstons Mills MA 02648 August 7, 2013 required for 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.): l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is Marstons Mills MA 02648 August 7 2013 required for every 9 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is Marstons Mills MA 02648 August 7, 2013 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 11/23/2009 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Approved design plan on file with the Board of Health shows bottom of system to be 7.6 feet above the bottom of a witnessed test pit in which no water or groundwater was encountered. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 118 Concord Lane Property Address Joseph D. and Nancy C. Spivey Owner Owner's Name information is Marstons Mills MA 02648 August 7 2013 required for every 9 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �, TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date I2 I , Time: In Out Owner 7:�&m Sq o!d Tenant Address l 0 A bat, Address �L ,-l%Q-MCP( 4 AP,:s IL15 MA Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities �Z(� zzo L' ;,�rrevnvet�:. 3. Bathroom Facilities tic 4. Water Supply 5. Hot Water Facilities or- LNSPtc..- %00 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities , 10. Curtailment of Service 11. Space and Use _ 12. Exits 13. Installation and Maintenance of Structural / Elements v 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal I/ 16. Sewage Disposal zcop\- Mk 17.Temporary Housing 18. Driveway Width I/ 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) 0 Number of Persons Allowed (max) Person(s) Interviewed A � � Inspector l If Public Building such as Store or Hotel/Motel specify here ` TOWN OF BARNSTABLE LOCATION 1\g G�nc�,^c� .�c�S�SL SEWAGE -582 VILL-AGE ►��GS3?t*�o, ;1`> ASSESSOR'S MAP&PARCELASg 'b- f �n> ��1`1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY V U qr/ LEACHING FACILITY:(type) (� /+"� 50 s (size).a9.3 '0/l- NO. OF BEDROOMS OWNER 501..V PERMIT DATE: 09 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 aY on site or within 200 feet of leaching facility) IV w,e .feet. Edge of Wetland and Leaching Facility(if any wetlands exist.? ,. within 300 feet of leaching facility). ` ` L feet FURNISHED BY-/ HCA 3LP 8-3 c.3 0 ,Dat��a� �, f "D3 3 7 a o � No. O"`00 1 O : Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppliLAtion for ]Disposal &pstem Construction Permit Application for a Permit to Construct( ) Repair W Upgrade( ) Abandon( ) ❑Complete System gIndividual Components Location Address or Lot No. ( Cc A Coo LAr4 e Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Initaller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �7er�C J.1 -rc�{v►,4.4�'-I �k to i. S sM v<c,� Q G -e.n V 2.c�S T X,4-r.•ct� c h 33 2/ 2 7 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(min.required) ;!C) gpd Design flow provided 3 G 3 gpd Plan Date (! - _ 2-cv-`i Number of sheets ( Revision Date rZ, " e_ Title Size of Septic Tank P X ST rn I csK--Fo Type of S.A.S. ke'c 5-6 CA stv" (oe.-,Y Description of Soil S2 Q/!}*1 Nature of Repairs or Alterations(Answer when applicable) 1e .a 1 4<-.-- C,C 1-, 421 '7 T Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 3—0_ �- 22 Application Approved by D Date ;,'3 -y Application Disapproved by Date for the following reasons Permit No. 3 8 5L Date Issued ((' ��`d 1 Fee f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS Yes application for Misposal *pstem Construction-,permit Application for a Permit to Construct( ) Repair(4 Upgrade( ) Abandon( ) ❑Complete System -.®Individual Components Location Address or Lot No.I( CO'roi�( GAS a Owner's Name,Address,and Tel.No. P^A,S4-ol,s /,-x,t f�4142 S'/1 f*Vf Assessor's Map/Parcel (2. Z At 5 { 5 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Jc�h� c(� S/1n A y i3 o k k S L�.,d t rn fy C t V P ct S 7 J'a,- c� c !, ff3 2/ 27 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(min.required) gpd Design flow provided .j G 3 gpd Plan._ Date (( - 7 — Z cz> Number of sheets l Revision Date n 6 1 . Title Size of Septic Tank p X,5 7 (tea Type of S.A.S. 41*c p C6 A-v" (o el-IT Description of Soil_ Se P /) �!✓1 V i � Nature of Repairs or Alterations(Answer when applicable) PZ /�c F ... ( , .0,( (• c,C 1— 12t 'I` r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed / p Date Application Approved by Date Application Disapproved by Date x r. for the following reasons S , Permit No. a 0r)01 -3 7Z Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Comphance THIS IS TO CCERTIF/Y,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by t?o t,5-t`� P l 5� t- 4- ,, Sf -u r c•e 7, at 11 (a (0A 60,04 6,f9�4 "' bkA/14 _ has been constructed in accordance o� with the provisions of Title5 and the for Disposal System Construction Permit No..0pdq-3$3' dated /f Installer /96 u5ri-C / S ,-�/�,•,��,JP�y C��,�,tDesigner �/�t P/1 #bedrooms j Approved design flow At gpd The issuance of this p"rmit shall not be construed as a guarantee that the system w ion( desi �d Inspector . Date �I 1�;, gn\J Fee WD — THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION 7 BARNSTABLE,MASSACHUSETTS ]Disposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) /Repair(X) Upgrade( ) Abandon( ) System located at `7; r �✓t t!�Ji 1 "�1 2 "Cc, S 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. � I Provided:Construct1on must be completed within three years of the date of this permit. Date — �a i Approved by Town of Barnstable .HE.r Regulatory Services Thomas F.Geiler,Director a Public Health Division Thomas McKean,Director 200 Alain Street,Hyannis,IOTA 02601 Office:.508-862-4644. Fax: 508-790-6304 Installer &Designer Certification Form Date: �4 24 TO(ID . Designer: 1. 0 Installer: Address: . Address: Too�� On f I- Z 3 -0 91�0\996(J 6A tVL was issued a permit to install a (date) (installer) yy�l septic system at �, 1 based on a design drawn'by (address) r cD ''i,�60w R-C-7 dated it- 7- 0q. (designer) 1/ ]Certi that the septic stem referenced auove was inst fy p y alled substantially acct�rdxrz9'tee Tlie design, which may include mini- approved-changes such as late, locatio- of the djsb ibution box and/or septic tank. . I cerff that the septic system referenced above was installed with":ihapor changes (i:e greater the 10' lateral relocation of the SAS or--any vertica;reacaian of any compont of the septic:system)but in accordance with State &Local.Regdlations. Plan revisiozk or certified as-biriltby designer to'follow. tH'Q Mqs (Installer's Signature) ASO . s col q er s Si _ T .