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Home My WebLink About0077 GREAT HILL DRIVE - Health 77 Great Hill Drive - - — Marstons Mills A= 174-013 C 4 'i i TOWN OF BARNSTABLE LOCATION '7_7 &dCt4—L. j)j :I 1' SEWAGE# VILLAGE/�� n/ �) ASSESSOR'S MAP&PARCEL 1 ,q—J I V,- u _ INSTALLER'S NAME&PHONE NO. ,�,A � (\; _�. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ® (size) /', i 12 X 2-5-- NO.OF BEDROOMS OWNER �( PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ` Feet FURNISHED B jn0r, (� y� c L[ 55` L No. Fee s / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Disposal *pstrm (Construction i3ermit Application for a Permit to Construct( ) Repair(fl-lul"Pgrade( ) Abandon( ) ❑Complete SystemEWndividual Components Location Address soor�Lot No. 7 y G�✓Pry L i�i ! I Owner's Name,Address,and Tel.No. Assessors Map/Parcel y M` Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Y -V Type o uil mg: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building (c5 Y"r'r a"I c_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) j 3 Q gpd Design flow provided 3 , gr Plan Date Number of sheets l' Revision Date XV 3 1a Title 7 - 9 c Cwml4 n (/G/�o Size of Septic Tank �jJtfj�. Ode (- yr Type of S.A.S. `-A Description of Soil Cr Nature of Repairs or Alterations(Answer when applicable) / AZw jo �.cJ� �� x►5�-i�g � � � �c'� a�t(�zP [��Ny�o.n �ro� ��k- 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. ed Date Application Approved by Date �--� Application Disapproved by Date for the following reasons Permit No.p� Date IssuedAV "No. / rf -Fee IV THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for -MispoBal 6. tent Construction Permit Application for a Permit to Construct( ) Repair( pgrade( ) Abandon( ) ❑Complete Systemdividual Components .a Location Address or Lot No. 7 7 !d✓�rsf f>li f� yf�( Owner's Name,Address,and Tel.No. Assessor's Map a cel 7 y ,.. M ) Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 4/m-v51 vi Type of►W mg: " { Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) 10 Other Type of Building lryr .�hi�., No.of Persons Showers(,. ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 0 G1, ,d, / Owl* Plan Date Number of sheets ( Revision Date Title ? a Size of Septic Tank £milhNl 200 GF I v, Type of S.A.S. i Description of Soil } Nature of Repairs or Alterations(Answer when applicable) it. G P A l�l7e 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 beeaossued by this Board of Health. S ed '. Date - Application Approved by Date Application Disapproved by Date F for the following reasons Permit No.0 D'� } Date Issued �9 _ - -:_-_-- -- _-- - ---------- -----.------ -- : _ _----.- .-_ - _ - ---- w THE COMMONWEALTH O.F MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( graded Abandoned( )by A Btow at '7 (;�, �j&t j Q, Chas been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N dated Installer , A 1 r,,�)T C Designers 0 m u sue) #bedrooms Approved design flow y�".3 C gpd The issuance of this permit shall not be con�10 ued as a guarantee that the system wil c • as des'�ned. Date Inspector No. ~' J Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal Opstem (Construction Permit Permission is hereby granted to Construct( ) Repair( W5_� Upgrade( ) Abandon( ) System located at ? % r and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be coippleted within three years of the date of this Kermit. T- Date Approved by r Town of Barnstable Regulatory Services Richard V. Scali, Interim Director BARN Public Health Division 'macs" Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification.Form Date: , 8QZ0 Sewage Permit# -, �� --- Assessor's Map\Parcel 17`i` Designer: 1� yi l�f �� Installer: Q '� Address: ') Address: �C-- On 2 Q was issued a permit`to install a (date) (installer) septic system at 77 64EC) /A)GL- based on a design drawn by —T (address) - e3 dated y l /?,01 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the TJ distribution box and/or septic tank. Strip out (if required) was inspected and the soils , were found satisfactory. _PL1q e q Cre �w4cvZi 70 I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in_co..gj4ance with the terms of the I\A approval letters (if applicable) VV DAVID r � � NMASONm, �, (Installer's Signature) 2 `vv No.1066 . �Fc�srE��<) S"tNITA R\l`� esi er's Si ature Affix De i�,:m Here PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc ��tTti Town of Barnstable Inspectional Services Department • aa BLL ,�� Public Health Division rfOA"�p 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 1050 November 4, 2019 LANE, MARK& SUSAN E PO BOX 627 WEST BARNSTABLE, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 77 Great Hill Drive, Marstons Mills, MA was inspected on 10/19/2019 by Sean M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: C Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years 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 THE OARD OF HEALTH n, ., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\77 Great Hill Drive Marstons Mills.doc i PROF T MF l�ti Town of Barnstable RA STABM A 6 9 Inspectional Services Department rfD MA'S A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or-cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation o Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) /eaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Great Hill Drive r Property Address Mark&Susan Lane Owner Owner's Name information is required for every W„tr�eble M N/ Ma 02668 10/19/2019 page. City/Town State Zip Code Date of Inspection } k 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. Inspector Information 45l4P 4f on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Company A Lane Co Company Address Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 10/19/2019 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owners Name information is required for every West Barnstable Ma 02668 10/19/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes:. ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form s�� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Great Hill Drive i ' Property Address Mark&Susan Lane Owner Owner's Name information is West Barnstable Ma 02668 10/19/2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Ia Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark& Susan Lane Owner Owner's Name information is required for every West Barnstable Ma 02668 10/19/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /may/ 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owner's Name information is required for every West Barnstable Ma 02668 10/19/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z 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. ❑ Z Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10 000 d to 15 000 d. 9 � 9p gp For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owner's Name information is required for every West Barnstable Ma 02668 10/19/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs.of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ 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)] t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owner's Name information is required for every West Barnstable Ma 02668 10/19/2019 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system Inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: vacant Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form (o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owner's Name information is required for every West Barnstable Ma 02668 10/19/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gPd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owner's Name information is required for every West Barnstable Ma 02668 10/19/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: original system 1985 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. 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.): Joints in good condition, no leakage, vented through roof. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 I Commonwealth of Massachusetts rs Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owner's Name information is required for every West Barnstable Ma 02668 10/19/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: .5 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: 1000 gallons Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Water level 2' below outlet invert due to either leaking tank at seam or evaporation. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 f - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owner's Name information is for every required West Barnstable Ma 02668 10/19/2019 q page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 I Commonwealth of Massachusetts h - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owner's Name information is required for every West Barnstable Ma 02668 10/19/2019 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 is rotted I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owner's Name information is required for every West Barnstable Ma 02668 10/19/2019 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® , leaching trenches number, length: 1 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system .Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 F Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owner's Name information is required for every West Barnstable Ma 02668 10/19/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of etc.,vegetation, : 9 ) leach trench was video inspected and found with signs of past overloading and large buildup of sludge and roots. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owner's Name information is required for every West Barnstable Ma 02668 10/19/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owner's Name information is required for every West Barnstable Ma 02668 10/19/2019 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately for & P11- rr 3 C I 216 C2- 2� 6 133 2 5 c3 3Lt t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owner's Name information is required for every West Barnstable Ma 02668 10/19/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was not established Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Great Hill Drive Property Address Mark&Susan Lane Owner Owner's Name information is required for every West Barnstable Ma 02668 10/19/2019 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: 'Explanation of estimated depth to high groundwater included I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 V i • 4 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION s ONE WINTER STREET,BOSTON MA 02108(617)292-5501r; �j VE !. - �`�"i 1 �� OZOoO ' P�'OF r DR'SS RUHS ARGEO PAUL CELLUCCI Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTA CERTIFICATION Property Address: 77 Great Hill Drive,West-Barnstable,MA Name of Owner: Jody & Carl Bentley Date of Inspection: 9/14/00 Address of Owner: Same Name of Inspector:(Please Print) Mr.Carmen E.Shay I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: CARMEN E. SHAY-Environmental Services,Inc. Mailing Address: 34 Thatchers Lane,East Falmouth,MA 02536 Telephone Number:508-548-0796 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: .r., Zv . i XX Passes ��'P��NOF AgASSq a o� ti\ Conditionally Passes � CARMEN E. Needs Further Evaluation By the Local Approving Authority v r � Fails T Fgl ti Inspector's Signature: Date: 9/14/00 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department or-Environmental'Protection.The original should be sent to the system owner-and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS This Certification of this septic system is for the inspection performed of the system on this date only and implies no warranty of future performance under different loadings. Inspection based on observations of septic tank and D-Box. Stone around the leach area was probed to for signs of hydraulic failure. No evidence noted during stone probing of trench. No evidence of backup into septic tank noted. No evidence of water infiltrating into the tank or D-Box or backing up from the leaching area. revised 9/2/98 Pagel of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:77 Great Hill Drive,West Barnstable,MA Owner: Jody&Carl Bentley Date of Inspection: 9/14100 INSPECTION SUMMARY: Check A,B.C,01 D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or mores stem components as described in the"Conditional Pass"section need to be replaced or repaired.The system,u Y P P P Y on P completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or ex-filtration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system wilt pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping-more than four times a year-due to broken or abstracted pipe(s).The system will pass inspection if(with approval of the Board of Health); broken pipe(s)are replaced obstruction is removed revised 9/2/98 page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:77 Great Hill Drive,West Barnstable,MA Owner: Jody&Carl Bentley Date of Inspection: 9114/00 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE HITH310 CMR 15.303 11Kb)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER. IF ANY) DETERMINES THAT THE SYSTEM FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(MS)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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that ` the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 page 3 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:77 Great Hill Drive,West Barnstable,MA Owner: Jody&Carl Bentley Date of Inspection: 9114100 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure Yes No Backup of sewage into the facility or system components due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped— Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for •coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2).Please consult the local regional office of the Department for further information. revised 9/2/98 page 4 of 11 L • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTB CHECKLIST Property Address:77 Great Hill Drive,West Barnstable,MA Owner: Jody&Carl Bentley Date of Inspection: 9114/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health. X _ None of the system-components have been pumped for at least two-weeks and the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X _ As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System, have been located on the site. X _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on-the site has be determined based on: X _ Existing information.For example. Plan at B.0.H. X _ Determined in the field(if any of the failure criteria related to Part Cis at issue,approximation of distance is unacceptable)(15.302(3)(b) X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal S revised 9/2/98 page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTC SYSTEM INFORMATION Property Address:77 Great Hill Drive,West Barnstable,MA Owner: Jody&Carl Bentley Date of Inspection: 9114100 FLOW CONDITIONS RESIDENTTAL: Design flow: 110_g.p.d./bedroom. Number of bedrooms(design): 3 Number of bedrooms(actual): 3 Total DESIGN flow 330 apd Number of current residents: 3 Garbage grinder(yes or no): No Laundry(separate system) (yes or no): No ; If yes,separate inspection required Laundry system inspected(yes or no) N/A Seasonal use(yes or no): No Water meter readings, if available(last two year's