(D Signature) � ) (Affix e i er's Starnp.Here) PLEASE'RETURN TO tA,�TI+TSTA&LE`PUBLIC-HEALTH.DIVISION.-LURIMCATE �F CONZPIANCE Wl<I.L SSITED:= BOTH "$][S'{F( RNI BIJYi,T CAS ARE RE CEFVW l 'YzTI[E BARNS RARNSTABLE PURLI. )UeG TRANK,YOUL , Q:HealflV.Septic/Designer Certification'Forrr, ,`, } r • APPLICANT: ADDRESS: DESIGN FLOW: �j� gpd REVIEWED BY: DATE: N/A OK NO Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided 310 CMR 15.2204 t Plan proper scale?(1"=40' for plot plans, 1"=20'or fewer for components) [310 CMR 15.220(4) Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- i not, a variance is required 310 CMR 15.412(4 Location of impervious surfaces (driveways, parking areas etc.) 310 CMR I5.220(4)(d) Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas / [310 CMR 15.220(4)(e)] System Calculations 310 CMR 15.220(4)(f)] daily flow septic tank capacity (required andprovided) soil absorption system (required andprovided) whether system designed for garbage grindet North arrow [310 CMR 15.220(4)( )] Existing and ro osed contours [310 CMR 15.220(4)( )] Location and log of deep observation holes (existing grade el. on / each test) 310 CMR 15.220(4)(h) 1/ Names of soil evaluator And'BOH representative [310 CMR 15.220(4)(h) and (i)] V Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] 1/ Percolation test results match loading rate? [310 CMR 15.242] , Certification statement by Soil Evaluator 310 CMR 15.220(4) ')) Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Location of every water supply,public and private, [310 CMR [I 5.220(4)(k)] 41 f� . Goof C,©pf' ---- — Address Sheet 1 of 7 ` f within 400'feet of the proposed system location in the case of surface water supplies and grovel packed public water supply within 250 feet of the pioposed system location in the case within 150 feet of the proposed system location in the case / of private water supply wells ✓ Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. 310 CMR 15.220(4)(1)] Water lines-and cith6 subsurface"utilities located [310 CMR / 15.220(4)(m if water line cross see 310 CMR 15.211(]) 1 ) V Profile of system showing invert elevations of all system components and the bottom of the SAS 310 CMR 15.220(4)(o)] .Stamp of designer 310 CMR 15.220 1 and 310 CMR 15.220(2) Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) 310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2)or as .approved for an upgrade under LUA at 310 CMR 15.405(1)(k Test hole adequate to demonstrate four feet of suitable material? / 310 CMR 15.103(4)) 1/ Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3) Benchmark within 50-75' of system [310 CMR 15.220(4)( )] Materials specifications noted? [various sections of 310 CMR 15.000 System components not> 36" deep (unless Local Upgrade Approval or LUA requested) 310 CMR 15.405(1(b) i Address Sheet 2 of 7 Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line 310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6) Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228 1 1 Separation between inlet and outlet tees (no less than liquid / depth) 310 CMR 15.227(2) V Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for P upgrades under LUA 310 CIv1~R 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR f5.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (b 7/07) 310 CMR 15.228(2) Access to within 6 of grade - one port for systemg<h000gpd, two fors stems>1000 gpd 310 CMR 15.228(2) All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done 310 CMR 15.221(8) H-20 Where appropriate? 310 CMR 15.226(3)] Setbacks from resources 310 CMR 15.211] t3i + Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(l)(b)] ✓ First compartment 200% daily flow; Second compartment 100% ✓' daily flow 310 CMR 15.224(2) and (3) "U" pipe through or over baffle, outlet of each compartment with as baffle or approved filter 310 CMR 15.224(4) I Address Sheet 3 of 7 Located at least ten feet from any waterline?[310 CMR 15.222(2) Disposal piping at least 18"below water line (when water and / sewer cross, see 310 CMR 15.211(1) 1 ) 1/ Cleanouts required/provided ? r310 CMR 15.222(8) Thrust blocks specified in force mains? 310 CMR 15.221(6)(c) Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6) Proper pitch on all runs?(.005 within gravity-distributed trenches and beds) 310 CMR 15.25](9) R and 310 CM 15.252(2 c} Siphonproblem/ leachfield below um chamber) Endca s or vent manifoldspecified? Size and orientation of discharge holes specified?(not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 / CMR I5.252(2)(h)] V Materials specified (310 CMR 15.251(5) specifies various pipe , ,types allowed) 0. Stable compacted base [310 CMR 15.22](2) and 310 CMR 15.232(2)(a) Splash plate or baffle tee required on inlet/provided?(when pressure server to d-box or steep pitch of gravity sewer) [310 CMR 15.323 3) a Riser if deeper than 9" 310 CMR 15.232(3)(0] Inside minimum dimension 12" 310 CMR 15.232(2)(b) Minimum sum 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] Capacity(emergency storage above working=design flow)?[310 / CMR 231(2)) Proper setbacks 310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 2ina ST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep,with disconnects accessible) Alarm floats - alarm on circuit separate from um specified? Exceeds two units must have two pumps operating lag / mode. [310 CMR 15.23](6) and (8)] �/ Stable Compacted Base [310 CIvIR 15.22](2)] Buoyancy calculations needed ? Provided? [310 CM21(8)] Address I �� C '�'Y�� Sheet 4 of 7 Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation togroundwater? 310 CMR 15.212).] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13) Breakout requirements met?(No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(l)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6) Each structure with one inspection manhole (if>2000 gpd must be tograde) 310 CMR 15.253(2)] Aggregate 1'minimum-4' maximum. 