usage(gpd): 1999-64.000 2,000-25,000(6 months) 1998-59.000 Sump Pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gg_d(Based on 16.203) Basis of design flow: Grease trap present:(yes or no)_ Industrial Waste Holding Tank present:(yes or no)_ Non-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: PUMPING RECORDS and source of information: None Available System pumped as part of inspection:(yes or no) No(not for over 3 years) If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM X 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information: 1985-Per Home Owner&As Built Plan Sewage odors detected when arriving at the site:(yes or no) No revised 9/2/98 page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTC SYSTEM INFORMATION (continued) Property Address:77 Great Hill Drive,West Barnstable,MA Owner: Jody&Carl Bentley Date of Inspection: 9114/00 BUILDING SEWER: (Locate on site plan) Depth below grade: 24" Material of construction: cast iron 40 PVC XX other(explain) Distance from private water supply well or suction line 28' Diameter 4" Comments:(condition of joints,venting,evidence of leakage,etc.) Building sewer line appeared to be in good condition with no obvious signs of cracks or other problems. SEPTIC TANK: X (locate on site plan) Depth below grade: 12" Material of construction: X concrete_metal_Fiberglass_Polyethylene_other(explain) If tank is metal,list age_Is age confirmed by a Certificate of Compliance_(Yes/No) Dimensions: 6'wide_ by 12 feet long and 5 feet deep (2,000 gallon-H-20 Loading) Sludge depth: 4.5' Distance from top of sludge to bottom of outlet tee or baffle: 2.5' Scum thickness: 1/2" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 16.5" How dimensions were determined: Measured Comments: (recommendation for pumping,condition of inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Structural integrity of tank is good with no notable cracks or leaks. No evidence of water infiltration or exfiltration. Outlet Baffle in good condition. Water level equal to bottom of outlet invert. GREASE TRAP: N/A (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping;condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) revised 9/2/98 page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTC SYSTEM INFORMATION (continued) Property Address:77 Great Hill Drive,West Barnstable,MA Owner: Jody&Carl Bentley Date of Inspection: 9/14100 TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene—other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes_No— Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: 2-Separate D-Boxes for Primary& Reserve Area Comments: (note-if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.). Level in active D-Box was equal to outlet invert at outlet pipe. No evidence of significant deterioration or leakage. No evidence of solids carryover. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No)_ Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 page 8 of 11 , o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) perty Address:77 Great Hill Drive,West Barnstable,MA ner: Jody&Carl Bentley to of Inspection: 9/14/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: 1-Primary consisting of four 5'x 8'chambers and stone. leaching pits,number:__ leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number,length: 1 -6'wide by 34 feet long each. leaching fields, number,dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) No sign of hydraulic failure.ponding or stressed vegetation. Probed stone surrounding the SAS Area to determine hydraulic failure criteria. No evidence of hydraulic failure in reserve area. CESSPOOLS: N/A (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(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of-vegetation,etc.) PRIVY: N/A (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.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTC SYSTEM INFORMATION (continued) Property Address:77 Great Hill Drive,West Barnstable,MA Owner: Jody&Carl Bentley Date of Inspection: 9114/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks Swing Ties: locate all wells within 100'(Locate where public water supply comes into house) A- Tank In- 16' B- Tank In- 15' B-D-Box#1 -29' C-D-Box#1 -29' B-SAS#1 Access-27' C-SAS#1 Access-3 V G R E A T SAS H A Existing 3-bedroom house I L L 0 0 D D-Box B R Septic tank I V E Driveway revised 9/2/98 page 10 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORI PARTC SYSTEM INFORMATION (continued) Property Address:77 Great Hill Drive,West Barnstable,MA Owner: Jody&Carl Bentley Date of Inspection: 9/14100 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date web site visited Observation Wells checked Groundwater depth:Shallow___Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 25+ Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) X Determined from local conditions _Checked with local Board of health -_Checked FEMA Maps _Checked pumping records X Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) Bottom of SAS was determined to be approximately 6 feet below grade. Based on the USGS Quadrangle, the depth to groundwater is approximately 25 feet. revised 9/2/98 page 11 of 11 LO CAST I -� S EW A GrE PE/RMIT, NO. PILLAGE INSTALLER'S NAME i ADDRESS R U I.I. D E R OR OWN ER � DATE PERMIT ISSUED ® 0A.TE. COMPLIANCE ISSUED L.lv �.