310 CMR 15.253(1)(b) 2'sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)J Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length 310 CMR 15.251(1) a Minimum separation 2x effective depth or width whichever eater(3x if reserve between trenches) [310 CMR 251 1)(d)] I/ Situated along contours [310 CMR 15.251(2) Breakout OK? [310 CIv1R 15.211(l)[4] and Guidance Document] s minimum 2 distribution lines 310 CMR 15.252(2)(a) Maximum separation between lines 6' 310 CM R15.252 2 (d Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)( )] Separation between beds 10' minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only 310 CMR 15.252(2)(i) 4 Address I (� `�- - Sheet 5 of 7 Pressure Dosed System ? Provided pump and piping~ �� calculations as re wired. 310 CMR 15:220(4)(r) li Pressure dosing required on all systems>2000gpd or alternative systems undef,remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] VZ If used in gravelless system - make sure jet is directed as not to scour soil interface Guidance Document Inspections once per year(systems<2000 gpd)or quarterly (>2000 dgood to note on plan 310 CMR 15.254(2)(d)] Construction in fill - Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Im ervious barrier and/or retaining wall ? Guidance Document Impervious barrier installation must be supervised by designer[310 CMR 15.25 5(2)(b)] Retaining wall all must be designed by Registered Professional Engineer[310 CMR 15.255(2)(a) Side slope not exceed 3:1 ? f3l0 CMR 15.255(2) Breakout requirements met? [310 CMR 15.252(2) and Guidance Document At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) 310 CMR 15.255 (2)(e)] Mar MO > - 3 Check DEP Approwlletters for credits and desi n conditions If used with pressure dosing do not allow pressure discharge to scour soil interface IM—Mg M.M. KENN'% Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a coy of a maintenance Are the variances listed on the plan ? [310 CMR 15.220 (4)( ) RLS Stamp necessary on plan if a component is within five feet of ro erty line [310 CMR 15.412(4)] New construction or increased flow proposed - [Refer to 310 CMR 15.414] l/ Address � � �v v1C,�,� l� 'a Sheet 6 of 7 l Is the system in a Designated Nitrogen Sensitive Area(Zone 11 for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2) Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Pumping to septic tank? 310 CMR 15.229 Shared System [310 CMR 15.290 Address I ` V v' V��"� Sheet 7 of 7 oE�� Town of Barns'ta ble Department of Regulatory Services ' Public Health • Division ` 2 F Date" / 2 O Main Street Hyannis-MA 02601 ArED MAt Wc2 1 f�f ' Date Scheduled Time , l IDd �. . ---- Fee Pd. Soil Suitability &.' ssmen Performed By: t for Sew�ag�e asposal Witnessed By: � LOCATION & GENERAL INFO Location Address �r RMATION y►, �')co-0 �Aj e- Owner's Name 'FP;v e /yl RrS•70rI S /1?I 1lI' Address f 0(n 2j Pi 6,1(e rlCc�/iqq Assessor's Map/Parcel: Engineer's Name Vgc e n u( C t/6 NEW CONSTRUCTION REPAIR MA-fdn) Telephone# .F33 i.I g 7 Land Use e Sl ZAf'i/a Slopes(4oj Surface Stones Distances from: Open Water Body----- ft possible Wet,Area ft Drinking Water Well ft Drainage Way ft Property Line Other ft 1 "ETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximi to holes) ) fq' Vj Parent material ( 1(geologic) • Depth to Bedrock tl/�J Depth to Groundwater. Standing Water in Hole: Weeping from Pit Pnee Estimated Seasonal High Groundwater Method Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE Depth Observed standing in obs.hole: Depth to weeping from side of obs.hole: �n Depth to s011 mottles: Index Well# ReadingIn, arnundwaterAdJtistment in, Date: Index Well levelf[. R_.. Adj,factar— Adj.droundwnterI vel PERCOLATION TEST' Observation . I bUte Tli11e Hole# Time at 9" Depth of Perc "_—`— '- Time at 6" ^� Start Pre-soak Time @ 241 Time(9"•6"), � End Pre-soak RateMin./Inch �Z ( Site Suitability Assessment: Site Passed Site Failed: i Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- i , ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1) week prior to beginning. Q:4S EPTICIPERCFO RM.DOC DEEP.OBSERVATION HOLE LOG' Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) � Other (USDA) (Munsell) Mottling (Structure,Stones;Boulders. on istene % ravel 2 DEEP OBSERVATION.HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) Other (USDA) (Munsell) Mottling (Structure,Stone-s,Boulders. Consistency,%Go ve1) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon • Soil Texture Soil Color Soil Other Surface(in.) " " _ r (USDA) (Munsell) Mottling (Structure,Stones,Boulders. r . CnnaiEtency,3' Gravel j DEEP OBSERVATION HOLE.:LOG _ _ Hole# - Depth from Soil Horizon Soil Texture 4 Soil Color Soil ' Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, 1 Flood Insurance Rate Map: Above 500 year flood boundary No Yes 1 _— ''Within 500 year boundary Within 100 year flood boundary No Yes . Depth of Naturally Occurring Pervious Material ' Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of ha tally occurring pervious material? Certification ' - I certify that on (date)I have passed the soil evaluator-examination approved by the Department of,Environ enta Protection and that the above analysis was perf, rmed by me consistent with . the requ' ed t fining,experti and x eri nc described in 310 CMR 15.017. Signature Date Q:\SEPT1C\Pf RCFO RM.DOC � s D fL CO y CO t M 0 'qC 0 Ln Postage $ C3 Certified Feeni p� C3 far. Q Return Receipt Fee ``Y�.. O (Endorsement Required) `Jy ere Qy O Restricted Delivery Fee J� O (Endorsement Required) m c13 Total Postage&Fees $ Sent To , CO h M Streef,Apt No.; 'n J r, or PO Box'No. 0Ir 1L. R� City,State,Z I'WRI :11 11. IV Vi� Certified Mail Provides: CG"Y s A mailing receipt t a A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Mails. o Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ® For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. m For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3600,August 2006(Reverse)PSN 7530-02-000-9047- SHE own of Barnstable Barnstable Tri„ Regulatory services Department AS-Ameica CnIp rrsrnsLe; " . Public Health Division tea" b 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geder,Director FAX: 508-790-6304 Thomas A.McKean,CHO 07/27/09 Joseph and Nancy Spivey + 1 Olney Road Billerica, MA 01821 FINAL ORDER �j Q FW7 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 118 Concord Lane, Marstons Mills, MA was last inspected on 01/21/2008, by Patrick O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: "System is in Hydraulic Failure-Backup of sewage into facility or system component due to overloaded or clogged SAS" The deadline for repair has past. We, The Department of the Board of Health, have not been informed that you have taken any steps to bring your failed system into compliance. Therefore, you are ordered to repair or replace the septic system within 60 days from the date you receive this notification. You may request a hearing before the Board of Health, a written petition requesting a hearing on the matter, within seven(7) days after the day this order was received. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health ai Town of Barnstable Barnstable �� - �� rd1ESIC.9�11y' Regulatory Services Department BARNSTABLE. " 3 9 Public Health Division �\� p�m FD MA 6 n A026012007 —� 200 Main Street, Hyannis M Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO J March 17, 2008 Joseph &Nancy Spivey 1 Olney Road Billerica, MA 01821 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 118 Concord Lane, Marstons Mills MA was last inspected on January 21, 2008, by Patrick O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS . You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. ' Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF HE BOARD OF HEALTH T as cKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL# 7006 2150 0002 1038 6964 Q:\SEPTIC\Letters Septic Inspection Failures\118 Concord Lane.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �( M 118 Concord Lane, O i e IUA 02655 1 Property Address 1 [� Joseph & Nancy Spivey l i as Owner Owner's Name information is required for 1 Olney Road, Billerica MA 01821 January 21, 2008 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key, Septic Inspection Services Co. Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 City/Town State Zip Code 508-428-1779 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fail_s ' M1 Z_ _4 wy s: ❑ Needs Further Evaluation by the Local Approving Authority ^. _ U) -� January 21, 2008 c) M Ins ector'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. 08.17 Spivey.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Concord Lane, Osterville MA 02655 Property Address Joseph & Nancy Spivey Owner Owner's Name information is required for 1 OlneyRoad, Billerica MA 01821 January 21, 2008 every page. City/Town 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: 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: ❑ i 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 08-17 Spivey.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Concord Lane, Osterville MA 02655 Property Address Joseph& Nancy Spivey Owner Owner's Name information is 1 Olney Road, Billerica MA 01821 January 21, 2008 required for y ry every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: 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 fain 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. 08.17 Spivey.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Concord Lane, Osterville MA 02655 Property Address Joseph & Nancy Spivey Owner Owner's Name information is 1 Olney Road, Billerica MA 01821 January 21, 2008 required for y rY every page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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_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. 06-17 Spivey.doc-06106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 f Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Concord Lane, Osterville MA 02655 Property Address P Joseph & Nancy Spivey Owner Owner's Name information is required for 1 OlneyRoad Billerica MA 01821 January 21, 2008 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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. 08-17 Spivey.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts � W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Concord Lane, Osterville MA 02655 Property Address Joseph & Nancy Spivey p Y P Y Owner Owner's Name information is y Road, January required for 1 Olney Billerica MA 01821 J 21, 2008 every page. Cityrrown 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)) 08-17 Spivey.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Concord Lane, Osterville MA 02655 Property Address Joseph& Nancy Spivey Owner Owner's Name information is 1 Olney Road, Billerica MA 01821 January 21, 2008 required for y �' every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 0 Number of current residents: 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 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: One year prior to inspection. 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: Last date of occupancy/use: Date Other(describe): 08-17 Spivey.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Concord Lane, Osterville MA 02655 Property Address Joseph & Nancy Spivey Owner Owner's Name information is required for 1 OlneyRoad Billerica MA 01821 January 21, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Tank pumped in 2006 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 20-25 years Were sewage odors detected when arriving at the site? ❑ Yes ® No 08-17 Spivey.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Concord Lane, Osterville MA 02655 Property Address Joseph & Nancy Spivey Owner Owner's Name information is 1 Olney Road, Billerica MA 01821 January 21, 2008 required for y rY every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1 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: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 4" 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 91, How were dimensions determined? Measured 08-17 Spivey.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts .Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Concord Lane Osterville MA 02655 Property Address Joseph & Nancy Spivey Owner Owner's Name information is 1 Olney Road, Billerica MA 01821 January 21 2008 required for y rY every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition; structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found 2-Y below outlet invert due to vacancy. Tees are intact with evidence tank had been full to top. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): 08-17 Spivey.