�,� �� .,�.- � � 1� � � 4 3 t �, c, s � THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH � Sa�-.-a:yl.Aa�_Ve n---.---.....OF..... ..........--••-----...---- ApplirFation for Disposal Works C9unstrurtion Frrutit Application is hereby made for a Permit to Construct (,_�or Repair ( ) an Individual Sewage Disposal System t: ....... .<V.... Z...c ..:T -Ai --/- � t. r.tl�/. -Location-Addy�s� �' or Logo........ y� ........... ...... .. -d r.......car-a ./....................... :...r._....S. .. ........................................................... Address P .......... Installer ess Type No. of Bedrooms ...............................Ex Expansion Attic SizerLot-Garba Grinder feet d YP g -/� ... q• � g P .�/� g VC) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures -------•------------------------ - W Design Flow...........sr,-7S.....................gallons per person per day. Total daily flow-------21.3..C.)......................gallons. WSeptic Tank—Liquid capacity t)gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total.leaching area....................sq. ft. Seepage Pit No----------------_-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) '� .. Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. .......minutes per inch Depth of Test Pit ....__.. Depth to ground water....................... P3 Test Pit No.�44�...minutes per inch Depth of Test Pit.... ..! ... Depth to ground water). �____ - 0 Description of Soil 0 l..��: Lq�t......7.... �4f - -- - - 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 TITLIJ 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. Si . ---------------- -----5�/� Date Application Approved By................... _ .........--- ...................................... ......��..1� J-- dx� Date Application Disapproved for the following'i-easons:..................................................---------•-------------------•------•----------•------------- ....---..•-------------------•-------•--••-•----•-••---.......--------••--------------..............-•---•-------••-••---••••-••--•--•---•--------•-----•---•------------••-----••---•......--•--------- Date 'Permit No----------��• _:5.'--1-------------- __ Issued.................•-- t Date r ok . THE COMMONWEALTH OF MASSACHUSETTS .- BOAR® OF" H E -TH -............OF....;t ..... X.-C"ZX(--..-.--.--------__------ Appliration for Disposal Works Tonstrnrtion amit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Systemt: a... ...... ....... ............................................... Location-Add .s �""" or Lot No. - .... :?...�!J..A•a.+L", "..... ar -------------•---------- -- •---- ...... .1.. �---...................................................... Owner L.�Ai..LA Address ,Cyl. W fir., �A ................................ ........._-----•:._ ,,.....---------•--..............•...........•...........-•----..... Installer Address d Type of Building Size Lot_. ,_(.,3...Sq. feet U Dwelling—No. of Bedrooms.......- .Expansion Attic 40 Garbage Grinder:903 .� '4 Other—T e of Building No. of persons............................ Showers — Cafeteria 0.1 Other fixtures .-------•-------------------------------------------... W Design Flow............ 4 .....................gallons per person per day. Total daily flow....... . ._ ......................gallons. WSeptic Tank—Liquid'capacity 000.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.--_____-_---____-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ `4 Test Pit No.A.��........minutes per inch Depth of Test Pit.......//..__.. Depth to ground water.... .......... ...... (i, Test Pit No. ,�_ ..._minutes per inch Depth of Test Pit.__ _. .... Depth to ground water�f........,�_... a0 .........................• -•-- .._ .. ----- ---• --•................. ----- - Description of Soil �f ._ �.r i �_. rL �r -•--........-•---.....--- txj ----------------•-----------....._.. ..1 .c°:cl!f1?t--..., Cs ......F' '=rt? ri �!7-> ' ...... 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 TITLL 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. - --- ``f ) / i i'�` }. j •may Date Application Approved B -a z 1 / ......_-.'....-�.....------�--/..............PP PP Y--•••--•-•-.--•-- -.,.. Date Application Disapproved for the following reasons-......................................----------------•-----------------------•------------------.._..-••---. •-•-----•------------•-•---•-----------------•••--•----••-•-•...••----.....-•----....._...•---------...••----•-------•-••-•--••---------•--............................................................ _ ,i Date Permit No.---- (�-J -- Issued Date THE COMMONWEALTH OF MASSACHUSETTS .., BOARD OF HEAV t4:7CL...............OF.....f':� l�:S�.. ... .f ............................ Tn tifirate of Tontpliattrr TI�7 IS TO C TIFY, Tha he Individual Sewage Disposal System constructed 4oOror Repaired ( ) at --•-- �._�" .. -._-ice ��-....