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Concord Lane, Osterville MA 02655 Property Address Joseph & Nancy Spivey Owner Owner's Name information is 1 y required for Olne Road Billerica MA 01821 January 21, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box had previously been full to top. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 08-17 Spivey.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 118 Concord Lane, Osterville MA 02655 Property Address Joseph& Nancy Spivey Owner Owner's Name information is 1 Olne Road, Billerica MA 01821 January required for Y 21, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ® leaching pits number: One 6x6 pit. ❑ leaching chambers number: ❑ 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.): Pit was empty at time of inspection, high stains indicate pit had been full to top and in hydraulic failure. 08-17 Spivey.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Concord Lane, Osterville MA 02655 Property Address Joseph & Nancy Spivey Owner Owner's Name information is 1 Olney Road required for Y , Billerica MA 01821 January 21, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): 08-17 Spivey.doc-08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Concord Lane, Osterville MA 02655 Property Address Joseph & Nancy Spivey Owner Owner's Name information is 1 Olney Road, Billerica MA 01821 January 21, 2008 required for y ry every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 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. 37 39 3 33 7 28 Water Service Concord Lane Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 118 Concord Lane, Osterville MA 02655 Property Address Joseph & Nancy Spivey Owner Owner's Name information is 1 Olney Road, Billerica MA 01821 January 21, 2008 required for Y ry 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 ground water: N/A feet Please indicate all methods used to determine the high ground water elevation: Obtained from system Eldesi n Plans on record Y g If checked, date of design plan reviewed: -Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: 08-17 Spivey.doc•08106 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 15 of 15 1HE Town of Barnstable pp Tp� . yP� �r Regulatory Services snxrrsrAsM Thomas F. Geiler,Director XkS& g 1639. Public Health.Division ATED MAy a Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this DiN ision does not warranty the functionality of the septic system in the future not does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. No (a.-S I?- FRB.35.. THE COMMONWEALTH OF MASSACHUSETTS BOAR® Off' HEALTH_ Applir�ation for Bhivoii ai Works Tonotrurtion Errant Application is hTcalvco" ade for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal ' V 4 System at ... - -°_T ---....•--•......... •---��•. .............. -= --------.•....-•----------------•-•••-•---...........•--•-- oc lion•Addre s or Lot No. --••----• - _I, � / 1 win �1 ------------------------- .............................................d� p W ��V IV W l V, l�q C/ CA- 1 � r I...... 1 -•-••.................... .................................... _.T� M....... Installer Address QType of Building Size Lot................ Sq. feet Dwelling—No. of Bedrooms_-_-``� ..... ....................� Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ( .. lM No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -.----.----..-------•-------------- W Design Flow................q.?�...........gallons per person perday. Total daily�flow.._....; 3......................... ..............._.......gallons. WSeptic Tank—Liquid capacityl6Q0.gallons Length.....e--..... Width----Z{__._... Diameter........:`..... Depth.._-.......... x Disposal Trench—No........I........... Width............:....... Total Length.................... Total leaching area...MID.......sq. ft. Seepage Pit No--_------------------ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosingnk'( )Percolation Test Results Performed by...... _,4-k.T K....t.y.!ir................... Date........................................ as Test Pit No. 1...I -.?n.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........................ ----------------------------•-•----•-----------------------------------•..................... -----------........................... Description of Soil......I........_..-S �W l-G' ' 1�f 1 !f_.._- x W •-••-----------------------------•-------•-------------------------------------------...-••--•---•-----••-•----•----------------- ---•••----•---•-•---------------------------------••--••-----•---_.... UNature of Repairs or Alterations—Answer when applicable......................... ...................................................................... ------------------- -----------------------•-------•-------•------------------------...............---•-•--.....--------------------•--------...-•-----------------------------------•--••--._.._..•--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI'i TIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issute4lby t oar �f.)h C) ed.............. .......................................................... .� .. Date Application Approved By.....--•--- = r/ y ......... ... ............................. 8 A- Date Application Disapproved for the following reasons-----------------------------•------------•--------------------•-----------------------------------....._-•••---- -----••---•......................•----•---•----••----•••-----...-•- -•-.....--••-•----......-•••••-•-•--•-------------•--------•----...---•-•-------•-•--•--------------••------•---------------...••••. _ Date PermitNo.............. ......................................... Issued_....................................................... Date Y No....� 5/ 4= Fims- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................I—_......O F...-..-..:....-.............._...._-...-------------- Appliru#uau for Ili_gpas t1 Works Towitrurtiuu Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: ..... - .. --•- ----. ..... . :. ...--- ---------------------------------------•-- Location-Address or Lot No. •-----------•--•------................••---•-•-----•••-•---•--._._...__._.._.._._._........----.. ..........--------------------.._.._...---.....--•--•------.......---•------------._...........--- Owner Address W Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ----------------------------•-•• . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic 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. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by_•_______________________________________________________________________ Date........................................ a 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-------_................ 9 --•-------••------------•-------------------------•----.....---------•........._-••----------...•---........---•-•----•---------------..............-------- 0 Description of Soil....................................................................................................................................................................... x w -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ..................................................................................................................................................... ---- ------------ • - •---•------....•----• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ed•-••--••----•--------- --- -------------•••-•-••--------...-----------_----• ................................ r Q Date L Application Approved By--- .....................° -•-------` /..................... Date Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------•--- ----------------•---••••--•----------------------=-----•--=-•--------------•------------...._..------_._..__....__..____.._..•-•-•----------••----•--•--•-•-•••--------•---- ............................ Date PermitNo_........................:..::.•--•••-----------•-------_. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ..........................................OF..............................................................I...................... (�rr�if�rtt�.r of fP�ntu�rli�turr . THIS I,S TO CERTIFY •That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by............ ..C.r_....• ------------......-------------------------------------.........._..------...---------..........---------------......_..._--•----------••••- Installer�,„/� at------------------ -! ... �'" � � -� ------------- ----`- has been installed in accordance with the provisions of TITS 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----- ____________ dated................................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACT RY. DATE................................................................ �� Inspector............... ....../....................•---------•-•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No �5Z 5/2. ........................................OF..................................................................................... .... ........... FEE... .... Disposal Works Toustriuluatt .erutit � Permission s re by granted......../c:....... ___________________ ____r ._- ___--•-•-••-•--••-•----------------------------••--•---•-••--•--------- to Construct or Repair ( ) an Individ Se-VP Disposal System at No.---•-••-- '�-•�-X1.......... .- :� f t�_._.---�----.---'-------------r. .. ...... Street as shown on the application for Disposal Works Construction Permit No..................... 1E)ated.......................................... L B d of Health DATE............... ----------------- 1J FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 1 5 GLr-- FAMILY - 6EORo0MA 4 Ile- DAILY F%.ow a Ito x 3 = 3306.pp. �C .� • SEPTIC TAIJK = 330x150% =A95G.P. q USE— l o o.o GAL. \ `q S 015P05AL PIT u'SE 1000 GAL• SIDIiWALI. A2Gh = I>os,F P az�� BOTTOM AQE.A= .. Irk. F•_ ` i �O S.F X I. O N° 1 T, 0 .� 'TOTAL DESIGN • .q-25 GPD q� TOTAL DA I LN( FLOV4 = 330 G.PO. Al' N�e PF-2GOLATIOt4 RATE , V'IN ?-MIN OV-LE555 �S .1R `1Gi'�ZLo� 60 IN i ��RACHARD J I, ' A. M oa ALAN 9 BAXTER ? Na 24048 v+ hp SUR`1�6' I, V r/ TO P FNp.. 11 8 •r/v' 4ANA loov INV. D►ST. INd. bG PT IG GI S � Bv7� �1•L .L Ioov INV, To►NK i LEAGu i PIT INV. INV . II 1 31/qu��L I, II (N1hsU WASNGD i j 'CEV-TI PIS 0 PLOT PLAN PRoFILG II _ . 1..cz4'TIcN Mr ro s ILa j �) ►a' No 5cA,UE $CALF 11� o' -- A— `1 -$'t.. �I ( o (,�a.Tb'12._ p2o o SvD P 626►� GE A P PLAN -RE I GS r-%? 'TNT THE goo is 5Nc WN �INER60hl r;OMPI.`(5 yJITN'LHE SIp�LINE � � / T �� !A A w P S6TQ4GK 9-r=Q 019-C-MENTMi 0F 'TN� . -TOWN Or— 12Af2.a'7TA j-L& A►•1 D I f, kIor' , 'I I.OGp.TED WITNI T .E F OD LAIN II DATE Cl 13AxTE2e Wye INC. i! R.E6 I'S't fcQ6.V'LA1I D S u 2Y EYomP6 "TIdIS PLa►�l 115 NET gLvSED Old AN MAS$. IN,5TR.uMaW— SVQVCY �-TIAS OFE" 6LCU0 -T C ljl•LtX,I�S- - L. C,NoD C OF BARNSTABLE !� LOCATION LOfZ /IS Cc, Lam SEWAGE # 9Y-K00 VILLAGE SSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. /�►�G�U�, 3 SEPTIC TANK CAPACITY /j 6ro LEACHING FACILITY: (type) Z (size) 90 X 2 NO.OF BEDROOMS BUILDER OR")no PERMITDATE: F-/�7�P��1 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 a 1 - � a w �l 16 c /S TOWN OF BARNSTABLE LOCATION (b`"K' ZJb C*,OtogAC Qo, SEWAGE # L OO VILLAGE IN\ d�-l� r O 5�""" ASSESSOR'S MAP ra LOT - INSTALLER'S NAME & PHONE NO. W",C \L-0rLj Co-mY--&� AEPTIC TANK CAPACITY 400-t� 1 LEACHING FACILITY:(type) D)7 So (size) s ,§O. OF BEDROOMS PRIVATE WELL O UBLIC WATER . BUILDER R OWNER DATE PERMIT ISSUED: slo c y DATE COMPLIANCE ISSUED: 21\11`iz VARIANCE GRANTED: Yes No i1�1 //J�' � .. ..._ lJ1 W 1 �� t ` ,� �, �� • C F t V ` ,�, �� w No.... /FuB ........._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ®W N _OF........�.. Smk. ................................... Appliration for Uiipniittl Works Tnnitrnrtion rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...i 1. ... ...f Z-------------------------------- ......................................_.T---- ..........M.J.M.:------- Location-Address Lot N tg_ ddress .Q ----------------------------------- ---- ._ �. .......1. .......... �1 t11. .-------------- Installer Address Type of Bui ding Size Lot--- C ¢_.......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic (yo) Garbage Grinder (No) '4 Other—Type of Building No. of persons............................ Showers — Cafeteria W Other fixtures --------------- -----------------••--• - W Design Flow............. ..................:.gallons per person per day. Total daily flow..............330.................gallons. WSeptic Tank—Liquid capacity)Z P.gallons Length................ Width................ Diameter................ Depth................ x Di s osaI Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. JI it o...... -....----- Diameter..fL??� Z_. Depth below inlet..._ _9�P_._.__ Total leaching area.... 1....sq. ft. Z Other Distribution box (6--) - Dosing tank ( ) ~' Percolation Test Results Performed by------------------ '1 ....................... Date........................................ aTest Pit No. I.....�.____minutes per inch Depth of Test Pit.....tQe5.-.... Depth to ground water_-_140___ 6/_l 77EL (i Test Pit No. 2................minutes per inch Depth of Test Pit.....ZZ o.... Depth to ground water....No...YY 4#:1 ----�---------------- --------------------------------------------- ---------- ----------------------------------------------------------------------- Description of Soil...?-""5... ,�.... ....... . .. .. } ,, ------------------�zj.0-3--S........XsoAm.% a8 i�ri.ZAMMJZI.---tx1_ ?lcafyl_.,� r�y...14 W ----••-----------------------------•-----------------------•--.._..-------•----------------•------------•--------•------------------------------------------------------------•---------------------•-•• VNature of Repairs or Alterations—Answer when applicable................................................................................................ •------------------------------------ --------•-•••---------------------------------------------------------------------------------------------------•--••-•-------------------------- Agreement: tM OF N The under agrees 1 the aforedescribed Individual Sewage Disposal System in accordance with the provisions Th Ckf th Environmental Code—The undersigned further agrees not to place the system in ope u NdM fi Compliance een issue y the board of health. 7- No.333 C!V!L ign _(12 � /� -- -- --'---�-'----- ------------ ------ Date ................ T a Qy Application AP .... ----------i----- ---------"// Dale ApplicationDisapp ep ollowingtiVasons- -------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------.................................................. ---------------------------------------- PermitNo. .......� .-.....-. ��.�........................ Issued .............................................................. [e Date 9 l� No................--.....-- Flea. ..................._ THE COMMONWEALTH OF MASSACHUSETTS } BOARD OF HEALTH ...................... ..................OF..........I...............---•--........---• Alip irFa#ion for Disposal 10orkri Tomarttrtiun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ---------------...---............ .. ---------............-----............... ...------------------.._..........---.....-• .....------_... - Location-Address or Lot No. .................................................................................................. ..._............._...-----------------.....•--•••------•-•---------........................_..... Owner Address W Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Gunder ( ) Other—T e of Building No. of persons............................ Showers a YP g ---------------------------- P ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------•••-••••-•----------•-----•-••------------••••-•••••••••••••••••------•-•••••....------------ W Design Flow............................................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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.--.--.............. Depth to ground water----_------------------ (.Tq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..----..............---. P4 •-----------•---•••-••------•---•------•--•-•-••-•---------••-•-------------•••---------.._.._...•----....---------••---••---•••-----•- -------------------- 0 Description of Soil..................................................................................................................................................••...................... V -••---•--------------------•----••-•-•---....-------------------------------•-••••••--------•------•----••••••--•---•----------•-•-••••-•-•-----••••••--•--•-----•---------•-•--...-----•--•-•.......... W UNature of Repairs or Alterations—Answer when applicable............................................................................................... -- •-------------•--•-•--•••--••--•------._.....-----------•--•--------------••-----------••••----------••---••-•---••••-•••••-••••.......---•----•• Agreement: The u tied agrees tall the aforedescribed Individual Sewage Disposal System in accordance with the provisi f if tate Environmental Code—The undersigned further agrees not to place the system in Lit tionNio sibloCer e of Compliance has bee is ed the -oard of health. CIVIL Signed ............ '.�`. ..LG'. ..... '.: ....... ........................................ O a Date Application �_` A _ Nate Application Disappt or the following reasons- ----------------- ------------------------------------------------------------------------------------------------------------------- --------------------------------- -------------------------------------------------------------------- ---- --------------------------- --- ----------------------------............................. .................................... Date Permit No. ...... Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :...<4i. OF --- . ` : ..-= f;-.:�..,....;^f_---------------------------------------------- GPrttfi ate of V ontyliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by 1 _ � Installer � at .. ...t...- ..... ...... - `' 'f Ira Y ...... has been installed in accordance with the provisions of TITLE_ 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No f1-f------V-17A...................... dated ......---------------------.._-------_------_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................ ................ ... :.^... �, ----'-` -1 Lj.................................... Inspector ............. -------------- --------.--------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. ..................... FEE... ............... Disposal Workii Tnnstruailan Virrutit Permission is hereby granted.......... .`..C V.i'e... 1 to Construct { .) or-Repair ( ) an Individual Sewage Disposal System atNo.....................--......------......------..........---.....--=------------•--•... -----..--_-- -1 r -----------------•------......•--------••••••••-----•--••......