(_•�1�+�l�tf/�l has been installed in accordance with the provisions of TITIE__5 of he State Sanitary Code as described in the application for Disposal Works Construction Permit No..__�;,.3~.'._ ..... dated_.... ............. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............... ............ r� ..^. ................................. Inspector.--------.• .----- THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEA �j No.'=.................... FEE.:: �......... Disposal Works, onotr ion rrnti# Permission is ereby granted_:_..: 7_ '_ -___ ...................................................................... to Constryct ( or R jai (, )/a ndividual Se" ge Dispos System at No. Ce P4�-- i ( r ` Street, _/J as shown on the application for Disposal Works Construction Permit I .=tl'7�'___ Dated.... .............. DATE. Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON F - P .tY LET 6 ` 7 03\S, 07 }t ; 9 AT $A D �,5"�,,�5 : ; •ri 7` - _ % per, '� � _ d s: TS TIED �'/Ponr71 cam. t r _ o r y� Oq - fT r. MN y` s�/evt�•.9 H'T' n Sv r,o✓�'v '/O F `1" F ` n `j7 / 71 17. s ` ALBERT 51 �T ZAr�oS 3y o6,c� _ , at L MORSE T No, ioy-5i•,4 V j --4cx-d 3J 0 t r eW ROB�EiT yr. - 4 ft rX i '; ', '.._ _. tr+.7•E� S,.t� i !�� 1 � ELDREDGE ' N ,, `3'�!4 �?,� s,�-:s a �Q ° d'(�Ot:;. Z ' � .1. � �ti�°t �`�,t G•�SiE�i 4v'� ' v. eye CERTIFIED PLOT PLAN ` "�f� `, > �r • �-�,;,. � ��1�',c-Y. /�� 1�)c,� �,� ``�*`,; Lp�'6 Cr��.�1T fli�4 .�ie.�✓E':._ '"'�-, .gym l,.V.��. ; •/ter .5�*�sy ;< / �. y�.� IN SCALE, / �4D DAT 5 , t RED ENMEERING ;COt IN CLIENT. I CERTIFY , THAT THE. PROPOSED $ h EGLSTERE, REGISTE ED r" �— BUILDMG SHOWN ON TN IS ,PLAN r C1VIL LAND CONFORMS' TO THE 20'NIN0 p tTA� ENGINEER R EYDR.BY�y' f'�'! 'OF BARNSTABL �' MASS 6 : =7Vwn712- MA'I N..STREET: k < CH. BY" ,. f = , `N YA N N 1`S MASS. `, G.; »f �' �' SHFET! OF ..�..:. ATE REQ. LAND. SURVEYOR ��'� �'.�°� „�FA h +s.!^' N�Fa� 3 }`: $t•'`i�;ir aP,k�a < ,�T �+.,��S '.6�t�,'C}.t'i7��di�l�ir��n l y€. � - �r r.� t, �r, r 4 '7 Prof .(+ �a'�i r- r'-fY}'`� e•. - '� �F=•�+.`•�.bR�x^.ert&:,ar7a�,,7,.,vFis' 4.:*;+a-�'d. �f�«�•.�sv�.wWw.:�F•.ue.,.;.«F:n-...�w,y..,x.�n•.r.w..xw._.::,,,.ta.as±t�. c>;a,�4,�+w•..±Pk':�:,.,;.�;.�.o-�:r.. n•..:,.�.....anwawr�.,tia..wro::.+u.. �........ w.. e 20 FT MlN Npt'E !F: THE SEPT/C 7AA/K AT 1410RE • , 2,A-/AAl /2 11VCHES QELOJA/ G,gAOE, .4 24•- ; INCH.01,41vU R CONC/?ETE CO YFR Sf1ALL q"PYC P/oE BE BROUGHT. TO GRADE �fLV EXTRA NEAYY Co7crCRETE MIN: PITCH CAST IRON COVER`.S•1-IALL faP USPD �L��4a;a CDYERS "PEA FT /)R/V IC . AY r--x FLON�D/FFUSOR O ova .� . GRADE EpU/YALENT,GALLE/P/ES � Q 2� M/N• TO aE CC�/y/YEG'TEO • �- "G/QIJ/O LE"f�EL �--- CL.EAN .SA/VO 's SG.YEDUGE 40 _� 4 a cf o c cl ' P.V.C. P/DE ZyGa p GAL Q Q C1 C= O/SG!-/A RGE L/NE �4..PER FT BOX -' O�: I�f•"r�— G .•. F —r�� NAS�O STONE LEA 4C141HG GAA-LEI�Y S W a:•7: �V . or SroE t4 x l;G� _ Z3� SECT/ONaF GROUNDWATER?�sLE Ecv GPO'' SEWA646 -0/.5'POSL A SYSTEM �_ . —rA-S 1LA77-0H Borram: Z S Z, 7c 0-.7 / /7 B �.P•D. Y i -rdTgL CAPAC 7-y, 41 7 {,tp.D. D/MENsfoK A z-S FT SCALE . 4 =! - O.. D/M&H510/Y B L FT 1j /FT / D/�cAENS/aN C z4 01L TEST ssu/� T Esr p-4402-- 4 Fr. F, S F�- g//9 l�'s SO /L LC& EST /SATE OF Sale T l.L TE ��,� �.;��_�,^, SO sT fiE/ SO/1 TEST#2 RFSUGTS fYIT/V�SSED !3Y �EZEY. 8�.o �LFV Sy o RCOLAT/O/Y RA'TE #6 1 ._�2_I►a Inf r//NCK PERCOL..4T/C/Y RA7-E f12 MIN"//NGX r t:&e—lc 7^� ,fl � o �c Sc!i''Grc� ?E,:=G,�,Sr✓ft- 4CS/GN l- Cc E/4N LAYER OF 4M/L � � ,�•�.� A1V,0 pOLYETIf�yLENE MUM4ER OF BEDROOMS 3 DYER 2.,L A YELP a. 5,4 Al J _ G�9Rd,4riE D/Sf'OSAL UNIT � �/�•�- ��(y� / SID� Sir C] C1 _ J-IA•S•fi4770A/E E57-/N/A7Z-p FLOW 3'3 0 GAL./DAY CCpC1/IN(� SI�ELEACH1,Vrr AREA BOTTOM 4CACNING:ARZA 59.FT. c L-,¢ SECT/ON -?G 7-0 rA L AREA RESERt/E'- AREA" SQ:FT. - SCA�E. �4~ f-O " n!o amoumo jvATAR ENCOUNTERED 1 NVERT FL-&VAT!ONS O'ROUNO. WATER A]r' EL EY. LOT G G'iztNr" �/�� Dzt VE IF /Ni/ERT A'T l3UlL D/NG 87, FZ. v ALStRT r, �7� _ G ET SEPTIC Ti4Nq' A,' r n 03E�� /&L {ti C3MCOIR SE . . �. tN OUTLET ,$'FPTIC ?'AHN PT , �tQFiED£ ( /IYLET 0/STR/64T/6N Dom•" .APT E4PREDGE ENG/NEERfNG CO: IHF. No. 10951: J .. f P QFGi LT �� rbo.:i�3s QurCl T v D4X ° 8 pT:. 7l2 MAI/►e 5r, HYAIVIV 15,' i®u ♦ov �FFSS 5 ��.�'/ a A£�STE�' �a. Y. LNLETFLDN/D/FFUSoR , 86' o F7 CLIENT: loNA / YT � [ L � `JAS'/YO, r?--Qf s..' t .. � •.as ik ...�,. � u Sn,. ,.,.,•�w. .a• ..,.�^. � e ,:w 8 .,r,r. ,+,b,.. a,r x��,e�, ..,�h rr_ w .. _� - 1 Pl ]T tiX1, l ; � . �� •�°; µ ^ETA` oi— C-�' . ' r F. �4,7" 5, 5 { ,`.� rw 0 /�7 ASIJC�vOIC x \ \" 1 0 8 � HO�EgT ` "API�'�G /�'�lC 6�� 5, � ;y v FI DRtDC C= 01 rye.' a r r �. � r ,�� G � e�, ,Lp 0 r �r4►.�c'41`'' JO� � ��LL �\ c; {Vi�RSE tin` ° �� f. a F Cr✓IL�, �r NA /5 ioe - \7 M� �IZMr �Z(r✓ � �� W^"I L.(?U/477 41 r13 _ y r ' LEGEND � 4;z� ELEVATION CERTIFIED PLOT PLAN EF�t�8T SPOT �Ox c.4�,H X STIN0iCONTOUR --- p Lo ?' G /7►-fo PAnr L '/� PCNnif�� F1NtSF� D POT ELEVAT .S ION FRl1R •'CQNTOUR 0 IN °i _ QyVED BOARD : "OF�_ l\ `M2 1 �\ 1. 1 /.S SGB ;AGENT 7 }; SCALE: �(o DATE 1 Glklzf_��✓�h'/err �t�REOG ' ENONEERING COIN CLIENT 1 CERTIFY THAT THE PROPOSED EC�I$TERE `I: REGISTERED �� J08 NO:e-3 Z"9 BUILDING SHOWN: ON THIS PLAN kl,C.11II.L'. z r LAND _ "� CONFORMS TO THE ZONING LAWS _ x QINEER 'SURVEYO OR BY OF BARNSTABLE, MASS ='Trl'2; M'A IrN YSTR'E ET # - CH. BY: �� {� , HFYAN.N i Sty AAASS SHEETOF Z- ATE REG. LAND SURVEYOR +� . ON ..a .� •,� .,, 20 F?' /J/N. NOTE /F 7H,E SEPTIC 7AAZK /S MORE -_- THAN /2 /IVCHES L- 0 JA/ GRAOEr A 24 - .- ' - /OFT M/iV. _INCH .DIAMETER C:UNC?ETE C�YER Sf1AL1 4"PYC P<�'E BE BROUGHT To G.QAOE �e4W EX7�.4 NEAYy C6J�/CRETE CAST IRa/V CO M1N. PLTGH I YER SHALL. c3� USEG /F N �B"PER FT. /OR/1/G{N.A�I R �e0U/VALENT,GALLEi?/ES Q TO BE CUnI/YECTEO /N SER/ESAT EnrO ,4 4"O/A- tes SCHEDULE 40 —� _-i e- d. ca o c-� t=3 f//z ro 4 �% P.V.G. P/'PE Z4m0 GAL. Q Q Q C1 lcl '� O/SCHA,I'GE L/NE a SEPTIC rA NK DiST, ,.,.�• ;,• :/. r, •y';- _ EL ono'S.d :. O FY i I��-6 la PER � X 1 ,. ao � iFr. LEA Cffln/G C .=e�..c...,FeeY' $ WASHED STONE Z 3 SEC7lOJY DF GftDU��r !-VATCR7,4aLE EL-•v, �-GPO -go.TTaw�: Zsz x o.7r - /7'g PD: SE'WA(9E V/SODSAe- SYSTEM'( L__ T.4QULA.T/D/5E s TdTRt CAnAC/TY. `4/ 7 GrR`D'. /Y D/MENs1CK.IQ 3 AFC FT.. /� SyU/L. TEST 5o,L ie5r p/n'�E.vs�cni C 4o FT. FT !FT 4 i �.4?'EOFSOIL: TEST `P�i9 les- SO LCCT v.�/ SOIL TEST ! / SO/t TEST#2 RESULTS ff�lTWESSED.QY RaE C�" z- �'o B ,# CpL.AT/D/Y'RA1TE #1 -A Z--v. ELEV 8 �a PE�eCCL�T/cNRATE f/Z ,►9/ /lnrck v-' y "�r O- ,I z` !F. ► ��s iG f*�. �?QI{,� �?- l�<'r,��•-t A••-v sc'�r+c '�+�tc� v �-SiJ(3 s o►�-' o �Sud S t�i t,.- - OCS/G/Y CRITL�R/A: r CLEA IV' LAYER OF SA NO` POLYETiVYLENE KV MQER OF BEDROOMS . . OVER 2'.LAYE.-C /v1 CC'. S,q n/D gyp, y p o r GARBAGE D/SPOSA4 /!IV/T /V o ORI % w1r/f s�n'f� c irf�'Tj0',Sv�7E. `L,� to cfWASNE�S7owe' 'EST/N/ATEO FLOYV 33 y GAL�D�1Y �(tgC- S/DE LE. cHl"4 AREA. 4 5.4.FT,. $ocC 'TT BOTTOM LEACf//NG - - TrJTAL AREA . .. Sp, FT $ SE C T'1 ON tC X , o 2.S ro•� RESERVE AREA 3�' SQ.FT SC-Al.E 14 /VO G,tDUMO yl/AT_CP E/VCO/J/VTERED , 5ur�so,� INVERT ELEI/.4T/ONs `.. 694_ 0 WA7A AT 0L ffY.. FeF LoT OF. A9A.. ' INVERT A-r azi1LA/NG J FT a 4 y o', •.: ' ttQ c:,. • ALSERT•4,. G °y �-:,; '' � . ,,;.•,;: . ,Cy ,„ ,j, . _ i- gt�p /C?L �A o s�cTs' f /KLET.SEPT/C Ti+1NK F�' A k # ;. _ a see g3R8 K - "- \ 8. TiLET EPT1C`rAK PT.. o ORSE _v . 0 - O S y Eo y L�..,.E�A ,:. �<,,, .:� �,-' .rA .� lJFt�f�G.E'L�NG IV��f4/N NC � %INLET-D/'STR/aLITIONBC�X� �°� `/. F�' u ., � .. ,� .�..e A�: # •�' 67�r-,G? :�' \ •.+"� !F 1. J.ra -' °F' f- 4. .aY.�"L �k.:: ^-Mt+./ :o c�� / •t„ •.c, No.:193 �. ,,,, ti tir Y <~ 71Z M.4, Fs• �<. � �p �1 !.. �;? C�` � ''CL'[L�Rt�'... 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(Non-refundable) INEER TELEPH NE NO. -L5--ZZYYY E SCHEDULED �1��9A-,5 �-�- (Applicant' s signature ) • • • • O O O O 010 • O • O O O O O • • 4 O . . . O O O . O O O • • • • • • . • . . O • • . . . • . • O • • . . . . • • . O . O . • • O 4 . Y . • • . • . SOIL LOG / -DIVISION ,NAME DATE_ L/'�/ �j ( TIME f l.'�o✓�K ANSI614 AREA YE NO _ _ i/�/1.r�6�/ /j' /h/��5 ENGINEER ' N WATER PRIVATE WELL �� Gv BOARD OF HEALTH Pn C 5 Gol I. EXCAVATOR r TCH; (Street name, etc. ,dimensions of lot, exact location of test holes and ypereola°ton tests , l.ocat:e.-wetlands in proximity to .test, holes NOTES : M t� 3, COLATION RATE: T HOLE NO: ELEVATION: TEST HOLE NO: ,� ELEVATION: 2 2 - - - �- 3 "D 5 4 _ - - �2. '? o a � 4 7 / 7 \ �z B �„®I �iL'�'�J 8 - • 9 4 / 9 10 10 — Nd 11 12 12 - 13 - ..� 13 14 14 15 15 16 16 TABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS LEACHING TRENCHES UITABLE FOR SUB-SURFACE SEWAGE. REASONS: E: ENG I NEEIZ I NG PLANS MUST S11OW NUMBER ASSIGNED ON PERC TEST APPLICATION G I NAIL: COI.113JIT '1'1?1) 714 rN7'I RPTY BY P . F . AND RETURNED TO BOARD OF 1I1:AI,1PI1 j President: Member of: ROBERT BRUCE ELDREDGE,R.L.S. CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS ELDREDGE ENGINEERING MASS.ASSOC OF LAND SURVEYORS Associates: AND CIVIL ENGINEERS ALBERT A.MORSE,P.E.,R.L.S. COMPANY, INC. AMERICAN CONGRESS ON PHILIP WEINBERG.P.E.,R.L.S. SURVEYING AND MAPPING / AMERICAN SOCIETY FOR CREC�CIEEZEA GRECJ.iStE4Ed TESTING AND MATERIALS -'and �ivi� 712 MAIN STREET IS_UTVEt/O%s a ,yr^ ,o° �n9inEE°cs HYANNIS,MASS.02601 TEL.(617)775-22" August 28 , 1985 Baord of Health Town Office Building 367 Main Street Hyannis , Massachusetts 02601 RE: Greenbrier Development Corp . Lot 6 Great Hill Drive , Centerville : Job No . 83209 (See Proposed Plot PLans dated 5/l/85 , revised 6/18/85) Gentlemen : A final inspection was. made on August 26 , 1985 and the results are as follows : DESIGN AS-BUILT Inv , at foundation Elev. 87 . 0 Elev . 87 . 1 Inv , at Septic Tank Inlet if 84.0 it 86 . 6 Inv , at Septic Tank Outlet � 83 .8 if 86. 2 Inv , at Distribution Box Inlet " 82 . 4 IT 85 . 5 Inv , at Distribution Box Outlet " 82 . 2 it 85 . 2 Inlet to Flow Diffuser " 82 . 0 " 82 . 1 The system appears to have been installed substantially in conformance to the minimum design standards specified in our sewerage plot plans . Sincerely , EL.DREDGE .ENGINEERING COMPANY, INC. Y. Robe; rt B. Eldredge , R. L. S . President cc : Greenbrier RBE/etb ix r PIe/I�flt Memoer of ROBERT BRUGE ELDREDGE.R.L.S. - - CAPE COD SOCIETY OF PROFESSIONALENGI E 4 t AND LAND SURVEYORS ELDREDGE ENGINEERING MASSNEERS ASSOC OF LAND SURVEYORS - t i° - - - ANO CIVIL ENGINEERS.- f IERT A.MORSE,P.E..R.L.S. COMPANY, INC. . . AMERICAN CONGRESS ON ' PHILIP WEINBERG. . ..R.L.S.