-•------•----_..... Street as shown on the application for Disposal Works Construction Permit No.........._'........ Dated.......................................... ........................................------------------•-------------•-------••-----------------•••-- DATE_ Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS i d v` ( ASSESSORS MAP: .A--Z-tlz TEST HOLE LOGS NOTES: 7ARCEL: -:' ttq C- SOIL L EVALUATOR:- � �� F� G� FLOOD ZONE: (�� 1) The installation shall comply with Title V and To-*-n of Barnstable Board of _ WITNESS: Vet REFERENCE: G1'F�eT"t DATE: 'rb i. � Health Regulations. 2) The installer shall verify the location of utilities,sewer inver`Ls and septic PERCOLATION ON RATE: .- � �tl�t I —__ components prior to installation and setting base elevations. LA I.IN, 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first - TH- I TH-2 two feet out of the d-box to the leaching shall be level to 4) This plan is not to be utilized for property line determination nor any other 1 b�� tC7 Z, purpose other the r.the Proposed system installation. 1 « - 5) All septic components must meet Title V specifications. 15` � LD 6) 'Parking shall not be constructed over HI septic components. _ - 'n The property is bounded by property corners and property lines. LOCATION MAP 2� 8) The property owner shall review design considerations to approve of total '� design flow and number of bedrooms to be considered for design. Receipt 100. v + J"� '� of payment for the plan and installation based on the plan shall be deemed - - - ,Z approval of the design flow by the owner. Z � � 9) The existing leaching or cesspools shall be pumped and filled with material Z t per Title V abandonment procedures. Those within the proposed SAS shall ( 1 be removed along with contaminated soil and replaced with clean sand per 1 _'-zv D 1' �r ' << � ___ Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossing .ie water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if applicable. The proposed SAS is being installed below the water serrice SEPTIC SYSTEM DESIGN line. The line is to be sleeved as aforementioned:and maintained in lacy. � P ��'t 11) If a garbage grinder exists it is to be removed and is the responsibility of FLOW EST I M_ .TE owner to ensure such. 12)The installer is to take caution in excavation around the gas line if such exists. i '� , SEDROOI ') AT �� GAL/DAY/8EDR0 M - '7JDGAL/DAY I'' - � 5 - - :3)The installer shall �:e-ifj, the location, quart' a,,d �?e 1 � r �f tie Se '. P Lines exiting the dwelling prior to the ir:stallat n- 1 � '�; SEPTIC TAN,, 2 v C� � ► - �+ ''� 9 GAL/D1 Y x 2 DAYS - 0 GAL O � /= USE 1600 t ALLON SEPTIC TA:VK / Y,(�-fk�4) �O 1 L A01Z1 I old`S4STI:'M 1 l o Z I` "_ 6 - �� SIDE AREA: )5 21 -t' 7 4"� - 0► = 30TTC 4 AREA: Z Z -1 X a1-1 -z� q SEPTIC SYSTEM SECTION Icc) DO ► ram" _- — - — _ _ --- non ,yAA ;u t 1. JY 1t - f !b I DOD .GAL ' S D 0 p c --- _ -- -- 1 SEPTIC TANK b 7(� t S t TE:. � �E�_ GE � PLAN 1 . LOCATION , r _ ON PREPARED , F0 3 ; u, K v DES { G v IBS OX ~ _ - ATE HEA€." AGENT ll ic) 5UI L SITE PLAN �4477 NO- I w0 2 i TD�'SC/L 0 i S 'BSC/L I • • TO 4 5. TOP OF FOUNDATION EL : �'�-� �'�`.E . • 6 ! - 99 8. esF�; FINISHED N I S N E D ! ., d✓�rHi�✓/z•• yv.ce. G R A D E cegvE� 9 —� �.i 1 N El G736 -� - �s. 77 o I2 " MIN. COVER ,ecxg/co 10 ; IN It /2 F.G• 4- . - 2 COVER 1/8 3/8 WASHED STONE E�., t ( •; N Et 7f , h iN ! ,.6'8y �G Z o 1 ss7 • i . p IN EL• O� °r • • s 0/ B W/ 6 SUMP '. :•:• 11 ; © ;•o° . 3/4 1 1/2 WASHEb STONE Na G�uvoai�iT • 4 LIQUID LEVEL . • , t i • • , 6 EFF ®•. �—�- • ; DEPTH , 1 I • • PERC TEST RESULTS PRECAST SEPTIC TANK WITH • °. '• 0�6 PRECAST LEACHING PITS PERC RATE : <' z i''/ /. l�E2 //rct� CAST IN PLACE INLET AND �o•Z •. . °. �: 0.: "AL G � '1)iA. ,t 6'EFF a�� EL. N0.: . LSIZE -T WITNESSED BY OUTLET T 'S PER TITLE V 2� BOARD OF HEALTH S I Z E : /GY�D 6 A L L 0 N* S , snN —D I Aa•vE s y o OF STONE DATE: LONG x 4/b WIDE x S 7 DEEP ) `� Pervious Materi I !o;pIA ALL AROUND ! ` EL. sG- Z I I PROFILE OF PROPOSED SEW -AGE SYSTEM Sf�AZ Z 0W /:O//v > I>/T/VE SYSTEM DES16NED BY THE TOWN OF REGULATIONS AND STATE TITLE V FOR SUBSURFACE DISPOSAL OF SEWAGE , SCALE 1/4�• V0 " �1 $bED�E �� e�� E*'1.57'/NG R9vENyENT �� N . B . ► � � I 1 . ALL PIPES SHALL BE SCHEDULE 40 P.V.C . SEWER PIPE '' ' 47. 2 ALL PIPES SHALL BE SLOPED 1/4 " PER FOOT EXCEPT FOR THE FIRST 2 FEET OUT OF THE 0 /B WHICH SHALL BE LEVEL' �Z 3. DESIGN FLOW _.,� JEOROOMS AT 110 GALDAY PER BR _ GAL/ DAY '` � M*re ` SEPTIC TANK - SIZE 3�X/--,oi- c - 2E 6 A L 77.,9V2"N• 1A4,,TZ x USE /000 6AL. W/ OU7 GARBAGE DISPOSAL L A H i N 6 SYSTEM : USE • ovE `' a-4M x .0 /9Wc.9.s T Z-64cN �iT /OD' W�Z' DF IglASf�(ED STONE L,J TiVi�. I EFFECTIVE AREA : SIDE ZTfehx 2.s=zXTrxsX� xz s = ¢7/ D V, P.T T,r:: iz' ��s B 0 T T.0 M zx /,o =7.rA Zs-,r /.0 = �B ��,o X 5 - X �X L o? N /D09� 4 9 0 � TOTAL FLOW yr7r->t /7 =s¢9 6p1b � - i TOTAL REQ'D FLOW 330_ XIoo`T = 330eVIb W/� GARBAGE ;DISPOSAL 3 RESERVE FLOW s�`9— 330 2� GAL/ DAY x . ,_RESERVE REFERENCE PLANS : zFcVX -4-010 101-IG& 09 N 3" Z8" 43" �✓ Z38-z7' ' ! f t APPROVED BY : BOARD OF HEALTH I � TOWN O� B4,TN,5 --4. Z. -- DATE : I ._, Is PROPERTY OWNER : N/CKUGAS BU/LD/N6 co SITE � �, � SEw��`, E PLAN I � /OL•¢ MA/N 5T. ' JAI, BARiVSTABt.E MA. &JA OF Mq ��` ''•Ss FOR : w/CKLILAS Bl1/L,D/NG CO. JOHN boy o� �w �cyG THe� BEDROOM SINGLE FAMILY DWELLING P. LIEpERMAN c.� No. 3589 " � Q, ��O r;, L 0 T /�/�• . / 5f/�ILLoh/ fbivz> sER�.y°� 4 DOYLE ENGINEERING ASSOCIATES, INCORPORATE U Box 595- 530 Thomas B. Landers Road W. Falmouth, ILA 02574 r � i v BRUNING 40-5020 60504-03 i6 Y mow.%"✓�.,�y,✓ '�T -3 O"116�_`#yD L.w7'1 T„ -.� T^sei't T Y g� � fi"iu i �E I i. .. �' ) ?.. '7 f + i c , � r � y 1 ; Al— 71Z Inz �} , -f t rye.. Ii� 7"� t C't'rC-+s �°.l pc°7•k�..�g' �'�`' �,4-�'�. 'r14. !_ Mw w, t } f E - I r � _ d a { " fl t I t a q l V i _ _ _ --_ OF OF € PATRICK J. E� � s ROSEINGRAVE PATRICK J. ' No.33376 "' c4 ROSEINf RAVE a CIVIL No. 35790 At pVE }. vAr � 1�4L.,F,-r E+�kv EFT 4- T F� INS �11=32"". i .5`G 0(-.3?,t_VT ,�tv . .. �_ .� —'�"f`! ,.) f;�„A��`�".C1Ff�.� .:- IE��. : �,7��Si.,�5,, .,...�✓ ...- F".;✓, lzsti'... �✓ j - � ""'�` r : �ti.-rs"?.'_ �?✓ 1 '1-2 / C� 1 (-T .•--, r' F I zo :y t).-57, �)V� r 1.+..F � ..:�...—+Lf; )i.,.3e•'.4.-� 1�J`r'.'- � t j sWp 1 > 2 6_:.✓ ✓�k ! t F � r� ^�"�iw� T i