� rt PE R SURVEYING AND MAPPING , AMERICAN SOCIETY FOR ) p / TESTING AND MATERIALS f R .}"' �`e9 isrteae CJ`eCgilteTe0. i s < s -'and 712 MAIN STREET 3 r HYANNIS,MASS.02601 { esu¢vey0%s k Cn9inee¢a TEL.(617)775-2244 August 28 , 1985" Baord of Health Town. Office Building 367 Main Street Hyannis ; Massachusetts 02601 : ARE: Greenbrier Development Corp. Lot 6 Great Hill Drive , Centerville Job No. 83209 (See Proposed Plot PLans dated 5/1/85 , revised 6/18/85) 'F >Gentl•emen : krt r A final inspection was made on August 26 , 1985 and the results are as r follows . DESIGN AS-BUILT Inv . .at foundation Elev . 87 .0 Elev . 87 . 1 84 .0 " 86 . 6 Inv . at Septic Tank Inlet =' h' Inv.. at Septic Tank Outlet 83 . 8 " 86. 2 Vtf;T Inv, at Distribution Box Inlet 82 . 4 " 85 . 5 tr , "Inv . at Distribution Box: Outlet 82 . 2 " 85 . 2 �0 Inlet to, 'Flow Diffuser " 82 . 0 " 82 . 1 The system appears to have been installed substantially in conformance ``.*to the minimum design standards specified in our sewerage plot plans . Sincerely , { ELDREDGE ENGINEERING COMPANY , INC. Robe rt B . Eldredge , R. L. S . ' r •r, President. 'cc: Greenbrier RBE/etb. �Y i n / 4 -TS s 1 1r. k L f V -74 PEI ASSESSORS MAP : � 1 T E J T H O L_E LOGS* 1) The installation shall comply with the State Environmental Code Title V and Town of�,M% PARCEL: `� +----- - --- -- � Board of Health Reg ulations. ZONE: FLOOD SOIL EVALvATOR % 2) The septic system as proposed on this plan shall not be installed until a licensed town installer. W I T N E S S t YID receives approval and an installation permit from the applicable town. . REFERENCE:- 4 '� �..''t" �`!5 _` '4 2 0ATE: ��- i --- - — �- 3) Prior to Installation,the installer shall verify the location of utilities,sewer inverts,sewer lines PERCOLAT I Off ATE: � ._.�' and existing septic components prior to installation, .�..►'C� :�"`� l� (� �� 1 q ,/ �,I, . r, 0 Q�� 4 g Pp All ravit ewer piping is to be 4 inch schedule 40 PVC at 1 8"per foot. The first 2 feet out of p�1 _ TH- 1 TH-2 - the distribution box shall be level. All piping connections to be glued. 5) This septic design plan is not to be utilized for property line determination or for any other *'•° 37.'.2 8 "sue --..� F11-.L. �, � -�tii +R►�'! � purpose other then the proposed septic system installation. • . /S ( v?i t J' I,�j 6) All Title V components are to meet Title V specifications.r ^ ^ - '� 446 7) Parking shall be prohibited over Title V components unless components are H2O loaded. LOCATION MAP j - � � � `� �`v tJ lt�fJy � \ i3) The existing leaching or cesspools shah be pumped and filled with material per Title V 57 cS S � � abandonment procedures. teaching and cesspool(s)and contaminated soils within the r proposed SAS shall be removed and replaced with clean sand per Title V specifications. r' 9) Septic components are to be 10'from a water service line.Sewer lines crossing a water line shall 7 75,E be sleeved with an appropriately sized schedule 40 PVC with ends routed. The water service ��(�'LO�j� � �S t�(,C�',Uc� . S G line or the septic tine can be sleeved with the sleeve being distance of 10' on both sides of A ',? Q, iG"i � crossing the line. AID l`- t,7 j ,e�_,.` 8 (�, 10) If a garbage grinder exists In the structure,it is to be removed if the septic system Is not _ /J designed to accommodate a garbage grinder. ram, 11) The installer is responsible for care of excavation around ail utilities on the property and SEPT I C SYSTEM DES S I G N protecting the structural integrity of all structures during the installation process of the septic system. FLOW.`!ESTI�IAT 8 1 12)This plan only represents that a septic system can be Installed on the property meeting Title V requirements. c� .3 86110o0 AT 110 GAL/DAY/BEDROOM » A AY -� LIt3 13) The property owner shall review design criteria to approve the total number of bedrooms and N a design flow.Installation of the septic system as proposed and receipt of payment for the design SEPTIC TAME, . shall be deemed approval of the design criteria by the property owner or agent of. ! v 14) The validity of this Ian shall expire with the expiration of the town installation ermit issued for l GAL/DAY. x 2 DAYS GAI. y p p p f - this plan or the validity of this plan shall expire on the expiration of the Certificate of Compliance Q ! USE GALLON SEPTIC TANK(6/-J,- iGj a� �.. `- � Issued for the installation.of the proposed system on this plan. twi �- _ ...?` n t i t. SG --SYSTEM - U- �,5 .5►f�lr% P'T1 t�i�i i b i7 ►9$� � -- -G ate �.. . 00, t Z4 s l laE AREA: Z _ r � BOTTOM AREA: - 'x_J'2 +G �3 'X ':, iw1D. :G. ' �-tt'0i-rj,�,� DA1llD ;- _ . a Q. . �� a -�-�- SEPT ! C Y S E►� S ECT old 10 �? nl — d RG�ST R r l 1 ;�M5ve- o abli . s 9 ^ dd f ✓M1a i j 1 �t , y �, r_ �. . �lY /PSVA—N' I' // t l i - 41 era G i Dy � tom.. -- - 0 t 1AZIf" � µIP r_ A j , _ .., ,.� r , �Al \y I ' SEPT I C TANK x l23 t` _ ZL CAM-t—\12 L.,u, 10 SITE W 3 AND SEWAGE PLAN -17 10 LOCATION : � �� 1t,1- T)IV�i N2- x, `i PREPARED FOR : lp—vk '; SCALE : DAV I D B . MASON 'RS DATE: !z- DBC ENV I R�3NMENC'AL DESIGNS u n � DATE HEALTH AGENT avTtvu�1�►• I z P-4P-V, vr¢T1G S